Young Children Research Articles

To Sew or Not to Sew: A Case Report

Introduction-Tongue injuries in children vary from slight lacerations to complete amputations. It could be due to fall, self-mutilation, epilepsy, child abuse, or sport injury. The anterior dorsum is the most common site followed by the mid dorsum and anterior ventral part. These injuries may cause dysfunction of tongue, hemorrhage, and disfigurement. Management of injuries of tongue in young children is challenging. There are no established guidelines for managing tongue lacerations. This is a case report of a three-year-old girl with a laceration on the anterolateral part of the tongue with non-approximating wound edges. The laceration extended from the dorsal to the ventral part. The parents were apprehensive about the surgical management of the injury due to the age of their daughter. Hence, healing of the injury with conservative management without suturing was achieved. Conclusion-The management of traumatic injuries of tongue in children is difficult due to their age and cooperation. The pediatrician has to decide whether to heal the tongue by primary or secondary intention. Our decision to allow the healing by secondary intention was successful. The tongue healed without any complications barring a small scar with satisfactory aesthetic and functional outcome. Both the parents and the child were satisfied with the management of the injury.

Severe childhood poisoning caused by Ferraga practices. Data from the Moroccan Poison Control and Pharmacovigilance Centre.

To highlight the complications associated with the products and practice of healers "Ferraga" who treat young children using traditional Moroccan pharmacopoeia. This is a retrospective analysis of cases of products and practice of "Ferraga" intoxication in young children reported to the Moroccan Poison Control and Pharmacovigilance Center (MPCPC), Rabat, Morocco, from 2010-2020. During the study period, 24 cases of products and practice of "Ferraga" poisoning were reported to MPCPC, Rabat, Morocco. The average age of the patients was 2.48 years. The oral route was noted in 21 cases. The vast majority of patients (23 cases) exhibited symptoms upon admission, predominantly of digestive (16 cases), respiratory (3 cases), and neurological (4 cases). However, 29.16% of patients presented with both digestive and respiratory symptoms, 20.83% had digestive and neurological symptoms, and 4 cases manifested all 3 types of symptoms. The outcome was positive in 18 patients and fatal in 2 infants. Products and practice of "Ferraga" poisoning in children remains a major health problem. It is crucial to implement a strategy to combat this type of practice in order to reduce the prevalence of such poisoning.

The Pittsburgh Study: A Tiered Model To Support Parents During Early Childhood

ObjectiveTo test the feasibility of implementing The Pittsburgh Study’s (TPS) Early Childhood Collaborative, a population-level, community-partnered initiative to promote relational health by offering accessible preventive parenting program options for families with young children. Study designTPS partnered with healthcare and community agencies serving families in Allegheny County, Pennsylvania, to enroll and screen 878 parents of 1,040 children 4-years-old and under. Participants were assigned to one of four tiered groups based on identified needs: (1) universal, (2) targeted/universal, (3) secondary/tertiary, or (4) tertiary programs. Parents were offered choices in empirically supported parenting programs within group ranging from texting programs to intensive home visiting. Program selection was optional. Chi-square tests were conducted to examine the likelihood of selecting a program by group. ResultsAbout 25% of participants were assigned to each tiered group; 78% of parents chose to enroll in a parenting program. In general, parents with higher levels of adversity were more likely to select a parenting program compared with those reporting less adversity, including secondary/tertiary versus targeted/universal groups (81.4% vs. 72.8%), and tertiary versus universal and targeted/universal groups (83% vs. 74.1% and 72.8%, respectively; p < .001). ConclusionOur high program enrollment rate supports the feasibility of TPS. TPS successfully engaged families in the study by offering choices in, and optimizing accessibility to, parenting programs. TPS is highly aligned with recent recommendations by the American Academy of Pediatrics for tiered approaches as part of a broad public health strategy for supporting early relational health.

Bidirectional Relations Among Maternal Positive Emotion, Infant Positive Emotionality, and Infant Physiological Regulation Across the First 18 Months of Life.

Respiratory sinus arrhythmia (RSA), a marker of self-regulation, has been linked to developmental outcomes in young children. Although positive emotions may have the potential to facilitate physiological self-regulation, and enhanced self-regulation could underlie the development of positive emotions in early childhood, the relation between positive emotions and physiological self-regulation in infancy has been relatively overlooked. The current study examined the bidirectional associations among maternal positive emotion, infant positive emotionality, and infant resting RSA across the first 18 months of life. We used data from the Longitudinal Attention and Temperament Study (LanTs; N=309 in the current analysis) to test the within- and between-person relations of study variables over time using a random-intercepts cross-lagged panel model. We found that infants with higher overall levels of positive emotionality also displayed greater resting RSA, and their mothers exhibited higher levels of positive emotion. However, there were negative cross-lagged associations within-person; higher than average infant positive emotionality predicted lower levels of infant resting RSA at the subsequent timepoint during early infancy, whereas higher than average infant RSA subsequently predicted decreased levels of infant positive emotionality later in infancy. Results highlight the importance of considering transactional relations between positive emotion and physiological self-regulation in infancy.

Performance of stool-based molecular tests and processing methods for paediatric tuberculosis diagnosis: a systematic review and meta-analysis

There has been a global pursuit to improve the diagnosis of tuberculosis in young children by applying diagnostic methods on accessible biospecimens such as stool. We aimed to conduct a systematic review on the accuracy of stool-based molecular tests for tuberculosis diagnosis in children and to assess the impact of the available pre-processing methods and other design characteristics. In this systematic review and meta-analysis, we evaluated studies in children younger than 16years with presumptive tuberculosis that were published in English, Spanish, French, and Portuguese from Jan 1, 2000, to May3, 2024, in MEDLINE, Embase, and Embase Classic, comparing the molecular detection of Mycobacterium tuberculosis DNA in stool with microbiological tests on other samples or a clinical diagnosis. We did not exclude studies based on geographical location, sample size, or study design if they were reporting primary data. Two independent reviewers (LC-C and SM) screened titles, abstracts, and full-text articles for eligibility and extracted data on study characteristics, study population, and diagnostic performance. If information relevant to the main analysis was not reported in the article, the corresponding authors were contacted. Point estimates and 95% CIs were calculated for sensitivity and specificity for each study and for the different molecular tests (Xpert MTB/RIF, Xpert Ultra MTB/RIF [Cepheid, Sunnyvale, CA, USA], and other tests) versus a reference standard (culture only, any bacteriological confirmation, and tuberculosis case definition). Sensitivity and specificity were stratified by the stool processing method. We also quantified the additionality of stool Xpert Ultra tests for tuberculosis bacteriological confirmation. The protocol was registered with PROSPERO, CRD42022341514. A total of 4521records were identified through the database search, one record was identified from an article bibliography, and 67studies were retained for full-text reading. 39studies were included in the qualitative synthesis, 35of which were included in the meta-analyses. When using any bacteriological confirmation from a respiratory sample as the reference standard, stool Xpert sensitivity was 0·60 (95% CI 0·48-0·71), stool Xpert Ultra sensitivity was 0·73 (0·63-0·81), and sensitivity was 0·44 (0·29-0·60) for other in-house molecular methods combined. When using tuberculosis case definition as the reference standard, stool Xpert sensitivity was 0·23 (0·11-0·41), stool Xpert Ultra sensitivity was 0·38 (0·22-0·56), and sensitivity was 0·17 (0·09-0·23) for other in-house molecular methods. The addition of stool Xpert Ultra increased bacteriological confirmation of tuberculosis by 38·6% overall. Further, the utilisation of centrifuge-free simplified methods improved the sensitivity of stool Xpert Ultra when using any bacteriological confirmation as a reference standard (0·77 [0·66-0·85] for centrifuge-free methods vs 0·61[0·41-0·78] for non-centrifuge-free methods). This systematic review and meta-analysis supports the use of Xpert Ultra in stool samples as a diagnostic tool for paediatric tuberculosis diagnosis. Stool-based Xpert Ultra can contribute to increase the bacteriological confirmation in this population, even when respiratory specimens are also tested. The EDCTP2 programme supported by the EU via Stool4TB Project and the European Society of Pediatric Infectious Diseases.

Construction and validation of a mouse model for studying severe human adenovirus infections

Human adenoviruses (HAdVs) are highly contagious pathogens with various genotypes implicated in acute respiratory disease (ARD) and linked to mortality, especially in immunosuppressed patients, young children, and military recruits. Currently, no vaccines or specific drugs are approved for clinical use. The hosts of adenoviruses are strictly species-specific, which strongly limits the development of vaccines and drugs against HAdVs. In this study, immunocompetent BALB/c mice were challenged with different doses of human adenovirus type 5 (HAdV-5) via tail intravenous injection (i.v.). All mice challenged with a high dose of HAdV-5 (3.2×1010 TCID50/kg) died within 3 to 5 days, while those receiving a low dose of HAdV-5 (8×109 or 4×109 TCID50/kg) survived. Interestingly, among the mice receiving a medium dose of HAdV-5 (1.6×1010 TCID50/kg), 60% (n = 3/5) of male mice died, while all female mice survived. This suggests that male mice may be more susceptible to HAdV-5 infection than female mice, consistent with clinical findings in children. HAdV-5 DNA was mainly distributed in the liver, followed by the spleen and lungs. Pathological changes were observed in the lungs, liver, and spleen, with severity increasing in correlation with the virus challenge dosage. Transcriptome and qPCR analyses of the liver indicated that the down-regulated expression of the H2-Aa, H2-Ea-ps, CD74, and H2-Eb1 genes in male mice, as well as the AHR gene in female mice, may contribute to the observed higher mortality rates in male mice. Therefore, this effective, feasible, and cost-efficient mouse model could serve as a candidate for evaluating HAdV vaccines and anti-adenovirus therapeutics.

Food rejection is associated with tactile sensitivity and tactile appreciation in three-year-old children.

Food rejections are common in young children and often include healthy foods, hereby impairing the quality of their diet. Previous studies indicate that food texture may play a role in children's food preferences and intake. Building on these findings, as part of an ongoing longitudinal project, the present study investigated whether food rejection is related to tactile sensitivity and tactile appreciation in three-year-old children. A total of 259 children and 289 parents participated in the study. Child food rejection was measured using an ad libitum taste test, in which children were asked to try four different types of vegetables. Next to this, parents reported on their child's food rejection tendencies by completing the Child Food Rejection Scale (CFRS), and indicating their child's liking of 14 vegetables and 11 fruits (Liking of foods). Tactile appreciation was measured using a behavioural Affective Appreciation of Textures (AAT) task, in which children were asked to feel five different objects with their hands and were asked to indicate the pleasantness of the sensation on a three-point smiley-scale. The subscale Touch of the parental questionnaire Sensory Profile (SP-t) was further used to measure tactile sensitivity. Results show that stronger food rejection measured using an ad-libitum taste test is related to a dislike of textures measured using the AAT task. Similarly, parent-reported food rejection measured using CFRS and Liking of foods is positively related to parent-reported tactile sensitivity measured using SP-t. Together, these findings suggest that some children do not only reject food because of its taste, but also because of their dislike of textures. To increase healthy food intake in picky children, it may thus prove helpful to improve children's appreciation of textures.

Markers of Environmental Enteric Dysfunction Are Associated with Poor Growth and Developmental Outcomes among Young Children in Lusaka, Zambia

Markers of Environmental Enteric Dysfunction Are Associated with Poor Growth and Developmental Outcomes among Young Children in Lusaka, Zambia

Development and Validation of an Assessment-Driven Behavioral Intervention for Primary Complex Motor Stereotypies in Young Children.

Complex motor stereotypies are rhythmic, repetitive, fixed, and non-goal directed movements (e.g., bilateral flapping/waving movements of the hands/arms). Movements typically begin in early childhood and can occur in otherwise normally developing ("primary") or autistic ("secondary") children. Stereotypies persist, occur multiple times a day, have prolonged durations, can be socially stigmatizing, and may lead to bullying and isolation. Prior behavioral treatment studies have focused on older children (ages 6-12) and report modest reductions in stereotypy (i.e., between 14% and 33%). The current study involves the functional assessment and treatment of five children with Primary Complex Motor Stereotypy using a modified awareness training procedure, differential reinforcement of other behavior, and schedule thinning in a nonconcurrent multiple baseline design. Results suggest a 99% reduction of motor stereotypy from baseline across all participants.

Media Use in Daily Routines and Young Children’s Social Skills

ABSTRACT Research Findings: The current study examined (1) whether children’s media use during afterschool or bedtime routines, beyond their total media use, contributes uniquely to their peer social skills, and (2) whether joint media engagement serves as a protective factor for any negative associations between media use in daily routines and peer social skills. The study followed 459 children in a Midwestern U.S. state from kindergarten to Grade 1. Teachers reported on children’s peer social skills at both time points. Parents reported frequency of media use in afterschool and bedtime routines, daily media use duration, and joint media engagement. Hierarchical linear modeling was utilized to account for class-level clustering effects. Frequency of media use in afterschool routines negatively predicted children’s peer social skills in first grade, controlling for total media use, peer social skills in kindergarten, and demographics. However, media use in bedtime routines did not significantly predict social skills. Neither of these associations was significantly moderated by parental joint media engagement. Practice or Policy: The current results call for future research focused on effective means to regulate children’s media use in their daily routines to foster positive social development.

Development of Self-Determination in Young Children: Strategies to Promote Children’s Self-Determined Action

Development of Self-Determination in Young Children: Strategies to Promote Children’s Self-Determined Action

Characteristics of Fentanyl Toxicity in Very Young Children

Characteristics of Fentanyl Toxicity in Very Young Children

Age Stratification and Prognostic Factor Analysis in Pediatric Differentiated Thyroid Cancer.

Differentiated thyroid cancer (DTC) is rare in the pediatric population. It remains unclear whether younger children are at greater risk of more aggressive disease. We aimed to identify prognostic factors for aggressive pediatric DTC and to define an appropriate age stratification. This retrospective cohort study included all patients aged 18 years or less who were treated for DTC between 1985 and 2021 in a tertiary medical center and were followed up for a minimum of 1.5 years after treatment. Seventy-eight patients were included, all diagnosed with papillary thyroid carcinoma: 30 (38.5%) low-risk, 21 (26.9%) intermediate-risk, and 27 (34.6%) high-risk according to the American Thyroid Association (ATA) risk stratification. The mean duration of follow-up was 11.8 ± 7.8 years. No evidence of disease was documented in 52 patients (66.7%) at 1-year post-treatment and 64 patients (82.1%) at the end of follow-up. On analysis by age, evidence of disease at 1-year post-treatment was found in 66.7% of children younger than 11 years, compared to 25.4% of older children (p = 0.002). There was no significant difference by age in evidence of disease at the last follow-up (p = 0.453). Patients aged <11 years at diagnosis were associated with more aggressive disease features on histopathologic examination, metastatic disease, and high ATA risk level. Patients aged <8 years were associated with more frequent bilateral disease and extrathyroidal extension. Pediatric DTC patients who are younger than 11 years at diagnosis have more aggressive disease features and a lower early remission rate than older patients. Nevertheless, their long-term outcome is satisfactory. 4-retrospective cohort study Laryngoscope, 134:4818-4825, 2024.

Association of nurse–mother partnerships with parenting stress and family resilience among South Korean mothers of children with congenital heart disease

PurposeAdvances in the management of congenital heart disease (CHD) have significantly decreased mortality rates, indicating a need for continuous care as a chronic condition throughout the child's lifespan. This study examined the association of nurse–mother partnerships with parenting stress and family resilience among South Korean mothers of children with CHD. Design and methodsThis descriptive study involved 93 mothers of children aged six years or younger with CHD admitted to a hospital. Data were collected from September to November 2020 and analyzed using SPSS/WIN (version 29.0) for t-tests, analyses of variance, Pearson's correlation coefficient, and multiple regression analyses. ResultsThe means and standard deviations of the nurse–mother partnership, parenting stress, and family resilience were 4.13 ± 0.47, 76.98 ± 16.6, and 56.54 ± 7.86 points, respectively. Parenting stress increased as the number of hospitalizations and surgeries increased and with complex types of CHD. Nurse–mother partnerships were stronger with longer hospital stays. Family resilience was higher with younger children, fewer rehospitalizations, and shorter hospital stays. A positive correlation was found between nurse–mother partnerships and family resilience, and a negative correlation between parenting stress and family resilience. Factors influencing parenting stress included family resilience, rehospitalizations, and complex types of CHD, and those affecting family resilience were nurse–mother partnerships, parenting stress, and the child's age. ConclusionNurse–mother partnerships significantly affect family resilience. Practical implicationsEnhancing nurse–mother partnerships can improve family resilience, which in turn can reduce parenting stress, thus offering guidance for future nursing interventions.

Agency, life satisfaction, hope, potentially traumatic events, trauma symptoms, and psychological signs. A two waves study with a sample of Palestinian children living in different geographical areas

We sought to examine the changes over time regarding children’s agency, life satisfaction, hope, psychological problems, trauma symptoms and potentially traumatic events in areas where warfare, military presence and settler-colonial violence are affecting children’s lives. 965 Palestinian children, 494 males and 471 females, were assessed with the Traumatic Check List, Children Impact of events scale-Revised, Strength and difficulties scale, Children Hope Scale, Brief Multilevel Children Life satisfaction scale, and War Child Agency assessment Scale-Palestinian version. MANOVA and t-tests were run to detect differences between groups and in the two waves of data collection. Findings showed variations that suggested Palestinian children were potentially in danger of not having the capacity to take charge of their lives and losing hope. In contrast, life satisfaction, contrary to our expectations, remained stable. While the number of potentially traumatic events decreased, psychological distress and trauma symptoms among the participants increased. Girls were more hopeful than boys, and the most satisfied children were found in the West Bank. The younger children had more significant trauma symptoms, while the older children were exposed to more potentially traumatic events such as those with fewer siblings. Gaza, Jerusalem, and Bedouin areas had the highest risk of potentially traumatizing events, and children in these areas were the most exposed. Our research study revealed a worrisome decrease in agentic resources and an increase in trauma symptoms because of the widespread armed conflict, impeding their healthy development, life satisfaction and hope for the future.

Universal free school meals and children’s bodyweight. Impacts by age and duration of exposure

We study the impact on children’s bodyweight of switching from means-tested to universal provision of nutritious free school meals in England. We exploit the roll-out of universal provision across Local Authorities to estimate effects at different ages and durations of exposure, based on nurse-collected, population-wide health data for state school children. Exposure to universal free lunches reduces obesity prevalence and BMI among children aged 4–5 and 10–11, but older children’s bodyweights are less responsive than younger children’s. We find tentative evidence that effects may be cumulative, as impacts are largest for those exposed to universal free school meals throughout primary school.

Tubercular dactylitis/Spina ventosa-A rare skeletal form of extrapulmonary tuberculosis.

A 9-year-old girl presented with progressive, painful swelling over the left index finger, associated with local signs of inflammation and restriction of finger movements. After the swelling was punctured using a needle, chronic discharging sinus formed. Examination revealed firm swelling over the right parotid area, bilateral cervical and left axillary lymphadenopathy, and firm swelling over the left index finger with a chronic discharging sinus over the lateral aspect of proximal phalanx. Mantoux intradermal injection was reactive (22x24 mm induration). Blood and pus cultures were sterile. Hand radiograph revealed dactylitis (Figure 1A-C). Fine aspiration and cytology of the cervical lymph node showed degenerated inflammatory cells, epithelioid granuloma and acid-fast bacilli. She was initiated on 4-drug antitubercular therapy (ATT). At 2-months follow-up, she was asymptomatic and had the pain and swelling over the left finger have reduced with significant radiological improvement. Tubercular dactylitis or 'spina ventosa' (wind-filled sail) refers to cystic expansion of short, tubular bones. It is commonly seen in younger children (between 1 and 6 years of age) and adults (between 20 and 50 years of age). A common presentation in endemic areas is presence of a painless, fusiform swelling over a single digit, most commonly the proximal phalanx of index or middle finger as in the index case, or over the metacarpals of middle and ring fingers. Earliest radiological clues include periosteitis followed by gradual destruction of bone and cyst formation in the cavity giving a ballooned-out appearance.

Characteristics and Circumstances of Suicide Among Children Aged 6 to 9 Years: 2006-2021.

Limited research exists on suicide among children aged 5 to 9 years. The objective of this study was to examine characteristics of suicide in children younger than 10 years. Data are from the National Fatality Review-Case Reporting System (NFR-CRS) for years 2006 through 2021 for children aged 6 to 9 years who died by suicide. No suicide deaths were reported in NFR-CRS for children aged ≤ 5 years. Descriptive analyses by demographics and circumstances were conducted. A thematic analysis of prevention recommendations made by child death review teams was performed. From 2006 to 2021, NFR-CRS identified 78 suicide decedents aged 6 to 9 years. The largest share were aged 9 years (72%), male (74%), non-Hispanic Black (42%), and died by hanging (86%) at home (91%). School-related problems (39%), history of child maltreatment (36%), history of mental health services (30%), argument with parents (23%), and familial discord (19%) were common circumstances. Key suicide prevention themes included education for caregivers and school staff, improved behavioral health services, and implementation of school policies and programs. Results provide a more complete picture of suicide among younger children, improving understanding of their unique characteristics. It is recommended that program planners consider both age-appropriateness and the impacts of social (eg, racism) and structural inequities in their approaches to prevention, encompassing both community and school-based strategies. For pediatricians, results emphasize the importance of lethal means counseling, safety planning, and educating parents and caregivers on the distinct warning signs of suicide for younger children.

Bigger versus smaller: Children's understanding of size comparison words becomes more precise with age.

The ability to compare plays a key role in how humans learn, but words that describe relations between objects, like comparisons, are difficult to learn. We examined how children learn size comparison words, and how their interpretations of these change across development. One-hundred-and-forty children in England (36-107 months; 68 girls; majority White) were asked to build block structures that were bigger, longer, smaller, shorter, or taller than an experimenter's. Children were most successful with words that refer to size increases. Younger children were less accurate with smaller and shorter, often building bigger structures. The dimensional aspect of taller emerged gradually. These findings suggest that children's interpretation of the meaning of size comparison words changes and becomes more precise across development.

The use of biologics in food allergy management.

Patients and families living with food allergy may experience significant burdens, including social isolation, impaired quality of life, and anxiety. Allergists/immunologists play a critical role in educating families living with food allergies about risk, particularly with regard to the rarity of fatal food allergy. Appropriate risk framing can greatly decrease the fear-based burden of disease. In 2024, an increasing complex fabric of food allergy treatments has emerged that includes oral immunotherapy (OIT), sublingual immunotherapy (SLIT), and omalizumab, with the promise of additional treatments, including epicutaneous immunotherapy and oral mucosal immunotherapy in the near future. Younger children may be most likely to benefit from OIT and SLIT, with some evidence that suggests the possibility of an immunomodulatory effect. Omalizumab, approved in 2024 for use in conjunction with strict avoidance, increases the threshold of reactivity before a moderate-to-severe reaction for many, but not all, patients. There is no evidence to date that omalizumab has an immunomodulatory effect, and young children treated with omalizumab monotherapy may bear a lost opportunity cost from possible immunomodulation would they have been treated with OIT or SLIT instead; however, within a shared decision-making paradigm, beyond label use of omalizumab may include treatment with OIT or SLIT. Fortunately, the co-evolution of shared decision-making with modern food allergy treatments will facilitate the critical preference-sensitive care that must be characteristic of all decisions surrounding active food allergy management.