Rapport building with adolescents to enhance reporting and disclosure

Adolescents comprise a vulnerable population that is exposed to crime and also may be reluctant to disclose full details of their experiences. Little research has addressed effective ways of increasing their willingness to disclose and provide complete reports. Strategies that improve honesty and report completeness in other age groups have not been evaluated to determine whether they are similarly effective at increasing adolescents' reporting. In the current study, we tested whether rapport building techniques, modified from those commonly used with children and adults to address reasons why adolescents are likely reluctant, enhance the amount of detail adolescents provide about prior experiences. The participants, 14- to 19-year-olds (N = 125), completed an online questionnaire regarding significant events (e.g., big argument with family member) they experienced during the last 12 months. After a delay, they completed a remote interview asking them to recount details of one of the events. The interview began with either standard rapport building composed of largely yes/no questions about the adolescents' background or one of two expanded rapport building phases: open-ended (questions about the adolescents' backgrounds that required narrative answers) or enhanced (open-ended questions paired with the interviewer also sharing personal information). Although only adolescents in the standard condition showed age-related increases in information disclosed, overall adolescents in the enhanced condition provided significantly longer and more detailed narratives than adolescents in the other conditions. This effect was largest for the youngest adolescents, suggesting that mutual self-disclosure may be especially beneficial for eliciting honest complete reports from adolescents about salient prior experiences.

Disorders of Consciousness in Children: Assessment, Treatment, and Prognosis

Children with acquired brain injury may experience prolonged disorders of consciousness (DoC); research on children with DoC lags behind adult literature. Rigorous evaluation of assessment tools used in children with DoC is lacking, though recent developments may contribute to improvements in care, particularly for assessment of young children and those without overt command following. Literature on prognosis continues to grow, reinforcing that early signs of consciousness suggest better long-term outcome. Although large clinical trials for children with DoC are lacking, single-site and multisite programmatic data inform standards of care and treatment options for children with DoC.

Pediatric hemophagocytic lymphohistiocytosis after concomitant administration of SARS-CoV-2 vaccine and influenza vaccine

Hemophagocytic lymphohistiocytosis (HLH) is a highly lethal disease characterized by fever, cytopenia, splenomegaly, and hemophagocytosis. Whereas infectious diseases, malignant tumors, and autoimmune diseases are often triggers for HLH, reports of HLH associated with vaccination are limited. In this report, we describe a case of HLH in a 12-year-old female patient after simultaneous administration of the bivalent messenger RNA severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine and quadrivalent inactivated influenza vaccine. The patient presented to our hospital with fever on the day after vaccination. Considering the splenomegaly, cytopenia, hemophagocytosis in the bone marrow, and high ferritin level, HLH was diagnosed 12 days after vaccination. Various tests ruled out any infectious disease, malignant tumor, or autoimmune disease. The patient was treated only with 2 mg/kg/day of oral prednisolone, fever improved 13 days after vaccination, and blood test findings rapidly improved. Although HLH after SARS-CoV-2 vaccination or concomitant administration with influenza vaccination is still rare, we emphasize the importance of early HLH diagnosis when persistent fever is observed following vaccination.

Innovative advances in pediatric radiology: computed tomography reconstruction techniques, photon-counting detector computed tomography, and beyond

In pediatric radiology, balancing diagnostic accuracy with reduced radiation exposure is paramount due to the heightened vulnerability of younger patients to radiation. Technological advancements in computed tomography (CT) reconstruction techniques, especially model-based iterative reconstruction and deep learning image reconstruction, have enabled significant reductions in radiation doses without compromising image quality. Deep learning image reconstruction, powered by deep learning algorithms, has demonstrated superiority over traditional techniques like filtered back projection, providing enhanced image quality, especially in pediatric head and cardiac CT scans. Photon-counting detector CT has emerged as another groundbreaking technology, allowing for high-resolution images while substantially reducing radiation doses, proving highly beneficial for pediatric patients requiring frequent imaging. Furthermore, cloud-based dose tracking software focuses on monitoring radiation exposure, ensuring adherence to safety standards. However, the deployment of these technologies presents challenges, including the need for large datasets, computational demands, and potential data privacy issues. This article provides a comprehensive exploration of these technological advancements, their clinical implications, and the ongoing efforts to enhance pediatric radiology's safety and effectiveness.

Characteristics and predictors of chronic kidney disease in children with myelomeningocele: a nationwide cohort study

BACKGROUND

Myelomeningocele (MMC) is highly prevalent in developing countries, and MMC-related neurogenic bladder is an important cause of childhood chronic kidney disease (CKD). This nationwide study aimed to evaluate demographic and clinical features of pediatric patients with MMC in Turkey and risk factors associated with CKD stage 5.

METHODS

Data from children aged 0-19 years old, living with MMC in 2022, were retrospectively collected from 27 pediatric nephrology centers. Patients > 1 year of age without pre-existing kidney abnormalities were divided into five groups according to eGFR; CKD stages 1-5. Patients on dialysis, kidney transplant recipients, and those with eGFR < 15 ml/min/1.73 m2 but not on kidney replacement therapy at time of study constituted the CKD stage 5 group.

RESULTS

A total of 911 (57.8% female) patients were enrolled, most of whom were expectantly managed. Stages 1-4 CKD were found in 34.3%, 4.2%, 4.1%, and 2.4%, respectively. CKD stage 5 was observed in 5.3% of patients at median 13 years old (range 2-18 years). Current age, age at first abnormal DMSA scan, moderate-to-severe trabeculated bladder on US and/or VCUG, and VUR history were independent risk factors for development of CKD stage 5 (OR 0.752; 95%; CI 0.658-0.859; p < 0.001; OR 1.187; 95% CI 1.031-1.367; p = 0.017; OR 10.031; 95% CI 2.210-45.544; p = 0.003; OR 2.722; 95% CI 1.215-6.102; p = 0.015, respectively). Only eight CKD stage 5 patients underwent surgery related to a hostile bladder between 1 and 15 years old.

CONCLUSION

MMC-related CKD is common in childhood in Turkey. A proactive approach to neurogenic bladder management and early protective surgery in selected cases where conservative treatment has failed should be implemented to prevent progressive kidney failure in the pediatric MMC population in our country. A higher resolution version of the Graphical abstract is available as Supplementary information.

Associations between Parental Factors and Children's Screen Time During the COVID-19 Pandemic in South Korea

This study investigated how parental depression, parental self-care, family conflict, and parental fear of COVID-19 are associated with children's screen time during the COVID-19 pandemic. Data were collected online among South Korean families, resulting in 246 parents (59% fathers) with children between 6 and 12 years of age. Path analysis and multi-group structural equation modelling of fathers and mothers were conducted. Parent's fear of COVID-19 was positively associated with parental depression. Parent's fear of COVID-19 and parental depression were negatively related to parental self-care, which was negatively linked to family conflict. Family conflict was positively associated with children's screen time. The relationships between parental factors and children's screen time were different for mothers and fathers. Our results show that multiple family dynamics interact with children's screen time, emphasizing the need to look beyond parenting practices in understanding the effects of COVID-19 pandemic on children's screen time.

Transition of Care for Patients with Thalassemia

Thalassemia is one of the most common hemoglobinopathies affecting a large number of people in India and other countries of South-East Asia. For patients with most severe form of the disease- Transfusion Dependent Thalassemia (TDT), stem cell transplantation or gene therapy are only curative treatment which are not available to most of the patients because of lack of experts, financial constraints and lack of suitable donors. In such situations, most cases are managed with regular blood transfusion and iron chelation therapy. With this treatment, over the years, survival of the patients has improved and 20-40% cases are entering into adulthood. In the absence of structured transition of care programs, currently most adult TDT patients are being managed by pediatricians. This article highlights the need for transition of care for TDT patients, barriers to transition and how to overcome the barriers and process of transition of care to adult care team. The importance of empowering the patients in self-management of the disease and educating the adult care team to achieve the desired outcome of transition program is highlighted.

A Developmental Psychopathology Perspective on Adverse Childhood Experiences (ACEs): Introduction to the Special Issue

Adverse childhood experiences (ACEs), including child maltreatment and other adversities in the home context and beyond (e.g., witnessing domestic violence; parental mental illness; parental separation; living in a disadvantaged neighborhood) are prevalent in the population and often covary together. Research based on the construct of ACEs has transformed the field of adult mental health, yet child and adolescent mental health has often been overlooked in this work. This special issue of Research on Child and Adolescent Psychopathology focuses on the developmental science of ACEs and child psychopathology. The research presented here draws on the extensive evidence base that now exists regarding the co-occurrence of common childhood adversities, while informing the integration of theory and research on ACEs with that of developmental psychopathology at large. This Introduction provides an overview of ACEs and child mental health from a developmental psychopathology perspective, with an emphasis on key concepts and recent progress spanning the prenatal period through to adolescence and intergenerational pathways. Models of ACEs that emphasize the multi-dimensional nature of adversity and the importance of developmental timing to risk and protective pathways, have played a driving role in this progress. Methodological innovations in this work are highlighted, along with implications for prevention and intervention.

Pediatric perioperative fluid management

The purpose of perioperative fluid management in children is to maintain adequate volume status, electrolyte level, and endocrine system homeostasis during the perioperative period. Although hypotonic solutions containing glucose have traditionally been used as pediatric maintenance fluids, recent studies have shown that isotonic balanced crystalloid solutions lower the risk of hyponatremia and metabolic acidosis perioperatively. Isotonic balanced solutions have been found to exhibit safer and more physiologically appropriate characteristics for perioperative fluid maintenance and replacement. Additionally, adding 1-2.5% glucose to the maintenance fluid can help prevent children from developing hypoglycemia as well as lipid mobilization, ketosis, and hyperglycemia. The fasting time should be as short as possible without compromising safety; recent guidelines have recommended that the duration of clear fluid fasting be reduced to 1 h. The ongoing loss of fluid and blood as well as the free water retention induced by antidiuretic hormone secretion are unique characteristics of postoperative fluid management that must be considered. Reducing the infusion rate of the isotonic balanced solution may be necessary to avoid dilutional hyponatremia during the postoperative period. In summary, perioperative fluid management in pediatric patients requires careful attention because of the limited reserve capacity in this population. Isotonic balanced solutions appear to be the safest and most beneficial choice for most pediatric patients, considering their physiology and safety concerns.

Risk factors of prolonged diarrhea in children under 2 years old

BACKGROUND

Prolonged diarrhea, defined as diarrhea lasting longer than 7 days, is known to negatively impact children's growth and development. However, studies of the risk factors of prolonged diarrhea remain limited.

PURPOSE

This study aimed to analyze the risk factors for prolonged diarrhea in children under 2 years of age with acute diarrhea.

METHODS

This 1-year nested case-control study was conducted at Fatmawati General Hospital in 2021-2022. Participants were selected using a consecutive sampling method from among children under 2 years of age with acute diarrhea within the previous 2-4 days. Children with diarrhea that lasted 7 days were considered positive for prolonged diarrhea, whereas those with acute diarrhea were considered negative. Children with comorbidities such as malnutrition were excluded. Clinical information including age, breastfeeding history, antibiotic exposure history, and nutritional status was recorded. Complete blood count, blood zinc levels, Rotavirus, adenovirus, and norovirus serology, alpha-1 antitrypsin (AAT) levels, and stool analysis were acquired as laboratory data.

RESULTS

There were 62 subjects in the study and control groups. Overall, the median age was 12 months (6-24 months); most patients were boys. A history of antibiotic use (odds ratio [OR], 15.860; 95% confidence interval [CI], 5.286-47.591; P<0.001), zinc deficiency (OR, 4.758; 95% CI, 1.711-13.229; P=0.003), and elevated fecal AAT levels (OR, 2.677; 95% CI, 1.046-6.850; P=0.040) were the main risk factors for prolonged diarrhea in children under 2 years of age with acute diarrhea.

CONCLUSION

A history of antibiotic use, zinc deficiency, and elevated fecal AAT levels were the main risk factors for prolonged diarrhea in children under 2 years of age with acute diarrhea. Thorough testing and appropriate antibiotic use are required to prevent prolonged diarrhea in children under 2 years of age.

Description and outcomes of Afro-Caribbean children treated for multisystem inflammatory syndrome in the French West Indies

Introduction

Several studies have reported a higher frequency and greater morbidity and mortality of multisystem inflammatory syndrome in children (MIS-C) of black African descent.

Objectives

We aimed to describe the clinical, laboratory and echocardiographic characteristics as well as outcomes of children with MIS-C requiring admission to a pediatric intensive care unit (PICU) in the French West Indies (FWI), where the majority of the population is Afro-Caribbean.

Methods

Ambidirectional observational cohort study between April 1, 2020 and August 31, 2022. Children (age ≤18 years) with MIS-C and organ failure were included. Every patient was monitored and treated following the same protocol, with repeated biological tests, echocardiography, intravenous steroids and polyvalent immunoglobulins. The primary outcomes were clinical, laboratory and echocardiography characteristics.

Results

Forty children (median age 7 years, range: 5-11) were included. The majority (77 %) were included prospectively. Thirty-five (87 %) had gastrointestinal symptoms, 30 (75 %) presented initial heart failure (with persisting diastolic dysfunction at day 7) and 18 (45 %) had pericarditis. Sixteen (40 %) were in cardiogenic shock and required inotropic support. Median duration of inotropic support and hospitalization in PICU were respectively 4 and 5 days. The evolution curves of the inflammatory variables matched after treatment. The clinical outcomes were favorable. The Delta variant was associated with the highest incidence of MIS-C.

Conclusion

This is the first description of MIS-C course among children of Afro-Caribbean descent. The outcomes were good, without any death or cardiac sequelae. Our work does not support an ethnic susceptibility for severity of MIS-C in Afro-Caribbean population.

Stepped-care versus therapist-guided, internet-based cognitive behaviour therapy for childhood and adolescent anxiety: A non-inferiority trial

Objective

This preregistered randomized trial examined whether a stepped-care approach to internet-delivered cognitive behaviour therapy (ICBT-SC) is non-inferior to therapist-guided ICBT (ICBT-TG) for child and adolescent anxiety.

Method

Participants were 137 Australians, aged 8-17 years (56 male), with a primary anxiety disorder. This randomized, non-inferiority trial compared ICBT-SC to an evidence-based, ICBT-TG program with assessments conducted at baseline, 12 weeks and 9-months after treatment commencement. All ICBT-SC participants completed the first 5 online sessions without therapist guidance. If they responded to treatment in the first 5 sessions (defined as reductions of anxiety symptoms into non-clinical range), they continued without therapist guidance for the final 5 sessions. If they did not respond to treatment in the first 5 sessions, the final five sessions were supplemented with therapist-guidance (through email). All ICBT-TG participants received therapist guidance (email) after each session, for all 10 sessions. Measures included clinical diagnostic interview (severity rating as primary outcome), as well as parent and child reported anxiety and anxiety-related interference (secondary outcomes).

Results

ICBT-SC was found to be non-inferior to ICBT-TG on primary and secondary outcomes, according to clinician, parent and young person report at 12-weeks and 9-months. Treatment satisfaction was moderate to high for both conditions. Significant clinical benefits were evident for participants in both treatments. Of participants who remained in the study, 77 % (50.7 % ITT) of ICBT-SC and 77 % (57.1 % ITT) of ICBT-TG were free of their primary anxiety diagnosis by 9-month follow-up, with no differences between conditions.

Conclusion

A stepped-care ICBT approach for clinically anxious children and adolescents may offer an acceptable treatment model that can increase access to evidence-based treatment.

A cross-sectional study on the reasons for vaccine hesitancy in children under seven years of age in Isfahan, Iran

Introduction

The diminution in vaccination coverage in recent years has contributed to the reappearance of infectious diseases, and vaccine hesitancy is one of the main causes. As a result, we investigated the causes of vaccine hesitancy in children.

Materials and methods

This descriptive-analytical study was conducted cross-sectionally in 27 comprehensive health service centers in Isfahan City from June to October 2022. This study included Iranian families living in Isfahan who did not vaccinate their children by the due date. A researcher-made questionnaire collected data on children's vaccine hesitancy after verifying validity and reliability over the phone and in person by the researcher. The mothers completed informed consent. Independent T-tests, Pearson's correlation coefficient, analysis of variance, and a generalized linear model were used to analyze the data.

Findings

Finally, 298 families participated in the study, 34.3% refused, and 65.7% delayed their child's vaccination. Vaccination was hesitant due to the child being sick at the time of injection (57.3%), believing that vaccination is not necessary to prevent uncommon diseases (49%), and being concerned about severe side effects caused by the vaccine (48.7%). Vaccine hesitancy among mothers with bachelor's degrees and families less than one kilometer from the health center was significantly less than among others. Additionally, Vaccines at birth, four, six, twelve, and eighteen months, and six-year-old vaccines were associated with vaccine hesitancy.

Conclusion

Children's illness at the time of vaccination, the belief that vaccination is unnecessary to prevent uncommon diseases, and the worry about severe complications were among the most common reasons for vaccine hesitancy. Mother's education, distance to the health center, and vaccine type were associated with vaccine hesitancy.

Chest computed tomography in severe bronchopulmonary dysplasia: Comparing quantitative scoring methods

PURPOSE

Bronchopulmonary dysplasia (BPD) is the most common complication of extreme preterm birth and structural lung abnormalities are frequently found in children with BPD. To quantify lung damage in BPD, three new Hounsfield units (HU) based chest-CT scoring methods were evaluated in terms of 1) intra- and inter-observer variability, 2) correlation with the validated Perth-Rotterdam-Annotated-Grid-Morphometric-Analysis (PRAGMA)-BPD score, and 3) correlation with clinical data.

METHODS

Chest CT scans of children with severe BPD were performed at a median of 7 months corrected age. Hyper- and hypo-attenuated regions were quantified using PRAGMA-BPD and three new HU based scoring methods (automated, semi-automated, and manual). Intra- and inter-observer variability was measured using intraclass correlation coefficients (ICC) and Bland-Altman plots. The correlation between the 4 scoring methods and clinical data was assessed using Spearman rank correlation.

RESULTS

Thirty-five patients (median gestational age 26.1 weeks) were included. Intra- and inter-observer variability was excellent for hyper- and hypo-attenuation regions for the manual HU method and PRAGMA-BPD (ICCs range 0.80-0.97). ICC values for the semi-automated HU method were poorer, in particular for the inter-observer variability of hypo- (0.22-0.71) and hyper-attenuation (-0.06-0.89). The manual HU method was highly correlated with PRAGMA-BPD score for both hyper- (ρs0.92, p < 0.001) and hypo-attenuation (ρs0.79, p < 0.001), while automated and semi-automated HU methods showed poor correlation for hypo- (ρs < 0.22) and good correlation for hyper-attenuation (ρs0.72-0.74, p < 0.001). Several scores of hyperattenuation correlated with the use of inhaled bronchodilators in the first year of life; two hypoattenuation scores correlated with birth weight.

CONCLUSIONS

PRAGMA-BPD and the manual HU method have the best reproducibility for quantification of CT abnormalities in BPD.

Does Cognitive-Behavioral Therapy for Youth Anxiety Disorders Improve Social Functioning and Peer Relationships?

Child and adolescent anxiety disorders (ADs) contribute to impairment in social functioning and peer relationships, exacerbating anxiety and related difficulties. The extent to which the AD treatment with the strongest evidence-base, cognitive-behavioral therapy (CBT), improves social functioning and peer relationships is unclear. In this article, we report results of the first systematic narrative review of this topic. Randomized clinical trials of CBT for child and/or adolescent ADs were included if they used at least one measure of social functioning or peer relationships as a treatment outcome. Sixteen studies met our inclusion criteria. From each study, we extracted the sample characteristics, treatment arms, social and/or peer outcome measures, and statistical findings. Results show that social functioning and/or peer relationships improved over time in the majority of studies, highlighting an important aspect of treatment efficacy beyond anxiety reduction. There were also several treatment-specific effects, but considerable variability across studies' samples, methods, and findings, makes it difficult to draw firm conclusions about which specific treatments improve specific outcomes. We recommend next steps for research to reconcile these findings, including improved operationalization and standardization of social and peer outcomes, and research on treatment specificity and mechanisms.

Quality of the Parent-Child Relationship as a Moderator of Witnessing Violence and Youth Trauma Symptoms

Traumatic event exposure affects two in every three adolescents in the United States and there is the potential for numerous deleterious effects including higher levels of youth depression, anxiety, posttraumatic stress symptoms, and emotional and behavioral problems. Witnessing violence is one of the more common experiences associated with trauma exposure. Despite the ample research on mental health outcomes associated with witnessing violence, less is known about the extent to which parent-child relationships play a role in youth mental health outcomes when youth are exposed to violence. With a clinically relevant, diverse sample of 806 youth ages 12 years old who experienced maltreatment or were at risk of being maltreated, we tested hypotheses that the parent-child relationship quality would moderate the associations between witnessing violence and youth mental health outcomes. Results supported hypotheses for youths' symptoms of anxiety, depression, dissociation, and posttraumatic stress. The study contributes to the trauma literature by determining that the quality of the parent-child relationship moderated the effects of witnessing violence on trauma outcomes.

Successful treatment with avacopan (CCX168) in a pediatric patient with C3 glomerulonephritis

BACKGROUND

C3 glomerulonephritis (C3GN) is a subtype of C3 glomerulopathy (C3G), characterized by dysregulation of the alternative pathway of complement and by dominant C3 by immunofluorescence on the kidney biopsy. There is no approved treatment for patients with C3G. Immunosuppressive drugs as well as biologics have been used with limited success. In recent decades, substantial advances in the understanding of the complement system have led to the development of new complement inhibitors. Avacopan (CCX168) is an orally administered small-molecule C5aR antagonist that blocks the effects of C5a, one of the most potent pro-inflammatory mediators of the complement system.

CASE REPORT

We describe a child with biopsy-proven C3GN treated with avacopan. She was enrolled in the ACCOLADE double-blind placebo-controlled Phase 2 study (NCT03301467), where during the first 26 weeks she was randomized to receive an avacopan-matching placebo orally twice daily, while in the following 26 weeks, the study was open-label and she received avacopan. After a wash-out period, she was restarted on avacopan through an expanded access program.

CONCLUSIONS

In this case, use of avacopan in a pediatric patient with C3GN was safe and well tolerated. On avacopan, the patient was able to discontinue mycophenolate mofetil (MMF) while maintaining remission.

Otitis media at 6-monthly assessments of Australian First Nations children between ages 12-36 months: Findings from two randomised controlled trials of combined pneumococcal conjugate vaccines

OBJECTIVES

In remote communities of northern Australia, First Nations children with hearing loss are disproportionately at risk of poor school readiness and performance compared to their peers with no hearing loss. The aim of this trial is to prevent early childhood persisting otitis media (OM), associated hearing loss and developmental delay. To achieve this, we designed a mixed pneumococcal conjugate vaccine (PCV) schedule that could maximise immunogenicity and thereby prevent bacterial otitis media (OM) and a trajectory of educational and social disadvantage.

METHODS

In two sequential parallel, open-label, randomised controlled trials, eligible infants were first allocated 1:1:1 to standard or mixed PCV primary schedules at age 28-38 days, then at age 12 months to a booster dose (1:1) of 13-valent PCV, PCV13 (Prevenar13®, +P), or 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugated vaccine, PHiD-CV10 (Synflorix®, +S). Here we report findings of standardised ear assessments conducted six-monthly from age 12-36 months, by booster dose.

RESULTS

From March 2013 to September 2018, 261 children were allocated to booster + P (n = 131) or + S (n = 130). There were no significant differences in prevalence of any OM diagnosis by booster dose or when stratified by primary schedule. We found high, almost identical prevalence of OM in both boost groups at each age (for example 88% of 129 and 91% of 128 children seen, respectively, at primary endpoint age 18 months, difference -3% [95% Confidence Interval -11, 5]). At each age prevalence of bilateral OM was 52%-78%, and tympanic membrane perforation was 10%-18%.

CONCLUSION

Despite optimal pneumococcal immunisation, the high prevalence of OM persists throughout early childhood. Novel approaches to OM prevention are needed, along with improved early identification strategies and evaluation of expanded valency PCVs.