Children-Basel最新文献

Purpose: To evaluate short-term motor and sensory-motor outcomes following postoperative OT in children with IXT after strabismus surgery. Methods: This prospective before-after observational study included children with IXT who underwent bilateral lateral rectus recession and were referred for postoperative OT based on predefined clinical criteria. A structured 12-week OTplan was initiated approximately six months after surgery. Outcome measures included angle of deviation (prism diopters, PD), near point of convergence (cm), positive fusional vergence amplitudes (PD), and convergence amplitudes at distance and near (PD). Pre- and post-therapy changes were analysed using paired-samples t-tests with effect sizes calculated using Cohen's d. Final postoperative alignment was additionally compared cross-sectionally between children who underwent OT and those managed without OT. Results: Eighty-eight children had complete paired motor and sensory-motor data and were included in the analyses. Changes in static ocular alignment were small, with mean residual deviation improving from -7.02 ± 6.91 PD to -5.22 ± 6.60 PD after OT (mean change +1.80 PD; p < 0.01; d ≈ 0.30). No significant difference in final postoperative alignment was observed between the OT and non-OT groups (p = 0.827). In contrast, marked improvements were observed in sensory-motor outcomes. Positive fusional vergence amplitude increased from 7.30 ± 8.33 PD to 22.19 ± 9.26 PD (p < 0.001; d ≈ 1.5). Distance convergence amplitude improved from 7.30 ± 8.33 PD to 22.19 ± 9.26 PD, and near convergence amplitude from 10.95 ± 12.50 PD to 33.29 ± 13.89 PD (both p < 0.001; d ≈ 1.5). Near point of convergence showed a modest but significant improvement. Conclusions: Postoperative OT was associated with substantial short-term improvements in sensory-motor function, particularly fusional and convergence capacities, while changes in static ocular alignment were small and of limited clinical relevance. These findings support the role of OT as a functional adjunct to surgery, aimed at enhancing binocular control and postoperative sensory-motor stability in children with IXT.

Background/objectives: Children born small-for-gestational-age (SGA) have varying growth patterns and developmental risks. In this study, we aimed to examine the relationship between weight-for-age z-scores (WAZ) at 2 years and neurodevelopmental and obesity outcomes at 6 years in children with SGA.

Methods: We conducted a population-based cohort study using the National Health Insurance Service database of South Korea (N = 39,809). WAZ at 2 years was used to categorize children into four groups: G1 (WAZ < -1.28 [10th percentile], n = 9416), G2 (-1.28 ≤ WAZ < 0 [50th percentile], n = 20,322), G3 (0 ≤ WAZ < 1.04 [85th percentile], n = 8280), and G4 (1.04 ≤ WAZ, n = 1791). Neurodevelopment was assessed using the Korean Developmental Screening Test (K-DST). Overweight and obesity were defined using a body mass index-for-age z-score greater than the 85th and 95th percentiles, respectively, at 6 years of age. Adjusted odds ratios (aORs) and prevalence rates were estimated using Poisson and logistic regression models. Group-based comparisons were interpreted as exploratory analyses.

Results: The prevalence of suboptimal neurodevelopment was highest in G1 (5.03%), followed by G4 (3.75%) at 6 years. A significantly increased risk of suboptimal K-DST scores was observed in G1 (aOR: 1.544; 95% confidence interval [CI]: 1.253-1.902), whereas a nonsignificant increase was found in G4 (aOR: 1.447; 95% CI: 0.938-2.234). At age 6, the prevalence of obesity was highest in G4 (19.60%), followed by G3 (7.11%), G2 (1.81%), and G1 (0.64%). The G4 group had the highest risk of overweight (aOR: 9.94) and obesity (aOR: 14.29) at 6 years.

Conclusions: Weight status at age 2 in children with SGA was significantly associated with neurodevelopmental and obesity risks at age 6. These findings highlight the need for early weight monitoring and interventions to optimize long-term health in children with SGA.

Background: Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are prevalent neurodevelopmental conditions in childhood. Beyond biological factors, social and environmental conditions influence developmental experiences and pathways to diagnosis. Nationally representative studies examining multiple social determinants in relation to ADHD, ASD, and comorbidity across recent years remain limited. Methods: We analyzed pooled cross-sectional data from six cycles (2018-2023) of the U.S. National Survey of Children's Health, including 205,480 children aged 3-17 years. Parent-reported, clinician-diagnosed current ADHD and ASD were the primary outcomes; comorbid ADHD and ASD were examined secondarily. Social determinants included household income relative to the federal poverty level, parental education, health insurance type, food insecurity, and caregiver-reported neighborhood safety. Survey-weighted prevalence estimates and logistic regression models accounted for the complex sampling design and adjusted for demographic, family, regional, and temporal factors. Results: The weighted prevalence of ADHD was 9.7% and ASD was 2.9%; 1.1% of children had comorbid ADHD and ASD. Lower household income, food insecurity, unsafe neighborhood conditions, and lower parental education were associated with higher adjusted odds of both conditions. Boys had substantially higher odds of ADHD and ASD. After adjustment, non-Hispanic Black and Hispanic children had lower odds of ASD than non-Hispanic White children, consistent with differential identification rather than lower underlying prevalence. Comorbidity was concentrated among socially disadvantaged children. Conclusions: ADHD and ASD are socially patterned across U.S. children. Integrating developmental screening with assessment of social risks may support more equitable identification and intervention.

Background: Pediatric proximal humerus fractures (PHFs) typically heal well due to their strong remodeling potential, supporting non-operative management even in displaced injuries. However, surgery for Neer-Horowitz grade III-IV fractures has become more frequent despite limited evidence of superior outcomes.

Methods: A retrospective analysis of 152 children (<14 years) treated for isolated PHFs at a tertiary pediatric orthopedic center (2004-2023) was performed. Clinical records and telephone follow-up provided demographic data, fracture classification, management, complications, and functional outcomes (QuickDASH, Tegner, return to sport). A direct cost analysis compared conservative and surgical pathways.

Results: Of 152 patients, 133 were treated non-operatively and 19 surgically. Conservative management achieved excellent results across all fracture types: nearly all patients reported normal QuickDASH scores and full shoulder function. Among Neer III-IV fractures (n = 37), functional outcomes, activity levels, and sport resumption were similar between treatment strategies. Minor transient issues (pin migration, temporary stiffness, delayed return to sport) occurred only after surgery. No meaningful complications were observed in the conservative cohort. Mean costs differed substantially: €1452.09 for non-operative management versus €7832.12 for surgical treatment.

Conclusions: Long-term outcomes of pediatric PHFs were uniformly excellent, regardless of fracture severity or treatment modality. Surgery did not improve recovery, function, or return to sport and was associated with higher costs and minor postoperative issues. Conservative management should remain the standard of care for nearly all pediatric PHFs, with surgery reserved for exceptional circumstances such as open fractures, neurovascular compromise, or failed closed reduction.

Objectives: The aim of the current study was to evaluate changes in olfactory sensitivity with Sniffin' Sticks^® (Burghart Messtechnik, Germany) in patients undergoing palatal expansion. Methods: The study sample consisted of 20 patients enrolled from the Department of Paediatric Dentistry (0-14 years old) at the Policlinico of Rome "Tor Vergata", according to the following inclusion criteria: negative posterior transverse interarch discrepancy ≥ 4 mm, mixed dentition phase with first permanent molars erupted and prepubertal skeletal maturation stage (CS1-2), evaluated on a lateral radiograph through the Cervical Vertebral Maturation (CVM) method. Each patient underwent a dental examination, orthopantomography and lateral cephalometric X-rays were requested, and dental impressions were taken using digital scanner. Every patient was treated with maxillary rapid expander and underwent ear, nose, and throat (ENT) assessment before and after treatment. Moreover, questionnaires before and after treatment to obtain a subjective assessment of their olfactory perception were given to all participants. Results: About odor identification, the analyses revealed an increase in mean scores of 1.28; however, this change, although slight, did not reach statistical significance (Z = -1.85; p = 0.064). In contrast, about odor discrimination, the test results indicated a statistically significant increase in the children's scores of 3.41 (Z = -2.87; p < 0.001). Conclusions: This study supports the hypothesis that rapid maxillary expansion (RME) can improve olfactory function by enhancing nasal airway dimensions and airflow. Further studies are required to confirm these results.

Background: Schools play a central role in child development and socialization and can function as protective environments that mitigate the effects of adversity. Building on the Social Ecological Model and Community School Transformation, we propose a "Schools-as-Neighborhoods" framework that conceptualizes schools as intentionally designed microenvironments capable of generating social capital, promoting positive childhood experiences, and buffering harmful neighborhood exposures through trauma-informed programming.

Methods: We conducted a convergent mixed-methods study across four public and charter schools in Milwaukee, Wisconsin, serving grades five through nine. STRYV365's peak team and Brain Agents gamified intervention were implemented between 2022-2024. Quantitative surveys and qualitative data assessed students' lived experiences, exposure to adversity, emotional awareness, coping skills, and school connectedness/climate across multiple waves.

Results: Across the four schools (n = 1626 students), baseline academic proficiency was low, and exposure to adversity was high among surveyed participants (n = 321), including bereavement (74%) and family incarceration (56%). Despite these challenges, qualitative findings revealed strengthened emotional regulation, empathy, motivation, and goal setting among students engaged in trauma-informed programming. Teachers reported improved peer interaction and community building during sustained implementation.

Conclusion: The Schools-as-Neighborhoods framework highlights the value of trauma-informed, relationship-centered school environments in promoting student well-being. By positioning schools as cohesive ecosystems that foster belonging and cultivate social capital, this approach offers educators and policymakers a pathway for mitigating the effects of hostile lived environments and supporting students' mental health, social development, and engagement in learning.

Background/objectives: This study examines factors associated with child overweight/obesity (OW/OB), pre-COVID-19 and during the COVID-19 pandemic, among all U.S. children aged 10-17 years, with or without developmental disabilities (DD) and, separately, among the subgroup of children diagnosed with a DD.

Methods: Using data from the National Survey of Children's Health (NSCH, 2018-2021), we applied descriptive statistics and multivariate logistic regression analyses to estimate the odds ratios of associations between family resilience, screen time, and childhood overweight/obesity. Family resilience measures families' communication and problem-solving behaviors. Screentime is time spent on TV, computer, cellphone or electronic devices.

Results: In descriptive analyses, during COVID-19, 35.8% of all children were identified as OW/OB compared to 32.8% pre-COVID-19-a weighted increase of 3.0%. Among children with developmental disabilities, OW/OB increased from 37.4% to 39.3%. Children reporting ≥4 h of screentime use increased from pre-COVID-19 to during COVID-19 in both groups (All Children: pre-COVID: 33.5%, during COVID: 41.6%; Developmental Disabilities: pre-COVID: 39.9%, during COVID: 49.4%). Among all children, there was a positive and strong association between screentime use and OW/OB at both pre- and during COVID-19 years. Children belonging to households with low family resiliency had 1.31 times the odds of being overweight/obese (95% CI, 1.06-1.63, p < 0.05) before the pandemic. However, these results were not significant after the pandemic.

Conclusions: Prevalence of overweight/obesity in all children and children with DD during the COVID-19 pandemic continued to rise. Screentime was found to be a key determinant in increased weight status. Contrary to our hypothesis, family resilience failed to emerge as a significant protective factor for OW/OB; additional research is needed to explore the protective role of family resiliency on childhood obesity. Study findings may provide insights into developing best practices and tailored interventions with early OW/OB screening and programs tailored towards the youngest group of children aged 10-12 years or below.

Background: Parents of youth with chronic health conditions face several challenges in supporting their children across contexts. Involvement of parents in a child's pain management approach is accepted as best practice, yet there is little guidance on how to best parent the child with chronic pain. Prior studies have shown that parents require support and education to effectively care for their children and themselves. This quality improvement program evaluation aimed to evaluate group-level: (1) feasibility of the Creating Bonds program, (2) acceptability and perceived effectiveness of the program, and (3) suggestions for program improvements. Methods: In this quality improvement program evaluation, parents (N = 40) of youth with chronic pain from the United States and Europe were recruited online to participate in a virtual peer-support and educational program, Creating Bonds, offered through the nonprofit organization, Creative Healing for Youth in Pain. Creating Bonds is an 8-week, virtual, supportive, and educational program for parents and caregivers of youth with chronic pain led by a licensed clinical psychologist. A mixed methods approach evaluated the impact of and suggestions for improving the program. Independent samples t-tests were used to examine quantitative items related to understanding of pain, isolation, confusion, distress, relationships, and self-care. Qualitative responses were evaluated for common themes through an inductive thematic analysis. Results: Results indicated that Creating Bonds significantly improved parents' level of understanding of chronic pain, relationships with others, and self-care, and significantly reduced confusion about parenting a child with chronic pain, stress, and anxiety levels (ps < 0.05). Levels of isolation moderately decreased. Parents qualitatively described the experience as validating, connecting, and educational, with both emotional relief and practical strategies emerging as benefits. Conclusions: Quantitative results and qualitative themes capture the dual role of the Creating Bonds program in providing tangible parenting tools alongside education and critical psychosocial support. Parents entered with uncertainty, a desire for strategies, and hope for connection, and they came away with validation, practical parenting tools, and a community facing similar experiences.

Purpose: Hyperparathyroidism (HPT) is a condition marked by excessive secretion of parathyroid hormone (PTH), leading to disturbances in calcium, phosphate, and vitamin D metabolism. HPT is classified into primary (pHPT), secondary (sHPT), and tertiary (tHPT) types, which can cause systemic complications. Parathyroidectomy (PTX) remains the cornerstone treatment for pHPT and refractory cases of sHPT and tHPT. Methods: A retrospective review was conducted on 10 pediatric patients who underwent PTX for HPT at our clinic between 2016 and 2024. Demographic data, preoperative imaging, laboratory findings, surgical details, pathology reports, and postoperative outcomes were analyzed. Patients were categorized as having either pHPT (n = 6) or renal HPT (r-HPT; n = 4), which included one case of sHPT and three cases of tHPT. Results: The mean age of pHPT and r-HPT patients was 15 and 13 years, respectively. While 50% of pHPT patients were female, all r-HPT patients were female. Preoperative imaging localized parathyroid lesions using ultrasonography in all cases, but Sestamibi scintigraphy had a lower detection rate (66.7%). Minimally invasive parathyroidectomy was performed in single-gland pHPT cases, while bilateral neck exploration was used for multiglandular pHPT and all r-HPT cases. No intraoperative complications were observed. Postoperatively, all patients demonstrated normalized calcium, phosphate, and PTH levels with significant symptomatic improvement. Hungry bone syndrome developed in one r-HPT patient and was managed successfully. No recurrences were noted during an average follow-up of 39 months. Conclusions: PTX is a safe and effective treatment for pediatric HPT, providing excellent biochemical and clinical outcomes. Multidisciplinary collaboration is crucial in managing pediatric cases, particularly those with complex renal HPT.