School Start Research Articles

Conceptualizing, Defining, and Measuring Before-School Physical Activity: A Review With Exploratory Analysis of Adolescent Data

Physical activity (PA) among children and adolescents is often reported by time segments centered around the school day, including before school. However, there is no consistent approach to defining the before-school segment, to accurately capture PA levels and facilitate synthesis of results across studies. Therefore, this study aimed to (a) examine how studies with children and adolescents have defined the before-school segment, and (b) compare adolescents’ before-school PA using various segment definitions. We conducted a systematic search and review of literature from six databases, and subsequently analyzed accelerometer data from Australia (n = 472, mean age 14.9 years, 40% male), to compare PA across five before-school definitions. Our review found 69 studies reporting before-school PA, 59 of which used device-based measures. Definitions ranged widely, but justifications were rarely reported. Our empirical comparison of definitions resulted in a range of participants meeting wear time criteria (≥3 days at >50% of segment length) from the latest-starting definition (30 min prior to school; n = 443) to the earliest-starting definition (6:00 a.m.–school start; n = 155), implying that for many participants, accelerometer wear was low in the early hours due to sleep or noncompliance. Statistically significant differences in light and moderate-to-vigorous PA (mean minutes/school day, proportion of segment length, and proportion of wear time) were found between definitions, indicating that before-school PA could potentially be underestimated depending on definition choice. We recommend that future studies clearly report and justify segment definition, apply segment-specific wear time criteria, and collect wake time data to enable individualized segment start times and minimize risk of data misclassification.

Language Policy Implementation in Latvian Pre-School: Latvian Language Skills of Minority Children

Summary Latvian is the only official language in Latvia and one of the symbols of an independent state. The article provides a brief insight into the history of its reinforcement, which has not been easy. Education is one of the areas in which it is very important to develop multilingualism, while not forgetting to strengthen state language skills and their application. As the education system continues to reveal shortcomings in the process of Latvian language acquisition, Cabinet Regulations adopted in 2018 “Regulations Regarding the State Guidelines for Pre-school Education and the Model Pre-school Education Programmes” update the need for a successful transition from pre-school education to primary education at school, from pre-school education to bilingual primary school education or education carried out in Latvian. In minority families with a dominant Russian language, children acquire Russian well before pre-school age, and it is time to start learning the state language at pre-school age if this has not already been done. Taking these requirements into account, the article analyses the Latvian language skills of children of pre-school age, using 375 child speech recordings made by researchers in 2019 and 2020 in three regions – Kurzeme (Western Latvia), Latgale (Eastern Latvia), and Riga (capital). The materials are divided into three groups in each of the territories: recordings of Latvian children, recordings of minority children in groups with the Latvian language on a daily basis, and recordings of minority children in groups with the Russian language on a daily basis. The main problem is that regardless of the region, the Latvian language skills of minority children who attend pre-school education groups with a dominant Russian language on a daily basis are still insufficient and do not comply with the requirements set in Cabinet Regulation No. 716 of 2018 that the children should be prepared to start school with the Latvian as the learning language or bilingually. This suggests that the legislative provisions are not fully implemented and improvements are necessary for the Latvian language training system for minority children.

The Intellectual Assumptions and Critical Thinking in Preparing a Child for School Education

The study deals with the development of pupils' intellectual assumptions and cognitive functions. The optimization strategy in the subject research are educational activities that are applied in primary education. The subject of the investigation is the identification of the impact of educational activities on the level of pupils' intellectual assumptions, operationalized at the level of pupils' general knowledge (factual, conceptual, procedural). The research design is based on a pedagogical experiment with pupils in the transition period. According the results, pupils who have been applied educational activities achieve a higher level of intellectual prerequisites at start of the primary school.

0110 The Influence of Changing School Start Times on Frequency and Timing of Nurse’s Visits for Sleep and Nutrition

Abstract Introduction Healthy school start times are important for ensuring students obtain sufficient sleep, which may impact other health outcomes. Previous studies have not examined the impact of changing school start times on nurses’ visits related to sleep and nutrition in students in grades K-12 after district-wide changes to delay start times in middle and high school and advance start times in elementary school. Methods Electronic medical record data (reason for student visit and time of visit) were retrieved from nursing offices for elementary (n=44), middle (n=14), and high (n=6) schools. For this study, we included sleep and nutrition visits within the first two hours of the school day in April/May for the year prior (pre-change) and two years after (post-change, follow-up) implementing new school start times. Within each school level (i.e., elementary, middle, high), descriptive statistics examined the number of visits by health category. Results In elementary school, nurse visits increased in the first two hours when school start times were moved from 9:00am to 8:00 am for both sleep (pre-change n=45; post-change n=78; follow-up n=58) and nutrition (pre-change n=30; post-change n=63; follow-up n=48). For middle school, nurse visits slightly decreased in the first two hours of school when start times were moved from 8:00am to 8:50am for both sleep (pre-change n=14; post-change n=11; follow-up n=11) and nutrition (pre-change n=47; post-change n=42; follow-up n=6). High school nurse visits also slightly decreased in the first two hours of school when start times moved from 7:10am to 8:20am for both sleep (pre-change n=16; post-change n=7; follow-up n=7) and nutrition (pre-change n=5; post-change n=5; follow-up n=2). Conclusion While not unexpected, elementary school nurse visits for sleep and nutrition increased when start times were moved earlier. However, at follow-up, visit frequency notably decreased, suggesting that it may take time for families to adjust to the new start times. For both middle and high school students, nurse visits for sleep and nutrition slightly decreased with later start times. More research is needed to determine optimal start times for elementary school students, as healthy start times are essential for adolescent health and well-being. Support (if any) RWJF Evidence for Action (#75277)

0770 The Effect of In-Home Sleep Extension on Insulin Sensitivity for Habitually Short-Sleeping Adolescents

Abstract Introduction The interplay of physiological and behavioral factors of adolescence that result in dramatically insufficient sleep may confer a notable cardiometabolic risk. Increasing sleep duration reverses the negative metabolic consequences of insufficient sleep in adults, but this has not been examined in youth. Thus, the current study aimed to evaluate the impact of in-home sleep extension on insulin sensitivity (Si) in habitually short-sleeping adolescents. Methods Twenty-six healthy adolescents obtaining ≤7h sleep on school nights (age=16.6±1.1, 69% female, 73% non-Hispanic White) completed a randomized crossover trial consisting of one week each of Typical Sleep (usual school schedule) and Sleep Extension (≥1h additional time in bed) during the academic year. Sleep was estimated via actigraphy, and an intravenous glucose tolerance test (IVGTT) measured Si following each condition. Spearman and Kendall correlations assessed associations and paired samples t-tests and Wilcoxon signed-rank tests examined change in variables from Typical Sleep to Sleep Extension. Results A significant association between sleep and insulin sensitivity was observed during Typical Sleep, with poorer Si associated with longer sleep onset latency (rho=-0.29, p=0.04), and greater variability in waketime (rho=-0.44, p=0.02) and sleep duration (rho=-0.43, p=0.03). During Sleep Extension, participants significantly increased sleep duration by 1.4±0.7h (Typical Sleep=5.59±0.82, Sleep Extension=6.95±0.83 h; p< 0.001) by shifting bedtimes to an earlier clock hour (Typical Sleep=00:34±01:12; Sleep Extension=23:10±00:57; p< 0.001). Si did not significantly change between conditions (p=0.52). However, a trend was observed for a decrease in fasting glucose during Sleep Extension compared to Typical Sleep (Typical Sleep=92.5±8.87; Sleep Extension=88.48±12.06 mg/dL; p=0.055). Conclusion Habitually short-sleeping adolescents were successful at increasing sleep duration during an in-home intervention, but Si did not change compared to Typical Sleep. Notably, sleep duration during Sleep Extension was still less than the 8-10 h of sleep per night recommended for adolescents. A sufficiently early bedtime that supports adequate sleep is a biological challenge for adolescents when wake times are fixed due to early school start times. Future research is recommended examining whether combining sleep extension with a circadian health intervention can have a larger impact on sleep and cardiometabolic outcomes in adolescents. Support (if any) NIH NIDDK K23DK117021; NIH BIRCWH 2K12HD057022; CTSA UL1TR002535

Lifestyle Pathways Affecting Children's Mental Health in Japan during the COVID-19 Pandemic.

The recent prolonged COVID-19 pandemic has worsened the daily lives of preschoolers and elementary school children worldwide. Although these changes may have affected their mental health, the full picture still remains unknown. Since March 2020, Japan has intermittently experienced several COVID-19 waves. This survey was conducted between February and March 2022. In this study, we investigated the pathways by which specific lifestyle factors (such as exercise, sleep, diet, and life skills) affect physical/psychosocial health (PPH) in 1183 preschoolers (3-5 years old) and 3156 elementary school children (6-11 years old) in Toyama Prefecture, Japan. These pathways were examined using a path analysis. Consequently, "life skills" was found to be the factor most strongly associated with PPH in both preschoolers and elementary school children (p < 0.001). Furthermore, it was associated with the physical activity score and with PPH via physical activity. Moreover, both boys' and girls' mental health declined with age among elementary school children (p < 0.001). The results of the current study may be helpful for early interventions (around the start of elementary school) at home and at school to improve children's mental health during the COVID-19 pandemic.

The influence of a permanent double-shift school start time on adolescent sleep and chronotype across different age groups

ABSTRACT The main objective of this study was to explore the differences in sleep habits and chronotype across different age groups in Mexican adolescents attending a permanent double-shift school system. This cross-sectional study consisted of 1,969 (1,084 girls) students from public elementary, secondary, and high schools, as well as undergraduate university students from Mexico. Age range was 10–22 [15.33 ± 3.28 (mean ± SD)] years, 988 morning shift and 981 afternoon shift students. Questions regarding usual self-reported bedtime and rise time were collected, and from that, estimates for time in bed, midpoint of sleep, social jetlag, and chronotype were evaluated. Afternoon shift students reported later rise times, bedtimes, midpoint of sleep, and longer time in bed on school days than morning shift students, as well as less social jetlag. Overall, afternoon shift students reported a later chronotype than morning shift students. Peak lateness of chronotype in afternoon shift students was at age 15, with girls peaking at age 14 and boys at age 15. Meanwhile, morning shift students reported peak lateness of chronotype around age 20. In this study, adolescents from different age ranges attending an extremely delayed school start time reported adequate sleep compared with adolescents attending a fixed morning school start time. In addition, the analysis presented in this study seems to suggest that the peak of late chronotype may be influenced by school start times.

Impact of delaying high school start times on weight and related behaviors - the START study

In the US, few adolescents get adequate school night sleep, largely due to early school start times. In the START study we aimed to test the following hypothesis: That following the implementation of later high school start times students have lesser longitudinal increases in body mass index (BMI) and shift to more healthful weight-related behaviors relative to students attending schools that retain early start times. The study enrolled a cohort of students (n = 2426) in five high schools in the Twin Cities, MN metro. Heights and weights were measured objectively, and surveys were administered annually from 9th through 11th grades (2016–2018). All study schools started early (either 7:30 am or 7:45 am) at baseline (2016). At follow-up 1 (2017) and continuing through follow-up 2 (2018), two schools delayed their start times by 50–65 min, while three comparison schools started at 7:30 am throughout the observation period. Using a difference-in-differences natural experiment design, we estimated differences in changes in BMI and weight-related behaviors over time between policy change and comparison schools. Students' BMIs increased in parallel in both policy change and comparison schools over time. However relative to changes in comparison schools after the start time shift, students in policy change schools had a modestly more healthful profile of weight-related behaviors – for instance they had a relatively greater probability of eating breakfast, having supper with their family, getting more activity, eating fast food less frequently, and eating vegetables daily. Later start times could be a durable, population-wide strategy that promotes healthful weight behaviors.

The Impacts of Delaying School Start Time on Sleep and Academic Performance in the Adolescent Population

Sleep has a significant impact on the physical and mental health of adolescents. However, most adolescents face sleep deprivation and a range of adverse consequences. The policy of delaying the start of school has gained the attention of many researchers in the last two decades in response to the problem of improving sleep quality and increasing the total number of hours of sleep among adolescents. This paper assesses the influences of delayed school start times on adolescent sleep and related outcomes, identifies the limitations and shortcomings of this policy implementation, and the available research data, provides a comprehensive analysis of the impacts of delayed school start times, and offers suggestions for the future direction and prospects of this policy implementation.

University students' diurnal learning-directed behavior is strongly influenced by school start times with implications for grades.

School start times impose constraints on sleep-wake timing that may influence academic achievement. We used large university archived datasets to test the hypothesis that larger differences in timing of students' diurnal learning behavior on school days relative to non-school days would be associated with lower grades. Diurnal learning-directed behavior was examined in 33 645 university students by analyzing their learning management system (LMS) login rhythm. We tested the associations between the phase-difference in students' behavioral rhythm on school days versus non-school days with grade point average, LMS-login phase on non-school days (LMS-login chronotype), and school start time. We also tested the chronotype-dependent effects of school start times on diurnal behavior to determine whether students obtained better course grades when their first class of the day was in synch with their LMS-login chronotype. Students whose LMS-login rhythm was more than 2 hours earlier on school days had significantly lower grades than their peers. The change in LMS-login phase was larger in students with a later LMS-login chronotype and for earlier school start times. Minimal changes in LMS-login phase and higher course grades were observed when students' first class of the day was aligned with their LMS-login chronotype. Our findings demonstrate that school start times have a profound impact on students' diurnal learning behavior with implications for grades. Universities can potentially improve learning by starting school later to minimize differences in diurnal learning behavior between school days and non-school days.

Medical School Clinical Trials Educational Intervention: Impact on Knowledge and Attitudes.

Medical student knowledge and opinions of clinical research have important ramifications for how likely they will be to refer patients into clinical trials as practicing physicians. This study examined students understanding, knowledge, and attitudes about clinical trials at the start of medical school and after completion of a multi-faceted intervention designed to increase medical students' confidence in understanding and explaining clinical trials during the pre-clinical and clinical years. Medical students were surveyed about their knowledge of and attitudes toward clinical trials in their first (N = 724) and third (N = 191) years of medical school. During the intervening years, students attend a lecture delivered by University of Hawai 'i Cancer Center faculty, were provided a resource manual from National Cancer Institute, participated in two problem-based learning clinical scenarios, and completed an optional practicum. After completing the comprehensive clinical trials education, there were significant increases in student understanding and knowledge and a decrease in student perception that clinical trials exploit participants. Most students agreed or strongly agreed that inclusion of clinical trials in the curriculum was important and would influence their future practice. Integration of clinical trials education into the medical school curriculum improved students' understanding of clinical research, their ability to communicate the clinical trials process, and confidence in conducting, referring to, and locating clinical trials. Medical students appreciate the importance of clinical trials in advancing medicine and medical education. Further integration of clinical trials education and opportunities to engage in research during medical school are warranted to address students' uncertainty about the benefits of participation for patients.

Relative Age Within School Grade, Including Delayed and Accelerated School Start: Associations With Midlife Psychiatric Disorders, Suicide, and Alcohol- and Drug-Related Mortality.

Within a school grade, children who are young for grade are at increased risk of psychiatric diagnoses, but the long-term implications remain understudied, and associations with students who delay or accelerate entry underexplored. We used Norwegian birth cohort records (birth years: 1967-1976, n= 626,928) linked to records in midlife. On-time school entry was socially patterned; among those born in December, 23.0% of children in the lowest socioeconomic position (SEP) delayed school entry, compared with 12.2% among the highest SEP. Among those who started school on time, there was no evidence for long-term associations between birth month and psychiatric/behavioral disorders or mortality. Controlling for SEP and other confounders, delayed school entry was associated with increased risk of psychiatric disorders and mortality. Children with delayed school entry were 1.31 times more likely to die by suicide (95% confidence interval: 1.07, 1.61) by midlife, and 1.96 times more likely to die from drug-related death (95% confidence interval: 1.59, 2.40) by midlife than those born late in the year who started school on time. Associations with delayed school entry are likely due to selection, and results thus underscore that long-term health risks can be tracked early in life, including through school entry timing, and are highly socially patterned.

The efficacy of preoperative intravenous acetaminophen for laparoscopic extraperitoneal closure in children with inguinal hernia for The enhanced recovery after surgery: A prospective randomized study

PurposeA postoperative pain management strategy for the enhanced recovery after surgery (ERAS) protocol has recently become more important in pediatric surgery and growing attention is being paid to perioperative use of intravenous acetaminophen (IV-A). In laparoscopic extraperitoneal closure (LPEC) procedure, postoperative pain is still occurring and optimal analgesia remains unclear. We aimed to evaluate the efficacy of preoperative IV-A (pIV-A) for postoperative analgesia after LPEC in children. MethodsAfter approval of the ethics committee of our hospital (#2,018,131), 40 consecutive pediatric patients with unilateral inguinal hernia were randomized into two group (20 each) and received LPEC procedure with pIV-A (group-A) and without (group-C). The pain scale score (PSS), the frequency of the postoperative acetaminophen bolus use (FPAB) and school start day (SSD) were assessed. ResultsThe PSS and the FPAB are significantly lower in group-A compared to group-C on POD0 and POD1, indicating a significant reduction in pain in group-A at an early stage after the operation. In addition, SSD after LPEC operation was shorter in group-A compared to group-C. ConclusionOur results suggest that pIV-A for postoperative analgesia after LPEC in children is safe and useful for the ERAS.

Impact of Hospitalizations due to Chronic Health Conditions on Early Child Development.

To assess the impact of hospitalization for chronic health conditions on early child development and wellbeing at school start. We conducted a longitudinal cohort study of children starting school using population-based record linkage of routinely collected admitted hospital data and standardized assessment of early childhood development (Australian Early Developmental Census: AEDC). Developmental vulnerability (DV) was defined as children scoring <10th centile in any one of five developmental domains. Children scoring <10th centile on two or more domains were considered developmentally high-risk (DHR). Children hospitalized with chronic health conditions were compared to children without hospitalizations prior to school start. Among 152,851 children with an AEDC record, 22,271 (14·6%) were hospitalized with a chronic condition. Children hospitalized with chronic health conditions were more likely to be DHR (adjusted odds ratio 1.25, 95% CI: 1.18-1.31) compared to children without hospitalizations. Children hospitalized more frequently (>7 times) or with longer duration (>2 weeks) had a 40% increased risk of being DHR (1.40, 95% CI: 1.05-1.88 and 1.40, 95% CI: 1.13-1.74, respectively). Children hospitalized with mental health/behavioral/developmental conditions had the highest risk of DHR (2.23, 95% CI: 1.72-2.90). Developmental vulnerability was increased for physical health (1.37, 95% CI: 1.30-1.45), language (1.28, 95% CI: 1.19-1.38), social competence (1.22, 95% CI: 1.16-1.29), communication (1.17, 95% CI: 1.10-1.23), and emotional maturity (1.16, 95% CI: 1.09-1.23). Frequent and longer duration hospitalizations for chronic health conditions can impact early childhood development. Research and interventions are required to support future development and well-being of children with chronic health conditions who are hospitalized.

Inclusivity in transitioning to medical school.

Inclusivity in transitioning to medical school.

Teacher Reports of Social Determinants of Health in Preschool Classrooms

Social determinants of health (SDOH) are nonmedical factors (e.g., poverty) that have an influence on health and development. Early childhood education settings, such as preschools, play a dual role in children’s well-being; high quality is considered both a social determinant of health and a context for receiving referrals to address other SDOH. The current study examines reports of SDOH among a sample of 139 preschool teachers recruited from a Mountain West state. Reported prevalence of SDOH were rated as higher by teachers with more familiarity with SDOH, teachers in public/Head Start schools (vs. private schools), and assistant teachers (vs. lead teachers). Teachers who were more familiar with SDOH and who reported a higher prevalence of SDOH in their classrooms were more likely to refer students to resources to address SDOH.

Relative heritage language and majority language use before school start explains variance in 2nd grade majority language but not reading skills.

The present study examined whether parents' and bilingual children's own relative use of the heritage language vs. the majority language in the homes of bilingual children in Denmark before school start explains variance in 2nd grade majority language skills and reading skills. The study included two groups of children: the Mixed bilinguals group (defined by having a native Danish and a nonnative parent, N = 376) and the Heritage bilinguals group (defined by having parents who were both speakers of a Heritage language, N = 276). Four-stage hierarchical regression analyses showed that, after accounting for type of bilingualism, socioeconomic status (SES) and home literacy environment quality, relative use of the heritage vs. the majority language explained variance in 2nd grade Danish language comprehension scores, but did not explain variance in two reading scores, namely decoding and reading comprehension. In addition, a home literacy factor denoting book exposure (number of books, frequency of reading, library visits, and age of beginning shared book reading) was a significant predictor of both 2nd grade language and reading outcomes, whereas SES became a nonsignificant predictor when adding home literacy and language use predictors. We interpret the results to mean that parents' and the child's own relative use of the heritage language vs. the majority language before school start does not influence bilingual children's early reading skills, whereas a supportive early home literacy environment is a positive predictor of reading skills independently of SES and parental majority language use and skill.

Literacy Movement in Indonesian and Spanish Context: A Comparative Case Study

&lt;span lang="EN-US"&gt;Literacy movement serves a vital role to support, facilitate, and enhance literacy skills that is crucial to every human being overall development including character, social, and professional development. This comparative study on literacy movement in Indonesia and Spain analyze how these nations promote literacy movement to accelerate students’ literacy skills and how the literacy movement implemented. Likewise, this study adopts a case study in which the data were derieved from observation protocol, document analysis, questionnaies, and interview transcripts. The data analysis revealed that Indonesia through &lt;em&gt;Gerakan Literasi Nasional&lt;/em&gt; (GLN) promotes the literacy by creating literacy culture in educational ecosystem start in family, school, and society as a mean of long-life learning to improve life quality whereas the Ministry of Education Culture and Sport in Spain created a program called Act on The Improvement of the Quality of Education (LOMCE in Spanish) to promote and create a literate environment and improve educational result. As it further investigated, the most noticeable comparison between the practice of literacy movement in Indonesia and Spain is on the equality of literacy movement in every region. In Spain, the literacy movement is equally well-established in every region whereas the equality of literacy movement in Indonesia region is still not equal yet. In this matter, the implementation of literacy movement should be supported by qualified educators, appropriate materials, adequate infrastructure, and effective literacy policies in order to effectively promote the students’ literacy skills and development.&lt;/span&gt;

Parents’ experiences of participating in the Healthy School Start Plus programme – a qualitative study

BackgroundThe rise in overweight and obesity among children is a global problem and effective prevention interventions are urgently required. Parents play an important role in children’s lifestyle behaviours and body weight development and therefore there is a great need to investigate how to involve parents effectively in health promotion and prevention programmes. The aim of the study was to describe parents’ experiences of barriers and facilitators of participating in the Healthy School Start Plus (HSSP) intervention study.MethodsHSSP is a parental support programme, conducted in Sweden, with the aim to promote a healthy diet, physical activity and preventing obesity in 5-7-year-old children starting school. In total 20 parents from 7 schools participated in semi-structured telephone-based interviews. The data was analysed using qualitative content analysis, with a deductive approach based on the Consolidated Framework for Implementation Research (CFIR).ResultsParental experiences of barriers and facilitators informing the implementation of the HSSP intervention were identified within all five domains of the CFIR. Two additional constructs, not included in the CFIR were identified: Social factors and Cooperation. The findings of parental experiences of barriers and facilitators related to the importance of (1) adaptation of the intervention to fit the abilities of the parents with different social and cultural backgrounds; (2) the need for continuous delivery of information related to healthy behaviours; (3) the commitment and efforts of the deliverers of the intervention; (4) the need for repetition of information related to healthy behaviours given by the deliverers of the intervention; (5) encouragement and facilitation of the involvement of the family and key people around them through the intervention activities and by the deliverers of the intervention; (6) awareness of unexpected impacts and social and cultural conditions complicating the execution of the intervention and; (7) cooperation and a well-functioning interaction between parents and school staff.ConclusionsBarriers and facilitators indicated by the parents highlighted that interventions like the HSSP need to be adapted to fit the parents’ abilities, with reminders, follow-ups and delivery of relevant information. Variations in social and cultural conditions need to be taken into consideration. The commitment of the school and the interaction between the school staff and the family as well as key people around them appears to be important.Trial registrationThe Healthy School Start Plus trial was retrospectively registered in the International Standard Randomised Controlled Trial Number Registry on January 4, 2018 and available online at ClinicalTrials.gov: No. NCT03390725.

Severe near Reflex Spasm in a Healthy Teenager. A Case Report

Spasm of the near reflex usually includes accommodative spasm, esophoria/tropia, and different degrees of miosis. Patients usually refer to distance blurred and fluctuating vision, ocular discomfort, and headaches. The diagnosis is established with refraction with and without cycloplegia; most of the cases have a functional etiology. However, some cases require neurological conditions to be ruled out; cycloplegics have an important diagnostic and therapeutic role. To describe a case of bilateral severe accommodative spasm in a healthy 14-year-old teenager. A 14-year-old boy with progressive diminished visual acuity attended for YSP consultation. The diagnosis of bilateral spasm of the near reflex was made, based on a gap refraction of 9.75 D between retinoscopy with and without cycloplegia and esophoria with normal keratometry and axial length. The spasm was eliminated with 2 drops of cycloplegic in each eye separated by 15 days; no clear etiology was found other than the start of school. Clinicians should be aware of pseudomyopia, especially in children with acute changes in visual acuity, who are usually exposed to myopigenic environmental factors that induce overstimulation of the parasympathetic third cranial nerve's innervation.