Parental worry about children: Scale development and validation among Chinese parents of preschool children.

Chinese parents tend to exhibit a high level of worry about their children during the preschool years, which may adversely influence children's mental health. Few studies have investigated the content and intensity of parental worry about children among Chinese parents of preschool children. This study developed and validated the Parental Worry About Children Scale (PWCS) for Chinese parents of preschool children. A pool of 70 items was created after an open-ended questionnaire survey of 1069 Chinese parents of preschool children and an Internet-content analysis, followed by an assessment for content validity by eight experts. Exploratory factor analysis was then conducted with 680 Chinese parents of preschool children, resulting in the formal PWCS consisting of 40 items in four dimensions: physical well-being, psychological well-being, learning/living abilities, and future/uncertain risks. With a sample of 1548 Chinese parents of preschool children, the PWCS demonstrated good structural validity, internal consistency reliability, measure invariance across mothers and fathers, and criterion-related validity. The PWCS may help elucidate the characteristics and antecedents of parental worry about children and the mechanisms underlying its influence on children's mental health in the Chinese context. In clinical practice, this new instrument may facilitate the emergence of effective intervention strategies for alleviating parental worry about children and its negative impact on children's mental health.

Los padres chinos tienden a demostrar un alto nivel de preocupación por sus hijos durante los años de preescolar, lo cual puede influir negativamente en la salud de mental de los niños. En pocos estudios se ha investigado el contenido y la intensidad de la preocupación de los padres por los niños entre los padres chinos de niños en edad preescolar. En este estudio se desarrolló y se validó la Escala de preocupación de los padres por los hijos (Parental Worry About Children Scale, PWCS) para padres chinos de niños en edad preescolar. Se creó un grupo de 70 ítems después de una encuesta abierta de 1069 padres chinos de niños en edad preescolar y un análisis de contenido de internet, seguido de una evaluación de validez del contenido realizada por ocho especialistas. Luego se llevó a cabo un análisis factorial exploratorio con 680 padres chinos de niños en edad preescolar, cuyo resultado fue la PWCS formal que consta de 40 ítems en cuatro dimensiones: bienestar físico, bienestar psicológico, habilidades de aprendizaje/para la vida y riesgos futuros/inciertos. Con una muestra de 1548 padres chinos de niños en edad preescolar, la PWCS demostró una buena validez estructural, fiabilidad de la coherencia interna, invariancia de las medidas entre las madres y los padres, y validez relacionada con el criterio. La PWCS puede contribuir a dilucidar las características y los antecedentes de la preocupación de los padres por los niños y los mecanismos que subyacen a su influencia en la salud mental de los niños en el contexto chino. En la práctica clínica, este nuevo instrumento puede facilitar el surgimiento de estrategias eficaces de intervención para aliviar la preocupación de los padres por los niños y su efecto negativo en la salud mental de los niños.

Efficacy of a peer-based in-home education program in improving social-emotional outcomes of parents and children.

Significant disparities in education and social-emotional outcomes exist between racial/ethnic groups, particularly impacting children growing up in impoverished environments. Home visitation intervention programs, such as the Home Instruction for Parents of Preschool Youngsters (HIPPY), have been used for decades to improve academic readiness in these vulnerable preschool-aged children. Although the benefits of HIPPY on academic readiness and performance are well-documented, there has been no examination of social-emotional benefits to participating parent-child dyads. This study followed a HIPPY cohort over the course of 1 year to evaluate change in maternal and child social-emotional and behavioral functioning. Program participants demonstrated reduced parental stress and depression and increased parental social connection as well as reduced child externalizing behaviors and improved child adaptive functioning over the course of the program, even in the context of the COVID-19 pandemic and associated lockdown. These data highlight the additional benefits of early home-based academic intervention programs.

Las significativas disparidades en educación y resultados socioemocionales existen entre grupos raciales/étnicos, ejerciendo particularmente un impacto en los niños que crecen en ambientes empobrecidos. Los programas de intervención de visitas a casa, tales como la Instrucción en el Hogar para Padres y Niños Pequeños en Edad Prescolar (HIPPY), han sido utilizados por décadas para mejorar la preparación académica en estos niños de edad prescolar vulnerables. A pesar de que los beneficios de HIPPY en cuanto a preparación y rendimiento académicos están bien documentados, no se ha dado una revisión de los beneficios socioemocionales para las díadas progenitor-niño que participan. Este estudio le dio seguimiento a un grupo de HIPPY a lo largo del curso de un año para evaluar el cambio en el funcionamiento socioemocional y de comportamiento materno y en el niño. Los participantes en el programa demostraron un reducido nivel de estrés y depresión en progenitores y un aumento en la conexión social de progenitores, así como niveles reducidos de comportamiento externalizantes en el niño y un incremento en el funcionamiento de adaptación del niño a lo largo del curso del programa, aun dentro del contexto de la pandemia del COVID-19 y el aislamiento que con ella se asocia. Estos datos subrayan los beneficios adicionales de programas tempranos de intervención académica en casa.

Des inégalités importantes dans l'éducation et les résultats socio-émotionnels existent entre les groupes raciaux/ethniques, ce qui impacte particulièrement les enfants grandissant dans des milieux appauvris. Des programmes d'intervention de visite à domicile, comme le programme d'Instruction à Domicile de Parents de Jeunes Enfants d'Age Préscolaire (abrégé HIPPY en anglais), ont été utilisés depuis des dizaines d'années afin d'améliorer la préparation académique de ces enfants vulnérables d'âge préscolaire. Bien que les bénéfices du programme HIPPY sur la préparation académique et la performance académique soit bien documentée, les bénéfices socio-émotionnels de la participation des dyades parent-enfant n'ont jamais été examinés. Cette étude a donc suivi une cohorte HIPPY au cours d'une année afin d'évaluer le changement dans le fonctionnement émotionnel et comportemental maternel et de l'enfant. Les participantes ou participants au programme ont fait preuve d'une réduction du stress parental et de la dépression et de plus de lien social parental ainsi qu'une réduction de comportements d'externalisation de l'enfant et d'un fonctionnement adaptatif de l'enfant amélioré au cours du programme, même dans le contexte de la pandémie du covid-19 et du confinement. Ces données mettent en évidence les bénéfices supplémentaires des programmes d'intervention académique précoce à domicile.

Maternal depressive symptoms, poverty, and young motherhood increase the odds of early depressive and anxiety disorders for children born prematurely.

Children born preterm, compared to term, are at risk for behavioral problems. However, the prevalence and predictors of internalizing disorders among children born preterm are unclear. The purpose of this study was to identify the prevalence of depressive and anxiety disorders at 2 years of age among children born preterm and determine the extent to which poverty, maternal depressive symptoms, or young motherhood increase the likelihood of these disorders. Mothers and their infants (N = 105) were recruited from two neonatal intensive care units affiliated with a major U.S. university. A sociodemographic questionnaire, the Patient Health Questionnaire-9, and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition scale scores from the Preschool Child Behavior Checklist were used to measure primary variables. We examined mothers' family satisfaction and quality of caregiving as well as children's degree of prematurity, morbidity, gender, cognitive functioning, and motor function as covariates. Fifteen percent of children met criteria for an anxiety disorder and another 15% for depression. Maternal depressive symptoms increased the odds of children developing both anxiety and depression, whereas young motherhood was associated with child anxiety and poverty with child depression. Results indicate the need for mental health assessment of children born preterm during their first 2 years of life and the importance of early therapeutic and tangible support to vulnerable mothers and children.

Los niños nacidos prematuramente, comparados con los no prematuros, están bajo riesgo de problemas de comportamiento. Sin embargo, la prevalencia y factores de predicción de la internalización de los trastornos entre niños nacidos prematuramente no están claras. El propósito de este estudio fue identificar la prevalencia de trastornos depresivos y de ansiedad a los 2 años de edad entre niños nacidos prematuramente y determinar hasta dónde la pobreza, los síntomas depresivos maternos o la maternidad joven aumentan la probabilidad de estos trastornos. A las madres y sus infantes (N = 105) se les reclutó de 2 unidades de cuidados intensivos neonatales afiliadas con una importante universidad de los Estados Unidos. Un cuestionario sociodemográfico, el PHQ-9 y los puntajes de la escala DSM-5 de la Lista de Verificación de la Conducta Prescolar del Niño se usaron para medir las variables primarias. Examinamos la satisfacción familiar y la calidad de la prestación del cuidado de las madres, así como el grado de prematuridad, la morbilidad, el género, el funcionamiento cognitivo, y la función motora de los niños como covariables. Quince por ciento de los niños cumplía los criterios para un trastorno de ansiedad y otro 15% para depresión. Los síntomas depresivos maternos aumentaron las posibilidades de que los niños desarrollaran tanto ansiedad como depresión, mientras que la maternidad joven se asoció con la ansiedad del niño y la pobreza con la depresión del niño. Los resultados indican la necesidad de evaluar la salud mental de niños nacidos prematuramente durante sus dos primeros años de vida y la importancia del temprano apoyo terapéutico y tangible a las madres y niños vulnerables.

Les enfants nés prématurés, comparés aux enfants né à terme, sont à risque de problèmes de comportement. Cependant, la prévalence et les prédicteurs de troubles d'intériorisation chez les enfants nés avant-terme ne sont pas claires. Le but de cette étude était d'identifier la prévalence des troubles dépressifs et des troubles d'anxiété à l'âge de 2 ans chez des enfants nés avant terme et de déterminer dans quelle mesure la pauvreté, les symptômes dépressifs maternels ou le statue de jeune mère augmente la probablbilité de ces troubles. Des mères et leurs nourrissons (N = 105) ont été recrutées dans deux services de réanimation néonatale dans une CHU américaine importante. Un questionnaie sociodémographique, le PHQ-9 et les scores de l'échelle DSM-5 de la Checklist de Comportement de l'Enfant d'Âge Préscolaire ont été utilisés pour mesurer les variables primaires. Nous avons examiné la satisfaction familiale des mères et la qualité du mode de soin ainsi que le degré de prématurité des enfants, leur morbidité, le genre, le fonctionnement cognitif et la fonction motrice comme covariants. Quinze pourcent des enfants ont rempli les critères pour un trouble de l'anxiété et un autre 15% pour la dépression. Les symptômes dépressifs maternels ont augmenté les chances que les enfants développent à la fois de l'anxiété et de la dépression, alors que le fait d'être une jeune mère était lié à l'anxiété de l'enfant et la pauvreté avec la dépression de l'enfant. Les résultats indiquent le besoin d'une évaluation de la santé mentale des enfants nés avant terme durant les deux premières années de leur vie et l'importance d'un soutien thérapeutique précoce et tangile pour les mères et les enfants vulnérables.

[Family influences on maternal feeding practices of preschool children from vulnerable families in the Metropolitan Region of Chile]. / Influencias familiares en las prácticas de alimentación materna a niños preescolares de familias vulnerables de la Región Metropolitana de Chile.

OBJECTIVE: To explore family members' influences on mothers' feeding practices of preschoolers in Chilean families residing in vulnerable neighborhoods from the Metropolitan Region of Santiago, Chile. DESIGN: Qualitative study. LOCATION: Nine child care centers in Región Metropolitana, Santiago, Chile. PARTICIPANTS: Twenty-four mothers and one father of preschool children. METHOD: Photo-elicitation techniques were applied to 25 semi-structured interviews and their subsequent inductive thematic analysis of family influences. RESULTS: The participants described that the family influences on their feeding practices depended on the family structure and the interpersonal closeness between relatives. Some influences directly affected child eating behavior, especially in relatives who live together, while others were mediated by the relationships generated between parents and other members of the family. Fathers, in two-parent families, and grandparents are the most influential relatives on the participants' feeding practices. Generally, fathers participated and were in line with the mother's feeding practices of their children. Grandparents enriched their grandchildren's eating experiences by offering homemade preparations, expressing affection with food, including unhealthy options, and supporting parents to diversifying and structuring feeding practices. CONCLUSIONS: According to their interpersonal closeness or cohabitation, parental feeding practices and child eating behaviors were impacted by family members and their dynamics. The development of strategies to prevent and treat childhood obesity should consider a family approach in vulnerable families.

[Family functioning, parental rearing and its relationship to nutritional status in preschoolers]. / Funcionalidad familiar, crianza parental y su relación con el estado nutricional en preescolares.

AIM: To analyze association among family functioning, parental rearing and nutritional status in preschoolers. DESIGN: Quantitative, descriptive and correlational cross-sectional study. LOCATION: Preschool public institutions in Nuevo León, Mexico. Primary Care. PARTICIPANTS: Sample of 228 dyads (mother or father and preschooler); sole inclusion criterion was to be main responsible for the upbringing of the preschooler. MAIN MEASUREMENTS: Sociodemographic data questionnaire was used, nutritional status was determined based on the recommendations of the World Health Organization, Family Adaptability and Cohesion Evaluation Scale and Parental Rearing Style Questionnaire were used. Descriptive and Spearman's correlation coefficient were obtained. RESULTS: Mean age of parents was 32.09 years, 60.5% of mothers were housewives and 100% of fathers had a job; mean years of schooling were 12.16, 68.9% of participants were married; 29.4% of preschoolers were overweight or obese. Regarding family functioning it was identified that 44.3% is semi-related in cohesion dimension. The parental rearing style that prevailed was the permissive with 62.3%. CONCLUSIONS: Most parents presented an imbalance in family functioning. No statistical significance was found among family functioning and parental rearing with nutritional status in preschoolers (P<.05).

Hypoxaemia in Mozambican children <5 years of age admitted to hospital with clinical severe pneumonia: clinical features and performance of predictor models.

OBJECTIVE: To determine the prevalence of hypoxaemia among under-five children admitted to hospital with clinical severe pneumonia and to assess the performance to diagnose hypoxaemia of models based on clinical signs. METHODS: We conducted a hospital-based survey in a district hospital from Southern Mozambique. RESULTS: A total of 825 children were recruited after obtaining an informed consent. The prevalence of hypoxaemia on admission was 27.9%, and 19.8% of these children died (OR compared with non-hypoxaemic children 3.22, 95% CI 1.98-5.21, P < 0.001). The model with larger area under the ROC curve (AUC-ROC) to predict hypoxaemia included cyanosis or thoracoabdominal breathing or respiratory rate ≥70 breaths per minute. None of the models performed well when tested in different case scenarios of oxygen availability through mathematical modelling, with over 50% of hypoxaemic children not receiving oxygen even in favourable case scenarios. CONCLUSIONS: Clinical signs alone or in combination are not suitable to diagnose hypoxaemia. The use of pulse oximeters should be strongly encouraged.

[Dental caries and early childhood development: a pilot study]. / Caries dental y desarrollo infantil temprano. Estudio piloto.

OBJECTIVE: To investigate the association between dental caries and early childhood development in 3-year-olds from Talca, Chile. METHOD: A pilot study with a convenience sample of 3-year-olds from Talca (n = 39) who attend public healthcare centers. Child development was measured by the Psychomotor Development Index (PDI), a screening tool used nationally among pre-school children to assess language development, fine motor skills and coordination areas. Dental caries prevalence was evaluated by decayed, missing, filled teeth (DFMT) and decayed, missing, filled tooth surfaces (DFMS) ceo-d and ceo-s indexes. The children were divided into two groups according to the PDIscore: those with a score of 40 or more were considered developmentally normal (n = 32), and those with a score below 40 were considered as having impaired development (n = 7). RESULTS: The severity of caries (DMFT) was negatively correlated with PDI (r = -0.82), and children with the lowest TEPSI score had the highest DFMT values. The average DMFT in children with normal development was 1.31, and 3.57 for those with impaired development. CONCLUSION: This pilot study indicates that the severity of dental caries is correlated with early childhood development.

Spirometry interpretation feasibility among pre-school children according to the European Respiratory Society and American Thoracic Society Guidelines / Factibilidad de la interpretación de espirometrías en preescolares según criterios ATS/ERS.

INTRODUCTION: Spirometry is the most used test to evaluate pulmonary function. Guidelines that defined acceptability and repeatability criteria for its implementation and interpretation among preschoolers were published in 2007. Our objective was to quantify the actual compliance with these criteria among pre-school patients. METHODS: A review was performed on the baseline spirometry measured in patients aged 2 to 5 years in the Pediatric Respiratory Laboratory of the Pontificia Universidad Católica de Chile, who were admitted due to recurrent or persistent coughing or wheezing. Only those results obtained in patients who took the test for the first time were considered. They were analyzed by international standards. RESULTS: A total of 93 spirometry results (mean age 57.4 ± 8.6 months, 48 males) were obtained, of which 44 (47%) met all acceptable criteria, 87 (93%) obtained expiratory time of ≥ 0.5seconds, and 67 (72%) of the patients had an end-expiratory flow of ≤10% from peak flow. The variation in the measurement of forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) was very low (intraclass correlation coefficient > 0.9). CONCLUSION: It was possible to meet the acceptability and repeatability criteria for spirometry among pre-school children in our Center, which was similar to previous reports. As in older children, this test is fully recommended for pre-school children who require lung function studies.

[Children with minor head injury in the emergency department: Is skull radiography necessary for children under 2 years?]. / Niños con traumatismo craneal leve en urgencias: ¿es necesaria la radiografía de cráneo en pacientes menores de 2 años?

BACKGROUND: Current guidelines on the management of mild head trauma (traumatic brain injury/TBI) do not include the presence of a skull fracture in determining the risk of intracranial injury. However, in our setting cranial radiography is still performed frequently to rule out the presence of skull fracture. OBJECTIVE: To estimate the prevalence of clinically-important traumatic brain injuries (ciTBI) in children younger than two years of age with mild TBI. PATIENTS AND METHODS: Descriptive observational study. All children attended in emergency department with mild TBI (Glasgow ≥14 points) for a year were included. We defined ciTBI as intracranial injuries that caused death or required neurosurgery, intubation for more than 24 hours, inotropic drugs or mechanical ventilation. RESULTS: The study included 854 children, of which 457 (53.5%) were male. The median patient age was 11.0 months (P25-75: 7.5-17.0 months). In 741 cases (86.8%) the mechanism of TBI was a fall. In 438 cases (51.3%) skull radiography was performed. Eleven children (1.3%) had intracranial injury, but none met the criteria for ciTBI (estimated prevalence of ciTBI was 0%; CI 95%: 0%-0.4%). CONCLUSION: Children younger than two years of age with mild TBI have low prevalence of ciTBI. Consequently, it is possible to monitor children younger than two years with a TBI without performing skull radiography.

[Feeding and growth patterns in preterm children at 3-4 years of age]. / Patrones de alimentación y crecimiento de los niños prematuros a los 3-4 años de vida.

Introduction: Aim: to describe the feeding and growth patterns of preterm-born children at preschool age, considering feeding problems based on behaviours and skills, diet quality and parental feeding practices. Methods: a cross-sectional study was performed on preterm children born in Asturias (Spain) in 2016 (n = 94). When preterm-born children reached 3-4 years of age their families were asked to complete the Behavioral Pediatrics Feeding Assessment Scale and a food frequency questionnaire to identify possible feeding problems and assess diet quality (KIDMED index), respectively. Self-reported anthropometric data were also collected to assess weight growth. Electronic health records were reviewed to gather gestational and neonatal clinical data. Results: feeding problems were found in 7.4 % of children and 20.2 % of parents. According to the KIDMED index, 25.5 % of children had a high-quality diet. Feeding problems were higher in children born before 32 weeks of gestation, and decreased in frequency as the gestational age increased (p = 0.030). No differences were found in parental feeding practices (p = 0.455) or diet quality according to gestational age (p = 0.399), but body weight at 3-4 years was lower in preterm-born children (p = 0.015). Conclusions: feeding patterns of preterm-born children were suitable at the age of 3-4 years, but diet quality was moderate to poor in the majority of children. Follow-up of very preterm children beyond 3-4 years of age becomes necessary as they displayed more feeding problems and lower body weight.

Introducción: Objetivo: describir el patrón de alimentación y crecimiento de los niños prematuros en edad preescolar, incluyendo los problemas de alimentación basados en sus conductas y habilidades, la calidad de la dieta y el afrontamiento de sus padres. Métodos: estudio transversal de niños prematuros nacidos en Asturias en 2016 (n = 94). A los 3-4 años se contactó con las familias y se utilizó el cuestionario Behavioral Pediatrics Feeding Assessment Scale para identificar problemas en la alimentación, y el índice KIDMED para resumir la calidad de la dieta. También se recopilaron datos antropométricos autoinformados para evaluar el crecimiento ponderal. Se revisaron las historias clínicas electrónicas para recopilar información gestacional y neonatal. Resultados: el 7,4 % de los niños y el 20,2 % de los padres presentaron problemas relacionados con la alimentación infantil. El 25,5 % tenían un patrón dietético de alta calidad. En los prematuros < 32 semanas se identificaron más conductas alimentarias alteradas, disminuyendo su frecuencia al incrementarse su edad gestacional (p = 0,030). No se observaron diferencias en las conductas de los padres (p = 0,455), ni en la calidad de la dieta según la edad gestacional (p = 0,399), pero sí en el peso, que fue menor en los muy prematuros (p = 0,015). Conclusiones: el patrón de alimentación de los prematuros a los 3-4 años y las estrategias de sus padres fueron adecuados, y la calidad de la dieta moderada. Es importante un adecuado seguimiento de los prematuros con menor edad gestacional, ya que presentaron más dificultades en la alimentación y menor peso.

[Parenting stress, maternal feeding styles related to preschooler body mass index]. / Estrés de la crianza, estilos maternos de alimentación y su relación con el índice de masa corporal del preescolar.

Introduction: Introduction: excess weight in childhood is influenced by multiple factors; parenting could contribute to this problem, given that during the infant stage the parents, and mainly the mother, are responsible for providing food and feeding their children. Objective: to explore the relationship of parenting stress and maternal feeding styles with preschool BMI. Materials and methods: a cross-sectional study. A total of 382 dyads, mother and child (3-5 years of age) participated. The children attended public preschool institutions. Participating mothers completed the Parenting Stress Scale and the Caregiver Feeding Styles Questionnaire. Weight and height were measured, and the child's BMI was calculated. Results: 34 % of the mothers more frequently used an indulgent style, 28.2 % of the preschool children had overweight-obese. Mothers with an authoritative style had the highest mean range of parenting stress compared to other categories (H = 15.302, gl = 3, p = 0.002). Maternal schooling, responsibility and demand dimensions were identified as contributing to preschooler BMI. Conclusion: parenting stress and feeding styles are variables that contribute to the risk of overweight-obesity in prescho.

Introducción: Introducción: el exceso de peso en la infancia se ve influenciado por múltiples factores; la crianza podría contribuir a este problema, dado que durante la etapa infantil son los padres y principalmente la madre los responsables de proporcionar alimento y de alimentar a sus hijos. Objetivo: explorar la relación del estrés de la crianza y los estilos maternos de alimentación con el IMC del hijo preescolar. Materiales y métodos: estudio transversal. Participaron 382 díadas madre e hijo, los últimos de 3-5 años. Los hijos asistían a instituciones públicas de educación preescolar. Las madres participantes contestaron la Escala de Estrés de la Crianza y el Cuestionario de Estilos de Alimentación del Cuidador. Se midió peso, talla y se calculó el IMC del preescolar. Resultados: el 34 % de las madres utilizaban con mayor frecuencia un estilo indulgente y el 28,2 % de los hijos preescolares tenía sobrepeso-obesidad. Las madres con estilo autoritario presentaban el rango promedio más alto de estrés de la crianza comparado con las otras categorías (H = 15,302, gl = 3, p = 0,002). Se identificó que la escolaridad materna, la dimensión de la responsabilidad y la demanda contribuyen al IMC del hijo preescolar. Conclusión: el estrés de la crianza y los estilos de alimentación son variables que contribuyen al riesgo de sobrepeso-obesidad en los hijos preescolares.

Association between attention-deficit/hyperactivity symptoms and sleep in preschoolers.

INTRODUCTION: Sleep problems are frequent in children with attention-deficit/hyperactivity disorder (ADHD). Some authors have tried to characterize paediatric sleep habits in Portugal, but none has focused on preschool-age children nor attempted to establish their association with ADHD. We aimed to assess the prevalence of ADHD symptoms in preschool-age children and to study their association with sleep habits. MATERIAL AND METHODS: We conducted a cross-sectional study. We distributed questionnaires to a random sample of caregivers of children enrolled in early childhood education centres in Porto. We collected data on sociodemographic characteristics, television watching and outdoor activities. We assessed ADHD symptoms and sleep habits with the Portuguese versions of the Conners' Parents Rating Scale, Revised and the Children's Sleep Habits Questionnaire (CSHQ-PT), respectively. RESULTS: The study included 381 preschoolers (50.90% male). We found high scores for ADHD symptoms in 13.10%, with a higher prevalence in girls (14.40% vs. 11.85%; P = 0.276). In the CSHQ-PT, 45.70% of participants had a mean total score greater than 48, which is the cut-off point applied in the screening of sleep disturbances in the Portuguese population. There was a significant association between high scores for ADHD symptoms and a lower maternal education level (P < 0.001), a shorter sleep duration (P = 0.049), and higher scores on parasomnias (P = 0.019) and sleep disordered breathing (P = 0.002) in CSHQ-PT subscales. CONCLUSIONS: ADHD and sleep disorders are common in preschoolers, in Porto, and this study suggests some clinical correlations between them. Since these interactions are complex and far from being elucidated, further studies are paramount to provide guidance for prevention and managing strategies in younger children at risk for ADHD.

[Síndrome de fiebre periódica, adenitis, faringitis y aftosis en un preescolar con síndrome de Asperger: reporte de caso].

Background: Autoinflammatory diseases are a heterogeneous group of pathologies whose prevalence is undefined to date. Within these, the Periodic Fever Syndrome, Adenitis, Pharyngitis and Aphthosis (PFAPA) is determined as the most common and the most studied. Neurodevelopmental and behavioral disor- ders, including those of the Autism Spectrum, are especially prevalent in patients with allergic and autoimmune diseases, however, there is little documented regarding their relationship with autoinflammation. Case report: The case of a patient with Asperger Syndrome with subsequent onset of this autoinflammatory disease is shown. Two weekly blood counts and complete serum immunoglobulins are obtained, which do not show a decrease in neutrophil counts or sublevels or supralevels in immunoglobulins. Conclusion: When he returned to his follow-up appointment, he reported a feverish peak 2 days before, which ceased with the administration of the steroid, and if there was presence of oral ulcers on this occasion, fulfilling the modified Marshall criteria. Likewise, a great change is noted in their development and cooper- ation in exploration. The duality of this autoinflammatory syndrome in a patient with Asperger Syndrome is determined.

Antecedentes: Las enfermedades autoinflamatorias son un grupo heterogéneo de patologías cuya prevalencia es indefinida hasta nuestra actualidad. Dentro de estas, el Síndrome de Fiebre Periódica, Adenitis, Faringitis y Aftosis (PFAPA, por sus siglas en inglés) se determina como la más común y de las mayormente es- tudiadas. Las alteraciones del neurodesarrollo y la conducta, entre estas las del Espectro Autista, son especialmente prevalentes en pacientes con enfermedades alérgicas y autoinmunes, sin embargo, hay poco documentado en cuanto a su relación con la autoinflamación. Reporte de caso: Se muestra el caso de un paciente con Síndrome de Asperger con debut posterior de esta enfermedad autoinflamatoria. Se obtienen 2 biometrías hemáticas semanales e inmunoglobulinas séricas completas, las cuales no muestran descenso en conteos de neutrófilos ni infraniveles ni supraniveles en las inmunoglobulinas. Conclusión: Al reacudir a su cita de control refiere pico febril 2 días previos, el cual cesó con la administración del esteroide, ya si presencia de úlceras orales en esta ocasión, cumpliendo los criterios modificados de Marshall. Por igual, se nota un gran cambio en su desenvolvimiento y cooperación a la exploración. Se determina la dualidad de este síndrome autoinflamatorio en un paciente con Síndrome de Asperger.

Association between recreational screen time and excess weight and obesity assessed with three sets of criteria in Spanish residents aged 2-14 years.

INTRODUCTION AND OBJECTIVE: Studies that assess the association between excess weight and screen time in childhood and adolescence are methodologically heterogeneous, and few studies have analysed the exposure to smartphones and tablets. Our study aimed to assess the association between daily recreational screen time and excess weight (overweight+obesity) and obesity in children aged 2-14 years residing in Spain using different sets of standards. METHODS: We conducted a cross-sectional study using data from the 2017 Spanish National Health Survey (N=4528). We assessed the prevalence of overweight and obesity applying the criteria of the World Health Organization (WHO), International Obesity Task Force (IOTF), and Orbegozo 2011 study. We categorised daily recreational screen time in minutes as 0-59, 60-119, 120-179, and ≥180. We calculated crude and adjusted prevalence ratios (aPR) of excess weight and obesity based on the daily minutes of recreational screen time with the corresponding 95% confidence intervals (95%CI). Moreover, we calculated crude and adjusted change (aΔ) in the expected number of fulfilled excess weight/obesity criteria based on the minutes of daily recreational screen time with the corresponding 95% CI. We adjusted the association analyses for potential confounders. RESULTS: We found that spending 180min or more a day of recreational screen time was associated with an increase in the adjusted prevalence of excess weight (e.g. Orbegozo 2011 aPR≥180, 1.20; 95% CI, 1.02-1.42) and of obesity (e.g. IOTF aPR≥180, 1.41; 95% CI, 1.06-1.86) as well as an increase in the adjusted number of fulfilled criteria for excess weight (aΔ≥180, 1.18; 95% CI, 1.06-1.31). CONCLUSIONS: Longer periods of recreational screen time were associated with excess weight and obesity in children aged 2-14 years. Cohort studies are required to confirm these findings, as this may be a determinant of health in children.

Nonpharmacological pain management in vaccination. Perception of paediatricians, patients and guardians.

INTRODUCTION: The use of nonpharmacological measures to reduce pain during vaccination has been studied extensively in infants, but there are fewer studies on its effectiveness in older children and on the parental perception of pain in children. METHODS: We conducted a multicentre, quasi-experimental interventional study with a control group. PATIENTS: infants aged 2-11 months and children aged 4 years that attended routine vaccination appointments. SETTING: Primary care. Intervention during vaccination: infants were breastfed and 4-year-old children blew a party horn. CONTROL: vaccination performed following routine practice. MEASUREMENT: NIPS (Neonatal Infant Pain Scale) and duration of crying in infants, Wong-Baker FACES pain rating scale in older children and parents. RESULTS: The study included 125 children (intervention: 60; control: 65). There was a significant decrease in perceived pain in the intervention groups: NIPS score in infants, 3.8 ± 1.1 compared to 5.2 ± 0.7 (P < .001); Wong-Baker FACES score at 4 years of 3.3 ± 1.7 compared to 4.2 ± 1.6 (P = .042). These same differences in support of the intervention were reflected in the parental assessments (3.4 ± 1.3 vs 4.5 ± 1.5; P < .001). The correlation between child and parent scores was strongly positive: 0.7 (95% CI, 0.59-0.78). However, the duration of crying was longer in the intervention group. CONCLUSION: The use of distraction techniques reduces pain in children and the pain perceived by parents in their children, thus increasing their satisfaction with the procedure.

Association between parental attitudes towards their offspring's diet and children's actual dietary habits - The SENDO project.

INTRODUCTION: Introduction: the preschool stage is a critical period for teaching and modeling healthy habits to positively influence children's health and wellbeing throughout their lifetime. Objectives: to evaluate the association between parental attitudes towards their offspring's dietary habits in Spanish children aged 4 to 7 years participating in the Follow-up of Children for Optimal Development (SENDO) project. Methods: we defined an index to measure information on parental attitudes towards their offspring's diet (0 to 8 points), and another one to measure children's actual dietary habits (0 to 19 points). A higher score meant healthier attitudes and healthier habits, respectively. Information was collected through an online questionnaire completed by parents. We calculated crude and multivariable-adjusted odds ratios (OR) and 95 % confidence intervals (CI) for children's healthy dietary habits associated with parental scores in the parental attitudes index. Generalized estimation equations (GEE) were used to account for intra-cluster correlation between siblings. Results: a total of 423 preschoolers (52.3 % boys, mean age 5.3 years) were included in the analyses. Half of the children (51 %) reported unhealthy dietary habits, whereas 56 % of parents reported high adherence to the healthy eating index. Compared to those in the lowest category, the children whose parents were in the highest category in the parental attitudes index showed significantly higher odds of having healthy dietary habits (OR: 2.91; 95 % CI: 1.30-6.53, p for trend = 0.004). Conclusions: our results support a direct association between parental attitudes and their offspring's dietary habits, suggesting that public health interventions aimed at improving children's dietary habits should shift from the individual- to a family-based approach.

INTRODUCCIÓN: Introducción: la etapa preescolar es un período crítico para enseñar y modelar hábitos saludables que influyan positivamente en la salud y el bienestar de los niños a lo largo de su vida. Objetivos: evaluar la influencia de las actitudes de los padres en los hábitos alimentarios de sus hijos (entre 4 y 7 años) participantes en el proyecto SEguimiento del Niño para un Desarrollo Óptimo (SENDO). Métodos: se definieron dos índices diferentes para medir la información sobre las actitudes alimentarias de los padres (0 a 8 puntos) y los hábitos alimentarios de los niños (0 a 19 puntos). Las puntuaciones más altas reflejaban actitudes y hábitos más saludables, respectivamente. La información se recopiló a través de un cuestionario online cumplimentado por los padres. Se calcularon las odds ratios (OR) bruta y ajustada, así como sus intervalos de confianza (IC) del 95 % para los hábitos alimentarios saludables de los niños asociados con las actitudes alimentarias de los padres. Se utilizaron ecuaciones de estimación generalizada (GEE) para tener en cuenta la correlación intra-grupo entre hermanos. Resultados: se incluyeron 423 niños en edad preescolar (52,3 % varones, edad media 5,3 años), teniendo el 51 % de los niños hábitos alimentarios poco saludables, mientras que el 56 % de los padres presentaban una alta adherencia al índice de actitudes alimentarias saludables en los progenitores. En comparación con la categoría más baja, los niños cuyos padres estaban en la categoría más alta en el índice de actitudes paternas presentaban una mayor probabilidad de tener hábitos alimentarios saludables (OR: 2,91; IC del 95 %: 1,30-6,53, p de tendencia = 0,004). Conclusiones: estos resultados indican una asociación directa entre las actitudes alimentarias de los padres y los hábitos alimentarios de sus hijos, lo que sugiere que las intervenciones de salud pública dirigidas a mejorar los hábitos alimentarios en la etapa escolar deben pasar del enfoque individual a un abordaje familiar.

Comparison of growth and psychomotor development in daycare centers attended by professionals.

BACKGROUND: Growth and development reflect the child's health condition. Currently, child care is supported in daycare centers. In this context, this article aimed to identify the differences in growth and psychomotor development in children according to their attendance at daycare centers. METHODS: We conducted an analytical cross-sectional study in children aged 25 to 48 months. Two groups were identified: 68 children attended daycare, and 68 children did not attend daycare. Growth was assessed with weight-for-height curves, and psychomotor development was evaluated with the child developmental assessment instrument (psychosocial, language, psychomotor, and cognitive area). The X2 test was used for statistical analysis. RESULTS: The percentage of daycare children with ideal weight was higher than those not attending in daycare (p = 0.035). Psychomotor development was significantly higher in daycare children: in the psychosocial (p = 0.000), language (p = 0.000), motor (p = 0.000), and cognitive development (p = 0.000) areas. CONCLUSIONS: The psychomotor development of children attending daycare centers is superior to that of children not in daycare centers.

INTRODUCCIÓN: La salud del niño se puede evaluar a partir de su crecimiento y desarrollo. En la sociedad actual, el cuidado de los hijos se comparte con las guarderías infantiles. En este contexto, el objetivo del artículo fue identificar las diferencias de crecimiento y desarrollo psicomotor en niños de acuerdo con su asistencia a las guarderías. MÉTODOS: Se llevó a cabo un estudio transversal analítico en niños de 25 a 48 meses de edad. Se identificaron dos grupos: 68 niños atendidos en guarderías y 68 niños no atendidos en guarderías. El crecimiento se evaluó con las curvas de peso para la talla y el desarrollo psicomotor, con el instrumento de evaluación del desarrollo del niño (área psicosocial, lenguaje, psicomotriz, y cognitiva). Se utilizó la prueba de X2 para el análisis estadístico. RESULTADOS: El porcentaje de niños de guardería con peso ideal es superior al de los no atendidos en guardería (p = 0.035). El desarrollo psicomotor es significativamente mayor en los niños de guardería: en el área psicosocial (p = 0.000), en lenguaje (p = 0.000), en el área motriz (p = 0.000) y en desarrollo cognitivo (p = 0.000). CONCLUSIONES: El desarrollo psicomotor de los niños atendidos en guardería es superior al de los niños no atendidos en guardería.

Proximal ureteral access for symptomatic stone removal using ultrathin semirigid ureterorenoscope in preschool-age children: Is it possible?

INTRODUCTION AND OBJECTIVES: We aimed to point out the ureteral access facility and obstruction removal efficiency of mini-URS in the use of proximal ureteral stone management in children under five-year-old. PATIENTS: We retrospectively reviewed the data of 26 children who underwent mini-URS-LL for obstructive stones in proximal ureter between January 2016 and August 2018. The effectiveness of the mini-URS-LL was assessed based on the feasibility, reliability, and success of the technique. RESULTS: Mean age was 3 ± 1.3 years, and 11 (42.3%) patients were ≤2 years old, remaining 15 (57.7%) were aged 3-5 years. Mean stone size was 9.11 ± 3.02 mm. A stone-free status was obtained at the end of 31 ureteroscopic procedure in 24 (92.3%) patients. The mean age was found significantly higher in patients who had the procedure without pre-stenting than the others who did (P = .027). No perioperative complication was experienced. CONCLUSION: In preschool-age children, laser lithotripsy with mini-URS may be a safe technique in the hands with advanced endo-urological skills but it has low efficacy with higher rates of prestenting causing additional anesthesia sessions.

COVID-19 Unmasked Global Collaboration Protocol: longitudinal cohort study examining mental health of young children and caregivers during the pandemic.

BACKGROUND: Early empirical data shows that school-aged children, adolescents and adults are experiencing elevated levels of anxiety and depression during the COVID-19 pandemic. Currently, there is very little research on mental health outcomes for young children. OBJECTIVES: To describe the formation of a global collaboration entitled, 'COVID-19 Unmasked'. The collaborating researchers aim to (1) describe and compare the COVID-19 related experiences within and across countries; (2) examine mental health outcomes for young children (1 to 5 years) and caregivers over a 12-month period during the COVID-19 pandemic; (3) explore the trajectories/time course of psychological outcomes of the children and parents over this period and (4) identify the risk and protective factors for different mental health trajectories. Data will be combined from all participating countries into one large open access cross-cultural dataset to facilitate further international collaborations and joint publications. METHODS: COVID-19 Unmasked is an online prospective longitudinal cohort study. An international steering committee was formed with the aim of starting a global collaboration. Currently, partnerships have been formed with 9 countries (Australia, Cyprus, Greece, the Netherlands, Poland, Spain, Turkey, the UK, and the United States of America). Research partners have started to start data collection with caregivers of young children aged 1-5 years old at baseline, 3-months, 6-months, and 12-months. Caregivers are invited to complete an online survey about COVID-19 related exposure and experiences, child's wellbeing, their own mental health, and parenting. DATA ANALYSIS: Primary study outcomes will be child mental health as assessed by scales from the Patient-Reported Outcomes Measurement Information System - Early Childhood (PROMIS-EC) and caregiver mental health as assessed by the Depression Anxiety Stress Scale (DASS-21). The trajectories/time course of mental health difficulties and the impact of risk and protective factors will be analysed using hierarchical linear models, accounting for nested effects (e.g. country) and repeated measures.

Antecedentes: Los primeros datos empíricos muestran que los niños en edad escolar, los adolescentes y los adultos están experimentando niveles elevados de ansiedad y depresión durante la pandemia de COVID-19. Actualmente, hay muy poca investigación sobre los resultados de salud mental de los niños pequeños. Objetivos: Describir la formación de una colaboración global titulada 'COVID-19 Desenmascarado'. Los investigadores colaboradores tienen como objetivos (1) describir y comparar las experiencias relacionadas con COVID-19 dentro y entre países; (2) examinar los resultados de salud mental de los niños pequeños (de 1 a 5 años) y los cuidadores durante un período de 12 meses durante la pandemia de COVID-19; (3) explorar las trayectorias/temporalidad de los resultados psicológicos de los niños y los padres durante este período e (4) identificar los factores de riesgo y de protección para las diferentes trayectorias de salud mental. Los datos de todos los países participantes se combinarán en un gran conjunto de datos transculturales de acceso abierto para facilitar más colaboraciones internacionales y publicaciones conjuntas. Métodos: COVID-19 Desenmascarado es un estudio de cohorte longitudinal prospectivo en línea. Se formó un comité directivo internacional con el objetivo de iniciar una colaboración global. Actualmente, se han formado asociaciones con 9 países (Australia, Chipre, Grecia, Países Bajos, Polonia, España, Turquía, Reino Unido y Estados Unidos de América). Los socios de investigación han comenzado la recopilación de datos con los cuidadores de niños pequeños de 1 a 5 años al inicio, a los 3 meses, a los 6 meses y a los 12 meses. Se invita a los cuidadores a completar una encuesta en línea sobre la exposición y las experiencias relacionadas con COVID-19, el bienestar del niño, su propia salud mental y parentalidad. Análisis de datos: Los resultados primarios del estudio serán la salud mental infantil según la evaluación de las escalas del Sistema De Información De medición de Resultados Informados Por El Paciente ­ Primera Infancia (PROMIS-EC) y la salud mental del cuidador según la evaluación de la Escala de estrés, ansiedad y depresión (DASS-21). Las trayectorias/temporalidad de las dificultades de salud mental y el impacto de los factores de riesgo y de protección se analizarán utilizando modelos lineales jerárquicos, teniendo en cuenta los efectos anidados (por ejemplo, el país) y las medidas repetidas.

Evolution of psychomotor development in pre-school children born prematurely.

INTRODUCTION: The rate of premature births has significantly increased, and it is important to determine its effects. The objective of this study is to determine the psychomotor development profile of a group of children born prematurely, at the age of 4, 5 and 6, and to compare them with a group of full-term birth children, in order to detect any differences. PATIENTS AND METHODS: The sample consisted of 98 participants, evenly distributed into two groups, premature and full-term born children. A prospective longitudinal observational analytical study, with a design of cases and controls, was carried out. For some analyses, the separation into early pre-term, moderate pre-term, and late pre-term was considered. The evaluations were performed using the McCarthy Scale of Aptitudes and Psychomotor skills for children. RESULTS: The data show achievements within the middle intervals. However, there are more difficulties in development at 4 years in the group of premature children, according to gestational age. Early pre-term (gestational age less than 32 weeks) showed significantly lower scores compared to moderate and late pre-term, mainly at 6 years, and with those born at term, at 4 and 6 years. CONCLUSIONS: Development difficulties are greater at a lower gestational age, and may affect the Primary Education stage. The need to monitor all premature children in the preschool stage is suggested, as well as to evaluate more specific skills and continue with the care from specialist teams.