Children, Volume 6, Issue 9 (September 2019) – 10 articles

Pneumomediastinum is the collection of free air in the mediastinum. Its incidence is higher in preterm infants and those on positive airway pressure support or on mechanical ventilation. But it has decreased dramatically after the introduction of surfactant and synchronized, non-invasive mechanical ventilation. Underlying cystic lesions could also increase the risk of pneumomediastinum and other air leak syndromes. Most cases resolve spontaneously but rare hemodynamic compromise may require ultrasound-guided intervention. Full article

Background and Objectives: Severe, recalcitrant cases of pediatric psoriasis or atopic dermatitis may necessitate treatment with biological agents; however, this may be difficult due to lack of treatment options and standardized treatment guidelines. This review evaluates the biological treatment options available, including off-label uses, and provides a basic therapeutic guideline for pediatric psoriasis and atopic dermatitis. Materials and Methods: A PubMed review of biological treatments for pediatric psoriasis and atopic dermatitis with information regarding age, efficacy, dosing, contra-indications, adverse events, and off-label treatments. Results: Currently there are three European Medicines Agency (EMA)-approved biological treatment options for pediatric psoriasis: etanercept, ustekinumab, and adalimumab. While dupilumab was recently Food and Drug Administration (FDA)- and EMA-approved for adult atopic dermatitis, it is still not yet approved for pediatric atopic dermatitis. Conclusions: Given the high morbidity associated with pediatric atopic dermatitis and psoriasis, there is a need for more treatment options. Further research and post-marketing registries are needed to extend the use of biologics into pediatric patients. Full article

According to the Migration Policy Institute, 2017 data revealed that a historic high 44.5 million people living in the United States (US) were foreign-born [1], more than double the number from 1990 [2]. Since the creation of the Refugee Resettlement Program in 1980, refugee families have settled in the US more than in any other country in the world [3]. In 2018, for the first time, Canada overtook the US in numbers of refugees accepted [1]. Foreign-born people now account for 13.7% of the total US population [1]. Further, a quarter of children in the United States currently live in households with at least one foreign-born parent [4]. These population shifts are important to note because immigrant and refugee families bring cultural influences and health experiences from their home countries which can greatly affect the overall health and well-being of children. For these new arrivals, oral health is often a significant health issue. The severity of dental disease varies with country of origin as well as cultural beliefs that can hinder access to care even once it is available to them [5,6]. As pediatricians and primary care providers, we should acknowledge that oral health is important and impacts overall health. Healthcare providers should be able to recognize oral health problems, make appropriate referrals, and effectively communicate with families to address knowledge gaps in high-risk communities. Full article

Pediatric chronic pain is common and can be related to reduced functioning in many domains for the young person and their parents. Existing psychological treatments such as Acceptance and Commitment Therapy (ACT) have shown to be effective, but improvements are needed. Qualitative approaches can help improve our understanding of treatment processes and outcomes. The aim of the present qualitative interview study was to explore the lived experiences of young people and parents who had participated in ACT for pediatric chronic pain. Four young persons and four parents were interviewed, and data was analyzed using Interpretative Phenomenological Analysis (IPA). Three themes were generated, each comprising two subthemes: (1) ‘Warning system’, which included experiences from being offered this psychological intervention, and the alternative explanations provided for pain; (2) ‘Change and challenges’, which suggested the importance of the values-based work, and of individual adaptation; and (3) ’A common language’ in which the interaction with others and new ways to communicate around the pain experience were described. Findings highlight the importance of pain education, formulating and acting in line with personal values, and communication around the pain experience, as well as the need for developmental and individual adaptations of interventions. Full article

Weight loss can reduce the hyperandrogenemia associated with polycystic ovary syndrome (PCOS) in peripubertal girls. Yet, adolescent girls have the lowest rates of physical activity and enjoyment of exercise. We created a dance-based support group (Go Girls!) to entice physical activity and improve enjoyment. Girls ages 7–21 over the 85th BMI percentile were recruited and attended once-weekly sessions for 3–6 months. We assessed changes in Physical Activity Enjoyment Scale (PACES), anthropometrics, laboratory data, and amounts of home exercise at 0, 3, and 6 months. Sixteen girls completed either 3 or 6 months. PACES scores were surprisingly high at baseline and remained high. Systolic blood pressure percentile decreased post-intervention. Although no group differences were observed, the majority of individual girls had decreased waist circumference, triglycerides, and metabolic syndrome severity score. Forty percent had decreased free testosterone levels. More girls enjoyed physical education class, got exercise outside of school, and made other lifestyle changes. This dance-based support group was enjoyed by girls and demonstrated health benefits. Continued efforts to engage girls in physical activity are necessary to protect girls from the consequences of obesity, including PCOS and metabolic syndrome. Dance exercise remains a promising tool to encourage physical activity in girls. Full article

Since the start of this millennium the diaspora of families with children has continued unabated. UNICEF estimates that nearly 31 million children have been forcibly displaced from their homes by the end of 2017. This includes 13 million child refugees, an estimated 17 million children internally displaced within their own countries and over 900 thousand children seeking asylum in a different country. Even more staggering is the 75 percent increase in the number of child refugees between 2010 and 2015. This Special Issue, Children on the Move: The Health of Refugee, Immigrant and Displaced Children, examines in detail the health and well-being of our most vulnerable children today. It follows the arc of migration from home country, through transit and finally the challenges experienced in a child’s new country. The papers explore a variety of acute and chronic health conditions as well as the mental health of these children and youth. The articles examine the trauma experienced in their home country, the fleeing of war, violence and/or poverty, the travails during their journey, the stress throughout their stay in detention centers and refugee camps, and finally the transition to a new home country. Full article

Tracheal rings (TR) are rare, congenital cartilaginous defect of the upper airway and are usually due to complete or near complete circumferential cartilaginous tracheal rings, with variable degrees of tracheal stenosis (TS) and shortening. Chromosomal anomalies like trisomy 21 are characteristically associated with a wide range of upper airway anomalies including TS and congenital heart disease (CHD). However, the overall prevalence of severe forms of TS is rare and reported in 1.2% of all CHD patients. Herein, we present a rare association of severe TS due to complete tracheal rings in a trisomy 21 patient with CHD and the challenges in the management. Full article

Gaps in knowledge of physicians and nurses about early childhood oral health care were reported and are likely due to the poorly focused education on oral health issues; therefore, the purpose of this study was to assess the knowledge level of Qassim University medical, dental and nursing students about early childhood oral health care and its relation to demographic variables, students’ perceived knowledge, satisfaction with their knowledge and interest in further education about the topic. A total of 571 medical, dental, and nursing students received a questionnaire that included demographic questions, questions to assess knowledge level of the students about early childhood oral health care, and questions to assess their perceived knowledge level, satisfaction with their knowledge and interest in further education about the topic. Results of the study revealed that knowledge of dental students was highest (score 7.72 out of 10) followed by nursing students (4.79), and medical students (4.43). Additionally, students with a higher level of perceived knowledge were more likely to score higher. In view of the inadequate knowledge level of medical and nursing students about early childhood oral health care when compared to dental students, improvements in medical and nursing education programs are necessary at Qassim University. Full article

Background: Parental educational attainment is protective against chronic medical conditions (CMCs). According to the minorities’ diminished returns (MDRs) theory, however, the health effects of socioeconomic status (SES) indicators are smaller for socially marginalized groups such as racial and ethnic minorities rather than Whites. Aims: To explore racial and ethnic differences in the effect of parental educational attainment on CMCs in a nationally representative sample of American youth. Methods: In this cross-sectional study, we used baseline data of 10,701 12–17 years old youth in the Population Assessment of Tobacco and Health (PATH; 2013). Parental educational attainment was the independent variable. The dependent variable was the number of CMCs in youth. Age, gender, and family structure were covariates. Race and ethnicity were the focal moderators. Linear and multinomial regression were applied to analyze the data. Results: Overall, higher parental educational attainment was associated with a lower number of CMCs. Race and ethnicity, however, showed significant interactions with parental educational attainment on a number of CMCs as well as 2+ CMCs, suggesting that the effect of parenting educational attainment on CMCs is significantly smaller for Black and Hispanic than White youth. Conclusions: In the United States, race and ethnicity alter the health gains that are expected to follow parental educational attainment. While White youth who are from highly educated families are most healthy, Black and Hispanic youth from highly educated families remain at higher risk for CMCs. That means, while the most socially privileged group, Whites, gain the most health from their parental education, Blacks and Hispanics, the least privileged groups, gain the least. The result is a disproportionately high number of CMCs in middle-class Blacks and Hispanics. Economic, social, public, and health policy makers should be aware that health disparities are not all due to lower SES of the disadvantaged group but also diminished returns of SES resources for them. Youth physical health disparities due to race and ethnicity exist across all SES levels. Full article

Chronic pain and its consequences are major global health challenges, and the prevalence is increasing worldwide among adolescents. Adolescents spend most of their waking hours in school; however, there is limited research available on how school nurses can address chronic pain among adolescents in the Swedish school context. Therefore, we designed a person-centred intervention, known as Help Overcoming Pain Early (HOPE), to enable school nurses to offer adolescents strategies to manage their stress and pain. We used the Medical Research Council (MRC) framework for developing and designing this new complex intervention. For this study, we describe two of the four phases: (a) development and (b) feasibility and piloting. The final version of the HOPE programme consists of (i) an educational package for school nurses in the areas person-centred care, stress and pain education/management and gender perspective; and (ii) an intervention package for adolescents with chronic pain. The programme consists of four sessions during which adolescents with chronic pain have person-centred dialogues with a school nurse. The HOPE programme is based on the existing evidence of managing chronic pain and on the assumption that school nurses can support adolescents with chronic pain by using person-centred care. Full article