Search Results (4,391)

Background: Pediatric sepsis, a life-threatening condition, often progresses to septic shock. However, microbiological and clinical profiles between pediatric sepsis patients with and without septic shock remain underexplored. Methods: This retrospective cohort study included 1200 pediatric sepsis patients (Phoenix Sepsis Score ≥ 2) from the Children’s Hospital of Chongqing Medical University between June 2018 and June 2023. Pediatric sepsis patients with septic shock were diagnosed based on the Phoenix Cardiovascular Score being ≥1. Clinical data and pathogens were taken from the electronic medical records and analyzed. Univariate and multivariable logistic regressions were conducted to identify the risk factors for septic shock. Results: Septic shock patients had longer hospital stays (14.8 vs. 12.0 days, p = 0.003) and higher mortality (17.4% vs. 4.7%, p < 0.001) when compared to non-septic-shock patients. Among these two groups, the pathogen prevalence revealed that bacterial pathogens dominated (48.9%), followed by viruses (10.3%). Acinetobacter baumannii, Escherichia coli, and Staphylococcus aureus remained the predominant pathogens; Pseudomonas aeruginosa and Mycoplasma pneumoniae were also increased. Combination antibiotic therapy was most frequent in patients with viral and fungal sepsis (79% and 86.5%, respectively). Patients with fungal sepsis had significantly longer hospital stays than those with viral sepsis (20.74 vs. 12.97 days, p = 0.017). Multivariable analysis identified that elevated lactate (OR = 1.49, 95% CI = 1.29–1.75) and pulmonary infection (OR = 2.25, 95% CI = 1.35–3.73) were independent risk factors for septic shock. Conclusions: Children with septic shock had higher mortality and prolonged hospitalization, with distinct microbiological profiles when compared with patients in the non-septic-shock group. Elevated lactate and presence of pulmonary infection are independent risk factors for septic shock. Early recognition of high-risk patients and tailored antimicrobial strategies are critical for improving outcomes. Full article

Background/Objectives: In Angola, malnutrition contributes each year to the deaths of an estimated 42,000 to 76,000 children under the age of 5. Addressing this issue must stand as a priority and requires providing local residents with access not only to nutritious food but also to adequate and accurate information in order to facilitate informed dietary choices. As part of the “Seigungo—Health, Education and Quality of Maternal and Child Life in Gungo project”, a nutrition-focused study was conducted in Gungo, Angola to evaluate the effectiveness of a training model designed to enhance food literacy among residents. Methods: Data were collected using a 14-item questionnaire developed to assess various key domains of food literacy: information seeking and access; comprehension and thematic knowledge; critical evaluation of information and behaviour; practical application and sound decision-making. Results: Thirty trainees took part in the study, of which 60% were men, with a mean age of 45.6 years. The majority were single (53.3%) and had completed six years of formal education (26.7%). Before attending the training program, 86.7% of the participants demonstrated inadequate or problematic food literacy. Following the intervention, the proportion of participants with adequate food literacy increased significantly from 13.3% to 73.3% (p < 0.001). Conclusions: The training program had a statistically significant impact on improving food literacy. Full article

Background: Child Development Accounts (CDAs) were introduced in the 1990s as a long-term asset-building policy aimed at supporting families in accumulating assets to achieve life goals for their children, including higher education, homeownership, and long-term economic security. Beyond their financial benefits, CDAs have been theorized to strengthen family relationships and improve children’s well-being by fostering a future-oriented mindset and increasing parental involvement in educational activities. Objective: This study investigates the impact of CDAs on parent–child educational engagement and children’s sense of hope for the future, contributing to the growing body of research on the multidimensional benefits of asset-based policies for children’s development. Methods: Data were drawn from the third wave of the SEED for Oklahoma Kids (SEED OK) study, a rigorous, longitudinal, randomized policy experiment in the United States. The analytic sample comprised 1425 families. Dependent variables were parent–child educational engagement and children’s hope. The independent variable was participation in the SEED OK CDA policy experiment. Baseline sociodemographic variables related to children, mothers, and households were controlled for in the analysis. Multivariate linear regressions and path analysis techniques were employed to assess direct and indirect effects. Results: Participation in CDAs was found to improve parent–child educational interactions and enhance children’s hope significantly in the pre-COVID-19 sample. The study’s rigorous design and consistent implementation allowed for establishing causal relationships and long-term developmental benefits. Conclusions: CDAs offer not only financial advantages but also contribute meaningfully to strengthening family dynamics and promoting positive psychosocial outcomes for children, supporting their inclusion in comprehensive social policy frameworks. Full article

Introduction: Secure infant/child–caregiver attachment is crucial for the development of social and emotional functioning and can affect long-term outcomes, such as adult relationships, but it may also be influenced by prenatal and early childhood risk factors. Children with a history of prenatal alcohol exposure (PAE) have a complex spectrum of strengths and difficulties and often have the additional risk of early life adversity. There is some evidence that children with PAE are at increased risk of insecure attachment, but it is unclear whether this is consistent or why it is the case. No published review has focused on the relationship between PAE and attachment. Methods: A systematic search of seven academic databases using the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines was undertaken by two reviewers to identify primary studies that have focused on the relationship between PAE and attachment. Quality assessments were undertaken using the Quality of Observational Cohort and Cross-Sectional Studies tool, and the report was written following the PRISMA-ScR checklist. Results: A total of 4199 records were returned from the database searches. A total of 11 studies (eight peer-reviewed papers and three dissertations), published between 1987 and 2021, met the criteria. Five studies showed that PAE was related to insecure or disorganised attachment, two of which showed that infant irritability and caregiver–infant interaction mediated this relationship. The other six studies found no significant relationship between PAE and attachment. Conclusions: This scoping review demonstrates that there is a dearth of published research on this topic, and none that takes advantage of more recent understanding of the relationship between adverse childhood experiences and neurodevelopmental disorders. There is some evidence that PAE may impact the attachment relationship via caregiver–infant interaction and infant irritability, but further studies, including those that assess the additional impact of early life adversity, are needed. Full article

Alcohol consumption during pregnancy and lactation remains a significant global issue. Preventive policies have proven insufficient, and consumption rates remain high, mainly due to a lack of awareness, the misconception that only high alcohol intake harms the fetus, inconsistent medical advice, and pre-existing alcohol use disorders. Alcohol consumption is linked to child harm during critical stages of development. Using a recently published model of fetal alcohol spectrum disorder (FASD) developed by our group, we analyzed brain changes in mothers who consumed alcohol during pregnancy and lactation and the behavioral consequences at the emotional-cognitive level and in caring for their offspring. We also considered the previous drinking history, using the paradigm of voluntary pre-gestational alcohol consumption. In addition, from gestational day 7 (GD7) until the day of sacrifice, mothers received a 3 g/kg dose of alcohol every 12 h via gavage. Our findings revealed deficiencies in maternal care, anxiety and depressive-like behavior, and aversive stimulus learning disturbances. These were associated with changes in gene targets linked to stress-axis regulation, reward circuits, and neuroplasticity. Additionally, we observed increased microgliosis and astrogliosis, indicating neuroinflammation in brain regions involved in cognition and emotional states’ regulation. Full article

Caregiver coaching is an essential component of caregiver-mediated interventions for young autistic children. Previous research evaluating usual practice in early intervention (EI) has found that EI providers often do not use caregiver coaching. Increasing the use of caregiver coaching strategies is critical to improving the outcomes of EI. We used a community-partnered process to develop a toolkit of implementation strategies to improve the use of caregiver coaching in EI. This study presents findings from a preliminary evaluation of the toolkit using a non-concurrent multiple-baseline design across groups of providers and caregiver–child dyads. The results indicate that providers’ caregiver coaching fidelity improved following the introduction of the toolkit. Caregivers demonstrated moderate growth in their use of supportive parenting techniques. All providers rated the toolkit as acceptable, appropriate, and feasible. The findings suggest that a toolkit of implementation strategies tailored to support the needs of community-based providers shows promise for improving caregiver coaching in EI. Full article

Background: While attention deficit/hyperactivity disorder (ADHD) is characterized by neurodevelopmental heterogeneity, the influence of familial structural factors—particularly parental age and skipped-generation caregiving—on comorbidity patterns remains insufficiently studied. This study examined the associations between parent–child age gaps, skipped-generation family structures, and psychiatric comorbidities in children with ADHD. Methods: Data came from Taiwan’s NHIRD (2009–2013), including 79,163 ADHD cases and 395,815 matched controls. Key variables included maternal and paternal age at childbirth and grandparent-paid insurance premiums as a proxy for skipped-generation caregiving. Conditional logistic regression was used to estimate odds ratios (ORs) for 20 psychiatric and developmental comorbidities. Results: Children with ADHD exhibited significantly higher odds of various comorbidities, including oppositional defiant disorder (OR = 147.05, 95% CI = 101.0–214.1), somatoform disorder (OR = 25.78, 95% CI = 7.96–83.46), anxiety disorder (OR = 24.49, 95% CI = 17.9–33.5), emotional disturbances during childhood and adolescence (OR = 13.99, 95% CI = 9.15–21.4), and autism spectrum disorder (OR = 8.07, 95% CI = 6.63–9.82). Advanced maternal age (>35 years) was associated with increased odds of autism spectrum disorder (OR = 1.47, 95% CI: 1.29–1.67) and speech/language delay (OR = 1.33, 95% CI: 1.17–1.52), whereas younger maternal age (≤25 years) was linked to higher odds of anxiety disorder (OR = 1.23, 95% CI: 1.13–1.33) and adjustment reaction (OR = 1.41, 95% CI: 0.95–2.11). Maternal age under 20 years showed the highest odds for bipolar disorder (OR = 2.01, 95% CI: 1.04–3.88). For paternal age, older age (>35 years) was associated with increased odds of autism (OR = 1.14, 95% CI: 1.04–1.26) and speech/language delay (OR = 1.15, 95% CI: 1.04–1.27), whereas paternal age ≤20 years was strongly linked to bipolar disorder (OR = 3.58, 95% CI: 1.54–8.32) and anxiety (OR = 1.39, 95% CI: 1.01–1.93). Children from skipped-generation families—defined as grandparent-paid insurance premiums without parental cohabitation—had significantly higher odds of bipolar disorder (OR = 2.88, 95% CI: 1.36–6.11), personality disorder (OR = 9.23, 95% CI: 2.23–38.20), adjustment reaction (OR = 2.23, 95% CI: 1.39–3.59), and emotional disturbances during childhood/adolescence (OR = 1.69, 95% CI: 1.13–2.54). Conclusions: Both extremes of parental age and skipped-generation caregiving are linked to specific associations with certain psychiatric comorbidity patterns in children with ADHD. These findings highlight the importance of integrating family structure into diagnostic assessments and treatment planning and support the development of targeted early interventions. Full article

Introduction Limited studies have reported data on the real-world clinical use of extended half-life (EHL) IX products in children and adolescents with haemophilia B, also referred to as people with haemophilia B (PWHB). Aim To examine the real-life experience with EHL factor IX products in PWHB regarding the clinical experience with standard half-life products (SHL). Methods A retrospective review of medical records of PWHB who have been prescribed EHL IX factor concentrates was conducted. Results Fourteen male PWHB were enrolled in the study, all with severe bleeding phenotypes being on prophylaxis (1–6 years old: n = 3, 7–12 years old: n = 5 and 13–18 years old: n = 6). Four of them were previously untreated patients; nine out of fourteen children (64%) had severe, four had moderate, and one child had mild haemophilia B. Median length of follow-up was 45 months (range 16–84 months). Children who transitioned from SHL prophylaxis to EHL prophylaxis experienced changes in their treatment outcomes. The median dosing interval increased from 3.5 days to 7 days, mean trough levels rose from 4.3% to 15.3% among children with severe haemophilia B, and the mean annual bleeding rate (ABR) decreased from 1.8 to 1 (p = 0.3, Wilcoxon test). Significant differences were found in EHL vs. SHL use regarding (a) the factor IX consumption for prophylaxis and bleeds (p = 0.046, t-test), with the EHL consumption (45.6 IU/kg/week) being significantly lower than the SHL consumption (70.3 IU/kg/week), and (b) the factor IX consumption only for prophylaxis (p = 0.022, t-test), with the EHL consumption (37.0 IU/kg/week) being significantly lower than the SHL consumption (66.0 IU/kg/week). There was no inhibitor development. Conclusion This study demonstrates the successful use of EHL prophylaxis in PWHB. Full article

The absence of parental presence has a direct impact on the emotional stability and social routines of children, especially during extended periods of separation from their family environment, as in the case of daycare centers, hospitals, or when they remain alone at home. At the same time, the technology currently available to provide emotional support in these contexts remains limited. In response to the growing need for emotional support and companionship in child care, this project proposes the development of a multi-platform software architecture based on artificial intelligence (AI), designed to be integrated into humanoid robots that assist children between the ages of 6 and 14. The system enables daily verbal and non-verbal interactions intended to foster a sense of presence and personalized connection through conversations, games, and empathetic gestures. Built on the Robot Operating System (ROS), the software incorporates modular components for voice command processing, real-time facial expression generation, and joint movement control. These modules allow the robot to hold natural conversations, display dynamic facial expressions on its LCD (Liquid Crystal Display) screen, and synchronize gestures with spoken responses. Additionally, a graphical interface enhances the coherence between dialogue and movement, thereby improving the quality of human–robot interaction. Initial evaluations conducted in controlled environments assessed the system’s fluency, responsiveness, and expressive behavior. Subsequently, it was implemented in a pediatric hospital in Guayaquil, Ecuador, where it accompanied children during their recovery. It was observed that this type of artificial intelligence-based software, can significantly enhance the experience of children, opening promising opportunities for its application in clinical, educational, recreational, and other child-centered settings. Full article

Refugee mothers are at heightened risk of developing negative family dynamics due to traumatic experiences and unstable living conditions, often impacting their children in lasting ways. This partially mixed, explanatory mixed-methods pilot study examines the potential of Drama Therapy as a psychosocial intervention to reduce harmful parenting behaviors and strengthen parent–child relationships. The study engaged 20 refugee mothers who participated in a three-session intervention based on Emunah’s five-phase model. Data collection included pre-intervention demographic information, two standardized psychological scales—The Child–Parent Relationship Scale and the Parent Anger Scale—and post-intervention focus group discussions. The findings indicate that the Drama Therapy Intervention (DTI) helped reduce parental anger and improve emotional regulation, leading to more positive interactions with children and decreased conflict within the family. Focus group insights revealed that the mothers’ ongoing and past traumas significantly shaped their emotional responses and parenting styles. This pilot study highlights the importance of addressing maternal mental health in post-displacement contexts. Although one cannot draw causal inferences of efficacy in the absence of a control group, the findings provide preliminary evidence that Drama Therapy can be an effective tool for reducing parental maltreatment and improving family relationships among refugee populations. Full article

Chad, a Sub-Saharan country, has some of the worst child mortality and health indicators. A lack of recent and accurate health records in Béré, rural Chad, due to decades of strife compromises the development of relevant health interventions by Project 21, a community health program. This study investigates child mortality, weight gain ability, and related factors in 0–2-year-olds through a cross-sectional study completed by trained community health workers using a survey questionnaire. Most household heads are Nangtchéré Christian males with secondary-level education. Male infants have the highest mortality rate. Infant mortality is predicted by non-exclusive breastfeeding started within 6 days after birth and by the number of household children who experienced and received treatment for meningitis. Toddlers’ mortality is predicted by the number of household adults who experienced and received treatment for meningitis and the number of household adults and children who were vaccinated. The odds of children having no difficulty gaining weight vary with their gender, age, the food or liquid given to them, the source of breastfeeding advice, handwashing and vaccination practices, and experiences with infectious diseases and their treatments. These findings provide targets for future health interventions towards achieving SDG3 in Sub-Saharan Africa. Full article

Background: Assistance dogs can support children with autism by improving emotional regulation and social functioning, but access is limited. The Family Dog Service was developed to help families of autistic children gain similar benefits through companion dogs. It offers tailored support for selecting, training, and integrating a dog into the home. This study explored parent perspectives on the service and perceived impacts of companion dogs. Methods: A cross-sectional online survey was conducted among UK residents who attended Family Dog Service workshops. The survey included demographic data, mental health and wellbeing measures, and questions about human–animal interactions. Quantitative data were analysed descriptively; qualitative responses underwent thematic analysis. Results: Of 118 participants, 101 (85.6%) owned a dog, while 17 (14.4%) were considering acquisition. Most owners reported improvements in their child’s mood (75.2%; n = 76) and reduced anxiety-related behaviours (70.3%, n = 71) following dog acquisition. Nearly half (49.5%, n = 50) rated the child–dog relationship as ‘very’ or ‘extremely’ positive within the first month, increasing to 86.1% (n = 87) by the time of data collection. Families also reported enhanced dynamics and reduced caregiver stress. Despite some challenges, the service was valued for its autism-specific guidance and ongoing support. Conclusions: The Family Dog Service may offer a practical, accessible alternative to assistance dogs, supporting autistic children’s wellbeing and strengthening family relationships through positive interactions between children and their dogs. Full article

Mucormycosis is a rare invasive fungal disease in pediatric patients with hematological malignancies and is associated with poor outcomes. We present a fulminant and ultimately fatal case of rhino-orbito-cerebral mucormycosis, addressing important issues including clinical signs and symptoms, diagnostic approaches and the challenges of timely diagnosis. The patient was an 11-year old girl undergoing re-induction chemotherapy for Central Nervous System relapse of B-cell precursor acute lymphoblastic leukemia. She presented six days into the second course of chemotherapy in profound neutropenia with aggravating headaches, painful abducens nerve palsy and anisocoria. At first (day −3), no significant radiological or ophthalmological correlations were found, and methyl–prednisolone was started due to suspected vasculitis following ICU admission. After further clinical deterioration, a second MRI scan (day 0) revealed a prolonged occlusion of the left carotid artery, which was successfully stented in a neuroradiological intervention (day +1). However, during the next day the child developed clinical signs indicating severe cerebral dysfunction. An emergency CT scan showed complete infarction of the left hemisphere including a progredient perfusion deficit and beginning brain edema. Based on the unfavorable prognosis, best supportive care was initiated, and the patient deceased on day +2. Pathological and microbiological workup identified thrombotic infarction in all major cerebral arteries. While microscopy was suspicious for mucormycosis, nested PCR from retained blood specimens confirmed the genus Lichtheimia. Final NGS on brain tissue led to the identification of Lichtheimia ramosa. This case illustrates the rapidity and severity of Mucorales infection. It shows the importance of early clinical suspicion and the need for an aggressive laboratory testing algorithms. The stratification of risk factors and definition of red flags may be a future task fighting these infections. Full article

Background: Pediatric tracheostomy decisions are challenging for clinicians and parents, especially when a child’s survival/neurodevelopmental outcome is uncertain. Better understanding of parents’ values over the decision period is crucial for clinical decision-making. Objective: To describe parents’ values during tracheostomy decision-making for their critically ill child and to identify opportunities to improve parent–clinician shared decision-making (SDM). Methods: We thematically analyzed 12 semi-structured interviews with parents who recently faced a tracheostomy decision for their critically ill child. Three study team members with qualitative expertise reviewed the transcripts, identifying key topics independently. A codebook was developed, and data were coded. Key research questions guided analysis, with findings iteratively reviewed by the study team. Results: We identified parents’ values at the three time points: when the decision was introduced, during their deliberations of it, and when the ultimate decision was made. Initially, parents resisted tracheostomy because it threatens normalcy. They valued proof of a need for tracheostomy and information with certainty. As certainty for tracheostomy increased over time, parents’ hope focused on reversibility of tracheostomy and improvement in normalcy compared to current status. They concurrently worried about practical issues such as emergencies, home care, and finances. Key considerations driving the final decision included best interest of the child, perceived benefits of tracheostomy compared to its downsides or other options, and potential for better quality of life and longer life. Conclusions: Parents’ dynamic values shifting with clinical uncertainty suggests opportunities to improve SDM by attending to parents’ individualized needs and managing expectations. Full article

Background/Objectives: This study aimed to determine the occurrence of vitamin D and iron deficiency in children with autism spectrum disorder (ASD) in Singapore and identify correlates of the presence of these deficiencies, if any. Methods: This is an observational, cross-sectional, retrospective review of children with a diagnosis of autism, aged 1 to 10 years old, seen at a tertiary developmental paediatric centre from January 2018 to December 2022, with blood investigations completed. Autism diagnosis was determined either clinically by a developmental paediatrician using DSM-5 criteria or using the Autism Diagnostic Observation Schedule (ADOS-2). Children with genetic disorders and chronic medical conditions were excluded. Logistic regression was used to evaluate associations with the deficiencies, and the Bonferroni method was applied on post hoc comparisons. Results: The overall sample comprised 241 children (79% males, mean age 4.2 years [SD 2.25]. There were 222 and 236 children who had blood investigations for vitamin D and iron levels performed, respectively. Out of the 222 children whose vitamin D tests were performed, 36.5% had vitamin D insufficiency/deficiency. Iron deficiency occurred in 37.7% for children who had their iron levels tested. There were 122 observations for both iron levels and complete blood count. Out of these, 19 (15.6%) had iron deficiency anaemia. There were no significant correlates for iron deficiency, with picky eating included. Conclusions: Vitamin D and iron deficiencies were common in this sample. Clinicians should consider testing for vitamin D and iron for children with ASD, especially for vitamin D in children of Indian ethnicity and older age. Full article