Identification of target behavior in process of intervention for children with feeding difficulty and relevant factors in randomized controlled trial

Objective To identify the target behavior in the process of behavioral intervention for children with feeding difficulty and relevant factors that may contribute to more effective intervention.Methods Children aged from 1 to 6 years with feeding difficulty randomly received interactive behavioral intervention(245 cases)or routine primary care(217 cases).By the end of the 1,3,6,and 9 months,the rating score of feeding difficulty and the body mass index(BMI)were assessed.The target behavior was determined based on the selecting criteria that simultaneously satisfied two conditions:①it was relevant to improving children's nutritional status;②it changed fast during intervention.Moreover,the relevant factors of target behavior were analyzed by multivariate analysis(Multi-Way ANOVA).Results Among nine behaviors of feeding difficulty,"eating slowly"was identified as a target behavior because it was closely relevant to the BMI z-score increment and had the biggest score reduction at early stage during intervention.Various factors were relevant to improving the target behavior,including parents acting as caregivers,caregiver's education level equal to and above junior college,and caregiver's concern about their children's feeding difficulty.Conclusion"Eating slowly"should be selected as the target behavior for early intervention for children with feeding difficulty and some social factors should be considered for optimizing the intervention.

The Prevalence and Risk Factors Associated with Otitis Media in Children under Five Years of Age in Mogadishu, Somalia: A Hospital-Based Cross-Sectional Study

Background: Otitis media (OM) is highly prevalent and is one of the most important causes of preventable hearing loss in developing countries and it may have long-term impacts on the children. Several hospital-based cross-sectional studies have been conducted in East African countries to assess the prevalence of OM;however, no similar studies have been conducted in Somalia. Therefore, we conducted a hospital-based cross-sectional study to identify the prevalence and the underlying risk factors of OM among children under the age of five in Mogadishu, Somalia. Methodology: A hospital-based cross-sectional study was conducted from July 2022 to November 2022 at three main hospitals in Mogadishu, Somalia. A total of 384 children aged less than 5 years were included. Parents of these children were interviewed with a questionnaire and a clinical examination was performed for each child. The Statistical Package for Social Sciences, SPSS (Version 22, IBM, Inc.), was used for the statistical analysis. Result: The prevalence of otitis media among the 384 children recruited was 31.25% (120/384). Otitis media was significantly associated with age less than one year (P = 0.006), malnutrition (P Conclusion: In summary, the present study found that otitis media was highly prevalent (31.25%) in Mogadishu, Somalia. The majority of the affected children were younger than one year. Age of the child, malnutrition, upper respiratory tract infections, feeding in lying position, and dripping something into a child’s ear were found to significantly increase the risk of developing otitis media in children. In contrast, breastfeeding for more than one year has been found to reduce the risk of developing otitis media in children.

Neuropsychological Profile Related with Executive Function of Chinese Preschoolers with Attention-Deficit/Hyperactivity Disorder： Neuropsychological Measures and Behavior Rating Scale of Executive Function-Preschool Version

Previous studies have found that schoolchildren with attention-deficit/hyperactivity disorder （ADHD） showed difficulties in neuropsychologicat function. This study aimed to assess neuropsychological function in Chinese preschoolers with ADHD using broad neuropsychological measures and rating scales and to test whether the pattern and severity of neuropsyehological weakness differed among ADH D presentations in preschool children. Methods： The 226 preschoolers （163 with ADHD and 63 controls） with the age of 4-5 years were included and assessed using the Behavior Rating Scale of Executive Function-Preschool Version （BRIEF-P） and a series of tests to investigate neuropsychological function. Results： Preschoolers with ADHD showed higher scorns in all domains of the BRIEF-P （inhibition： 30.64 ± 5.78 vs.20.69 ± 3.86, P 〈 0.001; shift： 13.40 ±3.03 vs. 12.41 ±2.79, P = 0.039; emotional control：15.10 ±3.53 vs.12.20 ±2.46, P 〈 0.001; working memory： 28.41± 4.99 vs.20.95± 4.60, P 〈 0.001 ; plan/organize： 17.04 ±3.30 vs. 13.29± 2.40, P 〈 0.001 ） and lower scores of Statue （23.18± 7.84 vs.28.27 ± 3.18, P = 0.001 ）, Word Generation （ 15.22 ± 6.52 vs. 19.53 ± 7.69, P = 0.025）, Comprehension of Instructions （ 14.00 ±4.44 vs. 17.02± 3.39, P = 0.016）, Visuomotor Precision （P 〈 0.050）, Toy delay （P = 0.048）, and Matrices tasks （P = 0.011）, compared with normal control. In terms of the differences among ADHD subtypes, all ADHD presentations had higher scores in several domains of the BRIEF-P （P 〈 0.001 ）, and the ADHD-combined symptoms （ADHD-C） group had the poorest ratings on inhibition and the ability to Plan/Organize. For neuropsychological measures, the results suggested that the ADHD-C group had poorer pertbrmances than the ADHD-predominantly inattentive symptoms （ADHD-I） group on Statue tasks （F = 7.34, η2= 0.12, P 〈 0.001 ）. Furthermore, the ADHD-hyperactive/impulsive symptoms group had significantly poorer perforulances compared to the ADHD-C group in the Block Construction task （F = 4.89, η2 = 0.067, P = 0.003）. However, no significant group differences were found between the ADHD-I group and normal control. Conclusion： Based on the combined evaluation of performance-based neuropsychological tests and the BRIEF-P, preschoolers with ADHD show difficulties of neuropsychological function in many aspects.

Childhood sleep:physical,cognitive,and behavioral consequences and implications

Background Sleep problems in children have been increasingly recognized as a major public health issue.Previous research has extensively studied and presented many risk factors and potential mechanisms for children’s sleep problems.In this paper,we aimed to identify and summarize the consequences and implications of child sleep problems.Data sources A comprehensive search for relevant English language full-text,peer-reviewed publications was performed focusing on pediatric sleep studies from prenatal to childhood and adolescence in a variety of indexes in PubMed,SCOPUS,and Psych Info published in the past two decades.Both relevant data-based articles and systematic reviews are included.Results Many adverse consequences are associated with child sleep deficiency and other sleep problems,including physical outcomes(e.g.,obesity),neurocognitive outcomes(e.g.,memory and attention,intelligence,academic performance),and emotional and behavioral outcomes(e.g.,internalizing/externalizing behaviors,behavioral disorders).Current prevention and intervention approaches to address childhood sleep problems include nutrition,exercise,cognitive–behavioral therapy for insomnia,aromatherapy,acupressure,and mindfulness.These interventions may be particularly important in the context of coronavirus disease 2019.Specific research and policy strategies can target the risk factors of child sleep as well as the efficacy and accessibility of treatments.Conclusions Given the increasing prevalence of child sleep problems,which have been shown to affect children’s physical and neurobehavioral wellbeing,understanding the multi-aspect consequences and intervention programs for childhood sleep is important to inform future research direction as well as a public health practice for sleep screening and intervention,thus improving sleep-related child development and health.

Early developmental levels of children with autism spectrum disorder with different adaptive behaviors:a retrospective analysis

The Diagnostic and Statistical Manual of Mental Disorders,5th Edition(DSM-5)(American Psychiatric Association,2013)defines autism spectrum disorder(ASD)as a complex neurodevelopmental disorder that begins in early childhood and is accompanied by social communication deficits and repetitive stereotyped behaviors.

Diagnosis,treatment and prevention of severe acute respiratory syndrome coronavirus 2 infection in children:experts'consensus statement updatedforthe Omicron variant

It has been more than 3 years since the novel coronavirus(SARS-CoV-2)pandemic raged globally.The coronavirus disease 2019(COVID-19)has greatly influenced human society.According to data from the World Health Organization(WHO),there were over 656 million confirmed cases of COVID-19 in the world as of January 1,2023,including over 6.6 million deaths[1].

Comparison of Electroacupuncture and Body Acupuncture on Gastrocnemius Muscle Tone in Children with Spastic Cerebral Palsy: A Single Blinded, Randomized Controlled Pilot Trial

Objective:To compare the immediate effects of electroacupuncture(EA)and body acupuncture(BA)on gastrocnemius muscle tone in children with spastic cerebral palsy(CP).Methods:Children with spastic CP,age from 24 to 60 months,who all received rehabilitation treatment in the Department of Developmental and Behavioral Pediatrics,the First Hospital of Jilin University from April 2016 to May 2017 were enrolled in this trial and assigned to EA group and BA group through a random number table.Both EA and BA therapies were performed on acupoints of Zusanli(ST 36),Shangjuxu(ST 37),Sanyinjiao(SP 6),and Xuanzhong(GB 39)for 30 min once.The root mean square(RMS),integrated electromyogram(iEMG)of the gastrocnemius of surface electromyography(sEMG),and Modified Tardieu Scale(MTS)of the two groups were evaluated before and after treatment.All adverse events were accurately recorded.Results:Thirty-six children with spastic CP completed the study(18 cases and 32 legs in the EA group;18 cases and 31 legs in the BA group).There was no significant difference in RMS,iEMG and MTS between the two groups before treatment(P>0.05).After treatment,compared with before treatment,RMS and iEMG significantly reduced and MTS(R2–R1)significantly increased in both EA and BA groups(P<0.05),and EA was more effective than BA in RMS and MTS(P<0.05).However,the iEMG between the two groups were not statistically significant after treatment(P>0.05).There was no serious adverse event during this clinical trial.Conclusion:Both EA and BA could significantly relieve the gastrocnemius muscle tone in spastic CP,and EA was more effective than BA.

Current status and challenge in clinical work of autism spectrum disorders in China

Autism spectrum disorders (ASDs) are a group of neurodevelopmentaldisorders featured by social communicationand interaction deficits, and with limited interests andrepetitive behaviors. In China, ASDs was first reported byTao from Nanjing Brain Hospital in the early 1980s [ 1 , 2 ].Since then, more children with autism have been diagnosed.While the past more than 30 years have witnessed steadygrowth in ASD research and clinical diagnosis and interventionin China, there are still many challenges to overcome.In this article, we will present the current status of prevalence,screening and diagnosis of ASD in China and proposefurther eff orts for practitioners and policy-makers to secureoptimal outcomes for children with ASD.

Somatic growth of lean children:the potential role of sleep

Background:Despite the current obesity pandemic,childhood malnutrition remains an urgent,public health concern.Similar to the obesity pandemic,childhood malnutrition is influenced by genetic and a number of social,environmental and biological factors.In this study,we investigated the association between sleep duration and somatic growth in lean children.Methods:A stratified,randomly clustered sampling design was used to select fifth grade students from 10 primary schools in Shanghai.Based on a body mass index below the 15th percentile a subsample of 143 lean children aged 10-11 years old was defi ned.Sleep duration and other potential confounders were surveyed through parental or self-report questionnaires.Body measurements were collected and used to calculate the Z score of weight,height,body mass index as well as body fat percentage.Results:Compared with children who slept<9 hours,those who slept for≥10 hours grew taller and gained more weight after adjusting for confounding factors.When children slept 9-10 hours,they had signifi cantly higher Z score of weight and body mass index.Conclusions:Prolonged sleep not only benefi ts weight gain but also improves height in lean children.Our findings might provide important public health advice such that prolonged sleep may be an effective modifi er of nutritional problems in childhood.

Maternal and neonatal blood vitamin D status and neurodevelopment at 24 months of age:a prospective birth cohort study

Background This study aimed to explore the relationship of 25-hydroxyvitamin D[25(OH)D]in three trimesters and at birth with neurodevelopment at 24 months of age.Methods From 2013 to 2016,pregnant women from the Shanghai Birth Cohort in China were recruited for the study.Altogether,649 mother-infant pairs were included.Serum 25(OH)D was measured with mass spectrometry in three trimesters,and cord blood was divided into deficiency(<20 and<12 ng/mL,respectively),insufficiency(20–30 and 12–20 ng/mL,respectively),and sufficiency(≥30 and≥20 ng/mL,respectively).Bayley-III scale was used to assess cognitive,language,motor,social-emotional,and adaptive behavior development at 24 months of age.The Bayley-III scores were grouped into quartiles,and scores within the lowest quartile were defined as suboptimal development.Results After adjusting for confounding factors,cord blood 25(OH)D in the sufficient group was positively correlated with cognitive[β=11.43,95%confidence interval(CI)=5.65–17.22],language(β=6.01,95%CI=1.67–10.3),and motor scores(β=6.43,95%CI=1.73–11.1);cord blood 25(OH)D in the insufficient group was also positively correlated with cognitive scores(β=9.42,95%CI=3.74–15.11).Additionally,sufficient vitamin D status in the four periods and persistent 25(OH)D≥30 ng/mL throughout pregnancy were associated with a lower risk of suboptimal cognitive development in adjusted models,although the effects were attenuated after applying the false discovery rate adjustment.Conclusions Cord blood 25(OH)D≥12 ng/mL has a significant positive association with cognitive,language,and motor development at 24 months of age.Sufficient vitamin D status in pregnancy might be a protective factor for suboptimal neurocognition development at 24 months of age.

Increasing prevalence and influencing factors of childhood asthma: a cross-sectional study in Shanghai, China

Background Asthma has been a global problem,especially in children.We aim to evaluate the contemporary prevalence and influencing factors of asthma among children aged 3–7 years in Shanghai,China.Methods A random sample of preschool children was included in this study.The International Study of Asthma and Allergies in Childhood questionnaire was adopted to assess the childhood asthma.Multivariable logistic regression models were used to evaluate the associations between independent variables and childhood asthma.Results Of 6389 preschool children who were invited to take part in this study,6163(response rate:96.5%)completed the questionnaire and were included in the analysis.The overall prevalence of asthma was 14.6%which increased more than six folds from 2.1%in 1990.Being male,younger age,preterm delivery,being born in spring or autumn,being delivered by elective cesarean section without indication,miscarriage,high socioeconomic status,having allergy history,and exposure to passive smoking,latex paint,and dust were potential risk factors for childhood asthma.Spending more time outdoors(>30 min/day),having indoor plants,and cleaning rooms more frequently were potential protective factors.Conclusions The prevalence of childhood asthma in Shanghai has increased dramatically during the past three decades.The findings about risk and protective factors of childhood asthma could be used to develop appropriate strategies to prevent and control childhood asthma in Shanghai and in other similar metropolitan cities.

Influence of parental education on the intelligence quotient profiles and socially adaptive behavior of school-age children with autism spectrum disorder in eastern China

Intelligence quotient(IQ)and adaptive behavior are the influencing factors of autism spectrum disorder(ASD)in children entering mainstream schools.This study explored the association between parental education level,IQ,and adaptive behavior in ASD groups.A total of 257 school-age ASD children were enrolled in our study from January 2017 to June 2021.Their parents completed a standard demographic form,including age at autism diagnosis,gender,school placement,and parents’educational background.The Chinese version of the Wechsler Intelligence Scale for Children,Fourth Edition(WISC-IV)was completed by a certified assessor for each enrolled child.Parents were interviewed on adaptive behavior using the Chinese version of the Adaptive Behavior Assessment System,Second Edition(ABAS-II).The average IQ of school-age ASD children was 76.88(standard deviation(SD)=22.62)and boys had higher IQ levels than girls.The IQ was positively correlated with age.The General Adaptive Composite(GAC)score was 82.47(SD=15.86)and adaptive behavior did not increase with age.ASD children who attended mainstream schools had better adaptive behavior profiles than other children.The mother’s education level showed a significant correlation with the IQ and adaptive behavior of autistic children,while the father’s education level did not.Consequently,better training and support for parents may help autistic children enter mainstream schools,with adaptive training being the most urgently required skill for parents.

Exploring atmospheric environmental drivers of asthma among children in Shanghai, China: Evidence-informed policies are required

It is important to identify atmospheric environmental drivers of childhood asthma because asthma is the most common chronic disease in children globally.We provided an overview of the impacts of exposure to atmospheric environmental factors(e.g.,meteorological factors and air pollutants)on childhood asthma,based on a series of studies with the cutting-edge environmental epidemiological methodology in Shanghai,China.Overall,we found that the prevalence of asthma among the children aged 3–7 years had increased by approximately 7 fold,from 2.1%in 1990 to 14.6%in 2019.Most meteorological factors(i.e.daily mean temperature,temperature difference,air pressure,air pressure difference,precipitation,relative humidity,sunshine and wind speed)and air pollutants(PM10,PM2.5,NO2,SO2 and O3)were significantly associated with childhood asthma(p<0.05),but meteorological factors appeared to play more important roles than air pollutants in the occurrence of asthma exacerbations.We also found that temperature variability was significantly associated with the elevated relative risk of daily outpatient visits for childhood asthma(p<0.05).Furthermore,we conducted a systematic review on climate change adaptation measures and childhood asthma and found that there were a number of adaptation measures proposed for childhood asthma in response to climate change,including vulnerability assessment,improving ventilation and heating,enhancing community education,developing forecast models,and early warning systems.However,the effectiveness of most adaptation measures,except for improving ventilation and heating in winter,have not been explored and quantified.Since asthma is sensitive to the variation of atmospheric environmental conditions,it is critical to develop and implement appropriate climate change mitigation and adaptation strategies as global heating becomes apparent.

Diagnosis,treatment,and prevention of monkeypox in children:an experts'consensus statement

Monkeypox is a zoonotic disease.Since the first human monkeypox case was detected in 1970,it has been prevalent in some countries in central and western Africa.Since May 2022,monkeypox cases have been reported in more than 96 non-endemic countries and regions worldwide.As of September 14,2022,there have been more than 58,200 human monkeypox cases,and there is community transmission.The cessation of smallpox vaccination in 1980,which had some cross-protection with monkeypox,resulted in a general lack of immunity to monkeypox,which caused global concern and vigilance.As of Sep-tember 14,2022,there are four monkeypox cases in China,including three in Taiwan province and one in Hong Kong city.Previous foreign studies have shown that children are vulnerable to monkeypox and are also at high risk for severe disease or complications.In order to improve pediatricians'understanding of monkeypox and achieve early detection,early diagno-sis,early treatment,and early disposal,we have organized national authoritative experts in pediatric infection,respiratory,dermatology,critical care medicine,infectious diseases,and public health and others to formulate this expert consensus,on the basis of the latest"Clinical management and infection prevention and control for monkeypox"released by The World Health Organization,the"guidelines for diagnosis and treatment of monkeypox(version 2022)"issued by National Health Commission of the People's Republic of China and other relevant documents.During the development of this consensus,multidisciplinary experts have repeatedly demonstrated the etiology,epidemiology,transmission,clinical manifestations,laboratory examinations,diagnosis,differential diagnosis,treatment,discharge criteria,prevention,disposal process,and key points of prevention and control of suspected and confirmed cases.

Risk factors for recurrent macrosomia and child outcomes

Background Women who had delivered a macrosomic newborn will have a higher risk to deliver another macrosomia.We aimed to examine the recurrence risk of macrosomia in the subsequent pregnancy and the implications in long-term child health.Methods Data from the Collaborative Perinatal Project,a longitudinal birth cohort with 54,371 singleton births,were used.401 recurrent macrosomic infants (macro-macro) and 1327 normal weight babies with a macrosomia in the last pregnancy (macro-normal) were selected to explore risk factors for recurrent macrosomia.Furthermore,768 newly onset macrosomia with normal birthweight infant in previous pregnancies (normal-macro) were identified to examine long-term health effects of recurrent macrosomia.Results The recurrent rate of macrosomia was 23.2% [95% confidence interval (CI) 21.2%,25.2%].White race,higher pre-pregnant body mass index (BMI),more gestational weight gain,male infant and more prior macrosomic infants were significant risk factors for recurrent macrosomia.At 4 years of age,recurrent macrosomic infants had a higher BMI (16.7 vs.16.1 kg/m2,adjusted fβ:0.36,95% CI:0.12,0.60) and a higher risk of overweight and obesity (adjusted OR:1.56,95% CI:1.10,2.23) than infants with normal birthweight after a previous macrosomic sibling.There was no significant difference between recurrent macrosomia and newly onset macrosomia in child outcomes after adjustment for covariates.Conclusions Fetal macrosomia has a high recurrence rate in the following pregnancy.Higher maternal pre-pregnant BMI and gestational weight gain are still important risk factors for recurrence of macrosomia,which in turn increases the risk for childhood obesity.

Prevalence and factors associated with pentavalent vaccination:a cross-sectional study in Southern China

Background Immunization is one of the most far-reaching and cost-effective strategies for promoting good health and saving lives.A complex immunization schedule,however,may be burdensome to parents and lead to reduced vaccine compliance and completion.Thus,it is critical to develop combination vaccines to reduce the number of injections and simplify the immunization schedule.This study aimed to investigate the current status of the pentavalent diphtheria-tetanus-acellular pertussis inactivated poliomyelitis andHaemophilus influenzae type B conjugate(DTaP-IPV/Hib)vaccination in Southern China as well as explore the factors in the general population associated with uptake and the differences between urban and rural populations.Methods A cross-sectional study was conducted with recently enrolled kindergarten students in Hainan Province between December 2022 and January 2023.The study employed a stratified multistage cluster random sampling method.Information regarding the demographic characteristics and factors that influence decisions were collected from the caregivers of children via an online questionnaire.Multivariate logistic regression was used to determine the factors associated with the status of DTap-IPV/Hib vaccinations.Results Of the 4818 valid responses,95.3%of children were aged 3-4 years,and 2856(59.3%)held ruralhukou.Coverage rates of the DTaP-IPV/Hib vaccine,from 1 to 4 doses,were 24.4%,20.7%,18.5%,and 16.0%,respectively.Caregivers who are concerned about vaccine efficacy[adjusted odds ratio(aOR)=1.53,95%confidence interval(CI):1.30-1.79],the manufacturer(aOR=2.05,95%CI:1.69-2.49),and a simple immunization schedule(aOR=1.26,95%CI:1.04-1.54)are factors associated with a higher likelihood of vaccinating children against DTaP-IPV/Hib.In addition,caregivers in urban areas showed more concern about the vaccine price(P=0.010)and immunization schedule(P=0.022)in regard to vaccinating children.Conclusions The DTaP-IPV/Hib vaccine coverage rate in Hainan Province remains low.Factors such as lower socioeconomic status,cultural beliefs,concerns about vaccine safety,and cost may hinder caregivers from vaccinating their children.Further measures,such as health education campaigns to raise knowledge and awareness,and encouragement of domestic vaccine innovation,which would reduce out-of-pocket costs,could be implemented to improve the coverage of DTap-IPV/Hib vaccination.

Shanghai Autism Early Development:An Integrative Chinese ASD Cohort

Why Was the Cohort Set Up?Autism spectrum disorder(ASD)is a child neurodevelopmental disorder,the onset of which is generally within 3 years of age,and often leads to lifelong impaired social and cognitive functions,which impose significant mental pressure and economic burdens on the family and society.