Pediatric Outpatient Clinic Research Articles

Correlation between vaccine hesitancy, vaccine reliability and perceptions of infectious diseases

Abstract Background Vaccine hesitancy is a delay in vaccine acceptance or refusal despite the availability of vaccination services. In recent years, the rise in vaccine hesitancy has attracted attention. This study aimed to evaluate the perception of vaccine hesitancy, vaccine safety, and infectious diseases among parents. Methods This cross-sectional study was conducted with 503 parents who applied to the pediatrics outpatient clinic of a university hospital. The questionnaire used in the study included questions on sociodemographic characteristics, factors related to vaccine hesitancy, The Vaccine Hesitancy Scale (VAS), the Vaccine Safety Scale (VSS), and the Perception Scale for Infectious Diseases (PPSID). Multivariate Linear Regression Analysis was used to find the variables associated with vaccine hesitancy. Results The mean age of the parents was 37.6±7.6 years. Parents’ scores on the ATS ranged from 17-85, with a mean score of 20.1±6.6 points. A moderate negative correlation was found between parents’ VAS and VSS scores, and between VAS and PPSID scores (r=-0.412, p < 0.001; r=-0.409, p < 0.001, respectively). According to the multivariate linear regression analysis the variables found to be associated with vaccine hesitancy, income status, maternal education level, child’s age group, having information about childhood vaccination schedule, child’s immunization status, the necessity of childhood vaccines, having sufficient information about the safety of vaccines, vaccine safety level, and infectious disease perception level were found to be significant predictors of vaccine hesitancy (F: 12,844, p ≤ 0.001, R2: 0.334). Conclusions This study determined that vaccine hesitancy was higher in families with lower income, who have not completed the schedule nor been vaccinated, doubt the necessity of vaccines to prevent infectious diseases, lack of knowledge about the reliability of vaccines, and whose children are still in primary school. Key messages • Health professionals have a critical role in reducing vaccine hesitancy. • It would be appropriate to plan face-to-face or online programs with parents.

The relationship between perceived parental phubbing and smartphone addiction in adolescents

Abstract Background Parental phubbing refers to the degree to which parents reduce or ignore their interactions with their children while taking care of their smartphones. Today, it has become important to conduct studies to understand the effects of parental phubbing on adolescents, which is increasing globally. This study aims to evaluate the relationship between perceived parental phubbing and smartphone addiction as well as depression in adolescents. Methods In this cross-sectional study, 314 adolescents aged 10-18 years who applied to the general pediatrics outpatient clinics of a university hospital in Ankara, the capital of Türkiye, were included. The questionnaire form used for data collection consisted of questions about the sociodemographic information of the participants, ‘Perceived Parental Phubbing Scale’, ‘Kutcher Adolescent Depression Scale Short Form’, and ‘Smartphone Addiction Short Form for Adolescents’ items. Descriptive statistics, Mann Whitney U, Kruskal Wallis H test and Spearman correlation analysis were used to analyse the data. A value of p < 0.05 was considered statistically significant. Results Depression and smartphone addiction levels were found to be significantly lower in adolescents who did not smoke, engaged in regular physical activity and had a close group of friends (p < 0.05). It was also found that the level of perceived parental phubbing was significantly higher in adolescents whose parents’ education level was above high school and who felt lonely (p < 0.05). Low level positive correlations was found between perceived parental phubbing and both depression (r = 0.116, p = 0.041) and smartphone addiction (r = 0.128, p = 0.023). Conclusions As the level of parental phubbing perceived by adolescents increased, the levels of depression and smartphone addiction in adolescents increased. These negative effects of parental phubbing on adolescents should be taken into consideration by mental health professionals. Key messages • It is important to consider and question parental phubbing as one of the related factors in adolescents with high levels of smartphone addiction and depression. • There is a need for studies to increase the awareness of parents, who are important role models for adolescents, about the concept of phubbing and its effects on adolescents’ mental health.

A Decision Support System for Machine Learning-Based Determination of Zinc Deficiency: A Study in Adolescent Patients

Background: Over the past three years, zinc deficiency among adolescents has varied based on region and access to healthcare. Globally, zinc deficiency affects approximately 2 billion people, leading to serious issues such as immune problems and growth delays, particularly in developing countries. In the U.S., around 10% of adolescents experienced zinc deficiency in 2021, with a higher prevalence among teenage girls. In Europe, deficiency rates are generally low but can be significant in Eastern Europe and Central Asia. In Asia, particularly in rural and low-income areas, deficiency rates range from 20 - 30%. In Turkey, the prevalence is high due to poor nutrition. Objectives: This study aimed to develop a machine learning-based decision support system to determine zinc deficiency in children and adolescents aged 10 - 18 years. Methods: This machine learning-based study was conducted with 370 adolescents aged 10 - 18 years to assess their zinc deficiency. The dataset consists of 8 feature vectors and an output vector. The machine learning methods used in the analysis include Logistic Regression, Naive Bayes, Decision Tree (CART), K-NN (K-Nearest Neighbors), SVM (Support Vector Machine), Gradient Boosting Classifier, AdaBoost Classifier, Bagging Classifier, Random Forest Classifier, MLP Classifier (Multilayer Perceptron), and XGB Classifier (XGBoost Classifier). Evaluation metrics such as accuracy, precision, recall, and F1 score were used to assess the performance of these methods. Including specific values for these metrics, such as "SVM achieved 94.6% accuracy," would allow readers to quickly compare the effectiveness of the models. Different metrics serve various purposes: Accuracy provides an overall view of performance, precision and recall highlight specific aspects, and the F1 score balances precision and recall. Results: The mean age of the patients in the dataset was 13.79 ± 1.18 years. Of the children, 64.32% (n = 238) were female and 35.68% (n = 132) were male. It was found that 62.7% (n = 232) of the children had low zinc levels, while 37.3% (n = 138) did not require zinc supplementation. Thirteen different machine learning methods were applied to a 70% training and 30% testing set. As a result, the SVM method provided the most successful outcome with 94.6% accuracy. Implementing the SVM-based system in pediatric clinics could improve efficiency and patient care by automatically detecting high-risk zinc deficiency patients based on lab results, providing early intervention alerts for faster treatment, and improving health outcomes. Highlighting these practical applications could increase the study’s appeal to healthcare professionals by demonstrating its real-world benefits. Providing detailed information on these applications would enhance the study’s clarity and practical value, making it more valuable for researchers and healthcare providers interested in AI tools for adolescent health. Conclusions: This study concluded that machine learning methods can effectively determine zinc deficiency in children. The SVM method demonstrated superior classification performance compared to the other methods. An SVM-based decision support system could be integrated into pediatric outpatient clinics to enhance diagnostic accuracy and patient care.

Diagnostic Approach to Children with Unexplained Global Developmental Delay in Pediatric Neurology Outpatient Clinic.

Global developmental delay (GDD) is a common pediatric disorder that affects up to 3% of children. Due to the heterogeneous etiology of GDD, diagnostic procedures and algorithms are complex and diverse. The aim of our study was to investigate the diagnostic yield of genetic, metabolic, and imaging studies in establishing the etiology of unexplained GDD (UGDD). In this retrospectively observational study, we examined the medical records of all children diagnosed with UGDD at the Department of Pediatric Neurology, University Medical Centre Ljubljana, Slovenia, between January and December 2019. We evaluated the effectiveness of various genetic, metabolic, and magnetic resonance imaging (MRI) tests in identifying the underlying cause of GDD. Additionally, we assessed subgroups of patients to determine whether any of the studied tests were particularly beneficial based on their clinical symptoms. A total of 123 patients met the inclusion criteria, with a median age of 4.3 years (range, 0-16 years), of which 71 (57.7%) were males. Genetic diagnosis was established in 47.1% (58/123) of patients. Metabolic laboratory testing did not identify a metabolic disease in any of the tested participants (114/123) and MRI was critical for diagnosis in only 1/81 (1.2%) patient. Our findings strongly suggest that genetic testing surpasses MRI and metabolic testing in establishing the etiology of UGDD in a pediatric neurology outpatient setting. This information will help guide the diagnostic evaluation of these children.

Long-Term Follow-Up of Persons Living with Perinatally Acquired HIV Infection at a Large HIV Treatment Clinic in Trinidad.

Data on persons with perinatally acquired HIV infection in the Caribbean are limited; thus, a chart review was conducted among these clients at an adult HIV treatment clinic in Trinidad over the period January 01, 2011-June 30, 2023. Sociodemographic, clinical, and laboratory data were extracted and analyzed using RStudio version 2021.09.0. Fifty-four study participants were followed up, age range 18-29 years, and there were 27 (50%) males. Eighteen participants (33.3%) were institutionalized until the age of 18 years, while 36 (66.7%) lived with caregivers/relatives and attended outpatient pediatric clinic. The transition from the sheltered environment of pediatric care to the adult HIV clinic was turbulent for some participants as they experienced HIV-related stigma, which may result in poor HIV outcomes. At the initial clinic visit, 28 (51.9%) study participants were virally suppressed (HIV viral load <1,000 copies/mL), which included 12 (66.7%) of 18 who were institutionalized as compared to 16 (44.4%) of 38 who lived with caregivers/relatives (p = 0.387). Data from their last clinic visit showed 31 (57.4%) participants were virally suppressed; 13 (24.1%) were lost to follow-up from care, and there were 6 (11.1%) deaths; 29 (53.7%) were on antiretroviral therapy single-tablet regimens (STRs) and 25 (46.3%) on complex multiple-tablet regimens (MTRs). Institutionalized clients and those on STRs were more likely to be virally suppressed than those living with relatives (p = 0.043) and those on MTR (p < 0.001), respectively. Reported deaths were higher among clients who lived with caregivers/relatives and those on MTR. Participants of younger age were less likely to achieve viral suppression (p = 0.02). Comprehensive programs that include STRs, the engagement of caregivers/relatives and health workers, life skills, and enhanced psychosocial interventions for youths living with perinatally acquired HIV are important to support the transition to adult care and reduce the complex challenges of living with a stigmatizing disease.

The association between ultra-processed food consumption and low-grade inflammation in childhood: A cross-sectional study.

This study aimed to investigate the relationship between the amount of ultra-processed food (UPF) in the diet and low-grade inflammation in children. This cross-sectional study was conducted in 50 healthy children recruited from children attending the Social Paediatrics Outpatient Clinic for follow-up of normal developmental stages. Low-grade inflammation was calculated by INFLA-score, dietary intake by three 24-h dietary recalls and dietary content analyses by BeBiS™ software. The mean age of the 50 children included in our study was 10.18 ± 3.98 years (5-17 years). UPF accounted for 24.5% of the total daily energy intake of children. In children with higher inflammation scores (INFLA-score ≥ 2), the amount in grams of UPF and the percentage of total energy from UPF were found to be significantly higher (p = 0.030 and p = 0.015, respectively). A weak positive correlation was found between the INFLA-score and the percentage of daily dietary energy intake coming from UPFs (r = 0.350, p < 0.01), the average daily energy intake from UPFs (r = 0.313, p < 0.05), and the average daily amount of UPF consumed (r = 0.260, p < 0.05). The linear regression model revealed that every one-unit increase (1%) in the percentage of total daily energy intake coming from UPF caused an increase in β = 0.154-unit in the INFLA-score. It was found that obesity was not a mediator in the association between the percentages of total energy intake from UPF on the INFLA-score, instead, the energy intake from UPF had a significant direct association with the INFLA-score. The average amount of UPF consumed daily showed an increasing pattern in parallel with inflammation-score quartile classes (Q1 to Q4) with 33.3% in Q1, 38.5% in Q2, 53.8% in Q3 and 66.7% in Q4 (p = 0.049). In conclusion, a positive association was found between low-grade inflammation and UPF consumption in children, independent of obesity.

Association between SARS-CoV-2 infection before the age of two and child development.

To compare the differences in child development between children who contracted COVID-19 after February 1st, 2022, the period when the B.1.1.529 variant outbreak began to peak in Thailand, and those who did not. A prospective cohort study was conducted in an outpatient pediatric clinic at a tertiary hospital in southern Thailand. COVID-19 was diagnosed based on the results of an FDA-approved antigen test or RT-PCR using a swab sample collected from the nasopharynx, nose, or throat. Child development was assessed using the Ages and Stages Questionnaire, Third Edition (ASQ-3). Of the 336 participants, 180 (53.6%) had a history of COVID-19. Almost all of them had mild COVID-19. The mean (SD) age at infection was 1.3 (0.3) years, and the median (IQR) duration between infection and ASQ-3 assessment was 193.5 (167.8, 216.2) days. The ASQ-3 scores at the ages of 18 (n = 166; 90 COVID-19 positive) and 24 months (n = 170; 90 COVID-19 positive) revealed no statistically significant differences between children with and without a history of COVID-19. Both groups had comparable proportions of developmental scores <1 SD below the mean. Mild COVID-19 in young children did not increase the risk of developmental delays. This cohort study was conducted during the Omicron pandemic. Of the 336 children, no clinical or statistically significant differences were observed in the scores of the Ages & Stages Questionnaire, Third Edition, at 18 or 24 months of age among the 180 participants with a history of mild SARS-CoV-2 infection, at an average of 6 months post-infection, and those without. The findings suggest that mild SARS-CoV-2 infection before the age of 2 years is not associated with developmental delays. Strategies to prevent severe SARS-CoV-2 infection in young children, especially COVID-19 immunization, need to be highlighted.

Increasing Screening for Sexually Transmitted Infections Among Adolescents and Young Adults Diagnosed With Sickle Cell Disease: A Quality Improvement Project

BackgroundSexually transmitted infections affect 20 million adolescents and young adults in the United States annually. Local ProblemIn a pediatric outpatient sickle cell disease clinic, in southeastern, US, 16% (43/272) of patients aged 16-24 had a documented sexual health history and 12% (4/77) completed STI screenings. The clinic's aim was to increase sexual health assessment, STI screenings, diagnosis, and treatment. Methods/InterventionUsing process redesign, a standardized sexual health and STI screening process at routine visits was implemented to increase completion of sexual health histories and STI screening. ResultsSexual health history collection rates increased from 16% (43/272) pre- to 92% (107/116) post-intervention. The rate of STI testing offered increased from 12% (5/43) pre- to 100% (116/116) post-intervention. The STI testing rates increased 22.5 % from 40% (2/5) pre- to 49% (20/41) post-intervention. ConclusionsEvidence-based standardized interventions can successfully be used to assist in sexual health documentation and STI screening.

Altered Surrogate Markers of Inflammation in Perinatal HIV-Exposed Children with Caries.

Dental caries is associated with immunologic response, yet its association with hematologic parameters and inflammatory markers is unclear. This study aimed to examine the relationship between some surrogate markers of inflammation and dental caries in the context of perinatal exposure to human immunodeficiency virus (HIV). This cross-sectional study involved 2 groups of children aged 4 to 11 y who were (1) HIV exposed but uninfected (HEU) and (2) HIV unexposed/uninfected (HUU) and recruited from HIV pediatric and child outpatient clinics, respectively, at a tertiary health facility in Nigeria. Medical records were reviewed, and trained dentists conducted oral and dental examinations. Five milliliters of EDTA blood was obtained and used for CD4 and CD8 and complete blood analysis, from which other inflammatory markers such as the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), systemic inflammatory index (SII), CD4/CD8 ratio were calculated using referenced formulas. In total, 245 (125 HEU and 120 HUU) children with a mean (standard deviation) age of 7 (2) y were included in this study. No differences in caries experience were observed in both groups of children (38 children [16%] were caries affected; 19 [16%] and 19 [15%] from the HEU and HUU groups, respectively). Examining the relationship between studied inflammatory markers and caries showed that leucocyte counts were slightly lower in caries-affected children compared with their caries-free counterparts (P = 0.05). Lower levels of neutrophils (P = 0.04) and higher levels of lymphocytes (P = 0.02) were associated with caries prevalence. Although not significant, NLR, PLR, and SII were lower in caries-affected children. Caries is associated with leucocytes and some of its subsets in both groups of children and independent of perinatal HIV exposure, highlighting the potential of evaluating inflammatory markers in caries prevention, treatment, and research. This study provides evidence that a relationship exists between dental caries, HIV exposure, and inflammation using affordable methods and advocates the inclusion of these markers in caries care in resource-limited settings.

Problematic screen exposure and oral health in preschool children: a comparison study

ObjectivesRecent studies have highlighted the association between problematic screen exposure (PSE) in preschool children and various health issues. This study aims to determine the relationship between PSE and oral/dental health as well as parafunctional oral habits in this population.MethodsHealthy children aged 3 to 6 years who visited the pediatric dentistry outpatient clinic were included in the study. PSE was evaluated using the parent-reported ‘Seven-in-Seven-Screen-Exposure Questionnaire’. An intraoral examination was conducted to record the number of decated, missing, and filled teeth, along with scores from the International Caries Detection and Assessment System II (ICDAS II), as well as dental plaque and gingival indices.ResultsA total of 210 mother–child pairs were included in the study, comprising 70 pairs with PSE and 140 pairs without PSE. The sociodemographic characteristics, frequency of daily tooth brushing behaviors, use of children's toothpaste, and regular dental examinations were statistically evaluated between the PSE and non-PSE group (p > 0.05). Additionally, there was no statistically significant difference between the groups in terms of having abnormal oral habits (p > 0.05). In the PSE group, the median scores for gingival and plaque index were significantly higher (p = 0.011 and p = 0.006, respectively). The median number of decayed teeth was significantly higher in the PSE group (p = 0.039).ConclusionsTurkish preschool children with PSE were found to have a significantly higher likelihood of experiencing poor oral health. Consequently, it is essential to conduct oral health examinations for Turkish preschool children exhibiting PSE. The study may have clinical implications for the evaluation of preschool children with problematic media use within dental practice.

Knowledge and perception of asthma among parents of children with asthma.

Parents' knowledge is an integral part of healthcare quality, impacting treatment adherence, patient loyalty and healthcare utilisation in pediatric asthma. Parental knowledge is particularly crucial as parents influence decision-making for their child's healthcare. To assess parents' knowledge and perceptions of their children's asthma and to identify areas for weakness in therapeutic education. This is transversal survey study based on validated and translated self-administered questionnaire (Arabic asthma knowledge questionnaire AAKQ). The study was conducted in 2 departments: pediatric primary care department at Elomrane and pediatric pneumology outpatient clinics at Bechir Hamza children's hospital of Tunis during 6 months (March2022- October2022). One hundred forty-four parents were involved in the study. Most of the participants were mothers. The mean age was 38 years. Only 27,0% had higher education and smoking in parents was observed in 58% of cases. Our results showed moderate knowledge in 67,9% of participants. The mean of the total knowledge score was 57,7/85. Forty-six per cent of parents had poor knowledge for the first category of the questionnaire. The second category was the most successful part where only 14% had poor knowledge. The mean score of the third category was 13,5/20 with 35,4% of parents having poor knowledge. The mean of total knowledge was found to be higher among participants with higher education (P=0,000), when the gender of the child is masculine (P=0,038), when the parents were asked in Hospital of children of Tunis (P=0,003) and when there is a history of asthma in the siblings (P=0,05). No difference in caregiver's knowledge was based on their age or gender or history of asthma, on the age of the child, his hospitalization for asthma, his asthma control level or his compliance with medication. Knowledge of parents and their children suffering from asthma is acceptable but insufficient. An approach focusing on improving patient education skills is needed to help families understand and accept the disease and achieve optimal control.

Implementation and analysis of clinic administered behavioural health screen in an outpatient paediatric cardiology clinic.

Previous studies investigating behavioural health screening processes have focused on selected diagnoses within paediatric cardiology and focused on a smaller number of potential concerns. We developed and administered a brief survey in our paediatric heart centre to assess the presence of a wider variety of behavioural health concerns and to connect patients with resources. A cohort of 305 patients aged 2-29 years (M = 11.97 years; SD = 6.00 years; 50.49% female), representing a variety of indications for a cardiology clinic visit, or a parent, completed a survey of 14 common behavioural health concerns. Behavioural health concerns were included based on practice patterns within paediatric psychology. Respondents indicated if they were currently receiving behavioural health services and if they were interested in behavioural health follow-up. Surveys were administered during check in and collected by clinic staff. A behavioural health provider attempted to reach all those who indicated interest by phone. Approximately 45% of the sample endorsed one or more behavioural health concerns and 30.16% of the sample endorsed at least one concern but were not already connected to services. Only 27.17% of this group requested follow-up. Most commonly endorsed concerns were anxiety, sleep problems, depressed/irritable mood, and somatic complaints. Survey results converge with existing literature to indicate that behavioural health concerns are common among youth seen in a paediatric cardiology clinic but most patients are not connected to appropriate services. Screening programmes can help meet this need but challenges remain. Clinical implications and future directions are discussed.

Children presenting with toe walking: when should concern arise?

Purpose: This study aimed to evaluate children who present with tiptoe walking (TW) and to identify potential indicators of underlying medical conditions. Materials and Methods: Out of the 248 patients who visited the Pediatric Neurology Outpatient Clinic for gait disturbances, 90 individuals aged 1-17 years were identified as exhibiting TW. After excluding those with systemic neurological diseases and pervasive developmental disorders (PDD), the study ultimately included 47 patients. Results: Among the participants, 19 were female (40.5%) and 28 were male (59.5%). The mean age of the patients was 4.9 years (SD ± 3.53). When evaluating the etiology of TW, 30 patients (63.8%) were found to have idiopathic tiptoe walking (ITW), 8 (17%) had cerebral palsy (CP), 6 (12.7%) had Achilles tendon shortness (ATS), 2 (4.2%) had hereditary spastic paraplegia (HSP), and 1 (2.1%) had syringomyelia. Imaging was not performed for 17 patients (36.1%), while cranial magnetic resonance imaging (MRI) was conducted for 13 (27.6%), spinal MRI for 2 (4.2%), and both cranial and spinal MRI for 15 (31.9%). Pathology was detected in 5 of the patients who underwent imaging (10.6%): 4 (8.5%) showed hypoxic-ischemic processes, and 1 (2.1%) showed syringomyelia. Conclusion: In cases where patients exhibit normal neurological examinations and neuromotor development, TW is often identified as idiopathic. However, for patients presenting with risk factors in their personal or family history, delays in neuromotor milestones, or abnormal neurological findings, a diagnosis should be pursued at an earlier stage.

Using Neuropsychological Profiling to Tailor Mental Health Care for Children and Youth: a Quality Improvement Project to Measure Feasibility.

Precision child and youth mental healthcare has great potential to improve treatment success by tailoring interventions to individual needs. An innovative care pathway in a pediatric mental health outpatient clinic was designed to allow for neuropsychology data to be integrated in psychotherapeutic care. This paper describes the feasibility of this new pathway, including implementation outcomes, acceptability, and potential for future integration. The target population was outpatients 6-17years old referred for individual treatment to a tertiary outpatient mental health (OPMH) clinic. The new care pathway was co-developed by neuropsychologists and mental health practitioners. A logic model was created to guide the evaluation, which was informed by the Reach Effectiveness Adoption Implementation Maintenance framework. As part of the logic model, a stepped assessment protocol was implemented, and reports on neuropsychological function were shared with patients, caregivers, and care providers. Evaluation data were collected from phone surveys, questionnaires, a focus group, and administrative records. Forty-two patients scheduled to receive therapy over a 6-month period were offered the opportunity to participate in the new care pathway and 39 (93%) agreed. Self-reported outcome data showed that 83% of patients and 94% of caregivers valued neuropsychology-informed care, with some describing it as transformative. Almost all practitioners (91%) reported that the project added value to their clinical care. There were no adverse effects on participants nor the flow of patients through the system. Neuropsychology-informed pediatric OPMH care was feasible and well-received. Clinical effectiveness should be studied in an experimental trial.

Investigation of perceived parental attitude in children exposed to sexual abuse: A case-control study.

The enduring impact of children being subjected to sexual abuse is characterized by lasting traumatic effects. This study aims to assess the influence of perceived parental attitudes on the incidence of sexual abuse in children who have experienced such abuse, comparing them with a control group. The research took place at the Child Advocacy Center (CAC) of a hospital in northern Turkey and in the pediatric outpatient clinics of the same institution. The study evaluated 101 children who were exposed to sexual abuse and 100 children who were not. Data collection took place between November 2022 and August 2023. The study employed a 'Descriptive Information Form' and the 'Parental Attitude Scale' for both case and control groups. The t-test for independent samples, descriptive statistics, and logistic regression analysis were used for data analysis. Analysis of scores from the Parental Attitude Scale revealed significantly lower mean scores in acceptance-involvement and strictness-supervision in the case group (p < .05). The mean scores for 'acceptance-involvement' (X¯ = 22.82 ± 6.26, X¯ = 25.71 ± 3.89) were highest in the case and control groups. Neglectful attitude (38.6%) was more prevalent in the case group, while the control group exhibited a higher frequency of democratic attitude (37%). In terms of predictors, acceptance-involvement (OR = 1.091, p = .005) and maternal employment (OR = 4.410, p < .001) were identified as the most significant predictors of exposed to sexual abuse. The study's Cronbach's alpha value for the scale was α = .743. The study's findings on parental attitudes suggest a potential connection between children's exposure to sexual abuse and inadequate parental acceptance, involvement, supervision, and control.

Assessment of Mothers' Shaking Behavior of their Babies and Related Factors: An Experimental Approach Using an Accelerometer and an Infant Manikin.

Our study aimed to investigate the factors associated with mothers' shaking behavior of their babies. Sixty-three mothers who stated that they shook their babies (Group B) and 91 mothers who stated that they did not (Group A) among those who applied to or were followed up from the Pediatric Outpatient Clinics of our University Hospital were included. The mothers (with a baby aged 0-30 months) completed the Brief Symptom Inventory (BSI) and psychiatric rating scales measuring attachment styles, empathic tendency, perceived social support, and self-esteem. The severity of the simulated shaking of the mothers was measured by an accelerometer placed on an infant manikin and separately scored on a Numerical Rating Scale by the researchers and an Illustrated Numeric Rating Scale by the mothers. In group B, babies' crying frequency was higher (P = .008); soothing the babies when they cried was more difficult (P = .019), mothers reported that they were exposed to physical violence more in their childhood (P = .003), BSI hostility scores (P = .004) and BSI-anxiety scores (P = .034) of the mothers were higher when compared with the group A. The age of the babies (P = .002, OR = 1.096), moderate crying frequency (P = .035, OR = 2.900), the mothers' difficulty in soothing their babies (sometimes P = .018, OR = 3.705, often/always P = .014, OR = 7.777), and the mothers' experience of physical violence in childhood (P = .002, OR = 5.674) were found to be factors affecting the shaking behavior. Clarifying the factors associated with the mothers' shaking behavior of their babies would be helpful in terms of protecting future generations.

Examination of the relationship between ABO/Rh blood groups and dietary compliance in children with coeliac disease: A single‐centre experience

AimCoeliac disease (CD) is an autoimmune enteropathy that develops upon ingestion of food containing gluten. The established link between ABO blood groups and numerous infectious and non‐infectious illnesses prompted this investigation into blood group distribution and its relationship with dietary compliance among children diagnosed with CD.MethodsIn this retrospective study, patients with CD who were followed for ≥1 year at the paediatric gastroenterology outpatient clinic of our hospital were evaluated. History, physical examination and coeliac serology results were reviewed for each patient. Patients were divided into two groups based on self‐reported compliance to a gluten‐free diet: diet‐adherent and non‐diet‐adherent. Patient and control groups were examined in terms of ABO blood groups.ResultsA total of 177 patients with CD were included in the study. A control group of 211 age‐ and sex‐matched children without any chronic disease who had undergone blood group testing for various reasons was included for comparison. A total of 65% (n = 115) of the patients were girls, and 35% (n = 62) were boys. No significant relationship was found between CD diagnosis and ABO blood groups among patients (P = 0.559). Furthermore, the dietary compliance status of the patients was not associated with any specific blood group (P = 0.951).ConclusionNo notable difference was found between patients with CD with or without gluten‐free diet compliance in terms of the distribution of ABO blood groups and Rhesus (Rh) factor. Therefore, it can be inferred that all blood groups and subgroups carry an equal risk for CD.

Bilateral tuberculous dactylitis of both hand and feet in a female toddler: a case report on a rare presentation of skeletal tuberculosis in children

BackgroundEven though tuberculosis is a common disease among children in developing countries, tuberculous dactylitis is an uncommon form of Skeletal tuberculosis specially with involvement of both the hands and feet.Case PresentationA one-and-a-half-year-old previously healthy female Ethiopian toddler presented to our pediatric outpatient clinic with a history of two-month duration of painful multiple swellings over both her hands and feet. The swelling involved the proximal phalanx of the left index finger, dorsum of the right hand, and dorsum of both feet over the first metatarsal bone. Physical examination, radiologic findings, and histopathology suggested tuberculous dactylitis. The patient was treated with anti-tuberculosis drugs for one year and she showed clinical and radiologic improvement and recovery.ConclusionTubercular dactylitis should be considered in the differential diagnosis of children from endemic areas presenting with bone and joint pain or swelling. Our experience of a twelve-month course of antitubercular treatment, which is in line with WHO recommendations, for skeletal tuberculosis, showed excellent outcomes.

Clinical Reasoning: Hyperventilation-Induced Alternating Hemiplegia With Concomitant Hemispheric EEG Slowing in a 7-Year-Old Girl With Headache.

A 7-year-old right-handed girl presented to the pediatric neurology outpatient clinic after 5 episodes of headache over the previous 3 months. Her family history was positive for migraine in the mother and maternal grandmother and for febrile seizures in the older sister. The neurologic examination and cognitive profile were normal. Five seconds after the end of hyperventilation, video-EEG showed high-amplitude delta waves predominantly over the left hemisphere with concomitant acute aphasia and right-sided weakness. After the event, which self-resolved over 8 minutes, the girl showed intact recall. A second instance of hyperventilation evoked the appearance of pseudo-rhythmic slow activity localized to the right hemisphere, associated with left-sided weakness, 20 seconds after the end of the test. This event spontaneously resolved in 3 minutes and was followed by headache.An exaggerated physiologic response to hyperventilation, the possible epileptic nature of the events, and a migraine variant were all considered in the differential. Nonetheless, the EEG slowing is shorter in duration and generalized in physiologic and paraphysiological conditions. A clear ictal morphology and evolution of the EEG activity were lacking in this case, and migraine attacks induced by hyperpnea have not been reported to date. Instead, EEG alterations similar to that observed in our patient are described in association with vascular abnormalities. We report the clinical presentation and diagnostic workup of a rare cerebrovascular disorder, highlighting the key features in the differential. Our case emphasizes the clinical value of the EEG rebuild-up phenomenon, which can help the clinician in achieving a prompt diagnosis.

Family meals on prescription as treatment for childhood obesity-a randomized controlled trial.

The aim with the present study was to evaluate the effects and tolerability of Family Meals on Prescription, a 3-month intensive dietary intervention with a participatory approach on body mass index (BMI) and metabolic health in children living with obesity. In this prospective randomized controlled trial, children aged 5-15years were included from the Pediatric Obesity outpatient Clinics in Halland, Sweden. Participants were randomly assigned to receive lifestyle treatment with or without Family Meals on Prescription (FMP) consisting of a subsidized prepacked grocery bag including recipes and provisions for five Family Meals per week for 3months. The primary endpoint was changed in BMIz after 3, 12 and 18-24months and secondary endpoints included to assess tolerability of FMP and effects on metabolic biomarker and frequency of shared meals. Eighty-nine children (51.7% female) entered the study, 54 patients in the intervention group and 35 in the control group. There were no significant differences between the groups concerning gender, age or level of obesity at baseline. The Family Meal on Prescription intervention combined with lifestyle treatment led to a significantly greater reduction in BMIz than lifestyle treatment alone after the 3-month long intervention (- 0.17 vs + 0.01, p < 0.01); however, this difference was not sustained throughout the study period, and in fact, the control group had a greater reduction in BMIz after 18-24months.A subsidized prepacked grocery bag may be a novel, well-tolerated and effective tool in the treatment of childhood obesity. The fact that the BMIz reduction shown at the end of the intervention did not persist over time emphasized the need of long-term treatment. Registered at clinicaltrals.gov 27 Nov 2020, retrospectively registered: clinicaltrials.gov number 19002468. https://clinicaltrials.gov/study/NCT05225350 What is Known: • Swedish data shows that lifestyle treatment alone is not sufficient for many families undergoing treatment for childhood obesity. • Regular family meals and mealtime routines have been shown to be important for nutritional health and dietary patterns in children and adolescents. What is New: • This intervention with a participatory approach involving prepacked family meals was well tolerated and led to a significant reduction in BMIz during the intervention. • That fact that these results were not sustained over time indicates a need to evaluate longer interventions, and that childhood obesity is a chronic and complex disease which requires long-time treatments.