Young Children Research Articles (Page 1)

Introduction: To report a rare presentation of an alveolar orbital rhabdomyosarcoma and the corresponding findings on computed tomography (CT), magnetic resonance imaging (MRI), and surgical outcome. Case Report: A 14-year-old Saudi boy, who presented with a progressively enlarging left upper eyelid mass. Associated with proptosis and limitation of extra-ocular muscles. He underwent imaging including CT scan and MRI which both modalities showed a large left intraconal mass with extraconal extension. The patient underwent a subtotal excision of the mass. Biopsy was sent for histopathology revealed a diagnosis of alveolar rhabdomyosarcoma, solid variant. Histogenetics, including fluorescence in situ hybridization (FISH) analysis for the FOXO1 gene, showed a negative gene rearrangement. The patient was referred to the oncology center in Dammam for confirmation of the diagnosis and to initiate appropriate management based on the disease stage. Conclusion: This case report highlights a rare instance of orbital alveolar rhabdomyosarcoma (RMS) in a 14-year-old boy from the Eastern Province of Saudi Arabia. Despite being a highly malignant tumor with aggressive progression typically affecting younger children, our patient presented with a relatively slower progression and a 6-week history of enlarging swelling and non-axial proptosis.

Organophosphate esters and plasticizers (OPEs) are used in consumer materials to meet flammability standards. Toxicological and epidemiological evidence suggests some OPEs are developmental neurotoxicants. We investigated associations between OPE exposures as measured in house dust and emotional and behavioral problems in young children. We used data from the CHILD Cohort Study (n = 601), a prospective birth cohort recruited in 5 cities across Canada (2008-2012). OPEs were measured in house dust at 3-4 months postpartum, and parents completed the Child Behavior Checklist (CBCL), which measures emotional and behavioral problems when their child was 5 years. We used logistic regression to examine associations between OPE Z-scores (individual and summed chlorinated [ΣOPECl] and non-chlorinated [ΣOPENCl]) and CBCL problem scale scores (borderline and clinical T-scores ≥60 and normal <60). Tris(2-chloroethyl) phosphate (TCEP) showed strong, positive associations with CBCL Total and Externalizing scores at or above the clinical cutoff, meaning children with higher levels of TCEP in house dust postpartum had higher odds of developing clinically relevant behavioral problems in early childhood compared to children with lower levels (Total ORadj: 1.37, 95% CI: 1.01, 1.87; Externalizing ORadj: 1.36, 95% CI: 1.00, 1.85). Similarly, 4-isopropylphenyl diphenyl phosphate, a Firemaster 550 component, had a strong, positive association with Internalizing scores (ORadj: 1.24, 95% CI: 1.02, 1.51). We observed a weak association between ΣOPECl and Total scores (Odds Ratio [OR] adjusted: 1.14, 95% Confidence Intervals [CI]: 0.97, 1.33) and null associations for ΣOPENCl. Associations were generally stronger among boys (ΣOPECl Total ORadj: 1.31, 95% CI: 1.02, 1.68). Visual summary of this manuscript, created with Microsoft PowerPoint. Organophosphate esters (OPEs) are common aspects of our built environment and increasingly recognized as developmental neurotoxicants. Using data from a large Canadian birth cohort, we investigated associations between OPE exposures as measured in house dust postpartum and emotional and behavioral problems in children. We found that levels of two OPE compounds (tris(2-chloroethyl) phosphate and a component of Firemaster 550) were associated with increased odds of clinically relevant behavioral problems in early childhood. This important work underscores the urgent need for public health policies to limit the use of certain OPEs in consumer products to reduce children's exposure to harmful chemicals.

While the severity and burden of SARS-CoV-2 infection in children are increasingly described, the literature on the clinical impact of SARS-CoV-2 compared to Respiratory Syncytial Virus (RSV) is still evolving. We compare the morbidity of SARS-CoV-2 with RSV among hospitalised children under 2 years. This was a retrospective, cross-sectional, single-centre study. All children under 24 months, admitted to a quaternary children's hospital in Queensland from January 2021 to December 2022 with SARS-CoV-2 or RSV infection, were included. Demographics, oxygen therapy, antibiotic usage and length of stay were compared. Of 639 children, 175 had SARS-CoV-2 and 465 had RSV. Proportionally more children with SARS-CoV-2 had medical co-morbidity compared to RSV (25.1% vs. 12.1%, p < 0.001), but there was no significant difference in other demographics. Children with RSV had significantly higher rates of oxygen therapy at admission (25.9% vs. 6.5%, p < 0.001), during admission (61% vs. 15.7%, p < 0.001), and a longer duration of stay (3 vs. 2 days, p = 0.002). Antibiotics were prescribed more often in SARS-CoV-2 (40% vs. 30.2%, p = 0.018). RSV infection in children under 2 years of age was associated with a more severe respiratory illness course than SARS-CoV-2. These findings are relevant to policy regarding RSV and SARS-CoV-2 immunisation in young children.

Washington state's adult use cannabis market operates under regulations by the Washington State Liquor and Cannabis Board to restrict access and promotion among young people. Cannabis edibles sold in the state are required to contain specific labels that inform consumers that the product contains cannabis and provide contact information for Poison Control. However, it is unclear how teens perceive such labels. Ten focus groups were conducted with a diverse sample of 28 teens (M = 15.93, SD = 1.25) in Washington state, United States. After viewing images of cannabis edible products available in Washington state, participants shared their thoughts and opinions about the packaging, warning labels and nutrition information. Through a thematic analysis, we noted that teens may be misinterpreting warning labels, and they think warninglabels are hidden or unnoticeable. Most teens paid little attention to nutrition labels and often found serving size informationconfusing. Teens said if an edible product looked similar to snack products they know, they might perceive them as lessrisky and more enticing. Knowledge of cannabis products also impacted teens' understanding of edible product packaging. Labels alert teens to the fact that products contain cannabis. However, teens often feel such labels apply to younger children and would not keep teens from using a product. Youth might benefit from additional guidance around interpreting cannabis packaging and labels.

Background and Aims: The management of very young children with type 1 diabetes (T1D) presents a considerable challenge for health care teams and the families from glycemic and psychosocial perspectives. The aim of this study was to evaluate the impact of hybrid closed-loop (HCL) system on glycemic control, with a particular focus on the patterns of glycemic parameters throughout the day. Methods: Seventy-two children under the age of six diagnosed with T1D (diabetes duration ≥6 months) who transitioned to CamAPS-FX-HCL were included. Data were collected prior to (pre-HCL) and at 1, 3, 9, and 12 months following HCL initiation. Pre-HCL and post-HCL periods were compared using linear mixed models. Results: Time in range (TIR70-180) increased by 11% ± 8% from the pre-HCL to 1 month post-HCL (P < 0.001), with a concomitant decrease in target above range (TAR180) of 13% ± 9% (P < 0.001). The improvement in glycemic control was sustained through 12 months, with the greatest differences observed overnight (P < 0.001). Hypoglycemic metrics (TBR70/TBR54) remained similar before and after HCL (all P > 0.05). However, hourly glycemic patterns indicated that the late-morning period after HCL initiation was a high-risk period for hypoglycemia with TBR70 peaking at 11% ± 9% between 11 AM and 1 PM. This elevated risk of hypoglycemia persisted after 1 year. Conclusions: In real-life setting, HCL was associated with increased TIR and reduced TAR in very young children with T1D from the first month of use. The present study suggests that late morning is a high-risk window for hypoglycemia in this age group. This finding highlights the importance of optimizing HCL therapy settings and educating parents about specific times of the day that carry a higher risk of glycemic instability.

Ensuring safe food practices among mothers is essential to protect the health of infants and young children, who are particularly vulnerable to foodborne illnesses. In low- and middle-income countries, unsafe household food handling, poor storage, and limited caregiver knowledge significantly contribute to diarrhoea diseases, malnutrition, and preventable childhood deaths. This study assessed food preparation, handling, and storage practices among mothers and examined the influence of various sociodemographic factors on these practices. A cross-sectional survey was conducted among 571 mothers in the Sekyere South Municipal via a structured questionnaire. Mothers were recruited through a convenience sampling technique. Data were coded and entered into Statistical Package for the Social Sciences (SPSS) version 21.0 for analysis. Descriptive statistics (frequencies, percentages, means, and standard deviations) were used to summarize the data. Associations between categorical variables were assessed using chi-square tests. Variables that showed statistical significance at p < 0.05 in bivariate analysis were entered into a multivariate logistic regression model to identify independent predictors of appropriate food handling practices. Statistical significance was set at p < 0.05. Most respondents practiced safe food preparation methods (91.1%), 43.1% demonstrated good food handling practices, and 56.6% practiced safe food storage. Significant sociodemographic predictors of food safety practices were age, marital status, occupation, monthly income, and educational level. Higher education consistently emerged as the strongest predictor across all three domains. Mothers with tertiary education had significantly greater odds of good practices in food preparation (AOR = 15.739, 95% CI: 10.86-15.39), handling (AOR = 15.390, 95% CI: 10.81-15.59), and storage (AOR = 15.779, 95% CI: 2.21-15.77). Occupation and income also showed significant associations, with self-employed and higher-income mothers being more likely to exhibit safe behaviors (AOR = 4.921, 95% CI: 2.04-11.88). This study revealed that while food preparation practices are generally good among mothers, food handling and storage practices require improvement. Key sociodemographic factors such as education, income, and occupation significantly influence food safety behavior. Improving mothers' food handling and storage practices is essential to reducing the burden of foodborne illnesses among children, thereby contributing to better child survival and overall community health.

Effectiveness of maternal vaccines and long-acting monoclonal antibodies against respiratory syncytial virus disease burden in early life: a scoping review of dynamic modelling studies.

ABSTRACT Higher education institutions (HEIs) are mostly led by professors drawn from within the ranks of the academic profession who are not specifically trained for leadership. Moving into top leadership positions requires a change of perspective, moving away from an inward-viewing individual focus into an outward-oriented institutional approach [Ruben, B., R. De Lisi, and R. Gigliotti. 2017. A Guide for Leaders in Higher Education. Core Concepts, Competencies and Tools. VA: Stylus Publishing], which is important for academic and administrative effectiveness [Gigliotti, R., and B. D. Ruben. 2017. “Preparing Higher Education Leaders: A Conceptual, Strategic, and Operational Approach.” Journal of Leadership Education 16 (1): 96–114. https://doi.org/10.12806/V16/I1/T1, 96]. While some degree of turbulence may occur, leadership transitions should ideally run smoothly and without greater periods of instability or insecurity, thereby maintaining continuity with the institution’s mission and serving to ground the institution [Van Mannen, J., and E. H. Schein. 1977. Toward a Theory of Organizational Socialization. Greenwich: JAI Press; Zenk, L. R., and K. Seashore Louis. 2018. “Mission as Metaphor: Reconceptualizing How Leaders Utilize Institutional Mission.” Teachers College Record 120 (9): 1–34]. To date little research has explored the experiences of HE leadership transitions, e.g. within the first 18 months of office. This study focusses on recently-elected women HEI leaders in Germany and the US, two countries chosen for their similar federal governance structures. Adapting a model of transition put forward by Manderscheid & Ardichvili, ([Manderscheid, S., and A. Ardichvili. 2008. “A Conceptual Model for Leadership Transition.” Performance Improvement Quarterly 20 (3-4): 113–129. https://doi.org/10.1002/piq.20006]), in association with post-heroic leadership theory, our findings from 10 qualitative interviews indicate the value in creating formal support structures and programming opportunities including coaching, mentoring, and cohort building for new women leaders. The comparative consideration of leadership trajectory structures in both countries indicate that there are particular considerations related to age that hold real-life implications for those with families and young children.

Celiac disease (CD) is an autoimmune disorder that may present with non-specific gastrointestinal symptoms. A serious, potentially lethal complication of CD is celiac crisis (CC), marked by severe diarrhoea, vomiting, dehydration and metabolic disorders. CD diagnosis in children relies on serological tests for anti-endomysium IgA antibodies and anti-transglutaminase IgA antibodies. However, false negatives may occur due to age, concomitant use of drugs, or technical errors. The paper reports the case of a 19-month-old child with severe symptoms despite a former negative serological screening. High clinical suspicion led to repeat the test, which confirmed CD. After starting a gluten-free diet, the child improved rapidly, gained weight and normalised bowel movements. This case illustrates the diagnostic challenges of CD and its most serious complication (CC) in young children and emphasises the need for continuing testing when symptoms persist, even with initial negative results. Timely diagnosis is crucial to prevent serious complications and prescribe an appropriate diet.

Parental engagement in stimulating activities and the use of different discipline behaviors play a significant role in young children's behavioral development. Psychological frameworks often posit that parental beliefs and psychological well-being are key drivers of these parental behaviors. However, the influence of parental beliefs and psychological well-being on these parenting behaviors, and consequently on children's behavioral outcomes, remains understudied, particularly in low- and middle-income countries (LMICs). We collected primary data from 267 parents of young children (Mage in months = 13.66; 52.06% girls) living in low-income households in Bogotá and Soacha, Colombia, and assessed how parental beliefs and psychological distress predict children's behaviors through parental engagement in stimulation activities and use of violent punishment. Structural equation modeling indicated that positive parental beliefs about violence were linked to reduced engagement in stimulating activities, predicting lower child effortful control and positive affectivity, while parental psychological distress was associated with greater use of violent punishment, predicting lower effortful control and higher negative affectivity in children. These results underscore the importance of addressing parental beliefs and psychological well-being to support positive parenting behaviors and promote healthy behavioral development in young children, particularly in LMIC contexts.

The study observed a high adherence rate to the 2023-2024 RSV immunization campaign. The administration of nirsevimab free of charge and before maternity unit discharge may have contributed to these results. Socio-demographic and medico-economic factors appeared to influence immunization adherence, suggesting that the period before maternity hospital discharge could represent a key time to carry out preventive actions and reduce social and territorial health inequalities. • Respiratory syncytial virus (RSV) is among the leading causes of acute lower respiratory-tract infection in young children with substantial economic impacts. • The first national passive immunization campaign against RSV was launched during the 2023-2024 RSV epidemics in France. • Medical, social, and territorial factors associated with parental adherence to passive immunization for their newborns are unknown. • Despite high adherence rates, disparities in passive immunization with nirsevimab uptake underscore the need for targeted interventions to ensure equitable access to healthcare: differences in uptake, despite free access, highlight the need for targeted communication and support strategies to overcome non-financial barriers and ensure equitable preventive care.

Pediatricians are the first professionals to provide guidance about language development to families with young children and referrals for those who may have a language or communication disorder. One-quarter of children in the United States are dual language learners (DLLs), yet there is little information about pediatrician's readiness to provide culturally and linguistically responsive care for these children. This pilot study sought to examine pediatricians' knowledge of bilingual language development and its relation to the provision of language and literacy promotion and developmental surveillance for Latine DLLs. Sixty-seven pediatricians at two academic pediatric clinics completed a survey asking about their knowledge about bilingual language development, Spanish proficiency, and provision of culturally effective health care to Latine DLLs. Analyses examined mean levels of these variables as well as relationships between knowledge, proficiency, and practices. On average, pediatricians' responses to the knowledge-based questions agreed with the evidence 69% of the time. Only 29% of pediatricians said they felt comfortable counseling Latine parents on bilingual language development, and 75% indicated they had difficulty recognizing signs of a language or communication disorders in Latine children from Spanish-speaking homes. Multiple regressions showed that pediatricians with higher Spanish proficiency and those with greater knowledge of bilingual language development provided more culturally and linguistically responsive care to Latine DLLs. We identified significant gaps in pediatricians' knowledge about bilingual language development that were associated with their practice patterns. Results highlight the need for incorporating training about bilingual language development into pediatric education and increasing the number of providers that speak languages other than English. https://doi.org/10.23641/asha.29954468.

Children's decreasing outdoor time and increasing screen time (ST) raise concern, as both can impact children's health unfavourably. However, little is known about the association between young children's context-specific outdoor time and ST. This study investigated the associations between parent-child outdoor visit frequency in nature, own yard, playground, and in total and preschoolers' ST on weekdays and weekends. Data were collected via a survey assessing parent-child outdoor visits and a 7-day ST diary completed by parents of children (n = 673, 3-6 years) participating in the DAGIS intervention study in Finland. The cross-sectional associations were examined by linear regression analyses adjusted for child age, sex, socioeconomic factors, and season. More frequent parent-child visits to own yard (B -1.98, 95%CI -3.43, -0.52) and nature (B -2.31, 95%CI -4.01, -0.60) were associated with less weekday ST among children, whereas more frequent visits to playground (B -3.68, 95%CI -7.18, -0.18) were associated with less weekend ST. Also, more frequent visits to nature (B -2.28, 95%CI -4.20, -0.38), own yard (B -2.38, 95%CI -4.03, -0.73), and playground (B -2.48, 95%CI -4.71, -0.25) were associated with less whole-week ST. More frequent total outdoor visits were associated with less weekday (B -1.547, 95%CI -2.38, -0.71), weekend (B -1.91, 95%CI -3.38, -0.45), and whole-week ST (B -1.77, 95%CI -2.71, -0.84). In conclusion, visiting different outdoor spaces was associated differentially with children's ST on weekdays and weekend days, whereas total outdoor visit frequency was associated with less ST throughout the week. Hence, municipalities should ensure the availability of different types of safe outdoor spaces in neighbourhoods to provide alternatives for young children's screen use. ISRCTN57165350, Registration date 08/01/2015.

We aimed to assess perceived stress and influencing factors in mothers with children at risk of type 1 diabetes and coeliac disease who did, or did not, develop islet autoantibodies (IA) or coeliac autoantibodies (CA) by 4 years of age. Maternal perceived stress was assessed postpartum and when their child was approximately 4 years of age using the Perceived Stress Scale (range 1-56) in mothers followed prospectively in the multicentre Environmental Determinants of Islet Autoimmunity (ENDIA) pregnancy-birth cohort. Data were analysed using linear mixed models. In total, 818 mothers were included (642 children had no detected IA or CA [Ab negative], 97 had IA detected [IA positive] and 79 had CA detected [CA positive]). The development of IA or CA in young children did not add significantly to the perceived stress of their mothers at a median of 1.8 [IQR 0.8-2.5] and 1.6 [IQR 0.9-2.3] years later, respectively (Ab negative, adjusted predicted mean score 23.8 [95% CI 22.7, 24.9]; IA positive, 22.8 [21.0, 24.6]; CA positive, 25.2 [23.3, 27.2]). Maternal type 1 diabetes did not alter this result. On exploratory predictor analysis a higher perceived stress score at 4 years was associated with a history of mental health illness (β=4.66 [95% CI 3.30, 6.02]) and mental health medication use (β=2.71 [0.64, 4.78]), independent of child autoantibody status or maternal type 1 diabetes status. Detection of IA or CA in their child did not increase ongoing maternal perceived stress after 1-2 years in a cohort that received consistent support and education. History of mental health illness and mental health medication use were associated with increased perceived stress in mothers regardless of their child's autoantibody status.

Delta-9 THC detection in the young pediatric postmortem population: 2018-2024.

The recommended chest compression site during pediatric cardiopulmonary resuscitation (CPR) is based on studies that did not account for dynamic respiratory changes in cardiac position. Since cardiac position changes with respiratory phase, the optimal site during CPR without respiratory support, which physiologically corresponds to the end-expiration state, may differ. We assessed heart position at end-expiration using echocardiography. A prospective observational study was conducted in 18 children under 7 years of age. Transthoracic echocardiography was performed to identify the position of the left ventricle during both inspiration and expiration. Each subject underwent five measurements in each respiratory phase. The position of the left ventricle was recorded relative to the inter-nipple line and categorized by intercostal space (ICS). At end-expiration, the left ventricle was commonly located at the first upper ICS (53.3%) and nipple line (27.8%), with only 4.4% located at the first lower ICS and none below that level. During inspiration, the left ventricle was located at the first lower ICS (50.0%) and nipple line (35.6%). Linear mixed-effects regression demonstrated a significant upward shift in heart position during expiration compared to inspiration (β = -1.46; 95% CI, -1.91 to -1.00; p < 0.001), independent of age, sex, and weight. These findings confirm that respiratory phase affects heart position in young children, with expiration associated with consistent cephalad shift. Therefore, the optimal chest compression site during pediatric CPR without respiratory support may be more cephalad than current guideline recommendations, suggesting the need to re-evaluate traditional landmarks in light of physiologic cardiac motion.

Pediatric deep neck infections (DNIs) pose diagnostic and therapeutic challenges due to their varied presentation across age groups. Current management strategies lack age-specific guidelines despite known anatomical and clinical differences. Our study aims to evaluate age-related variations in clinical presentation, imaging use, treatment approach and outcomes in pediatric DNIs, and to assess potential implications for modifying existing management algorithms. This retrospective study analyzed 268 pediatric patients diagnosed with retropharyngeal or parapharyngeal infections between 2009 and 2020 at a tertiary pediatric center. Patients were stratified into 3 age groups: <1 year, 1-6 years and >6 years. Clinical features, imaging modality, treatment and outcomes were compared across age groups. Multivariate logistic regression was used to identify predictors for surgical drainage and prolonged hospitalization. Retropharyngeal infections were predominant in children under 6, while parapharyngeal infections were more common in those over 6. The clinical presentation varied significantly by age, with infants more likely to present with nonspecific symptoms and older children presenting with localized signs. Computed tomography scan performance was the strongest predictor for surgical drainage (P < 0.001). However, age did not significantly influence the surgical intervention rate or hospitalization length. The overall rate of surgical drainage was low (7.8%). Pediatric DNIs exhibit distinct age-related patterns in presentation and infection site, though outcomes remain consistent across groups. These findings support the need for age-specific clinical algorithms, particularly regarding diagnostic imaging and thresholds for intervention, to optimize care and reduce unnecessary procedures in young children.

Cereal-based complementary foods are widely consumed by children, yet limited data exist on their elemental composition and potential health risks. This study quantified As, Cd, Co, Cr, Cu, Fe, K, Mn, Mg, Mo, Ni, P, Pb, Se, Si, V, and Zn in eight commercial cereal-based products collected in Campo Grande, Brazil, using inductively coupled plasma optical emission spectrometry (ICP OES). Arsenic, cadmium, cobalt, and chromium were consistently below the detection limit. Phosphorus and potassium were the predominant elements across brands, followed by Fe, Mg, and Zn, with significant inter-brand variability (Kruskal–Wallis, p &lt; 0.05). Lead was detected in Brands 1–5 (0.11–0.41 mg/kg), but it was below the limit of detection (LOD = 0.003 mg/L) in the other samples. Estimated daily intake (ID) values at 30 g/day and 90 g/day showed that Fe, Zn, Mn, and Se frequently met or exceeded dietary reference intakes for children aged 1–3 years, while Cu, Ni, and P remained below tolerable levels. Comparison with tolerable upper intake levels and ATSDR minimal risk levels indicated that higher consumption (90 g/day) could result in excess intake of Mn, Zn, and Se, with Pb contributing to cumulative hazard indices above the safety threshold (HI &gt; 1). These findings emphasize the dual role of cereal-based foods as important nutrient sources and potential contributors to excessive trace element exposure in young children.

Objectives: This study evaluated changes in serum sodium (S Na) 24 h after the administration of isotonic versus hypotonic intravenous fluids (IVFs) and the incidences of dysnatremia and hyperchloremic metabolic acidosis. Methods: This double-blind, randomized controlled trial involved children aged 3 months to 5 years who were admitted to a general ward between November 2020 and September 2022 and required IVF. We randomly assigned patients (1:1) to receive either an isotonic solution (D50.9%NaCl) or hypotonic solution (D50.45%NaCl). Serum electrolyte and venous blood gas levels were obtained at the time of IVF administration and 24 and 48 h after IVF administration. During this study, all participants were monitored for vital signs, body weight, fluid intake and output, and clinical symptoms of dysnatremia. Results: Totals of 69 and 68 patients received isotonic and hypotonic solutions, respectively. The mean age was 1.95 ± 1.25 years in the isotonic group and 1.91 ± 1.32 years in the hypotonic group. The initial degrees of dehydration and biochemical indicators were not different. The change in serum sodium level at 24 h was 2.97 (2.32–3.62) mmol/L in the isotonic group and 2.19 (1.54–2.84) mmol/L in the hypotonic group. In both groups, no significant hyponatremia nor hypernatremia occurred. The incidence of hyperchloremic metabolic acidosis was not different between the groups. Neither group showed any complications. Conclusions: Isotonic fluids may be a preferred option for IVFs in pediatric patients under 5 years of age with medical conditions on a general ward, especially within 24 h, due to their potential to better maintain serum sodium levels without increasing the risk of fluid overload or electrolyte complication.

ABSTRACT The presentation of children’s drawing achievements not only connects perceptual and cognitive experiences but can also reflect their direct psychological and emotional experiences in collective activities. This study from a kindergarten in Chengdu, China, deeply listens to children’s drawings from experiential activities and combines these with their narratives about their work to understand their true thoughts. Combining observations, case studies and interview methods, it attempts to interpret drawings from the perspective of children instead of subjectively evaluating unconnected images. The data come from videos of activities, 16 children’s drawings and interview texts. The research finds that the children’s drawings exhibited certain gender differences and were influenced by evaluations from others, including peers. In addition, family culture, life experiences and other backgrounds can also influence their work. Adults can better understand children by listening deeply to their drawings as visual language as well as how they discuss them. Teachers therefore need to continuously improve their listening and analytical abilities in respect of children’s drawings, to support the sustained development of young children.