Total intravenous anesthesia (TIVA) in children has gained popularity due to potential advantages, including decreased respiratory adverse events, postoperative nausea and vomiting, and emergence agitation. British Columbia Children's Hospital (BCCH) has a reputation for TIVA use, training, and advocacy, including intravenous induction. To inform practice change and education by exploring how institutional culture impacts TIVA adoption, particularly regarding intravenous cannulation in awake children. Current and former BCCH anesthesiologists and trainees were surveyed and interviewed about TIVA practices at BCCH and at their current institutions. The survey covered demographics, practice settings, past and current methods for induction and maintenance of anesthesia, factors contributing to technique selection, TIVA barriers and facilitators, and implementation factors. Semi-structured interviews conducted with a subset of participants were analyzed using deductive and inductive thematic analysis. Twenty-six participants completed the survey: 21 attending physicians, 2 fellows, and 3 residents; 58% with < 10 years' and 23% with > 20 years' anesthesia practice. Most participants (92%) practised in an academic setting, caring for a median [interquartile range] 400 [200-500] children annually. Most (96%) indicated their BCCH experience had changed their practice, with a greater effect on using intravenous anesthesia for maintenance than induction. Changes were influenced by a positive experience (77%), supportive environment (42%), and scientific evidence (42%). Choice of anesthetic technique depended on patient factors (89%), institutional expectations (46%), pharmacology (42%), and patient preference (39%), but not parental preference (15%). Interviews with 11 participants focused on intervention bundles to enable success, expectation-setting, family education, equipment and staff availability, and supportive workflows. Training in a TIVA institution can have a profound effect on using TIVA in children and drive changes in anesthetic practice elsewhere. Introducing TIVA requires a supportive culture, appropriate equipment, and the personalization of approaches, and may benefit from understanding factors in change management.

Cardiovascular genetics evaluation in the cardiac ICU (CICU) is essential for patient and family care. However, engaging genetic counseling (GC) consultation by frontline care teams in the CICU is challenging. This quality improvement (QI) project aimed to: 1) increase GC consultations for eligible CICU patients, 2) decrease time from admission to consultation, and 3) assess whether changes aligned with parental preferences. Single-center QI study, from January 2020 to June 2024. Large tertiary care children's hospital in the United States. Two hundred sixty-five patients with congenital heart defect (CHD). None. In 2022, we introduced a standardized admission process for admissions with CHD, including: electronic medical record (EMR) notifications, accurate diagnostics, improved referral workflow and collaboration with fetal cardiology clinic, and parent surveys. A before-vs.-after analysis showed an associated increase in GC consultation from 76% to 94%; the mean time from admission to consultation decreased from 6 to 3 days. Post-introduction, there was reduced variability and less delay compared with pre-implementation. A needs assessment survey via a parent-support group had 151 responses, which indicated that 83% of families wanted genetic testing. Sixty-nine percent of families wanted to discuss genetic testing through in-person consultation during their child's initial inpatient admission. Thirty-two percent of families preferred contact as soon as possible and 47% preferred contact before cardiac surgery. Last, 75% of parents with a fetal diagnosis of CHD expressed interest in discussing testing while pregnant. In our pre- vs. post-introduction of a QI intervention, we found that eligible CICU patients are more reliably and promptly identified for GC consultation by leveraging the EMR and partnering with CICU staff and fetal cardiology. Parents supported genetic testing, typically delivered through integrated GC consultations in both the fetal and inpatient settings.

Co-design of an innovative mHealth intervention for preventing mental health disorders after perinatal loss: A qualitative study with parents and healthcare professionals (e-Perinatal study).

To compare 3-year visual outcomes of toric and nontoric intraocular lens (IOL) implantation in children aged 3-8 years with congenital cataracts and ≥2.0D corneal astigmatism. Prospective, nonrandomized, comparative, single-center clinical study SUBJECTS: We enrolled children with congenital cataract who had ≥2.0D corneal astigmatism and were aged 3 to 8 years. Among 236 eligible patients, we included 194 who completed the 3-year follow-up. Participants underwent toric IOL implantation (toric group) or nontoric monofocal IOL implantation (nontoric group) based on the parental preference. The primary outcome was corrected distance visual acuity (CDVA) during the 3-year follow-up period, which was measured in logMAR units. Among the 194 participants (75 [38.7%] female), there were 106 and 88 patients in the nontoric and toric groups, respectively. Both groups demonstrated significant improvements in uncorrected distance visual acuity (UDVA) and CDVA at the endpoint (P < .001). At 3 years, the toric group had a significantly better mean CDVA than the nontoric group (P = .003). The toric group had a significantly higher proportion of eyes that achieved nonamblyopic vision (CDVA ≥ 0.8) than the nontoric group (86.4% vs. 69.8%, P = .009). In the subgroup analysis, among patients with preoperative corneal astigmatism >3.0 D, the toric group exhibited significantly better CDVA than the nontoric group from 3 months to 3 years postoperatively (P < .001). Contrastingly, among patients with astigmatism ≤ 3.0 D, there was no significant between-group difference in CDVA. Notably, the toric group demonstrated significantly lower postoperative refractive astigmatism than the nontoric group throughout the follow-up period (P < .05). None of the patients rotated ≥ 10° or required IOL repositioning surgery. For children aged 3 to 8 years with congenital cataracts and corneal astigmatism ≥2.0 D, toric IOL implantation provided superior long-term visual outcomes and reduced amblyopia rates compared with nontoric monofocal IOL implantation. This supports its consideration as the preferred surgical approach for optimizing visual rehabilitation in this population.

Parental decision-making style preferences in aerodigestive multidisciplinary clinics.

The rapid integration of large language models (LLMs) into online medical consultations demands rigorous evaluation, particularly in specialized fields like paediatric ophthalmology. This study systematically assessed the diagnostic accuracy, safety and communication quality of advanced LLMs in real-world paediatric ophthalmology tele-consultations, with a focus on comparing text-only inputs to multi-modal inputs (text paired with parent-taken mobile photographs). A prospective, blinded, multi-model study was conducted using 50 authentic paediatric ophthalmology cases from an internet-based hospital platform. Four leading LLMs-Grok 4.1, GPT 5.1 Thinking, Gemini 2.5 Pro (advanced models) and GPT-4o (baseline)-were tested in multi-modal and text-only scenarios. Responses were evaluated by three blinded senior paediatric ophthalmologists using composite scoring system (maximum 19 points), encompassing diagnostic accuracy (up to six points), guideline adherence and safety (up to four points) and parent communication quality (up to nine points). Advanced LLMs consistently outperformed GPT-4o, driven by superior Safety and Communication efficacy. Grok 4.1 led with the highest overall score in the multi-modal arm (15.06 ± 0.68), followed by GPT 5.1 Thinking (14.52 ± 1.19) and Gemini 2.5 Pro (14.30 ± 1.08), while GPT-4o lagged significantly at 11.20 ± 0.72. In the text-only arm, advanced models again excelled: Grok 4.1 (14.08 ± 1.18), GPT 5.1 Thinking (13.62 ± 1.77) and Gemini 2.5 Pro (13.42 ± 1.50). Multi-modal inputs significantly boosted scores (e.g., Grok 4.1: Δ = 0.98, p < 0.001), with gains specifically attributable to improvements in Safety and Communication rather than diagnostics. Regarding safety, advanced models exhibited markedly fewer major harmful responses (Grok 4.1: 4%; GPT 5.1 Thinking: 8%; Gemini 2.5 Pro: 10%) compared to GPT-4o (16%). Parent preferences favoured advanced LLMs, with Grok 4.1 receiving 23% of votes, reflecting higher perceived clarity, empathy and trustworthiness. Advanced LLMs demonstrate markedly superior capabilities over GPT-4o in handling paediatric ophthalmology tele-consultations, especially with multi-modal data, offering enhanced safety, communication and parent trust. However, persistent variations in safety across models and residual risks of harmful advice underscore the need for condition-specific validation and stringent safety guardrails prior to deployment. Multi-modal integration is essential for optimizing LLM reliability in this high-stakes domain.

Clinical trials are critical for advancing care in critically ill children, yet enrollment remains challenging because of surrogate decision-making, narrow recruitment windows, and caregiver stress. To evaluate strategies aimed at improving enrollment, particularly around consent, in clinical trials involving critically ill children, we conducted a scoping review of literature through December 2024. Studies involving children aged less than 18years in critical care settings that described factors targeting consent were included. Nonhuman, hypothetical, and non-health care setting studies were excluded. Two reviewers independently screened studies, resolving conflicts through discussion. Of 2770 studies screened, 26 met the inclusion criteria. Study designs varied and included randomized controlled trials, observational studies, and qualitative research. The populations targeted included neonatal (12), pediatric (12), cardiac (1), and mixed critical care units (1). Six themes emerged as barriers to consent: family/social dynamics, emotional/psychological stress, limited understanding of clinical trials, logistical issues, clinical concerns, and study design. Facilitators included parental preferences, communication approaches, increased awareness, family motivation, and recruitment strategies. Alternative consent models, such as deferred consent, and multicenter designs were associated with improved enrollment. Co-enrollment and telesimulation had limited impact. Although few studies have directly focused on improving consent, strategies shown to enhance overall enrollment should be incorporated into future pediatric critical care trials.

Background: Hippotherapy, a sensorimotor-rich intervention proposed for children with Autism Spectrum Disorder (ASD), is suggested to influence executive function (EF). However, the underlying electrophysiological mechanisms, particularly changes observed in resting-state Electroencephalography (EEG), remain underexplored. Methods: A total of forty-eight children with ASD, aged 9-12 years, participated in this quasi-experimental, non-randomized pre-test-post-test study. Participants were assigned to either a standardized 12-session hippotherapy program (n = 24) or a waitlist Control group (n = 24). EF was evaluated pre- and post-intervention using validated measures: the Wisconsin Card Sorting Test, Stroop Color-Word Test, Corsi Block-Tapping Task, and Tower of London. Resting-state EEG data (19 channels, 250 Hz) were recorded before and after the intervention and analyzed for spectral power, pairwise Pearson correlation, phase-based functional connectivity using the Phase Lag Index (PLI), and directed effective connectivity using Phase Transfer Entropy (PTE). EEG effects were tested with linear mixed models in MATLAB (fitlme), with the measured values in each ROI as the dependent variable, group and time as fixed effects, and SubjectID included as a random intercept; EF outcomes were analyzed with ANCOVA/MANCOVA, adjusting post-test scores for baseline. The assumptions of homogeneity of slopes, Levene's test, and the Shapiro-Wilk test were examined, and the Holm-Bonferroni correction together with partial η2 effect sizes were reported. Results: Following baseline adjustment, the hippotherapy group showed substantial and statistically significant improvements across all EF measures compared with controls partial η2 range = 0.473-0.855; all adjusted p < 0.001; e.g., Stroop Incongruent Reaction Time (F(1,45) = 265.80, p < 0.001, ηp2 = 0.855). EEG analyses revealed localized Group × Time interaction effects involving frontal delta power as well as selected alpha-, theta-, and beta-band connectivity measures within frontally anchored networks. In addition to these focal interaction effects, the hippotherapy group exhibited a narrower distribution of pre-post EEG changes across spectral power and connectivity metrics compared with controls, indicating greater temporal consistency in resting-state electrophysiological dynamics across sessions. Because group allocation was non-random (based on scheduling feasibility and parental preference), results should be interpreted as associations rather than causal effects. While the hippotherapy group exhibited significant EF improvements and relative stabilization in EEG spectral and connectivity metrics, particularly in frontal delta/theta/alpha/beta bands, a direct mapping between individual EEG changes and behavioral gains was not observed. Conclusions: A standardized 12-session hippotherapy program was associated with substantial improvements in EF and with relative stabilization of resting-state electrophysiological dynamics in children with ASD. However, the direct mechanistic link between these EEG and behavioral changes warrants further investigation. Larger randomized trials employing active control conditions, task-evoked electrophysiological measures, and extended longitudinal follow-up are needed to confirm efficacy, clarify mechanisms, and establish the durability of effects.

Recruiting, enrolling, and retaining families in pediatric obesity clinical trials is challenging. This study examined perceptions of facilitators and barriers related to clinical research, and preferences of specific research formats, in parents of a child with overweight or obesity. Associations between parental research perceptions and sociodemographic and health factors were also explored. A descriptive, cross-sectional online survey of 103 parents of children 2 to 17 years with overweight or obesity was conducted between May 2021 and March 2022 in the southeastern US. Barriers and facilitators of research participation, child weight status, child COVID-19 health care and parental COVID-19 stress, demographic characteristics (e.g., child age, child gender, child race/ethnicity, family income, geographic location), and preferences for specific research formats (e.g., telehealth, in person, group sessions, individual sessions, COVID-19 testing, single-dose COVID-19 vaccine, and multiple-dose COVID-19 vaccine) were assessed. Linear regression analyses were conducted. Parents endorsed more reasons and benefits for participation than mistrust, social pressure, and reasons against participation. Lower child body mass index was associated with higher perceptions of research participation benefits. Pandemic parental stress was associated with increased social pressure and benefits. Parents of non-Hispanic White and male youth endorsed more mistrust of clinical research. Findings can inform future pediatric overweight and obesity clinical research and trial designs to enable equitable recruitment, reduce participation burden, and increase feasibility and sustainability of interventions.

Cow's milk allergy (CMA) remains one of the most common food allergies in infancy, requiring the avoidance of cow's milk and its derivatives. Breast milk is the best source of nutrition for infants. For those infants with CMA whose mothers are unable to breastfeed or choose not to, extensively hydrolysed formulas (eHFs) are widely recommended as first-line milk substitutes, whereas hydrolysed rice formulas (HRFs) are increasingly recognised as a viable alternative. This concept paper provides a healthcare professional (HCP) perspective on HRF, drawing on expert consensus from two meetings convened in 2025. Discussions noted the long history of safe and effective HRF use in Europe, its nutritional adequacy, and the evolving international guidelines supporting HRF as an alternative first-line option. A key meeting outcome was the development of a practical decision tree to help UK clinicians decide when HRF should be the preferred choice. Key considerations for its use in non-breastfed infants include the following: parental/caregiver stress related to persistent symptoms; ongoing symptoms despite multiple interventions; cultural and lifestyle choices; religious dietary requirements; and specialists' recommendations. Secondary considerations highlighted by HCPs include the following: proven reactions whilst infants are breast-milk-fed together with parental request for formula; faltering growth; multiple symptoms; taste acceptance (older infants); and parental preference based on experience. The role of functional components, such as prebiotics and human milk oligosaccharides (HMOs), was noted in regard to the emerging evidence of benefits to the microbiome and immune development. The experts emphasised the importance of engaging HCPs across all levels of CMA care and addressing challenges in translating current guidance into treatment practice. It was concluded that, overall, HRF represents a nutritionally complete, plant-based alternative that has been shown to be well tolerated (taste, symptoms) in clinical studies. It can be used to broaden therapeutic options for infants with CMA in the UK who are not exclusively fed breast milk.

Early childhood represents a critical period for sex education and family-based education is essential to this process. However, many parents lack the knowledge and skills to deliver effective sex education, which significantly hinders implementation and effectiveness for this age group. In a cluster-randomized trial conducted in 2022, parents of preschool children from four kindergartens in Luzhou City were assigned by class to receive either a 6-month online sex education program grounded in the Theory of Planned Behavior (TPB) via WeChat or conventional health education. Parental knowledge, attitudes, and practices (KAP) were assessed at baseline and post-intervention. Intervention effects were evaluated using Analysis of Covariance (ANCOVA) and Generalized Estimating Equations (GEE) to account for baseline covariates and potential cluster effects. A total of 217 parents were enrolled in the study. Post-intervention, the intervention group demonstrated significantly higher scores and improved pass and good rates across all KAP (knowledge, attitudes, and practices) dimensions compared to the control group (p < 0.05). Notably, the KAP consistency rate and parental preference for online learning channels also increased significantly in the intervention group (p = 0.001). The TPB-based online intervention effectively enhances parental competencies in early childhood sex education. This digital model provides a scalable and accessible strategy for health promotion, with significant implications for narrowing the implementation gap in family-based sex education and supporting children's long-term sexual health.

With the increasing variety of pediatric diagnostic procedures, a growing number of children require sedation for diagnostic examinations. Appropriate sedation protocols guarantee the safety of children during sedation and improve its efficiency. Currently, there are significant differences in pediatric sedation practices across countries, regions, and medical institutions. The Pediatric Anesthesiology Group of the Chinese Society of Anesthesiology organized experts from multiple countries to develop the "Chinese Society of Pediatric Anesthesiology Guideline for Pediatric sedation (2025)" based on evidence-based medicine, considering the safety and efficacy, the preferences of children and parents, and drug accessibility. The guideline provided 28 recommendations addressing 12 clinical issues related to pre-sedation assessment, safety measures for sedation personnel and facilities, sedation protocols, sedation monitoring, and post-sedation recovery. The guideline is planned to be disseminated globally through multiple channels, aiming to standardize the management of pediatric sedation and improve its safety and efficacy.

Parental help-seeking for sleep in children aged 0-5 years: A systematic review.

Introduction: There are various stressors associated with parenting a child with sensory integration difficulties and although family-centered practice is essential in paediatric occupational therapy, there is limited research focused on the needs of the parent. This study aimed to identify what therapist-parent support methods are valued by South African parents of children with sensory integration difficulties. Methodology: A non-experimental cross-sectional descriptive study was conducted. A self-administered online survey was completed by 103 South African parents living in Gauteng province whose children attended occupational therapy for sensory integration difficulties. Results: Most parents (62.14%) reported that they were ‘very satisfied’ with the support they receive from their child’s occupational therapist. The most common therapist-parent support currently in place included electronic communication (72,82%), followed by therapy ‘homework’ (66,99%) and verbal feedback (65.05%) after therapy sessions. The least utilised support included parent support groups (0.97%), parent education seminars (1.94%) and home visits (1.94%). Support methods that were rated the most helpful by participants included parent-therapist consultations or feedback meetings (69.90%), formal reports (62.75%) and electronic communication (60.78%). Conclusion: This paper outlines the importance of using multi-component parent support methods in the context of family-centered care, and presents factors which can guide South African occupational therapists in their selection thereof. Implications for practice: Occupational therapists working with children with sensory integration difficulties should use multi-component support methods to support parents throughout the therapy process. This study provides a comprehensive list of parental support methods that therapists can use when treating children with sensory integration difficulties. Consideration should be given to context and parental preferences when selecting and implementing methods.

In the context of China's relaxed fertility policies and persistently low fertility rate, this study examines how parental gender preferences - son preference, daughter preference, balanced preference, and no preference - differentially associate with the ideals to have a second child versus a third child. Using nationally representative mixed cross-sectional data from 2017 to 2021 (N=15,668), we conduct the first systematic comparison across these two parities. The research revealed that (1) notable child heterogeneity exists in gender preferences: a balanced preference is significantly positively associated with the inclination to have a second child but negatively associated with the desire for a third child, whereas gender-specific preference shows the opposite pattern; (2) the gender composition of existing children plays a crucial moderating role, with son preference markedly increasing the willingness to have a third child in families with two daughters compared with other configurations; and (3) traditional preference habituation (son preference) is more pronounced among rural households, male respondents, and youths from low socioeconomic status (SES). This study addresses key gaps in the literature, which has largely focused on a single parity or exclusively on female respondents, by examining both second- and third-child fertility ideals among both men and women. This reveals the complexity of the dynamics of gender preferences in the fertility decisions of Chinese families.

The application value of indocyanine green in assisting vascular identification during microsurgical varicocelectomy in children.

Given the uniquely sensitive context of neonatal death in China, neonatal intensive care unit (NICU) clinicians face considerable pressure as they are required to communicate this profound loss to parents in a culturally appropriate manner. To examine how NICU physicians and nurses communicate with parents about neonatal death, navigate cultural expectations in the process, and manage communication decisions across varied clinical scenarios. This qualitative study used semistructured interviews to collect data and a descriptive phenomenological approach to analyze interview data. The study was conducted with clinicians at 2 NICUs in 2 tertiary care hospitals in Yangzhou City, Jiangsu Province, China. Participants were enrolled through purposeful sampling and included physicians and nurses with prior experience with caring for neonates. Data were collected from September 2024 to May 2025 and were analyzed from October 2024 to June 2025. Experiences of informing families of neonatal death. In-depth, semistructured interviews were conducted at a rate of 1 participant per day and continued until data saturation was achieved. Data were analyzed using the Colaizzi 7-step phenomenological method. A total of 24 individuals (10 physicians and 14 nurses; mean [SD] age, 39.2 [7.5] years; 20 females [83%]) participated in the study. Among participants, 20 (83%) were married with at least 1 child, and the mean (SD) length of service was 16.3 (8.1) years. All participants held a bachelor's degree, were of Han Chinese ethnicity, and had no religious affiliation. Three main themes and 9 subthemes emerged from the interviews. The first theme was that fathers were prioritized over mothers as to whom to make the death disclosure. The subthemes were perceiving the father as the primary family decision-maker, encountering barriers to direct death disclosure to the mother, and being instructed to prioritize death disclosure to the father. The second theme was that death disclosure was handled sensitively, with the explicit term death avoided. Its subthemes were incrementally disclosing bad news, avoiding directly using death-related vocabulary, and using metaphors to explain medical terminology. The third theme was that postdisclosure procedures were handled exclusively in accordance with cultural norms. The subthemes were suppressing personal expressions of grief, being delegated full authority for handling the child's remains, and adjusting disposition arrangements to safeguard familial reputation. In this qualitative study of death disclosure, participating NICU medical staff disclosed death with sensitivity to traditional Chinese cultural norms. Insights from their experiences highlight key areas for improvement, including reducing stigma around neonatal death, developing culturally sensitive bereavement services, and exploring parental experiences and preferences.

Larger eggs are more attractive? Parental preference trapped in the brood parasitism strategy

For decades, population research has been interested in the complex relationship between child mortality and fertility, with a key focus on identifying hoarding behavior (i.e., fertility response to expected aggregate child mortality). Using unique data from the Malawi Longitudinal Study of Families and Health, we investigate the impact of individual-specific subjective expectations about infant mortality on fertility behavior. We instrument the potentially endogenous infant mortality expectations with the average of parents’ ratings of children's health to address the potential for omitted variable bias, such as parental preference for health. Consistent with the hoarding mechanism, we find that a 10-percentage-point increase in community-level child mortality expectations leads to a 14-percentage-point increase in the propensity to have a child in the next two years from a baseline propensity of 39%.

Understanding Parental Preferences and Concerns Regarding Dental Radiography in Pediatric Dentistry: A Cross-sectional Study