Young Toddlers Research Articles

Psychometric properties of the preschool strengths and difficulties questionnaire (SDQ) in UK 1-to-2-year-olds.

The SDQ demonstrated satisfactory psychometric properties, suggesting that it may be a useful tool for the detection of early mental health difficulties, particularly externalising symptoms, even in very young toddlers. Further research is needed to validate the SDQ in younger populations and to establish cut-off scores for clinical interpretation. The implications of these findings are discussed. • Clinically significant emotional and behavioural problems can and do emerge in early toddlerhood. • Parenting interventions can reduce mental health problems. • Valid, reliable, brief, and affordable tools are needed to identify very young children who may benefit from such support. • The Strengths and Difficulties Questionnaire was found to have acceptable factor structure and psychometric properties for use with young children aged 1-2 years old in the UK. • The externalising subscale in particular shows promise as an early screening tool.

Are Late Talkers Just Late? Neighborhood Density and Word Frequency Properties of Late Talkers' Spoken Vocabularies.

Typically developing toddlers extract patterns from their input to add words to their spoken lexicons, yet some evidence suggests that late talkers leverage the statistical regularities of the ambient language differently than do peers. Using the extended statistical learning account, we sought to compare lexical-level statistical features of spoken vocabularies between late talkers and two typically developing comparison groups. MacArthur-Bates Communicative Developmental Inventories American English Words and Sentences (N = 1,636) were extracted from Wordbank, a database of CDIs. Inventories were divided into three groups: (a) a late talker group (n = 202); (b) a typically developing age-matched group (n = 1,238); and (c) a younger, typically developing group (n = 196) matched to the late talkers on expressive language. Neighborhood density and word frequency were calculated for each word produced by each participant and standardized to z scores. Mixed-effects models were used to evaluate group differences. The late talker and younger, language-matched groups' spoken vocabularies consist, on standardized average, of words from denser phonological neighborhoods and words higher in frequency of occurrence in parent-child speech, compared to older, typically developing toddlers. These findings provide support for the extended statistical learning account. Late talkers appear to generally be extracting and using similar patterns from their language input as do younger toddlers with similar levels of expressive vocabulary. This suggests that late talkers may be following a delayed, not deviant, trajectory of expressive language growth.

Age-related Variation in Sleep-dependent Obstruction in Surgically Naive Children.

Little is known about age-related variations in sites and grade of sleep-dependent airway obstruction in children with obstructive sleep apnea (OSA) or obstructive sleep-disordered breathing (oSDB). The objective was to compare sites and grade of obstruction on drug-induced sleep endoscopy (DISE) across different age groups of surgically naïve children with OSA or oSDB. A retrospective chart review was performed for surgically naïve children aged 0-18 years with OSA/oSDB who underwent DISE from July 2021 to August 2023. Participants were categorized into: infants (aged 0-1 years), younger toddlers (aged 1-2 years), older toddlers (aged 2-3 years), preschool (aged 3-5 years), younger school-aged (aged 5-10 years), and older school-aged (aged 10-18 years). On DISE, obstruction was rated 0 = none/mild, 1 = moderate, 2 = severe for inferior turbinates, adenoid, velum, palatine tonsils/lateral pharyngeal wall, lingual tonsils, tongue base, epiglottis, and supra-arytenoid tissue. A series of multiple regression analyses were used to identify age differences in the grade of obstruction across all sites combined and at each individual site separately. The sample consisted of 252 children aged 1 month to 17 years with 57.9% males. Older patients had greater total obstruction scores (B = 0.42, SE = 0.10, p < 0.01) and greater number of sites that were severely obstructed (B = 0.11, SE = 0.05, p = 0.03). Older age groups had more obstruction at inferior turbinates (p = 0.02), adenoid (p < 0.01), palatine tonsils/lateral pharyngeal wall (p < 0.01), lingual tonsil (p < 0.01), and base of tongue (p < 0.01). Younger age groups had more obstruction at the supra-arytenoid tissue (p < 0.01). Varying patterns of sleep-dependent airway obstruction should be expected across different age groups in children with OSA or oSDB. 3 Laryngoscope, 2024.

Characteristics of patients admitted to the intensive care unit during the 2019 measles epidemic in Samoa: A retrospective clinical case series.

Our report describes the characteristics of patients admitted to the intensive care unit of the National Hospital of Samoa during the 2019-2020 measles epidemic. The study design was a retrospective review of clinical records; the age range was 2 months to 51 years, with the majority of cases in the 2-23 month age group (71%). Vaccination status was unknown or unrecorded for 17 (24%). Of the 54 (75%) who were not fully vaccinated, 35 (65%) did not survive. Almost all (98%) presented with multiple complications on admission, mostly pneumonia (91%). The mortality rate was 61%, implying a low survival rate particularly among young infants and toddlers, even when optimal care was available and administered.

Current options in obesity pharmacotherapy for children and adolescents

Obesity is pervasive from infancy to adulthood and presents a major challenge to healthcare systems worldwide. In children and adolescents, the prevalence of overweight and obesity continues to increase, especially in classes II and III, and in younger toddlers and preschool-aged children. Childhood obesity may be associated with comorbidities in all organ systems and increased cardiovascular risk, as it tracks into adolescent and adult obesity. Although intensive health and behavior lifestyle treatments form the foundation of obesity treatment, there are limitations in the extent and maintenance of weight loss with lifestyle modifications alone. The offering of obesity pharmacotherapy in adjunct to intensive lifestyle treatment in children aged &gt; 12 years may improve outcomes in pediatric obesity. In this review, we discuss currently approved medications for childhood and adolescent obesity, focusing on orlistat, phentermine monotherapy, glucagon-like peptide-1 receptor agonists (liraglutide and semaglutide injections), and phentermine/topiramate combination.

Gendered pathways to socioemotional competencies in very young children

Parent–child and teacher–child relationship closeness have been shown to be crucial for children’s development of socioemotional competencies from preschool to school-age stages. However, less is known about the importance of developing close relationships with young infants and toddlers attending childcare group settings for their early socioemotional development. The current study aimed to address this gap and to explore how child gender may influence the associations. Participants included 378 Hong Kong Chinese children (196 girls; Mage = 22.05 months, SD = 9.81 months) enrolled in childcare centres, along with their parents and teachers. Parents reported on children’s socioemotional competencies as well as their relationship closeness with children; teachers reported on their relationship closeness with children. Multiple group structural equation modelling was used to analyse the results. The findings showed that both parent–child and teacher–child closeness were positively associated with children’s social competence, while teacher–child closeness was negatively associated with children’s anxiety behaviour. Parents of girls reported greater parent–child closeness, higher levels of social competence, and higher levels of anxiety behaviours compared to parents of boys. Furthermore, teacher–child closeness was significantly associated with social competence exclusively among girls, while parent–child closeness was significantly associated with anxiety behaviours solely among boys. Findings are discussed in terms of the role of child gender in influencing the associations between parent–child closeness, teacher–child closeness, and children’s socioemotional competencies in the earliest years.

Evaluating the effect of recombinant human growth hormone treatment on sleep-related breathing disorders in toddlers with Prader–Willi syndrome: a one-year retrospective cohort study

BackgroundRecombinant human growth hormone (rhGH) therapy is beneficial for children with Prader–Willi syndrome (PWS) in improving short stature and metabolism, but the effect of early rhGH treatment on respiratory and sleep parameters for PWS children under three years old remains elusive. Thus, this study aimed to investigate the impact of rhGH treatment on sleep-related breathing disorders (SRBDs) for toddlers with PWS.MethodsA total of 17 age-matched PWS patients receiving rhGH treatment (rhGH group) and 17 control individuals not receiving rhGH treatment (non-rhGH group) were recruited for this study between October 2018 and January 2023. Data related to polysomnography-polygraphy (PSG) and serum levels of insulin-like growth factor (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP-3) were collected.ResultsThe mean age in the rhGH group was 20.76 ± 9.22 months, which was comparable to that of the non-rhGH group (25.23 ± 13.81 months). The demographic and anthropometric parameters were similar across the two groups after 52 weeks of treatment. Administration of rhGH to toddlers did not exert adverse effects on the obstructive apnea–hypopnea index (OAHI), central apnea index (CAI), oxygen desaturation index (ODI), mean percutaneous oxygen saturation (SpO2), lowest SpO2, duration when SpO2 is lower than 90%, or proportion of the patients with SpO2 lower than 90%. Furthermore, the increased IGF-1 z-score and IGFBP-3 level did not worsen SRBDs.ConclusionTreatment with rhGH for 52 weeks on young toddlers with PWS showed no deleterious effects on SRBDs. This shed more light on the importance of initiating rhGH therapy early in PWS patients.

“A Complex Conundrum”- Fanconi-Bickel Syndrome

Fanconi-Bickel Syndrome (FBS) is a rare form of Glycogen Storage Disease (GSD) type 11 characterised by massive hepatomegaly due to the buildup of glycogen and severe hypophosphatemic rickets due to a proximal renal tubular dysfunction. Since 1940, it has been initially known as hepatorenal glycogenesis with proximal renal tubular dysfunction. It is due to a pathogenic mutation of the GLUT-2 (glucose transporter) gene. Herein, present case report a young toddler who is the firstborn of 3rd-degree consanguinity, presented with rickets, recurrent respiratory tract infections, and hepatomegaly, and was subsequently diagnosed with FBS with the help of genetic studies, showing a mutation in the GLUT-2 gene. With less than 200 cases reported so far, this child represents a unique case with recurrent respiratory infections and developmental delay as presentations along with rachitic features.

IMPLEMENTASI PROGRAM INTERVENSI GIZI SPESIFIK PADA REMAJA PUTRI DAN BALITA DI PUSKESMAS PATEAN KABUPATEN KENDAL

The scope of implementing specific nutrition intervention programs at the Patean Health Center for young women and toddlers in 2021 and 2022 was still not in line with the national target. This study aimed to analyze the implementation of a specific nutrition intervention program for girls and toddlers at the Patean Health Center. This research was a qualitative research with a descriptive approach through in-depth interviews conducted from January to July 2023. The data processing method used content analysis.The results showed that the implementation of the specific nutrition intervention program for young women and toddlers are not optimal. Obstacles in the activities of young women are caused by unclear communication, limited and inadequate support facilities and fragmentation that is not in accordance with policy. Obstacles in toddler activities are caused by limited quality of posyandu cadres, limited budget and inadequate supporting facilities. It can be concluded that the implementation of specific nutrition intervention programs for girls and toddlers at the Patean Public Health Center is not optimal because it is influenced by communication factors, resources, attitudes and bureaucratic structures

Carotid Artery Patency and Neurodevelopmental Outcomes After Decannulation in Pediatric Extracorporeal Life Support

IntroductionDecannulation from veno-arterial extracorporeal life support may involve ligation or repair of the carotid artery; however, differences in outcomes are not clear. This study aimed to describe short- and long-term artery patency and neurodevelopmental outcomes in neonatal and pediatric patients who underwent carotid artery repair (CAR) versus ligation at decannulation. MethodsPatients supported on veno-arterial extracorporeal life support during the first 15 mo of life from 2010 to 2020 at a large, tertiary care children's hospital were included. Decannulation strategy, postdecannulation imaging, and follow-up visits were reviewed. Results74 patients were identified with median age at cannulation 2 d (interquartile range [IQR] = 1-21 d) and median weight 3.7 kg (interquartile range= 3.2-4.4 kg). Indications included congenital cardiac conditions (27%), congenital diaphragmatic hernia (19%), pulmonary hypertension (19%), meconium aspiration (16%), and pneumonia/sepsis (14%). Forty-two patients (57%) underwent CAR. Patients on extracorporeal life support >5 d were 95% less likely to undergo CAR (P < 0.001). Of CAR patients, 18 (43%) had doppler ultrasound performed within the 2-y follow-up period. Ten of 18 patients (55.6%) had >50% stenosis (3) or complete occlusion (7). Only 36% (27/74) had formal neurodevelopmental follow-up within 6 mo and 41% (30/74) within 2 y; however, no significant differences in function were seen between groups. ConclusionsNeonates and young toddler patients undergoing CAR following extracorporeal life support decannulation are at risk for partial or complete artery occlusion. In our study population, repair and ligation at decannulation appear to have similar neurodevelopmental outcomes; however, follow-up to assess function is not standardized. Longer term follow-up and risk stratification are needed to guide decannulation strategy.

Bibliometric analysis on principles of digital content creation for toddlers

oung toddlers’ early experience of digital screen-watching engagement is extraordinary for their first three years of cognitive, language, physical, social, and emotional development. While previous studies have doc-umented that toddlers’ digital use negatively impacts from an ecological perspective. However, some work has shown that digital screen media opens learning outcomes for toddlers around three years old. Besides, there are significant literature gaps related to well-designed, theoretically proven, empirically researched principles of digital content creation for young toddlers. Therefore, the present study used inclusion and ex-clusion criteria, a PRISMA (The Preferred Reporting Items for Systematic reviews and Meta-Analyses) flow chart, and screening research hot spots to reveal the principles of creating digital content for toddlers aged 0 to 3. Bibliometric analysis on research hotspots and leading researchers’ publications evokes constitute the trends in digital content creation and consumption. The findings showed a compilation of eleven principles of digital content creation for young screen consumers based on the screening process from the Dimension data-base. This study used the bibliometric analysis method to seek publications on principles of digital content creation for young toddlers to provide further research directions in empirical research

MAPPING SPREAD OF COVID-19 CASES IN TODDLERS AND CHILDREN AT CENTRAL JAVA USING K-MEANS CLUSTER

Background: Toddlers and children under 12 are still easily sick, particularly during the COVID-19 epidemic. The high number of COVID-19 cases in toddlers and children in Central Java Province must be monitored to prevent transmission to toddlers and children still susceptible to the disease. Purpose: The purpose of this study was to map the spread of COVID-19 cases in toddlers aged 0-5 years and children aged 6-11 years in the province of Central Java using the K-means cluster Methods: This was a descriptive observational study with a cross-sectional design. Data on COVID-19 cases in children 6-11 years and toddlers 0-5 years from 35 cities in Central Java in 2020-2021 were analyzed using the K-means cluster. The K-means cluster was used to cluster low, medium, and high cases and then map the spread of COVID-19. Results: Semarang, Semarang Regency, Boyolali, Klaten, Surakarta, and Banyumas became high cluster areas in cases of COVID-19 toddlers and children in 2021. Based on the mapping data, COVID-19 spread in young children and toddlers in 2020 and 2021 followed a nearly identical pattern. The high zone of COVID-19 in toddlers and children mostly had a higher total population, healthcare facilities, and population density than the medium and low zones. Conclusion: Semarang City, Semarang Regency, Boyolali, Klaten, Surakarta, and Banyumas should be looking for COVID-19 cases in toddlers and young children.

Rare Oral Hemangioma in Pregnancy: A Case Series Providing Clinical Insight into Patient Care.

BACKGROUND Hemangiomas are defined as benign soft tissue vascular tumors that are histologically classified as capillary, cavernous, or mixed types. Hemangiomas can also be described based on clinical appearance as superficial, mixed, or deep lesions. Following a thorough search, only 3 case reports of superficial protruding lip mass were found in the literature. Other cases of tongue hemangioma have been reported in infants or young toddlers, and only rarely in adults. CASE REPORT The first case was a 43-year-old pregnant woman, with an unremarkable medical and surgical history, in the second trimester who presented to the Otolaryngology Clinic with a chief concern of a progressively growing lesion, measuring 0.7×0.5 cm, over the lateral right side of the tongue for the last 2 weeks after accidentally biting her tongue during dinner. The second case was a 26-year-old woman with unremarkable medical and surgical history who presented to our Otolaryngology Clinic with a chief concern of a non-painful soft fungating pink-red lip lesion 1.5×1 cm across the right lower lip growing for the last 4 months. This lesion appeared during the third trimester of pregnancy following a lip injury that was described as minor trauma. CONCLUSIONS Although hemangiomas can occur anywhere on the body, they are most commonly found in the head and neck. These lesions are usually recognized quickly by patients and treating physicians and are thus clinically diagnosed. Most vascular benign lesions regress on their own, but if detected early, they are surgically excised for cosmetic and functional reasons.

Microbial and immune faecal determinants in infants hospitalized with COVID-19 reflect bifidobacterial dysbiosis and immature intestinal immunity

The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly worldwide, seriously endangering human health. Although SARS‐CoV‐2 had a lower impact on paediatric population, children with COVID-19 have been reported as suffering from gastrointestinal (GI) symptoms at a higher rate than adults. The aim of this work was to evaluate faeces as a source of potential biomarkers of severity in the paediatric population, with an emphasis on intestinal microbiota and faecal immune mediators, trying to identify possible dysbiosis and immune intestinal dysfunction associated with the risk of hospitalization. This study involved 19 patients with COVID-19 under 24 months of age hospitalized during the pandemic at 6 different hospitals in Spain, and it included a comparable age-matched healthy control group (n = 18). Patients and controls were stratified according to their age in two groups: newborns or young infants (from 0 to 3 months old) and toddlers (infants from 6 to 24 months old). To characterize microbial intestinal communities, sequencing with Illumina technology of total 16S rDNA amplicons and internal transcribed spacer (ITS) amplicons of bifidobacteria were used. Faecal calprotectin (FC) and a range of human cytokines, chemokines, and growth factors were measured in faecal samples using ELISA and a multiplex system. Significant reduction in the abundance of sequences belonging to the phylum Actinobacteria was found in those infants with COVID-19, as well as in the Bifidobacteriaceae family. A different pattern of bifidobacteria was observed in patients, mainly represented by lower percentages of Bifidobacterium breve, as compared with controls. In the group of hospitalized young infants, FC was almost absent compared to age-matched healthy controls. A lower prevalence in faecal excretion of immune factors in these infected patients was also observed.Conclusion: Hospitalized infants with COVID-19 were depleted in some gut bacteria, such as bifidobacteria, in particular Bifidobacterium breve, which is crucial for the proper establishment of a functional intestinal microbiota, and important for the development of a competent immune system. Our results point to a possible immature immune system at intestine level in young infants infected by SARS-CoV2 requiring hospitalization.What is Known:• Although SARS‐CoV‐2 had a lower impact on paediatric population, children with COVID-19 have been reported as suffering from gastrointestinal symptoms at a higher rate than adults.• Changes in microbial composition have been described in COVID-19 adult patients, although studies in children are limited.What is New:• The first evidence that hospitalized infants with COVID-19 during the pandemic had a depletion in bifidobacteria, particularly in Bifidobacterium breve, beneficial gut bacteria in infancy that are crucial for the proper establishment of a competent immune system.• In young infants (under 3 months of age) hospitalized with SARS-CoV2 infection, the aberrant bifidobacterial profile appears to overlap with a poor intestinal immune development as seen by calprotectin and the trend of immunological factors excreted in faeces.

Auditory influences on walking: Children's walking to the beat.

Research on the multisensory control of locomotion has demonstrated that adults exhibit auditory-motor entrainment across an array of contexts. In such work adults will consciously modulate the cadence of their walking when instructed to match their footfalls to an auditory metronome equal to, slower than, or faster than, their natural walking cadence. The current study extends such investigations to young toddlers between 14 and 24 months (n = 59, drawn from Toronto, Ontario), as well as adults (n = 20, drawn from Toronto, Ontario), demonstrating that even new walkers will modify their gait when presented with auditory input at or faster than their natural walking cadence. Additionally, the current study demonstrates that such modulations will occur in the absence of explicit instructions to modify gait for both toddlers and adults, suggesting an automatic level of auditory-motor entraining across ages. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Correction of Habit along with Laser Assisted Frenectomy in High Frenal Attachment - A Case Report

Digit sucking is the most prevalent oral fixation seen in young toddlers. Digit sucking can be brought on by fatigue, boredom, excitement, hunger, fear, and both mental and physical stress. If these practices persist until the preschool years, when permanent teeth start to erupt, they may operate as a substantial environmental etiological factor in the development of malocclusion. The diode laser can be used to successfully remove pathological frenum. The diode laser can be used in paediatric dentistry due to its application, adequate coagulation, lack of need for sutures, and decreased discomfort and inflammation. In the case study presented in this paper, an 8-year-old female patient who had a high frenal attachment and had thumb-sucked her entire life was treated with fixed appliance therapy and laser labial frenectomy. In addition to resolved malocclusion, acceptable secondary intention wound healing, and beginning functional recovery of a physiological upper lip movement, the clinical evaluation revealed that the malocclusion had been corrected. The surgery was well tolerated, according to the patient. Keywords: Thumb sucking, Fixed appliance therapy, Laser frenectomy

Pronoun comprehension and cross-linguistic influence in monolingual and bilingual children

Aims and objectives/purpose/research questions: Pronoun comprehension can present challenges for young bilingual and monolingual children. The current study aimed to assess cross-linguistic influence (CLI) and pronoun comprehension in early childhood. Several studies have demonstrated the role of overlap across languages and its impact on language development. The present study investigates the influence of the acquisition of another language containing third-person pronouns on pronoun comprehension in English. Additional possible social influences are also discussed. Design/methodology/approach: In addition to the completion of language surveys and vocabulary tests, toddlers and preschoolers were presented with a forced-choice test to identify the pronouns ‘he/she/it’ between a man doll, a woman doll, a ball, and a monkey. Data and analysis: Accuracy in pronoun comprehension was analysed based on age and preschooler’s accuracy was compared across language groups (monolingual in English, bilingual with and without third-person pronouns). Findings/conclusions: Overall, the results demonstrated that, although young toddlers were able to comprehend ‘it’, children struggled with ‘he’ and ‘she’ until 3 years of age. In addition, bilingual preschool children that were learning a language that distinguished between the third-person pronouns, ‘he’ and ‘she’, performed similarly to monolingual English-speaking children and both groups performed better than bilingual children learning a language that did not distinguish between ‘he’ and ‘she’. The findings are discussed in the context of within- and between-language factors that can impact comprehension. Originality: Most recent research on early pronoun development involves production. This study presents evidence of early pronoun comprehension and investigates the role of CLI in this difficult, yet common component of language. Significance/implications: The results suggest that learning a language with different features can negatively impact pronoun comprehension in another language. The findings are discussed in the context of an integrated system for bilinguals.

The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination.

The AIUM Practice Parameter for the Performance of the Musculoskeletal Ultrasound Examination.

Infant Fecal Fermentations with Galacto-Oligosaccharides and 2'-Fucosyllactose Show Differential Bifidobacterium longum Stimulation at Subspecies Level.

The objective of the current study was to evaluate the potential of 2'-FL and GOS, individually and combined, in beneficially modulating the microbial composition of infant and toddler (12-18 months) feces using the micro-Matrix bioreactor. In addition, the impacts of GOS and 2'-FL, individually and combined, on the outgrowth of fecal bifidobacteria at (sub)species level was investigated using the baby M-SHIME® model. For young toddlers, significant increases in the genera Bifidobacterium, Veillonella, and Streptococcus, and decreases in Enterobacteriaceae, Clostridium XIVa, and Roseburia were observed in all supplemented fermentations. In addition, GOS, and combinations of GOS and 2'-FL, increased Collinsella and decreased Salmonella, whereas 2'-FL, and combined GOS and 2'-FL, decreased Dorea. Alpha diversity increased significantly in infants with GOS and/or 2'-FL, as well as the relative abundances of the genera Veillonella and Akkermansia with 2'-FL, and Lactobacillus with GOS. Combinations of GOS and 2'-FL significantly stimulated Veillonella, Lactobacillus, Bifidobacterium, and Streptococcus. In all supplemented fermentations, Proteobacteria decreased, with the most profound decreases accomplished by the combination of GOS and 2'-FL. When zooming in on the different (sub)species of Bifidobacterium, GOS and 2'-FL were shown to be complementary in stimulating breast-fed infant-associated subspecies of Bifidobacterium longum in a dose-dependent manner: GOS stimulated Bifidobacterium longum subsp. longum, whereas 2'-FL supported outgrowth of Bifidobacterium longum subsp. infantis.

Etiology, pathophysiology, and management of Allergic Asthma in Children’s

Many young toddlers experience frequent chest discomfort, wheezing, and coughing. Before the age of six, one-third of preschoolers experience these symptoms, yet only 40% of these wheezing preschoolers go on to develop asthma. The majority of youngsters in older school-aged children suffer asthma. Controlling asthma affects quality of life. Only a small portion of patients who receive asthma therapy succeed in controlling their condition. Even if co-morbidities, an erroneous diagnosis, or subpar inhaling technique could be to blame, non-adherence is frequently the main factor in therapy failures. Non-pharmacological interventions focus on avoiding cigarette smoke and avoiding allergens when a child is allergic. The GINA and the British Guideline for the Therapy of Asthma are two international standards for pharmacological management.