Towards a better diagnosis of mouth breathing: validity and reliability of a protocol for assessing the awake breathing pattern in preschool children

Abstract Purpose The Awake Breathing Pattern Assessment (ABPA) is a prototypical clinical grid recently designed through an international consensus of Speech and Language Pathologists (SLPs) to categorize the awake and habitual breathing pattern during the orofacial myofunctional assessment. This cross-sectional study aims to explore the psychometric properties of the ABPA in a preschool population. Methods 133 children from 2;11 to 6 years old were assessed with the ABPA. The percentage of time spent breathing through the mouth was objectively measured by a CO2 sensor and used as a baseline measurement. We first performed a multivariate Latent Profile Analysis based on the CO2 measurement and a parental questionnaire to define the number of categories that best characterize the breathing pattern. Subsequently, we assessed the intra- and inter-rater reliability, internal consistency criterion validity, construct validity and sensitivity and specificity. Results The awake breathing pattern can best be described by two groups: nasal and mouth breathing. The ABPA, initially designed in three groups, was adjusted accordingly. This final version showed excellent intra-rater and inter-rater reliability. There was a significant correlation between the ABPA and the CO2 measurement. The ABPA showed a fair sensitivity and a good specificity. Conclusion The reference tool based on CO2 data was used in children for the first time and was found to be reliable. The ABPA is a suitable tool for SLPs to confirm the diagnosis of mouth breathing in preschool children if more sensitive screening tools, like parental questionnaires, are used beforehand.

The Moderating Role of Maternal Praise and Positivity in the Association Between Callous-Unemotional (CU) Traits and Later Aggression: A Prospective Study in Preschool Children in Colombia.

Our previous findings in the UK and Colombia show that CU traits predict later aggression specifically among children who are already aggressive. We hypothesised that this effect would be reduced in the presence of maternal praise and positivity. In a sample of 220 mothers and children from Colombia, mother-child interactions were coded for maternal praise and positivity, and mothers reported on children's CU traits at age 3.5 and aggression at ages 3.5 and 5 years. The results show three-way interactions between CU traits, child aggression and observed parenting at age 3.5 years in the prediction of later child aggression, and two-way interactions indicating a protective effect of positive parenting in the high aggressive children. Based on our finding, it is plausible that positive parenting may modify the effect of CU traits in the highly vulnerable group of children who are already aggressive in early childhood.

Tools to Assess Screen-related Dependency in Children: a Narrative Review of Validated Questionnaires

@#Children are using digital screen media at an even younger age as they use it for a wide range of activities such as watching videos, playing games, and educational purposes. Due to its accessibility and portability, children also spend a significant amount of time on screen. Excessive screen time in children is associated with many consequences, including language delay, hyperactivity, impulsivity, visual problems, and lower psychological well-being. With the emergence of behaviour addictions related to technologies such as addiction towards online games, the internet, and the mobile phone, researchers are looking into these incidences among children. However, a validated and reliable tool is important to detect the problem early, especially for young children at increased risk. To date, many tools have been developed to detect screen-related dependencies for adolescents and adults but lacking among children. This review aims to elicit tools available specifically for children below 10 years of age, to analyse its psychometric properties and validation process as well as to compare between them.

[Surgical strategies in the treatment of neuromuscular scoliosis]. / Operative Strategien bei der Versorgung neuromuskulärer Skoliosen.

As part of the underlying condition, neuromuscular scoliosis occurs in early childhood. Compared to idiopathic scoliosis, neuromuscular scoliosis shows a more rapid progress of deformity, which continues even after the end of growth. This progress and the associated complications can only be prevented by surgical treatment. Depending on the patient's age and the extent of the deformity, different strategies have been established: in early childhood, so-called "growing implants" are used, while between the ages of 10 to 12, definitive treatment by reposition and fusion of the deformity is the treatment of choice. In this review, we present different surgical strategies as well as indications for surgery and discuss challenges in the treatment of these complex deformities.

Evaluation of dietary behaviors of preschool children in Seoul and Gyeonggi-do associated with the level of parents' health consciousness: using nutrition quotient for preschoolers (NQ-P).

BACKGROUND/OBJECTIVES: This study aimed to assess the dietary behaviors of preschool children using the nutrition quotient for preschoolers (NQ-P) and analyzed the difference in the scores of the children's dietary behaviors in regards to the parents' health consciousness. SUBJECTS/METHODS: The subjects were 257 children aged 3-5 years and their parents residing in Seoul and Gyeonggi-do, South Korea. The questionnaire is composed of demographic characteristics, the NQ-P questions, and health consciousness. All data were statistically analyzed by SPSS program (ver. 25.0) and the statistical differences in variables were evaluated by χ2 test, Fisher's exact test, t-test, 1-way analysis of variance and Tukey's multiple comparison test. RESULTS: There was a significant difference on the intake frequency of processed meat by region and fast foods by age, region, and weight status (P < 0.05). There was also a significant difference in not moving around while eating by weight status and parents' effort to have healthy eating habits by sex (P < 0.05). The mean score of NQ-P of the total subjects was 59.47, which was within the medium-low grade. The mean score of balance was 61.62, and the boys were significantly higher than girls (P < 0.05). As the age of children increased, the mean score of the moderation was significantly decreased (P < 0.05). The scores of NQ-P (P < 0.05), balance (P < 0.01), and environment (P < 0.05) were significantly higher in the high group of parents' health consciousness than the low group. CONCLUSIONS: According to the results of the evaluation by NQ-P, the dietary behaviors of preschoolers residing in Seoul and Gyeonggi-do need to be improved. For improving their eating behavior and nutritional health status, parents and children need customized nutrition education programs based on sex, age, region and weight status of preschool children as well as the degree of parents' health consciousness.

[Correlation between screen-watching time and emotional problems as well as combination effect of outdoor time among preschool children].

Objective: To evaluate the positive correlation between excessive screen-watching time, combined effect of screen-watching and outdoor time and the emotional problems in preschool children. Methods: A total of 27 200 preschool children aged 3-6 years in 109 kindergartens in 11 cities in Jiangsu, Hubei, Anhui participated in the study. Information on both screen-watching and outdoor time and social-demographic characteristics was collected through the Questionnaire on the healthy Development of Preschool Children. Emotional problems of these children were accessed by using the Strengths and Difficulties Questionnaire (SDQ). Correlation intensity between excessive screen time and emotional problems (suspicious or abnormal) in preschool children, and the combined effects of screen-watching and outdoor time were analyzed by binary logistic regression model. Results: The overall detected rate of emotional symptoms in preschool children was 17.9% (4 868/27 200). Rates showed in preschool children would include: with screen-watching time>1 h/d as 62.4% (16 983/27 200) and with outdoor time<2 h/d as 65.7% (17 873/27 200). After adjusting for confounding factors as gender, age, place of residence, family economic status, BMI, parents' age and education level, data showed that the screen-watching time was positive correlated with emotional symptoms (OR=1.15, 95%CI: 1.08-1.24) while the outdoor time was positive correlated with emotional symptoms (OR=1.08, 95%CI: 1.01-1.16). Strong correlation between the combination of screen-watching and outdoor time and the existing emotional problems among preschool children was seen. Conclusions: Excessive screen-watching time was prevalent among preschool children. Screen-watching time was positively associated with the existing emotional problems while the combined effect of screen-watching time and outdoor time was stronger.

Correlation between screen-watching time and emotional problems as well as combination effect of outdoor time among preschool children / 中华流行病学杂志

Objective@#To evaluate the positive correlation between excessive screen-watching time, combined effect of screen-watching and outdoor time and the emotional problems in preschool children.@*Methods@#A total of 27 200 preschool children aged 3-6 years in 109 kindergartens in 11 cities in Jiangsu, Hubei, Anhui participated in the study. Information on both screen-watching and outdoor time and social-demographic characteristics was collected through the Questionnaire on the healthy Development of Preschool Children. Emotional problems of these children were accessed by using the Strengths and Difficulties Questionnaire (SDQ). Correlation intensity between excessive screen time and emotional problems (suspicious or abnormal) in preschool children, and the combined effects of screen-watching and outdoor time were analyzed by binary logistic regression model.@*Results@#The overall detected rate of emotional symptoms in preschool children was 17.9% (4 868/27 200). Rates showed in preschool children would include: with screen-watching time>1 h/d as 62.4% (16 983/27 200) and with outdoor time<2 h/d as 65.7% (17 873/27 200). After adjusting for confounding factors as gender, age, place of residence, family economic status, BMI, parents’ age and education level, data showed that the screen-watching time was positive correlated with emotional symptoms (OR=1.15, 95%CI: 1.08-1.24) while the outdoor time was positive correlated with emotional symptoms (OR=1.08, 95%CI: 1.01-1.16). Strong correlation between the combination of screen-watching and outdoor time and the existing emotional problems among preschool children was seen.@*Conclusions@#Excessive screen-watching time was prevalent among preschool children. Screen-watching time was positively associated with the existing emotional problems while the combined effect of screen-watching time and outdoor time was stronger.

[Dietary patterns among preschoolers and its association with education level of the parents].

Objective: To identify the dietary patterns among preschoolers in Ma'anshan, and to investigate its association with the education levels of the parents. Methods: A total of 16 439 children aged 3-6 were recruited from 91 kindergartens in Ma'anshan city to participate in the study. Food frequency and socio-demographic information were collected through questionnaire survey. Dietary data was collected using a food frequency questionnaire (FFQ), and principal-components analysis was used to derive the dietary patterns. Ordinal multinomial logistic regression was employed to explore the association between the education level of parents and the dietary patterns. Results: Five dietary patterns- "processed" , "beverage" , "snack" , "protein" and "vegetarian" were identified. Data showed that the total variance was 48.02% and the cumulative proportion of processed reached 24.78%. Low educational level of the father was positively associated with both "beverage" (OR=1.36, 95%CI: 1.15-1.63) and "snack" dietary pattern (OR=1.21, 95%CI: 1.01-1.43). Low educational level of mother was positively associated with the "processed" (OR=1.31, 95%CI: 1.09-1.57) and "beverage" dietary pattern (OR=1.48, 95%CI: 1.23-1.77), and showed a negative correlation with "protein" (OR=0.62, 95%CI: 0.52-0.74) and "vegetarian" dietary pattern (OR=0.72, 95%CI: 0.60-0.86). Conclusion: Findings from this study showed that preschoolers in Ma'anshan tend to choose unhealthy dietary pattern. Dietary pattern was directly influenced by the parents, and especially the education level of the mothers.

Dietary patterns among preschoolers and its association with education level of the parents / 中华流行病学杂志

Objective To identify the dietary patterns among preschoolers in Ma'anshan,and to investigate its association with the education levels of the parents.Methods A total of 16 439 children aged 3-6 were recruited from 91 kindergartens in Ma'anshan city to participate in the study.Food frequency and socio-demographic information were collected through questionnaire survey.Dietary data was collected using a food frequency questionnaire (FFQ),and principal-components analysis was used to derive the dietary patterns.Ordinal multinomial logistic regression was employed to explore the association between the education level of parents and the dietary patterns.Results Five dietary patterns-"processed","beverage","snack","protein" and "vegetarian" were identified.Data showed that the total variance was 48.02％ and the cumulative proportion of processed reached 24.78％.Low educational level of the father was positively associated with both "beverage"(OR=1.36,95％CI:1.15-1.63) and "snack" dietary pattern (OR=1.21,95％CI:1.01-1.43).Low educational level of mother was positively associated with the "processed" (OR =1.31,95％CI:1.09-1.57) and "beverage"dietary pattern (OR=1.48,95％CI:1.23-1.77),and showed a negative correlation with "protein" (OR=0.62,95％ CI:0.52-0.74) and "vegetarian" dietary pattern (OR=0.72,95％ CI:0.60-0.86).Conclusion Findings from this study showed that preschoolers in Ma'anshan tend to choose unhealthy dietary pattern.Dietary pattern was directly influenced by the parents,and especially the education level of the mothers.

Dietary patterns among preschoolers and its association with education level of the parents / 中华流行病学杂志

Objective To identify the dietary patterns among preschoolers in Ma'anshan,and to investigate its association with the education levels of the parents.Methods A total of 16 439 children aged 3-6 were recruited from 91 kindergartens in Ma'anshan city to participate in the study.Food frequency and socio-demographic information were collected through questionnaire survey.Dietary data was collected using a food frequency questionnaire (FFQ),and principal-components analysis was used to derive the dietary patterns.Ordinal multinomial logistic regression was employed to explore the association between the education level of parents and the dietary patterns.Results Five dietary patterns-"processed","beverage","snack","protein" and "vegetarian" were identified.Data showed that the total variance was 48.02％ and the cumulative proportion of processed reached 24.78％.Low educational level of the father was positively associated with both "beverage"(OR=1.36,95％CI:1.15-1.63) and "snack" dietary pattern (OR=1.21,95％CI:1.01-1.43).Low educational level of mother was positively associated with the "processed" (OR =1.31,95％CI:1.09-1.57) and "beverage"dietary pattern (OR=1.48,95％CI:1.23-1.77),and showed a negative correlation with "protein" (OR=0.62,95％ CI:0.52-0.74) and "vegetarian" dietary pattern (OR=0.72,95％ CI:0.60-0.86).Conclusion Findings from this study showed that preschoolers in Ma'anshan tend to choose unhealthy dietary pattern.Dietary pattern was directly influenced by the parents,and especially the education level of the mothers.

Simultaneous assessement of social skills and behavior problems: Education and gender / Avaliação simultânea de habilidades sociais e problemas de comportamento: escolaridade e gênero

The aim was to compare the social skills of preschool and school-age children, considering groups differentiated by behavior problem indicators, according to the assessment performed by parents and teachers. Children of both genders participated in this study. Parents/primary caregivers assessed 194 children and 294 children were assessed by their teachers. The results indicated that, for the parents and teachers, the children without problems were more socially skilled. The gender of the children distinguished the repertoire of social skills, according to their parents, mainly the school-age children. For the teachers, considering both school periods, girls were more socially skilled and, for both parents and teachers, boys presented more behavior problems. These data have implications for assessment and intervention procedures.(AU)

Objetivou-se comparar as habilidades sociais de crianças pré-escolares e escolares considerando grupos diferenciados por problemas de comportamento e gênero, tendo por referência as avaliações de pais e professores. Participaram crianças de ambos os sexos, 194 avaliadas por pais/cuidadores primários e 294 por professores, dos períodos pré-escolar e escolar. Os resultados indicaram que para pais e professores as crianças sem problemas são mais habilidosas, tanto na pré-escola como na idade escolar. O gênero das crianças diferenciou o repertório de habilidades sociais, segundo os pais, para escolares. Para os professores, em ambos os períodos escolares as meninas foram mais habilidosas e, para pais e professores, os meninos apresentaram mais problemas de comportamento. Esses dados têm implicações para procedimentos de avaliação e intervenção.(AU)

Simultaneous assessement of social skills and behavior problems: Education and gender / Avaliação simultânea de habilidades sociais e problemas de comportamento: escolaridade e gênero

The aim was to compare the social skills of preschool and school-age children, considering groups differentiated by behavior problem indicators, according to the assessment performed by parents and teachers. Children of both genders participated in this study. Parents/primary caregivers assessed 194 children and 294 children were assessed by their teachers. The results indicated that, for the parents and teachers, the children without problems were more socially skilled. The gender of the children distinguished the repertoire of social skills, according to their parents, mainly the school-age children. For the teachers, considering both school periods, girls were more socially skilled and, for both parents and teachers, boys presented more behavior problems. These data have implications for assessment and intervention procedures.

Objetivou-se comparar as habilidades sociais de crianças pré-escolares e escolares considerando grupos diferenciados por problemas de comportamento e gênero, tendo por referência as avaliações de pais e professores. Participaram crianças de ambos os sexos, 194 avaliadas por pais/cuidadores primários e 294 por professores, dos períodos pré-escolar e escolar. Os resultados indicaram que para pais e professores as crianças sem problemas são mais habilidosas, tanto na pré-escola como na idade escolar. O gênero das crianças diferenciou o repertório de habilidades sociais, segundo os pais, para escolares. Para os professores, em ambos os períodos escolares as meninas foram mais habilidosas e, para pais e professores, os meninos apresentaram mais problemas de comportamento. Esses dados têm implicações para procedimentos de avaliação e intervenção.

[Manual medicine and osteopathic methods on the growing spine]. / Manuelle Medizin und osteopathische Verfahren an der wachsenden Wirbelsäule.

The application of various techniques in manual medicine on infants, toddlers and adolescents enjoys widespread acknowledgement not only in the musculoskeletal field but also beyond that. For a long time, the seminars of the DGMM have been trying to structure the advanced training of doctors and the vocational training of physiotherapists and to adjust it according to the latest clinical and scientific findings (in this subject matter). Considering the controversial debates, this seems particularly necessary and meaningful. This article aims to identify the current state of discussion and the consensus between medical associations but it also means to provide assistance in daily routine.

Umbilicus application with Chinese medicine for chronic diarrhea due to food intolerance in kids：a multicenter randomized trial / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of umbilicus application with Chinese medicine in treating children’s chronic diarrhea due to food intolerance and the value of healthy diet education. Methods:Eighty kids with chronic diarrhea due to food intolerance were recruited from multiple centers and divided by using the random number table into a treatment group of 40 cases and a control group of 40 cases. For both groups, based on the level of serum food-specific immunoglobulin G (Ig-G), the patients were given unified diet following the healthy diet guidance: safe, alternate, and forbidden, while the treatment group was additionally given umbilicus application with Chinese medicine. The therapeutic efficacy and symptom score of traditional Chinese medicine (TCM) were observed and compared respectively after 1-week, 2-week, 4-week, and 12-week treatment. Results:The diarrhea symptoms and coupled symptoms scores dropped significantly in the two groups after treatment ( all P<0.05), and the inter-group comparisons also showed statistical significances (P<0.05). The total effective rate was 97.5% in the treatment group versus 77.5% in the control group, and the inter-group difference was statistically significant (P<0.05). Conclusion:The healthy diet guidance based on the food intolerance test is effective in helping treat diarrhea, while umbilicus application with Chinese medicine works better in treating diarrhea for kids with chronic diarrhea due to food intolerance and can significantly enhance the therapeutic efficacy.

The use of antipsychotics in preschoolers: a veto or a sensible last option?

Recent reports have illustrated a dramatic rise in the use of antipsychotics in preschool children, medications originally designed and licensed for the treatment of adult psychotic disorders. Within this context, the current usage and the associated diagnoses are reviewed and compared with official guidelines and licensing for such use, highlighting a controversial challenge for clinicians. A review of the evidence base of the relative efficacy of such medications for a range of disorders is given. Associated safety and side effects are discussed, with compelling evidence for increased adverse events associated with use of antipsychotics in preschoolers, and neurodevelopmental hypotheses are used to guide predictions of long-term risk. An apparent gap in the literature and evidence base supporting such use and elucidating the risks and benefits leaves a challenge for clinicians and researchers and hinders the development of appropriate guidelines. Pragmatism in clinical practice, mindful of the limited evidence base that does exist and the propensity for harm, is necessary; far more research is required in this important area.

Mid-upper Arm Circumference Based Undernutrition among Bengalee Children of Chapra, West Bengal, India.

OBJECTIVE: To investigate age and sex variations in undernutrition using mid-upper arm circumference (MUAC) cut-off values among 2016 (930 boys and 1086 girls). 3-5 years old rural children of Bengalee ethnicity at 66 Integrated Child Development Services (ICDS) Centers of Nadia District, West Bengal, India. METHODS: In a cross sectional study in west Bengal of India, MUAC was measured using standard technique. A total of 2028 children (935 boys and 1093 girls) from 66 ICDS centers were enrolled in this study. The response rate was approximately 95%. FINDINGS: Mean MUAC among boys was higher than girls at all ages except 5 years. Significant sex differences were not observed over ages. The age-combined rates of overall (moderate and severe) undernutrition among boys (38.49%) was higher than among girls (32.22%).The age-combined rates of moderate undernutrition were 36.34% and 31.03% among boys and girls, respectively. The rates of severe undernutrition were 2.15% and 1.20% among boys and girls, respectively. There were sex differences in both moderate and severe undernutrition. In general, there was an increasing trend in the rates of overall undernutrition from 3 to 5 years in both sexes. CONCLUSION: These children were experiencing severe nutritional stress.

Therapeutic Effect of Jianpi Yin for Repeated Respiratory Tract Infection in Preschool Children / 广州中医药大学学报

0.05).However,the effect on decreasing mean yearly incidence of RRTI and duration of each onset in group A was superior to that in group B(P0.05).【Conclusion】JY can reduce the mean yearly incidence of RRTI and duration of each onset in preschool children with RRTI,and its mechanism may be related to the regualtion of cellular immune function by improving the parameters of subgroups of T lymphocytes.

Preliminary Study on the Relationship Between Blood Lead Levels and Height, Weight of Preschool Children in Harbin / 环境与健康杂志

ve To explore the levels of boood lead of preschool children in Harbin and their impacts on the growth and development of children. Methods 310 preschool children aged 4~7 years were selected for measurement of height and weight, and for collection of fasting blood samples, determined for concentrations of lead by ICP/ MS assay. The state of lead poisoning in selected subjects was defined based on the blood lead level of ?100?g/L ruled by the standard of children's lead poisoning established by CDC in 1991 and Health Assessment Scale for Growth and Development of Children set by Academy of Preventive Medicine. Results The prevalance rate of lead poisoning a-mong selected preschool children was 14.9%. Significantly negative correlation was observed between the blood lead levels and heights (H), body weights(BW) in children aged 4~5 years (rBw = -0.158, P

Investigation on Blood Lead Levels of Preschool Children in Harbin and Jixi / 环境与健康杂志

Objective To understand the effects of environmental pollution on blood lead levels of children.Methods The blood lead levels of605children aged2-7in6urban districts of Harbin and307children aged2-7in Jixi were deter-mined by graphite furnace atom absorption spectrophotometry during the period from April to June in1999.Results The data on blood lead levels of children in two cities showed both positive skewness distribution.The geometric means of blood lead lev-els of children were0.354?mol/L in Harbin and0.441?mol/L in Jixi,the medians were0.369?mol/L in Harbin and0.440?mol/L in Jixi,the values of P 95 were1.575?mol/L in Harbin and1.304?mol/L in Jixi.The children with blood lead levels of≥0.483?mol/L accounted for44.5%of total observed in Harbin and44.9%in Jixi.Conclusion Environmental lead pollution had coused potential adverse effects on preschool children health.

Effects of Environmental Lead Exposure on Immune System in Preschool Children / 环境与健康杂志

Objective To explore the effects of environmental lead exposure on immune system in preschool children. Methods The blood lead levels of 217 preschool children were determined by graphite furnance atomic absorption spectrophotometry. The distribution of T_lymphocyte subsets: CD 3+,CD 3+CD 4+,CD 3+CD 8+, B cells (CD 3- CD 19+), NK cells (CD 3-CD 16+CD 56-) were analyzed by flow cytometer, the levels of serum immunoglobulin G and immunoglobulin M were determined by scattering turbidimetry, the levels of serum immunoglobulin E were examined with ELISA. Results The mean level of blood lead of 217 preschool children was (0.46?0.27)?mol/L(range:0.11～2.71 ?mol/L). The blood lead levels of 63 preschool children were ≥0.48 ?mol/L. 38 preschool children among 63 preschool children with blood lead level of ≥0.48 ?mol/L were selected as the high_blood_lead group, 35 preschool children with blood lead levels of 0.05). Condusion The blood lead levels of ≥0.48 ?mol/L presented adverse effects on the T_lymphocyte subsets.