Elementary Classroom Views of Nature Are Associated with Lower Child Externalizing Behavior Problems.

Exposure to nature views has been associated with diverse mental health and cognitive capacity benefits. Yet, much of this evidence was derived in adult samples and typically only involves residential views of nature. Findings from studies with children suggest that when more greenness is available at home or school, children have higher academic performance and have expedited attention restoration, although most studies utilize coarse or subjective assessments of exposure to nature and largely neglect investigation among young children. Here, we investigated associations between objectively measured visible nature at school and children's behavior problems (attention and externalizing behaviors using the Brief Problem Monitor Parent Form) in a sample of 86 children aged seven to nine years old from 15 classrooms across three schools. Images of classroom windows were used to quantify overall nature views and views of specific nature types (sky, grass, tree, shrub). We fitted separate Tobit regression models to test associations between classroom nature views and attention and externalizing behaviors, accounting for age, sex, race/ethnicity, residential deprivation score, and residential nature views (using Google Street View imagery). We found that higher levels of visible nature from classroom windows were associated with lower externalizing behavior problem scores, after confounder adjustment. This relationship was consistent for visible trees, but not other nature types. No significant associations were detected for attention problems. This initial study suggests that classroom-based exposure to visible nature, particularly trees, could benefit children's mental health, with implications for landscape and school design.

Clowntherapy in paediatric dentistry: The psychological approach to the paediatric patient.

AIM: Anxiety towards dental treatments and visits in children are often cause for the avoidance and/or failure of the treatment itself, as well as a reason for stress in both the patient and the orthodontist. The aim of the research is to understand if the use of clown therapy in dental waiting rooms is efficient in bringing down the level of preoperative anxiety in paediatric dental patients. METHODS: Two psychometric tests were used: CFSS-DS (Dental Subscale of the Children's Fear Survey Schedule) and FIS (Facial Image Scale), after the translation of the original versions, to both the patients and their parents. The CFSS-DS is the most used instrument in order to assess dental fear in children, it is composed by 15 questions that outline situations which children and adolescents will have to face while on the dental chair. The FIS is a visual analogical scale that uses faces as indicators of anxiety. CONCLUSION: Clowntherapy proves to be an efficient non-pharmacological method to reduce anxiety and dental fear in paediatric patients, offeringa valid and practical support for paediatric dentists.

The effect of a mindfulness-based intervention on executive, behavioural and socio-emotional competencies in very preterm young adolescents.

Very preterm (VPT) children and adolescents show executive, behavioural and socio-emotional difficulties that persists into adulthood. This study aims to assess the effectiveness of a mindfulness-based intervention (MBI) in improving these competencies in VPT young adolescents using a randomised controlled trial design. 56 young adolescents aged 10-14 years, born before 32 gestational weeks, were randomly assigned to an "intervention" or a "waiting" group and completed an 8-week MBI in a cross-over design. Executive, behavioural and socio-emotional competencies were assessed at three different time points via parent and self-reported questionnaires, neuropsychological testing and computerised tasks. The data were analysed using an intention-to-treat approach with linear regression modelling. Our findings show a beneficial effect of MBI on executive, behavioural and socio-emotional competencies in VPT young adolescents measured by parent questionnaires. Increased executive competencies were also observed on computerised task with enhanced speed of processing after MBI. Two subgroups of participants were created based on measures of prematurity, which revealed increased long-term benefits in the moderate-risk that were not observed in the high-risk subgroups of VPT young adolescents. MBI seems a valuable tool for reducing detrimental consequences of prematurity in young adolescents, especially regarding executive, behavioural and socio-emotional difficulties.Clinical Trial Registration ClinicalTrials, NCT04638101. Registered 20 November 2020-Retrospectively registered, https://clinicaltrials.gov/show/NCT04638101 .

Internalizing problems are associated with oral health-related quality of life in early childhood: Outcomes from an Asian multi-ethnic prospective birth cohort.

Oral health status ideally warrants for a holistic biopsychosocial approach to health and wellness. Little is known about the impact of behavioral problems on oral health-related quality of life (OHRQoL) in children due to the paucity of studies in early childhood, particularly in Asian multi-ethnic populations. This study evaluated the relationship between early child's socioemotional factors and OHRQoL, as well as its association with orofacial pain (OFP) and early childhood caries (ECC) in the Asian GUSTO birth cohort. Mother-child dyads were postnatally assessed at 3 time points. The Child Behavior Checklist (CBCL) was used to assess the child's socioemotional and behavioral problems at age 4-4.5 years together with other validated questionnaires to evaluate maternal anxiety and depression. ECC detection was performed at age 5, and OHRQoL (primary) and OFP (secondary) outcomes were assessed at age 6 from a total of 555 mother-child dyads. After a univariate regression analysis was performed to identify potential predictors and confounders, a multivariate regression model was run with predisposing factors (CBCL internalization and externalization problems, OFP, ECC) and adjusted for confounders (maternal psychosocial states, maternal education) to determine associations with OHRQoL. Results showed an association between CBCL internalization scores and poorer OHRQoL (RR = 1.03, p = 0.033, 95% CI 1.01 to 1.05), although the limited risk ratio may not have a practical applicability in psychosocially healthy children, alike the majority of those evaluated in this cohort. The average OHRQoL overall score among children with OFP was 2.39 times more than those without OFP (OR = 2.39, p < 0.001, 95% CI 2.00 to 2.86). Thus, in early childhood, OFP, and to lesser extent internalizing behaviors, may negatively impact OHRQoL. This study therefore highlights the complex relationship between OHRQoL and its predisposing socioemotional and somatic pain factors, and demands further investigations in clinically relevant populations.

Effect of community-based nutritional counseling intervention on children's eating habits.

AIM: This study aimed to assess the outcome of community-based nutritional counseling interventions on eating habits of rural-dwelling children. METHODS: A group-randomized trial design was used in this study. A total of 108 rural-dwelling children from a community in the Enugu North agricultural zone, Enugu State, who participated in the study. The children were randomly assigned to 2 groups: the treatment group (n = 54) and the no-treatment control group (n = 54). The child eating behavior questionnaire was used for data collection. Parents of the participating children within each study group completed the child eating behavior questionnaire at 3 time points. The data collected were analyzed using an independent sample t test at a probability level of .05. RESULT: The outcome of the study showed that the children's eating habits in the treatment group improved positively following the community-based nutritional counseling intervention. The positive gain from exposure to the community-based nutritional counseling intervention program was sustained during follow-up for children in the treatment group compared with the no-treatment group. CONCLUSION: The community-based nutrition counseling intervention carried out among children in rural communities had a positive adjustment in children's eating habits. The intervention requires the constant collaboration of professional childhood educators, caregivers, home economists, school staff, healthcare specialists, families, and the children themselves. Furthermore, there is a need for future long-term evaluations of the effects of community-based nutritional counseling interventions on children's nutrition and eating habits.

'The Mould that Changed the World': Quantitative and qualitative evaluation of children's knowledge and motivation for behavioural change following participation in an antimicrobial resistance musical.

BACKGROUND: A primary school musical ("The Mould that Changed the World") was developed as a unique public engagement strategy to combat antimicrobial resistance (AMR) by engaging children in the story of the discovery of antibiotics, the risks of drug-resistant infections and the importance of prudent antibiotic use. METHODS: The musical intervention was implemented in two UK primary schools by music specialists through a series of workshops, associated learning resources and performances to relatives. Participating children (n = 182), aged 9 to 11 years, were given an online questionnaire in the classroom before rehearsals began and at two weeks post-performance with a six-month evaluation in one school. The impact of the musical was analysed using generalised linear models to control for confounding factors. For the qualitative evaluation, fifteen participating children were selected randomly from each school to take part in semi-structured focus groups (n = 5 per group) before rehearsals began and two weeks post-performance. FINDINGS: Knowledge gain was demonstrated with children being more likely to answer questions on key messages of the musical correctly at two weeks post- performance (response rate 88%, n = 161) compared with the pre-rehearsal questionnaire (response rate 99%, n = 180) (bacteria can become resistant to antibiotics OR 4.63, C.I. 2.46-9.31 p<0.0001, antibiotic resistant infections can be life threatening OR 3.26 C.I. 1.75-6.32 p = 0.0001, prudent use of antibiotics will slow the rise of antibiotic resistant infections OR 2.16, C.I. 1.39-3.38, p = 0.0006). Long term knowledge gain was demonstrated by a consistent level of correct answers on key messages between two weeks (response rate 95%, n = 89) and 6 months post musical (response rate 71%, n = 67). Following the musical children participating in the focus groups (n = 30) articulated a greater understanding of AMR and the risks of antibiotic overuse. They discussed motivation to minimise personal antibiotic use and influence attitudes to antibiotics in their family and friends. INTERPRETATION: This study demonstrates that musical theatre can improve both short and long-term knowledge. It demonstrates a hitherto infrequently reported change in attitude and motivation to change behaviour in children at an influential age for health beliefs. This unique public health tool has the potential for high impact particularly if rolled out within national education programmes for primary school aged children.

Children's and parents' looking preferences to gender-typed objects: Evidence from eye tracking.

Differences between children's and parents' implicit and explicit gender stereotypes were investigated in two experiments. For the first time, the visual world paradigm compared parents' and 7-8-year-old children's looking preferences toward masculine- and feminine-typed objects stereotypically associated with a story character's gender. In Experiment 1 participants listened to sentences that included a verb that inferred intentional action with an object (e.g., "Lilly/Alexander will play with the toy"), and in Experiment 2 the verb was replaced with a neutral verb (e.g., "Lilly/Alexander will trip over the toy"). A questionnaire assessed participants' explicit gender stereotype endorsement (and knowledge [Experiment 2]) of children's toys. Results revealed that parents and children displayed similar implicit stereotypes, but different explicit stereotypes, to one another. In Experiment 1, both children and parents displayed looking preferences toward the masculine-typed object when the story character was male and looking preferences toward the feminine-typed object when the character was female. No gender effects were found with a neutral verb in Experiment 2, reinforcing the impact of gender stereotypes on implicit processing and showing that the effects are not simply driven by gender stereotypic name-object associations. In the explicit measure, parents did not endorse the gender stereotypes related to toys but rather appeared to be egalitarian, whereas children's responses were gender stereotypic.

Verbal and Behavioral Expressions of Child Sexuality Among 1-6-Year-Olds as Observed by Daycare Professionals in Finland.

A safe childhood respecting sexual rights forms the foundation of an individual's sexual health. However, the understanding, support, and protection of early sexuality are seldom discussed. Children already express their sexuality verbally and behaviorally in daycare, often requiring a response from staff. These day-to-day situations may have an influence on children's later sexuality. The World Health Organization Regional Office for Europe and BZgA (2010) published a framework for professionals on age-appropriate, holistic sexuality education. Using this framework, we evaluated children's sexuality-related expressions in Finnish daycare. Our nationwide questionnaire among professionals in early childhood education and care (n = 507) focused on how 1-6-year-old children expressed their sexuality in their speech and behavior. All eight topics in the WHO framework emerged regularly. The two most prevalent topics were the body and emotions. Also, 71% of professionals had a child in their group who masturbated openly. Early sexual development manifested as curiosity about one's own body, exploring its functions, traits, and attributes, while on an emotional level it manifested as abundant feelings of infatuation and tenderness, shown openly toward those-peers and adults alike-whom the child cares for. Childhood sexuality is broadly and diversely present in children's verbal and behavioral expressions in daycare settings. Children need and have the right to receive explicit responses related to issues concerning their sexual development and to receive age-appropriate information, skills, and attitudes fostering healthy development.

Portion size selection in children: Effect of sensory imagery for snacks varying in energy density.

Food sensory imagery - creating a vivid mental image of the sensory experience of eating - can lead to the selection of smaller portions because it serves as a reminder that eating enjoyment does not necessarily increase with portion size. The evidence is mostly limited to adults and to energy-dense foods for which it is particularly difficult to predict the satiating effects of consumption quantity. The objective was to study how food sensory imagery influences portion size selection of foods varying in energy density (brownie and applesauce) by 7- to 11-year-old children. During after-school time, 171 children were randomized into two conditions. Children in the food sensory imagery condition were asked to imagine the taste, smell, and texture of eating palatable foods, i.e., chocolate cereal, chocolate waffle, and chocolate candies. Children in the control condition performed a similar sensory imagery task for non-food-related activities. Children were then asked to choose between the recommended serving size, a 50% larger portion, and a 125% larger portion of either brownie or applesauce. One week later, they were placed in the same condition for the other food. Compared to the control condition, food sensory imagery led children to choose 7.1% less brownie but had no effect on applesauce portion selection. Exploratory findings showed that the food sensory imagery intervention was especially effective at reducing brownie portion size selection among children who were moderately hungry, who usually eat fast, and whose parents pressure them to eat. In conclusion, food sensory imagery may be a useful intervention to nudge children towards healthier portion size choices because it reduces the selected portion size of an energy-dense snack without reducing the selected portion size of a healthier snack.

Psycho-art-drama: development and testing a new integrated complementary method of psychiatric treatments for hospitalised children with cancer (a case study).

Objective: Art therapy as a psychotherapy method using art, and psychodrama as a therapeutic method using role play, have different roots, principles, techniques and different effect mechanisms and advantages. Integrated psychotherapies are aimed to maximise each of the component advantages, as well as minimising disadvantages. Therefore, the main objective of this study was to develop a new integrated psychotherapy method, named psycho-art-drama (PAD) for hospitalised children with cancer and testing its effectiveness.Methods: After designing the PAD protocol, five hospitalised children with cancer accompanied with their mothers selected based on inclusion and exclusion criteria to participate in this single-subject study.Results: The results showed that PAD was significantly effective in reducing the bio-psycho-social expressions of incompatibility in the hospital (BPSEIH) in all of the five children.Conclusions: Findings of this study give preliminary support using the PAD model in similar conditions.

Mindful feeding: A pathway between parenting style and child eating behaviors.

Certain child eating behaviors (e.g., food fussiness, emotional overeating, and disruptive mealtime behaviors) can create challenges for caregivers and result in short- and long-term health consequences (e.g., lower fruit and vegetable intake, a deficiency of essential nutrients, greater intake of energy-dense foods and sugary beverages, and/or higher BMI) for the children. The role of mindful feeding-cultivating a present-centered awareness in the feeding context to increase parents' awareness of their own responsive (and non-responsive) feeding behaviors-has not been explored as it relates to parenting and children's problematic eating behaviors. The objective of this study was to understand whether the relations between parenting style and child eating behaviors often documented in the literature are mediated by mindful feeding. Using self-reports from Amazon's Mechanical Turk (MTurk) of 496 mothers and fathers of young children (age 2-7 years old), we explored whether mindful feeding mediates the relation between parenting style and child eating behaviors. As hypothesized, authoritative parenting was related to higher rates of mindful feeding (ß=.16, 95% C.I. [.05, .18]), while authoritarian (ß=-.34, 95% C.I. [-.32, -.17]) and permissive parenting (ß= -.15, 95% C.I. [-.18, -.05]) were related to lower rates of mindful feeding. Mindful feeding mediated the relation between each parenting style and each child eating behavior (i.e., food fussiness, problematic mealtime behaviors, and emotional overeating). These findings suggest that that mindful feeding may be a promising new construct, and its relation to feeding interventions aimed at improving problematic child eating behaviors should be further evaluated.

El Miedo en Relación a la Odontología Uso de la Escala del Miedo Dental / Fear in Relation to Dentistry Using the Dental Fear Scale

La atención odontológica despierta en numerosos pacientes, especialmente en los niños, miedo y ansiedad que pueden originar conductas de rechazo a la misma o dificultar el trabajo del profesional. Para registrar la prevalencia e identificar los miedos más frecuentes en relación a la atención odontológica, se realizó un estudio observacional, descriptivo y longitudinal en un trabajo interdisciplinario con Musicoterapia. Se utilizó la Escala del Miedo (CFSS-DS), Dental Subscale of the Childrens' Fear Survey. Los resultados en un promedio de edades en años 11,41; desvío = 2,80, registraron el 53% en la puntuación 38:39. Corresponde 54.34% al sexo femenino y 45.66% al sexo masculino. El mayor porcentaje de miedo se registró a los 10 años de edad 15.24% y en el sexo femenino 54.34%. En conclusión, registrar y reconocer los miedos dentales ofreció un espacio de reflexión y elaboración de los mismos, con docentes y alumnos de grado, para desarrollar, en un tratamiento interdisciplinario con musicoterapia, estrategias que favorezcan una mejor adherencia de los pacientes al tratamiento odontológico y habilidades inherentes y habilidades sociales inherentes a la relación odontólogo-paciente. El miedo manifiesto a la atención odontológica sin ser resuelto satisfactoriamente puede entorpecer las mejores intenciones del profesional en el desarrollo de su tarea (AU)

It's the Moments That Matter.

Brief encounters and events can sometimes change lives.

Examining the effects of an eHealth intervention from infant age 6 to 12 months on child eating behaviors and maternal feeding practices one year after cessation: The Norwegian randomized controlled trial Early Food for Future Health.

OBJECTIVES: The Norwegian randomized controlled trial Early Food for Future Health provided parental anticipatory guidance on early protective feeding practices from child age 6 to 12 months through an eHealth intervention. Previously published outcomes at child age 12 months indicated that the eHealth intervention increased daily vegetable/fruit intake and promoted more beneficial mealtime routines. The objective of the current paper is to evaluate the effects of the intervention at child age 24 months, one year after cessation. METHODS: Parents of infants aged 3-5 months were recruited via social media and child health clinics during spring 2016. At child age 5.5 months, 715 mothers were randomized to either control (n = 358) or intervention (n = 360) arm. Primary study-outcomes were child eating behaviors, dietary intake, mealtime routines and maternal feeding practices and feeding styles. Secondary outcome was child anthropometry. RESULTS: In total 295 mothers (41%) completed the follow-up questionnaire at child age 24 months. Regarding fruit intake, 54.3% in the intervention group had a high score compared with 48.3% of the control group (p = 0.29). For intake of vegetables, 54.5% in the intervention group had a high score compared with 50.7% in the control group (p = 0.49). A total of 65.7% of the children in the intervention group were eating breakfast together with family ≥ 4 times per week, compared with 57.3% of the children in the control group (p = 0.12). There was no difference between the groups for child anthropometric outcomes at child age 24 months. CONCLUSIONS: At child age 24 months, we found no evidence of sustained intervention-effects. Although dietary patterns and mealtime routines at child age 24 months were reasonably consistent and in the same directions as at child age 12 months, the between-group differences were not significant. The large loss to follow-up may have limited power and validity and makes it difficult to draw overall conclusions. Future research is needed to improve knowledge of how short-time effects could be retained over longer term, taking into account that larger samples are necessary when planning longer-term follow-up studies. TRIAL REGISTRATION: ISRCTN, ISRCTN13601567.

How can mindful parenting be related to emotional eating and overeating in childhood and adolescence? The mediating role of parenting stress and parental child-feeding practices.

To explore whether the association between mindful parenting and children/adolescents' disordered eating behaviors (i.e., emotional eating and overeating) may be mediated by parenting stress and parental child-feeding practices. The sample comprised 726 family dyads composed of a mother (79.8%) or a father (20.2%) and their child (7-18 years old), of which 362 children/adolescents had normal weight (BMI = 5-85th percentile) and 364 had overweight or obesity (BMI ≥ 85th percentile) according to the WHO Child Growth Standards. Parents completed self-report measures of mindful parenting, parenting stress, and child-feeding practices, and children/adolescents completed measures of emotional eating and overeating. The path model was estimated in AMOS. Mindful parenting was negatively associated with children's emotional eating through lower levels of parenting stress followed by less frequent use of food as a reward and through less frequent use of food as a reward only. Mindful parenting was linked to children's overeating through lower levels of parenting stress. Moreover, mindful parenting was associated with less frequent use of food as a reward, pressuring to eat and monitoring through lower levels of parenting stress, among parents of girls, mostly from the early stage of adolescence. Additionally, higher levels of parenting stress were associated with using food as a reward and, consequently, with higher levels of emotional eating among girls, and with more restriction and, consequently, with more overeating among early-stage adolescents. A comprehensive model suggesting that mindful parenting can help children/adolescents engage less in disordered eating behaviors through lower levels of parenting stress and the adoption of more adaptive child-feeding practices is proposed. Parental practices, particularly mindful parenting, may have an important role in promoting healthier eating behaviors among children/adolescents.

Childhood Vitiligo.

Vitiligo is a common acquired depigmenting skin disease characterized by a progressive loss of functional melanocytes. It may appear from the first years of life to late adulthood. Childhood vitiligo (CV), defined as vitiligo that begins before the age of 12 years, is common and may differ from post-CV in terms of epidemiology, clinical presentation, comorbidities, and treatment options. Taking into consideration the potential significant psychosocial impact of the disease on both children and their parents, all available therapeutic options must be offered to patients who desire treatment. According to the most recent guidelines, topical corticosteroids, topical calcineurin inhibitors, and narrowband ultraviolet B phototherapy are the most commonly used treatment modalities for vitiligo in children. This review presents recent data regarding the whole spectrum of CV. Differences between CV and post-CV are also discussed.

Behavioral and cognitive effects of docosahexaenoic acid in drug-naïve children with attention-deficit/hyperactivity disorder: a randomized, placebo-controlled clinical trial.

This study aimed to investigate the efficacy of docosahexaenoic acid (DHA) dietary supplementation on behavior and cognition in school-aged, drug-naïve children with attention-deficit/hyperactivity disorder (ADHD). A total of 50 participants with ADHD aged 7 to 14 were enrolled in a 6-month randomized, placebo-controlled clinical trial and received either DHA or placebo. The primary outcome measure was the change in the ADHD rating scale IV Parent Version-Investigator (ADHD-RS-IV) after 4 and 6 months. Secondary outcome measures included Conners Parent Rating Scale-revised, other behavioral rating scales including quality of life and global functioning, and computerized cognitive tasks. Baseline assessment also addressed the blood fatty acids profile. No superiority of DHA supplement to placebo was observed on ADHD-RS-IV, the a priori primary outcome. DHA supplementation showed a significant, nonetheless quite small, effect on children's psychosocial functioning, emotional problems, and focused attention. Neither major nor minor adverse events were reported throughout the trial. This study shows that 6-month DHA supplementation has no beneficial effect on the symptoms of ADHD in school-aged, drug-naïve children with an established diagnosis of ADHD. Nevertheless, the 6 months treatment with supplemental DHA appears to have small positive effects on other behavioral and cognitive difficulties, which, in light of the absence of side-effects, could be reasonably followed up in future intervention studies. ( https://clinicaltrials.gov/ct2/show/NCT01796262 : The Effects of DHA on Attention Deficit and Hyperactivity Disorder (DADA)).

Feasibility of the Musical Contour Regulation Facilitation (MCRF) Intervention for Preschooler Emotion Regulation Development: A Mixed Methods Study.

Emotion regulation (ER) describes the goal-directed ability to manage and shape the dynamics and timing of one's emotional experiences and expressions, an ability that develops early in life. Though development of maladaptive ER skills can significantly impact developmental outcomes, interventions for at-risk children are limited. The purpose of this mixed methods study was to examine feasibility and preliminary efficacy of the Musical Contour Regulation Facilitation (MCRF) intervention, a multi-session strategy for promoting ER development in preschoolers, with a focus on typically developing preschoolers as a preliminary exploration of a novel intervention. Eight typically developing children (M = 3.88 years) participated in the 11-session MCRF intervention across four weeks. ER-related behaviors were assessed pre- and post-intervention, and teacher interviews were conducted post-intervention. Teachers noted positive change in children's behavior following the intervention in terms of their emotion skills and peer interactions. Furthermore, they believed in the importance of music for developmental outcomes. Large and medium effects sizes in ER-related abilities were noted, and acceptability and integration of the intervention into the regular daycare environment was supported by interview data. Findings support further refinement and examination of the MCRF intervention in children who are at risk.

Development and initial validation evidence for a mindful eating questionnaire for children.

Mindful eating interventions have become a focus among health professionals, which warrants a need for a psychometrically solid assessment tool. The current study outlines the development and initial validation of the Mindful Eating Questionnaire (MEQ) adapted for Children (MEQ-C). Participants included 262 third through fifth grade students (53% female, 57% white, non-Hispanic) who participated in a mindful eating intervention Foodie U. Data was also collected from 140 parents. Exploratory factor analysis delineated two factors (Awareness and Mindless Eating). Test-retest analysis with a subsample (n = 93) indicated moderate correlations for both factors. The two subscales have good construct validity and can be utilized in an exploratory sense for mindful eating interventions among children. Specifically, the eight-item mindless eating subscale has good internal consistency reliability and can independently be used as a questionnaire to assess overall mindless eating practices among children. Further research is needed to explore and better understand domains of mindful eating among children besides awareness.