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Children, Volume 8, Issue 2 (February 2021) – 113 articles

Cover Story (view full-size image):

Have the extreme circumstances of the COVID-19 outbreak impaired the adaptive functioning and behavior of children with Autism Spectrum Disorder?

Have the home confinement, interruption of in-person therapeutical interventions and routine disruption constituted real challenges for ASD children and their families?

Does web-delivered intervention represent an effective choice in emergency situations like COVID-19?

Our research on 85 Italian children with ASD investigates the answers to these questions. Specifically, through a comparison with a baseline evaluation performed during the months preceding COVID-19, we evaluated whether after compulsory home confinement, any improvement or worsening was reported by parents of ASD individuals using standardized instruments. View this paper

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Review
Abdominal Wall Defects—Current Treatments
Children 2021, 8(2), 170; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020170 - 23 Feb 2021
Viewed by 676
Abstract
Gastroschisis and omphalocele reflect the two most common abdominal wall defects in newborns. First postnatal care consists of defect coverage, avoidance of fluid and heat loss, fluid administration and gastric decompression. Definitive treatment is achieved by defect reduction and abdominal wall closure. Different [...] Read more.
Gastroschisis and omphalocele reflect the two most common abdominal wall defects in newborns. First postnatal care consists of defect coverage, avoidance of fluid and heat loss, fluid administration and gastric decompression. Definitive treatment is achieved by defect reduction and abdominal wall closure. Different techniques and timings are used depending on type and size of defect, the abdominal domain and comorbidities of the child. The present review aims to provide an overview of current treatments. Full article
(This article belongs to the Special Issue Rare Disease and Recent Advances in Neonatal and Pediatric Surgery)
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Editorial
Integrated Multidisciplinary Treatment for Pediatric Inflammatory Bowel Disease
Children 2021, 8(2), 169; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020169 - 23 Feb 2021
Cited by 4 | Viewed by 571
Abstract
Inflammatory Bowel Disease (IBD) is a chronic and relapsing inflammatory disorder of the gastrointestinal tract [...] Full article
Article
Sleep and the General Behavior of Infants and Parents during the Closure of Schools as a Result of the COVID-19 Pandemic: Comparison with 2019 Data
Children 2021, 8(2), 168; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020168 - 22 Feb 2021
Cited by 3 | Viewed by 802
Abstract
This study compared cross-sectional data from online surveys describing the sleep behavior of infants and caregivers in March 2020 (the school closure period during the early stages of the COVID-19 pandemic; n = 295, 23.8 ± 3.8 months old) and March 2019 (before [...] Read more.
This study compared cross-sectional data from online surveys describing the sleep behavior of infants and caregivers in March 2020 (the school closure period during the early stages of the COVID-19 pandemic; n = 295, 23.8 ± 3.8 months old) and March 2019 (before the pandemic; n = 2017, 24.2 ± 3.8 months old). In comparing those two points in time, no significant differences were found in wake-up times (2019: 7:19 ± 0:46 am vs. 2020: 7:18 ± 0:47 am, p = 0.289), bedtimes (21:01 ± 0:48 pm vs. 21:04 ± 0:53 pm, p = 0.144), or nocturnal sleep times (593.7 ± 43.9 min vs. 588.1 ± 50.3 min, p = 0.613). Regarding the caregivers, in 2020, wake-up times (2019: 6:46 ± 0:50 am vs. 2020: 6:39 ± 0:50 am, p = 0.017) and bedtimes (22:53 ± 1:17 pm vs. 22:42 ± 1:04 pm, p = 0.016) became significantly earlier compared to 2019. Among infants staying at home, total sleep time and percentage of outdoor play decreased significantly, and media use increased significantly in 2020. Lower levels of exercise and more frequent media viewing may have caused prolonged sleep latency in these children. The percentage of caregivers responding with “negative childcare feelings” was significantly higher in the group with less than three nursery school attendance days. Caregivers and infants staying at home are a high-risk group during the pandemic. Full article
(This article belongs to the Special Issue Factors Affecting the Quality of Sleep in Children)
Article
The Challenges to Promoting Attachment for Hospitalised Infants with NAS
Children 2021, 8(2), 167; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020167 - 22 Feb 2021
Cited by 2 | Viewed by 1294
Abstract
The postnatal period is crucial for infants in establishing a connection with and security in primary caregivers and can have enduring effects on attachment patterns. However, due to the need for symptom management, many infants diagnosed with neonatal abstinence syndrome (NAS) may be [...] Read more.
The postnatal period is crucial for infants in establishing a connection with and security in primary caregivers and can have enduring effects on attachment patterns. However, due to the need for symptom management, many infants diagnosed with neonatal abstinence syndrome (NAS) may be separated from primary caregivers and cared for in a neonatal intensive care unit (NICU) or special care nursery (SCN) soon after birth. Research has shown that substance-exposed infants are more likely to experience insecure attachment patterns with their primary caregivers and that mothers with a history of substance abuse are less sensitive to their infants’ cues. Therefore, the aim of this research was to explore nurses’ and midwives’ experiences in promoting the attachment relationship for infants admitted to an NICU/SCN with NAS. A qualitative research design was used to gather data on the experiences of nine nurses/midwives from various NICU and SCN settings in Australia. Individual, semi-structured interviews were conducted, and transcribed interviews were coded using thematic analysis. While nurses/midwives valued the attachment relationship for infants with NAS, facilitation of the attachment relationship was mainly promoted when the mother was present. However, parents were often reported to be absent from the nursery. Difficulties in promoting an attachment relationship were also identified when an infant had child protection involvement. This research identifies areas in need of innovative change regarding the approach taken to promote the attachment relationship for infants with NAS when they are admitted to an NICU/SCN. Full article
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Review
Important Aspects Influencing Delivery of Serious News in Pediatric Oncology: A Scoping Review
Children 2021, 8(2), 166; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020166 - 22 Feb 2021
Viewed by 785
Abstract
Delivering serious news presents a major challenge for clinical practice in pediatric oncology due to the complexity of the communication process and a number of aspects that influence how the serious news is delivered and received. This study aims to review and explore [...] Read more.
Delivering serious news presents a major challenge for clinical practice in pediatric oncology due to the complexity of the communication process and a number of aspects that influence how the serious news is delivered and received. This study aims to review and explore the aspects influencing the delivery of serious news in pediatric oncology from the perspective of physicians, parents, siblings and patients themselves. The MEDLINE, Embase, Scopus, Cochrane Library, PsycInfo and Medvik databases were systematically searched for relevant articles published from 1990 to 2017. Following the Preferred Reporting Items for Systematic Review and Meta-analysis extension for scoping reviews (PRISMA-ScR) guidelines, 36 original papers were included. Identified aspects of communication were categorized into six thematic groups: initial setting, physician’s approach, information exchange, parental role, illness related aspects and age of the ill child. The importance of the aspects is perceived differently by parents, patients, siblings and physicians. This scoping review highlights that delivering serious news requires an individualized approach towards the patient and the family. Ten key objectives built upon the results of the literature review offer guidance for daily clinical practice in communication with pediatric patients and their families. Full article
(This article belongs to the Section Oncology and Hematology)
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Article
The Role of Alexithymia in Social Withdrawal during Adolescence: A Case–Control Study
Children 2021, 8(2), 165; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020165 - 22 Feb 2021
Viewed by 589
Abstract
Although social withdrawal is becoming increasingly common among adolescents, there is still no consensus on its definition from the diagnostic and psychopathological standpoints. So far, research has focused mainly on social withdrawal as a symptom of specific diagnostic categories, such as depression, social [...] Read more.
Although social withdrawal is becoming increasingly common among adolescents, there is still no consensus on its definition from the diagnostic and psychopathological standpoints. So far, research has focused mainly on social withdrawal as a symptom of specific diagnostic categories, such as depression, social phobia, or anxiety disorders, or in the setting of dependence or personality disorders. Few studies have dealt with social withdrawal in terms of its syndromic significance, also considering aspects of emotion control, such as alexithymia. The present case-control study aimed to further investigate the issue of social withdrawal, and try to clarify the part played by alexithymia in a sample of Italian adolescents diagnosed with psychological disorders (n = 80; Average Ageg = 15.2 years, SD = 1.49). Our patients with social withdrawal (cases) scored significantly higher than those without this type of behavior (controls) in every domain of alexithymia investigated, using the Toronto Alexithymia Scale (TAS-20) and with the scales in the Youth Self-Report (YSR) regarding internalizing problems, anxiety–depression, social problems, and total problems. Internalizing problems and total levels of alexithymia also emerged as predictors of social withdrawal. These variables may therefore precede and predispose adolescents to social withdrawal, while social problems may develop as a consequence of the latter. Full article
(This article belongs to the Special Issue Recent Advances in Child and Adolescent Psychiatry)
Review
Detection of Early Warning Signs in Autism Spectrum Disorders: A Systematic Review
Children 2021, 8(2), 164; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020164 - 22 Feb 2021
Cited by 1 | Viewed by 963
Abstract
Due to the exponential increase of autism spectrum disorders’ prevalence in Western countries, it is necessary to improve early detection and intervention to enhance developmental milestones. This systematic review identified the most effective screening instrument, which can be used at an early age [...] Read more.
Due to the exponential increase of autism spectrum disorders’ prevalence in Western countries, it is necessary to improve early detection and intervention to enhance developmental milestones. This systematic review identified the most effective screening instrument, which can be used at an early age and which identifies the maximum number of autism cases. We identified several instruments with adequate predictive properties—the Autism Parent Screen for Infants (APSI), Battelle Development Inventory, second edition (BDI-2); Brief Infant-Toddler Social and Emotional Assessment (BITSEA); First Year Inventory (FYI); Infant-Toddler Checklist/Communication and Symbolic Behavior Scales Developmental Profile (ITC/CSBS-DP); Program of Research and Studies on AUTISM (PREAUT-Grid); Checklist for Early Signs of Developmental Disorders (CESDD); Social Attention and Communication Study (SACS); and the Screening Tool for Autism in Toddlers and Young Children (STAT)—that can be applied from 12 months of age in Western countries. The ITC/CSBS-DP has been proposed for universal screening from 12 months of age onwards, complemented by the Modified Checklist for Autism in Toddlers, Revised/Revised with Follow-Up (M-CHAT-R/F), which can be used from 15 months of age onwards. This strategy could improve early detection in at-risk children within the current health system, thus allowing for early intervention. Full article
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Perspective on Similarities and Possible Overlaps of Congenital Disease Formation—Exemplified on a Case of Congenital Diaphragmatic Hernia and Neuroblastoma in a Neonate
Children 2021, 8(2), 163; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020163 - 22 Feb 2021
Viewed by 530
Abstract
The coincidence of two rare diseases such as congenital diaphragmatic hernia (CDH) and neuroblastoma is exceptional. With an incidence of around 2–3:10,000 and 1:8000 for either disease occurring on its own, the chance of simultaneous presentation of both pathologies at birth is extremely [...] Read more.
The coincidence of two rare diseases such as congenital diaphragmatic hernia (CDH) and neuroblastoma is exceptional. With an incidence of around 2–3:10,000 and 1:8000 for either disease occurring on its own, the chance of simultaneous presentation of both pathologies at birth is extremely low. Unfortunately, the underlying processes leading to congenital malformation and neonatal tumors are not yet thoroughly understood. There are several hypotheses revolving around the formation of CDH and neuroblastoma. The aim of our study was to put the respective hypotheses of disease formation as well as known factors in this process into perspective regarding their similarities and possible overlaps of congenital disease formation. We present the joint occurrence of these two rare diseases based on a patient presentation and immunochemical prognostic marker evaluation. The aim of this manuscript is to elucidate possible similarities in the pathogeneses of both disease entities. Discussed are the role of toxins, cell differentiation, the influence of retinoic acid and NMYC as well as of hypoxia. The detailed discussion reveals that some of the proposed pathophysiological mechanisms of both malformations have common aspects. Especially disturbances of the retinoic acid pathway and NMYC expression can influence and disrupt cell differentiation in either disease. Due to the rarity of both diseases, interdisciplinary efforts and multi-center studies are needed to investigate the reasons for congenital malformations and their interlinkage with neonatal tumor disease. Full article
(This article belongs to the Special Issue Rare Disease and Recent Advances in Neonatal and Pediatric Surgery)
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Article
Behavioral Inhibition in Childhood: European Portuguese Adaptation of an Observational Measure (Lab-TAB)
Children 2021, 8(2), 162; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020162 - 21 Feb 2021
Cited by 1 | Viewed by 684
Abstract
The assessment of behaviorally inhibited children is typically based on parent or teacher reports, but this approach has received criticisms, mainly for being prone to bias. Several researchers proposed the additional use of observational methods because they provide a direct and more objective [...] Read more.
The assessment of behaviorally inhibited children is typically based on parent or teacher reports, but this approach has received criticisms, mainly for being prone to bias. Several researchers proposed the additional use of observational methods because they provide a direct and more objective description of the child's functioning in different contexts. The lack of a laboratory assessment of temperament for Portuguese children justifies the adaptation of some episodes of the Laboratory Temperament Assessment Battery (Lab-TAB) as an observational measure for behavioral inhibition. Method: In our study, we included 124 children aged between 3 and 9 years and their parents. The evaluation of child behavioral inhibition was made by parent report (Behavioral Inhibition Questionnaire) and through Lab-TAB episodes. Parental variables with potential influence on parents’ reports were also collected using the Social Interaction and Performance Anxiety and Avoidance Scale (SIPAAS) and the Parental Overprotection Measure (POM). Results and Discussion: The psychometric analyses provided evidence that Lab-TAB is a reliable instrument and can be incorporated in a multi-method approach to assess behavioral inhibition in studies involving Portuguese-speaking children. Moderate convergence between observational and parent report measures of behavioral inhibition was obtained. Mothers’ characteristics, as well as child age, seem to significantly affect differences between measures, being potential sources of bias in the assessment of child temperament. Full article
(This article belongs to the Special Issue Mental Health and Well-Being in Children)
Article
Physical Activity of Serbian Children in Daycare
Children 2021, 8(2), 161; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020161 - 21 Feb 2021
Viewed by 450
Abstract
Background: Monitoring of physical activity within the educational institution is of great importance, primarily because of the orientation and content implemented in the daycare. This research aimed to examine the number of steps children took during their stay in daycare with regards to [...] Read more.
Background: Monitoring of physical activity within the educational institution is of great importance, primarily because of the orientation and content implemented in the daycare. This research aimed to examine the number of steps children took during their stay in daycare with regards to age, gender and the frequency of going out. Methods: The research was conducted in four daycares in the urban environment of Novi Sad (Republic of Serbia), where 231 children, aged 5 to 7, were monitored (129 boys and 102 girls). Data on the number of steps were obtained using the pedometers. Results: The result of the univariate analysis of the variance test confirmed a statistically significant difference in the number of steps in relation to the age of children (p = 0.04). Boys were more active than girls in both age groups (p = 0.001). Children who were going to the daycare yard three to five times a week took drastically more steps than children who went up to twice a week (p = 0.001). Conclusion: The results of the current study show that age, gender, and time spent outdoors are significant determinants of physical activity in preschool age. Therefore, interventions regarding physical activity should be made during early childhood in order to promote health and prevent disease. Full article
(This article belongs to the Special Issue Sports Science for Children)
Article
Epidemiology and One-Year Follow-Up of Neonates with CDH-Data from Health Insurance Claims in Germany
Children 2021, 8(2), 160; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020160 - 20 Feb 2021
Cited by 1 | Viewed by 433
Abstract
Congenital diaphragmatic hernia (CDH) is a major congenital malformation with high mortality. Outcome data on larger unselected patient groups in Germany are unavailable as there is no registry for CDH. Therefore, routine data from the largest German health insurance fund were analyzed for [...] Read more.
Congenital diaphragmatic hernia (CDH) is a major congenital malformation with high mortality. Outcome data on larger unselected patient groups in Germany are unavailable as there is no registry for CDH. Therefore, routine data from the largest German health insurance fund were analyzed for the years 2009–2013. Main outcome measures were incidence, survival and length of hospital stay. Follow-up was 12 months. 285 patients were included. The incidence of CDH was 2.73 per 10,000 live births. Overall mortality was 30.2%. A total of 72.1% of the fatalities occurred before surgery. Highest mortality (64%) was noted in patients who were admitted to specialized care later as the first day of life. Patients receiving surgical repair had a better prognosis (mortality: 10.8%). A total of 67 patients (23.5%) were treated with ECMO with a mortality of 41.8%. The median cumulative hospital stay among one-year survivors was 40 days and differed between ECMO- and non-ECMO-treated patients (91 vs. 32.5 days, p < 0.001). This is the largest German cohort study of CDH patients with a one-year follow-up. The ECMO subgroup showed a higher mortality. Another important finding is that delayed treatment in specialized care increases mortality. Prospective clinical registries are needed to elucidate the treatment outcomes in detail. Full article
(This article belongs to the Special Issue Rare Disease and Recent Advances in Neonatal and Pediatric Surgery)
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Article
A First Step toward the Clinical Application of Landmark-Based Acoustic Analysis in Child Mandarin
Children 2021, 8(2), 159; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020159 - 20 Feb 2021
Viewed by 548
Abstract
As an initial step for the clinical application of landmark-based acoustic analysis in child Mandarin, the study quantified the developmental trajectories of consonants produced by four-to-seven-year-old children who acquired Taiwanese Mandarin as their first language. The results from a total of 80 children [...] Read more.
As an initial step for the clinical application of landmark-based acoustic analysis in child Mandarin, the study quantified the developmental trajectories of consonants produced by four-to-seven-year-old children who acquired Taiwanese Mandarin as their first language. The results from a total of 80 children (20 in each age group, with gender balanced) indicated that younger age groups produced more +b landmark features than seven-year-olds did, showing that the development of obstruents was not completed by the age of six. A multiple regression showed that the participants’ speech intelligibility scores could be predicted by landmark features. Additionally, the +b landmark feature demonstrated the strongest net effect on speech intelligibility scores. The findings indicated that: (a) the landmark feature +b was an essential indicator of speech development in child Mandarin and; (b) the consonantal development in child Mandarin could be predicted by the physiological complexity of the articulatory gestures. Future studies focusing on a wider range of population (e.g., typically developing adults, aging and other clinical groups) with different language backgrounds are encouraged to apply landmark-based acoustic analysis to trace the linguistic development of a particular group. Full article
Article
Children’s Views and Experiences of Treatment Adherence and Parent/Child Co-Management in Eczema: A Qualitative Study
Children 2021, 8(2), 158; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020158 - 20 Feb 2021
Cited by 1 | Viewed by 894
Abstract
Eczema affects one in five children and can have a substantial impact on quality of life. This qualitative study aimed to explore children’s views and experiences of eczema and what may affect treatment adherence from their perspective. We conducted semi-structured, face-to-face interviews with [...] Read more.
Eczema affects one in five children and can have a substantial impact on quality of life. This qualitative study aimed to explore children’s views and experiences of eczema and what may affect treatment adherence from their perspective. We conducted semi-structured, face-to-face interviews with children with eczema aged 6–12 years from March to July 2018. Interviews were transcribed verbatim and analysed using inductive thematic analysis. We found that children do not typically view eczema as a long-term condition, and topical treatments (predominately emollients) were seen to provide effective symptom relief. Uncertainty around co-managing at home was expressed as children typically felt that parental reminders and assistance with applying different types of topical treatments were still needed. For some children, eczema can be difficult to manage at school due to a lack of convenient access and appropriate spaces to apply creams and psychosocial consequences such as attracting unwanted attention from peers and feeling self-conscious. Treatment adherence could be supported by reinforcing that eczema is a long-term episodic condition, providing clear information about regular emollient use, practical advice such as setting reminders to support co-management at home, and working with schools to facilitate topical treatment use when necessary. Full article
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The Effect of Environmental Contexts on Motor Proficiency and Social Maturity of Children: An Ecological Perspective
Children 2021, 8(2), 157; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020157 - 19 Feb 2021
Cited by 2 | Viewed by 737
Abstract
Physical environmental factors affect the developmental process of children. Thus, the main purpose of the present study was to investigate the two intervention models of affordances on the motor proficiency and social maturity of children. A semi-experimental research design with a pretest–posttest design [...] Read more.
Physical environmental factors affect the developmental process of children. Thus, the main purpose of the present study was to investigate the two intervention models of affordances on the motor proficiency and social maturity of children. A semi-experimental research design with a pretest–posttest design and two groups were used, adopting the convenience method. Two groups of 15 children (aged 5.5–6.5 years) engaged in 12 weeks of nature school or kindergarten. The Bruininks–Oseretsky test of motor proficiency and the Vineland social maturity scale were used. The results of a mixed ANOVA showed that natural outdoor activity has a greater positive effect on motor proficiency and social maturity than kindergarten activities. Intra-group analysis also showed that both groups had progressed, but the nature school group made more progress. These results were discussed and interpreted based on the types of environmental affordances, Gibson’s theory, Bronfenbrenner theory, and child-friendly environment. It was suggested that natural environmental stimulations play a critical role in optimal child motor and social development during the early stages of life. Full article
(This article belongs to the Special Issue Physical Activity and Motor Competence in Preschool Children)
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Article
Differences in Weight Status and Autonomous Motivation towards Sports among Children with Various Profiles of Motor Competence and Organized Sports Participation
Children 2021, 8(2), 156; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020156 - 18 Feb 2021
Cited by 2 | Viewed by 840
Abstract
This study aimed (1) to identify profiles in children based on actual motor competence (AMC), perceived motor competence (PMC), and organized sports participation (OSP), and (2) to examine differences among these profiles in weight status as well as autonomous motivation towards sports. Children’s [...] Read more.
This study aimed (1) to identify profiles in children based on actual motor competence (AMC), perceived motor competence (PMC), and organized sports participation (OSP), and (2) to examine differences among these profiles in weight status as well as autonomous motivation towards sports. Children’s (N = 206; 112 boys; Mage = 10.83 ± 0.92 years) AMC, PMC, OSP, weight status, and autonomous motivation towards sports were measured using validated assessment tools. Cluster analyses identified three profiles with completely convergent levels of AMC, PMC, and OSP and three profiles with partially convergent levels. Children in the convergent profiles with average to high levels of AMC, PMC, and OSP had the most optimal profile, as they combined a healthier weight status with elevated levels of autonomous motivation, while the opposite was true for children with low levels on all three cluster-variables. Partially convergent profiles showed that AMC and PMC appear crucial for weight status, as profiles with relatively low levels of AMC and PMC had the highest weight status, independent of their OSP levels. Overall, the findings highlight the importance of promoting AMC, PMC, and OSP simultaneously to help children in achieving a healthy weight status and being autonomously motivated towards OSP. Full article
(This article belongs to the Special Issue Sports Science for Children)
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Review
Neonatal Seizures Revisited
Children 2021, 8(2), 155; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020155 - 18 Feb 2021
Viewed by 1644
Abstract
Seizures are the most common neurological disorder in newborns and are most prevalent in the neonatal period. They are mostly caused by severe disorders of the central nervous system (CNS). However, they can also be a sign of the immaturity of the infant’s [...] Read more.
Seizures are the most common neurological disorder in newborns and are most prevalent in the neonatal period. They are mostly caused by severe disorders of the central nervous system (CNS). However, they can also be a sign of the immaturity of the infant’s brain, which is characterized by the presence of specific factors that increase excitation and reduce inhibition. The most common disorders which result in acute brain damage and can manifest as seizures in neonates include hypoxic-ischemic encephalopathy (HIE), ischemic stroke, intracranial hemorrhage, infections of the CNS as well as electrolyte and biochemical disturbances. The therapeutic management of neonates and the prognosis are different depending on the etiology of the disorders that cause seizures which can lead to death or disability. Therefore, establishing a prompt diagnosis and implementing appropriate treatment are significant, as they can limit adverse long-term effects and improve outcomes. In this review paper, we present the latest reports on the etiology, pathomechanism, clinical symptoms and guidelines for the management of neonates with acute symptomatic seizures. Full article
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Article
A Cost Analysis of an Outreach School-Based Dental Program: Teeth on Wheels
Children 2021, 8(2), 154; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020154 - 18 Feb 2021
Cited by 1 | Viewed by 762
Abstract
Background: This study evaluated an outreach mobile dental service called Teeth on Wheels (TOW). The dental program targeted Australian children from low household income, who are eligible for the Child Dental Benefits Scheme (CDBS) in Victoria, Australia. The program is complemented with a [...] Read more.
Background: This study evaluated an outreach mobile dental service called Teeth on Wheels (TOW). The dental program targeted Australian children from low household income, who are eligible for the Child Dental Benefits Scheme (CDBS) in Victoria, Australia. The program is complemented with a school-based oral health promotion element. Methods: A retrospective cohort study was performed with a convenience sample. Children must have had at least three dental examinations during the 2016–2019 calendar years to be included in the study. Comparisons were made between the 2016–17 and 2018–19 calendar years. It was hypothesised that the program would result in reduced costs and the number of restorations and extractions in the latter period. Results: A total of 414 children were included in the analysis. The total mean costs of the program per child reduced from AU$605.3 in 2016–17 to AU$531.1 in 2018–19. The results showed an overall mean reduction in all restorations and extractions performed, but only statistical significance was noted for reductions of restored deciduous teeth. Conclusions: This outreach program, which is focused on prevention and minimally invasive dentistry, can be a promising alternative model of delivery for dental services in young children. Full article
(This article belongs to the Special Issue Dental Caries and Oral Health in Children)
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Review
Respiratory Distress in the Newborn with Primary Ciliary Dyskinesia
Children 2021, 8(2), 153; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020153 - 18 Feb 2021
Viewed by 630
Abstract
Primary ciliary dyskinesia (PCD) is inherited in a predominantly autosomal recessive manner with over 45 currently identified causative genes. It is a clinically heterogeneous disorder that results in a chronic wet cough and drainage from the paranasal sinuses, chronic otitis media with hearing [...] Read more.
Primary ciliary dyskinesia (PCD) is inherited in a predominantly autosomal recessive manner with over 45 currently identified causative genes. It is a clinically heterogeneous disorder that results in a chronic wet cough and drainage from the paranasal sinuses, chronic otitis media with hearing impairment as well as male infertility. Approximately 50% of patients have situs inversus totalis. Prior to the development of chronic oto-sino-pulmonary symptoms, neonatal respiratory distress occurs in more than 80% of patients as a result of impaired mucociliary clearance and mucus impaction causing atelectasis and lobar collapse. Diagnosis is often delayed due to overlapping symptoms with other causes of neonatal respiratory distress. A work up for PCD should be initiated in the newborn with compatible clinical features, especially those with respiratory distress, consistent radiographic findings or persistent oxygen requirement and/or organ laterality defects Full article
(This article belongs to the Special Issue Neonatal Respiratory Distress)
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Article
The Feasibility of Studying Metabolites in PICU Multi-Organ Dysfunction Syndrome Patients over an 8-Day Course Using an Untargeted Approach
Children 2021, 8(2), 151; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020151 - 18 Feb 2021
Cited by 1 | Viewed by 660
Abstract
Metabolites are generated from critical biological functions and metabolism. This pediatric study reviewed plasma metabolites in patients suffering from multi-organ dysfunction syndrome (MODS) in the pediatric intensive care unit (PICU) using an untargeted metabolomics approach. Patients meeting the criteria for MODS were screened [...] Read more.
Metabolites are generated from critical biological functions and metabolism. This pediatric study reviewed plasma metabolites in patients suffering from multi-organ dysfunction syndrome (MODS) in the pediatric intensive care unit (PICU) using an untargeted metabolomics approach. Patients meeting the criteria for MODS were screened for eligibility and consented (n = 24), and blood samples were collected at baseline, 72 h, and 8 days; control patients (n = 4) presented for routine sedation in an outpatient setting. A subset of MODS patients (n = 8) required additional support with veno-atrial extracorporeal membrane oxygenation (VA-ECMO) therapy. Metabolites from thawed blood plasma were determined from ion pairing reversed-phase liquid chromatography–mass spectrometry (LC-MS) analysis. Chromatographic peak alignment, identification, relative quantitation, and statistical and bioinformatics evaluation were performed using MAVEN and MetaboAnalyst 4.0. Metabolite analysis revealed 115 peaks per sample. From the partial least squares-discriminant analysis (PLS-DA) with variance of importance (VIP) scores above ≥2.0, 7 dynamic metabolites emerged over the three time points: tauro-chenodeoxycholic acid (TCDCA), hexose, p-hydroxybenzoate, hydroxyphenylacetic acid (HPLA), 2_3-dihydroxybenzoic acid, 2-keto-isovalerate, and deoxyribose phosphate. After Bonferroni adjustment for repeated measures, hexose and p-hydroxybenzoate were significant at one time point or more. Kendall’s tau-b test was used for internal validation of creatinine. Metabolites may be benign or significant in describing a patient’s pathophysiology and require operator interpretation. Full article
(This article belongs to the Special Issue Advances in Pediatric Critical Care)
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Article
The Complexities Associated with Caring for Hospitalised Infants with Neonatal Abstinence Syndrome: The Perspectives of Nurses and Midwives
Children 2021, 8(2), 152; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020152 - 17 Feb 2021
Cited by 1 | Viewed by 1055
Abstract
The global incidence of Neonatal Abstinence Syndrome (NAS) has increased significantly in the last decade. Symptoms of NAS manifest from the central and autonomic nervous systems as well as the gastrointestinal system and vary in severity and duration. The clinical management of infants [...] Read more.
The global incidence of Neonatal Abstinence Syndrome (NAS) has increased significantly in the last decade. Symptoms of NAS manifest from the central and autonomic nervous systems as well as the gastrointestinal system and vary in severity and duration. The clinical management of infants experiencing NAS is dependent on symptoms and may include both pharmacological and non-pharmacological measures. In cases where symptoms are severe, infants may be admitted to special care nurseries or neonatal intensive care units. Existing research on nurses’ involvement in caring for infants with NAS focuses on pharmacological and non-pharmacological interventions to treat physical symptoms associated with NAS. This research sought to add to the body of knowledge around NAS and conveys nurses’ and midwives’ experiences of delivering care for infants with NAS. Semi-structured interviews were held with nine nurses/midwives. Interviews were audio-recorded, transcribed verbatim and thematically analysed. Five themes emerged from the data. These themes are: Complex care needs; Prioritising physiological care; Experiencing compassion fatigue; Lacking continuity of care; and Stigma. The findings demonstrated the complex nature of care provision for infants with NAS. Competing priorities and the stigmatising nature of NAS threaten optimal care being delivered to these vulnerable infants and their parents. Full article
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Article
Women’s Mental Health as a Factor Associated with Exclusive Breastfeeding and Breastfeeding Duration: Data from a Longitudinal Study in Greece
Children 2021, 8(2), 150; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020150 - 17 Feb 2021
Viewed by 656
Abstract
Background: This study investigated the relationship between exclusive breastfeeding and breastfeeding duration, and maternal psychological well-being in the perinatal period. Methods: A longitudinal study involving a retrospective follow-up of a group of 1080 women from pregnancy to the 1st year postpartum, who gave [...] Read more.
Background: This study investigated the relationship between exclusive breastfeeding and breastfeeding duration, and maternal psychological well-being in the perinatal period. Methods: A longitudinal study involving a retrospective follow-up of a group of 1080 women from pregnancy to the 1st year postpartum, who gave birth during the 5-year period between January 2014 and January 2019 in Athens, Greece, was designed. Women’s history and two psychometric tools—the Edinburg Postpartum Depression Scale (EPDS) and the Patient Health Questionnaire-9 (PHQ-9) administered at 5-time points—were used for data collection. Logistic regression analysis and a series of multiple analysis of variance (MANOVA) tests were performed. Results: The chance for exclusive breastfeeding (giving only breast milk) appeared to decrease (a) with an increase of the scores for psychometric tools antenatally (PHQ-9, p = 0.030) or at the 6th week postpartum (EPDS, p < 0.001 and PHQ-9, p < 0.001), (b) with an increase in the number of psychotherapeutic sessions needed antenatally (p = 0.030), and (c) when the initiation of psychotherapy was necessary postpartum (p = 0.002). Additionally, a shorter duration of any breastfeeding (with or without formula or other types of food/drink) seems to be associated with (a) the occurrence of pathological mental health symptoms (p = 0.029), (b) increased PHQ-9 scores antenatally (p = 0.018), (c) increased EPDS scores at the 6th week (p = 0.004) and the 12th month postpartum (p = 0.031), (d) the initiation of psychotherapy postpartum (p = 0.040), and e) the need for more than 13 psychotherapeutic sessions (p = 0.020). Conclusions: This study demonstrates a negative relationship between exclusive breastfeeding and breastfeeding duration, and poor maternal mental health in the perinatal period. Full article
(This article belongs to the Special Issue Research Progress in Breastfeeding)
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Article
Halitosis in Children Undergoing Full Mouth Rehabilitation under General Anesthesia
Children 2021, 8(2), 149; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020149 - 17 Feb 2021
Viewed by 498
Abstract
Interventions and management modalities of pediatric halitosis have been suggested in the literature, however, the effect of full mouth rehabilitation (FMR) under general anesthesia (GA) on pediatric halitosis was not reported. Therefore, the present study was conducted to investigate parents’ perceptions of their [...] Read more.
Interventions and management modalities of pediatric halitosis have been suggested in the literature, however, the effect of full mouth rehabilitation (FMR) under general anesthesia (GA) on pediatric halitosis was not reported. Therefore, the present study was conducted to investigate parents’ perceptions of their child’s halitosis before and after FMR under GA; and to evaluate the effect of FMR on clinical halitosis. Fifty-seven children between 3–8 years old, scheduled for FMR under GA, were included after satisfying the inclusion criteria and upon parental consent. Parents’ perception of halitosis in their children was evaluated using a standardized questionnaire and a breath sample was collected to assess the level of volatile sulfur compounds (VSCs) using OralChromaTM before and after FMR under GA. Sixty percent (n = 34) of the parents perceived halitosis in their children before FMR and about 80% (n = 27) of them reported improvement in halitosis after FMR. Clinical halitosis was detected in 84.2% (n = 48) of the sample before treatment. A statistically significant reduction in halitosis was found in 56.3% (n = 27) of the children after treatment (p < 0.001). In conclusion, majority of parents perceived an absence or reduction of halitosis in their children following FMR and significant improvement of clinical halitosis. Full article
Review
The Value of Non-Referential Gestures: A Systematic Review of Their Cognitive and Linguistic Effects in Children’s Language Development
Children 2021, 8(2), 148; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020148 - 17 Feb 2021
Cited by 1 | Viewed by 711
Abstract
Speakers produce both referential gestures, which depict properties of a referent, and non-referential gestures, which lack semantic content. While a large number of studies have demonstrated the cognitive and linguistic benefits of referential gestures as well as their precursor and predictive role in [...] Read more.
Speakers produce both referential gestures, which depict properties of a referent, and non-referential gestures, which lack semantic content. While a large number of studies have demonstrated the cognitive and linguistic benefits of referential gestures as well as their precursor and predictive role in both typically developing (TD) and non-TD children, less is known about non-referential gestures in cognitive and complex linguistic domains, such as narrative development. This paper is a systematic review and narrative synthesis of the research concerned with assessing the effects of non-referential gestures in such domains. A search of the literature turned up 11 studies, collectively involving 898 2- to 8-year-old TD children. Although they yielded contradictory evidence, pointing to the need for further investigations, the results of the six studies–in which experimental tasks and materials were pragmatically based–revealed that non-referential gestures not only enhance information recall and narrative comprehension but also act as predictors and causal mechanisms for narrative performance. This suggests that their bootstrapping role in language development is due to the fact that they have important discourse–pragmatic functions that help frame discourse. These findings should be of particular interest to teachers and future studies could extend their impact to non-TD children. Full article
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Review
Using Mediation Analysis to Understand How Treatments for Paediatric Pain Work: A Systematic Review and Recommendations for Future Research
Children 2021, 8(2), 147; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020147 - 16 Feb 2021
Cited by 1 | Viewed by 1113
Abstract
Clinicians have an increasing number of evidence-based interventions to treat pain in youth. Mediation analysis offers a way of investigating how interventions work, by examining the extent to which an intermediate variable, or mediator, explains the effect of an intervention. This systematic review [...] Read more.
Clinicians have an increasing number of evidence-based interventions to treat pain in youth. Mediation analysis offers a way of investigating how interventions work, by examining the extent to which an intermediate variable, or mediator, explains the effect of an intervention. This systematic review examined studies that used mediation analysis to investigate mechanisms of interventions on pain-relevant outcomes for youth (3–18 years) with acute or chronic pain, and provides recommendations for future mediation research in this field. We searched five electronic databases for clinical trials or observational longitudinal studies that included a comparison group and conducted mediation analyses of interventions on youth and assessed pain outcomes. We found six studies (N = 635), which included a total of 53 mediation models examining how interventions affect pain-relevant outcomes for youth. Five studies were secondary analyses of randomized controlled trials of psychological interventions for chronic pain; one was a longitudinal observational study of morphine for acute pain. The pain conditions studied were irritable bowel syndrome, functional abdominal pain, juvenile fibromyalgia, mixed chronic pain, and post-operative pain. Fourteen putative mediators were tested, of which three partially mediated treatment effect; seven did not significantly mediate treatment effect and four had mixed results. Methodological and reporting limitations were common. There are substantial gaps in the field with respect to investigating, and therefore understanding, how paediatric interventions work. Full article
(This article belongs to the Section Child Neurology)
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Editorial
“Selected Papers from the 2nd Ellisras Longitudinal Study and Other Non-Communicable Diseases Studies International Conference” Special Issue Editorial
Children 2021, 8(2), 146; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020146 - 16 Feb 2021
Viewed by 615
Abstract
Epidemics of non-communicable diseases (NCDs) are presently emerging and on the increase in South Africa. It is increasingly recognized that the occurrence of adult chronic disease are influenced by factors operating from childhood, which are sustained throughout the individual’s life course. Increased risk [...] Read more.
Epidemics of non-communicable diseases (NCDs) are presently emerging and on the increase in South Africa. It is increasingly recognized that the occurrence of adult chronic disease are influenced by factors operating from childhood, which are sustained throughout the individual’s life course. Increased risk may start in infancy or even before birth and will continue to be influenced by health related behavior during adulthood. The academic level of people in the community influence the level of their health status. Commitment to the promotion of health through prevention, education, and suitable management is the building block for creating a healthy society. The community must make strides to shift from traditional knowledge and medication, and seek new innovative ways of addressing issues facing the population with regard to obesity, overweight, hypertension health, smoking cessation, alcohol abuse, and low physical activity in line with a healthy living lifestyle. The NCDs pose health problems in South Africa and deserve more attention. Poor control of obesity, hypertension, and diabetes, to name just a few, only adds to the current problems. The South African government and the business sector of South Africa should provide safe walking/riding trails in the cities and in rural area to combat emerging NCDs that are killing our community members indiscriminately without considering race, gender, age, and place of residence. Compulsory introduction of physical education lessons to all public schools cannot be over emphasized in the current escalating NCD situation in South Africa. Full article
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Article
Risk Factors for Bullying Victimization in Children with Neurofibromatosis Type 1 (NF1)
Children 2021, 8(2), 145; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020145 - 15 Feb 2021
Cited by 1 | Viewed by 721
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal disorder associated with numerous physical stigmata. Children with NF1 are at known risk for attention-deficit/hyperactivity disorder (ADHD), academic struggles, and significant social difficulties and adverse social outcomes, including bullying victimization. The primary aim of this study [...] Read more.
Neurofibromatosis type 1 (NF1) is an autosomal disorder associated with numerous physical stigmata. Children with NF1 are at known risk for attention-deficit/hyperactivity disorder (ADHD), academic struggles, and significant social difficulties and adverse social outcomes, including bullying victimization. The primary aim of this study was to identify risk factors associated with bullying victimization in children with NF1 to better inform clinicians regarding targets for prevention and clinical intervention. Children and a parent completed questionnaires assessing the bully victim status, and parents completed a measure of ADHD symptoms. Analyses were completed separately for parent-reported victimization of the child and the child’s self-report of victimization. According to the parent report, results suggest ADHD symptoms are a significant risk factor for these children being a target of bullying. Findings for academic disability were not conclusive, nor were findings related to having a parent with NF1. Findings indicate the need for further research into possible risk factors for social victimization in children with NF1. Results provide preliminary evidence that may guide clinicians working with children with NF1 and their parents in identifying higher-risk profiles that may warrant earlier and more intensive intervention to mitigate later risk for bullying victimization. Full article
Article
Nicotine Dependence among Adolescents Single and Dual Cigarette Users
Children 2021, 8(2), 144; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020144 - 14 Feb 2021
Viewed by 628
Abstract
The prevalence of concurrent use of combustible and electronic cigarettes (dual-use) is on the rise among Malaysian adolescents. This study compares nicotine dependence among exclusive cigarette users, e-cigarette users, and dual adolescent users. A total of 227 adolescent smokers completed a self-administrated questionnaire [...] Read more.
The prevalence of concurrent use of combustible and electronic cigarettes (dual-use) is on the rise among Malaysian adolescents. This study compares nicotine dependence among exclusive cigarette users, e-cigarette users, and dual adolescent users. A total of 227 adolescent smokers completed a self-administrated questionnaire with items based on Hooked on Nicotine Checklist (HONC) incorporated. Endorsement of at least one HONC item indicates nicotine dependence. Exhaled carbon monoxide readings and salivary cotinine data were also collected. Over half (52.9%) of the participants were exclusive e-cigarette users (EC). The prevalence of exclusive conventional cigarette smokers (CC) and dual users was 11.9% and 35.2%, respectively. Adolescents who have mothers with secondary school education were more likely to become addicted to nicotine (Adjusted Odd Ratio (aOR) = 2.72; 95% CI = 1.17–6.32). Adolescents’ “mother’s education” level predicted nicotine dependence. This highlighted the need to target families within the identified demography with a more supportive anti-tobacco program. Full article
(This article belongs to the Section Global and Public Health)
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Article
Variability of Prognostic Results Based on Biological Parameters in Sickle Cell Disease Cohort Studies in Children: What Should Clinicians Know?
Children 2021, 8(2), 143; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020143 - 13 Feb 2021
Viewed by 489
Abstract
Background: Many pediatric studies describe the association between biological parameters (BP) and severity of sickle cell disease (SCD) using different methods to collect or to analyze BP. This article assesses the methods used for collection and subsequent statistical analysis of BP, and how [...] Read more.
Background: Many pediatric studies describe the association between biological parameters (BP) and severity of sickle cell disease (SCD) using different methods to collect or to analyze BP. This article assesses the methods used for collection and subsequent statistical analysis of BP, and how these impact prognostic results in SCD children cohort studies. Methods: Firstly, we identified the collection and statistical methods used in published SCD cohort studies. Secondly, these methods were applied to our cohort of 375 SCD children, to evaluate the association of BP with cerebral vasculopathy (CV). Results: In 16 cohort studies, BP were collected either once or several times during follow-up. The identified methods in the statistical analysis were: (1) one baseline value per patient (2) last known value; (3) mean of all values; (4) modelling of all values in a two-stage approach. Applying these four different statistical methods to our cohort, the results and interpretation of the association between BP and CV were different depending on the method used. Conclusion: The BP prognostic value depends on the chosen statistical analysis method. Appropriate statistical analyses of prognostic factors in cohort studies should be considered and should enable valuable and reproducible conclusions. Full article
(This article belongs to the Special Issue Sickle Cell Disease in Children)
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Article
Chronological Age in Different Bone Development Stages: A Retrospective Comparative Study
Children 2021, 8(2), 142; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020142 - 13 Feb 2021
Viewed by 459
Abstract
The assessment of an individual’s development by investigating the skeletal maturity is of much use in various medical fields. Skeletal maturity can be estimated by evaluating the morphology of the cervical vertebrae. The aim of this study was to conduct comparisons of the [...] Read more.
The assessment of an individual’s development by investigating the skeletal maturity is of much use in various medical fields. Skeletal maturity can be estimated by evaluating the morphology of the cervical vertebrae. The aim of this study was to conduct comparisons of the chronological age in different bone development stages. The retrospective study was conducted based on lateral cephalometric radiographs belonging to patients with ages between 6 and 15.9 years, from Romania. For the assessment of skeletal maturity, the Cervical Vertebral Maturation (CVM) method was used. In total, 356 radiographs were selected, but after applying the exclusion criteria, 252 radiographs remained in the study (178 girls and 74 boys). Different mean chronological age values were obtained for the general sample, as well as for the two genders. The chronological age started to be significantly different at the CS4 stage. Patients with CS4, CS5, and CS6 stages had a significantly higher chronological age compared to patients with CS1, CS2, and CS3 stages. It was noted that patients with CS1 and CS2 stages were more frequently boys, while patients with the CS5 stage were more frequently girls. Full article
(This article belongs to the Special Issue Bone Development and Disease in Infants)
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Article
Differences on Motor Competence in 4-Year-Old Boys and Girls Regarding the Quarter of Birth: Is There a Relative Age Effect?
Children 2021, 8(2), 141; https://0-doi-org.brum.beds.ac.uk/10.3390/children8020141 - 13 Feb 2021
Cited by 7 | Viewed by 805
Abstract
The aim of this study was to evaluate the differences on motor competence between boys and girls aged 4 years old and investigate the existence of Relative Age Effect on their motor competence. In total, 132 preschool children were evaluated, of whom 60 [...] Read more.
The aim of this study was to evaluate the differences on motor competence between boys and girls aged 4 years old and investigate the existence of Relative Age Effect on their motor competence. In total, 132 preschool children were evaluated, of whom 60 (45.50%) were girls and 72 (54.5%) were boys. The distribution of the participants was from quarter 1 [n = 28 (21.2%)], quarter 2 [n = 52 (39.4%)], quarter 3 [n = 24 (18.2%)], and quarter 4 [(n = 28 (21.2%)], respectively. The Movement Assessment Battery for Children-2 (MABC-2) was used to collect the data. The data show the main effects on quarter of birth factor in manual dexterity (MD; p < 0.001), in aiming and catching (A&C; p < 0.001), in balance (Bal; p < 0.001) and in total test score (TTS; p < 0.001). There are also statistical differences on gender factor in MD (p < 0.001) and in TTS (p = 0.031). A significant effect was also found in the interaction between two factors (gender and quarter of birth) in MD (p < 0.001), A&C (p < 0.001), and Bal (p < 0.001). There are differences in all the variables studied according to the quarter of birth and only in manual dexterity and in the total score if compared according to gender (the scores are higher in girls). Full article
(This article belongs to the Special Issue Physical Activity and Motor Competence in Preschool Children)
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