Pediatricians` attitudes, practices, and perceived barriers to school readiness.

BACKGROUND: School readiness (SR) has been adopted by the American Academy of Pediatrics (AAP) as a component of health supervision, but the medical community`s role is unknown. We evaluated the pediatricians` attitudes, practices, and perceived barriers to SR. METHODS: This multicenter, cross-sectional descriptive study was performed among 787 general pediatricians, pediatric residents, subspecialists, and subspecialty fellows. A 41-item survey was administered. RESULTS: Forty-nine point two percent of the pediatricians defined SR as a multidimensional issue, as outlined by the AAP, whereas 50.8% defined it as the child`s set of skills or passing the SR tests. Three-quarters of pediatricians believed that SR assessment tests are necessary before starting school, and children who do not appear ready should wait a year. To promote SR, the rates of usually fostering at least four of the five `Rs` (reading, rhyming, routines, rewarding, relationships) and integrating developmental surveillance into daily practice were 37.8% and 23.8%, respectively. Only 2.2% of pediatricians usually inquired about eight adverse childhood experiences (ACEs), and 68.9% did not usually ask about any. Usually fostering at least four of the five `Rs` was associated with usually integrating developmental surveillance (p < 0.001), usually inquiring about each ACE (p < 0.001), and being perceived as responsible for promoting SR (p < 0.01). Training on SR during pediatric residency was 2.7%. Time constraints and insufficient knowledge were the most common barriers. CONCLUSIONS: Pediatricians were not familiar with the concept of SR and had some misconceptions. There is a need for additional training regarding pediatricians` roles in promoting SR along with addressing multiple, modifiable barriers within the health system. < strong > Supplementary: < a href="https://www.turkishjournalpediatrics.org/uploads/2573-supplementary.pdf" target=`_blank` > Supplementary Appendix < /a > < /strong >.

Autism spectrum disorder in patients with inherited metabolic disorders-a large sample from a tertiary center.

BACKGROUND: There is increased awareness regarding the co-occurrence of autism spectrum disorder (ASD) and inherited metabolic disorders (IMD), and this is crucial for the management of both diagnoses in clinical practice. We aimed firstly to report twenty-two patients with a dual diagnosis of IMD and ASD who are still being followed up in the child metabolism outpatient clinic; secondly to evaluate the time of both IMD and ASD diagnosis and the clinical progress of their metabolic disorders to underline treatable conditions. METHODS: Among the patients admitted to the Pediatric Metabolism outpatient clinic because of IMD, twentytwo of them who had a diagnosis of ASD were included in the study. Data of the patients were collected from their medical records. The most recent progress of the patients concerning their metabolic disorder was obtained from the patients` files. RESULTS: Six cases with Phenylketonuria, 2 cases with partial Biotinidase Deficiency, 3 cases with Cerebral Creatine Deficiency Syndrome (CCDS), 5 cases with Mucopolysaccharidosis (MPS) Type-3b, 2 cases with MPS Type-3a, 1 case with MPS Type 4, 2 cases with Hypervalinemia and 1 case with Maple Syrup Urine Disease were all diagnosed as also having ASD. The diagnoses of CCDS and MPS Type 3 were after the diagnosis of ASD. Phenylketonuria and Mucopolysaccharidosis were the most common diagnoses in our study. In addition, rare entities such as MPS Type 3b and Type 4 and Hypervalinemia were also reported to co-occur with autism. CONCLUSIONS: Considering the co-occurrence of both disorders and implementing intervention strategies accordingly will certainly be beneficial in clinical practice and particularly in countries with a high rate of consanguinity.

How effective is family counselling on screen exposure of pre-school children?

BACKGROUND: Excessive screen viewing and background TV exposure are common problems all over the world. Therefore, intervention studies have gained importance. This study aims to investigate the effectiveness of family-based, developmental pediatrics clinic setting counseling in reducing screen time in typically developing children and to compare them with neurodevelopmental disorders. METHODS: Children (aged 24-62 months) who were exposed to screen viewing for at least 2 hours/day were included. Parents were given three counseling sessions to reduce excessive screen time. Parents reported daily screen time, co-viewing, background TV exposure, the duration of reading books and playing with their child. RESULTS: The study included 105 children (median age: 34 months IQR:28-41). Before counseling, the screen viewing time and the percentage of co-viewing among typically developing children (n=22) and children with a neurodevelopmental disorder (n=83) were similar. There was a statistically significant decrease in screen time in both groups after the intervention. A higher impact was shown in the neurodevelopmental disorder group. The increase in percentages of co-viewing, as well as the increase in the time spent playing with their children, were statistically significant in the neurodevelopmental disorder group. CONCLUSIONS: The study demonstrated that three pediatric office-setting counseling sessions including media use recommendations of the American Academy of Pediatrics are effective to decrease screen time for children who are either typically developing or with a neurodevelopmental disorder.

Sensory profile, ferritin and zinc levels in preschool-aged children with symptoms of attention deficit hyperactivity disorder.

BACKGROUND: Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders and has a big impact on the well-being of children. The disorder can lead to noticeable functional limitations for children and bio-ecological factors also contribute to symptoms of ADHD. We aimed to investigate the associations between ADHD symptoms and some related bio-ecological factors including serum ferritin, zinc levels and sensory processing in preschool-aged children. METHODS: Twenty-two children who had been referred to the division of Developmental Pediatrics because of ADHD symptoms and 22 participants from the general pediatric outpatient clinics were included in the study. The symptoms of ADHD were evaluated with Conners` Parent Rating Scale-Revised Short form. Complete blood count, serum ferritin and zinc levels were also evaluated. A blind occupational therapist implemented sensory processing measurements. The characteristics of each participant such as prematurity, perinatal complications, developmental practices and sociodemographic data were also considered. RESULTS: Sensory processing measurement analysis revealed that all Sensory Profile scores were significantly lower in the children with ADHD symptoms compared to the control group indicating that the child shows the behavior more than desired. The low level of zinc (p=0.026, OR=6.153, 95% CI= 1.247-30.362) and the presence of perinatal complications (p=0.045, OR=10.864, 95% CI=1.059-111.499) increased the risk of ADHD symptoms. We could not find an association for ferritin levels in our study. CONCLUSIONS: The evaluation of zinc level and sensory profile parallel to other strategies can be recommended during the management of ADHD symptoms in preschool children.

Turkish validation of the maternal responsiveness global rating scale in slow-to-talk toddlers.

BACKGROUND: The relation between maternal responsiveness and language development has been shown in previous literature however it is difficult to evaluate responsiveness because of the difficulties involved when coding the specific patterns of parent-child interactions. The maternal responsiveness global rating scale is important because it requires less time and expertise from professionals and predicts the language outcome of children. The aim of the study was to adapt the Maternal Responsiveness Global Rating Scale into Turkish, thereby making it accessible to a variety of professionals, and creating a way to use this useful scale. METHODS: Twenty-seven 18- to 42-month old children who had been admitted to the Developmental Pediatrics outpatient clinic with concerns of speech delay and had received a diagnosis of language disorder with the standardized language test were included in the study. The general development and language development of each participant was evaluated using Denver II, Bayley-third edition and Pre-school Language Scale-5. After the translation study of the Maternal Responsiveness Global Rating Scale, video collecting and rating procedures and finally reliability and validity analyses were implemented. RESULTS: The results of this study demonstrated that the Turkish translation of the Maternal Responsiveness Global Rating Scale shows strong evidence of adequate reliability and validity and is a feasible tool to measure responsiveness in routine child health care practice for children with language delay. CONCLUSIONS: This in expensive, easy-to-use and reliable tool may be recommended in order to identify which slow-to-talk toddlers and their mothers need early intervention and may be used by community-based practitioners and researchers in Turkey to support language development during early intervention stages.

Relationship between non-cardiac chest pain and internalizing problems in pre-school aged children.

OBJECTIVE: Non-cardiac chest pain is a common and persistent problem for children; yet, typically, there is no clear medical cause. To date, no behavioural and/or psychological factors have been studied to explain chest pain in a pre-school paediatric sample. We hypothesized that pre-school children with medically unexplained chest pain would have higher rates of behavioural problems compared to healthy controls. METHODS: We assessed 41 pre-school children with non-cardiac chest pain and 68 age matched children with benign heart murmurs as the control group using the Child Behaviour Check List-1 1/2-5 to evaluate emotional and behavioural problems. RESULTS: Internalizing problem scores comprising emotionally reactive, anxiety/depression, and somatic complaints were higher in children with non-cardiac chest pain than in the control group. Among the possible factors, the factor that is related to behaviour problem scores, in univariate analysis, was a significant and inverse correlation between maternal education and behaviour problem scores. Also, maternal employment status was associated with behavioural problems. Children with a housewife mother were more susceptible to having such behavioural problems. Based on multiple regression analyses, being in the non-cardiac chest pain group was found to be significantly related to internalizing problems in our total sample. CONCLUSIONS: These results suggest that pre-school children with non-cardiac chest pain may experience increased levels of certain behavioural comorbidities. Systematic behavioural screening could increase the detection of behavioural problems and improve care for this population. Future studies of non-cardiac chest pain in pre-school children should include larger samples and comprehensive diagnostic assessments as well as long-term follow-up evaluations.

The effect of colchicine and disease severity on physical growth in children with familial Mediterranean fever.

This study aimed to investigate the effects of colchicine on growth parameters in familial Mediterranean fever (FMF) patients. Fifty-one (29 girls, 22 boys) FMF patients were enrolled in the study. All of the patients were in the prepubertal stage and had not received colchicine treatment before the study. Anthropometric measurements, demographic features, clinical findings at diagnosis and during periods of attacks of FMF, disease activity, frequency of exacerbations, colchicine dosage, and weight and height measurements were recorded at an interval of 6 months. Height, weight, and body mass index standard deviation scores and Z-scores were calculated. The mean height standard deviation score (HSDS) was significantly increased from -0.64 ± 1.20 to -0.26 ± 1.07 (p < 0.001), the mean weight standard deviation score (WSDS) was significantly increased from -0.60 ± 1.03 to -0.45 ± 0.98 (p = 0.008), and the mean body mass index standard deviation score was decreased from -0.33 ± 1.06 to -0.47 ± 0.98 (p = 0.128) at 1 year after colchicine treatment compared with before initiation of treatment. In patients who had no FMF attacks during colchicine treatment, height and weight were significantly increased at 1 year (HSDS: p < 0.001 WSDS: p = 0.002), but in patients who had recurrent attacks, height and weight did not change (HSDS: p = 0.051, WSDS: p = 0.816). Even when subclinical inflammation is present, preventing attacks of FMF with colchicine allows growth to continue. However, suppression of subclinical inflammation and control of attacks of FMF are required for weight gain.