World Journal of Pediatrics最新文献

Background: The Chinese version of the Children's Sleep Habits Questionnaire (CSHQ-CH) has been widely used in clinical practice and research since it was developed in 2007. This study aimed to examine the psychometric properties of the revised version (CSHQ-CH-R) and establish cut-off values for screening for sleep disturbances in Chinese preschool-aged and school-aged children.

Methods: A community sample of 3850 preschool and school-aged children aged 3-12 years were obtained from 6 kindergartens and 2 primary schools in Shanghai, Beijing and Chengdu, China, from December 2019 to February 2020. A clinical sample of 119 children aged 3-12 years who were diagnosed with sleep disorders were recruited from a tertiary pediatric hospital in Shanghai from September 2019 to November 2021. Caregivers completed the original 33 items of the CSHQ-CH plus an additional 15 items through an online platform. Item analysis was conducted to develop the CSHQ-CH-R, which included discriminative validity, redundancy and ambiguity. Internal consistency, interobserver reliability, test-retest reliability, concurrent validity (correlations with actigraphy) and discriminative validity were then analyzed. The cut-off values for both the full scale and subscale scores were generated by receiver operating characteristics.

Results: The final version of the CSHQ-CH-R included 30 items and 8 subscales. Three subscales (bedtime resistance, sleep duration and daytime sleepiness) were revised, and the other five subscales were unchanged from those of the CSHQ-CH. The internal consistency for the full scale was 0.83 for the community sample, and 0.73 for the clinical sample. The internal consistency ranged from 0.47 (sleep duration) to 0.72 (bedtime resistance) for the community sample, and 0.38 (sleep duration) to 0.83 (sleep-disordered breathing) for the clinical sample. The interobserver reliability for the full scale was 0.55, and ranged from 0.38 (parasomnias) to 0.74 (bedtime resistance) for the subscales. The test-retest reliability was 0.70 for the full scale, and ranged from 0.54 (sleep duration) to 0.78 (bedtime resistance) for the subscales. Concurrent validities against actigraphy were 0.62 and 0.33 for "time in bed" and "night sleep duration", respectively. The clinical sample scored higher than the community sample did for the full scale and subscales (P < 0.01). A cut-off total score of 44 was determined, with an area under the curve of 0.76, a sensitivity of 0.64, and a specificity of 0.76. To facilitate cross-cultural comparisons, psychometric properties and cut-off values for the CSHQ-CH with the original 33 items were also provided.

Conclusion: The CSHQ-CH-R exhibits satisfactory to good psychometric properties, indicating its suitability for identifying sleep problems among Chinese preschool- and school-aged children.

Background: Preschoolers and young children are vulnerable to psychosocial and behavioral disorders linked to lifestyle factors such as screen time and sleep disturbances. Our study examines the relationship between screen time and adherence to recommendations with children's behavioral and emotional difficulties, with a focus on the role of sleep duration.

Methods: Cross-sectional analyses were conducted within the multicenter prospective Childhood Obesity Risk Assessment Longitudinal Study (CORALS), which included 1420 children aged 3-6 years. Screen time (hours/day) and adherence to recommendations (≤ 2 hours/day) were assessed. Behavioral and emotional difficulties were measured via the strengths and difficulties questionnaire. Multivariable linear and logistic regression models were used to estimate associations between screen time (continuous and dichotomous) and strengths and difficulties questionnaire scores, adjusting for potential confounders. We also tested the moderating effect of sleep and conducted isotemporal substitution analyses replacing screen time with sleep duration.

Results: Higher screen time was associated with higher total strengths and difficulties questionnaire scores [β 95% confidence interval (CI), 0.35 (0.10, 0.61)], emotional symptoms [0.10 (0.01, 0.19)], conduct problems [0.10 (0.01, 0.18)], and greater odds of exceeding the 16-point strengths and difficulties questionnaire cutoff for behavioral and emotional difficulties [odds ratio (OR) (95% CI), 1.21 (1.04, 1.41)]. Children who adhered to screen time recommendations had lower strengths and difficulties questionnaire total scores [β (95% CI), - 0.64 (- 1.19, - 0.10)] and odds of experiencing behavioral and emotional difficulties [OR (95% CI), 0.67 (0.47, 0.95)]. Sleep duration moderated the screen time-strengths and difficulties questionnaire association (P = 0.020). The isotemporal substitution of screen time for sleep duration was associated with lower strengths and difficulties questionnaire scores across all subscales, except for prosocial behavior.

Conclusions: Higher screen time was associated with greater emotional and behavioral difficulties, whereas adherence to screen time recommendations and adequate sleep duration were inversely associated. Managing screen time and promoting sleep are crucial for children's well-being.

Background: This study compared multilevel factors associated with sleep duration and bedtime regularity in children with and without neurological and developmental disorders (NDD) using a nationally representative sample.

Methods: We combined data from the 2016-2017, 2018-2019, and 2020-2021 United States National Survey of Children's Health (NSCH), including 86,014 children aged 9-17 years. Parent-reported outcomes included adequate sleep duration (yes/no) and bedtime regularity (yes/no). We assessed the relationship between twenty independent individual, social, and environmental variables on the sleep outcomes. We used random survival forest decision trees to identify the five most predictive variables [in terms of variable importance (VIMP)]. Regression analyses were then used to assess directionality and independent associations.

Results: A greater proportion of children with NDDs versus those who are typically developing (TD) had parent reports of not achieving adequate sleep duration (34.0% versus 30.9%, respectively) and bedtime regularity (18.8% versus 13.7%, respectively). For adequate sleep, achieving bedtime regularity, having more family meals together and older age emerged as the most important independent variables for both TD children and those with NDDs. For bedtime regularity, achieving adequate sleep, and having more family meals together were the most proximal independent variables for NDD and TD children.

Conclusion: Increasing the frequency of family meals and addressing both sleep duration and bedtime regularity may serve as key modifiable intervention targets to improve sleep health in children, including those with NDDs.

Background: Good sleep quality, appropriate sleep timing, and mindfulness support emotional and mental health well-being. However, few studies have examined their role in the association between neuroticism and subjective well-being (SWB) among adolescents. This study investigated their potential moderating and mediating effects on the neuroticism-SWB relationship in early adolescents.

Methods: We enrolled 1110 adolescents in the China Jintan Child Cohort-Wave II study, with 543 providing complete data on sleep, neuroticism, and SWB (2011-2013, 12.98 ± 0.88 years old, 49% females) and 188 providing trait mindfulness data (2013-2014). The sleep variables included sleep quality (Pittsburgh sleep quality index) and chronotype (mid-sleep time on weekends corrected for sleep debt). SWB was measured via the Oxford happiness questionnaire, neuroticism was measured via the Big Five Inventory, and mindfulness was measured via the five facet mindfulness questionnaire. Linear regression was used to estimate the moderating effect, and generalized structural equation modeling was used to examine the mediating effects.

Results: Neuroticism (b = -5.07, P < 0.001) significantly predicted lower SWB, which was mediated by poor sleep quality (β = -3.76, P = 0.002) and trait mindfulness (β = -2.13, P = 0.002). No moderating effects were found for sleep quality or mindfulness (P > 0.05). Chronotype was not a moderator or a mediator between neuroticism and SWB, although a moderate (vs. late) chronotype was independently associated with better SWB (b = 5.91, P = 0.04).

Conclusions: Poor sleep and mindfulness mediate, but do not moderate, the relationship between neuroticism and SWB. While the late chronotype predicts poorer SWB, it does not contribute to the neuroticism-SWB relationship. The findings underscore the importance of healthy sleep and mindfulness-based strategies to support well-being in early adolescents high in neuroticism.

Background: Social anxiety disorder (SAD) is one of the most prevalent anxiety disorders in adolescents but remains underdiagnosed due to the lack of objective diagnostic tools. This study aimed to identify serum metabolomic alterations in adolescent SAD patients and to develop an interpretable diagnostic model.

Methods: In this cross-sectional study, serum samples were collected from 78 adolescents, including 42 drug-naive, first-episode SAD patients and 36 matched healthy controls. Untargeted metabolomic profiling was performed, and feature selection was conducted via least absolute shrinkage and selection operator regression, followed by logistic regression for model construction.

Results: Among the 661 detected metabolites, 46 differed significantly between groups, mainly within amino acid and energy metabolism pathways. Five key metabolites, 2-hydroxybutanoic acid, L-alanine, L-asparagine, glutamine and beta-tocopherol, were selected for model construction. The diagnostic model achieved an area under the curve of 0.934 in the training set, but external validation is still lacking, and the findings should be interpreted as hypothesis-generating.

Conclusions: Adolescents with SAD exhibit distinct metabolic profiles, and a preliminary diagnostic model was developed. Exploratory microbiota-related observations suggested potential links between gut microbial activity, host metabolism, and anxiety phenotypes, but these findings remain preliminary and outside the scope of the present study. Overall, these findings provide hypothesis-generating support for further investigation of gut-metabolism-brain interactions and highlight the need for larger, externally validated studies to advance biomarker development.

Background: Bronchial asthma is a common chronic respiratory disease in children. For many years, concerns about exercise-induced bronchoconstriction have limited physical activity in this population, with negative consequences for both physical and mental health. Recent evidence indicates that exercise should be incorporated into the daily routine of children with asthma, with appropriately prescribed programs shown to improve disease control, lung function, and quality of life. This study aims to systematically describe the safety, benefits and key factors of exercise for children with asthma.

Data sources: Initiated by the National Clinical Research Center for Child Health, this set of recommendations was developed by a multidisciplinary team of 17 experts. A comprehensive Literature search was conducted across PubMed, Embase, Cochrane and other databases, yielding 64 studies that met inclusion criteria up to May 2025. The Oxford Centre for Evidence-Based Medicine 2011 levels of evidence were used to evaluate evidence quality. Two rounds of expert voting were conducted using Delphi methodology to formulate final recommendations on key clinical topics.

Results: Recommendations were formulated across nine core domains: exercise safety, exercise-related benefits, pre-exercise screening, exercise prescription design, plan adjustment and progression, pre-exercise preparation, exercise monitoring, outcome assessment and the management of exercise-induced bronchoconstriction. Specific guidance is offered on individualized exercise planning based on asthma control status, physical fitness, exercise habits and environmental factors. Recommendations also address appropriate modalities of aerobic, resistance and flexibility training, strategies for monitoring intensity and progression and both pharmacologic and non-pharmacologic approaches to exercise-induced bronchoconstriction prevention and management.

Conclusions: These recommendations provide scientific and practical guidance for the development and implementation of individualized exercise prescriptions in children with asthma. Moreover, they highlight the importance of multidisciplinary collaboration and reinforce exercise as an integral component of asthma management. Further high-quality clinical research is needed to optimize exercise protocols and evaluate long-term outcomes.

Background: Since the lifting of COVID-19 control measures, infections by common respiratory pathogens have emerged as a public health issue, and the impacts on vulnerable children with wheezing illnesses remain uncertain.

Methods: This prospective study enrolled children (< 18 years) hospitalized for wheezing disorders in Hong Kong (2016‒2025). Nasopharyngeal aspirates collected within 12 h of admission were tested via rapid antigen detection, viral culture, and multiplex polymerase chain reaction (PCR) for respiratory viruses. Bacterial pathogens were identified through cultures of blood/airway specimens or PCR, including Chlamydia pneumonia and mycoplasma pneumoniae detection via PCR.

Results: A total of 2499 children [66.8% male, median age 2.9 (3.6) years)] with 3272 admissions due to wheezing disorders were identified. There was a substantial reduction in pediatric wheezing admissions during the COVID-19 pandemic (February 2020 to January 2023) compared to the pre-pandemic period (September 2016 to January 2020). After removing pandemic restrictions, wheezing admissions drastically increased from February 2023 to February 2025, exceeding the pre-pandemic level. A fivefold increase was observed in admissions due to "bronchiolitis" compared with that during the pandemic period (P < 0.001). The post-pandemic proportion of respiratory syncytial virus (RSV) significantly increased, especially among those under 5 years of age (P < 0.01). Coinfections with multiple pathogens were more common during and after the pandemic than pre-pandemic (P < 0.05).

Conclusions: Lifting restrictions led to a resurgence of wheezing admissions and respiratory infections. Continued pathogen monitoring in the post-pandemic era is crucial, and preventive measures for future health crises are needed.