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Purpose of Study: The eXtraordinarY Babies Study is a natural history study of health and neurodevelopment in infants with a prenatal diagnosis of SCT. Given the increased risk for social difficulties and autism in SCT in later childhood and beyond, the study explores trajectories of early social communication development to identify early predictors of outcomes, and relationship of social communication skills to developmental profiles. Methods Used: A subset of 56 participants (XXY=43, XYY=4, XXX=9) from the eXtraordinarY Babies Study completed the Autism Diagnostic Observation Schedule- 2nd edition (ADOS-2), Toddler Module as part of the 12-month visit and The Bayley-3 Scales of Infant and Toddler Development. The ADOS-2 provides ratings of 0 (typical development), 1 (mild atypicality), and 2 (atypical) for communication, social interaction, and other behavior items, and an algorithm classifies total score into categories of: Little-No Concern, Mild-Moderate Concern, Moderate-Severe Concern. Analyses were limited to those who completed the assessment prior to COVID19 mask/shield requirements. Summary of Results: High rates of delayed or atypical development of early social communication skills were identified, with >75% of the sample showing scores of 1 or 2 in frequency of babbling, spontaneous vocalizations, gesture use, and pointing. 58% of the sample showed unusual eye contact and vocalizations. Over 50% received atypical scores on items assessing the quality of eye contact. Participants showed few restricted and repetitive behaviors. Results of ADOS-2 total scores: Little-no concern 50%, Mild-Moderate concern 35.7%, Moderate-severe concern 14.3%. No one was assigned a clinical diagnosis of ASD. For this group, Bayley-3 results showed average Cognitive (scaled score 10.8 sd1.9) and Fine motor skills (9.3 sd2.3), followed by lower Receptive (8.2 sd2.4) and Expressive Language (8.9 sd3.0) and below average Gross Motor skills (7.9 sd2.6). Receptive language scores negatively correlated with ADOS-2 Social Affect (r= -.38, p = < .001) and Overall Total (r= -.41, p = < .001). Conclusion(s): Even at an early age, toddlers with SCT are at increased risk for language, communication, and social interaction delays. While no participants were diagnosed with ASD at 12 months of age, social communication deficits known to be "red flags" for later diagnosis of ASD were seen in a subset of young children with SCT. Prospective follow-up will allow us to determine the trajectory of these deficits and those that may predict higher risk for more significant clinical symptoms.
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Background: Although mRNA SARS-CoV-2 vaccines have received emergencyuse- authorization for infants age 6 months and older, vaccine uptake is slow, stressing that questions of safety and durability of vaccine efficacy remain prominent. Method(s): Infant rhesus macaques (RMs) (n=8/group) at 2 months of age, comparable to human toddler age, were immunized intramuscularly at weeks 0 and 4 with 30mug stabilized prefusion SARS-CoV-2 S-2P spike (S) protein (Washington strain) encoded by mRNA encapsulated in lipid nanoparticles (mRNA-LNP) or 15mug S protein mixed with 3M-052 in stable emulsion (Protein). At 1 year, vaccinated and age-matched unvaccinated RM (n=8) were challenged intranasally (106pfu) and intratracheally (2x106pfu) with B.1.617.2. Lung radiographs and pathology were blindly assessed, viral N gene RNA (vRNA) copies were measured by qPCR in pharyngeal swabs and lung, and neutralizing antibody and peripheral blood T cell responses were measured. Result(s): At 1 year, D614G-specific neutralizing antibody (nAb) titers were still detectable in the Protein (ID50=755;range: 359-1,949) and mRNA-LNP groups (ID50=73;range: 41-240). Both vaccines also induced cross-neutralizing antibodies to B.1.617.2. Peripheral blood CD4+ T cell responses to the ancestral spike protein at week 52 did not differ between the groups. However, median CD8+ T cell responses were higher (p=0.002, Mann Whitney) in the mRNA-LNP group (2.8%;range: 0.9%-7.1%) compared to the Protein group (0.8%;range: 0.1%-1.6%). Control RMs had significantly higher median vRNA copies/ml (1.4+/-2.7x108) in day 4 pharyngeal swabs compared to Protein (3.8+/-6.8x103) or mRNA-LNP (4.4+/-9.7x105) vaccinated RMs. Severe lung pathology was observed in 7 of 8 controls compared to 1 of 8 or 0 of 8 RMs in the mRNA-LNP or Protein group respectively. Protection against lung inflammation was associated with nAb titers (r=-0.592, p=0.003) (Figure 1). Conclusion(s): These results demonstrate that despite lower vaccine doses compared to adults, both protein and mRNA vaccines were safe, induced durable immune responses and provided comparable protective efficacy against infection with a heterologous SARS-CoV-2 variant in infants, implying that early life vaccination of human infants may lead to durable immunity. Neutralizing ID50 antibody titers are a correlate of protection in infant RMs challenged with SARS-CoV-2.
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This study examined the stability and change patterns among toddlers' interactions with their teachers, teachers' sensitivity, and toddlers' development during the COVID-19 pandemic and the three plausible paths were tested to identify which of the study variables affected the development of toddlers in subsequent periods over time. The subjects of this study were 63 toddlers and 6 head teachers who attended a subsidized child care center, located in Kyunggi province, Korea. In order to carry out the research objectives, a non-experimental survey research design was undertaken, and the qualitative data was obtained via on-site observations by trained researchers. With regard to continuity and change patterns among the study variables toddlers who had been actively involved in initiating their verbal interactions with teachers showed more verbal interactions with their teachers even after 4 months passed. Also, it was found that the early (T1) social disposition of toddlers and the behavioral interaction that toddlers had initiated with teachers revealed a significant effect, supporting each of the three models, which are simultaneous, cumulative, and complex paths. The main results of this research support the contention that the interaction patterns vary by contexts of subject, time, and history, indicating that it would be useful to understand new competencies required for teachers within the context of the multi-faceted ramifications of the pandemic on toddler development.
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Objective: Non-invasive transcutaneous auricular vagal nerve stimulation (taVNS) paired with oral feeding is a novel intervention for infants with feeding delays that may improve feeding and help avoid a gastrostomy tube (Gtube). However, the long-term impact of this neurostimulation on infant's development remains unknown. We investigated the neurodevelopmental and sensory outcomes of infants who received taVNS paired with bottle feeding. Method(s): Twenty-one of 35 toddlers who participated in the open label trial of taVNS paired with one or two feeds a day for 2-3 weeks, underwent comprehensive developmental assessments at 18 months of age using Cognitive Adaptive Test, Clinical Linguistics and Auditory Milestone, and Peabody gross motor scores. Twelve of those assessed achieved full oral feeds ('responders') and 9 had G-tube placed for feeds ('non-responders'). Before COVID, 12 toddlers (5 responders, 7 non-responders) were also assessed in the home using the Bayley-III and Sensory Profile (SP-2) assessments. Area deprivation index (ADI) was used to measure resource poor environments and relate to test scores. We used Fishers exact test and Pearson correlation coefficients to compare neurodevelopmental and sensory performance in responders versus non-responders. Result(s): taVNS responders showed significantly better general sensory processing in SP-2 than did non-responders (p =0.04). There were no significant differences in Bayley-III or CAT/CLAMS/ASQ scores in areas of cognition, receptive language, fine motor, and gross motor skills in this small sample size, but are similar to published scores for preterm infants who received G-tubes. ADI was not significantly associated with neurodevelopmental scores. Conclusion(s): These results suggest that taVNS paired with feeding may have a potential long-term positive neurodevelopmental effect on sensory processing in neonates with poor feeding. The current open-label results need testing in randomized controlled trials of taVNS paired with oral feeding in developmentally delayed infants failing oral feeds. Research Category and Technology and Methods Clinical Research: 12. Vagus Nerve Stimulation (VNS) Keywords: Neurodevelopment, taVNS, feeding, developmental delaysCopyright © 2023
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The preschool years are a period of rapid growth and development, and children are at vulnerable to any amount and duration of nutritional shortfall. Globally, undernutrition remains a leading cause of death in this age group, with the prevalence of obesity rising in parallel. Young children need to be provided with a diet that is sufficiently nutrient dense and qualitatively diverse to meet their micronutrient needs but challenges with food shortage, access, and affordability often make this difficult. In this article, we present the current state of the evidence along with highlighting knowledge gaps on some of these topics. © 2023 Elsevier Ltd. All rights reserved
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Case Report: Patients with Multisystem Inflammatory Syndrome in Children (MIS-C) can commonly present with gastrointestinal symptoms of abdominal pain, vomiting, or diarrhea. These symptoms along with high fever and elevated inflammatory markers can often mask underlying gastrointestinal inflammation and lead to a diagnostic dilemma. Case Presentation: We report a case of a 16-month-old with a history of exposure to SARS-Cov-2 virus, who presented with fever, cough, vomiting, and decreased activity. Her initial workup showed neutrophil-predominant leukocytosis with elevated CRP, ferritin, NTProBNP, and fibrinogen. Serology was positive for COVID-19 IgG antibodies, strongly favoring a diagnosis of MIS-C. Initial CT of the abdomen showed findings consistent with mild enteritis. Intravenous immunoglobulin was not administered as leukocytosis and all inflammatory markers except CRP improved during the course of her hospital stay with parenteral antibiotics, but she remained febrile with worsening abdominal symptoms. She then developed classic symptoms of peritonitis with tenderness and rigidity. Ultrasound of abdomen was inconclusive due to overlying bowel gas. Repeat CT of the abdomen showed multiple intra-abdominal abscesses with the largest rim enhancing lesion in the right lower quadrant. Her presentation was consistent with acute appendiceal abscess due to perforated appendix that improved with CT guided drainage and three weeks of intravenous antibiotics. She was then discharged and planned for an interval appendectomy after two weeks. [Figure presented] Conclusion(s): Symptoms of appendiceal abscess can mimic MIS-C. This case underscores the importance of considering appendicitis in the differential diagnosis in patients with MIS-C. Appendicitis can be missed in toddlers. Hence, clinical suspicion and repeat imaging is key for early diagnosis in this age group. CT Abdomen and Pelvis with intravenous and oral contrast showing findings of perforated, complicated acute appendicitis, with multiple abscesses. Copyright © 2023 Southern Society for Clinical Investigation.
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BACKGROUND: Stunting is one of the global health and nutrition problems faced by toddlers because of the height growth problem caused by the lack of nutrition intake both the micro nutrition and macro nutrition and also infection diseases in long terms. OBJECTIVE(S): This research aims at analyzing the toddler factors as the stunting risk predisposition factor due to Covid 19 pandemic in stunting locus village area of Indonesia. DESIGN: This study applied case control study research design. This research was conducted for seven months (May 27th - November 20th 2022) in Stunting Locus Pudun Jae Village area, Padangsidimpuan City. PARTICIPANTS: This case control study took 112 toddlers as the samples who were divided into two groups;56 stunting toddlers were included in case group and 56 normal toddlers were included in control group. The sampling technique used was purposive sampling. KEY RESULTS: This research found that the poor eating frequency (OR=3,619), monotonous eating habit (OR=0,440), and exclusive breastfeeding history (OR=0,070) were stunting risk predisposition factors on toddlers. In addition, the result of multivariate analysis on the three stunting risk factors showed that the eating frequency (OR=3,619) was the most dominant factor leading to stunting. CONCLUSION(S): This research findings summary confirmed that eating habit, eating frequency, and exclusive breastfeeding history were the stunting risk predisposition factors with the value of OR > 1. Thus, any intervention which can overcome those predisposition factors to prevent stunting is needed such as family-based nutrition education and accurate nutrition intervention. Copyright © 2023 Wolters Kluwer Medknow Publications. All rights reserved.
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Background: SARS-CoV-2 is an emerging virus that has mainly affected adults; hence, most clinical information has been derived from that population. Most pediatric cases are mild and with nonspecific symptoms requiring outpatient management. Children are a major source of spread for most traditional respiratory viruses. Their role in SARS-CoV-2 transmission was thought to be relevant. Children under the age of two comprise a group that is more susceptible to infection since vaccines have not been approved for them until recently. The knowledge of clinical manifestation of COVID-19 in young children is scarce. Objectives: To describe the clinical, epidemiological, and demographic characteristics of children under 2 years old with confirmed COVID-19, who did not require hospitalization. Methods: This descriptive study was performed from May, 2020 to June, 2021. Children ages 0-2 years with COVID-19, confirmed by transcriptase-polymerase chain reaction assay that were performed in laboratories of the Red de Salud UC CHRISTUS Health Network, were selected to be contacted. If the parents accepted participating and their children were not hospitalized, a survey was sent to the patients' caregivers. Results: Of the 242 cases, 159 caregivers answered the survey (65.7%). The median age of the subjects was 14 months, and 53.5% were males. Fifty percent had comorbidities, of which one third corresponded to atopy. Ninety eight percent were secondary cases. Most of them were infected within their households (81%). The most frequent sources were their parents, followed by their grandparents. The most common symptom was fever (78%) followed by irritability (67.3%), rhinorrhea (66%), and fatigue (64.8%). Infants less than 6 months old more often presented with conjunctival congestion and less loss of appetite compared to older children (p < 0.05). Conclusions: This study provides valuable insights regarding COVID-19 in ambulatory young children. Most cases of SARS-CoV-2 infection in children under 2 years old do not require hospitalization. There was a slight male predominance, and the majority had been infected within their households. SARS-CoV-2 infection should be suspected in children under 2 years old presenting with fever, irritability, fatigue, and rhinorrhea. Children with positive household contacts and fever should also be tested for COVID-19.
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Aims Hand sanitizers are increasingly used in most households since the onset of the COVID-19 pandemic. However, improper use and accidental and deliberate ingestion of sanitizer solutions have been associated with numerous health risks to children. This study aimed to assess knowledge and practices regarding safe handling and disposal of alcohol-based hand sanitizers and surface disinfectants among a cohort of parents in urban Sri Lanka. Methods This observational cross-sectional study was performed including parents of children admitted to North Colombo Teaching Hospital for a period of six months from August 2021. Data were collected regarding parental knowledge regarding safe handling and disposal of hand sanitizers, and their health hazards by paediatric post-graduate trainees. Data were collected using a pre-tested interviewer administered questionnaire. All data were analysed using SPSS 17.0. Results Out of 153 children recruited to the study, the mean age was 5.3 years (range: 1 month - 14 years) and male children (92, 60.1%) outnumbered female children (61, 39.9%). The majority of mothers (126, 82.4%) and fathers (133, 86.9%) had received education at least up to secondary school. 124 parents (81%) had been using hand sanitizers at home regularly. Only 113(73.9%) parents believed that preschool children were the most vulnerable for accidental ingestion of sanitizers and 40 parents (26.1%) were unaware that sanitizer solutions can be accidentally inhaled by toddlers. Knowledge was poor regarding occurrence of potential symptoms and side effects such as sore throat (56, 36.6%), irritation of eyes (30, 19.6%), breathing difficulties (40, 26.1%), high heart rate (72, 47%), aspiration (43, 28.1%) and low blood sugar (108, 70.5%). Only 132 parents (86.2%) knew how to clean and disinfect their home premises safely and 29 parents (18.9%) didn't know how to store cleaning products safely. Sixty-four parents (41.8%) were unaware regarding how to get information on safe cleaning practices. Forty-two parents (27.4%) kept sanitizer bottles within easy access to children whilst 85 parents (55.5%) had been storing sanitizers in unlabeled bottles. Ninety-eight parents (64%) were not keen to read the signage alerts in sanitizer storage bottles. Only 25 parents (16.3%) safely disposed sanitizer bottles. Thirty-three parents (21.6%) put sanitizer bottles together with food items in carriage bags from super markets. Conclusion The findings of this study inform that knowledge in parents regarding safe use of sanitizers can further be improved specially, in areas of local and systemic effects of sanitizer poisoning and information resources of safe cleaning practices. As a number of parents use and dispose hand sanitizers unsafely, the effectiveness of awareness programs to improve safety practices among parents should be evaluated.
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INTRODUCTION: The rate of pediatric patients diagnosed with Sars Cov 2 has increased since the early stages of the pandemic. Gastrointestinal symptoms have been demonstrated to be relatively common in pediatric COVID-19 patients as well as severe complications like PIMS syndrome because of the expression of ACE II in different areas of the digestive tract which serves as a receptor for their entry and infection in the body. During the last months of the omicron variant wave, we observed some gastrointestinal conditions in pediatric patients days after the resolution of the Sars Cov 2 acute infection period, sparking our interest to execute further research and analysis. OBJECTIVE(S): Describe the presence of functional gastrointestinal disorders as a post-covid infection sequel METHODS: We performed a descriptive, cross-sectional, observational, retrospective study, were we recollected the clinical and epidemiological data from the medical records of pediatric patients with a history of Sars cov-2 infection confirmed with positive PCR or antigen (sars cov-2) tests at Hospital Angeles Lomas, Mexico City. We included children from 6 months up to 16 years of age, who presented functional gastrointestinal disorders at a minimum 15 days after the infection that fulfilled Rome IV criteria. We evaluated the frequency and proportion of the qualitative variables;we obtained the arithmetic mean and the standard deviation for the quantitative variables with normal distribution RESULTS: We included data from 30 patients with confirmed covid 19 diseases by positive pcr or antigen (sars cov-2) tests, with a mean age 5.327 +/- 3.8 years Min: 7 months Max: 16 years, with a female predominance of 56.7% vs 43% male patients. During the acute infection by covid, 20% presented respiratory symptoms, 13.3% gastrointestinal symptoms, 36.7% only fever, 3.3% dysgeusia and 26.7% were asymptomatic. Adequate nutritional status was detected in 93% of the patients. The mean days the patients presented manifestations was 32 +/- 14 days, at a minimum 15 days, with a maximum of 63 days, being the most frequent functional gastrointestinal disorders: abdominal pain 90%, bloating 76%, vomit and reflux 33%, diarrhea 30%, constipation 26.7%. There was no weight loss in the patients, the appropriate treatment was given for each case. There was no complication in 90% of the patients, 10% presented acute abdominal pain and were transferred to the emergency room, 1 patient was diagnosed with appendicitis and 2 patients with mesenteric lymphadenitis. CONCLUSION Special attention must be paid to toddler and preschooler patients with Sars Cov 2 infection, regardless of the clinical manifestation in acute infections, mild or asymptomatic, functional gastrointestinal disorders may occur in the first 2 months after a positive PCR test. The ileum and the colon are places in which there is a greater expression of the ACE II, so when the enterocytes are invaded by SARS CoV-2, they may produce alterations in absorption and other mechanisms that could be the cause of these consequences. It is of vital importance that all pediatricians are aware of the consequences of the disease to prevent misdiagnosis.
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In 2019 the Rumbai Bukit Public Health Center was the health center with the highest prevalence of stunting in Pekanbaru City at 38.8%;this is still above Indonesia's target of 14%. This study aims to analyze the factors associated with the incidence of stunting in children under five (12-59 months) in the working area of the Rumbai Bukit Public Health Center, Pekanbaru City, in 2021. This study is a cross-sectional study. The research sample was 161 mothers with children under five aged 12-59 months in the Rumbai Bukit Health Center working area. Data on stunting children were obtained from direct measurements. Data on knowledge, birth weight of children under five, exclusive breastfeeding, age of complementary feeding, immunization, parenting, economic status, and history of infectious diseases were collected through questionnaire interviews. Bivariate analysis was carried out with a chi-square test and multivariate with a multiple logistic regression test. The study found that 19.9% of children under five were stunted. A history of infectious disease was significantly related to stunting in children under five (p < 0.05). Children under five who have infectious diseases have a 5.5 times chance of becoming stunted. It is recommended that MCH and Nutrition program holders work together to continue counseling about the importance of good parenting for children under five and increase basic immunization coverage to prevent infection during the COVID-19 pandemic.
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Background: Children living in poverty may endure Adverse Childhood Experiences (ACEs) that can affect their cognitive and social-emotional development. Safe and nurturing caregiverchild relationships mitigate many of the deleterious effects of ACEs. Child development research suggests that talking, reading, and playing with young children living in poverty improves their developmental outcomes. Developmental coaching, unlike traditional anticipatory guidance, is an interactive format engaging caregivers through self-reflection, encouraging parents to attempt novel interaction approaches, and strengthening parent self- confidence through positive feedback. This study examined the efficacy of the Grow Your Kids: TREE (Talk Read Engage Encourage) program, an interactive developmental coaching program promoting positive caregiver-child interactions during well-child encounters (ages 0-2) with lowincome families. The TREE program was developed by the Emotional Health Committee of the Maryland Chapter American Academy of Pediatrics. (https://www.mdaap.org/tree/) Methods: The study used a quasi-experimental design in two pediatric training programs in an eastern mid-sized city (residents: intervention n=24, control n=42). A convenience sample (n = 167 families) was recruited (79 intervention;88 control). Data collection included parent STIMQ2 pre/post (4-6 and 9-15 months of age) and pediatric resident report of training impact. The StimQ2 is a structured validated parent measure designed to assess caregiver-child interactions at home. Results: Recruited children were 3-10 months old (both sites), predominantly Black (76% intervention;77% control), and on Medicaid (81% intervention;78% control). Due to COVID-19, follow-up data was obtained from 45% of families (38 intervention;38 control). A significance level of p < .10 was used due to the small sample size. Analyses demonstrated differences in the STIMQ2 total (d = .43;95% CI, -.04 to .89;p = .07) and Parent Verbal Responsivity scales (d = .68;95% CI, .17 to 1.18;p = .009). There was also a significant change over time in the intervention group for reading quality subdimension (d= -.34, 95% CI, -.7 to .03, p=.07), whereas the control group's reading quality decreased. Intervention residents demonstrated significantly greater change in talking to, reading to, and being positive and encouraging with infants and toddlers as well as confidence in fostering interactions, conveying child development, and providing feedback (all p-values = .005 to .09). Conclusion: The TREE program is a feasible, brief, inexpensive, easily replicated and learned, universal developmental coaching intervention delivered by pediatric primary care providers during well child encounters that enhances caregiver-child interactions among low-income families. The study demonstrated increased overall parent-reported caregiver-child interactions, including verbal responsivity and reading behaviors and had a significant effect on pediatric residents' perceptions of their competency in promoting positive caregiver-child interactions. Antagonists' Skin Tones are Darker than Protagonist' Skin Tones in Animated Films. Average weighted grayscale values of protagonist and antagonist skin tones were plotted and arranged into a box and whisker plot. The median grayscale value of antagonists (106.7) was lower than that of protagonists (134.9), indicating that antagonists overall were darker than protagonists. This difference was significant (p<.001). Average grayscale values of protagonist and antagonist skin tones in 91 films were plotted against the year of production. Trend lines and confidence bands were superimposed on these data points. In recent years, the skin tones of both protagonists and antagonists have changed to include darker shades. However, differences between protagonist and antagonist skin tones have remained constant over time, with protagonists consistently having lighter skin tones compared to antagonists.
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Background: Refugees are at risk for low health literacy and high rates of illness and hospitalization. A partnership between medical professionals at Yale and two New-Haven, CT-based refugee resettlement organizations aimed to create and implement a family-based, interactive pediatric healthcare curriculum with a goal of increasing childhood health knowledge among refugee families. Methods: Seven 1-hour, in-person classes and 1 virtual class were taught by pediatric residents with real-time translation in Pashto, Dari, Arabic, Swahili, and Kinyarwanda on the topics of child nutrition, safety, parenting, and oral health. Each class incorporated play-based activities for toddlers-a My Healthy Plate puzzle, street-crossing simulation, teeth-brushing demonstration, and block play-which were integrated into parental discussion with visual aids. Knowledge acquisition and satisfaction was assessed using pre- and posttests. Results: 67 adult participants had an 85% response rate. Average knowledge test scores increased in 5 of 7 classes, reaching significance in a class on parenting (mean 52% vs 90%, paired t-test p = 0.03) and child safety (mean 80% vs 97%, p = 0.04). 100% of respondents (67% response rate) reported increased understanding of the topic and would recommend the class to a friend. There were 5 participants for the virtual class. Conclusion: Child health education classes conducted for refugee families can improve knowledge of pediatric healthcare topics and provide positive experiences. A close relationship between healthcare providers and community refugee organizations has the potential to improve health education in refugee families. Future studies will assess efficacy and satisfaction of virtual classes during the COVID-19 pandemic.
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Background: Motor vehicle crashes (MVCs) remain the leading cause of death for Kentucky children above age 1. The Nest has four separate non-profit programs that provide respite child care, legal/psychological support services to survivors of intimate partner violence, parenting classes, and crisis assistance to families (toiletries/cleaning-supplies/papergoods/diapers/formula/food/rental-assistance since COVID, serving more than 400 clients per month). Community need for car seats was previously demonstrated by the 57 used seats they distributed in a year. Methods: Standard national Child Passenger Safety (CPS) checkup forms were utilized, with an Excel data base of seats provided/notes of special circumstances/problems with seats/cars. Forms from October 1, 2020 to July 1, 2021 were reviewed for quality improvement at least monthly, with immediate adjustments as necessary. All education and seat installation occurred outdoors during fall months and on all but the coldest winter days. Staff and families were masked, items used were sanitized and meticulous hand washing was done between families due to COVID. New convertible seats from grants were supplemented with individually- purchased harnessed booster seats to serve older children and with current (never-in- crash, not -recalled) donated infant seats. CPS services were conducted in 4 languages (English, French, Spanish and Arabic) with fluent staff or consenting family members as translators, and were offered both by appointment/previous consultation/referral from Family Assistance and as walk-ins requesting help or were observed to have car-seat/booster-sized children. Results: A small program that distributed seats as commodities without instruction or assessment of child/car was revised into a formal CPS fitting station, addressing difficult cars, large families, grandparents raising grandchildren, and resettled international refugees. Approximately 90% of families had annual family incomes of < $20,000/year, many below $10,000. Almost every consult for one child revealed multiple children in need of car seat education or new seats. More than 150 seats were checked in nine months. Types of misuse (in >90%) seen include: no seat, child too loose in seat, seat too loose in car, use of infant seats facing forward for too-big toddlers, premature use of no-back boosters (NBB) for small young children when family has no money for harnessed seats or at the mis-direction of a medical professional. Families that live in high crime areas with car theft are bringing in car seats at night so need lighter weight ones, as do grandparents. Conclusion: Taking CPS to the parking lot of an established non-profit has permitted us to reach more families with great need in a place they trust. Types of misuse have provided a real-world window into the potential optimal timing/messages of CPS within pediatric anticipatory guidance, and families have shown how our anticipatory CPS guidance may need to be adapted to work in the environment that people actually live in.
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Purpose/Objectives: Studies have shown that pediatric practice supporting healthy lifestyles and healthy weight for children under 2 can be improved considerably, suggesting a role for targeted quality improvement (QI) projects. Due to disparities in outcomes for low-income groups, it is important to engage practices caring for underserved populations, such as Federally Qualified Health Centers/Look-Alikes (FQHCs), although improving care may be particularly challenging in such settings. Projects must also ensure that care remains comprehensive and improvements do not interfere with other aspects of care. Optimize Infant and Toddler Feeding for Obesity Prevention is a 19-week, virtual, team-based, QI collaborative, designed to help providers comprehensively support healthy lifestyle/weight for children under 2 years during well visits. Participation by FQHCs was specifically solicited during the pilot. The objective of this analysis was to examine key results for FQHCs and Non-FQHCs. Design/Methods: The project began in January 2020 but was paused in mid-March for 10 weeks, due to the COVID-19 pandemic. Sixteen teams completed the pilot, including 9 FQHCs and 7 Non-FQHCs. During the collaborative, teams submitted 3 cycles of data (T1-3), based on 20 randomly selected charts, which were used to calculate 10 clinical measures. Teams also submitted a 4th monitoring data cycle 3-1/2 months after the collaborative. Within post-collaborative surveys, providers answered 6 Likert-type questions about the overall impact of participation on care and satisfaction. An additional question concerned the extent to which the pandemic had interfered with practice improvements. Changes in aggregate clinical measures were analyzed using Fisher's exact test (p<.025);other analyses were descriptive. Results: Several baseline clinical measures were lower in FQHCs but showed early and consistent improvement (Table 1). By T3, 6 measures improved for NonFQHCs (assessments for pre-/perinatal risks, weight-for-length, diet/nutrition, social determinants of health (SDOH);counseling for diet/nutrition, parenting/home environment), and 5 improved for FQHCs (assessments for pre-/perinatal risks, weight-for-length, patient/family concerns, parenting/home environment, SDOH). At T4, improvements were sustained for Non-FQHCs. For FQHCs, only minor shifts occurred in 2 high measures (patient/family concerns assessments became nonsignificant;diet/nutrition counseling became significant.). Results of summed measures showed an increase in total assessments and counseled topics per visit for both Non-FQHCs and FQHCs over time, with considerable catch-up by FQHCs (Figure 1). Within surveys, 54% and 70% of Non-FQHC and FQHC providers, respectively, reported at least a moderate impact of the pandemic on improvement efforts, possibly also accounting for somewhat low survey response rates.(Non-FQHCs=61%;FQHCs=72%%). Nevertheless, providers overwhelmingly did not perceive interference on other aspects of care, and 79% and 70% at Non-FQHCs and FQHCs, respectively, reported moderate to high overall levels of satisfaction with participation. Conclusion/Discussion: Clinical and survey measures support that both FQHCs and Non-FQHCs benefitted from participation in the pilot, despite significant ongoing challenges due to the pandemic.
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INTRODUCTION: According to ROMA IV (R-IV), in schoolchildren and adolescents in Colombia and Ecuador, the prevalence to present some functional gastrointestinal disorder (FGID) is 21.2%-22.3% being the main FGID the functional constipation (FC). There’s no data about infants and toddlers in latinoamerican countries (Latam). OBJECTIVE: To describe the prevalence of FGIDs in children in 3 Latam countries according to R-IV. METHODS: 11493 children in Colombia, Ecuador and Panama were included: 1382 infants aged 0-12 months (Group A, 7.3+/-3.7 months), 2631 toddlers aged 1-4 years (Group B, 2.5+/-0.9 years old), 2791 schoolchildren aged 8-12 years (Group C, 10.6+/-1.2 years) and 4689 adolescents aged 13-18 years (Group D, 14.8+/-1.4 years). FGIDs were identified through the Questionnaire of Pediatric Gastrointestinal Symptoms Rome IV (QPGS-IV). RESULTS: The prevalence to present some FGID was 15.8% in infants;23.3% in toddlers;21.1% in schoolchildren and 22.1% in adolescents;being the most frequent FGDI in the Group A, colic (7.6%), regurgitation (6.4%) and FC (4.7%);in the Group B, FC (17.6%), cyclic vomiting syndrome (5.4%) and functional diarrhea (0.3%);in the Group C, FC (12.5%), functional dyspepsia (2.8%) and irritable bowel syndrome (1.8%), and the Group D, FC (11.1%), functional dyspepsia (3.9%) and functional abdominal pain (1.9%). There were more FGDIs in infants with caesarean section (OR=1.7 95%CI=1.22-2.41 p=0.0010), toddlers with previous diarrhea (OR=1.7 95% CI=1.39-2.23 p=0.0000), in schoolchildren with previous dengue infection (OR=2.0 95%CI=1.24-3.25 p=0.0019) and adolescents in covid-19 confinement (OR=1.4 95%CI =1.13-1.78 p=0.0013). CONCLUSIONS: The prevalence for FGIDs was lower in infants whose main FGDI was colic;the FC was one of the main FGIDs in all the age groups, being associated in children younger than 4 years old to caesarean section and history of diarrhea and children between 8-18 years old to history of dengue and confinement.
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Objective: To investigate calls made to the Finnish Poison Information Center (FPIC) before and during the COVID-19 pandemic. We hypothesized that the number of calls concerning COVID-related drugs and disinfectants would have increased, as well as the number of calls regarding intentional poisonings, due to the social and economic stress caused by the pandemic. Methods: We analysed the FPIC call records to assess the impact of the COVID-19 pandemic on our statistics. The pandemic started in Finland in March 2020 and the highest peaks were experienced during April 2020, December 2020, March 2021 and August 2021. We compared the mean number of calls per month from the same time period (March-June) before the pandemic (years 2018-2019) and during the pandemic (years 2020-2021). Results: The FPIC receives approximately 40,000 calls yearly from healthcare professionals and the public. The total number of calls was not significantly changed by the pandemic. Compared with 2018-2019, we observed a mean 161% increase (2018, n=24;2019, n=25;2020, n=61;2021, n=67) in calls concerning hand disinfectants during the pandemic. Respectively, there was a 180% increase concerning hydrogen peroxide (2018, n=3;2019, n=2;2020 n=9;2021, n=5) and a 24% increase in calls concerning vitamin D (2018, n=38;2019, n=50;2020, n=60;2021, n=49). Hydrogen peroxide (1%) was used at the dentist as a mouth disinfectant during the pandemic, so the abundant use was seen in our call records. Most of the vitamin D and hand disinfectant exposures were accidental and concerned toddlers. There was also an increase in cases of intentional drinking of hand disinfectants due to their easy availability. Calls regarding intentional poisonings (including drug of abuse and suicide attempts) experienced a slight (13%) increase (2018, n=342;2019, n=351;2020, n=369;2021, n=413), which has also been the trend for the past few years. There was no increase in calls concerning drugs (such as antivirals) used in the treatment of COVID-19. Conclusion: The total number of calls to the FPIC was not affected by COVID-19. Some of the most prominent changes during the pandemic were the increase in calls concerning hand disinfectants and hydrogen peroxide. There was no increase in calls concerning COVID-related drugs, which has been the case in some Poison Information Centers in the United States.
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Background/Purpose: Cleft Surgery in our centre is delivered by a single specialist surgeon in a regional Burns and Plastic service. We see 35-45 cleft-affected births per annum and, prior to the COVID-19 pandemic, ran 6 theatre lists per month, conducting 170-180 cleft procedures annually. The pandemic severely hindered elective operating in even tertiary centres, due to the redeployment of theatre staff and resources to manage the emergency care load. Cleft surgery was suspended entirely during the first wave (March-June 2020), before efforts in collaboration with the RCPCH (UK) to conserve the cleft pathway restored it as a priority. Primary palatine reconstruction is recommended at 6-9 months of age to optimise velopharyngeal function and speech proficiency by 5 years (Slater et al 2019). Our service was restarted at 1-2 ad hoc lists a month, which was both insufficient to manage ongoing demands and deal with rising outstanding cases. We faced a major challenge in safely distributing scarce surgical time and capacity across the entire cleft surgical burden. Therefore, we aim to examine our response to these limitations in the face of rising cases and time pressures, illustrating our methods in prioritising cleft procedures. Methods/Description: We reviewed the current literature to determine which of the main cleft procedures were most time critical, and compiled a cleft priority document with a broad evidence basis. Babies with palate involvement were top priority, in light of the strong evidence advocating primary palate repair by 13 months of age (CRANE 2020), after which there is a risk of speech delay (Shaffer et al 2020). Primary lip +/- alveolar involvement were prioritised lower and performed later (∼1 year), as cosmesis during infancy was deemed less detrimental, although there remained the psychological impact on the parent (Grollemund et al 2020). Secondary speech surgery was next, the lack of which can inhibit education and require intensive speech therapy to support patients (Baillie and Sell 2020). This was followed by alveolar bone grafting, ideally performed prior to canine eruption at ∼8-9 years to limit further dental reconstructions (Vandersluis et al 2020). As per national consensus, all adult cleft surgery was suspended to accommodate higher priorities. Focusing on early palate repair helped restart the cleft pathway and prevent functional delay as well as further interventions and schoolage support. However, late lip repair saw a rise in complications - two cases of dehiscence were associated with self-inflicted toddler trauma. This is in addition to the psychosocial implications of cosmesis, including early maternal interactions (Montirosso et al 2011), stigmatisation by peers (Bous et al 2021), and parental anxiety (Bous et al 2020). We recommend isolated lip reconstructions are also undertaken within 9 months. Long-term physical and psychosocial impacts of delay in surgery should guide resource allocation in the event of future operating limitations.
ABSTRACT
It is well established that in utero exposure to Zika Virus causes a range of devastating adverse neurological outcomes1. Many of these are present at birth however early evidence suggests that there may be long term neurodevelopmental impacts even among children apparently not impacted at birth. The aim of this scoping review was to examine delayed neurodevelopmental outcomes in children exposed prenatally to Zika Virus but born without congenital Zika Virus symptoms. The review structure was guided by the Arksey and O'Malley methodology and the search process by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review (PRISMA-ScR) checklist2. A total of 9 studies were included. The studies used a variety of assessment tools, the most common being the Bayley Scales for Infant and Toddler Development III (cognition, language, and motor performance) for neurodevelopmental testing. Infants and toddlers in the age range of 9 weeks to 3.5 years were included. All but one report found a significant increase in adverse neurodevelopmental outcomes in children who were asymptomatic at birth but exposed to Zika Virus in utero. Prenatal exposure to Zika Virus appears to have long term adverse impacts on the central nervous system regardless of birth outcomes. Neurodevelopmental assessments of children exposed in utero should continue into childhood. These findings may be relevant to other viruses such as SARS-CoV-2 where research is limited.
ABSTRACT
Introduction: The Inherited Cardiac Conditions (ICC) clinical nurse specialist (CNS) team host coffee mornings for parents and their children who are affected by cardiomyopathy. These were held in response to parents' requests to meet other families affected by the condition. Support groups for families of children with heart disease can identify positive coping strategies and the need for psychological support (Jackson et al., 2018). Since the COVID-19 outbreak in the UK, incoming calls to the nurse specialists from families were greatly increased, due to heightened anxieties surrounding COVID-19 and its potential effects on children with cardiomyopathy. Therefore, the CNS team responded by adapting the coffee morning forum to a virtual platform with questions and answers surrounding COVID-19 and cardiomyopathy. Methods: The first virtual cardiomyopathy coffee morning was held on the 23rd June 2020 via Microsoft teams, a secure and accessible platform. Parents of children with cardiomyopathy under the age of 5 years were invited. Parents were asked to submit anonymous questions prior to the morning if they wished. It aimed to be more accessible for families, rebuild a support network and help ease anxieties surrounding COVID-19 in the presence of the consultant and the clinical nurse specialists. Results: 6 families attended. Feedback from parents was collated in relation to their experience of the first virtual coffee morning via email and feedback forms. This assisted in identifying the benefits of the event and how this can be adapted for future practice i.e. more regular sessions with guest speakers. Results identified that all parents found it very reassuring, informative and it eased their anxiety in relation to COVID-19 and cardiomyopathy. Conclusions: Overall, the adaptation of the coffee morning to a virtual platform was deemed valuable as evidenced by feedback from staff and families that attended. Although the coffee morning was focused around COVID-19 for the event that took place during the pandemic, the team envisage that the focus can change in accordance with participants wishes. The virtual coffee morning is an initiative that will be incorporated into the future practice of the CNS team to further support families with children affected by cardiomyopathy.