Young Children Ages Research Articles

A Systematic Review of the Existing Evidence on Early Year Interventions for Trauma and Violence Prevention.

Exposure to violence in early childhood is considered a public health issue and is a significant predictor of becoming a victim or perpetrator of violence later in life. There has been a significant increase in violence intervention and prevention programs that are available for children and young people; however, there are few evidence-based interventions for younger children. This review systematically explores the existing impact evidence for available intervention and prevention programs targeted at young children (ages 3-8) across the United States and United Kingdom. It also explores the feasibility and methodological issues faced with school-based prevention work. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, six electronic databases were systematically searched. Of the initial 766 articles, 13 met the final inclusion criteria. The findings showed that early intervention programs for vulnerable children can promote prosocial behaviors and protective factors. Outcomes included improved academic achievement, implementation of Social Emotional Learning-based learning, decrease in violence and criminal justice-related outcomes, and increased resiliency and emotional development among children. Evidence also showed that trauma-informed training for staff and teachers can increase teacher awareness of trauma and the importance of trauma-informed practices. Most programs showed a positive change in children as a result of early intervention programs. We discuss important issues for policy and practice in early years teaching, particularly for high-risk populations, and the importance of trauma-informed practices in the long-term, public health approach to violence prevention and reduction. We also highlight important areas for future research on violence prevention programs.

Intervention and Sampling Trends in Literacy Research for Young Augmentative and Alternative Communication Users: A Scoping Review.

This scoping review aims to characterize the body of literature addressing literacy interventions involving young children (ages 2-8 years) who use or would benefit from aided augmentative and alternative communication (AAC). A systematic search was conducted in six databases. The search yielded 33 intervention studies. Participant characteristics (i.e., age, gender, communication profile) were charted along with intervention characteristics (i.e., focus, outcome variables, settings, interventionists, aided AAC materials). Findings provide insight into intervention and sampling trends. Specifically, studies predominantly investigated shared reading interventions to support expressive communication with children who were already symbolic communicators. There was a noticeable lack of studies involving children with multiple disabilities including intellectual disabilities. The review highlights the necessity for more inclusive research that represents the diverse communication and disability profiles of young children who use or would benefit from aided AAC. Future studies should aim to include participants with varying abilities and access methods. Additionally, the emphasis on emergent literacy, particularly shared reading, should be expanded to include comprehensive emergent literacy skills such as generative writing, phonological awareness, and language comprehension. This broader focus will better support the literacy development of young children who use or would benefit from aided AAC.

Mental health and care seeking patterns of Middle Eastern and North African immigrant children in the United States.

To determine the prevalence of childhood mental and emotional health concerns and care seeking patterns among foreign-born MENA children compared to US- and foreign-born White children before and after adjusting for covariates. Data from the 2000-2018 National Health Interview Survey (NHIS) were analyzed. Poor toddler mental health in the past two months (2-3 years) and childhood emotional difficulties (4-17 years) in the past six months were measured. Parents also reported whether (yes/no) their child saw a doctor for behavioral or emotional concerns in the past 12 months. Parents of foreign-born MENA young children (ages 2-3 years) were less likely to report mental health concerns (44.8%) compared to US-born White counterparts (67.3%; p <.05). Parents of foreign-born MENA children were less likely to report emotional difficulties compared to US- and foreign-born White children (21.9% and 19.3%, respectively; p's < 0.05). Foreign-born MENA children with mental or emotional health concerns had lower odds of seeing a doctor in the last 12 months for emotional/behavioral problems (OR = 0.45; 95% CI = 0.24-0.86) or mental health concerns (OR = 0.47; 95% CI = 0.27-0.83) compared to their US-born White counterparts after adjusting for sociodemographic factors. Parents of foreign-born MENA children reported fewer mental and emotional health concerns compared to US-born Whites. Those with mental and emotional health concerns were less likely to seek mental health care compared to their US-born White counterparts. Further research is needed to confirm and expand on these findings once a unique racial/ethnic identifier for MENA children is made available for measuring national mental health statistics.

Association between sick child facility readiness and quality of care at the individual and facility level in five low- and middle-income countries

BackgroundRaising the quality of health services is key to continued progress in improving child health, however, data on service quality are limited and difficult to interpret. The relationship between facility readiness and the quality of care is complex.MethodsUsing publicly available data sets from five low- and middle-income countries (LMICs), we assessed the relationship between structural factors and the clinical quality of care for managing sick children. We developed indices for readiness and quality accounting for available indicators, expert opinion, and alignment with integrated management of childhood illness (IMCI) guidelines. In each country, we assessed the association between readiness and quality, with and without adjusting for other factors. We considered associations overall, by domain, and by provider type, explored non-linear associations, and compared associations at the individual and facility-level.ResultsThe analysis included data from 3,149 health facilities and 11,159 sick child observations. In four of the five countries included in the analysis, we observed for every 10%-point increase in readiness, quality increased by about 1% point after adjusting for facility type and managing authority. There was little evidence of a non-linear relationship or a threshold effect altering the relationship between readiness and quality of care. Beyond readiness, younger child age, higher cost of care, and having a respiratory, digestive, or febrile diagnosis were most often associated with a higher quality of care. Higher “human resources” readiness domain scores were most consistently associated with better quality of care, while the quality of care domain of “treatment” was the least influenced by readiness. Facility-level associations did not vary greatly from individual-level associations.ConclusionsThe weak correlation observed suggests readiness plays an important role in quality but as currently measured cannot be used to characterize clinical quality of care. Data for assessing quality of health services are limited, presenting challenges for understanding impediments, assessing interventions, and gauging changes in the quality of care over time. We need better data to assess the quality of care being delivered in LMICs to understand what factors drive quality, with the goal of improving the management of sick children.

Executive Function and young children's Cardinality Principle: the mediating role of the Approximate Number System and the moderating role of age.

Executive Function and the Approximate Number System are well-established as critical components in developing the Cardinality Principle in young children. However, most existing studies explore the relationship between these variables in isolation without examining whether Approximate Number System mediates the relationship between Executive Function and the Cardinality Principle and the role of age in this. This study aimed to address this gap by investigating the mediating role of the Approximate Number System in the relationship between Executive Function and the Cardinality Principle and the moderating role of age in young children. This cross-sectional study was conducted in China from February to June 2024. A total of 203 young children (97 boys and 106 girls, Mean age = 68.93 ± 7.076 months) participated. Participants were assessed using a range of tests: the Day-Night Stroop Task, Digit Recall Task, Dimensional Change Card Sort Task, Panamath Test Software, How Many Task, and Give-N Task to measure Executive Function, Approximate Number System, and Cardinality Principle. Data were analyzed using SPSS 26.0 and PROCESS v4.1 (Model 4) to explore the relationships among Executive Function, the Approximate Number System, and the Cardinality Principle through Pearson correlations, multivariate regression, and mediation analysis with 5000 bootstrap samples. Correlation analysis revealed that the Cardinality Principle was significantly and positively correlated with Inhibitory Control, Working Memory, Cognitive Flexibility, Executive Function, and the Approximate Number System. Regression analyses indicated that Executive Function positively predicted young children's Cardinality Principle. Specifically, Working Memory and Cognitive Flexibility were positive predictors of the Cardinality Principle, while Inhibitory Control was not. Mediation analysis results demonstrated that the Approximate Number System mediated the relationships between Inhibitory Control and the Cardinality Principle, Working Memory and the Cardinality Principle, and Cognitive Flexibility and the Cardinality Principle, respectively. In addition, the study found that young children's age negatively moderated the relationship between the Approximate Number System and the Cardinality Principle. The study emphasizes that in developing young children's Cardinality Principle, emphasis should be placed on improving their Executive Function and Approximate Number System while considering the age differences of young children and developing appropriate educational methods for different age groups.

No effect of napping on episodic foresight and prospective memory in kindergarten children.

Preschool children often have problems in remembering to carry out a planned behaviour. This study investigated the impact of napping on episodic foresight (planning for future events) and prospective memory (remembering to perform an action in the future) in 2-3-year-old children. In a quasi-experimental design, we compared children who napped (nap condition, n = 20) after receiving information about an upcoming problem (episodic foresight task) and a delayed intention (prospective memory task) with those who stayed awake (wake condition, n = 43). We hypothesised that napping would improve performance in the episodic foresight and the prospective memory tasks. Contrary to the hypothesis, napping did not significantly affect children's episodic foresight or prospective memory performance, even after controlling for the group difference in age. Task performance was primarily explained by memory effects and age. Further research that incorporates stricter controls and evaluates pre-nap memory strength is necessary fully to elucidate the complex interplay between napping, age, episodic foresight, and prospective memory performance in young children.

Prehospital Restraint Use in Pediatric Patients With Mental and Behavioral Health Emergencies.

The aims of the study are to characterize children with mental and behavioral health conditions (MBH) transported by emergency medical services (EMS) and examine differences in patient, emergency department (ED), and EMS transport characteristics based on restraint interventions during EMS transport. This is a retrospective cohort study of EMS patients with MBH crises, aged 5-18, transported to 2 pediatric EDs over 9 years. Demographic and ED data were collected electronically; EMS data were extracted manually from prehospital care records. Field interventions studied included pharmacologic and mechanical restraints by EMS clinicians. Univariate analysis compared variables between patients who received EMS restraints and those who did not and multivariable logistic regression identified patient factors independently associated with EMS restraint use. Among 10,264 patients transported by EMS for MBH crises, 1400 encounters were randomly selected, with 768 records available. EMS restraint interventions were used in 73 (9.5%) patients: 5 (0.7%) received only pharmacologic restraints, 58 (7.6%) received only physical restraints, and 10 (1.3%) received both. Those who received EMS restraints were more likely to be younger (35.6% vs 19.6%, P = 0.001), male (71.2% vs 44.6%, P < 0.0001), and had longer scene times (13 vs 9 min). Restraint use was more common when patients were picked up from schools (30.1% vs 14.8%, P = 0.007). EMS-restrained patients were also more likely to receive physical (12.3% vs 2.3%, P < 0.0001), mechanical (15.1% vs 1.0%, P < 0.0001), or pharmacologic (24.7% vs 3.9%, P < 0.0001) restraints in the ED. Predictors of EMS restraint use were male sex (odds ratio, 3.00; 95% confidence interval, 1.74-5.17) and being picked up from schools (odds ratio, 2.08; 95% confidence interval, 1.13-3.81), whereas age group, race, and insurance type were not independent predictors. Nearly 1 in 10 pediatric patients experiencing mental health crises and transported by EMS required restraint interventions in the field. Male patients, younger aged children, and those picked up from school represent a distinct and vulnerable population that could benefit from specialized prehospital care to manage agitation.

The Limping Child: A Guide for the Trainees.

Limping is a common presenting complaint in children. Despite this, it remains to be a diagnostic challenge for treating physicians due to an expanded list of etiologies. It arises from a spectrum of disorders, ranging from physiological variations of gait at different stages of development to systemic causes, such as inflammatory diseases or musculoskeletal infections. On rare occasions, non-musculoskeletal causes could result in limping. The diagnostic challenge increases in younger age children where a detailed physical examination that helps identify the exact source of pathology may not be possible. In older patients who have a well-developed gait cycle, the physical assessment might be easier. Clinical assessment in a child presenting with a limp includes gait analysis, which is essential to guide the appropriate request of diagnostic laboratory tests and imaging studies. In this paper, we provide a practical guide for a trainee in General Pediatric and Pediatric Rheumatology on an approach to a limping child, aiming to identify the common causes of limping and to describe normal and abnormal gait cycles. We also discuss other diagnostic considerations in the assessment of these children.

VipGrade® electronic clinical tool: retrospective evaluation on a paediatric cohort of European viper bites

Introduction The VipGrade® is a French electronic clinical tool that was created in 2022 to help frontline clinicians grade envenomations due to European Vipera spp. and decide whether to use specific immunotherapy. The aim of this study was to test VipGrade® on a paediatric retrospective cohort (2001–2022) of cases of Vipera spp. envenomation and evaluate the concordance with the initial grading assigned by clinicians on admission. Methods For each child in the cohort (n = 116), VipGrade® was applied by a single physician unaware of the initial clinical grading. We compared VipGrade® results with those obtained at the time of admission using the Audebert-Boels classification system. Results The proportion of discrepancies represented 26% of initial grade I (n = 39) cases, meaning that 10 children were upgraded to grade IIa (n = 9) or IIb (n = 1). The main reason was the VipGrade® cut-off for oedema size (4 cm) to distinguish grade I from grade II, while oedema evaluation using the Audebert-Boels clinical classification differs in this regard. The global correlation κ score was equal to 0.78; 0.71 with the exception of grades 0 (which is not usually a diagnostic issue); 0.64 considering both results for young children (age <6 years, n = 51) and 0.79 for older ones. Discussion Upgrading cases inappropriately could have a major impact on treatment and the use of the antivenom. Even if specific immunotherapy with Viperfav® (MicroPharm Ltd, Newcastle Emlyn, Carmarthenshire, SA38 9BY, United Kingdom) is safe, its use when inappropriate cannot be justified, particularly in times of supply shortage, as we have experienced over the last 10 years. Conclusion The current version of the VipGrade® electronic clinical tool produces a different distribution of envenomation grades, notably in grade I by overgrading a substantial number of cases. We suggest creating a paediatric version that incorporates the same oedema evaluation method as the Audebert-Boels clinical classification but also includes a more refined definition of "local or regional" oedema.

The Effect of Mixed Articulation Therapy on Perceptual and Acoustic Features of Compensatory Errors in Children with Cleft Palate.

Compensatory errors are a conventional part of an articulation disorder identified by speech pathologists in patients with Cleft palate (CP). This study aimed to evaluate the effect of new mixed articulation therapy on the perceptual and acoustic features of these errors. The single-case experimental design, ABA design, was used in this study. Five CP young children ages 3.9 to 5.4 months, received online multimodal articulation therapy for 5 weeks, 6 sessions per week, utilizing both standard and maximum opposition approaches. Patients underwent baseline and follow-up sessions before and after treatment for 3 weeks-1 session per week. The percentage of compensatory errors was calculated as a perceptual measure, and 2 acoustic measures-including the slope of the locus equation (LE slope) and the overall F2 Transition Frequency Extent (TFE)-were analyzed. Compensatory errors were eliminated in all 5 participants with the mixed articulation therapy (Percentage of nonoverlapping data [PND] ≥80%, percentage of Improvement Rate Difference [IRD] ≥73.33%), and this therapy effect was maintained for up to 3 weeks of follow-up. The acoustic measures showed a difference in the F2 changes during CV transition in compensatory error before and after therapy. This study supports the hypothesis that online mixed articulation therapy in children with CP can eliminate compensatory errors. The results of this study can also help extend the knowledge about F2 changes during CV transition in compensatory error before and after speech therapy to create objective and visual diagnostic documentation for patients with CP and prediction of some coarticulation models.

Characteristics and outcomes of children 2-23 months of age with prolonged diarrhoea: A secondary analysis of data from the 'Antibiotics for Children with Diarrhea' trial.

Approximately 12% of all diarrhoeal episodes last for 7-13 days. As such, they are termed prolonged diarrhoea, and are associated with over two-thirds of all diarrhoeal deaths. Due to a lack of robust data, we aimed to evaluate a comparative background characteristics of young children with acute and prolonged diarrhoea, and their outcomes at day 90 follow-up. We performed a secondary analysis of data from the Antibiotics for Children with Diarrhea (ABCD) trial. Children aged 2-23 months were enrolled between July 2017 and July 2019 from seven Asian and sub-Saharan African countries. For this analysis, we divide diarrhoea into two categories: acute diarrhoea (duration <7 days) and prolonged diarrhoea (duration ≥7-13 days). We used logistic regression to observe baseline crude and adjusted associations and linear regression to compare post-discharge outcomes. We analysed data on 8266 children, of whom 756 (9%) had prolonged diarrhoea and 7510 (91%) had acute diarrhoea. Pakistan had the highest proportion of children with prolonged diarrhoea (n/N = 178/1132, 16%), while Tanzania had the lowest (n/N = 12/1200, 1%). From an analysis that adjusted for sex, breastfeeding, nutritional status, clinical presentation, housing, water supply, sanitation, and country, we observed that presentation at a health facility with prolonged diarrhoea was associated with low age (2-12 months) (adjusted odds ratio (aOR) = 1.25; 95% confidence interval (CI) = 1.02, 1.53; P = 0.028), presence of three or more under-five children in the family (aOR = 1.54; 95% CI = 1.26, 1.87; P < 0.001), maternal illiteracy (aOR = 1.45; 95% CI = 1.21, 1.74, P < 0.001), moderate underweight (aOR = 1.25; 95% CI = 1.01, 1.55; P = 0.042) and pathogen (Campylobacter) (aOR = 1.27; 95% CI = 1.12, 1.44; P < 0.001). At day 90 follow-up, children with prolonged diarrhoea had significantly lower weight-for-age z-score compared to children with acute diarrhoea (-1.62, standard deviation (SD) = 1.11 vs -1.52, SD = 1.20; P = 0.032), as well as significantly higher frequency of hospital admission (6.1% vs 4.5%; P = 0.042). Prolonged diarrhoea was more common in children of younger age, those who were moderately underweight, those with Campylobacter in stool, those with three or more under-five children in a family, and those with illiterate mothers compared to those who had acute diarrhoea. Children with prolonged diarrhoea more often required hospitalisation during the three-month follow-up period compared to their counterparts.

Frequency and genotyping of group A rotavirus among Egyptian children with acute gastroenteritis: a hospital-based cross-sectional study

BackgroundThis hospital-based cross-sectional study aims to investigate the epidemiologic and clinical characteristics of rotavirus group A (RVA) infection among children with acute gastroenteritis and to detect the most common G and P genotypes in Egypt.MethodsA total of 92 stool samples were collected from children under five who were diagnosed with acute gastroenteritis. RVA in stool samples was identified using ELISA and nested RT-PCR. Common G and P genotypes were identified utilizing multiplex nested RT-PCR assays.ResultsRVA was detected at a rate of 24% (22 /92) using ELISA and 26.1% (24 /92) using VP6 nested RT-PCR. The ELISA test demonstrated diagnostic sensitivity, specificity, and accuracy of 91.7%, 100%, and 97.8%, respectively. G3 was the most prevalent G type (37.5%), followed by G1 (12.5%), whereas the most commonly detected P type were P[8] (41.7%) and P[6] (8.2%). RVA-positive samples were significantly associated with younger aged children (p = 0.026), and bottle-fed (p = 0.033) children. In addition, RVA-positive samples were more common during cooler seasons (p = 0.0001). Children with rotaviral gastroenteritis had significantly more frequent episodes of diarrhea (10.87 ± 3.63 times/day) and vomiting (8.79 ± 3.57 times/day) per day (p = 0.013 and p = 0.011, respectively). Moreover, they had a more severe Vesikari clinical score (p = 0.049).ConclusionRVA is a prevalent cause of acute gastroenteritis among Egyptian children in our locality. The discovery of various RVA genotypes in the local population, as well as the identification of common G and P untypeable strains, highlights the significance of implementing the rotavirus vaccine in Egyptian national immunization programs accompanied by continuous monitoring of strains.

Efficacy and safety of lumasiran for infants and young children with primary hyperoxaluria type 1: 30-month analysis of the phase 3 ILLUMINATE-B trial

BackgroundPrimary hyperoxaluria type 1 (PH1) is a genetic disorder resulting in overproduction of hepatic oxalate, potentially leading to recurrent kidney stones, nephrocalcinosis, chronic kidney disease, and kidney failure. Lumasiran, the first RNA interference therapeutic approved for infants and young children, is a liver-directed treatment that reduces hepatic oxalate production. Lumasiran demonstrated sustained efficacy with an acceptable safety profile over 12 months in infants and young children (age &amp;lt;6 years) with PH1 in ILLUMINATE-B (clinicaltrials.gov: NCT03905694), an ongoing, Phase 3, multinational, open-label, single-arm study.MethodsHere, we report interim efficacy and safety findings from ILLUMINATE-B following 30 months of lumasiran treatment. Eligible patients had an estimated glomerular filtration rate (eGFR) &amp;gt;45 ml/min/1.73 m2 if ≥12 months old or normal serum creatinine if &amp;lt;12 months old, and a urinary oxalate to creatinine ratio (UOx:Cr) greater than the upper limit of normal. All 18 patients enrolled in ILLUMINATE-B completed the 6-month primary analysis period, entered an extension period of up to 54 months, and continue to participate in the study.ResultsAt Month 30, mean percent change from baseline in spot UOx:Cr was −76%, and mean percent change in plasma oxalate was −42%. eGFR remained stable through Month 30. In 14 patients (86%) with nephrocalcinosis at baseline, nephrocalcinosis grade improved at Month 24 in 12; no patient worsened. In the 4 patients without baseline nephrocalcinosis, nephrocalcinosis was absent at Month 24. Kidney stone event rates were ≤0.25 per person-year through Month 30. Mild, transient injection site reactions were the most common lumasiran-related adverse events (17% of patients).ConclusionIn infants and young children with PH1, long-term lumasiran treatment resulted in sustained reductions in urinary and plasma oxalate that were sustained for 30 months, with an acceptable safety profile. Kidney function remained stable, low kidney stone event rates were observed through Month 30, and nephrocalcinosis grade improvements were observed through Month 24. Clinical Trial Registrationhttps://clinicaltrials.gov, identifier NCT03905694.

Are narrative story stem methods valid in “non-Western” contexts? A systematic review

Narrative story stem techniques (NSSTs) offer insight into attachment and other representational aspects of preschool to young school aged children’s inner lives. While the method moved into the academic and clinical mainstream some 35 years ago, their applicability to “non-Western” contexts remains little understood. This synthesis comprises 31 NSST studies of samples from parts of Africa, East Asia, Latin America, and the Middle East, and from US and UK ethnocultural minoritized backgrounds. In the reviewed studies, three specific NSSTs dominated, story stems were used most to evaluate attachment, and some were clinically focused. However, there was also a strong cultural focus and over half of samples were socioeconomically disadvantaged. Studies revealed both universal and culturally specific features of NSSTs. Attachment distributions were as expected, given the high clinical risk in pooled samples (49% secure, 19% avoidant, 12% ambivalent, 20% disorganized), including by clinical and socioeconomic risk status. Gender differences were similar to “Western” findings. However, the growing evidence for convergent validity across cultural groups is tempered by low reporting of psychometrics. Narratives may sometimes reflect children’s unintended interpretations of the task and therefore not activate internal representations, or may reflect reality but lack equivalent meaning in coding schemes. We discuss how researchers and clinicians can enhance the validity of NSSTs by considering the role of culture in the sense-making process. Pending further validation work, NSSTs have the added potential to give a voice to young children from underrepresented backgrounds.

Improving posttraumatic stress disorder assessment in young children: comparing measures and identifying clinically-relevant symptoms in children ages six and under

Young children exposed to trauma are vulnerable to developing posttraumatic stress disorder (PTSD). Although experts agree on the importance of tailoring PTSD assessments to be developmentally-appropriate for young children, there is little research on which assessment methods best identify clinically significant symptomatology in this difficult-to-assess population. Two competing models for assessing PTSD have been proposed by the DSM-5 and ICD-11. This study compared a DSM-5 measure to an ICD-11 measure in young children (ages 1–6) exposed to a natural disaster. The measures identified similar rates of PTSD in children; however, diagnostic agreement between the measures was low (31–36%). Both PTSD measures were associated with actual and perceived life threat, functional impairment, and comorbid psychopathology. PTSD symptom and cluster endorsement rates were also binned by age and compared to functional impairment to identify commonly-reported and highly impairing symptoms in trauma-exposed young children, as potential candidates for inclusion in future revisions of diagnostic criteria. Across age ranges, increased clinginess post-trauma was the most commonly reported symptom and was associated with functional impairment. Arousal symptoms (startle, hypervigilance) and Re-experiencing symptoms (nightmares) also emerged as relevant for young children. Findings may contribute to efforts to improve assessment for PTSD in young children.

Early Onset of Type 1 Diabetes in Kuwait: Distinct Clinical, Metabolic, and Immunological Characteristics

Objective: Exploring early-onset diabetes in terms of describing characteristics at time of diagnosis might aid in a better understanding of etiology and may have implications on management and prevention. The aim of this study was to investigate the prevalence of early-onset type 1 diabetes (T1D) in Kuwait as well as describe their baseline clinical, biochemical, and immunological characteristics. Methods: Medical records of children newly diagnosed with T1D and registered in the Childhood-Onset Diabetes electronic Registry (CODeR) in Kuwait between 2017 and 2022 were reviewed. Early-onset T1D was defined as diagnosis at age younger than 6 years. Results: 2,051 children were registered with new-onset T1D between 2017 and 2022, of which 657 (32.0%) were diagnosed at early onset. There has been a trend of slight increase in the percentage of early-onset T1D after 2020 (15.2%) with a prevalence of 18.4% and 20.2% in 2021 and 2022, respectively (p = 0.056). Age at onset was inversely related to admission to the pediatric intensive care unit (OR = 0.90, 95% CI: 0.85, 0.95, p < 0.0001) and was directly related to positive celiac autoimmunity (p = 0.022), higher hemoglobin A1C (p < 0.0001), and C-peptide levels (p < 0.0001). However, age at onset of T1D was inversely related to the higher vitamin D levels (p < 0.0001). Conclusion: These findings reinforce the need for increased attention to be given to study the development of T1D in children of younger age. This in turn will support special management and prevention measures targeted toward this vulnerable age group.

Developing an MLA-test for young learners – insights from measurement theory and language testing

This article presents the process of constructing and validating a test of metalinguistic awareness (MLA) for young school children (age 8–10). The test was developed between 2021 and 2023 as part of the MetaLearn research project, financed by The Research Council of Norway. The research team defines MLA as using metalinguistic knowledge at a point in real time. To develop the test, the research team relied heavily on general measurement theory (psychometrics) and insights from the field of language testing and assessment. This aids in the process of developing a practical and user-friendly MLA-test which yields valid scores and reliably measures the state and the development of MLA. This innovative approach to MLA testing offers explicitness about the theoretical construct of the test and at the same time contributes to controlling the difficulty and discriminatory power of each test item. We argue that the test development process presented here is useful when developing tests of MLA and similar concepts, as it facilitates comparison of results as well as replicability. This development process and its detailed description also make it possible to adapt the MetaLearn MLA-test to other contexts.

“They should ask me so that they can help me”: Patterns of young children's expressed feelings and beliefs when interviewed about violence and difficult experiences

BackgroundChildren's participation in research is a rights-based principle. However, young children are often excluded from research on sensitive topics, due to gatekeepers concerns that participation would cause distress/re-traumatization and conflict with the principle of providing adequate protection from harm. ObjectiveTo provide evidence around young children's feelings, including potential distress, and beliefs in mixed-method interviews about violence and difficult experiences. Participants and settingData were collected from South African interviewer focus group discussions and young child (age 6–10) interviews, along with observations and fieldnotes from young child (age 6–17) interviews. MethodsWe collected and analyzed qualitative data focused on children's displayed and reported emotions and beliefs in violence-focused interviews. ResultsFindings showed the quantitative interview was frequently a positive experience for young children, and children who became upset or emotional stated their feelings were due to violence they experienced. The interviewer seemed to represent a safe person to whom the child could disclose. The play- and arts-based methods of the interview were useful in building this safety and providing space for children to regulate difficult emotions. ConclusionsIn a carefully managed interview environment using developmentally appropriate methods, young children are enthusiastic participants and do not appear to experience undue distress or trauma when asked about violence and other sensitive topics. Findings demonstrate that young children can be safely included in research about violence and issues that impact them and can exercise their right to participation when research methods, environments, and safeguards are appropriately adapted to their needs.

Healthcare Communication Experiences of Hispanic Caregivers of Childhood Cancer Survivors.

Interpersonal communication is a crucial component of the cancer experience that can contribute to managing cancer care and improving cancer survivors' and caregivers' quality of life. Cultural and contextual factors may impact Hispanic childhood cancer survivor (CCS) and parent caregiver relationships and communication. This study sought to describe the healthcare communication experiences of Hispanic parents with CCS, families, and medical providers. We conducted 15 semi-structured interviews with Hispanic caregivers from a safety-net hospital in Los Angeles County. Interviews were conducted in English and Spanish, audio-recorded and professionally transcribed, and analyzed using a thematic approach. Caregivers shared the importance and impact of medical communication when exploring the "first big talk" of the diagnosis, uncertainty about treatment, navigating multiple providers, therapeutic communication (i.e., providing emotional reassurance), and current and lingering effects of cancer. All caregivers shared "good communication" experiences, while others shared various barriers to communication, including a lack of understanding of the cancer diagnosis and caregiver experience, psychological challenges impacting communication, cultural and language differences, physical factors that limit communication, and young age of child impacting communication with caregivers. Our findings suggest that a strong interpersonal communication skill set for clinicians can contribute to managing cancer care and improving caregivers' psychological adjustment.

Emotion Knowledge Relates to Cortisol for Children Attending Head Start Preschool

ABSTRACT Research Findings: The ability to manage emotions is thought to be important for regulating stress at a physiological level, yet no prior published studies have examined young children’s emotion understanding or knowledge in relation to the stress hormone cortisol. The present study investigated the statistical relation between emotion knowledge (EK) and cortisol levels for 307 young children ages 3–5 years who attended Head Start preschool, and their primary caregivers. All of the child participants faced economic hardship and 80% were Black, Indigenous, and People of Color (BIPOC) and thereby positioned to experience systemic racism. At the start of the preschool year, EK, or understanding of emotions, was assessed using a well-validated emotion matching task and basal cortisol levels were measured via salivary assay. Results of a multiple linear regression analysis revealed that, after accounting for demographic covariates, greater EK was associated with lower cortisol. Practice or Policy: The finding that EK relates to cortisol levels in early childhood highlights the importance of addressing emotional competence in early intervention programs. Notably, the relationship may be bidirectional and reducing stress levels also may facilitate advancing young children’s emotion understanding. Interventions that promote EK and reduce stress levels may advance overall school readiness.