Children's Strategies Research Articles

Evolution of Ventricular Assist Device Support Strategy in Children With Univentricular Physiology

BackgroundSince 2012, we have supported 18 children with single ventricle (SV) physiology on ventricular assist devices (VADs) as a bridge to decision, transplantation, or recovery. We provide a detailed report of our cumulative surgical experience and lessons learned from these patients. MethodsWe reviewed all SV-VADs between March 2012 and April 2020. Implanted SV-VADs intended for short-term support were excluded. Demographic and clinical data included palliation stage at the time of VAD implantation, cannulation configuration, device type, duration of support, circuit and device interventions, postoperative support, anticoagulation strategy, complications, mortality, and 1-year survival postdischarge. ResultsFive SV newborns without prior surgical palliation, 8 infants post-Norwood/hybrid procedure, 4 infants post-Glenn, and 1 infant post-Fontan were initially supported with either continuous-flow (n = 13 of 18, 72%) or pulsatile-flow (n = 5 of 18, 28%) devices. Three (17%) of 18 transitioned to another device during support. Before VAD conversion, 9 (50%) of 18 were supported by extracorporeal membrane oxygenation. Outcomes included 7 (39%) of 18 who transplanted, 2 (11%) of 18 who recovered, and 9 (50%) of 18 who died before discharge. Of these deaths, 2 occurred after transplantation and 2 after explantation, and 5 had redirection of care while on support secondary to previously undiagnosed pulmonary venoocclusive disease (n = 2) or severe neurologic events (n = 3). Overall, 6 (33%) of 18 experienced neurologic injury. At last follow-up, 9 (50%) of 18 children were alive (median 1.2 [interquartile range, 0.8-4.3] years postexplantation/transplantation). ConclusionsOur experience shows that SV children, including newborns, can be successfully bridged to desired endpoints with proper patient selection and using specific cannulation strategies. Continuing utilization of this strategy is warranted for future children requiring VAD support.

Bullying and coping with bullying among obese\\overweight and normal weight children

This study aimed to determine the obese\\overweight and normal weight children's status of encountering and coping with bullying and the correlational factors. This case-control study was conducted with 1.680 students in the second level (5th, 6th, 7th, 8th grades) from September 24, 2018 to May 31, 2019 in the Mediterranean Region in Turkey. The data were collected using a personal information form, the Traditional Peer Victimization Scale and the Coping with Bullying Scale. Data were analyzed using the Shapiro-Wilk test, Mann–Whitney U test, Binary Logistic Regression, Backward Wald Elimination, and Simple Linear and Backward Stepwise Multiple Linear Regression analyses. This study indicated that the risk of becoming victims, bullies or bully-victims increases among boys and 8th grade students. It also found that the risk of being victims and bully-victims increases among children whose father is illiterate. There was no significant difference between obese\\overweight and normal weight children in terms of being victims, bullies and bully-victims. Grade level, academic performance, father's education level and awareness of reporting bullying were effective in coping with bullying among the children, while weight was not. Further studies are needed to determine different factors that affect children's coping strategies against bullying.

Effects of presentation modality and duration on children's strategy use: A study in computational estimation.

Two experiments were run to determine how presentation modality and duration influence children's arithmetic performance and strategy selection. Third and fourth graders were asked to find estimates for two-digit addition problems (e.g., 52 + 39). Children were tested in three conditions: (1) time-unlimited visual, (2) time-limited visual, or (3) time-limited auditory conditions. Moreover, we assessed children's working-memory updating and arithmetic fluency. Children were told which strategy to use on each problem to assess arithmetic performance while executing strategies, in Experiment 1, and were asked to choose the best strategy of three available strategies to assess strategy selection, in Experiment 2. Presentation modality influenced strategy execution (i.e., children were faster and more accurate in problems under visual than auditory conditions) but only in children with low updating abilities. In contrast, presentation modality had no effect on children's strategy selection. Presentation duration had an effect on both strategy execution and strategy selection with time-limited presentation leading to a decline in children's performance. Interestingly, specifically in children with low updating abilities, time-limited presentation led to poorer performance. Hence, efficient updating seemed to compensate for detrimental effects of auditory in comparison to visual and time-limited in comparison to time-unlimited presentation. These findings have important implications for determining conditions under which children execute strategies most efficiently and select the best strategy on each problem most often, as well as for understanding mechanisms underlying strategic behaviour.

BrightHearts: A pilot study of biofeedback assisted relaxation training for the management of chronic pain in children with cerebral palsy.

BackgroundChronic pain is estimated to impact one‐in‐three children with cerebral palsy (CP). Psychological interventions including behavioral and cognitive strategies play a key role in chronic pain management, but there is a paucity of research exploring their use in children with CP.AimTo investigate the acceptability and feasibility of biofeedback assisted relaxation training (BART) for chronic pain management in children with CP using a mixed‐methods study design.MethodsBiofeedback assisted relaxation training was delivered via BrightHearts, an iOS application. Inclusion criteria were as follows: CP; self‐reported chronic pain; age 9‐18 years; and fluent English speaker. Children used BrightHearts for ten minutes daily, over four weeks. Qualitative post‐intervention interviews were undertaken (child, parent) and quantitative pre‐post measures (child) were gathered including pain intensity (numerical rating scale), and anxiety intensity (numerical rating scale). Content analysis was conducted for qualitative data. Descriptive statistics and exploratory analyses were performed for quantitative data.ResultsTen children participated (n = 3 male, mean age = 13.1 years SD = 2.5 years, GMFCS level I = 4, II = 2, III = 3, IV = 1). Predominant movement disorder was spasticity (n = 7) and dyskinesia, mainly dystonia (n = 3). Content analysis suggested an overarching theme “BrightHearts is a good thing to put in my toolbox” providing an overall representation of participants’ experiences. For many, BrightHearts was a valuable supplement to children's pain management strategies: “The source of the pain is still there, but the actual effect of the pain isn't so relevant.” Four sub‐themes were identified: “Managing my pain;” “Managing my anxiety and stress,” “Helping me do what I need to do;” and “Fitting it into my life.” Some participants reported improvements in their anxiety management, and others described benefits in sleep and school following improved pain/anxiety management. A range of practical and personal factors within this heterogeneous group presented barriers to using BrightHearts including limited time, attention, and boredom. Seven‐out‐of‐eight children would recommend BrightHearts to others with chronic pain and six‐out‐of‐eight noticed a difference in their pain since using BrightHearts (n = 2 missing data). Non‐significant reductions in pain or anxiety intensity scores were found following the intervention.ConclusionThis pilot suggests BrightHearts is an acceptable and feasible intervention for chronic pain management in children with CP and may be useful for some children as part of a multimodal approach.

Smoke Exposure Disclosure: Parental Perspectives of Screening in the Inpatient Setting.

Current screening questions for pediatric tobacco smoke exposure are suboptimal. Factors influencing screening accuracy, particularly in the pediatric inpatient setting, are unknown. Our objective was to identify facilitators of and barriers to parental disclosure of smoke exposure when screened during their child's hospitalization and strategies to promote accurate disclosure. This qualitative study was conducted with a convenience sample of parents of children admitted to the medical and surgical unit of a Midwest tertiary care children's hospital. Eligible parents included those with documented disclosure of smoke exposure in the child's electronic health record. A researcher trained in qualitative methods conducted semistructured, in-depth interviews with parents regarding their experiences with smoke exposure screening in the inpatient pediatric setting. Two researchers independently identified concepts directed at barriers, facilitators, and strategies for effective screening, which were compared and reconciled by a third researcher. Facilitators of disclosing their child's smoke exposure included the following: (1) the caregiver's internal characteristic(s) promoting disclosure, (2) perceived relevance of the screening question to the child's health, and (3) the questioner being viewed positively. Barriers included the following: (1) fear of negative consequences, (2) a vague question, (3) lack of knowledge, (4) guilt, and (5) unconducive environment and timing. The strategies parents suggested to improve screening for smoke exposure included the following: (1) communicate preemptively, (2) provide specific exposure examples, (3) improve questioner-caregiver rapport, and (4) improve screening environment and timing. Parents identified various mechanisms to improve tobacco smoke exposure screening. The facilitators, barriers, and strategies provide opportunities to improve the inpatient pediatric screening process.

Teaching Strategies of Children's Poetry Reading in Chinese Teaching in the Lower Grades of Primary Schools

Teaching Strategies of Children's Poetry Reading in Chinese Teaching in the Lower Grades of Primary Schools

Coping Strategies in Children of Parents Deceased from Cancer and Children of Parents Healed from Cancer

This study aimed to compare coping strategies in children of parents deceased from cancer and children of parents healed from cancer in the city of Shiraz, Iran. One-hundred and fifteen people [58 children of parents healed from cancer and 57 children of parents deceased from cancer] were recruited in this study via a convenience sampling method. Coping Inventory for Stressful Situations was used to measure different types of coping strategies [task-oriented coping strategy, emotion-oriented coping strategy, and avoidance coping strategy]. The results showed that the children of parents healed from cancer used task-oriented coping strategy significantly more than children of parents deceased from cancer. Moreover, the results showed that the use of emotion-oriented coping strategy in children of parents deceased from cancer was significantly more than children of parents healed from cancer. No significant difference was observed between the two groups in the use of avoidance coping. This study highlights the importance of coping strategies in families with a cancer parent which demand the importance of teaching appropriate coping strategies in order to reduce the adverse consequence of cancer in the family.

The Virtual City ParadigmTM for Testing Visuo-Spatial Memory, Executive Functions and Cognitive Strategies in Children With ADHD: A Feasibility Study.

Navigation is a complex process, requiring target localization, route planning or retrieval, and physical displacement. Executive functions (EFs) such as working memory, inhibition and planning are fundamental for succeeding in this complex activity and are often impaired in Attention Deficit and Hyperactivity Disorder (ADHD). Our aim was to analyze the feasibility of a new ecological navigation task, the Virtual City paradigm™ (VC™) to test visuo-spatial memory and EFs in children with ADHD. Visuo-spatial short and working memory, inhibition and planning skills were tested with standardized tasks. The VC™, a new paradigm developed by our group, used the Virtual CarpetTM technology, consisting of a virtual town with houses, streets and crossroads projected on the ground. It includes a motion capture system, tracking body movement in 3D in real time. In one condition, children were required to walk through the city and reach a sequence of houses. In the other, before walking, they had to plan the shortest path to reach the houses, inhibiting the prepotent response to start walking. The results show a good feasibility of the paradigm (feasibility checklist and ad hoc questionnaire), being ecological and motivating. VC™ measures of span positively correlated with visuo-spatial short and working memory measures, suggesting that VC™ heavily relies on efficient spatial memory. Individual subject analyses suggested that children with ADHD may approach this task differently from typically developing children. Larger samples of ADHD and healthy children may further explore the specific role of EFs and memory, potentially opening new avenues for intervention.

The Best Paracorporeal Ventricular Assist Device Strategy in Children? Remains Unanswered

In this issue of The Annals of Thoracic Surgery, the article by Sughimoto and colleagues1 astutely analyzes paracorporeal ventricular assist device (VAD) strategies in the pediatric heart failure population. The study period, 2005 to 2019, is a key time period in the development of the pediatric VAD field. In the beginning of this time period, the Berlin Heart EXCOR, a paracorporeal pulsatile (PP) device, began to have significant growth in clinical use in the United States. There were also sporadic reports of paracorporeal continuous (PC) devices in children before this period, mostly as a bridge to recovery for patients with postcardiotomy ventricular dysfunction, myocarditis, or acute rejection.

Objectives and strategies of unintentional injury prevention and control in 31 provincial Children's Development Outlines in China

Objective: To landscape the contents, similarities, and differences of the objectives and strategies for unintentional injury prevention and control in the national and 31 provincial Children's Development Outlines from 2011 to 2020, and propose relevant suggestions. Methods: The content analysis method was used to extract, encode and classify the objective and strategy text of unintentional injury in all Children's Development Outlines and construct the theme of strategy text combined with the '5E' Injury Prevention Framework. Taking the national Children's Development Outline as the benchmark, the relevant contents of 31 provincial Children's Development Outlines in the same period were compared. Results: All Children's Development Outlines took child injury prevention and control as the primary objective set in health, environment, and safety. The national and most provincial Children's Development Outlines set this goal in health, while others put it in environment or safety. Reducing injury-induced death, disability and occurrence were designated as the main content in the objective of child injury prevention and control. However, there were no quantitative requirements for injury occurrence and disability in all the provincial outlines. The themes of unintentional injury prevention and control strategies in all Children's Development Outlines could be divided into the mechanism, law enforcement, education, environment, engineering, first aid, assessment, and economic strategies. Mechanism strategy was the primary domain, followed by law enforcement, education, environment, and engineering strategies, but less attention was put on first aid, assessment, and economic strategies. The unintentional injury prevention and control strategy in the provincial Children's Development Outlines was mainly based on the national outline. Still, it also varied with some emphasis and refinement in different items among all the provinces. Conclusions: Children's Development Outline is a vital policy guarantee for implementing child injury prevention and control work. Developing a system involving good primary data, mechanisms and strategies, law enforcement, and environmental and engineering-related strategies for more common types of child injuries has been attached to great importance. Actively carrying out assessments and encouraging the adoption of more economical strategies could further enrich and improve the unintentional injury prevention and control in Children's Development Outline and promote the progress of related work in China.

Peer persuasion strategies during rule following in 4‐ to 6‐year‐olds

AbstractDespite being a ubiquitous form of communication, persuasive communication between children received relatively scant research attention. We used a novel approach to study children's persuasive interactions in a semi‐naturalistic paradigm where dyads of 4‐ to 6‐year‐old children were asked to follow a rule together. In this context, we observed (a) the frequency and types of strategies children spontaneously used to persuade their partners to abide by the rule, (b) compliance behavior following the persuasion attempt, and (c) strategy change following a failed attempt to persuade. We coded children's persuasive strategies as gentle control, negative control, and non‐engagement. Children tended to use gentle control and negative control strategies to a greater extent than non‐engagement strategies to prevent their partner's potential rule violation. However, after a violation occurred, children most frequently displayed non‐engagement. Gentle control brought about more compliance than the other strategies. Children tended to maintain their persuasive strategy of negative control and non‐engagement, even though these were mostly ineffective in achieving compliance. These results show that 4‐ to 6‐year‐old children spontaneously and flexibly utilized persuasive strategies with peers to abide by a rule.

“There is a gorilla holding a key on the book cover”: Young children's known picture book search strategies

AbstractThere is no information search system can assist young children's known picture book search needs since the information is not organized according to their cognitive abilities and needs. Therefore, this study explored young children's known picture book search strategies and extracted picture book search elements by simulating a search scenario and playing a picture book search game. The study found 29 elements children used to search for known picture books. Then, these elements are classified into three dimensions: The first dimension is the concept category of an element. The second dimension is an element's status in the story. The third dimension indicates where an element appears in a picture book. Additionally, it revealed a young children's general search strategy: Children first use auditory elements that they hear from the adults during reading. After receiving error returns, they add visual elements that they see by themselves in picture books. The findings can not only help to understand young children's known‐item search and reformulation strategies during searching but also provide theoretical support for the development of a picture book information organization schema in the search system.

Preschool Teachers’ Scaffolding Strategies in Children's Learning of Literacy and Numeracy

AbstractThis study aimed to investigate Preschool teachers Scaffolding Strategies in Children’s learning of Literacy and Numeracy. Using mixed approach, survey and case study design were applied to investigate the problem. Participants of the study were preschool teachers (n=67) (F=64, M= 4) selected from 15 private schools (n=8) and public schools(n=7) selected using random sampling. The schools were found in three Zones of the Amhara Regional State ( East Gojjam, west Gojjam and Awi ). Quantitative data were collected using questionnaire and observation rating scales from teachers. Qualitative data were gathered using Focus Group Discussions with selected preschool teachers (n=8) who participated in the survey. Descriptive and inferential statistics were applied to analyze quantitative data and thematic analysis was used to analyze qualitative one. Teachers specialized in Early Childhood Care and Education (ECCE) applied more scaffolding strategies than those teachers trained in other subjects. However, the mean difference was not statistically significant. Play as a method of scaffolding, employing concrete materials in helping children learn literacy and numeracy; using actions, and reinforcement and demonstration. The findings imply that teachers need to specialize in ECCE to support children’s learning.

Children's Functioning in Difficult Situations in the Contemporary World

Stress is an integral part of our lives. It also applies to our childhood. That is why it is so important to know how children cope with stress (how they learn coping strategies) and to equip them with the competences to cope constructively with stressful situations throughout life. This article describes strategies for coping with stress that are characteristic for children at the end of early school education. They have been identified in the course of my own research aimed at characterizing child stress and relate to a fragment of research activities aimed at 8- and 9-year-old children. The research established that in some children the developmental process of coping with stress has started: children look for, investigate, and think how to cope with difficulties. In this struggle, however, they focus on people who could be a source of support for them in coping with stressful situations. Among children's stress coping strategies, an important role is also played by emotionally focused strategies, which are aimed at reducing negative emotions and arousing positive emotions. Contemporary times show how important it is to develop, from the earliest period of an individual's life, competences in dealing with difficult situations, with stressful situations. Development of emotional intelligence, including emotional self-awareness, self-regulation, empathy, creative problem solving, the ability to establish and maintain relationships, including friendship relationships, the development of specific cognitive skills (divergent thinking, cognitive decentration), as well as psychological resilience are the basis of constructive coping with these situations. The family environment, a stable, harmoniously functioning home, as well as educational influence of preschool and early school environment play an enormous role in shaping these competences in children.

Making the process of strategy choice visible: Inhibition and motor demands impact preschoolers' real-time problem solving.

To examine the real-time process of strategy choice and execution and the role of inhibition in problem solving, 4- to 6-year-old children were asked to navigate a ball around a maze board under high- and low-precision motor demands. Employing a motor problem-solving task made normally hidden cognitive processes observable. Sequential analysis revealed two subtypes of inhibition (response and attentional) that are involved in problem solving and different developmental trajectories for each. Cognition-action trade-offs due to motor and inhibition demands adversely impacted children's strategy choices, but contributed to heightened variability of strategies. Children used fewer strategies with age, reflecting more efficient problem solving due to increasing inhibitory control. When solutions required precision, preschoolers were more likely to have difficulty inhibiting irrelevant and distracting strategies and maintaining appropriate strategies. By preschool age, executive functioning serves to make strategic motor control possible. A video abstract of this article can be viewed at https://www.youtube.com/watch?v=TCLxK7dvheE.

Children's Strategies for Giving Voice to Needs Consistent with the UN Convention on the Rights of the Child (UNCRC)

In this exploratory study, we analyze strategies presented by young children in the context of having their voices heard. We elicit first‐hand accounts of N = 113 5‐year‐old children's responses to rights‐based scenarios to identify their will‐expression strategies. We assess developmental factors including, emotional competence, social competence, IQ, and parenting style. Results indicate that the most common tactics involve verbal expression, followed by behavior‐avoiding strategies. Cluster analysis revealed that children who were more flexible in naming strategies were more advanced in socio‐emotional development but not in cognitive development.

Maternal substance use disorder predicting children's emotion regulation in middle childhood: the role of early mother-infant interaction

BackgroundMaternal prenatal substance use disorder (SUD) represents a dual risk for child wellbeing due to teratogenic impacts and parenting problems often inherent in SUD. One potential mechanism transferring this risk is altered development of children's emotion regulation (ER). The present study examines how mother's prenatal SUD and early mother-infant interaction quality predict children's ER in middle childhood. MethodThe participants were 52 polysubstance using mothers and 50 non-users and their children. First-year mother-infant interaction quality was assessed with the Emotional Availability (EA) Scales and children's ER with the Children's Emotion Management Scales (CEMS), and its parent version (P-CEMS) at 8–12 years. ResultsMother's prenatal SUD predicted a low level of children's adaptive ER strategies, whereas early mother-infant interaction problems predicted a high level of emotion dysregulation. The dyadic interaction also mediated the effect of SUD on emotion dysregulation. In the SUD group, more severe substance use predicted high emotion inhibition. ConclusionEarly mother-infant interaction quality is critical in shaping children's ER, also in middle-childhood. Interventions aimed for mothers with prenatal SUD should integrate parenting components to support the optimal development of multiply vulnerable children.

Addressing Pediatric HIV Pretreatment Drug Resistance and Virologic Failure in Sub-Saharan Africa: A Cost-Effectiveness Analysis of Diagnostic-Based Strategies in Children ≥3 Years Old.

Improvement of antiretroviral therapy (ART) regimen switching practices and implementation of pretreatment drug resistance (PDR) testing are two potential approaches to improve health outcomes for children living with HIV. We developed a microsimulation model of disease progression and treatment focused on children with perinatally acquired HIV in sub-Saharan Africa who initiate ART at 3 years of age. We evaluated the cost-effectiveness of diagnostic-based strategies (improved switching and PDR testing), over a 10-year time horizon, in settings without and with pediatric dolutegravir (DTG) availability as first-line ART. The improved switching strategy increases the probability of switching to second-line ART when virologic failure is diagnosed through viral load testing. The PDR testing strategy involves a one-time PDR test prior to ART initiation to guide choice of initial regimen. When DTG is not available, PDR testing is dominated by the improved switching strategy, which has an incremental cost-effectiveness ratio (ICER) of USD 579/life-year gained (LY), relative to the status quo. If DTG is available, improved switching has a similar ICER (USD 591/LY) relative to the DTG status quo. Even when substantial financial investment is needed to achieve improved regimen switching practices, the improved switching strategy still has the potential to be cost-effective in a wide range of sub-Saharan African countries. Our analysis highlights the importance of strengthening existing laboratory monitoring systems to improve the health of children living with HIV.

Identification of Psycho-Social Needs and Coping Strategies in Children with Cancer

Background: Studies have shown that cancer creates a variety of problems and issues for children with cancer. It creates unique challenges for both the patients and their families. Despite the severe stress associated with these problems, most children are able to adequately cope with and adapt to cancer. However, some of the patients experience more severe or prolonged problems that require psychological support. The present study investigated the needs and coping strategies of Iranian children aged 9 to 13 with cancer. The goal was to determine the needs, concerns and coping strategies in children after being diagnosed with cancer. Methods: For this purpose, 12 children aged 9-13 with cancer as well as their mothers were selected from among children admitted to Mofid hospital. Patient selection was conducted in a purposeful sampling method. Data was collected in an in-depth semi-structured interview with the child and their mother and then analyzed using content analysis method. Results: The content analysis of individual interviews with the child and mother showed that the main concerns of these children were related to the hospital space, support, society, family and educational needs, which were responded to by five distinct types of coping. These coping methods include spiritual coping, admission of support and assistance, visiting relatives (on a regular basis) in a positive manner and negative behaviors such as active and passive aggression and avoiding presence in the community and society. The findings of this study indicate that Iranian children with cancer have special needs some of which have mental and emotional aspects, including worry about being a burden on their families, and they use different coping strategies to cope with their condition. One of the most important means of coping with cancer are family and relatives. Conclusion: Treatment centers should address these factors in order to improve the mental and physical health of their patients.

Links Between Early Personal Characteristics, Longitudinal Profiles of Peer Victimization in School and Victimization in College or at Work.

This study used a longitudinal design from age six through age 19 (N = 1206 (603 girls)) to examine the associations between anxious-withdrawal and reactive aggression during childhood, distinct profiles of peer victimization from kindergarten to grade 11 and victimization in college or at work in emerging adulthood. In particular, it was tested whether the predictive effect of personal characteristics on victimization in emerging adulthood would be mediated via chronic peer victimization experiences during the school years. Teachers evaluated children's personal characteristics, whereas peer nominations and self-reports were used to assess victimization. Control variables included sex, parent-reported harsh parenting and SES. Longitudinal latent profile analysis revealed four distinct profiles of peer victimization during the school years: Consistently-Low (39.7%), Low-Moderate (42.8%), High-Decreasing (8.8%) and High-Increasing-Decreasing (8.7%). A subsequent 3-step regression-based path analysis supported the mediation hypothesis - albeit differently for different profiles of peer victimization. Specifically, compared to a Consistently-Low profile of peer victimization in school, a High-Decreasing profile was predicted by reactive aggression, but not anxious-withdrawal. In contrast, a High-Increasing-Decreasing profile was predicted by reactive aggression and anxious-withdrawal. In turn, elevated peer victimization profiles were associated with higher levels of later victimization in college or at work. The indirect effects linking the childhood behaviors to later victimization in college or at work - via elevated peer victimization profiles during childhood and adolescence - were significant. These results highlight the need for tailored interventions to optimize reactively aggressive or anxious-withdrawn children's response strategies to challenging and potentially threatening peer interactions.