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This study explores the combinations of conditional variables contributing to depressive symptoms in rural children. We analyzed data from 715 children from a rural mental health database, conducting detailed follow-up investigations on 129 children in Zhejiang and Henan provinces. We used fuzzy set Qualitative Comparative Analysis (fsQCA) and regression analysis to identify causal pathways leading to depression. The results indicate that depression in rural children does not stem from a single, necessary condition but arises from multiple factors. Our findings highlight significant contributions from both maternal and paternal involvement. Specifically, maternal involvement, combined synergistically with peer support and problematic behaviors, as well as paternal involvement, together with peer support and anxiety, significantly affects depressive outcomes. Additionally, anxiety and strong peer relationships independently have a substantial impact on these outcomes. Effective mitigation strategies involve active parental engagement and robust peer support, reducing the influence of risk factors such as problematic behaviors and anxiety. The generalizability of the results is limited by cultural and geographical variations. The study also does not account for all potential factors influencing depression in rural children. Depression in rural children results from multiple interacting factors. Tailored interventions addressing these specific combinations are recommended. • The etiology of depression in children residing in rural areas cannot be ascribed to a singular conditional factor. • Maternal and paternal involvement, peer support, problematic behaviors, and anxiety influence rural children's depression. • Effective mitigation of depression in rural children involves concerted parental engagement and strong peer support. [ABSTRACT FROM AUTHOR]

Social anxiety disorder (SAD) is a high-prevalence mental disorder among children and adolescents. The aim of this study is to compare and rank the effectiveness of several psychotherapies for SAD among children and adolescents. Only randomized controlled trials (RCTs) were utilized by searching PubMed, Embase, Cochrane Library, and Web of Science. We used network meta-analysis in the Bayesian framework to analyze the data. This study is registered with PROSPERO, number CRD42023476829. In total, 30 RCTs with 1547 individuals were included, and nine psychotherapies with three control conditions were compared and ranked in this study. The findings revealed that internet-delivered cognitive behavioural therapy (surface under the cumulative ranking curve [SUCRA: 71.2 %]), group cognitive behavioural therapy (SUCRA: 68.4 %), and individual cognitive behavioural therapy (SUCRA: 66.0 %) significantly reduced social anxiety symptoms; internet-delivered cognitive behavioural therapy also significantly decreased depression symptoms in these patients (SUCRA: 92.2 %). In addition, group cognitive behavioural therapy can enhance functioning in these patients (SUCRA: 89.6 %). These results suggest that internet-delivered cognitive behavioural therapy is the optimal type of psychotherapy for reducing social anxiety and depression symptoms in children and adolescents with SAD, internet-delivered parent-child interaction therapy and cognitive bias modification of interpretation have relatively poor treatment effects on social anxiety symptoms in children than other psychological interventions, and group cognitive behavioural therapy has better benefits in enhancing the functioning among children and adolescents with SAD. Further studies are needed to ascertain these results due to the limited number of included studies. • Network meta-analysis examines interventions for social anxiety disorder. • Internet-delivered CBT is an optimal psychotherapy for social anxiety disorder. • Group CBT has better benefits in enhancing the functioning. • Findings can provide recommendations for health care professionals and patients. [ABSTRACT FROM AUTHOR]

Super Skills for Life is a structured intervention rooted in cognitive-behavioral therapy and a transdiagnostic approach, aimed at preventing childhood emotional problems. Over the past decade, it has demonstrated positive outcomes in various formats and countries. This study evaluated the comparative effectiveness of two individual modalities: the computerized and the traditional version enriched with multimedia content, through a comparative randomized effectiveness trial. 109 children (55.24 % female) aged 8–12 years participated, randomly assigned to either the traditional (n = 54) or computerized (n = 51) groups. Pre- and post-intervention assessments involved emotional problem measures completed by children and parents. Both groups exhibited significant reductions in all outcomes according to parent reports, including depression, anxiety, and anxiety-related life interference. Children's self-reports indicated improvements across all general measures. Generalized Estimating Equations indicated marginally better improvements in the traditional group. Limitations included the absence of follow-up assessment, variability in participant regions across Spain, and input from other informants like teachers. This study pioneers the examination of short-term effects of the program in both a fully computerized format supervised by a specialized therapist and an enriched traditional individual format, and the promising results suggest their potential for indicated prevention of childhood emotional problems. • First study to evaluate short-term effects of fully computerized Super Skills intervention supervised by therapists. • Results show the fully computerized Super Skills format is as effective as the traditional one-to-one version. • Streamlined materials and shorter application times enhance cost-effectiveness of computerized format. • Promising results suggest transdiagnostic CBT interventions as effective tools for preventing children's emotional problems. [ABSTRACT FROM AUTHOR]

Vaccination is a crucial public health intervention protecting individuals and communities from vaccine-preventable diseases. However, unvaccinated children in low- and middle-income countries pose a significant challenge. Ethiopia, a Global Alliance for Vaccines and Immunisation (GAVI)-supported country, ranks fifth in zero-dose immunisation burden, indicating concerning vaccine coverage gaps. Despite the severity of this issue, there is a dearth of research investigating the disparities, prevalence and contributing factors associated with zero-dose children in Ethiopia. This study aimed to assess the prevalence, spatial distribution and determinants of zero-dose children in Ethiopia. A community-based cross-sectional study was conducted using data from the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS). Data were collected from 21 March 2019 to 28 June 2019. The study included a total of 1334 children aged 12–35 months (weighted sample). For spatial and multilevel analyses, ArcGIS 10.8 and Stata 17 software were used, respectively. The measure of association was determined by computing the adjusted odds ratio (AOR) at a 95 % confidence interval (95 % CI), and a p-value <0.05 was considered statistically significant. The prevalence of zero-dose children in Ethiopia was 46.5 % (95 % CI: 43.8, 49.2). Southeast Amhara, Afar, Somali, Oromia and SNNPR (Southern Nations, Nationalities and Peoples' Region) regions had high zero-dose proportions. Maternal age 15–19 years (AOR = 1.63; 95 % CI: 1.05, 2.64), lack of antenatal care (AOR = 1.77; 95 % CI: 1.34, 2.35), rural residence (AOR = 1.94; 95 % CI: 1.17, 3.19) and region were significantly associated to zero-dose status in Ethiopia. The prevalence of zero-dose children in Ethiopia was high and the distribution exhibited significant variation across the country's clusters. Individual and community factors were key contributors. It is essential that areas with a high prevalence of zero-dose children have access to recommended childhood vaccines. This proactive approach can help protect children from morbidity and mortality caused by vaccine-preventable diseases. [ABSTRACT FROM AUTHOR]

• This study includes 596 children with 26.5% having confirmed vitamin A deficiency. • Xerophthalmia is highly prevalent (48.8%) in this study population. • The most common ocular sign in this study population is conjunctival xerosis (38.9%). • Boys and indigenous schoolchildren have higher risk of xerophthalmia. • Overweight/obesity status is associated with a reduced risk of xerophthalmia. • Identified risk factors linked to xerophthalmia aid in targeted intervention efforts. Vitamin A deficiency (VAD) remains a major health issue in developing nations, contributing to preventable childhood blindness. However, there is lack of recent data on xerophthalmia, especially among school-aged children in Malaysia. We hypothesized that xerophthalmia persists among rural schoolchildren in Malaysia and potentially associated with socio-demographic status and malnutrition. We conducted a cross-sectional study on 596 schoolchildren (8-12 years) from ten rural primary schools located in five states across Malaysia. Children meeting the criteria for xerophthalmia assessment included those diagnosed with vitamin A deficiency (VAD) (plasma retinol < 0.70 µmol/L) and marginal VAD (plasma retinol 0.70 to < 1.05 µmol/L). The overall prevalence of xerophthalmia was 48.8%, with the most common ocular sign being conjunctival xerosis (38.9%). The occurrence of xerophthalmia was negatively associated with retinol-binding protein 4 (RPB4) (P =0.003), alpha-carotene (P =0.04), hemoglobin (P =0.004), weight (P =0.02), body mass index (BMI) (P =0.04) and WAZ (weight-for-age z-score) (P =0.04) status. Based on multivariate logistic regression analysis, a higher risk of xerophthalmia was observed in boys (Adjusted odd ratio [AOR]: 1.7, 95% confidence interval [CI]: 1.2-2.5) and Orang Asli (OA, indigenous) schoolchildren (AOR: 2.0, 95% CI: 1.3-3.0), while schoolchildren with overweight/obesity status (AOR: 0.5, 95% CI: 0.3-0.8) were associated with a reduced risk of xerophthalmia. The present study unveils a high prevalence of xerophthalmia among vitamin A-deficient primary schoolchildren in rural areas of Malaysia, especially among the indigenous community. The identified socio-demographic and nutritional factors associated to xerophthalmia would facilitate the implementation of more targeted interventions in addressing these issues. This cross-sectional study included 596 rural primary schoolchildren (8-12 years old) in Malaysia, diagnosed with vitamin A deficiency (VAD) and marginal VAD. Xerophthalmia prevalence was 48.8%, with conjunctival xerosis (38.9%) as the most common sign. Higher risk of xerophthalmia was seen in boys and Orang Asli (indigenous) students, while children with overweight/obesity showed reduced risk. The identified risk factors linked to xerophthalmia could aid in targeted intervention efforts. [Display omitted] [ABSTRACT FROM AUTHOR]

To identify subgroups of parents' food choice value systems and evaluate associations with restaurant eating behaviors of children. Cross-sectional survey. Parents with low income and children aged 2–11 years who were frequent restaurant visitors before the coronavirus disease 2019 pandemic (n = 1,146). Past week restaurant meals and the healthfulness of child meal orders. We used latent class analysis to identify patterns of stated food choice values (convenience, taste, cost, cooking, nutrition, locality, socialization, and food safety reputation) among parents. Logistic and linear regression models evaluated differences in child restaurant eating behaviors across classes. Three classes of parents' stated food choice values were identified: hassle-free, indulgent, and multifaceted consumers (7.94%, 54.97%, and 37.09% of parents, respectively). The children of the hassle-free consumers class were 91% less likely to select a healthy entree than an unhealthy entree and were even less likely to select a healthy entree than those of the indulgent and multifaceted consumer classes (P < 0.02). The multifaceted consumers class ate from restaurants the most in the last week (2.4 vs 2.1 and 1.9 times; P < 0.02). This subgroup approach could inform future restaurant interventions by tailoring to differences in parents' food choice values. [ABSTRACT FROM AUTHOR]

Despite known inequalities, little is understood about the burden and healthcare experiences of Aboriginal and Torres Strait Islander children who sustain a burn injury and their families. The Coolamon Study recruited parents and carers whose children (aged <16 years) were Aboriginal and / or Torres Strait Islander children and had presented to burn units across four Australian states, New South Wales (Sydney), Northern Territory (Darwin), Queensland (Brisbane, Townsville) and South Australia (Adelaide), between 2015 and 2018. Consent was obtained and carers completed baseline and subsequent interviews at 3, 6, 12 and 24 months. Data were collected on the injury event, patient care and safety, sociodemographic factors, health related quality of life (PedsQual), and psychological distress (Kessler K-5). Of the 208 participants, 64 % were male; 26 % were aged less than 2 years and 37 % aged 2–4 years. The most common burn mechanisms were scalds (37 %), contact (33 %) and flame burns (21 %), with more severe burns and flame burns occurring in rural and remote settings. Most carers rated their child's care as either excellent or very good (82 %). Family distress, measured by the K-5, lessened over the 24 months, however the changes were not statistically significant. While 77 % of carers reported that they received enough information, 18 % reported they would have liked more, and 3 % reported no information was provided before treatment. Parents described mixed access to information about the types of support available to them, such as accommodation, meals, travel or cultural support. Data from this cohort provide rich new information about risk factors and care received from point of injury through to rehabilitation for Aboriginal and Torres Strait Islander children with burns, providing unique insights into what is needed for appropriate, culturally safe care. • Severe burns and flame burns were more common in Aboriginal and Torres Strait Islander children from rural and remote regions. • Better burns support programs and strategies are needed for Aboriginal and Torres Strait Islander families. • Community centric gold standard burns first aid support is urgently needed for Aboriginal and Torres Strait Islander families. • Integration of Aboriginal Health Workers into multidisciplinary burns teams is needed for culturally safe and responsive care. [ABSTRACT FROM AUTHOR]

Although most countries recommend amoxicillin for paediatric pneumonia, there is a long tradition of treatment with penicillin V (PcV) in Sweden, thus not empirically covering Haemophilus influenzae. There are, however, large regional differences in treatment practice. The aim was to compare clinical outcomes (treatment failure and severe complications), in children aged 1–59 months treated with PcV vs. amoxicillin for pneumonia. This population-based emulated target trial included all children born in Sweden between 2001 and 2021, using national health, sociodemographic, and population registers. All pneumonia cases from hospitals and paediatric outpatient clinics in children aged 1–59 months treated as outpatients with PcV or amoxicillin between July 2005 and December 2021, were identified. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for treatment failure (newly dispensed antibiotic prescription or pneumonia-associated hospitalization day 1–14) and severe complications (lung complications, an invasive bacterial disease, admission to intensive care unit or death day 1–28) were calculated with logistic regression analysis. PcV was prescribed in 14 766 cases and amoxicillin in 10 566. Treatment failure occurred in 7.7% with PcV vs. 4.7% with amoxicillin, aOR 1.76 (95% CI: 1.54–2.00). Severe complications were rare, with no significant difference between PcV and amoxicillin (0.3% vs. 0.2%, aOR 0.96, 95% CI: 0.53–1.73). Sensitivity and interaction analyses showed consistent results. PcV treatment compared with amoxicillin, was associated with an increased risk for treatment failure but not for severe complications. The absolute risks for adverse outcomes were low in both groups suggesting a minor role of H. influenzae in paediatric pneumonia. [ABSTRACT FROM AUTHOR]

Anaerobic bacteria can cause many infections in children. Because they predominant in the normal human skin and mucous membranes bacterial flora, they are often associated with bacterial infections that originate from these sites. They are difficult to isolate from infectious sites, and are frequently missed. Anaerobic infections can occur in all body sites, including the central nervous system, oral cavity, head and neck, chest, abdomen, pelvis, skin, and soft tissues. Anaerobes colonize the newborn after birth and have been isolated in several types of neonatal infections. These include cellulitis of the site of fetal monitoring, neonatal aspiration pneumonia, bacteremia, conjunctivitis, omphalitis, and infant botulism. Management of anaerobic infection is challenging because of the slow growth of these bacteria, by their polymicrobial nature and by the growing antimicrobial resistance of anaerobic. Antimicrobial therapy may be the only treatment required, and may also be an adjunct to a surgical approach. Polymicrobial aerobic-anaerobic infection generally requires delivering antimicrobial therapy effective against all pathogens. The antibiotics with the greatest activity against anaerobes include carbapenems, beta-lactam/beta-lactamase inhibitor combinations, metronidazole, and chloramphenicol. Antimicrobial resistance is growing among anaerobic bacteria. The major increased in resistance have been reported with clindamycin, cephamycins, and moxifloxacin against Bacteroides fragilis group and related strains. Resistance patterns vary between different geographic areas and medical facilities. [ABSTRACT FROM AUTHOR]

Childhood adversity (CA) has a substantial correlation with mental health problems. Keeping a healthy lifestyle is essential for mental health interventions; it is unclear, however, how healthy lifestyle affect the relationship between CA and persistent mental health problems. This longitudinal study (n = 1112, 54.5 % male) collected the data on CA (measured through three dimensions: threat, deprivation and unpredictability), mental health problems, and lifestyle factors. Group-based multi-trajectory modeling (GBMTM) was utilized to estimate trajectories for three mental health problems (i.e., depression, ADHD and overanxiety). Close friendships, regular physical activity, appropriate sleep duration, shorter screen time, and healthy eating were combined to establish a healthy lifestyle score (which ranges from 0 to 5). Higher scores indicated a healthier lifestyle. Three trajectories of mental health problems were identified: persistently low risk (24.9 %), persistently medium-high risk (50.0 %), and persistently high risk (25.1 %). Multinomial logistic regression showed that high adversity (high-threat: β = 2.01, P < 0.001; high-deprivation: β = 1.03, P < 0.001; high-unpredictability: β = 0.83, P = 0.001; high-overall adversity: β = 1.64, P < 0.001) resulted in a persistently high risk of mental health problems; these outcomes were maintained after robust control for covariates. Further lifestyle stratification, null associations were observed among children with a healthy lifestyle, irrespective of their gender; however, after controlling for covariates, the above associations remained relatively stable only among boys. The generalizability of our findings is restricted by 1) limited racial diversity and 2) missing data. This finding underscores the benefits of promoting a healthy lifestyle in children to prevent persistent mental health problems caused by CA. • We identified three trajectories of multiple mental health problems in children. • Children exposed to high adversity are more likely to be at persistently high risk for mental problems. • A healthy lifestyle can help buffer the risk of a persistently high risk of mental health problems caused by adversity [ABSTRACT FROM AUTHOR]

Children who are looked after (CLA), including children and young people seeking asylum and refugees who are unaccompanied (CYPSAR-U), experience multiple intersecting vulnerabilities leading to an increased risk of infections throughout childhood. This population experiences a higher risk of maternal to child transmission of blood borne viruses as well as a higher risk of acquiring infections in childhood and adolescence. This article summarizes the infections of importance in children who are looked after, including blood borne viruses (TB, HIV, hepatitis B and C and syphilis) as well as more commonly neglected infectious diseases with maternal to child transmission (e.g. herpes simplex virus and Chlamydia) and infections of particular relevance to the CYPSAR-U population (e.g. schistosomiasis and strongyloidiasis). It is the responsibility of health care professional to identify and reduce the risks of infection in CLA. This article describes best practice at every stage of care; from identifying risk factors, through informed consent and counselling, to testing and sharing results, and finally with robust follow-up and ongoing education. We also describe where services are currently falling short, and give recommendations for service improvement and further research, with a particular emphasis on integrating the views of the children themselves. [ABSTRACT FROM AUTHOR]

[Display omitted] The bead-based epitope assay has been used to identify epitope-specific (es) antibodies and successfully used to diagnose clinical allergy to milk, egg, and peanut. We sought to identify es-IgE, es-IgG4, and es-IgG1 of wheat proteins and determine the optimal peptides to differentiate wheat-allergic from wheat-tolerant using the bead-based epitope assay. Children and adolescents who underwent an oral food challenge to confirm their wheat allergy status were enrolled. Seventy-nine peptides from α-/β-gliadin, γ-gliadin, ω-5-gliadin, and high- and low-molecular-weight glutenin were commercially synthesized and coupled to LumAvidin beads (Luminex Corporation, Austin, Tex). Machine learning methods were used to identify diagnostic epitopes, and performance was evaluated using the DeLong test. The analysis included 122 children (83 wheat-allergic and 39 wheat-tolerant; 57.4% male). Machine learning coupled with simulations identified wheat es-IgE, but not es-IgG4 or es-IgG1, to be the most informative for diagnosing wheat allergy. Higher es-IgE binding intensity correlated with the severity of allergy phenotypes, with wheat anaphylaxis exhibiting the highest es-IgE binding intensity. In contrast, wheat-dependent exercise-induced anaphylaxis showed lower es-IgG1 binding intensity than did all the other groups. A set of 4 informative epitopes from ω-5-gliadin and γ-gliadin were the best predictors of wheat allergy, with an area under the curve of 0.908 (sensitivity, 83.4%; specificity, 88.4%), higher than the performance exhibited by wheat-specific IgE (area under the curve = 0.646; P <.001). The predictive ability of our model was confirmed in an external cohort of 71 patients (29 allergic, 42 nonallergic), with an area under the curve of 0.908 (sensitivity, 75.9%; specificity, 90.5%). The wheat bead-based epitope assay demonstrated greater diagnostic accuracy compared with existing specific IgE tests for wheat allergy. [ABSTRACT FROM AUTHOR]

The recreational use of psilocybin or psilocin-containing products, a chemical found naturally in certain mushroom species, is on the rise across the United States. Several cases of serious clinical effects related to mushroom-containing products have recently been reported to the Food and Drug Administration (FDA). The emergence of these new products and their health consequences are not yet well understood. This case series aims to characterize exposures to mushroom-containing chocolate products, including patient characteristics, clinical effects, treatment(s), and clinical outcome severity, reported to a poison center network. This was a retrospective case series conducted in patients exposed to mushroom-containing chocolate products across three poison centers between January 2023 to August 2024. Patients were identified via a database search of ToxSentry®. Patients were included if they were exposed to a mushroom-containing chocolate product. Patients were excluded if they ingested an unrelated product or if there was insufficient information documented within ToxSentry®. The primary endpoint was to describe clinical outcome severity after exposure to mushroom-containing chocolate products. A query of ToxSentry® identified 164 cases; 36 cases met study criteria. The median age of patients in this case series was 17 years old. For most patients (23, 64 %), the reason for the exposure was intentional, with 20 reporting intentional abuse or misuse of the product. Common clinical effects reported included mental status changes (26, 76 %), paranoia/hallucinations (10, 28 %), dysrhythmias (7, 19 %) and gastrointestinal discomfort (6, 17 %). There was one report of seizure. Most clinical effects lasted between 3 and 24 h after ingestion (29, 81 %). Intravenous fluids (18, 50 %) and benzodiazepines (7, 19 %) were the most common treatments given. No fatalities were reported. While most patients in this series experienced minor clinical effects, some developed serious effects after ingestion of a mushroom-containing chocolate product. Findings from this study further characterize the limited patient demographics, clinical effects, and outcomes published thus far. Further characterization in a larger cohort of patients could expand on our initial findings and is needed to better identify factors that may influence clinical outcomes. [ABSTRACT FROM AUTHOR]

Celiac disease (CD) is a common yet underdiagnosed autoimmune disease with substantial long-term consequences. High-accuracy point-of-care tests for CD antibodies conducted at youth primary health care centers may enable earlier identification of CD, but evidence about the cost-effectiveness of such strategies is lacking. We estimated the long-term cost-effectiveness of active case finding and mass screening compared with clinical detection in the Netherlands. A decision tree and Markov model were used to simulate a cohort of 3-year-old children with CD according to each strategy, taking into account their impact on long-term costs (from a societal perspective) and quality-adjusted life-years (QALYs). Model parameters incorporated data from the GLUTENSCREEN project, the Dutch Celiac Society, the Dutch Pediatric Surveillance Unit, and published sources. The primary outcome was the incremental cost-effectiveness ratio (ICER) between strategies. Mass screening produced 7.46 more QALYs and was €28,635 more costly compared with current care (ICER: €3841 per QALY), and case finding produced 4.33 more QALYs and was €15,585 more costly compared with current care (ICER: €3603 per QALY). At a willingness to pay of €20,000 per QALY, both strategies were highly cost-effective compared with current care. Scenario analyses indicated that mass screening is likely the optimal strategy, unless no benefit in detecting asymptomatic cases is assumed. An earlier identification of CD through screening or case finding in children using a point-of-care tests leads to improved health outcomes and is cost-effective in the long-term compared with current care. If the feasibility and acceptability of the proposed strategies are successful, implementation in Dutch regular care is needed. Testing for celiac disease in children using a point-of-care test at Dutch youth primary care health centers results in improved health outcomes and is economically viable in the long-term. [ABSTRACT FROM AUTHOR]

• SARS-CoV-2 bronchiolitis had more severe outcomes than RSV bronchiolitis. • During the SARS-CoV-2 pandemic, RSV bronchiolitis was not severe during the first delayed RSV season. • For the second RSV season during the pandemic, RSV bronchiolitis was not severe, but SARS-CoV-2 bronchiolitis was. Severe acute respiratory syndrome related coronavirus (SARS-CoV-2) bronchiolitis has arisen with the SARS-CoV-2 pandemic. There is a paucity of literature on SARS-CoV-2 bronchiolitis. The purpose of our paper was to review and compare outcomes in bronchiolitis due to severe acute respiratory syndrome related coronavirus 2 (SARS- CoV-2) and Respiratory Syncytial Virus (RSV). We also performed a subgroup analysis of two disrupted RSV seasons during the pandemic. This was a retrospective study from a US TriNetX database from March 1, 2020-January 1, 2023. Propensity matching was utilized for confounders. There was a total of 3,592 patients (1,796 in each group) after propensity matching. There was an increased risk of oxygen saturation ≤95 % (RR=1.50 95 % CI 1.58–1.94, p = 0.002) and ICU admission (RR=1.44 95 % CI 1.06–1.94, p = 0.02) in those with SARS- CoV-2 but not for oxygen saturation ≤90 % (RR=1.03 95 %CI 0.75–1.42, p = 0.85) or intubation (RR=0.73 95 % CI 0.35–1.47, p = 0.37). There was a decreased risk of a patient with SARS- CoV-2 bronchiolitis being hospitalized (RR=0.65 95 % CI 0.57–0.74, p < 0.0001), respiratory rate ≥60 (RR=0.64 95 % CI 0.48–0.88, p < 0.001) or ≥70 (RR=0.64 95 % CI 0.43–0.96, p = 0.03) when compared to RSV bronchiolitis. Specifically examining SARS- CoV-2 versus RSV bronchiolitis during the delayed RSV seasons, during the first season both infections were not severe, but during the second RSV bronchiolitis season, patients infected with RSV had less risk of ICU admission compared to those infected with SARS- CoV-2. SARS- CoV-2 bronchiolitis patients appeared to have more severe outcomes since the risk of ICU admission was higher for these patients. Also, during the second delayed RSV season, SARS- CoV-2 bronchiolitis was more severe than RSV bronchiolitis. [ABSTRACT FROM AUTHOR]

Adequate serum vitamin D levels correlate with a more favorable lipid profile compared to deficient levels. Despite the well-established prevalence of vitamin D deficiency in children with obesity, studies investigating its influence on lipid profiles in this population are scarce. We explored the impact of vitamin D status on lipid profiles and markers of atherogenic dyslipidemia in a cohort of children and adolescents with obesity. A total of 271 Caucasian children and adolescents with overweight/obesity and a control group of 54 pediatric patients with normal weight. All participants underwent outpatient visits for the assessment of clinical parameters and venous blood collection for biochemical analysis such as triglycerides (TG)/HDL-C ratio, LDL-C/HDL-C ratio, atherogenic index of plasma AIP), vitamin D level. Individuals with obesity displayed severe vitamin D deficiency (25-OH-D ≤10 ng/ml) at a higher frequency compared to those with normal weight (p = 0.03). In patients with overweight/obesity and low 25-OH-D levels show higher values of glycemia (p = 0.001), insulin resistance (HOMA-IR and TRYG p < 0.001), TG (p < 0.001), TG/HDL-C (p = 0.001), AIP (p < 0.001), SBP (p = 0.01), and DBP (p = 0.04). In normal-weight individuals with low 25-OH- D levels an increased values of glycemia (p = 0.01), insulin resistance (HOMA-IR p = 0.01 and TRYG p = 0.002), TG (p = 0.01), TG/HDL-C (p = 0.02), AIP (p = 0.01). A direct correlation between 25-OH-D levels and metabolic parameters is observed. A correlation between vitamin D levels and the lipid/atherosclerotic profile was recorded. Vitamin D deficiency may represent a preventable and easily treatable cardiometabolic risk factor, emphasizing the importance of early intervention and preventive measures. • Adequate serum vitamin D levels correlate with a favorable lipid profile. • We explored the impact of vitamin D status on atherogenic dyslipidemia in children with obesity. • A correlation between vitamin D levels and the lipid/atherosclerotic profile was recorded. • Vitamin D deficiency may represent a preventable and treatable cardiometabolic risk factor. [ABSTRACT FROM AUTHOR]

Spinal muscular atrophy (SMA) is a hereditary neuromuscular disease that progresses toward restrictive respiratory failure due to muscle paralysis. We observed that SMA patients presented with a specific clinical and laboratory profile, consisting of severe metabolic acidosis following an episode of mild vomiting. This is an unusual, little-known, and life-threatening situation for these patients, as hyperventilation induced by metabolic acidosis can lead to exhaustion and to death by mixed acidosis. The aim of our study was to describe this paradoxical acidosis after vomiting in SMA patients and to discuss the physiological basis of this condition. We conducted a retrospective single-center study reviewing the clinical and laboratory data of SMA patients who were hospitalized in the intensive care unit for severe metabolic acidosis after vomiting. Our cohort comprised 11 cases. On arrival, the median pH of the patients was 7.23 with a median bicarbonate concentration of 11.7 mmol/L and almost half of them (45 %) had ketone bodies in the blood and/or urine. The median correction time was 24 h for pH and 48 h for bicarbonate concentrations after receiving intravenous hydration with a glucose solution. We suggest that SMA patients are particularly sensitive to ketoacidosis induced by fasting, even after a few episodes of mild vomiting. Moreover, they have a low buffering capacity due to their severe amyotrophy, which favors metabolic acidosis. They must be quickly hydrated through a glucose-containing solution to avoid exhaustion, mixed acidosis, and death. [ABSTRACT FROM AUTHOR]

• The largest series of pediatric cases of immediate hypersensitivity related to chlorhexidine, mostly represented by anaphylaxis (grades II–IV), confirmed by allergy tests and diagnosed in France. • In the setting of domestic use and misuse of chlorhexidine at home. • Hypothesis of sensitization, increases in case numbers, context of recurrence, and measures to prevent immediate allergies to chlorhexidine. Immediate allergic reactions to chlorhexidine have been clearly identified in numerous countries, generating governmental warnings worldwide. The aim of our study was to characterize (i) these allergies, which are less reported in pediatric populations, and (ii) the patient-at-risk profile so as to suggest preventive measures. In association with the allergy department and the regional pharmacovigilance center in Rennes University Hospital, France, a multicenter retrospective, descriptive, and observational study was conducted using data from the national pharmacovigilance database for the period of January 1, 2010 to June 30, 2020. Immediate allergies to chlorhexidine cases based on a clinical history compatible with an immunoglobulin E (IgE)-mediated reaction, along with positive allergic testing, were analyzed. Of the 478 cases identified, 17 pediatric cases of immediate allergic reaction to chlorhexidine (13 cases of grades II–IV anaphylaxis) were retained for the analysis. For 58.8 % of these cases, a history of a previous more moderate reaction to the substance was identified. The reactions occurred most frequently in cases of domestic misuse (88.2 %, n = 15/17) of chlorhexidine to dress a wound. Recurrence was reported for two cases, later leading to severe reactions at each new exposure to the allergen, suggesting an aggravation mechanism. The number of pediatric cases of immediate allergies to chlorhexidine has possibly been underestimated on account of insufficient knowledge of the allergy and in view of its common usage. Information on the method of caring for wounds among children and on the risk of allergic sensitization as well as exploring any unusual reaction to chlorhexidine application could reduce the number of allergic reactions. [ABSTRACT FROM AUTHOR]

• Minimum dietary diversity is associated with a lower risk of childhood underweight. • Consuming dairy, eggs, fruits, and vegetables lowers the risk of underweight. • Children exclusively fed mother's breast milk are more likely to be malnourished. A lack of consumption of a diversified diet is associated with poor physical and cognitive development in children. Evidence on the relationship between minimum dietary diversity (MDD) and childhood malnutrition remains inconclusive in India. We hypothesized that children aged 6 to 23 months on a diversified diet (five out of eight defined foods and beverages) are less likely to be malnourished (stunting, wasting, and underweight) compared to their counterparts who are not on a diversified diet. This cross-sectional study was based on the 2019-2021 National Family Health Survey of India, comprising a weighted sample of 57,714 children aged 6 to 23 months. Multilevel logistic regression was conducted for data analysis. The results showed a significant protective effect of dietary diversity on underweight (odds ratios [OR] = 0.91; 95% confidence intervals [CI]: 0.86-0.96). In addition, children who did not consume eggs (OR = 1.09; 95% CI; 1.03-1.15), dairy products (OR = 1.22; 95% CI: 1.17-1.27), or fruits and vegetables (OR = 1.11; 95% CI: 1.06-1.17) were more likely to be underweight than children who did. Children who did not consume dairy products, fruits, and vegetables were also more likely to be stunted and wasted. However, we did not find significant associations of MDD with wasting and stunting. Nutritional interventions promoting daily consumption of dairy products, eggs, fruit, and vegetables are recommended to address the growing problem of childhood malnutrition in India. Regions with higher rates of malnutrition and those lacking MDD, such as Uttar Pradesh and Rajasthan, should be prioritized. [Display omitted] The present study includes 57,714 children aged 6 to 23 months. The results reveal that achieving minimum dietary diversity (consumption of five or more food categories out of the eight recommended by WHO) is associated with a reduced risk of underweight in children. Daily consumption of at least one serving of dairy products, one serving of eggs or lean meats, half a serving of fruit, and two to three servings of vegetables is recommended to reduce childhood underweight. [ABSTRACT FROM AUTHOR]

This report discusses school meal charge policies nationwide, with an in-depth look at the contents of these policies in North Carolina. The US Department of Agriculture requires school districts to have policies related to unpaid school meal charges; however, there are no specific requirements for what must be included in these policies. School meal charge policies vary across North Carolina and the US. Many policies are vague, and some include provisions that may be harmful to children and families. The implications of these findings, including the suggested direction of future research and potential policy solutions, are discussed. [ABSTRACT FROM AUTHOR]

Centralisation of perioperative care for small children to a limited number of specialised paediatric centres has many theoretical advantages, but neither the optimal balance nor the current distribution of paediatric anaesthesia on a national scale are well elucidated. The aim of this study was to describe the distribution, adverse events, and mortality in children undergoing anaesthesia in Sweden. In this cohort study, data from all paediatric anaesthesia procedures registered in Sweden during the years 2019–22 were extracted from the Swedish Perioperative Register (SPOR). Data were analysed according to hospital level of care and ASA physical status. Data from 81 hospitals were analysed. During the 4-yr period, 214,964 procedures were registered. Most procedures in neonates and infants were managed in paediatric (73%) and other university hospitals (21%). Adverse events occurred in 2.71% of cases and severe adverse events in 0.067%. The all-cause 24-h mortality rate was 6.6:10,000 anaesthetics and the all-cause 30-day mortality was 14.7:10,000 anaesthetics. The 30-day all-cause estimated mortality was highest in paediatric hospitals (95% confidence interval [CI] 30–39) compared with other university hospitals (95% CI 6.1–12), county (95% CI 1.9–4.8), district (95% CI 0.07–2.2), and smaller hospitals (95% CI 0.0–22). Most procedures in neonates and infants were performed in tertiary centres, with county hospitals managing mainly older children, in accordance with national recommendations. Mortality was more common in tertiary centres, reflecting increased comorbidity and centralisation of anaesthesia of neonates and infants. [ABSTRACT FROM AUTHOR]

La condition physique est un déterminant important de la santé chez les jeunes. L'objectif principal était d'évaluer le niveau de la condition physique dans une large population de jeunes français par rapport aux normes françaises préexistantes. Les objectifs secondaires étaient d'évaluer la prévalence des enfants ayant un profil de santé cardiovasculaire à risque et d'évaluer l'influence d'une activité pratiquée dans une association ou club sportif sur la condition physique des jeunes. Dans cette population, 2061 enfants (1054 garçons, 1007 filles) âgés de 10,6 ± 0,9 ans [7,8–14,3] et provenant de 6 régions françaises ont été inclus. L'endurance cardiorespiratoire, la force musculaire, la vitesse, et l'agilité/coordination ont été évalués par des tests de terrain dans le contexte scolaire. Les garçons ont eu significativement de meilleurs résultats que les filles, excepté pour le test d'agilité/coordination (p = 0,198). Les enfants normo-pondérés ont réalisé de meilleures performances que les enfants en surpoids ou obèses pour chaque composante de la condition physique étudiée (p < 0,001). Les enfants dénutris ont eu significativement de meilleurs résultats au test d'endurance cardiorespiratoire comparés aux enfants avec un statut pondéral normal (p < 0,01). Le pourcentage d'enfants ayant un profil de santé cardiovasculaire défavorable (à risque) était important, et il était plus élevé chez les garçons (22,4 %) par rapport aux filles (15,7 %) (p < 0,0001). Les enfants déclarant être inscrits dans une association sportive ou un club ont réalisé de meilleures performances que les enfants non-inscrits pour chaque composante de la condition physique (p < 0,0001). Ces nouvelles données permettent d'établir un nouveau point d'évaluation dans la surveillance de la condition physique des enfants français. D'après nos résultats il est important de développer et de mettre en place des programmes d'intervention et/ou de promotion de la santé dans les écoles françaises, terrain de jeu essentiel, afin d'améliorer la santé et la condition physique de ces enfants. Il est également primordial de proposer et de faciliter l'accès aux associations sportives ou clubs sportifs (par une aide financière ou encore des actions de promotion des pratiques fédérales) afin que l'intégralité des enfants puissent en bénéficier. Physical fitness is widely recognized as a powerful marker of health in children. The main aim of this study was to assess physical fitness levels in French children and to compare the findings to national reference standards. Secondary aims were to determine the prevalence of children below the minimum level of muscular strength needed to guarantee future favorable cardiovascular profile and to investigate physical fitness according to their sports club (SC) participation. Participants were 2061 French children (1054 boys, 1007 girls) 10.6 ± 0.9 years old [7.8–14.3]. Cardiorespiratory fitness (CRF), muscular strength, speed, and agility were tested. Boys were physically fitter than girls, excepted for agility (P = 0.198). Normal weight children have significantly better results than overweight or obese children in all physical fitness tests (P < 0.001). Underweighted children have a better CRF compared to normal weighted children (P < 0.01). Our findings indicate that 22.4% of French boys and15.7% of French girls are at risk of future cardiovascular diseases (P < 0.0001). This subgroup also performed poorly in all tests used (P < 0.0001). Children participating in SC had a better physical fitness than children not participating in SC (P < 0.0001). These new data enable to establish a new assessment point in the monitoring of physical fitness in French children. Our findings indicate that the physical fitness of French children must be improved to prevent cardiovascular diseases, especially in boys. Developing and implementing interventions and/or health promotion programs in French schools, in order to improve the health and physical fitness of these children is crucial. In addition, policies should also offer and facilitate access to SC for children. [ABSTRACT FROM AUTHOR]

To analyze trends in breastfeeding and complementary feeding indicators for infants and young children receiving primary health care (PHC) services in Brazil, considering the contextual aspects of local nurturing care (NC) environments. Ecological time-series study. Ten feeding indicators were extracted from 1,055,907 food intake records of children aged <2 years reported by PHC facilities from 2015 to 2019. Local NC environments were assessed with the Brazilian Early Childhood Friendly Municipal Index, calculating overall and stratified scores for the NC domains of adequate nutrition, good health, opportunities for early learning, and security and safety. Prais–Winsten regression was used to calculate annual percent changes (APC) by sex and the contrast in APC between the lower and upper quintiles of NC scores. Positive or negative APC with P -values <0.05 represented increasing or decreasing trends. No significant trends of exclusive and continued breastfeeding, food introduction, or minimum dietary diversity were observed, with 2019 prevalences of 54.5%, 45.2%, 92.5%, and 78.2%, respectively. Increasing trends were observed for mixed milk feeding (2019: 19.2%; APC, +2.42%) and minimum meal frequency (2019: 61.1%; APC, +2.56%), while decreasing trends were observed for sweet beverage consumption (2019: 31.9%; APC, −5.92%) and unhealthy foods (2019: 16.1%; APC, −4.69%). Indicator improvements were significantly stronger in environments more favorable for NC. Although the indicators did not meet global targets for infant feeding practices, the results suggest that the local NC environment encompasses facilitators that may be strategic in the design of early childhood programs and policies to improve nutrition. [ABSTRACT FROM AUTHOR]

The aim of this study was to estimate the global burden, trends and health inequality of childhood nutritional deficiencies (CND) from 1990 to 2019. This was an epidemiological study. Data were extracted from the 2019 Global Burden of Disease study. Estimates and 95% uncertainty intervals (UIs) for the rates and numbers were used to evaluate the global burden of CND. Temporal trends in the burden of CND were examined using Joinpoint analysis and average annual percentage changes. To assess health inequality, the slope index was used. In 2019, 52 million new cases of CND and 105,000 deaths related to CND were recorded. Additionally, 435 million prevalence cases and 26 million disability-adjusted life years (DALYs) were recorded in the same year. From 1990 to 2019, the incidence rate of CND generally increased globally, except for the years 2010–2017; conversely, the prevalence, death and DALY rates exhibited decreasing trends over the study period. Half of the analysed regions and countries/territories demonstrated decreasing trends in the incidence, prevalence, death and DALY rates associated with CND. The incidence and prevalence of CND remained high in low-middle sociodemographic index (SDI) and low-SDI regions; however, they exhibited decreasing trends over the 30-year study period. The slope indexes showed that there were no significant changes in SDI-related inequality over 30 years. Despite decreasing trends in the prevalence, death and DALY rates associated with CND over the three decades, the degree of inequality related to SDI in the burden of nutritional deficiencies has not shown a significant decline. In summary, CND remain a major public health burden in middle-SDI and low-SDI countries. [ABSTRACT FROM AUTHOR]

To assess factors associated with the risk of severe disease in children aged 5 years or younger with laboratory-confirmed respiratory syncytial virus (RSV) infection. We conducted a nationwide retrospective cohort study in Mexico. Eligible participants included children aged 5 years or younger with laboratory-confirmed RSV infection January 1, 2023, and May 15, 2024. We collected relevant clinical and epidemiological data. Risk ratios (RR) and 95% confidence intervals (CI) were employed to identify factors associated with the risk of severe disease, characterized by clinical and radiographic evidence of bronchiolitis or pneumonia requiring hospital admission. Data from 2022 children were analyzed and the overall risk of severe disease was 21.0% (n = 424/2022). In multiple generalized linear regression analysis, a personal history of immunosuppression (due to any cause) showed a protective effect (RR = 0.14, 95% CI 0.05–0.42, P = 0.001) against severe RSV disease, while an increased risk was documented for each additional day elapsed between the date of symptom onset and the date of seeking healthcare RR = 1.06, 95% CI 1.02–1.10, P = 0.004). These findings provide insights into risk stratification and suggest specific directions for future research. This information informs the development of targeted intervention strategies to mitigate the impact of RSV infections in this vulnerable population. [ABSTRACT FROM AUTHOR]

Research on parent–child interaction (PCI) and its impact on children's weight status is a thriving study area. However, their potential pathways have not been established. This study investigated the association between PCI and children's body-mass index z score (BMIz) examining the role of appetite self-regulation (ASR) as a mediator. Mediation analysis. We included children from 33 kindergartens in Wuhan with parents' consent, measuring children's height and weight, and calculating BMIz. To assess the PCI quality, we utilized the Brigance Parent–Child Interactions Scale. Additionally, children's ASR was tested by satiety responsiveness (SR) and food responsiveness (FR) using the Children's Eating Behavior Questionnaire. Quantile regression was employed to examine the PCI-BMIz association, while mediation analysis was conducted to explore ASR's mediating effect on the relationship between PCI and BMIz. Of 3973 children (53.88% boys) included in the analysis, the mean BMIz was 0.24 ± 1.13. The results revealed that children with poorer PCI quality have higher BMIz across all selected BMIz percentiles, except for the 5th percentile. Furthermore, these associations were significant across most percentiles, whether for boys or girls. Mediation analysis suggested that these associations were partially mediated by children's ASR (ind FR = −0.026, P FR < 0.001; ind SR = −0.058, P SR < 0.001), with stronger effects observed among boys. The variation in how strongly BMIz was linked to PCI across different percentiles suggests that children with poorer PCI have higher BMIz. The link is partially mediated through children's ASR. It's important to pay attention to the PCI quality in children with higher BMIz levels, especially in boys. [ABSTRACT FROM AUTHOR]

Both obesity and non-alcoholic fatty liver disease (NAFLD) increase the risk of metabolic abnormalities. However, the metabolic status of children suffering from NAFLD and exhibiting various subtypes of obesity is currently unclear. We aimed to explore the association between NAFLD and metabolic abnormalities in children with different weight statuses. We included 6086 participants aged 6–18 years from the China Child and Adolescent NAFLD Study (CCANS), all of whom had undergone ultrasonography or magnetic resonance imaging-proton density fat fraction (MRI-PDFF) to identify NAFLD and metabolic abnormalities, including hyperglycemia, high triglycerides (TG), low high-density lipoprotein cholesterol (HDL-C), high low-density lipoprotein cholesterol, high total cholesterol, and hyperuricemia. Among the participants, there were 2408 children with obesity and NAFLD, 174 with NAFLD, 2396 with obesity, and 1108 without obesity and NAFLD. The odds ratios (ORs) of suffering from individual metabolic abnormalities were significantly greater in children with obesity and NAFLD than in children without obesity and NAFLD, with ORs ranging from 6.23 (95% CI: 4.56, 8.53) to 1.77 (95% CI: 1.06, 2.94). The ORs of metabolic abnormalities, except for low HDL-C, were greater in children with NAFLD alone than in children without obesity or NAFLD, with ORs ranging from 4.36 (95% CI: 2.77, 6.84) to 2.08 (95% CI: 1.14, 3.78). Notably, obesity and NAFLD had a multiplicative effect on overall metabolic abnormalities, high TG levels, and low HDL-C levels. Children with obesity and NAFLD could be at a significantly increased risk of metabolic abnormalities. Even for children without obesity, NAFLD appears to be associated with an increased risk of experiencing a worsened metabolic status. [ABSTRACT FROM AUTHOR]

Vitamin D deficiency stands out as a significant contributor to reduced bone mineral density in children diagnosed with cerebral palsy (CP). The objective of the meta-analysis was to estimate the prevalence of vitamin D deficiency in children with CP. This meta-analysis adhered to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guide. For children with CP aged between zero and 18 years with vitamin D deficiency, relevant articles were retrieved from PubMed, Scopus, ScienceDirect, and Cochrane. Following keywords were used: "cerebral palsy," "children," "childhood," "vitamin D," "vitamin D deficiency," "prevalence," and "frequency." Newcastle-Ottawa Scale was used to assess methodologic quality. Meta-analysis was performed using Stata 13.0. In total, seven articles were considered suitable for inclusion in the meta-analysis of 411 articles initially identified. These studies involved a total of 430 children diagnosed with CP, ranging in age from zero to 18 years. Among the seven studies, two followed a cross-sectional approach, whereas the remaining five utilized a case-control design. Six of these studies were determined to have a low risk of bias, whereas one exhibited a moderate risk of bias. The combined prevalence of vitamin D deficiency in children with CP was determined to be 42.18% (95% confidence interval = 32.90% to 51.73%, I 2 = 74.41%, and P < 0.001). In conclusion, this meta-analysis reveals evidence of high prevalence of vitamin D deficiency in children with CP. This finding underscores the importance of addressing nutritional factors in the management of CP among pediatric populations. [ABSTRACT FROM AUTHOR]

Background : Acute encephalopathy with biphasic seizures and late reduced diffusion (AESD) develops along with status epilepticus and widespread subcortical white matter edema. We aimed to evaluate the epileptic foci and networks in two patients with epilepsy after AESD using simultaneous electroencephalography and functional magnetic resonance imaging (EEG-fMRI). Methods: Statistically significant blood oxygen level-dependent (BOLD) responses related to interictal epileptiform discharges (IEDs) were analyzed using an event-related design of hemodynamic response functions with multiple peaks. Results: Patient 1 developed focal seizures at age 10 years, one year after AESD onset. Positive BOLD changes were observed in the bilateral frontotemporal lobes, left parietal lobe, and left insula. BOLD changes were also observed in the subcortical structures. Patient 2 developed epileptic spasms at age two years, one month after AESD onset. Following total corpus callosotomy (CC) at age three years, the epileptic spasms resolved, and neurodevelopmental improvement was observed. Before CC, positive BOLD changes were observed bilaterally in the frontotemporal lobes. BOLD changes were also observed in the subcortical structures. After CC, the positive BOLD changes were localized in the temporal lobe ipsilateral to the IEDs, and the negative BOLD changes were mainly in the cortex and subcortical structures of the hemisphere ipsilateral to IEDs. Conclusion: EEG-fMRI revealed multiple epileptic foci and extensive epileptic networks, including subcortical structures in two cases with post-AESD epilepsy. CC may be effective in disconnecting the bilaterally synchronous epileptic networks of epileptic spasms after AESD, and pre-and post-operative changes in EEG-fMRI may reflect improvements in epileptic symptoms. [ABSTRACT FROM AUTHOR]

At the beginning of the COVID-19 pandemic, it was recommended to provide emergency dental care and avoid aerosol-generating procedures (AGPs) when possible. This study aimed to determine how Saudi Arabian pediatric patients utilized emergency dental services at the national level at the beginning of the COVID-19 pandemic and what situations required an AGP. Data was collected from all Ministry of Health dental facilities in Saudi Arabia between March and May 2020. All pediatric dental patients who received emergency dental care during the COVID-19 lockdown were included in this study. The majority of the 1,544 pediatric dental patients who received emergency dental care during this period received treatment for caries (77.9 %). AGPs were predominant in the treatment of urgent dental conditions (51.5 %). About 64 % of cases with pulpal inflammation and 52.4 % with abscesses underwent an AGP. Emergency and urgent dental conditions were the main reason for seeking dental care during the pandemic (75.8 %), while only 24.2 % of cases were considered non-urgent. Despite the recommendations, AGPs were required for some urgent conditions to relieve the associated pain, and this comprised 46.8 % of dental treatment provided. [ABSTRACT FROM AUTHOR]

This study aimed to provide an external validation of morphometric outcomes, including recently developed parameters — vertico-longitudinal index (VLI) and vertex-nasion-opisthocranion (VNO) angle — along with a proposed stratification system for nonsyndromic sagittal craniosynostosis (NSC). Thin-cut CT scans performed before and after total calvarial remodeling in 70 NSC children (mean preoperative age, 7.0 months; mean postoperative age 23.8 months) were evaluated. The parameters, including linear dimensions, morphometry-based indices, and cranial angles, were measured at the cranial vault and base. Each patient was also assigned a scaphocephaly severity score (SSS). The obtained data were compared with an age-matched control group of 80 normocephalic children. After surgery, all dimensions of the cranial vault increased, but did not normalize (p < 0.0001). Contrarily, some normalization was noted in the skull base, within the anterior and posterior cranial fossae. Postoperative results confirmed the diagnostic cut-off level for VNO at 50°; however, the proposed VLI cut-offs skewed the accuracy of SSS in the control group. To the best of our knowledge, this study was the first to discuss the value of an NSC stratification system in relation to underlying components. The SSS has a relevant background, but its accuracy would increase with a redefinition of normative VLI ranges. [ABSTRACT FROM AUTHOR]

Airway management is one of the fundamental skills of any anaesthetist. Considerable anatomical changes occur between birth and adulthood during the development of the paediatric airway. Knowledge of these changes will influence airway planning during childhood. Airway obstruction complicates airway management and any anaesthetist working with children should be able to assess the airway for the presence of obstruction and generate a differential diagnosis of cause. This article aims to summarize key anatomical features of the paediatric airway, common causes of airway obstruction in children and provide suggestions for how to manage these patients. [ABSTRACT FROM AUTHOR]

Among the conditions underlying childhood daytime incontinence the most frequent is overactive bladder (OAB). Parasacral transcutaneous electrical nerve stimulation (parasacral TENS) is a promising therapy for OAB treatment in children; however, there is no standard treatment protocol. To evaluate the immediate and continued effects of parasacral TENS monotherapy in children with OAB. 57 children at mean age 10.8 years diagnosed with OAB at a single centre were prospectively enrolled from 2013 to 2018. The inclusion criterion was typical OAB symptoms. The treatment results were evaluated based on objective measurements from bladder diaries, 48 h frequency/volume (48 h F/V) charts, and uroflowmetry. The parasacral TENS treatment lasted for 4 months, twice daily, with 1 h sessions. Results were evaluated at three time points: 2 months of therapy, 4 months (end of active therapy), and 10 months (6 months after cessation of therapy). After 4 months of parasacral TENS treatment, the number of days with daytime incontinence decreased from 7.23 to 3.94/14 days (p < 0.05), nocturnal enuresis decreased from 6.81 to 3.77/14 days (p < 0.05), and urgency episodes from 7.36 to 3.58 in 14 days (p < 0.05). Treatment effects remained stable 6 months after therapy cessation regarding days with daytime incontinence (from 3.94 [immediately after treatment] to 3.28 in 14 days [6 months after treatment cessation]), nocturnal enuresis (from 3.77 to 2.91 in 14 days), and urgency episodes (from 3.58 to 2.12 in 14 days) (p < 0.05). Complete response after 6 months of therapy was observed in 32% of patients with daytime incontinence, 35% with nocturnal enuresis, and 50% with urgency episodes. A recent systematic review of parasacral TENS in children with OAB included only two studies with a follow up of 6 months or longer after treatment cessation; therefore, little is known about the continued effects of parasacral TENS. High rates of complete symptom remission were reported in studies where only subjective symptoms were evaluated. Results of our study reveal that the positive effect of treatment persist. The strengths of the present study include its prospective design, large sample size, and uniform standard urotherapy performed prior to TENS. The use of parasacral TENS in children with OAB is effective and results in a significant reduction in daytime incontinence, nocturnal enuresis, and urgency episodes. A longer treatment duration of 4 months leads to more improvement and the effects remain stable 6 months after treatment cessation. Summary Table Treatment results regarding daytime incontinence, nocturnal enuresis, and urgency episodes. Summary Table Initial evaluation before treatment After 4 months of pTENS After 6 months of pTENS cessation p Days daytime incontinence/14 days 7.23∗ 3.94∗∗ 3.28∗∗∗ ∗vs∗∗p < 0.05 ∗vs∗∗∗p < 0.05 ∗∗vs∗∗∗.ns Days with nocturnal enuresis/14 days 6.81# 3.77## 2.91####vs##p < 0.05 #vs###p < 0.05 ##vs###.ns Days with urgency episodes/14 days 7.36& 3.58&& 2.12&&&&vs&& p < 0.05 &vs&&&p < 0.05 &&vs&&&p < 0.05 Abbreviations: pTENS, parasacral transcutaneous electrical nerve stimulation. [ABSTRACT FROM AUTHOR]

Heated discussions have divided health care providers and policymakers on the risks versus benefits of general anesthesia in pediatric populations. We conducted this study to provide a comprehensive bibliometric analysis of general anesthesia in this specific population over the past decade. We summarized and quantitatively analyzed the studies related to general anesthesia in children and infants over the past decade. Using the Web of Science Core Collection as the data source, we analyzed the literature using CiteSpace software, focusing on authors, countries, institutions, keywords, and references to identify hotspots and predict research trends. A total of 2,364 publications on pediatric anesthesia were included in the analysis. The number of related publications and citations steadily increased from 2013 to 2022. The United States was the leading country in terms of output, and University of Toronto was the primary contributing institution. Co-citation analysis revealed that over the past decade research has mainly focused on the long-term adverse effects of general anesthesia on neurodevelopment and acute perioperative crisis events. Keyword analysis identified infant sedation and drug selection and compatibility as promising areas for development. In addition, improving the quality of perioperative anesthesia will be a major research focus in the future. Recent research in pediatric anesthesia has focused on mitigating the adverse effects of general anesthesia in infants and young children and studying the pharmacological compatibility of anesthetics. Our study results would assist researchers and clinicians in understanding the current research status and optimizing clinical practice in this field. [ABSTRACT FROM AUTHOR]

Spinal trauma in children and adolescents, including spinal cord injury, fractures and dislocations, is relatively uncommon, but represents the highest risk of morbidity and mortality of all paediatric injuries. Motor vehicle accidents, falls from heights and sport accidents resulting in blunt trauma are the most frequent mechanisms of injury. The average age of presentation is approximately 12 years old. Injury following spinal trauma differs according to age-specific biomechanical characteristics of the developing spine. The most common site of injury in younger children is the cervical spine, whereas injury to the thoracolumbar spine is more common in adolescents. Differential diagnosis following trauma should include physiological particularities of the developing spine. Search for concomitant lesions is mandatory as patients frequently present with more than one vertebral fracture. Injury in this population can significantly affect the developing spine leading to neurological trauma and progressive deformity. [ABSTRACT FROM AUTHOR]

Biomechanics is the application of principles of engineering and computers to biological problems. Clinical biomechanics of the spine is the understanding of normal and pathological functions of the human vertebral column in response to mechanical insult, which may include traumatic, degenerative, pathological, or slowly applied loads to the spine. Spinal biomechanics involves the regional features of the vertebrae, intervertebral discs, ligaments, facet joints and muscles. The role of these structures individually and in concert in relation to spinal injuries is discussed. Regional spinal biomechanics, maintenance of spinal stability and assessment of spinal instability following injury are described. Finally, the biomechanical principles, individual structural components, mechanisms of injury and principles specific to the adult and paediatric spine are reviewed. [ABSTRACT FROM AUTHOR]

Paediatric inflammatory bowel disease (PIBD), consisting of Crohn's disease, ulcerative colitis and inflammatory bowel disease unclassified, is a spectrum of chronic inflammatory conditions associated with significant morbidity. The incidence of PIBD continues to increase and disease phenotype is more severe than adult-onset disease. Referral to specialist services and diagnosis of PIBD can be slow; and faecal calprotectin is an invaluable tool for the prioritization of further investigation. Greater understanding of pre-existing treatments (such as anti-TNF monoclonal antibody therapy) and a growing arsenal of biologic and small molecule drugs have brought about significant changes in disease management. Whilst important challenges remain in the longer-term treatment of PIBD, including growth, nutrition and management of refractory disease, there remains a strong research focus on understanding underlying disease pathogenesis and a move towards personalized medicine. This review describes investigations, diagnosis and management of PIBD and presents contemporary evidence on nutritional and medical management. [ABSTRACT FROM AUTHOR]

Short bowel syndrome is the most common reversible cause of intestinal failure. Most of the children are started on parenteral nutrition (PN) after surgery to enable growth and allow time for intestinal adaptation. This is a process whereby the shorter length of bowel is able to achieve complete function as if the entire length of bowel is present. With management advances, most children with short bowel syndrome can discontinue PN and establish full enteral feeds. This article mainly focuses on the complications of short bowel syndrome that need to be avoided for the child to achieve intestinal adaptation, establish on enteral feeds/oral diet and achieve enteral autonomy. [ABSTRACT FROM AUTHOR]

Cyclical vomiting syndrome (CVS) was described over 100 years ago, but it is often underdiagnosed and undertreated, even after a diagnosis is made. It is relatively common, affecting almost 2% of school-age children in some studies. Although it is traditionally seen as a childhood disease related to migraine, CVS does occur in adults. The main characteristic of CVS is the stereotypical recurrent nature of episodes of intense nausea and vomiting lasting from few hours to few days and followed by a complete resolution of symptoms. The diagnosis is predominantly a clinical one and there are internationally accepted criteria for diagnosis. The management of acute attacks of CVS aims to relieve symptoms, reduce the duration of attacks and prevent dehydration and hospital admission. Management also includes appropriate counselling on healthy lifestyle, provision of individual management plans and preventive medications. The aim of management is to reduce the number of attacks and improve quality of life. About half the children with CVS start to have migraine with or without aura in late adolescence and around 40% continue with CVS into early adult life. This article is aimed at healthcare professionals looking after children with CVS and describes the clinical presentation, the criteria required for diagnosis and outlines the different treatment options. [ABSTRACT FROM AUTHOR]

• Ketamine has been reported to reduce perioperative opioid consumption. • Continuous perioperative ketamine infusion produces superior analgesia than a single bolus dose. • In the pediatric population, low-dose ketamine infusion provides effective postoperative analgesia after cardiac surgery. • Low-dose ketamine infusion is not associated with ketamine-related side effects. This study was designed to evaluate the effect of low-dose ketamine infusion on the perioperative consumption of opioids in pediatric open cardiac surgery. A randomized, controlled, double-blinded single-center study was conducted. The study took place in a tertiary care children's hospital. Patients of both sexes aged 2–12 years who underwent cardiac surgery were included. Patients in the ketamine group received a bolus of 0.3 mg/kg of ketamine before skin incision followed by continuous intraoperative infusion of 0.25 mg/kg/h and postoperative infusion of 0.1 mg/kg/h for 24 h. Patients in the control groups received volumes of normal saline either bolus or continuous infusion like that of the ketamine group. The primary outcome was the total dose of fentanyl consumed over the first 24 hours postoperatively. Secondary outcomes were intraoperative fentanyl consumption, time to extubation, modified objective pain score, and incidence of vomiting, pruritus, diplopia, or hallucinations. A total of 80 patients were recruited but the final analysis was done on 35 patients in the ketamine group and 34 in the control group. Fentanyl consumption during surgery and in the first 24 hours postoperatively was significantly lower in the ketamine than the control group. Patients in both the ketamine and control groups had similar times to extubation. Modified objective pain scores were significantly lower in the ketamine group than the control group. None of the patients in either group had diplopia or hallucinations. Low-dose ketamine infusion in children undergoing open cardiac surgery reduced intra- and postoperative opioid consumption and postoperative pain scores. Moreover, ketamine did not cause diplopia or hallucinations. [ABSTRACT FROM AUTHOR]

The excessive fructose intake including high-fructose corn syrup (HFCS) may be responsible for increase of obesity occurrence. This study was designed to find potential differences in duodenal fructose transporters on mRNA and protein levels between obese and normal weight children and adolescents. We performed a cross-sectional study on a group of 106 hospitalized patients aged 12 to 18. Glucose transporter 2 (GLUT2) and glucose transporter 5 (GLUT5) mRNA as well as protein levels (ELISA and Western blot methods) were assessed in duodenal mucosa biopsies of the patients categorized as obese or normal weight. Additionally, the expression of the aforementioned transporters was analyzed in patients based on the presence of insulin resistance (IR) and metabolic syndrome (MS). In children with obesity, increased duodenal protein levels of GLUT5 (Relative protein GLUT5 expression/ACTB) (0.027 ​± ​0.009 vs. 0.011 ​± ​0.006, p ​< ​0.05) but not GLUT2 as compared with the normal weight group, were revealed. No significant differences in duodenal relative GLUT2 and GLUT5 genes expression between the studied groups were found. There was no relationship between the presence of IR or MS and intestinal mRNA GLUT2 and GLUT5 as well as GLUT2 protein expression. The upregulation of the duodenal GLUT5 may contribute to obesity occurrence in children and adolescents. [ABSTRACT FROM AUTHOR]

• Sensitive endpoints are needed in the new era of mild cystic fibrosis lung disease. • MBW and MRI sensitively assess small airway disease in children with cystic fibrosis. • Lung MRI outcomes were more sensitive to early lung disease than lung function. Non-invasive and sensitive clinical endpoints are needed to monitor onset and progression of early lung disease in children with cystic fibrosis (CF). We compared lung clearance index (LCI), FEV 1 , functional and structural lung magnetic resonance imaging (MRI) outcomes in Swiss children with CF diagnosed following newborn screening. Lung function (LCI, FEV 1) and unsedated functional and structural lung MRI was performed in 79 clinically stable children with CF (3 – 8 years) and 75 age-matched healthy controls. Clinical information was collected throughout childhood. LCI, ventilation and perfusion defects, and structural MRI scores were significantly higher in children with CF compared with controls, but FEV 1 was not different between groups. Lung MRI outcomes correlated significantly with LCI (morphology score (r = 0.56, p < 0.001); ventilation defects (r = 0.43, p = 0.001); perfusion defects (r = 0.64, p < 0.001), but not with FEV 1. Lung MRI outcomes were more sensitive to detect impairments in children with CF (abnormal ventilation and perfusion outcomes in 47 %, morphology score in 30 %) compared with lung function (abnormal LCI in 21 % and FEV 1 in 4.8 %). Pulmonary exacerbations, respiratory hospitalizations, and increase in patient-reported cough was associated with higher LCI and higher structural and functional MRI outcomes. The LCI and lung MRI outcomes non-invasively detect even mild early lung disease in young children with CF diagnosed following newborn screening. Pulmonary exacerbations and early respiratory symptoms were risk factors for structural and functional impairment in childhood. [ABSTRACT FROM AUTHOR]

• Nasal nitric oxide (nNO) is reduced in people with cystic fibrosis (PwCF). • PwCF treated with elexacaftor/tezacaftor/ivacaftor (ETI) show reduced sinonasal symptoms. • We show that ETI treatment increases nNO in PwCF. • nNO may be a potential marker for sinonasal disease in CF. In health, nitric oxide (NO) shows high concentrations in the upper airways, while nasal NO (nNO) is significantly lower in patients with sinonasal inflammation, such as people with cystic fibrosis (PwCF). In PwCF treated with elexacaftor/tezacaftor/ivacaftor (ETI; PwCF-ETI), clinical improvement of sinonasal symptoms and inflammation was observed. We therefore hypothesised that ETI may increase nNO in PwCF. 25 PwCF-ETI underwent nNO measurement at baseline and after 3 to 24 months of ETI treatment. NNO was measured using velum closure (VC) techniques in cooperative patients and tidal breathing (TB) for all patients. As controls, 7 CF patients not eligible for ETI (PwCF-non ETI) and 32 healthy controls (HC) were also repeatedly investigated. In PwCF-ETI, sinonasal symptoms, lung function parameters and sweat chloride levels improved from baseline to follow-up whereas there was no change in PwCF-non ETI and HC. NNO increased from a median (IQR) value at baseline to follow-up from 348.2 (274.4) ppb to 779.6 (364.7) ppb for VC (P < 0.001) and from 198.2 (107.0) ppb to 408.3 (236.1) ppb for TB (P < 0.001). At follow-up, PwCF-ETI reached nNO values in the normal range. In PwCF-non ETI as well as HC, nNO did not change between baseline and follow-up. In PwCF-ETI, the nNO values significantly increased after several months of ETI treatment in comparison to baseline and reached values in the normal range. This suggests that nNO is a potential non-invasive biomarker to examine sinonasal inflammatory disease in PwCF and supports the observation of clinical improvement in these patients. [ABSTRACT FROM AUTHOR]

Congenital myelomeningocele, or spina bifida (SB), is the predominant congenital anomaly of the central nervous system. Beyond its implications on neonatal mortality, SB impacts the long-term quality of life in affected children. This study sought to investigate the health-related quality of life (HRQoL) among children with SB treated at Ethiopia's leading pediatric neurosurgical facility. Set at Zewditu Memorial Hospital in Addis Ababa, Ethiopia, this hospital-based cross-sectional study spanned from June 30 to September 30, 2022. It incorporated 232 children, using data gathered through interviewer-led questionnaires. The HRQoL was measured using the PedsQL 4.0, a 23-item generic scale. The study's participants had a median age of 5 years (interquartile range = 3 to 6 years). The aggregate mean scores on the PedsQL 4.0 tallied at 68.59 ± 18.01. The lowest scores emerged from queries on school participation, whereas physical and emotional functioning registered the highest scores. Through multiple regression analyses, variables such as family income, monthly household income, number of children, and the presence of a neurogenic bladder showed strong association with HRQoL. This study fills a gap in the literature providing information on the HRQoL and its associated factors for children with SB in low-resourced settings. We champion the proactive integration of quality-of-life metrics into neurosurgical care policy and practice. Given the enduring consequences of SB, interventions honing the HRQoL can steer children toward realizing their intrinsic and enhance societal participation and contribution. [ABSTRACT FROM AUTHOR]

Physical activity and sedentary behaviour are usually described using daily volume indicators. However, for young children (6–12 years) and specifically those with conditions such as Cerebral Palsy, exploration of how physical behaviours are accumulated may provide valuable insight for behaviour change intervention planning. How are physical activity and sedentary behaviour accumulated by 6–12 year old children with Cerebral Palsy and is this different from their typically developing peers? A cross-sectional study of a convenience sample of ambulatory children with CP (CP) and typically developing (TD) children, 6–12 years, was recruited. Children wore a thigh worn activity monitor (activPAL4) during typical daily activities. Overall volume of daily sedentary, upright and stepping time was characterised as well as how this was accumulated in bouts of activity. There were no differences (p<0.05) in either volume or accumulation measures of physical behaviours between TD (n=14, 8.2±1.8 years) and children with CP (n=15, 8.6±1.4 years). However, there was wide variation in activity accumulation patterns between individuals. The mean proportion of daily time in each physical behaviour, accumulated in bouts above set times was: Upright time: bouts >5 mins 46 % TD & CP, bouts >20 mins 9 % TD & CP; Stepping time: bouts >0.5 mins 50 % TD, 45 % CP, bouts >2 mins 10 % TD, 9 % CP; Sedentary time: bouts >5 mins 77 % TD, 76 % CP, bouts >30 mins 26 % TD, 29 % CP. Young children with CP aged 6–12 years do not appear to have different physical behaviours to their TD peers. However, for individuals, descriptors of accumulation of physical activity and sedentary behaviour bouts provides additional information over and above volume measures, giving insight into behaviour which may be used to inform intervention planning. • Children with Cerebral Palsy have similar physical behaviour to their peers. • Physical behaviour bout accumulation highlights different individual behaviours. • About 25 % of upright time is spent in bouts 10 minutes or more long. • Approximately only 20–25 % of time spent stepping is in bouts longer than one minute. • Over 25 % of sedentary time is spent in bouts longer than 30 minutes. [ABSTRACT FROM AUTHOR]

Many children with cerebral palsy (CP) show impairments in trunk posture control, one crucial factor contributing to impairments in gait and arm manipulation. The goal of this study was to test the feasibility of the cable-driven hippotherapy system on improving trunk posture control and walking function in children with CP. Ten children were recruited in this study with average age 6.4 ± 3.0 years old, and were randomly assigned to the robotic group and the conventional balance training group. A custom designed cable-driven robotic hippotherapy system was used to deliver controlled pelvis perturbations while children were sitting astride. Participants from both groups underwent intensive robotic hippotherapy training or conventional balance training, depending on their group assignment, for 6 weeks (3 time/week). Outcome measures were assessed pre and post 6 weeks of robotic or conventional balance training, and 8 weeks after the end of training (follow-up test). The primary outcome measure was trunk control, which was measured using the Trunk Control Measurement Scale (TCMS). In addition, the Gross Motor Function Measure (GMFM-66), self-selected overground walking speed, and 6-minute walking distance were also assessed. The change in TCMS score from baseline to the post intervention was significantly greater for the robotic group than that for the conventional group (i.e., 6 ± 3 vs. −1 ± 5, p = 0.048, Mann-Whitney test). GMFM scores, self-selected overground walking speed, and 6-minute walking distance showed no significant improvement after robotic hippotherapy and after conventional balance training (p > 0.05). Results from this study indicated that it was feasible to improve trunk posture control in children with CP using a cable-driven robotic hippotherapy system. Knowledge obtained from this study may provide an insight for the development of new perturbation-based intervention approaches for improving trunk posture control in children with CP. • A cable-driven robotic hippotherapy system has been tested in children with CP. • Greater improvement in trunk posture control was observed after robotic hippotherapy. • It was feasible to improve trunk posture control using robotic hippotherapy training. [ABSTRACT FROM AUTHOR]

En France, pour bénéficier d'une prise en charge médicosociale et éducative adaptée, les enfants ayant un trouble du spectre de l'autisme doivent obtenir une orientation par la maison départementale des personnes handicapées (MDPH) et que ces notifications soient appliquées. En Guyane, les inégalités sociales et territoriales de santé sont omniprésentes. Il n'existe pourtant aucune donnée sur la prise en charge des adolescents avec un trouble du spectre de l'autisme en Guyane. L'objectif du projet était de connaître le parcours scolaire et médicosocial des enfants inclus dans le registre des troubles du spectre de l'autisme de Guyane depuis 2016 (qui vivaient en Guyane en 2016 et dont leur TSA avait été diagnostiqué avant leurs 8 ans) au moyen d'une interview téléphonique et d'un recueil de données à la MDPH. Nous avons inclus 52 jeunes âgés de 11 à 18 ans dont 40 familles jointes par téléphone. Les résultats obtenus à travers les variables recueillies montrent que, malgré un diagnostic posé avant 8 ans, seulement 29 jeunes (sur 47 renseignés) bénéficient d'une prise en charge médicosociale et éducative coïncidente avec les préconisations de la Commission des droits et de l'autonomie des personnes handicapées en cours (CDAPH). Parmi les 52 jeunes suivis, il y en avait au moins 9 – soit 17,3 % – qui ne recevaient aucune forme d'éducation. Trente et un jeunes bénéficiaient d'une prise en charge médicosociale, sanitaire et/ou éducative au moment de l'enquête contre 16 qui n'en recevaient aucune, notamment parce qu'ils étaient sur liste d'attente, depuis 5 ans en moyenne. Par ailleurs, 34 % des familles interrogées disaient ne pas être satisfaites de la prise en charge globale promulguée à leur enfant, surtout du fait du manque de personnel. En conclusion, il existe en Guyane un décalage important et mal vécu entre ce qui est recommandé aux parents pour la prise en charge de leur enfant adolescent et ce qui est en réalité possible. In France, to benefit from appropriate medical, social and educational care, children with autism spectrum disorders must obtain a referral from the Maison Départementale des Personnes Handicapées (MDPH), and these notifications must then be implemented. In French Guiana, social and territorial inequalities in health are omnipresent. However, there are no data on the care of adolescents with Autism Spectrum Disorder in French Guiana. The aim of the project was to explore the educational and medico-social pathways of children included in Guiana's autism spectrum disorder register since 2016 (who were living in Guiana in 2016 and whose ASD had been diagnosed before their 8th birthday) by means of a telephone interview and data collection at the MDPH. We included 52 young people aged 11 to 18, including 40 families contacted by telephone. The results obtained through the variables collected show that, despite a diagnosis made before the age of 8, only 29 young people (out of 47 completed) benefit from medical, social and educational care that coincides with the recommendations of the current Commission des droits et de l'autonomie des personnes handicapées (CDAPH). Of the 52 young people monitored, at least nine – or 17.3% – were not receiving any form of education. Thirty one young people were receiving medical, social, health and/or educational care at the time of the survey, compared with 16 who were not receiving any, mainly because they had been on a waiting list for an average of five years. In addition, 34% said they were not satisfied with the overall care their child received, mainly because of staff shortages. In conclusion, in French Guiana, there is a significant gap between what is recommended to parents for their teenage child's care and what is actually possible. [ABSTRACT FROM AUTHOR]

Suicidal thoughts and behaviors (STBs) in children are an escalating public health concern. This study focused on 1 understudied candidate risk factor, namely, preschool-onset major depressive disorder (PO-MDD), as a predictor of persistent and emerging STBs from early childhood into preadolescence. Participants were 137 children 8 to 12 years of age who met criteria for PO-MDD when they were 3 to 6 years of age, and a nondepressed sample of 53 age-, income-, and sex-matched peers. STBs were reported by caregivers (preschool, preadolescence) and children (preadolescence) using age-appropriate diagnostic interviews. By preadolescence, children who had PO-MDD were 7.38 times more likely than their peers to have endorsed STBs after early childhood (p <.001; 67.9% vs 22.6%), including 6.71 times more likely to have engaged in suicide behaviors/attempts (p =.012; 21.9% vs 3.8%); they were also 8.98 times more likely to have endorsed STBs over the prior month (p =.005; 26.3% vs 3.8%). Similar findings emerged when limiting the PO-MDD group to children without preschool STBs, and when controlling for externalizing comorbidities, implicating PO-MDD as a unique diagnostic predictive risk factor. However, children who had PO-MDD with STBs were 3.46 times more likely than children who had PO-MDD without STBs to endorse later STBs (p =.018; 83.1% vs 54.2%), indicating substantial continuity of preschool STBs alongside strikingly high rates of emerging STBs into preadolescence. This longitudinal study explores preschool onset major depressive disorder (PO-MDD) as a predictor of having suicidal thoughts or attempting suicide by age 12. 137 children aged 8 to 12 years who met criteria for PO-MDD when they were 3 to 6 years of age and 53 non-depressed peers were included in the study. The study found that preadolescents who had experienced preschool-onset depression were 6.14 times more likely to experience active suicidal thoughts and 8.03 times more likely to have made a suicide attempt by age 12 when compared to preadolescents who did not experience preschool depression. Results suggest that children with preschool-onset depression would likely benefit from increased suicide screening, proactive safety planning and early interventions. PO-MDD is a strong risk factor for the emergence and persistence of STBs into preadolescence. Children with PO-MDD would likely benefit from increased suicide screening, proactive safety planning, and early interventions. [ABSTRACT FROM AUTHOR]

Self-injurious thoughts and behaviors (SITB) among preteen children have risen to the attention of researchers, practitioners, and policymakers. To shed light on potential treatment/prevention targets, we sought to identify empirically derived emotional and behavioral problem profiles of preteens with SITB, and to determine whether these profiles differ by age, gender and society. Caregivers of 46,719 children aged 6 to 12 years from 42 societies across the world completed the Child Behavior Checklist for ages 6-18 (CBCL/6-18). There were 1,656 children whose caregivers indicated that their child experienced SITB. We conducted a latent profile analysis (LPA) using scores from eight CBCL/6-18 problem scales to derive problem profiles of children with SITB. Multilevel modelling was used to estimate differences in the profiles by SITB, society, sex, and age. A 4-profile model provided the best fit to the data, with profiles reflecting low problems (39.7%), mild problems (42.6%), moderate problems (15.4%), and rule-breaking/thought problems (2.3%). The low problems profile had CBCL problem scale scores nearly indistinguishable from those of children without SITB. Children in the rule-breaking/thought problems group were mostly female, whereas children in the other profile groups were mostly male. Children with the rule-breaking/thought problems profile also were most likely to have both suicidal thoughts and self-harm behaviors. In this study, authors analyzed emotional and behavioral profile of preteens who experienced self-injurious thoughts and behaviors (SITB). Caregivers of over 46,000 children aged 6-12 from 42 countries completed the Child Behavior Checklist. The authors found that most preteens with SITB had low levels of other mental health problems. This study highlights the needs to screen all children for SITBs, not just those who have have significant mental health problems. Problem profiles of preteens with SITB are heterogeneous, with most having relatively low levels of other psychopathology. Selectively screening only children with clinically significant mental health problems for suicidal thoughts and self-harm behaviors (eg, asking about suicidal thoughts only among children with depression) risks missing many children experiencing SITB. [ABSTRACT FROM AUTHOR]