Syndrome Children Research Articles

Assessment of Psychological Well-Being and Coping Strategies among Family Caregivers of Children with Down syndrome

Background: Family caregivers of children with Down Syndrome are frequently unstable and forego their psychological well-being, suffer additional economic difficulties, ill health and cope ineffectively than families without disabilities. Aim: This study aimed to assess psychological well- being and coping strategies among family caregivers of children with Down Syndrome. Design: A descriptive research design was utilized in this study. Setting: This study was carried out in the Genes Clinics of Down Syndrome in the specialized clinics of the university pediatric hospital affiliated to Ain Shams University Hospitals. Subjects: A sample of 60 family caregivers of children with Down Syndrome. The study tools were: 1) Interviewing Questionnaire, 2) Brief-COPE inventory (Carver, 1997) and 3) Ryff’s Psychological well-being scale (1989). The results: The study showed that family caregivers of children with Down Syndrome depended mainly on emotion-focused coping strategies in managing burden of child caregiving and the most frequent used emotion focused coping strategies were religion, acceptance and venting while the most frequent used problem-focused coping strategy was use of instrumental support. Concerning to psychological well-being, more than half of family caregivers of children with Down Syndrome had psychological well-being less than usual. Conclusions: There was a negative statistically significant correlation between psychological well- being and all types of emotion-focused coping strategies except for humor, acceptance and religion. Meanwhile, there was a positive statistically significant correlation between level of psychological well-being and all subscales of problem-focused coping strategies. Recommendations: Future research to assess challenges encountered by siblings of Down Syndrome children and to apply supportive intervention that promotes positive relationships and attitudes as well as Establishment of counseling clinics for parents and siblings to improve their psychological well-being and coping strategies.

A case report on COVID-19 associated multisystem inflammatory syndrome in children

As severe acute respiratory syndrome coronavirus 2 continues to spread worldwide, there have been increasing reports from different parts of India during second wave of infection describing children and adolescents with COVID-19-associated multisystem inflammatory conditions. We describe clinical features and management in children with multisystem inflammatory syndrome children (MIS-C) from the Delhi metropolitan area, which had a high incidence of coronavirus disease 2019 (COVID-19). We report a similar case presenting with persisting fever, rashes, bulbar conjunctivitis, abdominal pain, decreased urine output and shock. Initial reports suggestive of high inflammatory markers, neutrophilic leukocytosis, high D-dimer and found to have COVID-19 IgG antibodies positive in high titre. Managed successfully in PICU with bolos fluids, intravenous antibiotics, steroids and anticoagulation.

Comorbidities in children with Down syndrome: experience in a tertiary care hospital of Bangladesh

Background: Down syndrome or trisomy 21 is one of the most common chromosomal disorders with moderate intellectual disability. In addition to mental retardation, this syndrome is associated with different congenital anomalies and characteristic dysmorphic features. Affected individuals are more susceptible to congenital heart disease and digestive anomalies, pulmonary complications, immune and endocrine system disorders. While several international studies have shown association of co-morbidities with trisomy 21, there is insufficient data available in Bangladesh.The present study aimed to evaluate the associated co-morbidities in children with Down syndrome.
 Methods: A cross-sectional study was conducted among pediatric cases with Down syndrome who attended the endocrine outpatient department (OPD) of BIRDEM General Hospital from June 2006 to December 2016. The cases were diagnosed either by Karyotyping or by characteristic phenotypes.The clinical and laboratory data of the patients were collected from outpatient history records for analysis.
 Results: There were total 42 children with Down syndrome, with mean age 4.2 years at assessment and female predominance (1.47:1). Thyroid dysfunction was the most common (69%) followed by congenital heart disease (57%). Among the thyroid disorders, acquired hypothyroidism was found in 55% cases, congenital hypothyroidism in 41% cases and only one had hyperthyroidism. Isolated patent ductus arteriosus (PDA) and atrial septal defect (ASD) comprised the commonest single congenital heart disease found in 53% and combined atrioventricular septal defect was the commonest among complex congenital cardiac defect observed in our study. Both thyroid dysfunction and congenital heart disease were found more in female children with Down syndrome than their male counterpart and it was found statistically significant. Fifty percent of our Down syndrome cases were referred from other healthcare centers to address developmental delay.
 Conclusion: Hypothyroidism and congenital heart disease are frequently associated in Down syndrome children in Bangladesh. This calls for developing awareness among health professionals to diagnose comorbidities at an early stage and to form recommendations for long term follow up.
 BIRDEM Med J 2021; 11(3): 191-196

Foot rotation asymmetry in Down syndrome and the relationship with crawling and walking onset: a cross sectional study

Introduction: Down syndrome individuals have different gait patterns, which include specific characteristics such as foot rotation asymmetry. Objective: The aim of this study was to analyze the relationship between this asymmetry and the previous acquisition of hands-and-knees crawling in Down syndrome children, as well as the probable association of this gait to gender, ethnicity, comorbidities, physiotherapy, and occupational therapy interventions. Methods: In this cross-sectional study, 361 children with or without foot rotation asymmetry were selected. An online questionnaire was administered to the parents or guardians of those children. Results: Hands-and-knees crawling decreased the prevalence of foot rotation asymmetry in Down syndrome children. The longer it took for walking onset, the higher the prevalence of this asymmetry. Indeed, for each month of delay there was a 7% increase in prevalence. There was a significant relationship between orthopedic alterations in knees or flat feet and foot rotation asymmetry. There was no significance related to gender, ethnicity, other comorbidities, physiotherapy or occupational therapy interventions. Conclusion: The findings in this study revealed that foot rotation asymmetry may be related to the acquisition of the motor skills described above, especially with regards to hands-and-knees crawling and walking onset.

Combined scheimpflug and optical coherence tomography imaging in screening of keratoconus in Down syndrome children

Combined scheimpflug and optical coherence tomography imaging in screening of keratoconus in Down syndrome children

"A Daily Born and Dying": Dynamics of Affective-Semiotic Self-Regulation Involved in Early Intervention Practices with Children with Congenital Zika Virus Syndrome.

From 2015 to 2016, an epidemic of births of children with Congenital Zika Virus Syndrome emerged in Brazil, and the state of Bahia concentrated the highest incidence of cases. The official health guidelines recommended that the affected children and their families should be supported by interdisciplinary teams of early intervention. This paper aims to deepen the comprehension of regulation and affective-semiotic mediation processes involved in the early intervention with children with Congenital Zika Virus Syndrome and their families. It focus on the experiences of a professional interviewed in a public health service in Salvador, Bahia - Brazil, through narrative analysis and the theoretical-methodological foundations of Cultural Psychology of the Semiotic Dynamics. These approaches allowed the understanding of the processes of construction of meanings, symbolic action and affective-semiotic regulation. The care of Congenital Zika Virus Syndrome children by professionals relates to disquieting experiences, inter subjectivity, meaning construction, affections and symbolic actions. These dynamic processes allowed the professional to better adapt to regulation and affective-semiotic mediation, as well as her own performance in face of children and their families. This analysis emphasizes the reflections of health care practices and their repercussions in the quality of the assistance.

Capacity of the CCC-2 to Discriminate ASD from Other Neurodevelopmental Disorders.

The Children’s Communication Checklist (CCC-2) has demonstrated its usefulness as an instrument to assess discrepancies between the use of structural dimensions of language and the pragmatic and sociointeractive uses of language. The aims of the present paper are: (1) to test the capacity of the Galician adaptation of the CCC-2 to discriminate the linguistic profiles of children with different disorders and (2) to test whether the capacity of the CCC-2 to discriminate the linguistic abilities of children with different disorders is the same at different ages: earlier development and later development. The sample is of 117 children previously diagnosed with different disorders: autism spectrum disorder (ASD), developmental language disorder (DLD), attention deficit with hyperactivity disorder (ADHD), Down syndrome children (DS) and typically developing children (TD). The children were divided into two different age groups: from 4 to 6 and from 7 to 16 years of age. The results indicate that the Galician CCC-2 (1) accurately identified children with and without communicative impairments, (2) distinguished between profiles with a predominance of pragmatic (ASD and ADHD) and structural disorders (DS and DLD) and (3) distinguished between different profiles of pragmatic impairment. The CCC-2 equally identified these profiles at both earlier and later ages. The Galician CCC-2 seems to be a useful instrument for differentiating among different clinical groups and for assessing pragmatic disorders from an early age, which can be valuable for planning early intervention.

Effectiveness of the Use of Manual and Electric Toothbrushes and the Effect of Educational Brushing Teeth with Video Animation on OHI-S Children with Down syndrome

Background: Down Syndrome children have better ability in capturing instructions visually. The audio-visual learning method can be applied to Down Syndrome children. Electric toothbrushes were made to make it easier for them to brush their teeth, besides those electric toothbrushes have a handle that is comfortable to hold and control. Purpose: The purpose of this study is to determine the effectiveness of electric and manual toothbrushes on Down Syndrome children OHI-S scores and determine the effect of education on tooth brushing with animated videos on Down Syndrome children OHI-S scores. Methods: Subjects of the study were 34 Down Syndrome children aged 6-19 years in Surabaya, East Java, Indonesia. OHI-S scores were recorded before and after the subjects were educated to brush their teeth with animated videos or dental phantoms. OHI-S scores were also recorded before and after the subjects brushed their teeth using manual toothbrushes or electric toothbrushes. Results: The test results Independent T-test (p> 0.05) showed there was no significant difference between tooth brushing using a manual toothbrush and an electric toothbrush to the decline of OHI-S score of Down Syndrome children. The results of the Mann-Whitney statistical test were p> 0.05, that there was no significant difference in the reduction in OHI-S scores between Down Syndrome children who were educated with animated videos and dental phantoms. Conclusion: There was no significant difference between manual toothbrushes and electric toothbrushes and there was no significant influence of Down Syndrome OHI-S children who were educated with animated videos or dental phantoms.

P-29: Rapid Progression of Parenteral Nutrition-associated Liver Disease on Liver Biopsies of Pediatric Patients with Short-gut Syndrome: a Case Series

Introduction: The rate of parenteral nutrition-associated liver disease (PNALD) development in short-bowel syndrome (SBS) children on total parenteral nutrition (TPN) is unknown. We present the first case series of pediatric SBS patients on TPN with rapid progression of their PNALD on liver biopsies (LB) obtained <12 months (m) after TPN initiation. Methods: Charts of 81 children with a history of TPN use at a single institution between 2009-2019 were reviewed for inclusion criteria: 1) SBS diagnosis 2) LB obtained <12 m after TPN initiation and 3) No underlying liver disease. Clinical history, nutritional support, and liver function markers (direct bilirubin [Dbili], aspartate aminotransferase [AST], alanine aminotransferase, international normalized ratio, AST to Platelets Ratio Index, ultrasound elastography and LB) were collected via retrospective chart review approved by our institutional review board. Liver pathology was graded by one pathologist. Results: 10 patients fulfilled criteria; the mean duration on TPN prior to LB was 4m (range 1-10.8m) with half on Intralipid, and the other half on an alternative lipid emulsion. Seventy percent also received enteral feeds. Forty percent patients had elevated Dbili. All LBs showed moderate to marked bile ductular reaction associated with a mixed, portal-predominant inflammatory infiltrate of lymphocytes, neutrophils, and occasional eosinophils of mild to moderate severity. Inflammatory infiltration of interlobular bile ducts was a rare finding in a subset of cases; plasma cells were not a prominent feature. Most samples showed some degree of cholestasis, usually canalicular. Lobular inflammation and hepatocyte necrosis were typically mild and nonzonal/spotty though some showed diffuse ballooning hepatocellular injury. No significant steatosis was observed. Fibrosis on trichrome stain was variable, typically portal-predominant; few cases demonstrated pericellular fibrosis. Based on the LB pathology, 70% had a change in medical care such as changing the lipid emulsion. Conclusion: The progression of PNALD in SBS children on LBs <12 months from TPN initiation was more rapid than previously hypothesized. LBs taken at the time of another surgical procedure may be warranted for SBS pediatric patients on TPN.

Psycho-educational Nursing Intervention for Improving Coping Strategies and Psychological Well-Being among Family Caregivers of Children with Down Syndrome

Background: Training family caregivers of children with Down Syndrome on how to promote their own psychological well-being and to cope effectively is essential as they are frequently unstable and forego their psychological well-being. Aim: This study aimed to assess the effect of psycho-educational nursing intervention on coping strategies and psychological well-being among family caregivers of children with Down Syndrome. Design: A quasi-experimental design was utilized in this study. Setting: This study was carried out in the Genes Clinics of Down Syndrome in the specialized clinics of the university pediatric hospital affiliated to Ain Shams University Hospitals. Subjects: A sample of 60 family caregivers of children with Down Syndrome. The study tools were: 1) Interviewing Questionnaire, 2) Brief-COPE inventory (Carver, 1997), 3) Ryff’s Psychological well-being scale (1989) and 4) Psycho-educational program. The results: There were highly statistically significant differences between pre &amp; post intervention regarding to emotion-focused coping strategies except for humor, acceptance, religion, venting and substance use and there were highly statistically significant differences between pre &amp; post intervention regarding to problem-focused coping strategies except for use of instrumental support. Conclusions: There were highly statistically significant differences between pre &amp; post intervention regarding the level of psychological well-being. There was a negative statistically significant correlation between psychological well-being pre &amp; post intervention and all types of emotion-focused coping strategies except for humor, acceptance and religion. Meanwhile, there was a highly positive statistically significant correlation between psychological well-being pre &amp; post intervention and problem-focused coping strategies regarding active coping and positive reframing and a positive statistically significant correlation regarding use of instrumental support and planning. Recommendations: Future research to assess challenges encountered by siblings of Down Syndrome children and to apply supportive intervention that promotes positive relationships and attitudes.

Epileptic Spasms-West syndrome secondary to Dravet syndrome due to SCN gene mutation from India

Objectives: West syndrome (WS) is a triad of epileptic spasms, developmental delay/regression, and hypsarrhythmia. SCN related epileptic encephalopathy is a rare epilepsy syndrome characterized by an early-onset, severe, and epileptic encephalopathy. The causes of WS are multiple and diverse ranging from genetic to structural, metabolic, and unknown causes. The objectives of the study were to report SCN related epileptic encephalopathies with epileptic spasms. Materials and Methods: This is retrospective chart review of children presenting with epileptic spasms secondary to SCN gene variants from January 2015 to March 2020 in a tertiary care referral center. Results: Out of 15 children, ten were boys. The mean age of presentation was 5 months. Thirteen children had preceded seizures before epileptic spasms in the 1st year of life, two children presented initially with epileptic spasms. No neuro-deficits were noted in all the children. In all the cases electroencephalogram was suggestive of hypsarrhythmia. Routine testing, neuroimaging, and metabolic tests were normal in all the cases. Various pathogenic variants seen in next-generation sequencing were SCN1A in 11, SCN1B and SCN2A in two children each. Three children responded for vigabatrin and five children responded for steroids but all of them had relapse and were refractory to other antiepileptic drugs. Conclusion: SCN related epileptic encephalopathy should be considered in the differential diagnosis of epileptic spasms. These infants present earlier compare to classical Dravet syndrome children.

Phonological Short-Term Memory Impairment in Children with Down Syndrome

Abstract Background: Children with Down Syndrome commonly suffer from phonological and other language disorders which have been partly attributed to underlying deficit in phonological short term memory. Its evaluation was previously confined to non word repetition and/or forward digit span tasks. Aim of Study: To assess phonological short term memory in children with Down Syndrome with mild degree of intel-lectual disability in comparison with non syndromic children with mild degree of intellectual disability to find out any possible correlation between Down Syndrome and phonolog-ical short term memory deficits through comprehensive eval-uation. Subjects and Methods: This case control study has been conducted on 40 children (20 Down Syndrome children with mild degree of intellectual disability, 20 non syndromic children with mild degree of intellectual disability with matched mental age). All of them underwent psychometric evaluation, audiological evaluation, language evaluation using Arabic version of Modified Preschool Language Scale-4th edition (PLS-4), and Arabic version of Phonological Short Term Memory Test (PSTM). Results: Down Syndrome group scored significantly lower than non syndromic children with mild degree of intellectual disability in all items of phonological short term memory test; digit span, syllable repetition, non sense word repetition, dissimilar word set recall, similar word set recall, total score (p-value 0.000, 0.001, 0.004, 0.000, 0.000, 0.000 respectively) and language test; expressive abilities was lower in Down syndrome children (p-value 0.002) but both groups were equal in their receptive abilities (p-value 0.054). Conclusion: Children with Down Syndrome scored below expected for phonological short term memory and their pho-nological store was extensively impaired.

The Impact of Educational Program on Stress and Coping Strategies among Mothers Caring for Down Syndrome Children

The Impact of Educational Program on Stress and Coping Strategies among Mothers Caring for Down Syndrome Children

The dynamics of sibling relationships with a down syndrome child

Siblings of special needs child are often seen as neglected children, especially when the special needs child needs more attention from their parents. This study aimed to find out the dynamics of sibling relationships with a down syndrome child. A phenomenological qualitative approach with data analysis of Interpretative Phenomenological Analysis (IPA) was chosen as the research method due to its suitability with the purpose of this study. The data were collected using in-depth semi-structured interviews on two biological older sisters (24 and 20 years old) of a boy with down syndrome (12 years old). The selection of subjects used a purposive sampling technique, which was based on the specified criteria. Three main themes were found in this study, namely (1) the functions of parents’ role, (2) acceptance towards a sibling with Down syndrome, and (3) sibling relationship. The results showed that the parents’ role in introducing the Down syndrome from the beginning helped the subjects accepted their sibling’s special needs. The subjects’ acceptance was expressed through their actions in supporting their younger sibling to become independent. Each subject also showed a sense of care in their own ways. Sibling relationships with a Down syndrome child were indicated by the existence of warmth, conflict, rivalry, role, engagement, stress, concern, and coping mechanisms.

Gut Microbial SNPs Induced by High-Fiber Diet Dominate Nutrition Metabolism and Environmental Adaption of Faecalibacterium prausnitzii in Obese Children.

Dietary intervention is effective in human health promotion through modulation of gut microbiota. Diet can cause single-nucleotide polymorphisms (SNPs) to occur in the gut microbiota, and some of these variations may lead to functional changes in human health. In this study, we performed a systematic SNP analysis based on metagenomic data collected from children with Prader–Willi syndrome (PWS, n = 17) and simple obese (SO) children (n = 19), who had better healthy conditions after receiving high-fiber diet intervention. We found that the intervention increased the SNP proportions of Faecalibacterium, Bifidobacterium, and Clostridium and decreased those of Bacteroides in all children. Besides, the PWS children had Collinsella increased and Ruminococcus decreased, whereas the SO had Blautia and Escherichia decreased. There were much more BiasSNPs in PWS than in SO (4,465 vs 303), and only 81 of them appeared in both groups, of which 78 were from Faecalibacterium prausnitzii, and 51 were nonsynonymous mutations. These nonsynonymous variations were mainly related to pathways of environmental adaptation and nutrition metabolism, particularly to carbohydrate and nucleotide metabolism. In addition, dominant strains carrying BiasSNPs in all children shifted from F. prausnitzii AF32-8AC and F. prausnitzii 942/30-2 to F. prausnitzii SSTS Bg7063 and F. prausnitzii JG BgPS064 after the dietary intervention. Furthermore, although the abundance of Bifidobacterium increased significantly by the intervention and became dominant strains responsible for nutrition metabolism, they had less BiasSNPs between the pre- and post-intervention group in comparison with Faecalibacterium. The finding of F. prausnitzii as important functional strains influenced by the intervention highlights the superiority of applying SNP analysis in studies of gut microbiota. This study provided evidence and support for the effect of dietary intervention on gut microbial SNPs, and gave some enlightenments for disease treatment.

Sandsack Physical Activity Increasing Balance Score in Children with Down Syndrome

Background: Down syndrome children have motoric and balance problems. Balance problems cause the child to be unable to maintain posture. Physical activity effective to stimulate development motor skills and balance in children. Sandsack physical activity can be applied to optimizing balance in children with down syndrome. The aim of the study was to investigate the effect of sandsack physical activity on balance in children with Down Syndrome. &#x0D; Methods: Quantitative research with pre-experimental research design one group pretest-posttest with a sample size of 13 children with Down syndrome in SLBN Surakarta. Eight sandsack physical activity models are provided in each session. Four sandsack physical activity models per sessions. Balance is measured by sixteen balance test before and after 12 section. The data analysis method uses a paired sample t-test of SPSS. &#x0D; Results: Paired sample t-test results showed that sig. (2-tailed) &lt; 0.05. The increase in the balance score occurred after being given the sandsack physical activity intervention (mean difference of 6.39). Sandsack physical activity intervention have a possitive and significant effect on balance in Down Syndrome children (ρ = 0.001). Most of Down Syndrome children in SLBN Surakarta were male (53.8%). Down Syndrome children in SLBN Surakarta is dominated at the age of 8 and 14 years old (23.1%). BMI score of Down syndrome children in SLBN Surakarta was 15.50 (15.4%). &#x0D; Conclusion: Sandsack physical activity intervention affects the balance in Down Syndrome children. Sandsack physical activity improved balance in children with Down Syndrome and should be applied in conjunction with physical and occupational therapy programs.

Reflection of Down Syndrome Children on Cartoons: Cases of ‘My Brother Ozi’ and ‘Punky’

&lt;p style="text-align:justify"&gt;In several shows prepared for children and adults in the media, the representation of “individuals with special needs” can ensure that other members of the society empathize with disability and the characteristics of disabled people, and make it easier that prejudices are replaced by social acceptance through gaining information. Finding a place frequently used in children’s literature, children’s reality satisfies the curiosity and experience-gaining demands of children about the cases they encounter for the first time using various examples, and helps them internalize the information and experience they gain. Children’s shows and cartoons have an effective power in influencing the viewpoint of children as target group for disabled people within the framework of “children’s reality” by means of the representation of children with special needs who are socially disadvantaged. In this context, the purpose of this study is to evaluate and examine in terms of various factors the social representation style of main characters with Down Syndrome represented in “My Brother Ozi” and “Punky” cartoons broadcasted on local children television channels and internet sites where cartoons for children can be found. 51 episodes of both cartoons (26 and 25) were viewed in the framework of the study and findings were analyzed using “document analysis” method which is a qualitative research method.&lt;/p&gt;

Case Report: A Case of a Cryptorchidism and Polyorchidism in Down Syndrome Child

Polyorchidism is an uncommon pediatric urological condition, having it in a down syndrome patient with bilateral cryptorchidism is tremendously rare. In this case report, a five-year old child with down syndrome was examined and admitted for further evaluation of bilateral undescended testicles. At the time of surgery, a third testicle was excised and sent to pathology department to exclude any type of cancer. The pathologist ruled out malignancy and confirmed the presence of atrophied testicular tissue. This is a rare case of undescended atrophied third testicle in a down syndrome child.

برنامج تدریبی مقترح من منظور الممارسة العامة فی الخدمة الاجتماعیة لتنمیة وعی الأمهات بأسالیب التربیة الجنسیة لأطفال متلازمة دوان

الملخص باللغة العربية هدفت الدراسة الحالية إلى التوصل إلى برنامج تدريبى متقرح من منظور الممارسة العامة في الخدمة الاجتماعية لتنمية وعى أمهات أطفال متلازمة داون بأساليب التربية الجنسية السوية. وکان التساؤل الرئيسى للدراسة : ما البرنامج التدريبى المقترح من منظور الممارسة العامة في الخدمة الاجتماعية لتنمية وعى أمهات أطفال داون بأساليب التربية الجنسية السوية؟ ومن أهم نتائج الدراسة تقديم برنامج تدريبى مقترح لتنمية وعى أمهات أطفال متلازمة داون بالتربية الجنسية السوية. الکلمات المفتاحية : الوعى، متلازمة داون، التربية الجنسية. A suggested program from the perspective of the generalist practice of Social Work to develop Mother's awareness of Sexual Education for Down's Syndrome children Abstract The current study aimed to reaching suggested training program from the perspective of the generalist social work practice to develop mother's awareness of Down's syndrome children about sexual education. And the study's questions were identified in a main question: what are the suggested program from the generalist social work practice to develop the mothers awareness of Down's syndrome children about sexual education? The study presented a training program to raise mother's awareness of Down's children about sexual education. Key words : Awareness, Down's syndrome, Sex education

POS-448 CORTICOSTEROID SPARING AGENTS IN FREQUENT RELAPSING AND STEROID DEPENDENT NEPHROTIC SYNDROME IN CHILDREN: A SINGLE CENTER RETROSPECTIVE STUDY

Children with frequently relapsing nephrotic syndrome (FRNS) or Steroid-dependent nephrotic syndrome (SDNS) may be prescribed non-corticosteroid immunosuppressive agents whenever there is a failure to maintain remission with low-dose alternate-day prednisone and/or significant adverse effects of prednisone develop. A wide variety of immunosuppressive agents have been used in these patients to reduce the number of relapses and maintain remission. A retrospective study was conducted on all steroid-sensitive nephrotic syndrome (SSNS) children (1-11 years) who received any type of second line agents (e.g. CNI, MMF, cyclophosphamide, and Rituximab) over a period of 9 years from January 2010 to January 2019 in pediatric nephrology unit in Prince Sultan Military Medical City, Riyadh. The study included 24 patients. Their age at diagnosis ranged between 1 and 11 years with a mean of 3.8 years and standard deviation of (±) 2.6 years. During the first year of steroid therapy, relapse occurred among 87% of patients; of them, the number of relapses being 4 or more in 21.7%. Regarding indication for the second line of treatment, SDNS was the most frequent reported (60.9%), followed by FRNS (30.4%). Concerning agents used in the second line, MMF ranked first (58.4%), followed by Cyclophosphamide (33.3%). Number of relapses after starting steroid sparing agent was more than once among 41.7% of patients. Duration of remission after starting steroid sparing agent ranged between 2 and 72 months (14±14.1). Overall response to the second line of treatment was observed among majority of patients (91.7%). Renal biopsy was performed in 45.8% of patients. Concerning side effects of steroid sparing agents, electrolytes disturbances and hypertension were reported by two (8.3%) and one (4.2%) patients respectively. Duration of remission was significantly longer among patients treated with cyclosporine (48±33.9 months) compared to other lines of treatment, p<0.001. On the other hand, hypertension was only reported among patients treated with cyclosporine, p=0.003. The overall response of children with SDNS and FRNS to the second line agents was significant, with favorable longer remission free period with Cyclosporine use with no major side effects. Our results affected by the retrospective design of the study, as well as the small sample size. Therefore larger scale study with prospective design is highly encouraged.