Therapy In Preschool Children Research Articles

Use of inhaled corticosteroids in preschool children and variability among pediatricians: a real-world analysis before and during the SARS-CoV-2 pandemic

BackgroundIn Italy, inhaled corticosteroids (ICSs) are inappropriately prescribed to provide relief in URTI symptoms. Extreme variation in ICS prescribing has been described at regional and sub-regional level. During 2020, extraordinary containment measures were implemented in attempt to halt Coronavirus, such as social distancing, lockdown, and the use of mask. Our objectives were to evaluate the indirect impact of the SARS-CoV-2 pandemic on prescribing patterns of ICSs in preschool children and to estimate the prescribing variability among pediatricians before and during the pandemic.MethodsIn this real-world study, we enrolled all children residing in the Lazio region (Italy), aged 5 years or less during the period 2017–2020. The main outcome measures were the annual ICS prescription prevalence, and the variability in ICS prescribing, for each study year. Variability was expressed as Median Odds Ratios (MORs). If the MOR is 1.00, there is no variation between clusters (e.g., pediatricians). If there is considerable between-cluster variation, the MOR will be large.ResultsThe study population consisted of 210,996 children, cared by 738 pediatricians located in the 46 local health districts (LHDs). Before the pandemic, the percentage of children exposed to ICS was almost stable, ranging from 27.3 to 29.1%. During the SARS-CoV-2 pandemic, the ICS prescription prevalence dropped to 17.0% (p < 0.001). In each study year, a relevant (p < 0.001) variability was detected among both LHDs and pediatricians working in the same LHD. However, the variability among individual pediatricians was always higher. In 2020, the MOR among pediatricians was 1.77 (95% CI: 1.71–1.83) whereas the MOR among LHDs was 1.29 (1.21–1.40). Furthermore, MORs remained stable over time, and no differences were detected in ICS prescription variability before and after pandemic outbreak.ConclusionsIf on one hand the SARS-CoV-2 pandemic indirectly caused the reduction in ICS prescriptions, on the other the variability in ICS prescribing habits among both LHDs and pediatricians remained stable over the whole study time span (2017–2020), showing no differences between pre- pandemic and pandemic periods. The intra-regional drug prescribing variability underlines the lack of shared guidelines for appropriate ICS therapy in preschool children, and raises equity issues in access to optimal care.

Theoretical Bases of Model of Intervention in Speech Therapy for Preschool Children with Phonological Insufficiency

At 5–6 years, most children pronounce all the sounds of their mother tongue correctly and have developed phonemic awareness, but not all children have reached an adequate level of speech and language development. In order to alleviate speech development and language acquisition disorders, it is necessary to carry out interventions based on sequential steps and activities. This article reveals the findings of various authors attempting to explain the action of such interventions. On the basis of the analysed literature, the author proposes a model of intervention in speech therapy for the reduction of phonological disorders.&#x0D;

Effectiveness, safety, and parental satisfaction of insulin pump therapy versus multiple-dose injection therapy in preschool children with type 1 diabetes: A systematic review and meta-analysis

Background: Despite the increasing demand for continuous subcutaneous insulin infusion (CSII) or insulin pump therapy in preschool children with Type 1 diabetes (T1D), reports on its advantages over conventional methods, particularly multiple dose injection (MDI) therapy, are scant. Objectives: We aimed to investigate the effectiveness, safety, and parental satisfaction of using CSII compared to MDI in preschool children with T1D. This study also seeks to establish criteria to help clinicians choose patients most suitable for CSII. Methods: Relevant terms based on the study outcomes were used to search electronic databases and manual search for the literature. Selected articles were then thoroughly reviewed and evaluated. Results: The effect in the meta-analysis showed a small, nonsignificant positive effect on HbA1c of the CSII compared to the MDI insulin intervention method (mean Cohen's d effect size = 0.25, Standard Error = 0.18, P = 0.16 (n = 127)) and a small, nonsignificant negative effect on safety of the CSII compared to the MDI insulin intervention method (mean Cohen's d effect size = −0.26, SE = 0.36, P = 0.47 [n = 70]). For parental satisfaction, data were small and therefore inappropriate for meta-analysis. Conclusion: For preschool children, the effectiveness and safety of insulin pump therapy compared with MDI therapy was considered statistically nonsignificant. All preschool children with T1D can be considered potentially eligible candidates for insulin pump therapy. Suggested selection criteria to apply when considering preschool children for insulin pump therapy were presented.

Acceptance commitment therapy for preschool children : A pilot study

IntroductionEmotion regulation is a key world to understand many human behaviors. Preschool children can exhibite disturbing behaviors that could interfeer with their integration, development and learning abilities. One way to understand these behaviors is their “immature” emotional regulation process. Helping children acquiring this ability can help to solve these disturbances’, which can lead to mental health problems.ObjectivesTo experiment with a new acceptance and committment therapy protocol in preschool childrenMethodsIt is a qualitative interventional study that relies on issues to enable the recognition and regulation of emotions. a protocol was implemented which consists of activities and techniques useful to help children recognize, regulate and accept their emotions, with the support of the educator.ResultsAll six selected children accepted to undergo the therapy till the end of the eight sessions. at fisrt, they were enable to recognise some emtions. it was the most difficult for them to recognise body expression of emotion. they had also difficulties find the different worlds to express them and to enact them.Throw different activities, we tried to help children visualize their emotions, imagine them under different faces and play with them. Children were introduced to mindfulness and emotional regulation technics. After One month of the intervention, children were still able to recognize emotions and to propose technics to regulate them. their score on the CBCL were below 70 one month after the intervention.ConclusionsEven at an early age of 4 years, ACT seems to be possible and helpful for children.

A Case-Based Review on the Diagnosis and Treatment Options for Recurrent Wheezing and Asthma in Preschool Children

To summarize the recent evidence on the various wheezing patterns in early life and provide a case-based review with insights into clinical application of individualized therapy in preschool children with recurrent wheezing. Preschool wheezing is often characterized predominantly by the risk domain with exacerbations and relatively limited impairment. In children with intermittent disease and a positive Modified Asthma Predictive Index, intermittent therapy with inhaled corticosteroids (ICSs) should be considered as an initial therapy to prevent exacerbations. Early administration of azithromycin at the onset of lower respiratory tract infections (LRTIs) reduces the risks of progression to severe illnesses in children who have a history of recurrent severe LRTIs, and more information is needed regarding the risks of developing drug-resistant organisms. In preschool children with mild persistent asthma, allergic sensitization to aeroallergens and absolute eosinophil count can help identify children most likely to have a good response to daily ICS. Recent clinical trials in preschool children with severe episodic wheezing and persistent asthma have made a significant impact on the approach for the care of these children, particularly with evidence directing individualized approaches based on specific clinical features and biomarkers.

PLAYDOUGH TO REDUCE ANXIETY”: Alternative Therapy in Pre-School Children with Hospitality

Hospitalization is an experience that produces every child who has physical and psychological effects as a result of the environment, and officers they do not know. Therefore the effort that can be done by nurses is to provide distraction therapy with playdough. The study aimed to prove the effect of treatment on Playdough play on anxiety in preschoolers because of hospitalization in the Kertawijaya Room Dr. Wahidin Sudiro Husodo Mojokerto. The design of this study uses pre-experiment with one group pretest approach. The population in this study were all preschool children who were in hospital treatment in the first week of October 2018. Samples were 20 children, with consecutive sampling. Playdough therapy for 20 children. Data collection used a mYPAS (Modified Yale Preoperative Anxiety Scale) questionnaire. After that, the data processing with Wilcoxon signed test was 0.00 which was &lt;0.05, As for the conclusions in this study there is a therapeutic effect of playing plasticine on children's anxiety with hospitalization. The value of preschool children's anxiety before being given play therapy is the majority of respondents 13 respondents (65%) experienced moderate anxiety and And a small proportion of respondents experienced severe anxiety as many as 5 respondents (25%). The value of anxiety after being given play therapy most of the respondents experienced a decrease in anxiety as many as 12 respondents (60%) experienced mild anxiety and almost half of the respondents were 8 respondents (40%). Stress will stimulate the body to send messages from the hypothalamus to the adrenal gland which will affect vasodilation and vasoconstriction of blood vessels that will determine the increase or decrease in blood pressure which is one of the physiological characteristics of the body when experiencing anxiety.

PLAYDOUGH TO REDUCE ANXIETY”: Alternative Therapy in Pre-School Children with Hospitality

Hospitalization is an experience that produces every child who has physical and psychological effects as a result of the environment, and officers they do not know. Therefore the effort that can be done by nurses is to provide distraction therapy with playdough. The study aimed to prove the effect of treatment on Playdough play on anxiety in preschoolers because of hospitalization in the Kertawijaya Room Dr. Wahidin Sudiro Husodo Mojokerto. The design of this study uses pre-experiment with one group pretest approach. The population in this study were all preschool children who were in hospital treatment in the first week of October 2018. Samples were 20 children, with consecutive sampling. Playdough therapy for 20 children. Data collection used a mYPAS (Modified Yale Preoperative Anxiety Scale) questionnaire. After that, the data processing with Wilcoxon signed test was 0.00 which was &lt;0.05, As for the conclusions in this study there is a therapeutic effect of playing plasticine on children's anxiety with hospitalization. The value of preschool children's anxiety before being given play therapy is the majority of respondents 13 respondents (65%) experienced moderate anxiety and And a small proportion of respondents experienced severe anxiety as many as 5 respondents (25%). The value of anxiety after being given play therapy most of the respondents experienced a decrease in anxiety as many as 12 respondents (60%) experienced mild anxiety and almost half of the respondents were 8 respondents (40%). Stress will stimulate the body to send messages from the hypothalamus to the adrenal gland which will affect vasodilation and vasoconstriction of blood vessels that will determine the increase or decrease in blood pressure which is one of the physiological characteristics of the body when experiencing anxiety.

EFEKTIFITAS TERAPI BERMAIN (MEWARNAI) PADA ANAK USIA PRASEKOLAH YANG MENGALAMI HOSPITALISASI DI RUMAH SAKIT ZAINAB PEKANBARU

The purpose of this study was to determine the effectiveness of play therapy in preschool children who experienced hospitalization. This research was conducted in hospitals Zainab Pekanbaru in October – December 2015 Number of respondents 20 children. The study design used was a pre experimental one group pretest posttest design. Samples were taken with a sampling technique used saturated or total population. Variables measured in this study is the impact of using questionnaires hospitalization. Based on the analysis of data it can be seen that there is the effectiveness of play therapy with hospitalization with p value = 0.01 (p &lt;0.05). The conclusion of this study the presence of the effectiveness of play therapy on hospitalization in the nursing room Zainab hospital Riau Province. Suggestions to further research may add a larger sample again with more specific inclusion criteria in order to get maximum results.

Safety and Efficacy of Tiotropium Respimat® Add-on Therapy in Pre-school Children with Symptomatic Persistent Asthma

Purpose: Asthma is the most common chronic disease of childhood (GINA. Diagnosis and management of asthma in children 5 years and younger. 2015). The preferred controller medication in children aged ≤5 years is a low dose of inhaled corticosteroids (ICS). However, treatment options for these patients are limited if their asthma symptoms are not then well controlled on ICS. The aim of this study was to evaluate the safety and efficacy of once-daily tiotropium Respimat® in patients aged 1-5 years with symptomatic persistent asthma, as add-on to ICS with or without further maintenance therapy. Methods: A Phase II/III, randomized, double-blind, placebo-controlled, parallel-group trial (NCT01634113) in patients aged 1-5 years with symptomatic persistent asthma. Patients received tiotropium 5 µg (two puffs of 2.5 µg), tiotropium 2.5 µg (two puffs of 1.25 µg), or placebo (two puffs), administered once daily in the afternoon for 12 weeks via the Respimat® device, each as add-on to usual maintenance therapy of ICS with or without other controller medication. The primary objective was to determine the safety of tiotropium Respimat®. Safety data included post hoc analyses of three composite exacerbation endpoints derived from adverse events (AEs), with treatment comparisons reported as hazard ratios (95% confidence interval [HR (95% CI)]). The primary efficacy endpoint was change in the weekly mean combined daytime asthma symptom score from baseline at Week 12 (response). The co-primary endpoint in 5-year-olds was peak forced expiratory volume in 1 second within 3 hours post-dose (peak FEV1(0-3h)) response. Treatment comparisons for efficacy endpoints were exploratory, and no formal hypothesis testing was performed. Results: Of the 102 patients randomized, 101 were treated and completed the 12-week treatment period: tiotropium 5 µg, n=31; tiotropium 2.5 µg, n=36; placebo, n=34. Safety results were comparable between all treatment groups, with a lower proportion of patients reporting any AEs in the tiotropium groups (5 µg: 58.1%; 2.5 µg: 55.6%) than in the placebo group (73.5%). No AEs leading to treatment discontinuation or death were reported, and AEs were of mild or moderate intensity. Serious AEs were reported in three patients (8.8%), all in the placebo group. In post hoc analyses, both tiotropium doses reduced the risk of asthmatic exacerbation over 12 weeks compared with placebo (e.g. see exacerbation [broad] with pneumonia plus worsening in the figure). Tiotropium and placebo were associated with comparable improvements in weekly mean combined daytime asthma symptom score and peak FEV1(0-3h) responses (exploratory analyses); treatment comparisons were not performed for peak FEV1(0-3h) response because of insufficient patient numbers in each treatment group. Conclusion: Once-daily tiotropium Respimat® add-on to ICS with or without further maintenance therapy is safe and well tolerated, and may reduce exacerbations in pre-school children with symptomatic persistent asthma.

Attitude of mothers on play therapy for pre-school children in selected Anganwadi Centers of Doiwala, Dehradun

Attitude of mothers on play therapy for pre-school children in selected Anganwadi Centers of Doiwala, Dehradun

A Study on Knowledge and Practice of Mothers on Play Therapy for Pre-school Children in Selected Anganwadi Centers of Doiwala, Dehradun

A Study on Knowledge and Practice of Mothers on Play Therapy for Pre-school Children in Selected Anganwadi Centers of Doiwala, Dehradun

The impact of group play therapy on creativity and control of aggression in preschool children

The main purpose of conducting this study was to investigate the effectiveness of group play therapy in preschool children’s creativity and aggression control. The research method was experimental ...

Comparing a Demands and Capacities Model Approach and the Lidcombe Program for Pre-school Stuttering Children: The Restart Randomised trail

In the Netherlands, the Demands and Capacities Model based treatment (DCM) has been the standard treatment for pre-school stuttering children since the late 1980s. The Lidcombe Program (LP) is a behavioural treatment program for stuttering pre-schoolers that was developed in Australia in the 1990s. Since 2000, this treatment program is also practised by a minority of Dutch clinicians. In 2007, a randomised trial in which both treatments were compared on effectiveness and costs was started. This study was named RESTART: the Rotterdam Evaluation study of Stuttering Therapy in preschool children- a Randomised Trial.In total, 199 stuttering children aged 3-6 years old and their parents participated in this study. They presented for treatment to one of the 24 participating clinicians who were qualified for both treatment methods (DCM and LP) and whose clinics were scattered over the Netherlands. To be admitted to the study, the children had to stutter at least mildly according the parent and the clinician, and children and parents had to be proficient in Dutch. Children stuttering less than six months before recruitment were excluded. Assessments were scheduled pre-treatment, 3, 6, 12 and 18 months post treatment, including audio speech samples outside the clinic, video recording inside the clinic, and questionnaires.Randomisation over treatment was stratified by age, gender, time since onset, severity of stuttering, family history of recovery/persistence from stuttering, and clinician. Every three months, meetings between the research group and all participating clinicians were held, enabling deliberation.At the conference, the results of the RESTART study regarding recovery of stuttering and cost effectiveness will be presented.

From uprooting to replanting: on post-trauma group music therapy for pre-school children

The paper presents a case study of short-term music therapy intervention administered to three groups of pre-school children in the aftermath of a forced evacuation from their homes. The setting relates the effects of the unilateral Israeli disengagement from the Gaza Strip in 2005 and the post-trauma treatment of the evacuees. The group treatment process is described in the context of Uprooting to rePlanting (UP) model and the broader Basic Ph model of Group Coping developed for dealing with community stress. Initial results point to the role of music in building post-trauma resilience and in reducing the vulnerability of pre-schoolers to traumatic events. The case study highlights the use of music therapy for post-traumatic stress disorder (PTSD) treatment with young children and stresses the way in which the community and family fabric can be harnessed in order to strengthen the coping of the individual.

Benefits of Continuous Subcutaneous Insulin Infusion (CSII) Therapy in Preschool Children

The incidence of type 1 diabetes mellitus (T1DM) in young children has increased considerably over recent years. The purpose was to examine the effectiveness and safety of continuous subcutaneous insulin infusion (CSII) therapy in preschool children with T1DM. A retrospective chart review of 113 children diagnosed with T1DM while younger than age 6 years. Mean age at diagnosis was 3.5±1.5 years and mean duration of follow 9.7±7.0 years. Patients were divided into 3 groups. Group1 initiated CSII therapy before the age of 6 years (n=26), Group 2 was treated with multiple daily injections (MDI) throughout follow-up (n=34), and Group 3 initiated CSII after age 6 (n=53). Metabolic control was assessed by HbA1C levels and safety by rates of severe hypoglycemia and diabetic ketoacidosis (DKA) events. In Group 1, the highest mean HbA1C value (8.5%) was observed 1-2 years prior to CSII initiation. During the 5 year period following CSII initiation, mean HbA1C levels ranged between 7.4 and 8.0%. Throughout the entire follow-up period, mean HbA1C levels were lower for Group 1 than Group 2 (p=0.05). In Group 3, mean HbA1C level decreased from 8.7% pre-CSII to 8.3% post-CSII (p<0.001). Nevertheless HbA1C levels remained higher than for those who started pump therapy before age 6 (p=0.02). Our study demonstrated better metabolic control in pre-school children treated with CSII compared to those treated with MDI. This benefit sustained for 5 years after CSII initiation and was not accompanied by increased risk of severe hypoglycemia or DKA events.

Efficacy of oral iron therapy in improving the developmental outcome of pre-school children with non-anaemic iron deficiency: a systematic review.

To systematically review the efficacy and safety of oral Fe therapy in pre-school children (1–5 years) with non-anaemic Fe deficiency, determined by children’s developmental and haematological status and the incidence of reported side-effects. A random-effects model was used to show mean differences with 95% confidence intervals of developmental and haematological scores between Fe-treated and non-treated groups. MEDLINE, EMBASE, Cochrane library and bibliographies of identified articles were searched up to September 2011. Randomized and observational studies were assessed by two reviewers independently. Quality of the trials was assessed on the basis of concealment of allocation, method of randomization, masking of outcome assessment and completeness of follow-up. From the titles of 743 articles, full text review was completed on forty-six and two randomized trials of acceptable quality met the inclusion criteria. The two trials included a total of sixty-nine children. One study showed a statistically significant difference in the post-treatment Mental Developmental Index score among children who received oral Fe therapy v. no therapy (mean difference56?3, 95% CI 1?5, 11?0, P value not provided). Both studies showed significant improvement in serum ferritin level (mg/l: mean difference551? 1, 95% CI 33?6, 68?6, P,0?01 and mean difference517?1, 95% CI 7?5, 26?6, P value not provided, respectively) in children who received Fe therapy. Evidence is insufficient to recommend oral Fe therapy to children with non-anaemic Fe deficiency. There is urgent need of conducting adequately powered, randomized trials examining the efficacy of oral Fe therapy in pre-school children with non-anaemic Fe deficiency.

Long term efficacy of insulin pump therapy in preschool children with diabetes

Long term efficacy of insulin pump therapy in preschool children with diabetes

Lung effects of inhaled corticosteroids in a rhesus monkey model of childhood asthma.

The risks for infants and young children receiving inhaled corticosteroid (ICS) therapy are largely unknown. Recent clinical studies indicate that ICS therapy in pre-school children with symptoms of asthma result in decreased symptoms without influencing the clinical disease course, but potentially affect postnatal growth and development. The current study employs a primate experimental model to identify the risks posed by ICS therapy. To (1) establish whether ICS therapy in developing primate lungs reverses pulmonary pathobiology associated with allergic airway disease (AAD) and (2) define the impact of ICS on postnatal lung growth and development in primates. Infant rhesus monkeys were exposed, from 1 through 6 months, to filtered air (FA) with house dust mite allergen and ozone using a protocol that produces AAD (AAD monkeys), or to FA alone (Control monkeys). From three through 6 months, the monkeys were treated daily with ICS (budesonide) or saline. Several AAD manifestations (airflow restrictions, lavage eosinophilia, basement membrane zone thickening, epithelial mucin composition) were reduced with ICS treatment, without adverse effects on body growth or adrenal function; however, airway branching abnormalities and intraepithelial innervation were not reduced. In addition, several indicators of postnatal lung growth and differentiation: vital capacity, inspiratory capacity, compliance, non-parenchymal lung volume and alveolarization, were increased in both AAD and Control monkeys that received ICS treatment. Incomplete prevention of pathobiological changes in the airways and disruption of postnatal growth and differentiation of airways and lung parenchyma in response to ICS pose risks for developing primate lungs. These responses also represent two mechanisms that could compromise ICS therapy's ability to alter clinical disease course in young children.

Effectiveness of Behavioral Parent Therapy in Preschool Children With Attention-Deficit Hyperactivity Disorder

The purpose of this study was to assess the effectiveness of a behavioral parent therapy (BPT) program in children with attention-deficit hyperactivity disorder (ADHD) using multidimensional evaluations, the Child Behavior Checklist (CBCL) and the Teacher Report Form (TRF). Between 2001 and 2005, the parents of 21 preschool children with ADHD were divided into six groups and participated in a series of 11 BPT sessions. Before and after BPT, the parents completed the CBCL, and the teachers completed the TRF. The behavioral and emotional problems of the children showed improvement after the BPT sessions, specifically for the following categories: internalizing problems, anxious/depressed syndromes, somatic complaints, externalizing problems, rule-breaking behaviors, aggressive behaviors, social problems, thought problems, and attention problems. In the DSM-oriented scale of the CBCL, affective problems, anxiety problems, somatic problems, ADHD problems, oppositional defiant disorder problems, and conduct disorder problems showed significant improvements. On the DSM scale of the TRF, Inattention syndrome improved significantly after the BPT sessions, while other syndromes showed non-significant changes. We conclude that the BPT program significantly improved the childrens behavioral problems at home and inattention problems at school.

Patient characteristics associated with improved outcomes with use of an inhaled corticosteroid in preschool children at risk for asthma

Maintenance inhaled corticosteroid (ICS) therapy in preschool children with recurrent wheezing at high-risk for development of asthma produces multiple clinical benefits. However, determination of baseline features associated with ICS responsiveness may identify children most likely to benefit from ICS treatment. To determine if demographic and atopic features predict response to ICS in preschool children at high risk for asthma. Two years of treatment with an ICS, fluticasone propionate (88 microg twice daily), was compared with matching placebo in a double-masked, randomized, multicenter study of 285 children 2 and 3 years old at high risk for asthma development. Baseline demographic and atopic features were related to clinical outcomes in a post hoc subgroup analysis. Multivariate analysis demonstrated significantly greater improvement with fluticasone than placebo in terms of episode-free days among boys, white subjects, participants with an emergency department (ED) visit or hospitalization within the past year, and those who experienced more symptomatic days at baseline. Children with aeroallergen sensitization experienced greater benefits in terms of oral corticosteroid use, urgent care and ED visits, and use of supplemental controller medications. More favorable responses to ICS than placebo in high-risk preschool children over a 2-year period were more likely in those with a ED visit or hospitalization for asthma within the past year, children with aeroallergen sensitization, boys, and white subjects.