Children, Volume 6, Issue 7 (July 2019) – 5 articles

Anecdotal reports suggest migrant children at the US border have had to undergo age assessment procedures to prove to immigration officials they qualify for special protections afforded to those under age 18. There are a variety of methods to assess the chronological ages of minors, including imaging studies such as X-rays of the wrist, teeth, or collarbone. However, these procedures have come under great scrutiny for being arbitrary and inaccurate, with a significant margin of error, because they are generally based on reference materials that do not take into account ethnicity, nutritional status, disease, and developmental history, considerations which are especially relevant for individuals coming from conflict and/or resource-constrained environments. Using these procedures for migration purposes represent an unethical use of science and medicine, which can potentially deprive minors with the protections that they are owed under US and international laws, and which may have devastating consequences. We should advocate for the creation special protocols, educate law enforcement and legal actors, ensure such procedures are carried out only as a last resort and by independent actors, emphasize child protection and always put the child’s best interest at the core. Full article

Pre-teen children face stressors related to their transition from childhood to adolescence, with a simultaneous increase in academic pressure. The present study compared the immediate effects of 18 min of (i) high frequency yoga breathing with (ii) yoga-based breath awareness and (iii) sitting quietly, on (a) attention and (b) anxiety, in 61 pre-teen children (aged between 11 and 12 years; 25 girls). Attention was assessed using a six letter cancellation task and Spielberger’s State Trait Anxiety Inventory STAI-S was used to measure anxiety before and after the three practices, practiced on separate days. Repeated measures ANOVA, followed by Bonferroni adjusted post-hoc analyses showed an increase in total attempts and net scores after high frequency yoga breathing (p < 0.05), while wrong attempts increased after yoga based breath awareness (p < 0.05). Anxiety decreased comparably after all three interventions. The 25 girls in the group had the same trend of results as the whole group with respect to the attention-based cancellation task, while boys showed no, how since change. For both girls and boys, anxiety decreased after all three 18min interventions. The results suggest that high frequency yoga breathing could be a short, useful school based practice to improve attention and reduce anxiety. Full article

Worldwide 37,000 people are forced to flee their homes every day due to conflict and persecution. The factors that lead people to leave their home countries often originate with economic deprivation and violence, escalated to a level that becomes a struggle for survival. Climate change, as it has accelerated over the last three to four decades and negatively impacted natural resources, contributes to a parallel increase in strife and migration. The US response to migration has been to construct an “Invisible Wall” of isolationist and xenophobic policies, many of which are especially harmful to children and their families. The southern US border is perhaps the most high profile location of the Invisible Wall’s construction, fortified by federal policies and a withdrawal from international cooperation. Global reengagement on climate change and migration, US ratification of the Convention on the Rights of the Child, and destruction of the Invisible Wall will help to create a world where children can thrive. Full article

Accountable care organizations (ACOs) have emerged as an effective healthcare delivery model for managing quality and cost at a population level. Within ACOs, pharmacists are critical for the delivery of high-value health care, offering patients and health care providers medication-related training, resources, and guidance that can improve quality of care at lower costs. Partners For Kids (PFK), one of the oldest and largest pediatric ACOs in the country, has successfully leveraged pharmacists to provide population health management and medication management to promote health outcomes for individual patients and the overall population it serves. This review explores how the inclusion of pharmacists in the development and execution of various quality improvement initiatives within PFK has positively impacted outcomes for patients while also lowering overall spend. A catalog of interventions is provided to offer various ways that pharmacists can intersect as providers in the triad of patient/family, payor, and provider. By providing enhanced training and education, on-site guidance, medication management, and population-level data analysis, pharmacists are able to identify and improve inefficiencies in care. Moving forward, ongoing engagement of pharmacists in health care operations will be a necessary feature to maximize health care value. Full article

Preterm birth (<37 weeks’ gestation) has been associated with problems in social functioning. Whether social inhibition is specifically related to preterm birth and whether early parenting may protect against social inhibition difficulties is unknown. To explore effects of gestational age and early parent–infant relationships on social inhibition, 1314 children born at 26–41 weeks gestational age were studied as part of the prospective Bavarian Longitudinal Study. Early parent–infant relationship quality was assessed postnatally with the parent–infant relationship index. Social inhibition was assessed at age 6 years using an experimental procedure, in which nonverbal and verbal responses were coded into social inhibition categories (disinhibited, normally responsive, inhibited). Multinomial logistic regressions indicated that children with lower gestational age showed more socially disinhibited (nonverbal: OR = 1.27 [95% CI = 1.17–1.40], verbal: OR = 1.23 [95% CI 1.13–1.35]) and inhibited (nonverbal: OR = 1.21 [95% CI = 1.11–1.32], verbal: OR = 1.11 [95% CI = 1.01–1.21]) responses. Good early parent–infant relationships were associated with less verbal disinhibition (OR = 0.70 [95% CI = 0.52–0.93]). Findings suggest that children with lower gestational age are at greater risk to be both socially inhibited and disinhibited. Early parenting affected risk of abnormal social responses. Supporting early parent–infant relationships may reduce preterm children’s risk for social difficulties. Full article