Restrictions In Children Research Articles

Examination of parents' sensitivity levels to violence against children during the COVID-19: A post-pandemic evaluation

PurposeThis study aimed to evaluate parents' thoughts, and sensitivity levels about violence against children during the COVID-19 period after the pandemic. Design and methodsThe population of this descriptive, cross-sectional, correlational, and multicenter study consisted of parents registered in six family health centers in a city in southern Turkey. Study data were collected between April and November 2023 using information forms that included questions about parents' personal information, and their thoughts about violence against children during the pandemic and the Sensitivity to Violence Against Children Scale and analyzed. ResultsAccording to 42.3% of parents, children's exposure to violence increased during the pandemic; 64.7% stated that children experienced emotional violence the most. Parents who thought that there was a decrease in the reports of violence due to school closures, social distancing, and restriction of children's access to health, and social and legal services had higher SVACS mean scores than those who did not think so (p < 0.01). ConclusionsMost of the parents thought that children's exposure to violence increased and reports of violence decreased during the pandemic. In addition, parents' thoughts toward violence against children during the pandemic period were associated with their level of sensitivity to violence against children. Implications for practiceDuring the pandemic period, it is important that pediatric nurses, who are in direct contact with children, are in contact with parents and take an active role in the process in the prevention, early detection and reporting of violence against children.

Less restrictions in daily life: a clinical practice guideline for children with cancer

PurposeIn current clinical practice, recommendations regarding restrictions in daily life for children with cancer are often lacking or not evidence-based. Critically reviewing the evidence and formulating recommendations are therefore of great importance as social restrictions (e.g., swimming, school attendance, sports) can impair the quality of life of these children severely. Therefore, our aim was to develop a clinical practice guideline for clinicians, children, and their parents regarding social restrictions in children with cancer.MethodsA comprehensive multidisciplinary panel was assembled, comprising 21 professionals and patient representatives. A systematic literature review was performed, including dual appraisal of all citations. The GRADE methodology was used to extract, summarize, and assess the evidence. Multiple in-person meetings were held to rank outcomes, discuss evidence, complete evidence-to-decision frameworks, and formulate recommendations. Final recommendations were unanimously supported by all panel members.ResultsSix studies, including 758 children, formed the evidence base for the recommendations. Given the scarcity of the available evidence and various designs of studies in children with cancer, additional evidence was extracted from adult oncology guidelines, and shared expert opinions were utilized. In total, 14 recommendations were formulated of which multiple result in changes in current policy and standard of practice in the Netherlands. Topics covered in this guideline are swimming, having pets, visiting the zoo or farm, performing sports or high-velocity events, attending school or kindergarten, and use of public transport. This guideline is not intended to provide recommendations for patients after end of treatment, for palliative care settings, or for children undergoing a stem cell transplantation.ConclusionsIn this clinical practice guideline, we provide recommendations regarding restrictions in daily life in children with cancer. These include evidence-based recommendations and, in the absence of sufficient evidence, recommendations based on expert evidence. With these recommendations, we provide guidance for clinicians, children, and parents and contribute to improving quality of life for children with cancer.

Effects of rapid maxillary expansion on upper airway parameters in OSA children with maxillary restriction: A CBCT study.

Rapid maxillary expansion (RME) has been proposed as an effective treatment for pediatric obstructive sleep apnea (OSA) and maxillary restriction in children. This study aimed to evaluate the effect of RME appliances on the nasomaxillary complex dimensions in children with OSA and maxillary constriction. This prospective longitudinal study included 34 children aged 8-12 years with maxillary restriction and OSA confirmed by polysomnography who had completed RME therapy. The nasomaxillary complex is segmented into the nasal cavity, maxillary sinuses, and nasopharynx. The effect of RME on nasomaxillary complex dimensions was assessed pre and posttreatment using cone-beam computed tomography, analysis, while a second standard overnight polysomnography (PSG) was performed to assess changes in respiratory parameters. Significant improvements were observed, including inferior maxillary dislocation (S-S1 distance and N-ANS), increased anterior and posterior facial height, and a 5.43 events/h reduction in Apnea-Hypopnea Index (p < .001). The nasal cavity volume increased by 2439 (±584) mm3 (p < .001), nasopharynx size increased by 883 (±479) mm3 (p = .008), mid cross-sectional area increased by 31.74 (±14.50) mm2 (p < .001), and the distance between the right and left maxillary sinuses increased by 8.37 (±3.67) mm (p < .001) all exhibited positive changes, with some insignificant variations in volume change (p = .254). RME treatment was found to be effective in improving nasal cavity and nasopharyngeal dimensions, leading to improved respiratory parameters in children with OSA and maxillary constriction. While these results are promising, considerations about the potential long-term benefits of RME on future growth are important. The study provides valuable insights into the efficacy of RME as a treatment option for this pediatric population.

Development and validation of the activities and participation children and adolescents –neck (APCAN) measure

BackgroundNeck pain is the fourth leading cause of years lost to disability in children warranting a comprehensive assessment of neck pain and its impact on activities and participation. Hence, the purpose of this study was to develop a new measure (i.e., Activities and Participation Children and Adolescents -neck [APCAN]) specific to evaluating activity limitation and participation restrictions in children and adolescents and to establish its content validity.MethodsDevelopment and content validation of the APCAN was completed in four steps: (1) item development, (2) item evaluation by content experts, (3) content validity calculation, and (4) cognitive testing via interviews to ensure readability and comprehension of the items on the APCAN.ResultsAn initial pool of 52 items was created that was revised to 20 items after modified Delphi process and cognitive interviews. Each item was rated on a 0–10 numeric rating scale (0 = not difficult at all, 10 = extremely difficult) with higher scores indicating higher perceived disability secondary to neck pain. All 20 items retained the content validity ratio critical value and the overall content validity index was 0.88 indicating excellent content validity.ConclusionThe APCAN provides an easy to use, comprehensive assessment of functional limitations associated with neck pain in children.

Impact of lower muscle stiffness on ankle dorsiflexion restriction in children with cerebral palsy evaluated using ultrasound elastography

BackgroundPlantar flexor muscles always contribute to limiting the range of motion of ankle dorsiflexion in children with spastic cerebral palsy, but the individual contributions of these muscles are not well defined. This study aimed to identify which muscles' stiffness impacts the dorsiflexion range of motion in children with cerebral palsy. MethodsTwenty-five children with cerebral palsy were included. The maximum passive dorsiflexion range of motion was measured in two positions: hip and knee joints in flexion, and both joints in full extension. Strain ratios indicating muscle stiffness were measured using strain elastography of the lateral and medial gastrocnemius, soleus, flexor hallucis longus, peroneus longus, peroneus brevis, and tibialis posterior muscles. To analyze which muscles impact the limitation of the dorsiflexion range, multiple regression analyses were conducted. The values of muscle stiffness were included as independent valuables, and the values of the dorsiflexion range were included as dependent valuables. A p-value <0.05 was considered statistically significant. FindingsIn the analyses, the soleus and flexor hallucis longus muscle stiffness were significant independent factors for the dorsiflexion range of motion of hip and knee flexion (adjusted R2: 0.50). The lateral gastrocnemius muscle stiffness was a significant independent factor for the dorsiflexion range of motion with both joints in full extension (adjusted R2: 0.61). InterpretationFlexor hallucis longus muscle stiffness, in addition to triceps surae muscle stiffness, was shown to impact dorsiflexion range; attention should be paid to muscle stiffness in children with cerebral palsy.

Let them play: A prospective study of postoperative activity restrictions in children

BackgroundWe aim to compare time to resume full activity, postoperative outcomes, and describe family preferences of self-directed activity restrictions (SDAR) and physician-directed activity restrictions (PDAR) following routine pediatric surgeries. MethodsWe conducted a single institution, clinical trial (NCT04145895) from January 2020 to February 2022. Patients who presented for a routine inguinal hernia repair (ages 2-13) or laparoscopic appendectomy for uncomplicated appendicitis (aged ≤ 18) were eligible for participation. Participants chose to enroll in either the control (PDAR) or experimental (SDAR) groups. Control patients were instructed to restrict full activities for two weeks. For SDAR, patients were instructed to return to full activity when the patient and family felt comfortable doing so. Postoperatively, participants were asked to complete a survey to assess time to resume full activity, surgical complications, and patient and caregiver satisfaction. Results20 (24.4%) enrolled in PDAR and 62 patients (75.6%) enrolled in SDAR. The majority of patients underwent laparoscopic appendectomy (78%). Of patients who completed the postoperative survey, the average time to resume full activity was 11.91 days for PDAR and 9.51 days for SDAR (p = 0.328). There was no difference in parent satisfaction or postoperative complications (p >0.999). ConclusionsThe time to resume full activity was two days sooner for SDAR without compromising post-operative outcomes. There are psychosocial benefits to children resuming normal activities, and SDAR may lessen a family's societal burden. Therefore, we propose that SDAR appears safe and should be utilized for routine surgery.

COVID-19 И ОЖИРЕНИЕ У ДЕТЕЙ, ИЛИ К ЧЕМУ ПРИВОДИТ ДИСТАНЦИОННОЕ ОБУЧЕНИЕ

The epidemiological situation in the country in recent years has led to an increase in the prevalence of childhood obesity, which was facilitated by quarantine measures, school closures and, as a result, restriction of children's access to healthy school meals, reduced control, and inactivity. And the Union of Pediatricians of Russia confirms the factors proven by world medical practice about the relationship between overweight and covid-19: adipose tissue contributes to better penetration of the coronavirus and increases the duration of virus persistence by 42%; obese people are more likely to have other chronic diseases, which, in turn, increase the risk of severe COVID-19. Therefore, the purpose of our work was to assess the mutual influence of COVID-19 and obesity in children, to optimize the “pron-position” method for patients with COVID-19 and overweight. We conducted preventive examinations of 366 students of the Lyceum of Philosophy and Planetary Humanism before and after quarantine measures and analyzed the medical histories of 54 children diagnosed with a New Coronavirus infection who were hospitalized in the infectious department of the Samara Regional Children's Infectious Hospital. As a result of our research, we observe a tendency for the growth of overweight children and a decrease in the level of health in the children's population of the Samara region, which directly indicates the need to introduce new preventive measures for children of the Samara region that can popularize a healthy lifestyle among students. And the product we developed made it possible to improve well-being and enhance the effectiveness of therapy in patients diagnosed with COVID-19, including overweight patients.

Quality of life, activity limitations, and participation restrictions in children 8–12 years old with speech-language-hearing complaints

ObjectiveTo investigate the association between the quality of life, activity limitations, and participation restrictions in children that attended a speech-language-hearing assessment and diagnostic service. MethodThis is an observational, analytical, cross-sectional study with children and adolescents 8–12 years old who had been submitted to the speech-language-hearing assessment process, and with their parents/guardians. The Brazilian Economic Classification Criteria (Brazilian Criteria), the Pediatric Quality of Life Inventory 4.0 (PedsQL), and the International Classification of Functioning, Disability and Health (ICF) were employed; secondary data were collected as well. The data were analyzed with the distribution of frequency, measures of central tendency and dispersion, and the Shapiro–Wilk, Mann–Whitney, and Kruskal–Wallis tests. ResultsOf the 45 participants, 37 were males and 8 were females, mean age of 10.23 years (SD=1.47 and median=10.16). There was a statistical difference between child and parent PedsQL domains and sex, economic classification, and parental schooling. The correlation between their age and the PedsQL domains had a weak correlation with the Social domain. A statistically significant difference was verified between the parent PedsQL domains and the ICF categories referring to Self-care, Particular interpersonal relationships, and Education. The child PedsQL domains had statistically significant differences with categories referring to Receiving, Producing, and General interpersonal interactions. ConclusionIn this study, the quality of life was associated with sociodemographic aspects and the ICF Activities and Participation component in children with speech-language-hearing complaints.

Data mining for prothrombin time and international normalized ratio reference intervals in children.

Reference intervals (RIs) help physicians in differentiating healthy from sick individuals. The prothrombin time (PT) and International normalized ratio (INR) fluctuate in coagulation pathway defects and have interlaboratory variability due to the instrument/reagent used. As direct method is difficult in children, we chose an indirect data mining method for the determining PT/INR RIs. The indirect method overcomes the substantial financial and logistic challenges, and ethical restrictions in children, moreover, allows partitioning in more fine-grained age groups. Prothrombin Time/INR measurements performed in patients aged birth-18 years between January 2013 and December 2020, were retrieved from laboratory management system of the Aga Khan Hospital. Reference intervals were computed using an indirect KOSMIC algorithm. The KOSMIC package function on the assumption that the non-pathologic samples follow a Gaussian distribution (after Box-Cox transformation of the data), following an elaborate statistical process to isolate distribution of physiological samples from mixed dataset. A total of 56,712 and 52,245 values were retrieved for PT and INR respectively. After the exclusion of patients with multiple specimens obtained during the study period, RIs were calculated for 37,356 (PT) and 37,192 (INR) children with stratification into 9 age groups. A comparison of 2.5th and 97.5th percentile results with those of established RIs from SickKids Handbook of Pediatric Thrombosis and Hemostasis demonstrated good agreement in between different age groups. This study supports data mining as an alternate approach for establishing PT/INR RIs, specifically in resource-limited settings. The results obtained are specific to studied population and instrument/reagent used. The study also allows understanding of fluctuations in coagulation pathways with increasing age and hence better clinical decision-making based on PT and INR results.

The synergistic interaction of systemic inflammation, dysbiosis and antimicrobial resistance promotes growth restriction in children with acute severe malnutrition: An emphasis on Escherichia coli

A healthy development is denied to millions of children worldwide as harsh life conditions manifest themselves in an altered inflammation-prone microbiome crosstalk environment. Keynote of this tragedy is that insufficient nutritious amino acid blocks lipids-intake to sustain diverse microbiota, and promotes the generalist strategy followed by Escherichia coli -besides other proteobacteria- of shifting gut metabolism, subverting the site specificity of first immune reaction. Furthermore, it could be hypothesized that selective success lies in their ability to induce inflammation, since this phenomenon also fuels horizontal gene transfer (HGT). In this review, we dilucidate how immune mechanisms of environmental enteric dysfunction affect overgrowth restriction, infectious morbidity rate, and acquired lifelong risks among severe acute malnourished children. Also, despite acknowledging complexities of antimicrobial resistant enrichment, we explore and speculate over the links between virulence regulation and HGT as an indissociable part in the quest for new inflammatory niches by open genome bacteria, particularly when both collide in the most vulnerable.

Growth and micronutrient levels of 6-12 years-old children with food allergies, food sensitisation, and food restrictions.

We investigated the association of food allergy, food sensitisation, and food restriction with growth and micronutrients levels in schoolchildren. A total of 195 schoolchildren (6-12 years old) from six elementary schools in Korea were enrolled, and questionnaires were administered to their parents during June and July 2015. Food allergy was defined by the presence of urticaria, skin rash, pruritus, throat tightness, gastrointestinal complaints, or respiratory difficulty after consumption of a food to which allergy was plausible during the past 12months. Skin prick tests were performed and serum levels of haemoglobin and micronutrients were measured. Among 195 participants (51.3% males) enrolled, 35 (17.9%) were reported to have food allergies, 17 (8.7%) were on food restriction, and 27 (14.0%) were sensitised to at least one food allergen. Food allergy and food restriction were associated with a lower height-for-age z-score (p for trend=0.018, p=0.048; p for trend=0.076, p=0.008). Food restriction was related to reduced serum calcium level (aOR: -0.094, 95% CI: -0.156 to -0.032). Signs and symptoms of food allergy and consequent food restrictions in children were related to lower height-for-age z-score and lower serum calcium levels.

Participation restriction of children with cerebral palsy living in Thailand and influential factors: A cross-sectional study

ABSTRACT Objective To explore participation in daily activities of children with cerebral palsy(CP) in Thailand and influential factors. Methods A convenience sample of family-caregivers of 80 children with CP, 6–18 year-old, completed self-administered questionnaires (i.e., frequency of participation, Gross Motor Function Classification System-Family Report) during clinic visits at a university hospital. Results Family-caregivers reported that more than one-third of the children never participated in outdoor activities. The gap in the frequency of participation between groups with high versus low motor function was very high. Better gross motor and communication were strong predictors of participation. Caregiver’s education and family income were associated with participation in art/cultural, leisure and tourist activities. Conclusions Family-caregiver-report suggests that Thai-children with CP, especially those with severe impairments, have limited participation in daily activities. Increasing mobility and communication may promote the participation. Comprehensive intervention is needed to narrow the participation gap found between high and low functioning children.

The Effects of Teacher’s Restriction of Children’s Free Play on Children’s Pretend Play

The purpose of this study is to investigate the effects of restricting children’s free play on children’s levels of pretend play. The level of play restriction was examined using the following: How many children can play in the same area of interest, freedom of using toys, the space available for play, and time limitation. The participants for this study were selected through two screening steps. First, a questionnaire concerning the extent of free-play restriction was sent out to 90 teachers in Korea. Of these teachers, two teachers with a high degree of limitation and two teachers with a low degree of limitation were chosen. Second, the 60 children from the classrooms of the 4 chosen teachers were observed in order to measure their levels of pretend play. The results of this study found children who were under the care of the teachers with a low degree of limitation engaged in pretend play more frequently, demonstrated a higher degree of make-believe actions and subjects, and played in more diverse areas of interest than the children under the care of the more limiting teachers. This study emphasizes the importance of providing children with an environment where they can play freely.

Predictors of range of motion restrictions in children with spastic cerebral palsy: A registry-based study.

Although children with spastic cerebral palsy (CP) commonly present with restricted passive range of motion (PROM) and contractures, knowledge about the child's characteristics that increase the risk of development of restricted PROM is limited. Identifying children who are more likely to develop contractures is important for early detection and the provision of appropriate medical management. This study aims to identify the most commonly restricted PROM of children with spastic CP and (2) to examine the combined effect of a child's age, gender, gross motor functional classification level and CP subtype on the development of restricted PROM in children with spastic CP. The PROM of 233 children diagnosed with CP was extracted from the national registry of CP in Jordan (CPUP-Jordan) in addition to information about children's age, gender, level of Gross Motor Function Classification System-Expanded and Revised (GMFCS-E&R) and subtype of CP. The mean age of the participants was 3.73 years (SD = 3.14), 57.5% were males and 80.3% had bilateral spastic CP. Point biserial correlations were calculated between the PROM and the child's variables. Multiple binary logistic regressions were conducted to identify the predictors of PROM. Hip abduction was the most common restricted PROM (57.9%), whereas the hip extension was the least (2.1%). Children with older ages demonstrated more restrictions in knee extension and ankle dorsiflexion; males demonstrated more restriction in hip abduction than females; children with lower GMFCS-E&R levels had more restrictions in hip internal rotation but fewer restrictions in hip abduction and ankle dorsiflexion; and children with bilateral spastic CP had more restrictions in hip abduction than children with unilateral spastic CP. PROM of the hip, knee and ankle joints of children with spastic CP was predicted by different sets of child characteristics. Implications for health professionals and follow-up registries of children with CP are provided.

Is an Exercise Intervention the only way to Reduce Visceral Fat without Reducing Fat-free Mass in Children and Adolescents?

Objectives: To maintain proper development, it is recommended that children/adolescents focus more on increasing physical activity than dietary restriction when treating obesity. In other words, adults are better able to tolerate the reductions in fat-free body mass that often occur when trying to lose fat mass. In contrast, children and adolescents should avoid losses in fat-free mass in order to ensure proper development. Therefore, when trying to reduce visceral fat in children via a negative energy balance (i.e., exercise with or without calorie restriction), it is necessary to set desirable conditions in order to minimize the loss of fat-free mass. To determine whether this is possible, we reviewed literature discussing the relationship between changes in visceral fat obtained by abdominal imaging and changes in total body fat and fat-free mass after exercise training with and without calorie restriction in children and adolescents.Methods: Literature review.Results and Conclusions: Previous work found no reduction in fat-free mass in the exercise interventions in which there was no dietary-induced calorie restriction. This supports the idea that reducing visceral fat by increasing physical activity is the preferred strategy over dietary restriction in children and adolescents. Although factors such as the type (e.g. aerobic and/or resistance) of exercise and the amount (i.e. energy expenditure) of exercise will likely have an effect on the magnitude of change in intra-abdominal visceral fat, the quantity of each that is needed without reducing fat-free mass is currently unknown.

Soil-Transmitted Helminthes Infection and Nutritional Status of Elementary School Children in Sorong District, West Papua, Indonesi

It is known that soil-transmitted helminths (STHs) infection in children associates with growth and developed restriction in children, which is shown by nutritional status. However, the studies which are investigating this phenomenon is still limited in Indonesia. This recent study aimed to compare students who infected and non-infected with STH towards their nutritional status. An analytic cross-sectional research design was conducted in two elementary school students at Mayamuk sub-district, Sorong district, in January 2020. STHs infection was identifi ed by lugol stained wet mount smear from their stool under a light microscope. Children nutritional status was determined by body mass index based on age. A total of 164 children (67.5%, 164/243) were voluntary to participate by informed consent and eligible. Twenty-seven children (16.5%, 27/164) were infected with one or more STH species of Ascaris lumbricoides, Trichuris trichiura, hookworm, and Strongyloides stercoralis. T. trichiura (81.5%, 22/27) was the most common species found, either in single or mixed infection. Children nutritional status was observed as thinness, normal, overweight, and obese, that was 6.1% (10/164), 75% (123/164), 6.7% (11/164), and 12.2 % (20/164) respectively. STHs infection occurred in children with nutritional status of thinness 3.7% (1/27), normal 74.1% (20/27), overweight 3.7% (1/27), and obese 18.5% (5/27). There was no signifi cant diff erence between STHs infected children and non-infected children on their nutritional status (p=0.616, ChiSquare test). Thus, it indicated that STHs infection was not only the factor to induce the impairment of nutritional status in children at Mayamuk sub-district. It needs further investigation to clarify the factors which are leading to the thinness, overweight, and obese in Mayamuk children.

Screen Time and Autism: Current Situation and Risk Factors for Screen Time Among Pre-school Children With ASD.

Objective: To investigate the current status of screen time in children with ASD, its correlation with autistic symptoms and developmental quotient (DQ), and the factors affecting screen time.Method: One hundred ninety-three Chinese children with ASD were recruited. We collected the demographic and screen time data using a questionnaire. The ASD core symptoms and developmental quotient (DQ) were measured by the Autism Behavior Checklist (ABC), Childhood Autism Rating Scale (CARS), Autism Diagnostic Observation Schedule-Second Edition (ADOS-2), Griffiths Development Scales-Chinese Language Edition (GDS-C), and Chinese Children's Parent-Child Relationship Questionnaire (CPCIS). Then, we analyzed the correlations between the screen time of children with ASD and the ABC, CARS, ADOS, GDS-C DQs, and CPCIS scores. Linear regression was used to analyze the risk factors that affect screen time.Results: The children's average daily screen time was 2.64 ± 2.24 h. Forty eight percent children were exposed to two or more types of electronic devices. Their favorite activity of screen time was watching cartoons. Only 34% children spent screen time accompanied by parents and with communication. 50.26% children had no screen time before sleeping. The screen time of children with ASD had a negative correlation with the GDS-C CQ (r = −0.234, P = 0.001) and the CPCIS score (r = −0.180, P = 0.012) and a positive correlation with the CARS score (r = 0.192, P = 0.009). A low father's education level (P = 0.010), less restriction of the child's screen time by the guardian (P = 0.001), greater caregiver screen time (P < 0.001), the use of the screen as a tool for child rearing (P = 0.001), and the child's ownership of independent electronic equipment (P = 0.027) are risk factors for long screen time in children with ASD.Conclusion: The screen time of children with ASD in China is higher than the recommended standard, and the current situation is serious. The screen time of ASD children is related to their autism symptoms, DQ and parent-child interaction. Low paternal education levels, less restriction of children's screen time by guardians, greater guardian screen time, the use of screens in child rearing, and children's ownership of independent electronic equipment can lead to an increase in children's screen time. These findings may have implications for family intervention strategies.

Rationale and design of DRINK-T1D: A randomized clinical trial of effects of low-calorie sweetener restriction in children with type 1 diabetes

BackgroundLow-calorie sweeteners (LCSs) provide sweetness without sugar or calories and are used to replace added sugars by many children with type 1 diabetes (T1D). However, the role of LCSs in diabetes management and cardiometabolic health is unclear. ObjectiveThe Diabetes Research in Kids Study (DRINK-T1D) aims to investigate effects of LCS restriction on glycemic variability, visceral adiposity, lipid profiles, and systemic inflammation among children 6–12 years old with T1D. MethodsChildren with T1D, who report habitual consumption of foods and beverages containing LCSs, are recruited from the Washington Nationals Diabetes Care Complex (DCC) at Children's National Hospital (CNH) in Washington, DC. Following a phone screening and two-week run-in period involving continuation of usual LCS intake, children are randomized to 12 weeks of LCS restriction (replacement of diet beverages with still or sparkling water and avoidance of other sources of LCSs) or continued usual LCS intake (control). The primary outcome is the difference in change in glycemic variability in the LCS restriction group versus the control group. Change in glycemic variability will be assessed as the difference in daily average time-in-range (TIR), measured using continuous glucose monitoring (CGM) during two weeks at the end of the 12-week intervention, compared with during the two-week run-in period prior to randomization. Participants also complete a variety of anthropometric, metabolic, dietary, and behavioral assessments throughout the 14-week study. ConclusionsDRINK-T1D is an innovative, randomized controlled trial, evaluating effects of LCS restriction on glycemic variability and cardiometabolic health in children with T1D. Findings of DRINK-T1D will support or challenge the common practice of recommending LCS use in this patient population and will have clinically relevant implications for pediatric T1D management. Trial RegistrationClinicalTrials.gov Identifier NCT04385888.

Participation Restrictions among Children and Young Adults with Acquired Brain Injury in a Pediatric Outpatient Rehabilitation Cohort: The Patients' and Parents' Perspective.

Improving participation is an important aim in outpatient rehabilitation treatment. Knowledge regarding participation restrictions in children and young adults with acquired brain injury (ABI) is scarce and little is known regarding the differences in perspectives between patients and parents in the outpatient rehabilitation setting. The aims are to describe participation restrictions among children/young adults (5–24 years) with ABI and investigating differences between patients’ and parents’ perspectives. At admission in 10 rehabilitation centers, patients and parents were asked to complete the Child and Adolescent Scale of Participation (CASP; score 0–100; lower score = more restrictions) and injury/patient/family-related questions. CASP scores were categorized (full/somewhat-limited/limited/very-limited participation). Patient/parent-reported outcomes were compared using the Wilcoxon signed-rank test. 223 patients and 245 parents participated (209 paired-samples). Median patients’ age was 14 years (IQR; 11–16), 135 were female (52%), 195 had traumatic brain injury (75%). The median CASP score reported by patients was 82.5 (IQR: 67.5–90) and by parents 91.3 (IQR: 80.0–97.5) (difference = p < 0.05). The score of 58 patients (26%) and 25 parents (10%) was classified as ‘very-limited’. Twenty-six percent of children and young adults referred for rehabilitation after ABI had “very-limited” participation. Overall, parents rated their child’s participation better than patients themselves. Quantifying participation restrictions after ABI and considering both perspectives is important for outpatient rehabilitation treatment.

Test-retest reliability of Picture My Participation in children with intellectual disability in South Africa

Background Picture My Participation (PmP) is a promising instrument for measuring the participation in everyday situations of children with intellectual disability (ID), particularly in low- and middle-income countries. Aim To explore test-retest reliability of PmP by comparing two repeated measurements of children with ID in an urban context in South Africa. Methods A picture-supported interview with 31 children with ID, aged 7–17 years, was conducted twice, two weeks apart. The children rated their participation, operationalised as attendance and involvement, in 20 everyday activities. Analyses were completed for total scores, for the four subcomponents and at item level. Results Test-retest agreement at an item level for both attendance and involvement showed slight/fair agreement for most activities (Kappa = 0.01–0.40), and moderate agreement for some activities (Kappa = 0.41–0.60). Moderate agreement was shown for the total scale and at component level (ICC = 0.5–0.75), except for (firstly) attendance of and involvement in ‘Family Activities’ (ICC = 0.26 for attendance, 0.33 for involvement), and (secondly) involvement in ‘Personal Activities’ (ICC = 0.33). Conclusion The result indicates that PmP can reliably be used at component level and as a screening tool for intervention planning to identify participation and participation restrictions in children with ID.