Salivary Cortisol Levels after Hydrotherapy and Land-Based Therapy as a Marker of Stress in Children with Psychomotor Developmental Disorders: A Pilot Study.

Background: The number of children experiencing postnatal situations of neurological risk (such as psycho-motor developmental disorders and delays) after birth has increased in recent years. These infants often require multiple pediatric interventions to address functional problems that might generate stress, anxiety, and discomfort. The aim of the present study is to determine whether the level of salivary cortisol, as a stress marker, increases after hydrotherapy and land-based therapy in children at risk of or currently presenting delayed psycho-motor development. Methods: Saliva samples were collected from 25 children (aged 3-36 months) between June 2022 and January 2023 at the Rehabilitation and Physical Medicine Clinical Management Unit of the Virgen de las Nieves University Hospital, Granada, Spain. Three samples were collected from each child, representing baseline, post-hydrotherapy and post-land-based therapy. Result: All salivary cortisol levels were within the normal range. Resting values were the highest, and both modes of therapy decreased salivary cortisol levels. There were no statistically significant differences between the two therapies. Conclusions: Both therapies appear to be useful for treating children with psychomotor developmental disorders without increasing stress during physiotherapy sessions. Although cortisol levels were slightly higher with hydrotherapy than with land-based therapy, this may be due to the small sample size.

Erector spinae plane blocks: A narrative update.

The erector spinae plane block (ESPB) is perhaps one of the most interesting of the tissue plane blocks described recently. There has been an exponential increase in the number of publications for both adults and children over the past 5 years. Single-shot, intermittent bolus, and continuous infusion techniques have been used effectively. Both the efficacy and safety of the procedure are widely accepted, but the exact mechanism by which the local anesthetic spreads from the tip of the transverse process to block the dorsal and ventral rami of the spinal nerves is controversial and needs clarification. Anatomical differences in children, particularly in neonates and infants, may explain the spread in this age group. In most pediatric studies, erector spinae plane block was opioid sparing, and noninferiority was observed when compared with other regional techniques.

ECHOTIP-Ped: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in pediatric patients.

Central venous access devices are routinely used in pediatric care for administration of fluids and medications and for drawing blood samples. The adoption of ultrasound guided venipuncture, the availability of bedside ultrasound devices and the use of intraprocedural methods for tip location have been shown to reduce procedure-related complications, as documented by the recommendations of most recent guidelines. In pediatric patients, bedside ultrasound is a promising tool not only for optimizing the choice of the vein and guiding the venipuncture, but also for ensuring an accurate and intraprocedural method of tip navigation and tip location. The aim of this paper is to review all the evidence about the accuracy of ultrasound methods for tip navigation and tip location in pediatric patients, and to suggest a structured protocol for clinical practice.

Surgery of uretero-pelvic junction obstruction (UPJO).

Uretero-pelvic junction obstruction (UPJO) is the most common cause of hydronephrosis in infants and children. Historically, this condition has been approached surgically through a retroperitoneal approach as described by Anderson and Hynes aiming for an open dismembered pyeloplasty. A true evolution of laparoscopy in pediatric urology took place within the last 30 years. Laparoscopy developed from a merely diagnostic tool for non-palpable testes to "interventional" laparoscopy for extirpative surgery. Finally the era of reconstructive pediatric laparoscopic urology started, when in 1995 Peters described the first laparoscopic pyeloplasty in a child. Laparoscopic dismembered pyeloplasty now has become the preferred surgical treatment of UPJO. It offers excellent visualization of the anatomy, accurate anastomotic suturing, thus the precise reconstruction of the UPJ along with good functional outcome. This article aims to provide the current status, indication and operative technique of laparoscopic dismembered pyeloplasty for UPJO in infants and children.

The effect of lexical status on prosodic processing in infants learning a fixed stress language.

In speech processing, in the first year of life, prosody and phoneme-relevant aspects serve different functions. Recent studies have assumed that the two aspects become integrated at around 9 months of age. The present study investigates the effect of lexical status on stress processing in a fixed stress language. We hypothesize that lexicality modulates stress processing, and where the stress cue is in conflict with the lexical status (legal deviant condition), we will observe differences in age indicating the stage of integration. We tested 69 6 and 10 month-old infants in an acoustic oddball event-related potential paradigm. A frequent word stimulus (baba) and a pseudoword (bebe) were used with legal versus illegal stress. We systematically swapped the standard and deviant roles of the different stress variants in two conditions. In the illegal deviant condition in the case of the word stimulus, the response pattern typical for the pseudoword (an MMR to the absence of the stress cue) was missing. This implies the suppression effect of lexicality. In the legal deviant condition, negative MMR (N-MMR) in the second time window indicated a facilitation effect of lexicality in both age groups. As only the 6-month-olds produced an N-MMR in the first time window, we concluded that in a fixed stress language, integration starts at 6 months but is only completed by the age of 10 months. Our results show that lexical status modulates stress processing at word level in a highly regularly stressed language in which stable, long-term language-specific stress representation exists from early infancy.

'Clap your hands' or 'take your hands'? One-year-olds distinguish between frequent and infrequent multiword phrases.

Although words are often described as the basic building blocks of language, there is growing evidence that multiword sequences also play an integral role in language learning and processing. It is not known, however, whether children become sensitive to multiword information at an age when they are still building knowledge of individual words. Using a central fixation paradigm, the present study examined whether infants between 11 and 12 months (N = 36) distinguish between three-word sequences (trigrams) with similar substring frequencies but different multiword frequency in infant-directed speech (e.g., high frequency: 'clap your hands' vs. low frequency: 'take your hands'). Infants looked significantly longer at frequent trigrams compared to infrequent ones. This provides the first evidence that infants at the cusp of one-word production are already sensitive to the frequency of multiword sequences, and suggests they represent linguistic units of varying sizes from early on, raising the need to evaluate knowledge of both words and larger sequences during development.

Reconceiving the field: Infant mental health, intersectionality, and reproductive justice.

The field of infant mental health is conventionally comprised of professional discourses including developmental science, psychology, and psychiatry, among others, and involves spheres of practice as wide-ranging as pediatrics, maternal/child health, early intervention, early care and education, and child welfare. The World Association of Infant Mental Health [WAIMH] put out its position paper on the rights of infants in 2014 (amended in March 2016) in recognition of the human rights implications of professional understanding of infants' unique, yet universal, developmental capacities and needs. This article links the policy issues outlined in the WAIMH position paper with critical issues in the field of reproductive justice, extending the reach of WAIMH's call to action on behalf of infants' rights, and pointing the way toward potent alliances among interconnected movements. Connecting the dots among economic injustice, race-based health disparities, and gender inequities, the article demonstrates that it is not possible to safeguard infant mental health unless we make reproductive justice a reality.

El campo de la salud mental infantil está convencionalmente compuesto de temas profesionales que incluyen a la ciencia del desarrollo, la sicología y la siquiatría, entre otras, e involucra esferas de práctica que varían de un extremo al otro como la pediatría, la salud materno-infantil, la intervención temprana, el temprano cuidado y educación, y el bienestar del niño. La Asociación Mundial de Salud Mental Infantil [WAIMH] presentó su posición en cuanto a los derechos de los infantes en un ensayo en 2014 (corregido y aumentado en marzo de 2016) en reconocimiento de las implicaciones de los derechos humanos sobre la comprensión profesional de las distintivas y universales capacidades y necesidades de desarrollo de los infantes. Este artículo conecta los asuntos relacionados con políticas descritas en el ensayo que presentó la posición de WAIMH con asuntos críticos en el campo de la justicia reproductiva, extendiendo así el alcance de la llamada que hace WAIMH para actuar en beneficio de los derechos infantiles, y señalando el camino hacia fuertes alianzas entre movimientos interconectados. Conectar los puntos entre la injusticia económica, las disparidades de salud basadas en la raza, así como las desigualdades de género, el artículo demuestra que no es posible resguardar la salud mental infantil a menos que hagamos de la justicia reproductiva una realidad.

Le domaine de la santé mentale du nourrisson est traditionnellement constitué de discours professionnels qui comprennent la science liée au développement, la psychologie, et la psychiatrie parmi tant d'autres, et inclut des sphères de pratique aussi étendues que la pédiatrie, la santé maternelle et la santé de l'enfant, l'intervention précoce, les soins précoces et l'éducation, et le bien-être de l'enfant. L'Association Mondiale de la Santé Mentale du Nourrisson et du jeune enfant, abrégée en anglais WAIMH a diffusé un exposé de position sur les droits des nourrissons en 2014 (modifié en mars 2016) en reconnaissant les implications liées aux droits de l'homme de la compréhension professionnelle des capacités et des besoins uniques mais aussi universels des nourrissons. Cet article lie les questions stratégiques délinéées dans l'exposé de position de la WAIMH à des problèmes cruciaux dans le domaine de justice reproductive, élargissant ainsi la portée de l'appel à l'action de la WAIMH au nom des droits des nourrissons, et montrant la voie vers des alliances fortes entre les mouvements reliés entre eux. Faisant le lien entre l'injustice économique, les disparités de santé basées sur la santé et les inéquités entre les sexe, cet article démontre qu'il n'est pas possible de protéger la santé mentale du nourrisson si nous ne faisons pas de la justice reproductive une réalité.

Immunogenicity and safety of 11- and 12-valent pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccines (11vPHiD-CV, 12vPHiD-CV) in infants: Results from a phase II, randomised, multicentre study.

BACKGROUND: We assessed 2 investigational 11- and 12-valent vaccines, containing capsular polysaccharides of 10 serotypes as in the pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine (PHiD-CV) and CRM197-conjugated capsular polysaccharides of serotypes 19A (11-valent) or 19A and 6A (12-valent). METHODS: In this phase II, partially-blind, multicentre study (NCT01204658), healthy infants were randomised (1:1:1:1) to receive 11vPHiD-CV, 12vPHiD-CV, PHiD-CV, or 13-valent CRM197-conjugate pneumococcal vaccine (PCV13), at 2, 3, and 4 (primary series), and 12-15 months of age (booster dose), co-administered with DTPa-HBV-IPV/Hib. Confirmatory objectives assessed non-inferiority of investigational vaccines to comparators (PHiD-CV for common serotypes; PCV13 for 19A and 6A), in terms of percentage of infants with pneumococcal antibody concentrations ≥0.2 µg/mL and antibody geometric mean concentrations, post-primary vaccination. Reactogenicity and safety were assessed. RESULTS: 951 children received ≥1 primary dose, 919 a booster dose. Pre-defined immunological non-inferiority criteria were met simultaneously for 9/11 11vPHiD-CV serotypes (all except 23F and 19A) and 10/12 12vPHiD-CV serotypes (all except 19A and 6A); thus, non-inferiority objectives were reached. For each PHiD-CV serotype, percentages of children with antibody concentrations ≥0.2 µg/mL were ≥96.7% post-primary (except 6B [≥75.2%] and 23F [≥81.1%]), and ≥98.1% post-booster vaccination. For each PHiD-CV serotype except serotype 1, ≥81.0% and ≥93.9% of children had opsonophagocytic activity titres ≥8, post-primary and booster vaccination. AEs incidence was similar across all groups. SAEs were reported for 117 children (29 in the 11vPHiD-CV group, 26 in the 12vPHiD-CV group, 38 in the PHiD-CV group and 24 in the PCV13 group); 4 SAEs were considered vaccination-related. No fatal events were recorded. CONCLUSION: Addition of 19A and 6A CRM197-conjugates did not alter immunogenicity of the PHiD-CV conjugates; for both investigational vaccines post-booster immune responses to 10 common serotypes appeared similar to those elicited by PHiD-CV. Safety and reactogenicity profiles of the investigational vaccines were comparable to PHiD-CV. Clinical trial registry: NCT01204658.

Developmental dynamics of autonomic function in childhood.

There is a paucity of developmental data examining the stability of autonomic function during childhood, and even less is known regarding the extent of coordination between autonomic branches. To address this, autonomic measures of sympathetic (cardiac pre-ejection period, PEP; electrodermal activity, and EDA) and parasympathetic (respiratory sinus arrhythmia and RSA) function were collected from 339 children annually from kindergarten to second grade. Physiology was quantified into 31 epochs 30 s in length, across a series of baselines and emotion-inducing films. Rank-order stability was observed for all three indices, but was higher for cardiac than electrodermal measures. A series of multilevel models was used to identify the proportion of variance in psychophysiological function attributable to the individual (trait), visit (potential developmental change), or epoch (reactivity to task). Both PEP and RSA had sizeable components of individual-level variance, with PEP showing very small variance attributable to experimental task. In contrast, variance in EDA was largely attributable to task epoch. Variance decompositions of the parasympathetic-sympathetic coordination (e.g., RSA-EDA) suggest that the branches of the autonomic system are prototypically cooperative, but evidence did not indicate traitlike stability or linear developmental change. The extent of coordination was moderated by emotional context, indicating that autonomic coordination varies dynamically within individuals. These findings have implications for future work attempting to identify the contextual, experiential, and demographic factors that modulate developmental trajectories of autonomic function and coordination, and for examination of how developmental changes in autonomic psychophysiology are related to or predict behavioral trajectories across a range of psychological domains.

Parent-child coregulation of parasympathetic processes varies by social context and risk for psychopathology.

The parasympathetic nervous system supports social interaction and varies in relation to psychopathology. However, we know little about parasympathetic processes from a dyadic framework, nor in early childhood when parent-child social interactions become more complex and child psychopathology first emerges. We hypothesized that higher risk for psychopathology (maternal psychopathology symptoms and child problem behavior) would be related to weaker concordance of respiratory sinus arrhythmia (RSA) between mothers and children (M = 3½ years old; N = 47) and that these relations could vary by social contextual demands, comparing unstructured free play, semistructured cleanup, and structured teaching tasks. Multilevel coupled autoregressive models of RSA during parent-child interactions showed overall dynamic, positive concordance in mother-child RSA over time, but this concordance was weaker during the more structured teaching task. In contrast, higher maternal psychological aggression and child externalizing and internalizing problems were associated with weaker dyadic RSA concordance, which was weakest during unstructured free play. Higher maternal depressive symptoms were related to disrupted individual mother and child RSA but not to RSA concordance. Thus, risk for psychopathology was generally related to weaker dyadic mother-child RSA concordance in contexts with less complex structure or demands (free play, cleanup), as compared to the structured teaching task that showed weaker RSA concordance for all dyads. Implications for the meaning and utility of the construct of parent-child physiological coregulation are discussed.

Time will tell: A longitudinal investigation of brain-behavior relationships during reading development.

ERPs are a powerful tool for the study of reading, as they are both temporally precise and functionally specific. These are essential characteristics for studying a process that unfolds rapidly and consists of multiple, interactive subprocesses. In work with adults, clear, specific models exist linking components of the ERP with individual subprocesses of reading including orthographic decoding, phonological processing, and semantic access (e.g., Grainger & Holcomb, 2009). The relationships between ERP components and reading subprocesses are less clear in development; here, we address two questions regarding these relationships. First, we ask whether there are ERP markers that predict future reading behaviors across a longitudinal year. Second, we ask whether any relationships observed between ERP components and reading behavior across time map onto the better-established relationships between ERPs and reading subprocesses in adults. To address these questions, we acquired ERPs from children engaging in a silent reading task and then, a year later, collected behavioral assessments of their reading ability. We find that ERPs collected in Year 1 do predict reading behaviors a year later. Further, we find that these relationships do conform, at least to some extent, to relationships between ERP components and reading subprocesses observed in adults, with, for example, N250 amplitude in Year 1 predicting phonological awareness in Year 2, and N400 amplitude in Year 1 predicting vocabulary in Year 2.

Effects of continuous and intermittent exercise on executive function in children aged 8-10 years.

Understanding the effects of acute exercise on executive function in prepubescent children may be important for the enhancement of school performance. This study assessed the effect of an acute bout of continuous (CONT) or intermittent (INT), moderate-intensity treadmill exercise on executive function in young children. Twenty healthy children, mean (SD); age: 8.8 (0.8) years; height: 140 (9) cm; weight: 36 (11) kg; boys: n = 9, performed a graded-exercise test to determine maximal oxygen uptake, and two 15-min submaximal bouts of treadmill exercise; protocols were either CONT or INT. During CONT, participants ran at 90% of gas exchange threshold. During INT, participants performed six consecutive 2.5 min blocks of exercise, which were designed to reflect children's typical activity patterns, comprising 45 s at a heavy intensity, 33 s at a moderate intensity, 10 s at a severe intensity, and 62 s at a low intensity. Participants performed the Stroop task before the submaximal exercise bouts and after, at 1-, 15-, and 30-min intervals. Near-infrared spectroscopy (NIRS) measured cerebral perfusion and oxygenation. Regardless of condition, Stroop performance was improved at 1 min after compared to before, 54.9 (9.8) s versus 57.9 (11) s, respectively, p < .01, and improvements were maintained until 30 min after. NIRS (oxyhemoglobin, total hemoglobin) explained a significant amount of variance in the change in Stroop performance for INT only (49%, p < .05). An acute bout of exercise, of either an intermittent or continuous nature, improves executive function in children, and effects are maintained for ≤ 30 min following exercise cessation. Accordingly, it is recommended that children should engage in physical activity during periods of school recess.

Early caregiving stress exposure moderates the relation between respiratory sinus arrhythmia reactivity at 1 month and biobehavioral outcomes at age 3.

There is a growing scientific interest in the psychophysiological functioning of children living in low-socioeconomic status (SES) contexts, though this research is complicated by knowledge that physiology-behavior relations often operate differently in these environments among adults. Importantly, such research is made more difficult because SES may be a proxy for a wide range of risk factors including poor caregiving and exposure to parental substance use. We used factor analysis to organize risk-exposure data collected from 827 children-many of whom were raised in low-SES contexts and exposed to substances prenatally-into dissociable components including economic stress, caregiving stress (e.g., stress the caregiver may experience, including parental psychopathology), and postnatal substance exposure. These factors, along with respiratory sinus arrhythmia (RSA) reactivity at age 1 month, were used to predict behavior dysregulation and resting RSA at age 3 years. A significant RSA Reactivity × Caregiving Stress interaction indicated that infants who exhibited high RSA reactivity at 1 month experienced the greatest behavior dysregulation at 3 years, but only when they were exposed to high levels of caregiving stress. Among African Americans, the highest resting RSA at 3 years was found in infants with less RSA reactivity, but only if they also experienced less caregiving stress. Our work is consistent with biological sensitivity to context, adaptive calibration, and allostatic load models, and highlights the importance of studying Physiology × Environment interactions in low-SES contexts for predicting behavior and resting RSA.

N1 and P2 to words and wordlike stimuli in late elementary school children and adults.

In an investigation of the development of fine-tuning for word processing across the late elementary school years as indexed by the posterior N1 and P2 components of the ERP waveform, third, fourth, and fifth graders and a comparison group of adults viewed words, pseudowords, nonpronounceable letter strings, and false font strings in a semantic categorization task. In adults, N1 was larger to and P2 was later to words as compared to pseudowords, a finely tuned effect of lexicality reflecting specialization for word processing. In contrast, in each group of children, N1 was larger to letter strings than false font strings and P2 was larger to false font strings than letter strings, reflecting coarse encoding for orthography. In regression analyses, scores on standardized behavioral test measures of orthographic knowledge, decoding skill, and fluency predicted N1 amplitude; these effects were not significant with age included as a separate predictor. None of the behavioral scores, in models including or not including age, predicted P2 amplitude. In direct comparisons between groups, there were multiple differences between the child and adult groups for both N1 and P2 amplitude effects, and only a single significant difference between two child groups. Overall, the findings suggest a lengthy developmental time course for the fine-tuning of early word processing as indexed by N1 and P2.

Practices and perceptions regarding pain and pain management during routine childhood immunizations: Findings from a focus-group study with nurses working at Toronto Public Health, Ontario.

INTRODUCTION: Despite the availability of a variety of evidence-based interventions, it has previously been reported that the majority of infants and children undergo vaccine injections without the benefit of analgesia. Nurses in public health administer a substantial number of injections; however, their attitudes and practices surrounding acute pain during vaccine injections have not been previously explored. METHODS: A focus-group interview was conducted in Toronto, Ontario, with 10 nurses who immunize children. Participants reported their perceptions and practices with regard to vaccine injection pain and pain management. RESULTS: THREE KEY THEMES EMERGED: environmental and process factors, perceptions regarding the effectiveness of different analgesic interventions, and perceptions regarding pain and fear. Participants reported a lack of control over their environment, resulting in fear and discomfort for children. They recommended increased support from external partners such as school teachers and administrators. Participants reported that pharmacological interventions, such as topical local anesthetics, were not used; however, psychological and physical interventions were commonly used. Nurses questioned the effectiveness of topical anesthetics, and indicated that more education was required regarding effective analgesic interventions. Needle pain was reported to be the most prominent concern for children undergoing vaccine injections, and children were described as being fearful. DISCUSSION: Nurses reported vaccination setting, analgesic effectiveness and relative importance given to pain as important factors for pain and pain management during vaccine injections. Future studies should explore whether additional perspectives are present in vaccinators in other geographical regions. The effectiveness of educational resources and pain management programs aimed at improving current practices should be investigated.