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Children, Volume 8, Issue 9 (September 2021) – 109 articles

Cover Story (view full-size image): Adverse childhood experiences (ACEs) are stressful childhood events associated with behavioral, mental, and physical illness. Parent experiences of adversity may indicate a child’s adversity risk, but little evidence exists on intergenerational links between parents’ and children’s ACEs. This study examines these intergenerational ACE associations, as well as parent factors that mediate them. View this paper
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Review
Mechanisms and Insights for the Development of Heart Failure Associated with Cancer Therapy
Children 2021, 8(9), 829; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090829 - 21 Sep 2021
Viewed by 487
Abstract
Cardiotoxicity is a well-recognized late effect among childhood cancer survivors. With various pediatric cancers becoming increasingly curable, it is imperative to understand the disease burdens that survivors may face in the future. In order to prevent or mitigate cardiovascular complications, we must first [...] Read more.
Cardiotoxicity is a well-recognized late effect among childhood cancer survivors. With various pediatric cancers becoming increasingly curable, it is imperative to understand the disease burdens that survivors may face in the future. In order to prevent or mitigate cardiovascular complications, we must first understand the mechanistic underpinnings. This review will examine the underlying mechanisms of cardiotoxicity that arise from traditional antineoplastic chemotherapies, radiation therapy, hematopoietic stem cell transplantation, as well as newer cellular therapies and targeted cancer therapies. We will then propose areas for prevention, primarily drawing from the anthracycline-induced cardiotoxicity literature. Finally, we will explore the role of human induced pluripotent stem cell cardiomyocytes and genetics in advancing the field of cardio-oncology. Full article
(This article belongs to the Special Issue Cardio-Oncology in Children)
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Article
Two Sides of a Coin: Parental Disease-Specific Training as Seen by Health Care Practitioners and Parents in Pediatric Liver Transplantation
Children 2021, 8(9), 827; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090827 - 21 Sep 2021
Viewed by 370
Abstract
In the absence of widely accepted education standards for parents of children after liver transplantation (LTx), the content and structure of parental training are influenced by health care practitioners’ (HCP) individual knowledge and assessment of the relevance of its contents. This study examines [...] Read more.
In the absence of widely accepted education standards for parents of children after liver transplantation (LTx), the content and structure of parental training are influenced by health care practitioners’ (HCP) individual knowledge and assessment of the relevance of its contents. This study examines the hypothesis that expectations towards training differ between HCPs and parents, and that the quality of parental training affects the job-satisfaction of HCPs. Attitudes towards disease-specific education were assessed by tailor-made questionnaires in HCPs (n = 20) and parents of children with chronic liver disease or after LTx (n = 113). These were supplemented by focused interviews in n = 7 HCPs and n = 16 parents. Parents were more satisfied with current counseling than HCP. Language barriers and low parental educational background were perceived as obstacles by 43% of HCPs. The quality of parental knowledge was felt to have a strong influence on HCPs job satisfaction. The expectations towards the content of disease-specific education largely overlap but are not synonymous. HCP and parents agreed with regards to the importance of medication knowledge. Parents rated the importance about the meaning of laboratory values and diagnostic procedures significantly higher (3.50 vs. 2.85, p < 0.001 and 3.42 vs. 2.80, p < 0.001) than HCPs. Parents and HCPs would prefer a structured framework with sufficient staff resources for disease-specific counseling. Full article
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Article
Feasibility and Safety of Percutaneous Cardiac Interventions for Congenital and Acquired Heart Defects in Infants ≤1000 g
Children 2021, 8(9), 826; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090826 - 21 Sep 2021
Viewed by 365
Abstract
The transcatheter closure of patent ductus arteriosus (TCPC) has been demonstrated to be feasible even in infants weighing ≤1000 g. However, other percutaneous cardiac interventions (PCI) for such small infants born with congenital heart defects (CHD) or acquired heart defects (AHD) have not [...] Read more.
The transcatheter closure of patent ductus arteriosus (TCPC) has been demonstrated to be feasible even in infants weighing ≤1000 g. However, other percutaneous cardiac interventions (PCI) for such small infants born with congenital heart defects (CHD) or acquired heart defects (AHD) have not been well described. The purpose of this study was to describe the feasibility and safety of PCI in infants ≤1000 g. A retrospective review was conducted between June 2015 and May 2021, looking at 148 consecutive PCIs performed on infants weighing ≤1000 g at the time of the procedure. The procedural success rate was 100%. The major adverse event (AE) rate for TCPC was 3%, while there were no major AEs for other PCI. It is feasible to perform PCIs in infants weighing ≤1000 g with CHD and AHD using currently available technologies. Full article
(This article belongs to the Special Issue Advances in Pediatric Heart Disease Research—Neonatal Interventions)
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Article
Complement 3 and the Prognostic Nutritional Index Distinguish Kawasaki Disease from Other Fever Illness with a Nomogram
Children 2021, 8(9), 825; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090825 - 20 Sep 2021
Viewed by 474
Abstract
Objective: This study aimed to establish a model to distinguish Kawasaki disease (KD) from other fever illness using the prognostic nutritional index (PNI) and immunological factors. Method: We enrolled a total of 692 patients (including 198 with KD and 494 children with febrile [...] Read more.
Objective: This study aimed to establish a model to distinguish Kawasaki disease (KD) from other fever illness using the prognostic nutritional index (PNI) and immunological factors. Method: We enrolled a total of 692 patients (including 198 with KD and 494 children with febrile diseases). Of those, 415 patients were selected to be the training group and 277 patients to be the validation group. Laboratory data, including the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR), the prognostic nutritional index (PNI), and immunological factors, were retrospectively collected for an analysis after admission. We used univariate and multivariate logistic regressions and nomograms for the analysis. Result: Patients with KD showed significantly higher C3 and a lower PNI. After a multivariate logistic regression, the total leukocyte count, PNI, C3, and NLR showed a significance (p < 0.05) and then performed well with the nomogram model. The areas under the ROC in the training group and the validation group were 0.858 and 0.825, respectively. The calibration curves of the two groups for the probability of KD showed a near agreement to the actual probability. Conclusions: Compared with children with febrile diseases, patients with KD showed increased C3 and a decreased nutritional index of the PNI. The nomogram established with these factors could effectively identify KD from febrile illness in children. Full article
(This article belongs to the Special Issue Kawasaki Disease, MIS-C and COVID-19)
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Review
The Link between Pediatric Obstructive Sleep Apnea (OSA) and Attention Deficit Hyperactivity Disorder (ADHD)
Children 2021, 8(9), 824; https://doi.org/10.3390/children8090824 - 19 Sep 2021
Viewed by 967
Abstract
Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing that affects up to 9.5% of the pediatric population. Untreated OSA is associated with several complications, including neurobehavioral sequelae, growth and developmental delay, cardiovascular dysfunction, and insulin resistance. Attention-deficit/hyperactivity disorder (ADHD) is among [...] Read more.
Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing that affects up to 9.5% of the pediatric population. Untreated OSA is associated with several complications, including neurobehavioral sequelae, growth and developmental delay, cardiovascular dysfunction, and insulin resistance. Attention-deficit/hyperactivity disorder (ADHD) is among the neurobehavioral sequelae associated with OSA. This review aims to summarize the research on the relationship between OSA and ADHD and investigate the impacts of OSA treatment on ADHD symptoms. A literature search was conducted on electronic databases with the key terms: “attention deficit hyperactivity disorder” or “ADHD”, “obstructive sleep apnea” or “OSA”, “sleep disordered breathing”, and “pediatric” or “children”. Review of relevant studies showed adenotonsillectomy to be effective in the short-term treatment of ADHD symptoms. The success of other treatment options, including continuous positive airway pressure (CPAP), in treating ADHD symptoms in pediatric OSA patients has not been adequately evaluated. Further studies are needed to evaluate the long-term benefits of surgical intervention, patient factors that may influence treatment success, and the potential benefits of other OSA treatment methods for pediatric ADHD patients. Full article
(This article belongs to the Special Issue Obstructive Sleep Apnea Syndrome in Children)
Case Report
Modifications of Rect-Spring to Enhance the Engagement of Ectopically Entrapped Molars with 2 Case Reports
Children 2021, 8(9), 823; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090823 - 19 Sep 2021
Viewed by 427
Abstract
The Rect-spring appliance, used for the management of ectopically erupting molars, shows weak retention on mesially tilted molars. We present three modifications of the appliance for better engagement and their advantages. We describe cases of two 7-year-old patients with ectopically erupting maxillary first [...] Read more.
The Rect-spring appliance, used for the management of ectopically erupting molars, shows weak retention on mesially tilted molars. We present three modifications of the appliance for better engagement and their advantages. We describe cases of two 7-year-old patients with ectopically erupting maxillary first molars with a 2.2 mm and 2.5 mm depth of entrapment, respectively. The modified Rect-spring (mRS) was inserted between the ectopically erupting first molar and adjacent primary second molar, and exerted a distalization force with an interproximal wedging effect at the same time. After 3 months, the ectopically erupting first molars were successfully brought into proper occlusion. No discomfort was reported. The mRS is suitable for various locking cases except for severely tilted molars without requiring any laboratory procedures. We suggest it as the first choice for unlocking the first molars. Full article
(This article belongs to the Section Pediatric Dentistry)
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Article
Gender Differences in Attention Adaptation after an 8-Week FIFA 11+ for Kids Training Program in Elementary School Children
Children 2021, 8(9), 822; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090822 - 18 Sep 2021
Viewed by 316
Abstract
School-based exercise intervention is recognized as an optimal tool for enhancing attentional performance in healthy school children. However, gender differences in the training adaptation regarding attentional capacities have not been elucidated clearly in the current literature. This study aimed to investigate the effects [...] Read more.
School-based exercise intervention is recognized as an optimal tool for enhancing attentional performance in healthy school children. However, gender differences in the training adaptation regarding attentional capacities have not been elucidated clearly in the current literature. This study aimed to investigate the effects of an 8-week Fédération Internationale de Football Association (FIFA) 11+ for Kids training program on attentional performance in schoolboys and girls. Based on a quasi-experimental design, fifty-two children registered in year five of elementary school were assigned into the following groups: training boys (n = 13), training girls (n = 13), control boys (n = 13), and control girls (n = 13). The training groups undertook an 8-week FIFA 11+ Kids intervention with a training frequency of five times per week, whereas the control groups were deprived of any exercise during the study period. All the participants maintained their regular physical activity and weekly physical education (PE) lessons (two 50-min lessons per week of school curriculum) during the training period. The Chinese version of the Attention Scale for Elementary School Children (ASESC) test was used for attentional assessment at the baseline and one week after the interventional period. The Kruskal–Wallis H test was used for between-group comparison, whereas the Wilcoxon signed-rank test was used for within-group comparison. Significant differences in total scale, focused attention, selective attention, and alternating attention were found in group comparisons (p < 0.001). Furthermore, the training children significantly increased their values in relation to total scale, focused attention, sustained attention, and selective attention (p < 0.05). Only training girls significantly improved their divided attention after the training period (p < 0.001, MD = −0.77, ES = −0.12). In conclusion, the FIFA 11+ for Kids is an effective school-based exercise intervention for attentional improvement in school children. The schoolgirls demonstrated a positive outcome regarding divided attention after the interventional period. Full article
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Review
NSAID Use and Effects on Pediatric Bone Healing: A Review of Current Literature
Children 2021, 8(9), 821; https://doi.org/10.3390/children8090821 - 18 Sep 2021
Viewed by 236
Abstract
This systematic review evaluates and synthesizes the available peer-reviewed evidence regarding the impact of non-steroidal anti-inflammatory drugs (NSAIDs) on fracture healing in skeletally immature patients. Evidence supports the use of NSAIDs in this patient population for adequate pain control without increasing the risk [...] Read more.
This systematic review evaluates and synthesizes the available peer-reviewed evidence regarding the impact of non-steroidal anti-inflammatory drugs (NSAIDs) on fracture healing in skeletally immature patients. Evidence supports the use of NSAIDs in this patient population for adequate pain control without increasing the risk of nonunion, particularly in long bone fractures and pseudoarthrosis after spine fusion. However, further clinical studies are needed to fill remaining gaps in knowledge, specifically with respect to the spectrum of available NSAIDs, dosage, and duration of use, in order to make broad evidence-based recommendations regarding the optimal use of NSAIDs during bone healing in skeletally immature patients. Full article
(This article belongs to the Special Issue Pediatric Fractures)
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Article
Extended Adhesion-Sparing Liver Eversion during Kasai Portoenterostomy for Infants with Biliary Atresia
Children 2021, 8(9), 820; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090820 - 17 Sep 2021
Viewed by 256
Abstract
Background: Despite the fact that Kasai portoenterostomy (KPE) is the primary treatment for biliary atresia (BA), liver transplantation (LT) remains the ultimate surgery for two-thirds of these patients. Their true survival rate with the native liver reflects the original KPE and the burden [...] Read more.
Background: Despite the fact that Kasai portoenterostomy (KPE) is the primary treatment for biliary atresia (BA), liver transplantation (LT) remains the ultimate surgery for two-thirds of these patients. Their true survival rate with the native liver reflects the original KPE and the burden of post-operative complications. We report an original modification of the adhesion-sparing liver eversion (ASLE) technique during KPE that facilitates the total native hepatectomy at time of transplantation. Methods: All consecutive patients with BA who underwent KPE at our department and subsequent LT at Paediatric Liver Transplant Centre at Papa Giovanni XXIII Hospital between 2010–2018 were retrospectively enrolled. All patients underwent ASLE during KPE. Patients’ demographic data, type of KPE, total transplant time (TTT), hepatectomy time (HT), intra-operative packed red blood cells and plasma transfusions, intra- and post-operative complications were noted. Results: 44 patients were enrolled. Median TTT and HT were 337 and 57 min, respectively. The median volume of packed red blood cell transfusion was 95 mL. No patients presented bowel perforation during the procedure or in the short post-operative course. No mortality after LT was recorded. Conclusions: In addition to the well-known advantages of the standard liver eversion technique, ASLE reduces the formation of intra-abdominal adhesions, lowering significantly the risk of bowel perforation and bleeding when liver transplantation is performed for failure of KPE. Full article
(This article belongs to the Special Issue Abdominal Surgery in Pediatrics)
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Article
A Case Series on Genotype and Outcome of Liver Transplantation in Children with Niemann-Pick Disease Type C
Children 2021, 8(9), 819; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090819 - 17 Sep 2021
Viewed by 399
Abstract
Background: To report on clinical presentation and outcomes of children who underwent liver transplantation (LTx) and were subsequently diagnosed to have Niemann-Pick type C (NPC). Methods: Retrospective, descriptive, multi-centre review of children diagnosed with NPC who underwent LTx (2003–2018). Diagnosis was made by [...] Read more.
Background: To report on clinical presentation and outcomes of children who underwent liver transplantation (LTx) and were subsequently diagnosed to have Niemann-Pick type C (NPC). Methods: Retrospective, descriptive, multi-centre review of children diagnosed with NPC who underwent LTx (2003–2018). Diagnosis was made by filipin skin test or genetic testing. Results: Nine children were identified (six centres). Neonatal acute liver failure was the most common indication for LTx (seven children). Median age at first presentation: 7 days (range: 0–37). The most prevalent presenting symptoms: jaundice (8/9), hepatosplenomegaly (8/9) and ascites (6/9). 8/9 children had a LTx before the diagnosis of NPC. Genetic testing revealed mutations in NPC1 correlating with a severe biochemical phenotype in 5 patients. All 9 children survived beyond early infancy. Seven children are still alive (median follow-up time of 9 (range: 6–13) years). Neurological symptoms developed in 4/7 (57%) patients at median 9 (range: 5–13) years following LTx. Conclusion: Early diagnosis of NPC continues to be a challenge and a definitive diagnosis is often made only after LTx. Neurological disease is not prevented in the majority of patients. Genotype does not appear to predict neurological outcome after LTx. LTx still remains controversial in NPC. Full article
Article
Young Children Feeding Practices: An Update from the Sultanate of Oman
Children 2021, 8(9), 818; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090818 - 17 Sep 2021
Viewed by 425
Abstract
Despite proven benefits, most countries fail to meet international targets for appropriate complementary and Breast Feeding (BF) practices. This study assessed feeding practices of children under two years of age and correlated them with family parameters in Oman, a high income country in [...] Read more.
Despite proven benefits, most countries fail to meet international targets for appropriate complementary and Breast Feeding (BF) practices. This study assessed feeding practices of children under two years of age and correlated them with family parameters in Oman, a high income country in the Eastern Mediterranean Region. Methods: Data from this study originated from the latest Oman National Nutrition Survey (ONNS). Assessment of children and their mothers’ socioeconomic, anthropometric, and nutritional variables was conducted at the household level. Evaluated feeding practices included age appropriate BF, diet diversity, and minimum acceptable diet (MAD). Results: Pairs of mothers and infants (n = 1344) were assessed. Early BF, exclusive BF at 6 months, infant formula, and iron rich meals were provided to 81, 29, 44, and 84% of children, respectively. Age appropriate BF and MAD were found in 58% and 35% of children, respectively. Low maternal education, younger age, low household income, and governorate negatively affected diet acceptability. Conclusion: Omani children successfully received early BF postpartum and consumed iron rich meals. Yet, rates of exclusive BF rates at six months and MAD for children under two were low. Comprehensive strategies should be placed to assess and influence children feeding practices in the Sultanate. Full article
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Article
Prevalence of Iodine Deficiency among School Children from New Settlement in Kyrgyzstan
Children 2021, 8(9), 817; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090817 - 16 Sep 2021
Viewed by 520
Abstract
This study assesses the status of iodine deficiency among at risk-children and adolescents living in migrant settlements in the Kyrgyz Republic. Children aged 7–15 years from two regional primary schools in the new settlement regions were screened for cognitive and behavioural signs of [...] Read more.
This study assesses the status of iodine deficiency among at risk-children and adolescents living in migrant settlements in the Kyrgyz Republic. Children aged 7–15 years from two regional primary schools in the new settlement regions were screened for cognitive and behavioural signs of iodine deficiency using questionnaires. The functional state of the thyroid gland was assessed using ultrasonography and blood tests. Out of 1058 schoolchildren, 15.8% showed signs of iodine deficiency. Female children aged 10–12 years showed a higher prevalence of iodine deficiency. The families of schoolchildren reported limited use of seafood and iodised salt. Children in the migrant regions were at risk of iodine deficiency disorder. Among children, clinical manifestations of iodine deficiency were observed as negative hormonal levels or the presence of goitre. Further investigation on standardised screening instruments for iodine deficiency and the relationship among multilevel analyses are warranted. Full article
(This article belongs to the Section Global and Public Health)
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Article
Does Maternal Mental Health and Maternal Stress Affect Preschoolers’ Behavioral Symptoms?
Children 2021, 8(9), 816; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090816 - 16 Sep 2021
Viewed by 381
Abstract
(1) Background: Maternal stress and depression are considered risk factors in children’s socioemotional development, also showing high prevalence worldwide. (2) Method: Participants correspond to a longitudinal sample of 6335 mother/child pairs (18–72 months), who were surveyed in 2010 and then in 2012. The [...] Read more.
(1) Background: Maternal stress and depression are considered risk factors in children’s socioemotional development, also showing high prevalence worldwide. (2) Method: Participants correspond to a longitudinal sample of 6335 mother/child pairs (18–72 months), who were surveyed in 2010 and then in 2012. The hypothesis was tested with SEM analysis, setting the child’s internalized/externalized problems as dependent variable, maternal depression as independent variable, and stress as a partial mediator. (3) Results: Both depression during pregnancy and recent depression has not only a direct effect on the internalizing and externalizing symptomatology of the child, but also an indirect effect through parental stress. Significant direct and indirect relationships were found. (4) Conclusions: Maternal depression and the presence of parental stress can influence children’s behavioral problems, both internalizing and externalizing. Full article
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Article
Parents’ Perspectives on Adaptive Sports in Children with Profound Intellectual and Multiple Disabilities
Children 2021, 8(9), 815; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090815 - 16 Sep 2021
Viewed by 381
Abstract
Children with profound intellectual and multiple disabilities (PIMD) need adaptations to participate in sports and it is more difficult for them to access these activities. We investigated the effects of adaptive sports in children with PIMD as perceived by their parents. The parents [...] Read more.
Children with profound intellectual and multiple disabilities (PIMD) need adaptations to participate in sports and it is more difficult for them to access these activities. We investigated the effects of adaptive sports in children with PIMD as perceived by their parents. The parents answered a postal questionnaire exploring the effects of adaptive sports during the 3 days following an activity. The questionnaire explored twelve domains of children’s daily lives, such as sleep and appetite. We calculated a composite score, including all of these domains, to assess whether the children globally benefited from adaptive sports. Of the families, 27/63 responded (participation 42.9%). Four domains improved after the sports activity in an important proportion of children (improvement in 64.0% of children for wellbeing, 57.6% for mood, 56.0% for comfort and 48.1% for sleep). Among the majority of children, the other eight domains remained mostly stable. Three quarters of parents reported a globally positive effect of adapted physical activities on their child. These findings support the further development and provision of adaptive sports for children with severe neurological impairments. Full article
(This article belongs to the Special Issue Physical Activity and Exercise Science for Children)
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Article
Early Deaths in Childhood Cancer in Romania—A Single Institution Study
Children 2021, 8(9), 814; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090814 - 16 Sep 2021
Viewed by 253
Abstract
(1) Background: Survival in childhood cancer has improved significantly over the last decades. However, early deaths (EDs) represent an important number of preventable deaths. Our aim was to provide more insight intoEDs in developing countries. (2) Methods: We conducted a retrospective analysis of [...] Read more.
(1) Background: Survival in childhood cancer has improved significantly over the last decades. However, early deaths (EDs) represent an important number of preventable deaths. Our aim was to provide more insight intoEDs in developing countries. (2) Methods: We conducted a retrospective analysis of patients aged 0–18 years with childhood cancer diagnosed between 1996 and 2008 and admitted in the Institute of Oncology “Prof. Dr. Ion Chiricuta” Cluj-Napoca (IOCN), Romania. After exclusion of patients (pts) older than 18 years at diagnosis, pts with a missing personal identification number and pts with unconfirmed diagnosis of malignancy, we included 783 pts in the final analysis. We defined ED as survival of less than one month after cancer diagnosis. We divided pts in groups according to age, major tumour categories and treatment time periods. (3) Results: ED was registered in 20 pts (2.55%). A total of 16EDs were registered in haematologic malignancies and 4 in solid tumours. Statistical analysis was performed on pts diagnosed with haematological malignancies. A statistically significant higher proportion of patients with performance status (PS) 3 and 4 died within one month after diagnosis (24.1%) than patients admitted with PS 0–2 (1%)—p < 0.01. We found no statistically significant difference regarding ED when comparing male versus female (p = 0.85), age at diagnosis or between the threeperiods of diagnosis (p = 0.7). (4) Conclusions: PS at admission is an important risk factor associated with ED in pts with haematologic malignancies. ED in our institution reflects frequent late presentation for medical care, late diagnosis and referral to specialised centres. Full article
(This article belongs to the Section Oncology and Hematology)
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Article
Is There a Role for Elective Early Upper Gastrointestinal Contrast Study in Neurologically Impaired Children following Laparoscopic Nissen Fundoplication?
Children 2021, 8(9), 813; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090813 - 16 Sep 2021
Viewed by 261
Abstract
Assessment of discomfort as a sign for early postoperative complications in neurologically impaired (NI) children is challenging. The necessity of early routine upper gastrointestinal (UGI) contrast studies following laparoscopic Nissen fundoplication in NI children is unclear. We aimed to evaluate the role of [...] Read more.
Assessment of discomfort as a sign for early postoperative complications in neurologically impaired (NI) children is challenging. The necessity of early routine upper gastrointestinal (UGI) contrast studies following laparoscopic Nissen fundoplication in NI children is unclear. We aimed to evaluate the role of scheduled UGI contrast studies to identify early postoperative complications following laparoscopic Nissen fundoplication in NI children. Data for laparoscopic Nissen fundoplications performed in NI children between January 2004 and June 2021 were reviewed. A total of 103 patients were included, with 60 of these being boys. Mean age at initial operation was 6.51 (0.11–18.41) years. Mean body weight was 16.22 (3.3–62.5) kg. Mean duration of follow up was 4.15 (0.01–16.65 years) years. Thirteen redo fundoplications (12.5%) were performed during the follow up period; eleven had one redo and two had 2 redos. Elective postoperative UGI contrast studies were performed in 94 patients (91%). Early postoperative UGI contrast studies were able to identify only one complication: an intrathoracal wrap herniation on postoperative day five, necessitating a reoperation on day six. The use of early UGI contrast imaging following pediatric laparoscopic Nissen fundoplication is not necessary as it does not identify a significant number of acute postoperative complications requiring re-intervention. Full article
(This article belongs to the Special Issue Abdominal Surgery in Pediatrics)
Article
The Relationship between Metabolic Syndrome and Smoking and Alcohol Experiences in Adolescents from Low-Income Households
Children 2021, 8(9), 812; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090812 - 16 Sep 2021
Viewed by 461
Abstract
Metabolic syndrome (MetS) in children and adolescents is increasing globally and the age of onset is gradually decreasing. MetS is associated with serious health problems and presents an early risk for adult morbidity and mortality. From 2014–2019, we investigated the relationship between MetS [...] Read more.
Metabolic syndrome (MetS) in children and adolescents is increasing globally and the age of onset is gradually decreasing. MetS is associated with serious health problems and presents an early risk for adult morbidity and mortality. From 2014–2019, we investigated the relationship between MetS and health behaviors such as smoking, alcohol consumption, and nutrition education in Korean adolescents (boys: 1235, girls: 1087, age: 13–18 years) based on household income; the relationship with hand grip strength was also evaluated. The prevalence of MetS was 8.8% in boys and 5.1% in girls; in the lowest income households, the risk increased ~1.5-fold for boys and ~4-fold for girls, whereas risks of smoking and alcohol use increased 1.81 vs. 2.34 times, and 2.34 vs. 2.37 times for boys and girls, respectively. In adolescents with the weakest grip strength, the risk of MetS increased 9.62 and 7.79 times in boys and girls, respectively. Girls lacking nutrition education exhibited a 1.67-fold increased risk of MetS, but this was not significant in boys. Low household income increased the risk of unhealthy behaviors such as smoking and alcohol consumption in both sexes, and together with low hand grip strength, was an important predictor for developing MetS. Full article
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Article
The Histopathology of the Appendix in Children at Interval Appendectomy
Children 2021, 8(9), 811; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090811 - 16 Sep 2021
Viewed by 502
Abstract
Whilst most surgeons agree that conservative treatment of appendiceal abscess in children is an adequate treatment, the need for subsequent interval appendectomy is still controversial. We analyzed the histopathology in interval appendectomy in search of signs of inflammation. All patients admitted between 2010 [...] Read more.
Whilst most surgeons agree that conservative treatment of appendiceal abscess in children is an adequate treatment, the need for subsequent interval appendectomy is still controversial. We analyzed the histopathology in interval appendectomy in search of signs of inflammation. All patients admitted between 2010 and 2017 with appendiceal abscess and scheduled for interval appendectomy were reviewed. The specimens were evaluated for grade of inflammation, type and distribution of cellular infiltrate, presence of necrosis or hemorrhage and infiltrate in the serosa. Forty-two patients had appendiceal abscess and were treated conservatively. Seven underwent emergent appendectomy. Thirty-three out of 35 patients underwent elective interval appendectomy. Thirty-two specimens were revised. Carcinoid tumor or other malignant lesions were not found. All of them presented some amount of inflammation, grade 1 to 2 in 53%, grade 3 to 4 in 47%. Twenty-five percent of the specimens had signs of necrosis accompanied by hemorrhage and in more than the half (53%) the infiltrate extended to the serosa. Conclusions: Although the appendix was mostly found not macroscopically inflamed intraoperatively, histology confirmed a certain grade of inflammation even months after the conservative treatment. No correlation was found between histopathologic findings and lapse of time between abscess treatment and interval appendectomy. Full article
(This article belongs to the Special Issue Abdominal Surgery in Pediatrics)
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Review
A Scoping Review of Life-Course Psychosocial Stress and Kidney Function
Children 2021, 8(9), 810; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090810 - 16 Sep 2021
Viewed by 520
Abstract
Increased exposure to maternal psychosocial stress during gestation and adverse neonatal environments has been linked to alterations in developmental programming and health consequences in offspring. A programmed low nephron endowment, among other altered pathways of susceptibility, likely increases the vulnerability to develop chronic [...] Read more.
Increased exposure to maternal psychosocial stress during gestation and adverse neonatal environments has been linked to alterations in developmental programming and health consequences in offspring. A programmed low nephron endowment, among other altered pathways of susceptibility, likely increases the vulnerability to develop chronic kidney disease in later life. Our aim in this scoping review was to identify gaps in the literature by focusing on understanding the association between life-course exposure to psychosocial stress, and the risk of reduced kidney function. A systematic search in four databases (PubMed, ProQuest, Wed of Science, and Scopus) was performed, yielding 609 articles. Following abstract and full-text review, we identified 19 articles meeting our inclusion criteria, reporting associations between different psychosocial stressors and an increase in the prevalence of kidney disease or decline in kidney function, mainly in adulthood. There are a lack of studies that specifically evaluated the association between gestational exposure to psychosocial stress and measures of kidney function or disease in early life, despite the overall evidence consistent with the independent effects of prenatal stress on other perinatal and postnatal outcomes. Further research will establish epidemiological studies with clear and more comparable psychosocial stressors to solve this critical research gap. Full article
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Article
Is Recent Exposure to Antibiotics a Risk Factor for Hospitalisation in Korean Children with Acute Non-Bacterial Gastroenteritis? A Nationwide Population-Based Study
Children 2021, 8(9), 809; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090809 - 15 Sep 2021
Viewed by 288
Abstract
The purpose of this study was to evaluate the effect of recent antibiotic therapy and probiotics on hospitalisation in children with acute gastroenteritis. Using a retrospective study design, data from the population aged up to 18 years were collected from the Korean National [...] Read more.
The purpose of this study was to evaluate the effect of recent antibiotic therapy and probiotics on hospitalisation in children with acute gastroenteritis. Using a retrospective study design, data from the population aged up to 18 years were collected from the Korean National Health Insurance Service-National Sample Cohort. The duration of antibiotic therapy within 14 days of the index visit, prescription of probiotics at initial presentation, the effect size of antibiotic exposure on hospitalisation, and its modification by probiotics were assessed. Of 275,395 patients with acute gastroenteritis, 51,008 (18.5%) had prior exposure to antibiotics. Hospitalisation within 7 days of the index visit was positively associated with exposure to antibiotics (p-trend < 0.001). The prescription of probiotics (as a main effect; odds ratio, 0.80; 95% confidence interval 0.72–0.87) was associated with a decreased risk of hospitalisation. Prior exposure to antibiotics might be a significant risk factor for hospitalisation in children presenting with acute gastroenteritis. This may be favourably modified by administering probiotics at the initial presentation. Full article
(This article belongs to the Collection Advances in Pediatric Digestive Diseases)
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Article
Is There a Dose-Response Relationship between Acute Physical Activity and Sleep Length? A Longitudinal Study with Children and Adolescents Living in Sweden
Children 2021, 8(9), 808; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090808 - 15 Sep 2021
Viewed by 309
Abstract
A declining physical activity (PA) and sleep in children and adolescents have been observed during the previous decades. PA could benefit sleep, but the findings are mixed. The aim of the present study was to examine if there is a dose-response relationship between [...] Read more.
A declining physical activity (PA) and sleep in children and adolescents have been observed during the previous decades. PA could benefit sleep, but the findings are mixed. The aim of the present study was to examine if there is a dose-response relationship between time spent in acute moderate and vigorous physical activity (MVPA) and sleep length in children and adolescents. Additional aims were to examine if the sleep length is higher for children and adolescents who conduct at least an average of 60 min in MVPA/day and to study differences between sex and school years. The study population consists of 262 participants in school year 5 (aged 11 years), 7 (aged 13 years), and 9 (aged 15 years). Accelerometers measured MVPA while sleep diaries measured sleep length. A linear and longitudinal mixed effect linear regression was conducted to study the primary aim. The secondary aims were studied with linear regressions. Included confounders were sex, school year, school stress, screen time, menstruation onset, family household economy, and health status. A stratified regression for sex and school year was conducted. The linear regression showed no statistically significant findings in the crude or adjusted model. The stratified linear regression found a significant positive association for girls but a negative association for school year 5. No associations were found in the longitudinal regression or when comparing sleep length for participants that did and did not spend an average of at least 60 min in MVPA/day. A dose-response relationship was found in the stratified linear regression, implying a possible weak association. The statistically non-significant differences between participants that did and did not spend an average of at least 60 min in MVPA/day implies that spending an average of at least 60 min in MVPA/day may not be associated with a higher mean sleep length. Full article
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Article
An Increased Risk of School-Aged Children with Viral Infection among Diarrhea Clusters in Taiwan during 2011–2019
Children 2021, 8(9), 807; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090807 - 15 Sep 2021
Viewed by 491
Abstract
Acute diarrhea is mainly caused by norovirus and rotavirus. Numerous factors modify the risk of diarrhea cluster infections and outbreaks. The purpose of this study was to explore the epidemiological characteristics, differences, and trends in the distribution of viral and bacterial pathogens that [...] Read more.
Acute diarrhea is mainly caused by norovirus and rotavirus. Numerous factors modify the risk of diarrhea cluster infections and outbreaks. The purpose of this study was to explore the epidemiological characteristics, differences, and trends in the distribution of viral and bacterial pathogens that cause diarrhea cluster events as well as the public places where diarrhea cluster events took place in Taiwan from 2011 to 2019. We examined publicly available, annual summary data on 2865 diarrhea clusters confirmed by the Taiwan Centers for Disease Control (CDC) from 2011 to 2019. There were statistically significant differences (p < 0.001) in event numbers of diarrhea clusters among viral and bacterial pathogens, and statistically significant differences (p < 0.001) in event numbers of diarrhea clusters among bacterial pathogens. There were also statistically significant differences (p < 0.001) in the event numbers of diarrhea clusters among public places. Norovirus infections were the first most numerous (77.1%, 1810/2347) diarrhea clusters among viral and bacterial infections. Among bacterial infections, Staphylococcus aureus infections accounted for the greatest number of diarrhea clusters (35.5%, 104/293). Schools were the places with the greatest number of diarrhea clusters (49.1%, 1406/2865) among various institutions. Norovirus single infection (odds ratio, OR = 4.423), Staphylococcus aureus single infection (OR = 2.238), and school (OR = 1.983) were identified as risk factors. This is the first report of confirmed events of diarrhea clusters taken from surveillance data compiled by Taiwan’s CDC (2011–2019). This study highlights the importance of long-term and geographically extended studies, particularly for highly fluctuating pathogens, to understand the implications of the transmission of diarrhea clusters in Taiwan’s populations. Importantly, big data have been identified that can inform future surveillance and research efforts in Taiwan. Full article
Systematic Review
A Systematic Review of the Prospective Relationship between Child Maltreatment and Chronic Pain
Children 2021, 8(9), 806; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090806 - 15 Sep 2021
Viewed by 298
Abstract
Objective: The present systematic review aimed to evaluate the association between childhood maltreatment and chronic pain, with specific attention to the temporal nature of the relationship and putative moderators, including, the nature (type), timing of occurrence, and magnitude of maltreatment; whether physical harm [...] Read more.
Objective: The present systematic review aimed to evaluate the association between childhood maltreatment and chronic pain, with specific attention to the temporal nature of the relationship and putative moderators, including, the nature (type), timing of occurrence, and magnitude of maltreatment; whether physical harm or injury occurred; and whether post-traumatic stress disorder (PTSD) subsequently developed. Method: We included studies that measured the prospective relationship between child maltreatment and pain. Medline, EMBASE, PsycINFO, and CINAHL were searched electronically up to 28 July 2019. We used accepted methodological procedures common to prognosis studies and preregistered our review (PROSPERO record ID 142169) as per Cochrane review recommendations. Results: Nine studies (17,340 participants) were included in the present review. Baseline participant age ranged from 2 years to more than 65 years. Follow-up intervals ranged from one year to 16 years. Of the nine studies included, three were deemed to have a high risk of bias. With the exception of one meta-analysis of three studies, results were combined using narrative synthesis. Results showed low to very low quality and conflicting evidence across the various types of maltreatment, with the higher quality studies pointing to the absence of direct (non-moderated and non-mediated) associations between maltreatment and pain. PTSD was revealed to be a potential mediator and/or moderator. Evidence was not found for other proposed moderators. Conclusions: Overall, there is an absence of evidence from high quality studies of an association between maltreatment and pain. Our results are limited by the small number of studies reporting the relationship between child maltreatment and pain using a prospective design. High quality studies, including prospective cohort studies and those that assess and report on the moderators described above, are needed to advance the literature. Full article
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Article
Comparison of Lower and Upper Quarter Y Balance Test Performance in Adolescent Students with Borderline Intellectual Functioning Compared to Age- and Sex-Matched Controls
Children 2021, 8(9), 805; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090805 - 14 Sep 2021
Viewed by 519
Abstract
The Lower (YBT-LQ) and Upper (YBT-UQ) Quarter Y Balance Test are well established assessment tools for the examination of dynamic balance and shoulder mobility/stability, respectively. However, investigations on YBT-LQ/UQ performance in students with borderline intellectual functioning (BIF) (i.e., intelligence quotient of 70–84 etc.) [...] Read more.
The Lower (YBT-LQ) and Upper (YBT-UQ) Quarter Y Balance Test are well established assessment tools for the examination of dynamic balance and shoulder mobility/stability, respectively. However, investigations on YBT-LQ/UQ performance in students with borderline intellectual functioning (BIF) (i.e., intelligence quotient of 70–84 etc.) are lacking. Thus, the aim of the study was to compare YBT-LQ/UQ performance in students with and without BIF. Thirty students with BIF (age: 13.7 ± 1.2 years) and 30 age-/sex-matched students without BIF (age: 13.7 ± 1.3 years) performed the YBT-LQ and/or YBT-UQ. Normalized maximal reach distances (% leg/arm length) per reach direction and the composite score were used as outcome measures. A univariate analysis of variance was conducted to test for significant group differences. Irrespective of limb and reach direction, students with BIF compared to those without BIF showed significantly worse YBT-LQ (p ≤ 0.001–0.031; Cohen’s d = 0.57–1.26) and YBT-UQ (p ≤ 0.001–0.015; Cohen’s d = 0.68–1.52) performance with moderate to large effect sizes. Due to the poorer performance levels of students with BIF, specifically tailored interventions should be developed that have the potential to improve their dynamic balance and shoulder mobility/stability. Full article
(This article belongs to the Special Issue Balance Disorders in Children and Adolescents)
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Review
Human Milk Oligosaccharides: A Comprehensive Review towards Metabolomics
Children 2021, 8(9), 804; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090804 - 14 Sep 2021
Viewed by 660
Abstract
Human milk oligosaccharides (HMOs) are the third most represented component in breast milk. They serve not only as prebiotics but they exert a protective role against some significant neonatal pathologies such as necrotizing enterocolitis. Furthermore, they can program the immune system and consequently [...] Read more.
Human milk oligosaccharides (HMOs) are the third most represented component in breast milk. They serve not only as prebiotics but they exert a protective role against some significant neonatal pathologies such as necrotizing enterocolitis. Furthermore, they can program the immune system and consequently reduce allergies and autoimmune diseases’ incidence. HMOs also play a crucial role in brain development and in the gut barrier’s maturation. Moreover, the maternal genetic factors influencing different HMO patterns and their modulation by the interaction and the competition between active enzymes have been widely investigated in the literature, but there are few studies concerning the role of other factors such as maternal health, nutrition, and environmental influence. In this context, metabolomics, one of the newest “omics” sciences that provides a snapshot of the metabolites present in bio-fluids, such as breast milk, could be useful to investigate the HMO content in human milk. The authors performed a review, from 2012 to the beginning of 2021, concerning the application of metabolomics to investigate the HMOs, by using Pubmed, Researchgate and Scopus as source databases. Through this technology, it is possible to know in real-time whether a mother produces a specific oligosaccharide, keeping into consideration that there are other modifiable and unmodifiable factors that influence HMO production from a qualitative and a quantitative point of view. Although further studies are needed to provide clinical substantiation, in the future, thanks to metabolomics, this could be possible by using a dipstick and adding the eventual missing oligosaccharide to the breast milk or formula in order to give the best and the most personalized nutritional regimen for each newborn, adjusting to different necessities. Full article
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Article
Infants’ Sleep: Israeli Parents’ Knowledge, Attitudes and Practices
Children 2021, 8(9), 803; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090803 - 14 Sep 2021
Viewed by 399
Abstract
The purpose of the study was to assess Israeli parents’ knowledge of and attitudes towards practices promoting infants’ safe sleep and their compliance with such practices. Researchers visited the homes of 335 parents in 59 different residential locations in Israel and collected their [...] Read more.
The purpose of the study was to assess Israeli parents’ knowledge of and attitudes towards practices promoting infants’ safe sleep and their compliance with such practices. Researchers visited the homes of 335 parents in 59 different residential locations in Israel and collected their responses to structured questionnaires. SPSS 25 statistical package for data analysis was used. Attitude scales were created after the reliability tests and scaled means of parental attitudes were compared between independent groups differentiated by gender, ethnicity, and parental experience. A logistic regression was run to predict the outcome variable of babies’ sleep positions. The total knowledge score was significantly higher for women (56.3%) than for men (28.6%; p < 0.001). Arabs were more committed to following recommendations (29.3%) than Jews (26.9%; p < 0.001). Consistent with safe sleep recommendations, 92% of the sampled parents reported avoiding bedsharing and 89% reported using a firm mattress and fitted sheets. The risk of not placing a baby to sleep in a supine position was higher among older parents (adjusted odds ratio—AOR = 0.36, 95%CI 0.16–0.82), smoking fathers (AOR = 2.66, 95%CI 1.12–6.33), parents who did not trust recommendations (AOR = 4.03, 95%CI 1.84–8.84), parents not committed to following recommendations (AOR = 2.83, 95%CI 1.21–6.60), and parents whose baby slept in their room (AOR = 0.38, 95%CI 0.17–0.88). Knowledge of safe sleep recommendations was not associated with actual parental practices. Trust of and commitment to recommendations were positively correlated with safe sleep position practices. It is essential to develop ethnic-/gender-focused intervention programs. Full article
Review
Palliative Care in Pediatric Pulmonology
Children 2021, 8(9), 802; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090802 - 13 Sep 2021
Viewed by 342
Abstract
Children with End Stage Lung Disease (ESLD) are part of the growing population of individuals with life-limiting conditions of childhood. These patients present with a diverse set of pulmonary, cardiovascular, neuromuscular, and developmental conditions. This paper first examines five cases of children with [...] Read more.
Children with End Stage Lung Disease (ESLD) are part of the growing population of individuals with life-limiting conditions of childhood. These patients present with a diverse set of pulmonary, cardiovascular, neuromuscular, and developmental conditions. This paper first examines five cases of children with cystic fibrosis, bronchopulmonary dysplasia, neuromuscular disease, pulmonary hypertension, and lung transplantation from Texas Children’s Hospital. We discuss the expected clinical course of each condition, then review the integration of primary and specialized palliative care into the management of each diagnosis. This paper then reviews the management of two children with end staged lung disease at Hospital Civil de Guadalajara, providing an additional perspective for approaching palliative care in low-income countries. Full article
(This article belongs to the Special Issue Pediatric Palliative Care Update)
Review
Symbolic Play among Children with Autism Spectrum Disorder: A Scoping Review
Children 2021, 8(9), 801; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090801 - 12 Sep 2021
Viewed by 401
Abstract
Symbolic play is considered an early indicator in the diagnosis of autism spectrum disorder (ASD) and its assessment. The objective of this study was to analyze the difficulties in symbolic play experienced by children with ASD and to determine the existence of differences [...] Read more.
Symbolic play is considered an early indicator in the diagnosis of autism spectrum disorder (ASD) and its assessment. The objective of this study was to analyze the difficulties in symbolic play experienced by children with ASD and to determine the existence of differences in symbolic play among children with ASD, children with other neurodevelopmental disorders and children with typical development. A scoping review was carried out in the Web of Science (WoS), Scopus, ERIC, and PsycInfo databases, following the extension for scoping reviews of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The number of papers included in the review was 22. The results confirm that children with ASD have greater difficulties with symbolic play than children with other neurodevelopmental disorders and children with typical development, even when controlling for their verbal age. Difficulties are greater in situations of free or spontaneous play. Results evidenced that the absence or deficiency in the symbolic play can serve as an early indicator of ASD between the first and second year of life, the developmental moment in which this type of play begins. Full article
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Article
Association between the Use of Backpack and Static Foot Posture in Schoolchildren with Static Pronated Foot Posture: A 36-Month Cohort Study
Children 2021, 8(9), 800; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090800 - 11 Sep 2021
Viewed by 406
Abstract
Background: Schoolchildren often spend a lot of time carrying a backpack with school equipment, which can be very heavy. The impact a backpack may have on the pronated feet of schoolchildren is unknown. Aims: The objective of this study was to evaluate the [...] Read more.
Background: Schoolchildren often spend a lot of time carrying a backpack with school equipment, which can be very heavy. The impact a backpack may have on the pronated feet of schoolchildren is unknown. Aims: The objective of this study was to evaluate the association of the backpack use on static foot posture in schoolchildren with a pronated foot posture over 36 months of follow-up. Methods: This observational longitudinal prospective study was based on a cohort of consecutive healthy schoolchildren with pronated feet from fifteen different schools in Plasencia (Spain). The following parameters were collected and measured in all children included in the study: sex, age, height, weight, body mass index, metatarsal formula, foot shape, type of shoes, and type of schoolbag (non-backpack and backpack). Static foot posture was determined by the mean of the foot posture index (FPI). The FPI was assessed again after 36 months. Results: A total of 112 participants used a backpack when going to school. Over the 36-month follow-up period, 76 schoolchildren who had a static pronated foot posture evolve a neutral foot posture. Univariate analysis showed that the schoolchildren using backpacks were at a greater risk of not developing neutral foot (odds ratio [OR]: 2.09; 95% CI: 1.08–4.09). The multivariate analysis provided similar results, where the schoolchildren using a backpack (adjusted OR [aOR]: 1.94; 95% CI: 1.02–3.82) had a significantly greater risk of not developing a neutral foot posture. Conclusions: A weak relationship was found between backpack use and schoolchildren aged from five to eleven years with static pronated feet not developing a neutral foot posture over a follow-up period of 36 months. Full article
(This article belongs to the Special Issue The Role of Orthopedics in Child Development)
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Article
A Short Version of the EFECO Online Questionnaire for the Assessment of Executive Functions in School-Age Children
Children 2021, 8(9), 799; https://0-doi-org.brum.beds.ac.uk/10.3390/children8090799 - 11 Sep 2021
Cited by 1 | Viewed by 409
Abstract
Executive function (EF) is a group of processes that allow individuals to be goal-oriented and to have adaptive functioning, so that adequate performance is essential for success in activities of daily living, at school and in other activities. The present study aims to [...] Read more.
Executive function (EF) is a group of processes that allow individuals to be goal-oriented and to have adaptive functioning, so that adequate performance is essential for success in activities of daily living, at school and in other activities. The present study aims to create a short version of the Executive Functioning Questionnaire (EFECO) since there is a gap in the Spanish literature due to the lack of behavioural observation questionnaires at school age. A total of 3926 participants completed the online questionnaire. Subsequently, the validity and reliability of the data are analysed. The results show that the short version of the questionnaire, the EFECO-S, has a structure with five dimensions (emotional self-control, initiation, working memory, inhibition, and spatial organisation), as well as a second-order factor (global executive skill) and high reliability (ordinal Alpha = 0.68–0.88). The EFECO is composed of 67 items, while the EFECO-S has 20 items, four per factor, which turns it into a quick and easy to apply test. Therefore, it becomes an interesting alternative to be applied in screening processes with children who may be experiencing executive difficulties. Full article
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