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Platypnea–orthodeoxia syndrome is a rare clinical entity characterised by positional dyspnoea and arterial desaturation while in the upright position, the symptoms generally occurring in adults. We describe a 12-year-old girl diagnosed with platypnea–orthodeoxia syndrome associated with patent foramen ovale. The symptoms resolved following percutaneous patent foramen ovale closure.
The association between suicide attempts (SAs) in parents and children is unclear, and risk indicators for intergenerational transmission remain undocumented. We aimed to assess this association, considering the child's developmental period at the time of parents' attempted suicide, and the parental relation.
Using a prospective cohort design, nationwide population data were linked to the Psychiatric Central Register and National Patient Register for all individuals aged 10 years or older living in Denmark between 1980 and 2016. We assessed incidence rate ratios (IRRs) and cumulative hazards for children's first SA.
In a cohort of 4 419 651 children, 163 056 (3.7%) had experienced a parental SA. An SA was recorded among 6996 (4.3%) of the exposed children as opposed to 70112 (1.6%) in unexposed individuals. Higher rates were noted when a parental SA occurred during early childhood (0 ⩽ age < 2) [IRR, 4.7; 95% confidence interval (CI) 4.2–5.4] v. late childhood (6 ⩽ age < 13) (IRR, 3.6; 95% CI 3.4–3.8) when compared to those unexposed. Children exposed prior to age 2 had the highest rates of all sub-groups when reaching age 13–17 (IRR, 6.5; 95% CI 6.0–7.1) and 18–25 years (IRR, 6.8; 95% CI 6.2–7.4). Maternal SA (IRR, 3.4; 95% CI 3.2–3.5) was associated with higher rates than paternal (IRR, 2.8; 95% CI 2.7–2.9).
Parental SA was associated with children's own SA. Exposure during early developmental stages was associated with the highest rates. Early preventive efforts are warranted as is monitoring of suicide risk in the children from age 13.
Dilated cardiomyopathy is characterised by dilatation and impaired contraction of the left ventricle or both ventricles, which is the most common childhood cardiomyopathy. In recent years, it has been recognised that many sorts of genetic mutations may contribute to dilated cardiomyopathy. We now report a rare association of dilated cardiomyopathy with site mutation of BMPR2 gene. We did not find such an association reported in the medical literature.
This article gives a general overview of the current situation in relation to a range of widely recognised and also newly identified types of child maltreatment. The academic and clinical evidence relating to the impact of child maltreatment on the mental and physical health of child victims is substantial and steadily increasing in volume. New types of abuse are being identified, and changing environmental circumstances, which exacerbate the possibility of widely recognised types of child maltreatment occurring, are also being described. These include multi-type maltreatment, female genital mutilation and online child maltreatment. Serious questions may arise regarding neglect of the moral and social development of children and young people who become addicted to online gaming and pornography. Multiple national and local definitions of each of these existing and new forms of maltreatment have been created, some of which are covered here. The impact of these abuses on the physical and mental health and development of child victims in families or settings where abuse or neglect has occurred is discussed.
Examine pre-existing learning disorders (LD) and attention deficit/hyperactivity disorders (ADHD) as risk factors for prolonged recovery and increased symptomology following pediatric mild traumatic brain injury (mTBI).
We conducted a retrospective cohort study of children/adolescents (5-17 years) with mTBI who presented to a Children’s Minnesota Concussion Clinic between April 2018 and March 2019. Differences across strata of pre-existing conditions (present vs. absent) in time to recovery measures were estimated via Kaplan–Meier and Cox proportional hazards analyses and differences in symptom trajectories were examined via linear mixed-effects regression models. Regression models were adjusted for age, sex and other confounders.
In our cohort of 680 mTBI patients, those with LD (n = 70) or ADHD (n = 107) experienced significantly longer median durations of symptoms (58 and 68 days, respectively) than those without (43 days). Accordingly, LD was significantly associated with delayed symptom recovery (adjusted hazard ratio (aHR) = 1.63, 95% CI: 1.16–2.29), return to school (1.47, 1.08–2.00), and return to physical activity (1.50, 1.10–2.04). Likewise, ADHD was associated with delayed recovery (1.69, 1.28–2.23), return to school (1.52, 1.17–1.97) and physical activity (1.55, 1.19–2.01). Further, patients with LD or ADHD reported, on average, significantly more concussion symptoms and higher vision symptom scores throughout recovery versus those without. There was no evidence that concussion or vision symptom recovery trajectories varied over time between those with/without LD or ADHD (joint P-interactions > 0.05).
Pre-existing LD and ADHD are risk factors for prolonged and more symptomatic mTBI recovery in youth. These results can inform clinical concussion management and recovery expectations.
More than 50 years of randomized clinical trials for youth psychotherapies have resulted in moderate effect sizes for treatments targeting the most common mental health problems in children and adolescents (i.e., anxiety, depression, conduct problems, and attention disorders). Despite having psychotherapies that are effective for many children, there has been a dearth of progress in identifying the contextual factors that likely influence who will respond to a given psychotherapy, and under what conditions. The developmental psychopathology evidence base consistently demonstrates that psychosocial risk exposures (e.g., childhood adversities, interpersonal stressors, family dysfunction) significantly influence the onset and course of youth psychopathology. However, the developmental psychopathology framework remains to be well integrated into treatment development and psychotherapy research. We argue that advances in basic developmental psychopathology research carry promising implications for the design and content of youth psychotherapies. Research probing the effects of psychosocial risks on youth development can enrich efforts to identify contextual factors in psychotherapy effectiveness and to personalize treatment. In this article we review empirically supported and hypothesized influences of individual- and family-level risk factors on youth psychotherapy outcomes, and we propose a framework for leveraging developmental psychopathology to strengthen psychotherapies.
Child and adolescent mental health is understood to be highly embedded in the family system, particularly the parent-child relationship. Indeed, models of risk pathways to psychopathology emphasize interactions and transactions between the family environment and individual differences at the child level, including gene-environment interplay. Therapist knowledge regarding the role of the family in these pathways is central to the clinical competencies involved in the evidence-based treatment of children and adolescents. This chapter provides an overview of current theory regarding family contributions to the major forms psychopathology seen among children and adolescents. Attention is given to key family and parenting variables as they are conceptualized in the current literature, the mechanisms by which these variables contribute to the emergence and maintenance of psychopathology and the origins and determinants of parenting.
The purpose of this systematic review is to describe the elements of the psychological experience of pediatric oncology patients facing life-threatening situations and the corresponding care needs.
The study design is a systematic review following the PRISMA standard of qualitative, quantitative, and mixed-methods research. The review was conducted using multiple databases, including Scopus, Web of Science, PubMed, and PsycINFO. The risk of bias of the articles was evaluated with the “Critical Appraisal Skills Programme.”
A total of 21 articles met inclusion criteria. The analysis of the evidence revealed that the psychological experience involves changes in relationships, thoughts about death, emotional changes, physical symptoms, spiritual changes, and feelings of uncertainty.
Significance of results
The care needs identified are maintaining normality, controlling physical and psychological symptoms, and that maintaining hope is an important aspect for children. Whether or not the children want to talk about death is another important aspect that needs to be reflected upon, and it would be appropriate to consider, on an individual level, involving patients in the discussion on the diagnosis and treatment of the illness. Future research should be conducted from the children's perspective since most existing research is from the perspective of the family members or health professionals. Furthermore, it is recommended to take into account qualitative approaches that provide more detailed information on the patients’ subjectivity.
Consumption is driven by children’s sensory acceptance, but little is known about the sensory characteristics of vegetables that children commonly eat. A greater understanding could help design more effective interventions to help raise intakes, thus realising beneficial health effects. This study sought to: (1) Understand the vegetable consumption patterns in children, with and without potatoes, using the Australian and WHO definitions. (2) Describe the sensory characteristics of vegetables consumed by children by age group, level of intake and variety. (3) Determine the vegetable preferences of children, by age group, level of intake and variety.
Analysis of National Nutrition Survey data, combining reported vegetable intake with sensory characteristics described by a trained panel.
A nationally representative sample of Australian children and adolescents aged 2–17·9 years (n 2812).
While consumption increased in older age groups, variety remained constant. Greater variety, however, was associated with higher vegetable consumption. Potato intake increased with consumption, contributing over one-third of total vegetable intake for highest vegetable consumption and for older age groups. Children favoured relatively sweet vegetables and reported lower consumption of bitter vegetables. There were no differences in the sensory properties of vegetables consumed by children in different age groups. After potatoes, carrots, sweetcorn, mixtures, fruiting and cruciferous types were preferred vegetables.
Children tend to prefer vegetables with sensory characteristics consistent with innate taste preferences (sweet and low bitterness). Increasing exposure to a variety of vegetables may help increase the persistently low vegetable consumption patterns of children.
The most effective treatments for child and adolescent psychopathology are often family-based, emphasising the active involvement of family members beyond the referred individual. This book details the clinical skills, knowledge, and attitudes that form the core competencies for the delivery of evidence-based family interventions for a range of mental health problems. Offering practical case studies to illustrate treatment principles, and discussing barriers to treatment and problem-solving in relation to common difficulties. Covers topics such as anxiety, attention-deficit hyperactivity disorder, sleep, and eating disorders. Therapist competencies are thoroughly examined, from the role they play in severe/complex cases and in achieving successful outcomes to commonly misunderstood aspects of family-based interventions and how they can be enhanced. Clinical approaches to working with diverse families, and those of children affected by parental psychopathology, child maltreatment and family violence are also explored. Essential reading for psychologists, psychiatrists, paediatricians, mental health nurses, counsellors and social workers.
In parallel with increased public awareness of the health and environmental benefits of consuming a plant-based diet, the numbers of people who identify as vegan has increased sharply. The question of whether vegetarian and vegan diets are appropriate for children is a longstanding and unresolved controversy. The more restrictive the diet and the younger the child, the greater the risk of nutritional deficiency. Nutrients of potential concern are protein quantity and quality, iron, zinc, selenium, calcium, riboflavin, vitamins A, D, B12 and essential fatty acids. Although intakes and status of some nutrients (e.g. vitamin D and iron) are low in many children, vegan children are particularly susceptible due to inadequate supply and/or excess dietary fibre as well as other components that limit bioavailability. Although position papers from North America state that well-planned vegetarian and vegan diets, supplemented appropriately, are suitable for all life stages, European statements include strong recommendations to parents that vegan diets should not be adopted by children without medical and dietetic supervision. Case histories of malnutrition and serious harm persist, including irreversible neurological damage due to vitamin B12 deficiency among un-supplemented children. The evidence available to evaluate the nutritional appropriateness of vegetarian diets for children is inadequate and dated. Although nutritionally adequate vegetarian diets are more easily achieved, successful provision of a complete vegan diet for a young child requires substantial commitment, expert guidance, planning, resources and supplementation.
To determine the impact of palliative care (PC) on end-of-life (EoL) care and the place of death (PoD) in children, adolescents, and young adults with life-limiting conditions.
Eight online databases (PubMed, Medline, EMBASE, Cochrane Library, CINAHL, Airiti, GARUDA Garba Rujukan Digital, and OpenGrey) from 2010 to February 5, 2020 were searched for studies investigating EoL care and the PoD for pediatric patients receiving and not receiving PC.
Of the 6,468 citations identified, 14 cohort studies and one case series were included. An evidence base of mainly adequate- and strong-quality studies shows that inpatient hospital PC, either with or without the provision of home and community PC, was found to be associated with a decrease in intensive care use and high-intensity EoL care. Conflicting evidence was found for the association between PC and hospital admissions, length of stay in hospital, resuscitation at the time of death, and the proportion of hospital and home deaths.
Significance of results
Current evidence suggests that specialist, multidisciplinary involvement, and continuity of PC are required to reduce the intensity of EoL care. Careful attention should be paid to the need for a longer length of stay in a medical setting late in life, and earlier EoL care discussion should take place with patients/caregivers, especially in regard to attempting resuscitation in toddlers, adolescents, and the young adult population. A lack of robust evidence has identified a gap in rigorous multisite prospective studies utilizing data collection.
As we present the fourth edition of Science in Early Childhood, we are continually aware of how much science education in early childhood has moved forward since the first edition. While retaining the essential elements of science learning and teaching that inform and guide pre-service and in-service educators/teachers of preschool and early years settings at school, this new edition provides a more expansive collection of topics. More detailed coverage and new chapters include scientific inquiry in the early years, teaching science inclusively, Indigenous Ways of Knowing science, encouraging playful young scientists and science learning through informal experiences. All other chapters have been updated.
Atrioventricular block in children is not common but is a life-threatening disease. As no spontaneous regression of conductive disruption was reported, those sustaining idiopathic atrioventricular blocks are difficult to manage and often require pacemaker implantation. In this study, we presented the first case of a child who surprisingly recovered from idiopathic complete atrioventricular block without intervention 4 years after initial presentation.
Paediatric anaesthesia and airway management is in many ways similar to adult practice; however, deep understanding of the differences in anatomy, physiology and behavioural psychology is necessary, particularly in younger children and infants. This chapter aims to provide the anaesthetist with information on these differences and (re)introduce techniques and practical tips that may help practitioners with airway management in this population. The broad range of equipment sizes and drug doses are a challenge to memorise and guides are highly advised. While difficult airways are less frequent in children, their management can be challenging. Upper airway obstruction is a particularly frequent occurrence, and should be anticipated and prevented, focussing on basic, and much underappreciated, skills such as positioning, effective bag-mask ventilation and occasional careful use of adjuncts. Safe and non-traumatic practice is key. It is important to stress that modern devices such as videolaryngoscopes should be used carefully and under visual guidance at all times. Awake flexible optical bronchoscope (FOB)-guided intubation is the gold standard in adult difficult airway management. In paediatric practice, however, advanced airway procedures may need to be performed with prior general anaesthesia. We offer an introduction to some advanced techniques including paediatric emergency front of neck airway.
In an age of environmental crisis, ecological theologians call for the “ecological conversion” of humanity. This article, a work of practical theology, plays on the grammatical ambiguity of Mark 10:15, in which disciples are told to “receive the kingdom as a child,” to argue that ecological conversion is a twofold conversion to the child. One conversion is a turn to the well-being of children in an age of climate crisis, which involves an adult personal transformation into the role of caregiver—and thus greater maturity. The other conversion is a recovery of certain childlike capacities, including presence in the moment, interdependence in relationship, urgency, animism, and love of the small. The article draws on Pope Francis’ encyclical Laudato Si’, discussions of childhood by the nineteenth-century Protestant theologian Friedrich Schleiermacher, and contemporary explorations of children and childhood, including the author's own experience of caregiving with children.
The health and well-being of families is an important consideration for all governments – federal, state and local. Based on past morbidity and mortality rates and recent knowledge of early childhood development (Marmot, 2010), family health policies have evolved to emphasise the importance of providing every child with the best possible start to life. This acknowledges that childhood sets the foundation for future health and well-being and recognises the 1979 United Nations’ Convention on the Rights of the Child (United Nations Children Fund, 2009). In order to have an impact on health inequalities, government policies and services must address the social determinants of early child health, development and well-being (Brinkman et al., 2012; Marmot, 2010). This chapter introduces maternal, child and family health nursing and outlines the key functions of this crucial community nursing role. Foundational principles of primary health care practice are explored and case studies used to explain strengths-based, family-centred care.
This study aimed to examine the predictors of cognitive performance in patients with pediatric mild traumatic brain injury (pmTBI) and to determine whether group differences in cognitive performance on a computerized test battery could be observed between pmTBI patients and healthy controls (HC) in the sub-acute (SA) and the early chronic (EC) phases of injury.
203 pmTBI patients recruited from emergency settings and 159 age- and sex-matched HC aged 8–18 rated their ongoing post-concussive symptoms (PCS) on the Post-Concussion Symptom Inventory and completed the Cogstate brief battery in the SA (1–11 days) phase of injury. A subset (156 pmTBI patients; 144 HC) completed testing in the EC (∼4 months) phase.
Within the SA phase, a group difference was only observed for the visual learning task (One-Card Learning), with pmTBI patients being less accurate relative to HC. Follow-up analyses indicated higher ongoing PCS and higher 5P clinical risk scores were significant predictors of lower One-Card Learning accuracy within SA phase, while premorbid variables (estimates of intellectual functioning, parental education, and presence of learning disabilities or attention-deficit/hyperactivity disorder) were not.
The absence of group differences at EC phase is supportive of cognitive recovery by 4 months post-injury. While the severity of ongoing PCS and the 5P score were better overall predictors of cognitive performance on the Cogstate at SA relative to premorbid variables, the full regression model explained only 4.1% of the variance, highlighting the need for future work on predictors of cognitive outcomes.