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Childhood obesity is a public health problem globally as well as in Poland. This paper aimed to provide age- and sex-specific waist circumference, hip circumference, waist-to-height ratio and waist-to-hip ratio normative values for Polish children and adolescents aged 3 − 18 years for more precise monitoring of abdominal fat accumulation. The waist circumference, hip circumference, waist-to-height ratio and waist-to-hip ratio references were constructed with the lambda-mu-sigma (LMS) method using data from two nationally representative health surveys: the OLA study and the OLAF study, the largest available paediatric surveys in Poland which provided measured height, weight, waist, hip and blood pressure for 22,370 children and adolescents aged 3 − 18 years. The predictive ability of newly established references for overweight/obesity as defined by the International Obesity Task Force criteria and elevated blood pressure was tested with receiver operating characteristic. Abdominal obesity cut-offs linked to adult cardiometabolic cut-offs were established. Reference values for waist circumference, hip circumference, waist-to-height ratio and waist-to-hip ratio are presented, as well as waist circumference, waist-to-height ratio and waist-to-hip ratio cut-off values linked to adult's cut-offs of cardiometabolic risk. The predictive value for overweight and obesity of population-based waist, hip and waist-to-height ratio references was outstanding–area under the receiver operating characteristic curve > 0.95 in both sexes, whereas with regard to the elevated blood pressure predictive ability was low—area under the receiver operating characteristic curve < 0.65. Conclusion: This paper presents the first waist, hip, waist-to-height ratio and waist-to-hip ratio references for Polish children and adolescents aged 3–18 years. The 90th and 95th percentile and cut-offs linked to adult thresholds for cardiometabolic risk are proposed as cut-offs for abdominal obesity. What is Known: • Waist circumference, waist-to-height ratio and waist-to-hip ratio are used to assess abdominal obesity in children and adults. • In Poland, there is no abdominal obesity and hip circumference references for children and adolescents from 3 to 18 years of age. What is New: • Population-based references of central obesity indices and hip references for children and youth aged 3–18 years and cardiometabolic risk thresholds for children and adolescents linked to adult's cut-offs were established. [ABSTRACT FROM AUTHOR]

Prescribing errors represent a safety risk for hospitalized patients, especially in pediatrics. Computerized physician order entry (CPOE) might reduce prescribing errors, although its effect has not yet been thoroughly studied on pediatric general wards. This study investigated the impact of a CPOE on prescribing errors in children on general wards at the University Children's Hospital Zurich. We performed medication reviews on a total of 1000 patients before and after the implementation of a CPOE. The CPOE included limited clinical decision support (CDS) such as drug-drug interaction check and checks for duplicates. Prescribing errors, their type according to the PCNE classification, their severity (adapted NCC MERP index), as well as the interrater reliability (Cohen's kappa), were analyzed. Potentially harmful errors were significantly reduced from 18 errors/100 prescriptions (95% CI: 17–20) to 11 errors/100 prescriptions (95% CI: 9–12) after CPOE implementation. A large number of errors with low potential for harm (e.g., "missing information") was reduced after the introduction of the CPOE, and consequently, the overall severity of potential harm increased post-CPOE. Despite general error rate reduction, medication reconciliation problems (PCNE error 8), such as drugs prescribed on paper as well as electronically, significantly increased after the introduction of the CPOE. The most common pediatric prescribing errors, the dosing errors (PCNE errors 3), were not altered on a statistically significant level after the introduction of the CPOE. Interrater reliability showed moderate agreement (Κ = 0.48). Conclusion: Patient safety increased by reducing the rate of prescribing errors after CPOE implementation. The reason for the observed increase in medication reconciliation problems might be the hybrid system with remaining paper prescriptions for special medication. The lacking effect on dosing errors could be explained by the fact that a web application CDS covering dosing recommendations (PEDeDose) was already in use before the implementation of the CPOE. Further investigations should focus on eliminating hybrid systems, interventions to increase the usability of the CPOE, and full integration of CDS tools such as automated dose checks into the CPOE. What is Known: • Prescribing errors, especially dosing errors, are a common safety threat for pediatric inpatients. •The introduction of a CPOE may reduce prescribing errors, though pediatric general wards are poorly studied. What is New: •To our knowledge, this is the first study on prescribing errors in pediatric general wards in Switzerland investigating the impact of a CPOE. •We found that the overall error rate was significantly reduced after the implementation of the CPOE. The severity of potential harm was higher in the post-CPOE period, which implies that low-severity errors were substantially reduced after CPOE implementation. Dosing errors were not reduced, but missing information errors and drug selection errors were reduced. On the other hand, medication reconciliation problems increased. [ABSTRACT FROM AUTHOR]

Perinatal (antenatal and postpartum) depression is increasingly becoming a global public health problem. Studies have shown that the presence of depression during the perinatal period impact on a mother's ability to adequately provide nutritional care for herself and her infants and young children. This may thus negatively influence the nutritional status of these vulnerable children resulting in poor growth, such as stunting which is currently a public health problem in low- and middle-income countries (LMICs). The aim of this systematic review and meta-analysis was to determine the association between maternal postpartum depression and child growth in LMICs. Electronic databases were systematically reviewed by screening abstracts, titles, full text and additional data sources of eligible papers. Articles were eligible for inclusion if based on children aged 0 to 59 months, if reporting maternal postpartum depression as an exposure, if based on observational studies evaluating the relation between maternal postpartum depression and child growth, if reporting at least one physical growth indicator such as stunting as an outcome, and if published after 2000. Article selection was based on the PRISMA guidelines for reporting systematic reviews. Twelve articles were included in the quantitative synthesis (12 for stunting, 8 for underweight and 2 for wasting). Maternal postpartum depression was observed to be associated with an increased risk of child stunting (1.87 (95% CI: 1.52, 2.30; I2 = 41.6%, p = 0.064)) and underweight (1.81 (95% Cl: 1.25, 2.62; I2 = 70.7%, p = 0.001)). These results were confirmed after influence analyses, with publication bias being negligible. Conclusion: Maternal depression is a risk factor for poor child growth in LMICs. This study contributes to the knowledge on this topic and calls on policymakers to improve on its understanding, screening and treatment to alleviate the potential negative impact on child growth. What is Known: • Maternal postpartum depression is currently a public health relevance in low- and middle-income countries (LMICs). • Maternal postpartum depression is a risk factor for poor nutritional status in children from LMICs. What is New: • Maternal postpartum depression is associated with an 80 to 90% increased risk of childhood stunting and underweight in LMICs. • The association between risk of childhood stunting and underweight with maternal postpartum depression is slightly influenced by geographical area, rural or urban location, by factors such as study design, study quality and sample size. [ABSTRACT FROM AUTHOR]

Air pollution exposure has been related to negative gross motor development in children. However, there is currently a lack of conclusive evidence for such a relationship. We carried out a systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria to examine whether exposure to air pollution has an impact on children's gross motor development. Of the 9746 papers found, 7 studies examined the impact of air pollutant characteristics, such as PM2.5, PM10, and NO2, on children's gross motor development. The results of the study reveal a significant association between air pollutants and an increased likelihood of negative gross motor development. PM10 was discovered to be considerably riskier for children's gross motor development (effect: − 1.83, 95% CI: − 3.04, − 0.62, p value = 0.002). Additionally, NO2 exhibited indications of a tendency to be connected to a detrimental impact on children's gross motor development (effect − 0.18, 95% CI: − 0.42, 0.07, p value = 0.097). Conclusion: Our study indicates that exposure to PM10, PM2.5, and NO2, especially PM2.5 and PM10, is negatively associated with children's gross motor development. However, further research is required to determine how exposure to prenatal air pollution affects children's gross motor development. What is Known - What is New: • In this study, we provide an overview of emerging data related to PM10, PM2.5, and NO2 exposure in child development, especially on the gross motor function that continues to emerge, and key findings are highlighted. • Additionally, we summarize the evidence on the underlying effect of air pollution on gross motor function from human studies.. • Overall, we emphasize that evidence from human studies is critical in suggesting detrimental child health outcomes of an action to promote preventive strategies that will effectively protect children's health.. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the effect of exercise training on arterial stiffness in obese and overweight children. Three databases were searched up to July 2021 for papers about exercise training and arterial stiffness in obese and overweight children. The quality of each identified study was evaluated. Effect sizes were estimated in terms of the standardized mean difference. Egger's test and sensitivity analysis were used to assess publication bias. In total, 26 studies by 19 researchers were included in the meta-analysis. Flow-mediated dilatation (FMD), pulse wave velocity (PWV), and intima-media thickness (IMT) were improved after exercise training in obese and overweight children. Subgroup analysis showed that exercise only reduced the PWV and IMT in individuals with a BMI < 30. FMD, PWV, and IMT were improved by exercise training in participants aged below 14 years, but only FMD was increased by exercise in participants aged 14 years and above. All types of training significantly improved FMD. Aerobic exercise (AE) and high-intensity intermittent training (HIIT) reduced the PWV of the participants, but were less effective than resistance training (RT) and aerobic plus resistance training. Only HIIT significantly reduced the IMT. Conclusions: Exercise training improved vascular endothelial function and vascular sclerosis in overweight and obese children, especially in those with a BMI < 30 and younger than 14 years. AE had a more favorable effect on arterial stiffness. What is Known: • Exercise training was a good way to lose weight and subsequently promoted vascular function in overweight and obese children. What is New: • Exercise training was more effective on the vascular endothelial function and vascular sclerosis in overweight and obese children with a BMI<30. • Aerobic exercise had a more favorable effect on arterial stiffness, while the improvement was not effective after resistance training and combined training mode. [ABSTRACT FROM AUTHOR]

The aim of the present study was to perform a critical reflection about intervention options for bruxism reduction in children and adolescents. Search was conducted based on the PICO-structured question: "What are the intervention options to reduce bruxism in children/adolescents?". No language, year, or study design restrictions were imposed. Studies reporting interventions to reduce bruxism in children (< 10) and adolescents (10 to 19 years old) were included. Reviews and letters to editors were not included. From 2723 records, 17 papers were included. Included studies were primarily randomized clinical trials performed in Brazil (35.3%) and using different criteria for the diagnosis of bruxism. Reduction in self-reported bruxism and headaches associated with bruxism were observed in studies that used medications (hydroxyzine/trazodone/flurazepam), occlusal splints, orthodontic interventions, and psychological and physical therapy interventions. Reduction in Rhythmic Masticatory Muscle Activity was observed with the use of the occlusal splint and in orthodontic interventions. Alternative treatments (medicinal extracts such as Melissa officinalis-L) have shown inconclusive results.Conclusions: Several intervention options are available to inhibit or reduce bruxism activity. The respective indication, contraindications, and side effects of each treatment option must be assessed individually and carefully, taking into account that bruxism is not considered a disorder in otherwise healthy individuals.What is known• Biological and psychological factors have been strongly correlated to the development of bruxism• Bruxism prevalence ranging from 6 to 50% in childrenWhat is new• Reduction in self-reported bruxism and headaches associated with bruxism were observed in studies that used medication (Hydroxyzine/ Trazodone/ Flurazepam), occlusal splints, orthodontic interventions, psychological, and physical therapy interventions• A reduction in Rhythmic Masticatory Muscle Activity was observed with the use of the occlusal splint and orthodontic interventions. Alternative treatments (medicinal extracts such as Melissa officinalis L) show inconclusive results in respect of the reduction in bruxism. [ABSTRACT FROM AUTHOR]

The baseline risk for multiple febrile seizures within the same febrile illness is largely unknown. Estimates range from 5 to 30%. Imprecise estimates can lead to incorrectly powering studies investigating the management of febrile seizures. To estimate the risk of multiple febrile seizures in the same febrile illness, we systematically reviewed and conducted a meta-analysis of studies from January 2000 to December 2021 that contained data for the number of children for both simple and complex febrile seizures in the same febrile illness. We searched MEDLINE, EMBASE, and Web of Science for randomized, quasi-randomized, prospective, and retrospective trials that involved children with febrile seizures. A total of 23,131 febrile illnesses with febrile seizures met the inclusion criteria. The estimated baseline risk of multiple febrile seizures in the same febrile illness was 17% (95% CI, 16–19%). However, the 30 cohorts that included both admitted and non-admitted patients had a lower percentage of multiple FSs within the same illness (14%; 95% CI, 12–15%) than the 30 cohorts that enrolled only admitted patients (20%; 95% CI, 16–25%). Conclusion: Researchers can use estimates in this paper to design future studies. Taking into the account the substantial heterogeneity between countries and studies, clinicians could cautiously use our estimates in their clinical assessment and be better able to set parental expectations about a child's chances of having another febrile seizure during the current illness. Trial registration: PROSPERO CRD42020191784. Registered July 18, 2020. What is Known: • There is renewed interest in the diagnostic workup and prophylactic treatment of febrile seizures to prevent repeat seizures in the same febrile illness. • There is a lack of accurate estimates of the baseline risk for multiple febrile seizures in the same illness to properly design studies investigating management. What is New: • This study provides the most robust estimates for the baseline risk for multiple febrile seizures in the same illness. [ABSTRACT FROM AUTHOR]

Correct diagnosis of nail disorders could be difficult for a non-trained eye, especially in children. For this reason, sometimes, probative diagnosis and treatment are the outcome of a consultation. This paper wants to underline how podiatric abnormalities should be considered possible causes of nail disorders in children and how they need an appropriate, most of the time non-medical, treatment in order to avoid future complications.Conclusion: Physicians should be aware of this possibility and refer these patients to a dermatologist or a podiatrist for a correct management. What is known: • Diagnosis and treatment of nail disorders in children could be difficult. • Differential diagnosis should be as much accurate as possible in order to avoid unnecessary and possible harmful treatments. What is new: • Podiatric abnormalities should not be underestimated. • Podiatric abnormalities should be considered as potential causes of nail abnormalities in children. [ABSTRACT FROM AUTHOR]

The rate of early misdiagnosis in patients with nodular fasciitis of the ear is high. To provide a basis for clinical diagnosis and treatment, we aimed to summarise the clinical manifestations, imaging results, pathological findings, treatment strategies, and postoperative follow-up results for three cases of paediatric nodular fasciitis (two girls, one boy) treated in the Department of Otorhinolaryngology, Head and Neck Surgery, at Beijing Children's Hospital of Capital Medical University from 2018 to 2020. The average age at diagnosis was 24 months. Lesions occurred in the left ear in two cases and right ear in one case. All patients had a history of biopsy before surgery. Rapid growth was observed following biopsy in two patients, and anti-inflammatory treatment was ineffective in all three cases. Fluorescence in situ hybridisation analysis of ubiquitin-specific peptidase 6 (USP6) was performed in two of the three cases, with positive results. The lesions exhibited hypo-intensity or iso-intensity on T1-weighted magnetic resonance imaging (MRI) and heterogeneous hyper-intensity on T2-weighted MRI. "Fascial tail" signs were observed on imaging in all cases. Surgical resection was performed in all cases. Intact ear appearance was observed at follow-up, and there were no cases of recurrence. Conclusion: Combining clinical features with imaging findings may improve the accuracy of preoperative diagnosis in patients with nodular fasciitis. In addition to pathological findings, genetic testing for USP6 may aid in diagnosis. The final diagnosis should be based on comprehensive assessment. Complete surgical resection can prevent recurrence. What is Known: • Paediatric NF around the ear is rare and is easily misdiagnosed as other inflammatory masses that have a higher incidence in children. • Most previous reports of NF were case reports. What is New: • Combining clinical and imaging findings with genetic testing for USP6 rearrangement may improve the accuracy of preoperative diagnosis in patients with NF. Nonetheless, the final diagnosis should be based on comprehensive assessment. • The present paper is significant in that it represents the only report of three cases of ear NF in children with a complete medical history and prognosis. [ABSTRACT FROM AUTHOR]

Pneumonia remains the leading cause of death globally in children under the age of five. The poorest children are the ones most at risk of dying. In the recent years, lung ultrasound has been widely documented as a safe and easy tool for the diagnosis and monitoring of pneumonia and several other respiratory infections and diseases. During the pandemic, it played a primary role to achieve early suspicion and prediction of severe COVID-19, reducing the risk of exposure of healthcare workers to positive patients. However, innovations that can improve diagnosis and treatment allocation, saving hundreds of thousands of lives each year, are not reaching those who need them most. In this paper, we discuss advantages and limits of different tools for the diagnosis of pneumonia in low- to middle-income countries, highlighting potential benefits of a wider access to lung ultrasound in these settings and barriers to its implementation, calling international organizations to ensure the indiscriminate access, quality, and sustainability of the provision of ultrasound services in every setting. What is Known: • Pneumonia remains the leading cause of death globally in children under the age of five. The poorest children are the ones most at risk of dying. In the recent years, lung ultrasound has been widely documented as a safe and easy tool for the diagnosis and monitoring of pneumonia and several other respiratory infections and diseases. During the pandemic, it played a primary role to achieve early suspicion and prediction of severe COVID-19, reducing the risk of exposure of healthcare workers to positive patients. However, innovations that can improve diagnosis and treatment allocation, saving hundreds of thousands of lives each year, are not reaching those who need them most. What is New: • We discuss advantages and limits of different tools for the diagnosis of pneumonia in low- to middle-income countries, highlighting potential benefits of a wider access to lung ultrasound in these settings and barriers to its implementation, calling international organizations to ensure the indiscriminate access, quality, and sustainability of the provision of ultrasound services in every setting. [ABSTRACT FROM AUTHOR]

For the past two decades, growing research has been pointing to multiple repercussions of bisphenol A (BPA) exposure to human health. BPA is a synthetic oestrogen which primarily targets the endocrine system; however, the compound also disturbs other systemic organ functions, in which the magnitude of impacts in those other systems is as comparable to those in the endocrine system. To date, the discoveries on the association between BPA and health outcomes mainly came from animal and in vitro studies, with limited human studies which emphasised on children's health. In this comprehensive review, we summarised studies on human, in vivo and in vitro models to understand the consequences of pre-, post- and perinatal BPA exposure on the perinatal, children and adult health, encompassing cardiovascular, neurodevelopmental, endocrine and reproductive effects. Conclusion: Evidence from in vitro and animal studies may provide further support and better understanding on the correlation between environmental BPA exposure and its detrimental effects in humans and child development, despite the difficulties to draw direct causal relations of BPA effects on the pathophysiology of the diseases/syndromes in children, due to differences in body system complexity between children and adults, as well as between animal and in vitro models and humans. What is known: • Very limited reviews are available on how BPA adversely affects children's health. • Previous papers mainly covered two systems in children. What is new: • Comprehensive review on the detrimental effects of BPA on children health outcomes, including expectations on adult health outcomes following perinatal BPA exposure, as well as covering a small part of BPA alternatives. • Essentially, BPA exposure during pregnancy has huge impacts on the foetus in which it may cause changes in foetal epigenetic programming, resulting in disease onsets during childhood as well as adulthood. [ABSTRACT FROM AUTHOR]