Healthy play, better coping: The importance of play for the development of children in health and disease

Balance training exercises and postural control in overweight and obese children: A systematic review

BACKGROUND

Childhood Obesity causes potential changes in sensory input and disrupts postural control and stability. Implementing balance exercises has been shown to improve postural impairment, enhance motor task development, and reduce the risk of injury in this population.

OBJECTIVE

The aim of this study is to discover balance exercises to enhance postural control in overweight and obese children.

DESIGN

Systematic literature review.

METHODS

A comprehensive search was conducted across five electronic databases to find randomized controlled/randomized controlled clinical/Quasi-experimental studies pertaining to balance control exercises and childhood obesity. Each reviewer used the PEDro scale to independently assess the data that was retrieved from studies that satisfied the inclusion criteria. A risk-of-bias assessment was also conducted.

RESULTS

After fulfilling the inclusion and exclusion criteria, 4 articles were assimilated in the systematic review. Two independent authors verified and screened data, third author double-checked and searched for additional articles. The PEDro scale rated the studies as moderate to good (scores >6), with minimal bias. Key biases stemmed from the lack of blinding and concealment.

CONCLUSION

There is strong evidence suggesting that balance exercise not only enhance stability but also address the difficulties associated with excess body weight. Thus, the integration of balance exercises in the regimen of overweight and obese children proves effective in advancing postural control.

Children's right to play in Chilean hospitals: A forgotten right?-A qualitative study protocol

BACKGROUND

Despite being a recognised human right (art. 31 of the United Nations Convention on the Rights of the Child), children's right to play is still insufficiently researched, understood and, above all, implemented. In Chile, the National Child Health Programme recognises the importance of this right for the hospitalised children but makes its provision dependent on the hospital's capacity. We therefore hypothesise that the provision of children's right to play in Chilean hospital settings will be irregular, varying from institution to institution, possibly reflecting the existing socio-economic inequalities in the country, thereby leaving much room for improvement.

AIMS

This study aims to collect qualitative data on the institutional arrangements and opportunities for children's play in public hospitals in Chile. Specifically, our goal is to (a) interpret the conditions and opportunities for play that Chilean public hospitals provide to children and adolescents; (b) interpret institutional arrangements and professional experiences of children's play in those institutions; (c) identify factors that favour and/or limit opportunities for children's play in the Chilean hospital setting.

METHODS

This is exploratory qualitative research, combining multiple and instrumental case study with ethnographic research. Its data collection techniques are semi-structured interviews with professionals in hospital settings (supported by a self-assessment questionnaire), and non-participant observations of hospital playrooms (and/or other play spaces).

CONCLUSION

This will be the first study to investigate children's right to play in Chilean hospitals, with a particular focus on the extent of its implementation, its understanding among health professionals, as well as existing limitations and opportunities for its development.

Characteristics of child development in the context of serious illness: a scoping review

BACKGROUND

Despite evidence on the benefits for including children in their own (palliative) care, studies show that children are not sufficiently involved nor are their preferences sufficiently elicited in a developmentally appropriate manner. The aim of this scoping review is to provide an overview of characteristics of child development in the context of serious illness.

METHODS

A scoping review was performed using methods from Arksey and O'Malley and the Joanna Briggs Institute. A structured literature search was conducted in four databases: Medline, Embase, Psychinfo and CINAHL. Articles were included until October 2022. Thematic analysis was performed to present domains and key factors influencing child development.

RESULTS

We selected 24 out of 11,246 articles. We found different characteristics describing the ongoing development of seriously ill children in early to middle childhood, early adolescence, and middle to late adolescence. Key themes were: psychological/emotional aspects, general cognitive aspects, social aspects, coping strategy, conceptualization of illness, conceptualization of death, and communication about their illness. Several accelerators of ongoing development were found (e.g. cortical maturation, prior medical experience, social experience with adults) and several decelerators (e.g. stress, hospital admission, avoidance of illness-related communication in the family).

CONCLUSION

Our review highlights essential aspects to consider when discussing illness and healthcare preferences with children at various developmental stages. However, our findings also underscore a significant gap in understanding the factors that impact the development of children with a serious illness. It is recommended to monitor development throughout the illness trajectory to gather more evidence and utilize this information to support the child's engagement in their own healthcare in a developmentally appropriate way.

Understanding the perceptions, behavior, and attitudes of healthcare professionals, hospitalized children, and their parents toward hospital play services: A mixed-methods approach

INTRODUCTION

This study examined the perceptions, behavior, and attitudes of healthcare professionals, hospitalized children and their parents toward hospital play services.

METHODS

A two-phase mixed-methods study was conducted in Hong Kong. In phase one, a cross-sectional survey was administered to 182 healthcare professionals working with hospitalized pediatric patients. In phase two, qualitative interviews were conducted with 20 healthcare professionals, 15 hospitalized children, and 14 parents.

RESULTS

Most healthcare professionals valued hospital play services. They believed that hospital play specialists (HPS) could alleviate their workload, especially given the shortage of healthcare professionals. Hospitalized children and their parents reported that HPS help with stress coping and mood improvement, built excellent relationships with children, and facilitated communications between children and healthcare professionals.

DISCUSSION

The findings highlight the importance of play services and HPS in pediatric units to enhance healthcare for hospitalized children. The results provide implications for hospital authority to implement supportive measures.

Personal growth through navigating the world as an artist: a qualitative study of the impact of creativity camp on adolescents with depression

BACKGROUND

A growing body of literature suggests that creative arts interventions can effectively support mental health and well-being in young people. We recently reported that after participating in "Creativity Camp"- a 2-week creative arts group intervention- 69 adolescents with depression showed significantly reduced depression symptoms and improved ratings of well-being. To understand the key processes impacting adolescents during and after this intervention, this study applies a multi-informant qualitative data approach.

METHOD

Qualitative data collection methods included participatory observation notes taken during the Creativity Camp sessions and interviewing the adolescents and their parents or guardians at the end of the intervention and six months later. We analyzed data using Constructivist Grounded Theory and triangulated the findings from both sets of data to gain comprehensive and reliable interpretation.

RESULTS

We found several key processes in the adolescents' experiences during and after camp: internal negotiation between novelty and discomfort, exploring playfulness and responsibility, discovering the uniqueness of self and others, flexible approach toward life, and an expanded view of creativity. From parent interviews, we found that their children expanded personal boundaries and enthusiasm through deep engagement, empowered perspective, and sustained enthusiasm. Triangulating the data from both sources, we constructed a theory that explains the benefits of Creativity Camp on adolescent well-being: "Personal growth by navigating the world as an artist."

DISCUSSION

The qualitative analysis identified key processes from the Creativity Camp intervention, along with changes and long-term impacts that may have fostered personal growth. The framework of navigating the world through an artist's lens as a pathway to personal growth presents a novel contribution to existing knowledge and practice in art-based interventions for adolescents with depression. This insight can help shape the design of future arts-in-health approaches for supporting adolescent mental health.

Playing sport as a central-line carrier: a survey to collect the European pediatric intestinal failure centers' view

BACKGROUND

The administration of home parenteral nutrition improves quality of life for patients with intestinal failure, thus fostering their will to actively participate to social activities. Nevertheless, sports participation can be risky for patients with a central venous catheter (CVC). Despite literature thoroughly proving the positive impact of sports on motor-psychosocial development, no consistent evidence assessing its role on central-line complications is available. This study aimed to report the European centers' approach to children with intestinal failure on home parenteral nutrition and interested in playing sports, further assessing complications and how to prevent them.

MATERIALS AND METHODS

A questionnaire focusing on children with intestinal failure regarding physical activity was circulated to 20 centers. Questions assessed the centers' policy for CVC management, the sports-related recommendations for patients on home parenteral nutrition and complication rates.

RESULTS

Sixteen (80%) centers filled in the questionnaire. Twelve centers reported not to have a standardized formal protocol for catheter care during sports. All centers encouraged patients to perform mild/moderate exercise, whereas high-contact sports were allowed by one center only. Specific dressings were suggested to protect the vascular access device, especially for water sports. Only one sports-related complication (rupture) was reported.

CONCLUSION

This survey emphasizes that sports should not be restricted in patients with intestinal failure and represents a blueprint for sports-related recommendations for these patients. Prospective studies assessing complication rates are advisable to ensure an improved access to sports for these patients.

Effect of team-building sports games on the resilience of Chinese rural children: evidence from Nanxian county, Hunan province

Purpose

Participation in competitive sports has been shown to enhance children's mental health. However, evidence regarding the impact of group sports within traditional physical education on children's mental development is scarce. This study designed a team-building-focused physical education program and examined its effects on the resilience of rural students.

Methods

A total of 86 rural elementary school students (mean age: 11 years) were cluster-randomized into the intervention and control groups. Both groups participated in regular physical education classes three times per week. In the intervention group, the first 15-min warm-up period was replaced with sports games. From a social perspective, all games subtly encourage children to forge new social relationships by engaging in physical contact, interacting with new team members, and collaborating to achieve shared goals in a sportsmanlike manner. Resilience was assessed using the Resilience Scale for Chinese Adolescents before and after the 12-week intervention.

Results

After 12 weeks, the intervention group showed significant improvements in affect control, positive thinking, and help-seeking compared to the control group. Overall, both the individual and supportive dimensions of resilience improved following participation in team-building sports games.

Conclusions

Whether winning or losing as a team member, these experiences positively enhance children's emotional regulation, their understanding of their social roles within a team, and the development of help-seeking and concern for a distressed other. As a result, children may build new and broader social connections that extend beyond the physical education class, fostering a sportsmanlike civic virtue in their daily lives.

The Mediating Role of Meaning-Making in the Relationship Between Mental Time Travel and Positive Emotions in Stress-Related Blogs: Big Data Text Analysis Research

BACKGROUND

Given the ubiquity of stress, a key focus of stress research is exploring how to better coexist with stress.

OBJECTIVE

This study conducted text analysis on stress-related Weibo posts using a web crawler to investigate whether these posts contained positive emotions, as well as elements of mental time travel and meaning-making. A mediation model of mental time travel, meaning-making, and positive emotions was constructed to examine whether meaning-making triggered by mental time travel can foster positive emotions under stress.

METHODS

Using Python 3.8, the original public data from active Weibo users were crawled, yielding 331,711 stress-related posts. To avoid false positives, these posts were randomly divided into two large samples for cross-validation (sample 1: n=165,374; sample 2: n=166,337). Google's natural language processing application programming interface was used for word segmentation, followed by text and mediation analysis using the Chinese psychological analysis system "Wenxin." A mini-meta-analysis of the mediation path coefficients was conducted. Text analysis identified mental time travel words, meaning-making words, and positive emotion words in stress-related posts.

RESULTS

The constructed mediation model of mental time travel words (time words), meaning-making words (causal and insightful words), and positive poststress emotions validated positive adaptation following stress. A mini-meta-analysis of two different mediation models constructed in the two subsamples indicated a stable mediation effect across the 2 random subsamples. The combined effect size (B) obtained was .013 (SE 0.003, 95% CI 0.007-0.018; P<.001), demonstrating that meaning-making triggered by mental time travel in stress-related blog posts can predict positive emotions under stress.

CONCLUSIONS

Individuals can adapt positively to stress by engaging in meaning-making processes that are triggered by mental time travel and reflected in their social media posts. The study's mediation model confirmed that mental time travel leads to meaning-making, which fosters positive emotional responses to stress. Mental time travel serves as a psychological strategy to facilitate positive adaptation to stressful situations.

Outcome measurement: Design of a social impact framework to measure shifts in the ecosystem for inclusion

Children with disabilities need comprehensive intervention spanning health, education, and social systems from infancy through adulthood, with ongoing assessment of outcomes. While assistive technology is crucial, it must be complemented by inclusive learning options and other systemic interventions. Bronfenbrenner's Ecological Systems Theory guides this approach. A project in South Africa's Northern Cape Province utilized Acumen's Lean Data methodology for monitoring and evaluation. This methodology emphasizes rapid, technology-enabled data collection to inform stakeholders effectively. The project focused on disability awareness, referral systems, assistive technology provision, and early childhood development, adapting programs for various stakeholders and virtual delivery during COVID-19 lockdowns. Results underscored the interconnectedness of assistive technology with broader inclusion efforts and the importance of adaptability and continuous assessment. Further research is recommended to explore the project's role in fostering disability inclusion comprehensively. This ecosystemic approach highlights the necessity of holistic intervention and ongoing evaluation for sustainable social transformation and inclusion.

Exploring Health Educational Interventions for Children With Congenital Heart Disease: Scoping Review

BACKGROUND

Congenital heart disease (CHD) is the most common birth defect, affecting 40,000 births annually in the United States. Despite advances in medical care, CHD is often a chronic condition requiring continuous management and education. Effective care management depends on children's understanding of their condition. This highlights the need for targeted health educational interventions to enhance health literacy among children with CHD.

OBJECTIVE

This scoping review aims to map and explore existing health educational interventions for children with CHD. The review identifies the types of interventions, target populations, delivery methods, and assessed outcomes. The goal is to consolidate fragmented research, identify gaps, and establish future research agendas.

METHODS

Comprehensive searches were conducted in February 2024 using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) framework across multiple databases: APA PsycINFO, MedlinePlus via Ovid, Web of Science, ACM Digital Library, Scopus, and EBSCOhost (CINAHL Complete, CINAHL Ultimate, Health Source: Nursing/Academic Edition, and ERIC). The search covered health care, design, and human-computer interaction disciplines to capture the interdisciplinary nature of CHD health educational interventions. There was no predefined time limit due to the limited number of relevant studies. Eligible studies were in English, published in peer-reviewed journals, and focused on primary data about educational health interventions for children with CHD. We extracted and synthesized data using thematic analysis.

RESULTS

The review identified 11 studies: 9 randomized controlled trials and 2 observational studies. These used 6 educational strategies: 3D patient-specific models (n=3), habit formation interventions (n=2), empowerment-based health education programs (n=2), rehabilitation interventions (n=2), web-based portals (n=1), and videotape presentations (n=1). Interventions ranged from brief outpatient sessions to 1.5-year programs, with follow-up from none to 24 months. Studies aimed to improve coping, self-management, and knowledge for children with CHD and their families. The most frequently used assessment method was the independent samples t test (n=4) for pre- and postassessments, and all 11 studies used questionnaires, 8 of which incorporated qualitative feedback. The target participants for these interventions were children aged 13 years and older (n=3), parents (n=2), and children of various ages and their parents (n=6). Outcomes included improved children's health literacy, reduced parental burden, and increased health care provider efficiency.

CONCLUSIONS

This review underscores the critical need for tailored educational interventions for children with CHD. Current research mainly focuses on adolescents and relies heavily on parental involvement, possibly overlooking the specific needs of younger children younger than 13 years of age. It is essential to develop engaging, age-appropriate interventions that actively involve children with CHD in their health care journey. Effective health educational interventions are crucial in empowering these young patients and improving their long-term health outcomes.

Attributes of Pediatric Music Therapists: A Qualitative Analysis of Parent Descriptions

Therapist attributes are known to contribute to positive therapeutic outcomes and are important to effective training and clinical practice. Although well researched in psychology and play therapy, few studies have directly explored music therapist attributes. To explore and understand these descriptions, we conducted a secondary analysis of parent interview data from a multisite trial investigating a music therapist-delivered intervention for young children with cancer and their parents. We used qualitative descriptive analysis to identify music therapists' attributes as described by parents who participated in the intervention. Our inductive analysis of 28 interviews revealed 135 descriptors of music therapists. We discovered that these descriptions grouped naturally using essential therapist attributes of supportive, attuned, and nonjudgemental, as identified in the extant literature. This analysis highlights music therapists' attributes perceived as central to their work with parents and young children in cancer settings.

The Relationship Between Digital Game Addiction and Levels of Anxiety and Depression in Adolescents Receiving Cancer Treatment

BACKGROUND

Adolescents diagnosed with cancer are vulnerable to symptoms of anxiety, depression, and posttraumatic stress.

OBJECTIVE

To examine the relationship between digital game addiction and levels of anxiety and depression in adolescents receiving cancer treatment.

METHODS

This analytical cross-sectional study was carried out with 120 adolescents aged 12-17 years who were receiving cancer treatment. Data were collected using the Digital Game Addiction Scale (DGAS-7) and the Hospital Anxiety and Depression Scale (HADS). Data were analyzed using independent-samples t test, 1-way analysis of variance, Pearson correlation analysis, and simple linear regression.

RESULTS

The mean age of the adolescents participating in the study was 15.21 ± 1.64 years. The mean DGAS-7 score was 15.19 ± 5.58, whereas the mean HADS Anxiety subscale score was 8.54 ± 4.33, and the mean HADS Depression subscale score was 7.72 ± 3.96. A positive, statistically significant relationship was found between the DGAS-7 mean score and the HADS Anxiety and Depression subscale mean scores ( P < .001).

CONCLUSIONS

As the addiction levels increased in adolescents diagnosed with cancer, their anxiety and depression levels also increased.

IMPLICATIONS FOR PRACTICE

Health professionals should be mindful that in adolescents diagnosed and treated for cancer, digital game addiction and levels of anxiety and depression may mutually reinforce each other.

The Impact of Traditional Children's Games on Internet Use, Social Skills, and Stress Level: A Cross-Sectional Design

INTRODUCTION

Traditional games are essential for children's social inclusion due to cultural values and beliefs. This study was conducted to measure the impact of traditional children's games on internet use, social skills, and stress levels.

METHODS

A cross-sectional design was carried out. Children who had parental approval and agreed to participate were included in the study (n = 314). The data were collected using a questionnaire, the Perceived Stress Questionnaire (8-11 years), and the Social Skills Assessment Scale. Linear regression and multinomial logistic regression were performed to analyze the data. Mantel-Haenszel chi-square test was performed to assess the confounding factors for playing traditional games.

RESULTS

The children's mean age was 11.58 (SD = 0.49), and 56.1% were girls. Children who did not play traditional games were more likely to use the internet than those who played traditional games (odds ratio [OR] = 2.16, p = .014). The social skills were significantly associated with daily internet use time (β = 0.164, p = .003), playing traditional games (β = 0.155, p = .008), and frequency of gaming per week (β = 0.123, p = .035). The stress levels were associated with gender (β = 0.120, p = .033) and academic level (β = 0.111, p = .048).

DISCUSSION

Traditional game playing reduced the duration of one sitting and daily internet use. Moreover, outdoor gaming, frequency of playing games, and daily internet use duration were predictors of social skills, whereas being a girl and sixth-grade student were predisposing factors of stress level. Nurses could benefit from traditional games in reducing internet use and stress and improving social skills in children.

From Play Date to Stress Fate: Juvenile Social Play Rescues Stress-Induced Changes in Adult Social Behavior

Long-term effects of social play on neural and behavioral development remain unclear. We investigated whether just 1 h of juvenile social play could rescue the effects of play deprivation on stress-related behavior and markers of neural plasticity. Syrian hamsters were reared from postnatal days 21-43 in three conditions: peer isolation, peer isolation with daily social play sessions (dyadic play), or group-housed with littermates. In adulthood, subjects were exposed to acute social defeat stress, and we examined changes in perineuronal net (PNN) expression surrounding parvalbumin (PV) neurons in the prelimbic (PL), infralimbic (IL), and basolateral amygdala (BLA). Peer deprivation led to exaggerated submissive and defensive behavior in a conditioned defeat test, but 1 h of dyadic play rescued the heightened conditioned defeat response in both males and females. In females, play deprivation reduced PNN/PV coexpression in the PL and IL compared to control groups with opportunities for social play. Males exposed to peer isolation showed elevated agonistic behavior when returned to their littermates compared to males exposed to 1-h play encounters. These findings indicate juvenile social play has long-lasting effects on PNN expression surrounding PV cells in the medial prefrontal cortex, which allows for the development of species' typical agonistic behavior and greater stress resistance in adulthood. The ability of just 1 h of social play to rescue the effects of peer isolation highlights the powerful role of social interactions in neural and behavioral development.

The effect of playing Onigokko on children's executive function and cardiovascular endurance in the early elementary school grades

This study investigated whether continuously playing Onigokko, a game similar to tag, could enhance children's cognitive flexibility, a component of executive function, and improve cardiovascular endurance. The intervention group comprised 34 students enrolled in the second-grade A class of H elementary school in Y prefecture. The control group comprised 34 students enrolled in the second-grade B class at the same school. Cognitive flexibility was assessed using the Trail Making Test Task B (TMT-B), while cardiovascular endurance was measured using a 20-meter shuttle run. These measurements were taken for both groups before and after four weeks playing Onigokko with the intervention group. A two-way ANOVA was applied for each measurement item, considering the group (intervention and control groups) and measurement period (pre and post). A significant interaction was found between cognitive flexibility (TMT-B response time) and cardiovascular endurance (20-meter shuttle run count and maximal oxygen consumption [VO2Max]); thereafter, a simple main effect test (Bonferroni method) was conducted. The results revealed that the intervention group's cognitive flexibility (TMT-B response time) and cardiovascular endurance (20-meter shuttle run count and VO2Max) significantly improved post-intervention compared to the control group. These findings suggest that continuously playing Onigokko can significantly enhance both cognitive flexibility and cardiovascular endurance among early elementary school students.

Impact of play restriction during the COVID-19 pandemic on mental well-being in children with a chronic condition

This study is to investigate the effects of social restrictions, induced by the COVID-19 pandemic, on play behavior, and the associations with mental well-being in children with a chronic physical condition. Additionally, we explored potential moderating effects of environmental factors. Data from the PROactive cohort study including children with a chronic physical condition was used. Play behavior was measured with a self-developed questionnaire distributed during the pandemic with questions concerning behavior before and during the pandemic (with whom they most often played, where, and how many days/week (face-to-face and online)). Mental well-being, including life satisfaction, quality of life, and internalizing symptoms were assessed during the pandemic. Analyses were performed separately for the ages 8-12 years and 13-18 years. Differences in play behavior were analyzed with McNemar's and Wilcoxon signed-rank tests. Linear regression analyses were used to analyse associations between play behavior and mental well-being. P-values were adjusted for false discovery rate. Interaction terms were added with several environmental factors, to explore potential moderating effects. In total, 756 participants (8-12 years: n = 261; 13-18 years: n = 495) were included in this study. Differences in play behavior between pre-pandemic and during the pandemic were observed. With whom they mostly played (friends/family members), compared to playing alone, was related to mental well-being in both age groups. Moreover, for children between 13 and 18 years playing outside was positively associated with life satisfaction and negatively related to internalizing symptoms. Experiencing a negative influence of the pandemic on leisure time, social support, and distress of the child are potential moderators.

CONCLUSIONS

The COVID-19 pandemic induced changes in play behavior. During the pandemic, mainly not playing alone, but with friends or family members, and for older children playing outside, was related to better mental well-being in children with a chronic physical condition.

WHAT IS KNOWN

• Children with a chronic physical condition are at risk for developing social and emotional problems, that include depressive symptoms, anxiety, aggression, physical impairment and problems in academic and social functioning. These problems may be related to limitations in play activities these children are thought to experience. However, there is limited empirical data to relate limitations in play and mental well-being in these children.

WHAT IS NEW

• The COVID-19 pandemic presented an opportunity to investigate alterations in play behavior in relation with mental well-being among children with a chronic physical condition. Based on data from the PROactive cohort, including data for children with a chronic condition, we determined the impact of the pandemic on play in these children and related it to their mental well-being. Our data emphasize the importance of play, and particular playing with others, for mental-well-being and may facilitate prevention strategies for children growing up with a chronic condition.

To Play or Not to Play? Effects of Playmate Familiarity and Social Isolation on Social Play Engagement in Three Laboratory Rat Strains

Social play is a motivating and rewarding behavior displayed by juveniles of many mammalian species, including humans and rats. Social play is vital to the development of social skills. Autistic children show less social play engagement which may contribute to their impairments in social skills. There is limited knowledge about what external conditions may positively or negatively influence social play engagement in humans or other animals. Therefore, we determined how two common external conditions, playmate familiarity and social isolation, modulate social play levels and social play defense tactics in juveniles of three common laboratory rat strains: Long-Evans, Sprague-Dawley, and Wistar. Males and females were socially isolated for either 2h or 48h prior to social play testing and were then exposed to either a familiar (cage mate) or novel playmate, creating four testing conditions: 2h-Familiar, 48h-Familiar, 2h-Novel, and 48h-Novel. Both playmate familiarity and social isolation length influenced social play behavior levels and tactics in juvenile rats, but did so differently for each of the three rat strains. Long-Evans played most with a familiar playmate, irrespective of time isolated, Sprague-Dawley played most in the 48h-Familiar condition, and Wistar played the least in the 2h-Familiar condition, but Wistar played more with a novel playmate than Long-Evans and Sprague-Dawley. Analysis of social play tactics by the playmates in response to nape attacks by the experimental rats revealed strain differences with novel playmates. Here, Sprague-Dawley and Wistar defended more nape attacks than Long-Evans. Sprague-Dawley evaded these attacks, thereby shortening body contact. In contrast, Wistar turned to face their playmate attacker and showed more complete rotations, thereby extending body contact and wrestling longer. Role reversals, which increase social play reciprocity and reflect the quality of social play, were higher in Long-Evans and Sprague-Dawley with familiar playmates. Role reversals decreased for Sprague-Dawley but increased for Wistar after 48h isolation. The effects of playmate familiarity or social isolation length on social play levels and tactics were similar across sex for all three strains. In conclusion, we showed that two common external factors (playmate familiarity and social isolation length) that largely vary across social play studies have a major impact on the level and quality of social play in the three rat strains. Strain differences indicate higher level and quality of social play with familiar playmates in Long-Evans, with familiar playmates after short isolation in Sprague-Dawley, and with novel playmates after longer isolation for Wistar. Future research could determine whether strain differences in neuronal mechanisms underlie these condition-induced variations in social play engagement. Our findings are also informative in suggesting that external conditions like playmate familiarity and social isolation length could influence social play levels and social play quality in typical and atypical children.

A BEME review of educational programmes on the use of play in paediatric practice: BEME Guide No. 82

BACKGROUND

Play can help paediatric patients cope with hospitalisation. Education on the use of play for healthcare professionals (HCPs) is lacking, with playful interactions often occurring unsystematically without formal training. This scoping review systematically describe the frameworks, design, and evaluation methods of educational programmes for HCPs on the use of play in paediatric clinical practice.

METHODS

We conducted the scoping review by searching nine databases for white literature and websites for grey literature. Two reviewers independently screened titles/abstracts and reviewed full texts. Kirkpatrick's evaluation model was applied to report the evaluation methods of educational programmes.

RESULTS

After identifying 16534 white and 955 grey items we included twenty articles but no grey literature. The educational programmes vaguely defined play for procedural and normalising purposes and mostly targeted mono-professional groups, mainly nurses. The evaluation methods identified in the articles were reported in accordance with Kirkpatrick levels 1: reaction (n = 13); 2a: attitude (n = 7); 2b: knowledge (n = 3); 3: behaviour (n = 6); 4a: organisational practice (n = 1) and 4b: patient outcomes (n = 4).

CONCLUSION

The few educational programmes available on the use of play for HCPs are not uniformly described. Future educational programmes would benefit from integrating the needs of HCPs, patients and parents, and using a theoretical framework and systematic evaluation.

Quality of life in pediatric patients on a paracorporeal ventricular assist device with a novel mobile driving system

Background

EXCOR ventricular assist device (VAD) is the gold standard circulatory support for children with end-stage heart failure. Until recently, the only available driving unit was the stationary Ikus. This study (NCT04634708) investigates the impact of the novel mobile EXCOR Active driving unit on patients' mobility and the quality of life (QoL) of their families.

Methods

Children on EXCOR VAD support with the Ikus who were mobilizable outside the hospital room were eligible for the prospective study. Patients remained on Ikus for 7 days, then switched to Excor Active, and were observed for another 45 days. The end-points were the rates of clinically relevant device exchanges (i.e., exchanges that could raise safety concerns for the patient) and successful patient outcomes, respectively. QoL of patients' families was recorded through 2 validated questionnaires: the Pediatric Quality of Life Inventory Family Impact Module and Depression, Anxiety and Stress Scale 21. Patients' mobility and activity levels were monitored through diary entries.

Results

A total of 24 patients were enrolled of which 23 patients completed the study. No clinically relevant device exchanges occurred and there was a successful outcome in 22/23 (95.7%) patients. Changing from the Ikus to the EXCOR Active improved QoL as seen in family impact total score (from 53.8 ± 19.8-66.5 ± 20.8, p = 0.005) and mental health (depression: moderate to mild, stress moderate to normal, both p < 0.05; anxiety: mild to normal, n.s.). Activity levels raised in both, mean time (from 100-300 min/day, p = 0.011) and distance (from 30-1,110 m/day, p = 0.002).

Conclusions

The EXCOR Active driving unit is safe and performs equivalent to Ikus. This study indicates considerable improvement in patients' mobility. In addition, data suggest that families' QoL is positively affected by means of the novel driving unit.

Experiences of Second-Grade Primary School Children and Their Teachers in a Mind-Body Activity Program: A Descriptive Qualitative Study

OBJECTIVES

This study explored the experiences of second-grade children and their teachers who participated in a mind-body program to understand its impact on their development.

METHODS

A qualitative descriptive study was conducted. Student data were collected through seven focus groups, and semi-structured interviews were conducted with tutors in December 2021. Data analysis was performed following COREQ guidelines.

RESULTS

Three themes were generated: (1) competitiveness and restlessness in children: something needs to be done; (2) seeds sown and fruits harvested; and (3) it is necessary to advance from the occasional to the structural. Participants reported positive changes in areas of their development such as self-regulation, relaxation, attention capacity, and stress reduction. Improvements in interpersonal relationships and social skills were also observed.

CONCLUSIONS

These improvements in emotional well-being and social skills highlight the importance of this type of intervention in the school environment.

Gamification in eHealth for Chronic Disease Self-Management in Youth: A Systematic Review

This systematic review primarily aims to provide a summary of the game mechanics implemented in eHealth tools supporting young people's self-management of their chronic diseases. This review secondarily investigates the rationale for implementing game mechanics and the effects of these tools. A systematic search was conducted in Embase, Medline, PsycINFO, and Web of Science, from inception until August 30, 2022. Studies were eligible if focus was on the utilization of gamification in eHealth self-management interventions for young people (age = 10-25 years) with chronic diseases. Primary quantitative, qualitative, and mixed-method studies written in English were included. We identified 34 eHealth tools, of which 20 (59%) were gamified tools and 14 (41%) were serious games. We found that 55 unique game mechanics were implemented. The most commonly used were rewards (50%), score (44%), creative control (41%), and social interaction (32%). In comparison with gamified tools, the number and diversity of game mechanics applied were higher in serious games. For most tools (85%), a general rationale was provided for utilizing gamification, which often was to promote engaging experiences. A rationale for using specific game mechanics was less commonly provided (only for 45% of the game mechanics). The limited availability of experimental research precludes to test the effectiveness of using gamification in eHealth to support self-management in young people with chronic diseases. In this study, we highlight the importance of reporting the rationale for utilizing specific game mechanics in eHealth tools to ensure a proper alignment with evidence-based practice and the need of conducting experimental research. PROSPERO: CRD42021293037.

Sports participation after craniosynostosis repair: the critical role of post-operative guidance in parental decision-making

PURPOSE

Despite previous research supporting patient safety in sports after craniosynostosis surgery, parental anxiety remains high. This study sought to evaluate the role of healthcare providers in guiding patients and families through the decision-making process.

METHODS

Parents of children with repaired craniosynostosis were asked to assess sports involvement and parental decision-making in children ages 6 and older. Questions were framed primarily on 5-point Likert scales. Sport categorizations were made in accordance with the American Academy of Pediatrics. Chi-squared, linear regression, and Pearson correlation tests were used to analyze associations between the questions.

RESULTS

Forty-three complete parental responses were recorded. Mean ages at surgery and time of sports entry were 7.93 ± 4.73 months and 4.76 ± 2.14 years, respectively. Eighty-two percent of patients participated in a contact sport. Discussions with the primary surgeon were more impactful on parental decisions about sports participation than those with other healthcare providers (4.04 ± 1.20 vs. 2.69 ± 1.32). Furthermore, children whose parents consulted with the primary surgeon began participating in sports at a younger age (4.0 ± 1.0 vs. 5.8 ± 2.7 years, p = 0.034). The mean comfort level with contact sports (2.8 ± 1.4) was lower than that with limited-contact (3.8 ± 1.1, p = 0.0001) or non-contact (4.4 ± 1.3, p < 0.0001) sports.

CONCLUSION

This study underscores the critical role that healthcare professionals, primarily surgeons, have in guiding families through the decision-making process regarding their children's participation in contact sports.

The imperative of the child life profession in KSA in transforming the quality of pediatric healthcare

Saudi Arabia has made substantial advancements in its pediatric healthcare infrastructure. However, substantial gaps persist in addressing hospitalized children's emotional safety, and psychosocial and developmental needs. Internationally, the child life profession has evolved over decades to specifically address these needs, through interventions such as therapeutic play, age-appropriate patient education, and family support. This article evaluates the imperative for integrating the child life profession into healthcare services in Saudi Arabia to transform the quality of pediatric healthcare. An analysis of the current landscape revealed gaps in pediatric psychosocial care. These gaps are listed as national priorities in the health transformation program aimed at improving healthcare quality and enhancing well-being. Integrating the child life profession can help achieve these objectives for children and families in Saudi Arabia. This article highlights the multifaceted benefits of the child life profession in improving patient experiences, healthcare delivery efficiency, pediatric healthcare quality, and the overall well-being of children and families. Strategies for phased implementation, involving healthcare institutions, academic partners, relevant non-profit partners, and policymakers, are proposed.

Play for hospitalized children: A qualitative enquiry of behaviour and motivation of nurses in a secondary level healthcare setting in Ghana

BACKGROUND

The World Health Organization recommends that healthcare workers, specifically doctors and nurses, utilize play within treatment and care to promote recovery and overall well-being of hospitalized children. This recommendation has extended the roles of nurses in pediatric settings to include play in their routine care for children hospitalized for various childhood illnesses. Nurses need to draw on their skills to use play as an essential tool to aid communication, assessment, diagnosis, and care of the hospitalized child. This study explored the behaviour and motivation of Ghanaian nurses towards the utilization of play for hospitalized children.

METHODS

Exploratory qualitative design was utilized and 12 registered nurses from the pediatric unit of a secondary-level health institution were selected purposively and interviewed using a semi-structured interview guide. Thematic analysis was done with two themes namely behaviour towards play and motivation to use play emerging with their corresponding sub-themes.

FINDING

In the study setting, play has not been formalized or fully integrated into the routine care of the sick child. Nurses have a positive attitude and believe in the positive impact of play on the sick child. Participants utilize play as and when there is a need, and they derive satisfaction and fulfilment anytime they engage in play activities with their patients. Lack of administrative support and resources for play interventions affect their motivation to use play for the children.

CONCLUSION

Formalization of play and integration of play into the routine care of the sick child is needed to motivate nurses to engage hospitalized children in play activities to help them derive the full benefits that play offers to the sick and hospitalized child.

IMPLICATIONS TO PRACTICE

The positive attitudes and behaviour towards play as demonstrated in this study calls for Ghanaian nurses in general to be empowered through the formalization and integration of play into routine nursing care.

Centring children's lived experiences in understanding the importance of play in hospitals

BACKGROUND

Children have a right to participate in matters affecting their lives. With increasing regularity, children's perspectives are being sought regarding their health and health care experiences. Though there is evidence that children find play to be one of the 'best' aspects of hospitalisation, studies rarely focus on children's perspectives on play in hospital.

METHODS

This qualitative study explored children's lived experiences of play during hospitalisation. Over five months, ethnographic observations were conducted on a paediatric oncology ward as well as interviews with 16 children ages 3-13 years.

RESULTS

Using interpretative phenomenological analysis, children's expressions and experiences illuminated three key points: safety and comfort are integral to children feeling able to play in hospital; the value and efficacy of play is decided by children; and that play is a way for patients to be (and be treated as) children first.

CONCLUSION

Hospitals can only be child-friendly if children find them friendly. Listening to and integrating children's perspectives in the discourse around the importance of play in hospital is essential for respecting children's rights and delivering person-centred paediatric healthcare.

The effect of behavioral activation play therapy in adolescents with depression: A study protocol for a randomized controlled trial

BACKGROUND

Depression is a common psychological problem in adolescents worldwide. Although the World Health Organization recommends that members of this population engage in physical activity to reduce depressive symptoms, compliance with this recommendation is often low. Furthermore, although behavioral activation (BA) is recommended as a treatment for adolescents with depression, the reported effect size is small. Compared with traditional exercises, gamified physical activity (GPA) can be particularly appealing to adolescents because it is perceived as an enjoyable experience. In this study, we integrated BA and GPA to create behavioral activation play therapy (BAPT). We designed a clinical trial to investigate the feasibility, acceptability, and effectiveness of this treatment in adolescents with depression.

METHODS

This study is a randomized controlled trial (RCT) with a three-arm, assessor-blinded design, conducted to validate the effectiveness and applicability of BAPT for treating adolescent with depression. We will recruit 258 participants and randomly assign them to a BAPT group, BA group, or GPA group using a ratio of 1:1:1. Based on conventional strategies for treatment and care, the three groups will receive nine BAPT sessions, nine BA sessions, or nine GPA sessions, respectively. We will compare the outcomes of the BAPT with those of the BA and GPA interventions.

DISCUSSION

This is the first RCT to explore the effectiveness and applicability of BAPT in adolescents with depression. This study will provide evidence that may help to decrease depressive symptoms in adolescents, and will demonstrate the treatment effectiveness in terms of increasing levels of physical activity, reducing the rate of non-suicidal self-injury behaviors, and improving sleep quality. We will also assess the presence of side effects and the treatment adherence of patients receiving BAPT.

TRIAL REGISTRATION

Trial registration: Chinese Clinical Trial Registry, ChiCTR2300072671. Registered on 20 June 2023.

Opportunities for play in paediatric healthcare environments: a scoping review

Play spaces are important components of paediatric healthcare environments. They provide children with critical opportunities to experience the social, emotional, and developmental benefits of play while in healthcare settings for appointments or hospitalizations. These spaces can help to mitigate stress, provide a sense of normalcy in unfamiliar environments, and facilitate social engagement for children and their families. Given the benefits of play spaces in paediatric healthcare settings, it is important to understand how these spaces can be designed to enhance children's inclusion and quality of care. The aim of this scoping review was to explore the current understanding of paediatric play space design. Using search terms related to children, health care, and play space, six interdisciplinary databases were searched over a 30-year period. The search found 2,533 records from which eighteen were included for review. Findings suggest that although it is well-documented that play spaces offer valuable social and emotional benefits, little is known about the specific design features that can and should be incorporated to enhance play opportunities and ensure that they benefit all children and families. Further, the literature mostly considers play spaces in the context of designated play or recreational rooms. Scholars are encouraged to consider how play opportunities can be incorporated into the designs of paediatric healthcare environments beyond the boundaries of these rooms. Future studies should also consider the diversity of play space users, including children of varying ages and abilities, to create more accessible and inclusive paediatric play spaces for children and their families. Advancing knowledge on play space design can help to optimize the quality of these important spaces and to ensure their designs meaningfully enhance children's play experiences and quality of care.

The Early Childhood Development of Pediatric Burn Patients

Our study aimed to provide a description of the early childhood development of pediatric burn patients relative to Dutch reference values, using both pre- and post-burn data from the Dutch Development Instrument and the D-score. Data from the Dutch Development Instrument were used to calculate the D-score and age-standardized D-score. Similar to a growth chart, the D-score was used to plot pediatric burn patients' development relative to Dutch reference values for their age. Pediatric burn patients' (n = 38) median age at the time of injury was 1.0 (1.0-2.0) years old. Burn size ranged from 1.0% to 36.0% of the total body surface area. Ninety-five percent (± 6.0%) of pediatric burn patients passed each of the age-appropriate developmental milestones at the target age. The mean age-standardized D-score was just above the Dutch average (+0.49 SD [0.18, 0.80]) and did not vary depending on sex (p = 0.06) or burn size (p = 0.41). In conclusion, among pediatric patients aged up to two-and-a-half years old, with non-full thickness burns, development was on track relative to the Dutch reference values. Our findings offer valuable first insights into the early childhood development of pediatric burn patients and may alleviate some parental concerns.

[The Importance of Play]

N/a.

Opportunities for risk-taking during play alters cognitive performance and prefrontal inhibitory signalling in rats of both sexes

Social play behaviour is a rewarding activity that can entail risks, thus allowing young individuals to test the limits of their capacities and to train their cognitive and emotional adaptability to challenges. Here, we tested in rats how opportunities for risk-taking during play affect the development of cognitive and emotional capacities and medial prefrontal cortex (mPFC) function, a brain structure important for risk-based decision making. Male and female rats were housed socially or social play-deprived (SPD) between postnatal day (P)21 and P42. During this period, half of both groups were daily exposed to a high-risk play environment. Around P85, all rats were tested for cognitive performance and emotional behaviour after which inhibitory currents were recorded in layer 5 pyramidal neurons in mPFC slices. We show that playing in a high-risk environment altered cognitive flexibility in both sexes and improved behavioural inhibition in males. High-risk play altered anxiety-like behaviour in the elevated plus maze in males and in the open field in females, respectively. SPD affected cognitive flexibility in both sexes and decreased anxiety-like behaviour in the elevated plus maze in females. We found that synaptic inhibitory currents in the mPFC were increased in male, but not female, rats after high-risk play, while SPD lowered prefrontal cortex (PFC) synaptic inhibition in both sexes. Together, our data show that exposure to risks during play affects the development of cognition, emotional behaviour and inhibition in the mPFC. Furthermore, our study suggests that the opportunity to take risks during play cannot substitute for social play behaviour.

Shifting perspectives and transformative change: Parent perspectives of an active music engagement intervention for themselves and their child with cancer

BACKGROUND

Children with cancer (ages 3-8 years) and their parents experience significant, interrelated distress associated with cancer treatment. Active music engagement (AME) uses music-based play and shared music-making to mitigate this distress. To advance our understanding about how AME works and its essential features, we interviewed parents who received the AME intervention as part of a multi-site mechanistic trial. The purpose of this qualitative analysis was to describe parents' experiences of AME for themselves and their child and to better understand how the intervention worked to lower parent-child distress.

PROCEDURE

We conducted a total of 43 interviews with parents/caregivers, and purposively analyzed all interviews from underrepresented groups based on race/ethnicity and parent role. We used thematic analysis and achieved thematic redundancy after analyzing 28 interviews.

RESULTS

The following statement summarizes resulting themes: Music therapists skillfully use AME to create a safe and healthy space (Theme 1), where parents/children have transformative experiences (Theme 2) that lead to learning and enactment (Theme 3) of new skills that counteract suffering (Theme 4) through empowerment, connectedness, and sustained relief.

CONCLUSIONS

This work elucidates how AME works to counteract stressful qualities of cancer treatment. As parents witnessed positive and transformative changes in their child, they experienced relief and reported shifts in their perspective about cancer treatment. This led to learning and use of music as a coping strategy that extended beyond therapist-led sessions. Accessible, music-based interventions, like AME, offer a developmentally appropriate and effective way to support parents and young children during treatment.

Effect of play-based intervention on children's mental status and caregiver involvement during hospitalization: findings from Pakistan

BACKGROUND

The nurturing care framework (NCF) encompasses responsive caregiving, health, nutrition, safety and security by parents and other caregivers. It improves health, development and wellbeing of children. A hospital environment can be detrimental to the developmental and emotional needs of children hence NCF can be applied to hospitalized children.

OBJECTIVE

The objective was to determine if (i) play stimulation intervention mediated by non-specialist providers (caregivers) improves mental status of children who are hospitalized; (ii) to examine if difference varies between different providers and iii) if there is variation based on child age and criticalness of illness.

METHOD

A one-group pretest-posttest research was carried out using purposive sampling in a pediatric unit in Karachi, Pakistan, from November 2017 to December 2019. Children aged 3 months to 6 years were offered play stimulation by trainee psychologists. The outcome was measured through an observation tool, the Mental Status Examination Scale (MSE-S) developed for the study.

RESULTS

A total of 524 sessions were delivered to 351 children. Significant mean difference was observed on MSE-S before and after the intervention when it was provided by trainees (9.95, CI = 8.11, 11.7), mothers (mean difference = 5.86, CI = 5.30, 6.42), fathers (mean difference = 5.86, CI = 4.48, 7.24) and non-specialist providers [caregivers (mean difference = 5.40, CI = 3.91, 6.89). Significant differences in mean was observed on MSE-S across different age groups and criticalness of illness.

CONCLUSION

It was concluded that play stimulation not only affects the behaviour of children but also varies when delivered by caregivers and trainees. Hence, interventions that involve parents are feasible.

Evaluating a Movement-Based Mental Health Promotion Intervention for Refugee Children in Uganda: A Quasi-Experimental Study

OBJECTIVE

Mental health promotion interventions are widely implemented in humanitarian settings and low- and middle-income contexts (LMICs), yet evidence on effectiveness is scarce and mixed. This study evaluated the movement-based mental health promotion intervention "TeamUp" in Bidibidi refugee settlement, in Northern Uganda.

METHOD

A quasi-experimental study including four schools (two per arm) assessed the outcomes of 10- to 15-year-old South Sudanese and Ugandan children (n = 549). Randomly allocated, they either participated in up to 11 TeamUp sessions (n = 265) provided by trained facilitators; or belonged to a control group, which continued care as usual (n = 284). Primary outcomes measured psychosocial wellbeing, friendships and attitude to school; secondary outcomes included traumatic distress, depressive symptoms, quality of life, physical health, bullying, interoceptive awareness, and irritability. Data were collected at baseline and endline.

RESULTS

Children joining TeamUp, showed significantly more improvements on primary outcomes: emotional and psychosocial wellbeing (Mdiff = -1.49, SE = 0.6, p = .01), satisfaction with and attitude toward school (-0.57, SE = 0.2, p = .004); and secondary outcomes: traumatic stress (2.64, SE = 0.8, p < .001), health-related quality of life (-1.56, SE = 0.4, p = .001), physical health (-0.78, SE = 0.3, p = .014) and the TeamUp mechanisms of action scale (-3.34, SE = 0.9, p < .001), specifically the subscales social connectedness (-0.74, SE = 0.3, p = .007) and sense of agency (-0.91, SE = 0.3, p = .005), compared to the control group. No significant differences were found on bullying, interoceptive awareness, irritability and depressive symptoms.

CONCLUSION

The results are promising for TeamUp as a mental health promotion intervention for children affected by armed-conflict, displacement and on-going adversity. Further research will need to assess the intervention's effectiveness.

Establishing consensus on principles and competencies for the use of play in clinical practice in hospitals: An international Delphi study

Although play has existed in paediatric hospitals for decades, a shared understanding of why and how healthcare professionals use play in clinical practice is lacking. This study aims to reach consensus on a common set of principles and competencies for play interventions and practices in hospitals. We conducted a three-round Delphi study that included healthcare professionals selected by hospital management. The first round comprised open-ended questions on the use of play in clinical practice. Principles and competencies, including learning objectives, were established using content analysis through an iterative process. Participants rated the importance of each principle and learning objective in the second and third rounds. Among the 66 participants, 45 (68%) responded in round 1 and 41 (62%) in rounds 2 and 3. The participants represented ten countries and nine different health professions. After the three rounds, we identified 33 principles and six overall competencies: building trusting relationships; delivering information and increasing understanding; promoting cooperation and participation; reducing procedure-related anxiety and pain; supporting coping and development; and ensuring a professional approach to play, which comprised 20 learning objectives.  Conclusion: According to healthcare professionals, play in clinical practice can be used to communicate and build relationships with paediatric patients and thus potentially help provide patient-centred care. Our findings may help guide and prioritize future research initiatives and operationalize play interventions and practices in hospitals. What is Known: • Evidence suggests that using play in clinical practice can help paediatric patients during hospitals stays. • Despite the evidence supporting the use of play, a shared understanding of why and how paediatric healthcare professionals use play is needed. What is New: • This international Delphi study contributes to a shared interprofessional understanding of the principles, competencies and learning objectives for the use of play in clinical practice. • The findings have the potential to aid initiatives in developing training programmes for healthcare professionals in using play to provide care with a patient-centred approach.

Maternal immune suppression during pregnancy does not prevent abnormal behavior in offspring

BACKGROUND

Offspring of hypertensive disorders of pregnancy are at an increased risk of developing neurodevelopmental and neurobehavioral disorders compared to offspring from non-affected pregnancies. Using rodent models of Preeclampsia (PreE; new onset of hypertension after 20 weeks gestation) and HELLP (hemolysis, elevated liver enzymes, and low platelets), we studied the behavioral outcome of their offspring in adolescence.

METHODS

A subset of dams received Orencia, a T-cell activation inhibitor, as T cells have been associated with the induction of hypertension and inflammation during pregnancy. We hypothesized that offspring from hypertensive dams would experience adverse behavioral outcomes in social, cognitive, locomotor, and anxiety tests, and offspring from dams treated with Orencia would demonstrate less adverse behaviors.

RESULTS

Male offspring of PreE + Orencia dams (p < 0.05) and female offspring from HELLP + Orencia dams (p < 0.05) spent more time playing compared to normal pregnant offspring. All offspring from hypertensive and Orencia-treated dams performed worse on the Barnes Maze test compared to normal pregnant. We also measured adult (postnatal day > 60) myelin basic protein (MBP) and NeuN expression in both the prefrontal cortex and hippocampus. In the hippocampus and prefrontal cortex, there was no difference in expression of either MBP or NeuN in all groups regardless of sex.

CONCLUSION

The results from this study suggest that offspring of hypertensive disorders of pregnancy have behavioral changes, specifically cognitive differences. This study has shown that there is a sex dependent difference in offspring neurobehavioral development, influenced in part by the type of hypertensive disorder of pregnancy, and alterations in the maternal immune system.

"Maze Out": a study protocol for a randomised controlled trial using a mix methods approach exploring the potential and examining the effectiveness of a serious game in the treatment of eating disorders

BACKGROUND

Eating Disorders (ED) are severe and costly mental health disorders. The effects of existing treatment approaches are limited and there is a need to develop novel interventions, including digital strategies that can increase engagement and effectiveness. Maze Out is a new serious game coproduced by patients and ED therapists, which allows patients to "play" with the reality of an ED and reflect on associated challenges.

OBJECTIVES

The present study has two main objectives: (1) to evaluate the effectiveness of adding Maze Out to treatment as usual (TAU) in a randomised controlled trial (RCT); and (2) to examine in depth the potential of Maze Out by examining how it is perceived and used in the context of an RCT.

METHODS

Participants will be recruited from mental health care services, endocrinology departments or Community Centres offering treatment for ED. Patients suffering from ED (N = 94) will be randomised to either TAU or TAU plus Maze Out. Primary outcome will be measured in terms of changes in self-efficacy, measured by a 5-item self-efficacy questionnaire (5-item SE_ED). Secondary outcome measures will include feelings of ineffectiveness and self-image, as measured by Eating Disorder Inventory, version 3 (EDI-3), Brief INSPIRE-O and Structural Analysis of Social Behaviour Intrex Questionnaire (SAS-B). Data will be collected at baseline (enrolment in the study), and subsequently 8 and 15 weeks after inclusion. Experiences of playing Maze Out will be examined in a sub-sample of participants, utilising both quantitative user analytics and qualitative interview data of patients, interview data of significant others, and healthcare professionals to explore the possible impact of Maze Out on disorder insight, communication patterns between patients and therapists and understanding of their disorder.

DISCUSSION

To our knowledge Maze Out is the first serious game coproduced by patients and therapists. It is a novel and theoretically grounded intervention that may significantly contribute to the healing process of ED. If found effective, the potential for wide-spread impact and scalability is considerable. Trial registration ClinicalTrials.gov NCT05621018.

Parental stress and child stimulation practices: examining associations with child developmental outcomes over time in Kenya and Zambia

BACKGROUND

Parental stress often arises when parenting demands exceed the expected and actual resources available for parents to succeed in the parenting role. Parental stress is an important contributor to parent-child relationships. This, in turn, affects opportunities to engage their children in stimulating activities which could improve their development outcomes. However, limited evidence exists from sub-Saharan Africa (SSA) on the association between parental stress, caregiving practices, and child developmental outcomes.

METHODS

The findings reported in this paper were derived from data collected through previous longitudinal work on nurturing care evaluation studies in Kisumu and Nairobi Counties in Kenya, and Chisamba District in Zambia. A total of 341 caregivers and their children who participated in the three rounds of data collection were included in this study. The children's mean age was 9.3 (SD = 8.2) months pre-intervention, 25.5 (SD = 8.6) months in mid-intervention, and 36 (SD = 10.0) months post-intervention. The Ages and Stages Questionnaire (ASQ), Parental Stress Scale (PSS), and caregiving tools were used to assess children's developmental outcomes, parental stress, and stimulation practices, respectively. A Random Intercept Cross-Lagged Panel model (RI-CLPM) was used to determine the association between caregivers' parenting stress, child stimulation practices, and child developmental outcomes.

RESULTS

The findings showed that caregiver stimulation practices were positively associated with developmental outcomes. Findings on the associations between parental stress and caregivers' stimulation practices and children's developmental outcomes were not universally supported.

CONCLUSION

The findings show that improved caregiver stimulation practices are likely to improve children's developmental outcomes. The policy implications of the findings from this study focus on improving parenting practices by addressing the predictors of parental stress. This includes subsidising childcare services to reduce costs.

TRIAL REGISTRATION

Pan African Clinical Trials Registry ( https://pactr.samrc.ac.za/ ) database (ID number: PACTR20180774832663 Date: 26/July/2018.

Motor Development of Children in the Kurdistan Region of Iraq: Parent Survey

The actual literature highlights the importance of the socio-cultural context in the development of children. However, there is a lack of specific evidence about the middle East, especially regarding the development of Kurdish children who are living in a post-war scenario, in a country which is experiencing continuous instability due to the different crises. The main aim of this study is to identify the features of the motor development of Kurdish children according to parents' opinion. A comparison with Italian children is provided as a Western example, which reflects data from the literature. In the study, 331 parents of Kurdish and Italian children aged between 3 and 7 years were involved. Parents filled the questionnaire at kindergartens, after providing consent. The questionnaire was conceptualized, designed, tested and provided ad hoc for this study; it focused on the timing of development, concerning major milestones like head control, sitting and standing-up. The questionnaire consists of 15 questions and has not been standardized yet. A logistic regression showed several differences between Kurdish and Italian children, like head control (p = 0.007) or the manipulation of big objects (p < 0.0001). These results identify the effect of the socio-cultural context and the impact of the growing environment of the child. Moreover, the results of this survey show the need for introducing different adapted, translated and validated assessment tools for motor development, considering differences related to the socio-cultural context.

A position statement on the post gene-therapy rehabilitation of aromatic I-amino acid decarboxylase deficiency patients

Aromatic L-amino acid decarboxylase (AADC) deficiency is a rare genetic disorder of monoamine neurotransmitter synthesis that presents with a range of symptoms, including motor dysfunction and limited attainment of developmental motor milestones. The approval of eladocagene exuparvovec, a gene therapy for AADC deficiency with demonstrated efficacy for motor improvements, now expands the range of motor outcomes possible for patients with this disorder. However, recommendations and guidelines for therapy following treatment with gene therapy are lacking. To ensure patients can reach their full potential following treatment with gene therapy, it is essential they receive rehabilitation therapies designed specifically with their impairments and goals in mind. Therefore, we highlight specific rehabilitative needs of patients following gene therapy and propose a set of recommendations for the post-treatment period based on collective experiences of therapists, physicians, and caregivers treating and caring for patients with AADC deficiency who have been treated with gene therapy. These recommendations include a focus on periods of intensive therapy, facilitating active movements, training for functional abilities, cognitive and communication training, parent/caregiver empowerment, collaboration between therapists and caregivers to develop in-home programs, and the incorporation of supplemental forms of therapy that patients and their families may find more enjoyable and engaging. Many of these rehabilitative strategies may be employed prior to gene therapy. However, these recommendations will be valuable for therapists, caregivers, and wider treatment teams as they prepare for the post-treatment journey with these patients. Furthermore, the considerations and recommendations presented here may prove beneficial outside the AADC deficiency community as gene therapies and other treatments are developed and approved for other rare diseases.

Do children with disabilities have the same opportunities to play as children without disabilities? Evidence from the multiple indicator cluster surveys in 38 low and middle-income countries

Background

Play is essential for the cognitive, social, and emotional development of all children. Disparities potentially exist in access to play for children with disabilities, and the extent of this inequity is unknown.

Methods

Data from 212,194 children aged 2-4 years in 38 Low and Middle-Income Countries were collected in the UNICEF supported Multiple Indicator Cluster Survey (2017-2020). Disability was assessed by the Washington Group-Child Functioning Module. Logistic regression models were applied to investigate the relationship between disability and play opportunities, controlling for age, sex, and wealth status. Meta-analysis was used to pool the estimates (overall, and disaggregated by sex), with heterogeneity assessed by Cochran's Q test.

Findings

Children with disabilities have approximately 9% fewer play opportunities than those without disabilities (adjusted RR [aRR] = 0.88, 95% CI = 0.82-0.93), and this varied across countries. Mongolia and Democratic Republic of São Tomé and Príncipe had the lowest likelihood of play opportunities for children with disabilities ((aRR = 0.26, 95% CI = 0.09-0.75; aRR = 0.46, 95% CI = 0.23-0.93, respectively). Moreover, children with disabilities are 17% less likely to be provided with opportunities to play with their mothers (aRR = 0.83, 95% CI: 0.73-0.93), which is further reduced for girls with disabilities (aRR = 0.74, 95% CI: 0.60-0.90) compared to their peers without disabilities. The associations varied by impairment type, and children with communication and learning impairments are less likely to have opportunities for play with aRR of 0.69 (95% CI: 0.60-0.79) and 0.78 (95% CI: 0.71-0.86), compared to those without disabilities, respectively.

Interpretation

Children with disabilities are being left behind in their access to play and this is likely to have negative impacts on their overall development and well-being.

Funding

HK and TS are funded by HK's NIHR Global Research Professorship (NIHR301621). SR is funded by a Rhodes Scholarship. This study was funded by the Programme for Evidence to Inform Disability Action (PENDA) grant from the UK Foreign, Commonwealth and Development Office.

Board game-based intervention to improve executive functions and academic skills in rural schools: A randomized controlled trial

INTRODUCTION

This research intends to increase the knowledge about the use of board games in the classroom to train executive functions and academic skills. 99 children from rural schools were assessed in executive functions and academic skills.

METHODS

Through a randomized controlled trial, they were assigned to a playing group (n = 51) and an active control group (regular classes without games, n = 48). Play program consisted of 12 sessions for 6 weeks with eight commercial board games.

RESULTS

In flexibility, the playing group was significantly faster after the program (p= = .01, d = 0.76), but not the control group (p = .23; d = 0.35). Both groups improved in the academic tasks, but the significance in calculus was greater in the playing group (p = .00; d = 2.19) than in the control group (p = .01; d = 0.97).

DISCUSION

The use of board games during school hours could be as good or better methodology for cognitive training and learning academic skills than regular classes.

The effectiveness of play therapy in children with leukemia: A systematic review

PROBLEM

Leukemia is the most common form of childhood cancer worldwide. Children living with leukemia experience various problems because of the disease's progression, harmful effects of treatment, and prolonged hospitalization process. To increase their well-being and alleviate their problems, these children require ongoing support. One solution that both parents and professionals can use is play therapy. This systematic review aimed to identify the type and effectiveness of play therapy in children living with leukemia.

ELIGIBILITY CRITERIA

We searched PubMed, Scopus, ScienceDirect, and ProQuest databases. Additionally, we performed manual searches on Google Scholar, Google Web, and grey literature. Inclusion criteria comprised: 1) Studies that implemented play therapy on leukemia children, 2) Full-text articles available in English or Indonesian languages from January 2000 to December 2021 and updated until July 2023, and 3) Intervention studies employing quasi-experimental or randomized controlled trial (RCT) designs.

SAMPLE

From 1099 articles, 16 studies were selected. Several forms of play therapy were found, including pretend, music, art, and sand play therapy.

RESULTS

Of the sixteen studies in this systematic review, fifteen demonstrated beneficial effects on psychological issues, particularly anxiety, despair, stress, and physical problems (fatigue and pain).

CONCLUSION

Play therapy effectively alleviates some physical and psychosocial problems in children living with leukemia.

IMPLICATION

Nurses can utilize play therapy as an intervention for children living with leukemia. Additionally, comparative research is recommended with a similar research strategy concerning studies with the same design.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022318549.

Levels of Physical Activity at Age 10 Years and Brain Morphology Changes From Ages 10 to 14 Years

Importance

Physical activity may promote healthy brain development in children, but previous research was predominantly cross-sectional and included small samples, providing limited knowledge.

Objective

To investigate the longitudinal associations of physical activity with brain morphology changes.

Design, Setting, and Participants

A 4-year longitudinal population-based cohort study in Rotterdam, the Netherlands, embedded in Generation R, a cohort from fetal life onward. From the women enrolled during pregnancy, children who had repeated measures of brain structure at ages 10 (range 8 to 12) years and 14 (range 13 to 15) years were included. Data were collected from March 2013 to November 2015 (baseline) and from October 2016 to January 2020 (follow-up). Data were analyzed from April to December 2022.

Exposure

At age 10 years, both the child and their primary caregiver reported the child's levels of physical activity with regard to sport participation, outdoor play, and total physical activity. Primary analyses were based on an average multi-informant report.

Main outcomes and measures

Brain morphology was quantified by magnetic resonance imaging. Hypothesized regions of interest were the bilateral amygdala and hippocampal volumes. Global brain measures were studied to test the specificity of the hypothesis.

Results

Data were available for 1088 children (566 girls [52%]; 693 [64%] Dutch). Their mean (SD) age at baseline was 10.1 (0.6) years. For amygdala volume change, positive associations with multi-informant reports of total physical activity (β = 2.6; 95% CI, 0.3-4.9) were found. Total physical activity was associated with hippocampal volume increases only when reported by the child (β = 3.1; 95% CI, 0.4-5.8). No robust associations with global brain measures were found.

Conclusions and relevance

In this cohort study of 1088 children, more physical activity at 10 years was consistently associated with an increase in amygdala volume in children aged 10 to 14 years. Physical activity and increases in hippocampal volume were found using child reports of physical activity only. These findings suggest physical activity in late childhood was prospectively associated with volumetric changes in specific subcortical structures, but not to global brain development, from late childhood to early adolescence. These findings may inform the design of future public health interventions to best facilitate neurodevelopment with physical activity.

Play in video games

Video game play is remarkably ubiquitous in today's society given its recent emergence only in the late 1950s. While this fast evolution could exemplify the power of play, video games exploit but also extend other types of play. Here, we review a classification of the ecosystem of video games useful in the emerging field of the cognitive neuroscience of video games. We then discuss how video games may leverage different play types, considering first locomotor-rotational, object, and social play before highlighting the importance of role, rule, and pretend play in video games. With an eye toward comparative studies of the neural bases of play across species, we discuss whether video games may fulfil the five criteria from Burghardt (2005) to identify play. Finally, in line with play's possible preparatory role for adulthood, we review the positive impact on cognition and future learning of action-like video games. Highlighting that not all video games have this impact, we note more granular hypotheses about the biological functions of play are to be encouraged.

Low Motor Dexterity and Significant Behaviors Following Hospitalized Isolation in Children

The main objective of this study was to describe the cortical patterns of brain activity during a gross dexterity task and develop a behavioral profile of children experiencing isolation. A cross-sectional assessment was conducted during one visit. Sample: Four pediatric patients who had undergone isolation within a hospital comprised the full data collection. During the collection, participants completed the Box and Blocks Test of gross manual dexterity while undergoing imaging of the motor cortex using functional near-infrared spectroscopy. Participants also completed a Behavioral Assessment System for Children, Third Edition (BASC-3) self-report, which was analyzed along with a parent report to quantify their emotional and social behaviors. All participants displayed lower gross dexterity levels than normative data. Furthermore, three out of the four participants displayed ipsilateral dominance of the motor cortex during the dexterity task. Three of the participants displayed behavioral measures reported within clinically significant or at-risk scores. Clinically significant behavioral scores coupled with lower than expected manual dexterity values and ipsilateral hemispheric dominance indicate that neuroplastic changes can occur in populations undergoing hospitalized isolation. While the impacts of the treatments and isolation in this case cannot be separated, further studies should be conducted to understand these impacts of isolation.

The effects of playing digital games on children's pain, fear, and anxiety levels during suturing: A randomized controlled study

OBJECTIVE

The aim was to determine the effects of digital game play on children's pain, fear, and anxiety levels during suturing.

METHODS

Data were obtained from 84 children between the ages of 8 and 17 years at the pediatric emergency department between January 16 and March 19, 2020, using the Socio-Demographic and Clinical Characteristics Form, the Wong-Baker Faces Pain Rating Scale (WBFPS), the Visual Analogue Scale (VAS), the Fear of Medical Procedures Scale (FMPS), and the State-Trait Anxiety Inventory for Children (STAI-CH). A four-block randomization system was used. The study group (n = 42) played digital games during the suturing procedure, unlike the control group (n = 42). Ethical permissions were obtained from the ethical committee, hospital, and families.

RESULTS

Before the suturing procedure, there was no statistically significant difference between the groups' mean scores. The intervention group was found to have statistically significantly lower WBFPS and VAS pain scores than the control group during the suturing procedure, and after the procedure, statistically significantly lower WBFPS, VAS, FMPS, and STAI-CH mean scores than the control group.

CONCLUSIONS

The digital game-playing approach applied before and during the suture procedure was found to be effective in reducing children's pain, fear, and anxiety levels.

Positive mindset and exercise capacity in school-aged children and adolescents with congenital heart disease

Introduction

Patients with congenital heart disease (CHD) have variable degrees of peak oxygen consumption (VO₂) that can be improved with supervised fitness training. The ability to exercise is affected by anatomy, hemodynamics, and motivation. Motivation is in part related to mindset, or personal attitudes and beliefs, and a more positive mindset around exercise has been associated with better outcomes. It is unknown whether variations in measured peak VO₂ in patients with CHD are related to having a positive mindset.

Methods

Patient's ages 8-17 years with CHD were administered quality of life and physical activity questionnaires at the time of their routine cardiopulmonary exercise test. Those with severe hemodynamic burden were excluded. Patients were grouped based on disease classification. Mindset was evaluated via validated questionnaires including a PROMIS Meaning and Purpose (MaP) survey and an Anxiety survey. Pearson correlation coefficients were calculated to estimate the magnitude of the association between percent predicted peak oxygen consumption (pppVO₂) and questionnaire scores overall and within CHD subgroups.

Results

Eighty-five patients participated; median age was 14.7 years, 53% were female, 66% had complex CHD, 20% had simple CHD, and 14% had single ventricle heart disease. Mean MaP scores were significantly lower in all CHD groups compared to population norms (p < 0.001). As a group, MaP scores were positively associated with the amount of reported physical activity (p = 0.017). In patients with simple CHD, MaP scores were positively associated with pppVO₂ (p = 0.015). The association was even stronger for MaP:Anxiety, with worse ratios associated with lower pppVO₂ (p = 0.005). Patients with complex and single ventricle CHD did not show a similar association.

Conclusions

Patients with CHD, regardless of severity, had lower meaning and purpose scores than the general population, and these scores were associated with amount of reported physical activity. In the simple CHD subset, having a more positive mindset was associated with higher peak VO₂ and a more negative mindset with lower peak VO₂. This relationship was not seen with more significant CHD. While underlying CHD diagnoses are not modifiable, mindset and peak VO₂ are, and consideration should be given to measuring both as each may be a target for intervention.

ehealth technology in cardiac exercise therapeutics for pediatric patients with congenital and acquired heart conditions: a summary of evidence and future directions

Many children and adolescents with congenital and acquired heart disease (CHD) are physically inactive and participate in an insufficient amount of moderate-to-vigorous intensity exercise. Although physical activity (PA) and exercise interventions are effective at improving short- and long-term physiological and psychosocial outcomes in youth with CHD, several barriers including resource limitations, financial costs, and knowledge inhibit widespread implementation and dissemination of these beneficial programs. New and developing eHealth, mHealth, and remote monitoring technologies offer a potentially transformative and cost-effective solution to increase access to PA and exercise programs for youth with CHD, yet little has been written on this topic. In this review, a cardiac exercise therapeutics (CET) model is presented as a systematic approach to PA and exercise, with assessment and testing guiding three sequential PA and exercise intervention approaches of progressive intensity and resource requirements: (1) PA and exercise promotion within a clinical setting; (2) unsupervised exercise prescription; and (3) medically supervised fitness training intervention (i.e., cardiac rehabilitation). Using the CET model, the goal of this review is to summarize the current evidence describing the application of novel technologies within CET in populations of children and adolescents with CHD and introduce potential future applications of these technologies with an emphasis on improving equity and access to patients in low-resource settings and underserved communities.

Parent-Reported Caregiving Roles of Siblings of Children with Inborn Errors of Metabolism

OBJECTIVES

Research examining sibling caregiving contributions to medically complex pediatric patients, including those with inborn errors of metabolism (IEMs), is limited. We assess caregiving roles and attributes of siblings and hypothesize that there will be differences in parent-reported contributions among siblings of children with IEMs and siblings of typically developing (TD) children.

STUDY DESIGN

A convergent parallel mixed-methods study design guided analysis of data from parental surveys and semistructured interviews. Interviews were conducted with parents (n = 49) of children with IEMs and parents (n = 28) of exclusively TD children. We used inductive thematic analysis to identify themes related to sibling caregiving. The caregiving and support roles for siblings (n = 55) of children with IEMs and siblings (n = 42) of TD children were coded to assess each sibling's caregiving contributions and personal attributes.

RESULTS

Logistic regressions, using generalized estimating equations, were fitted. Results showed that siblings of children with IEMs were significantly more likely to provide monitoring (odds ratio [OR]: 3.62, confidence interval [CI]: 1.30-10.07) and emotional/social support (OR: 4.02, CI: 1.67-9.67) than siblings of TD children. Themes arising from interviews with parents of children with IEMs focused on sibling attributes, parental expectations regarding sibling caregiving, and challenges to the sibling-sibling and parent-sibling relationships. Themes revealed nuances in the sibling caregiving experience.

CONCLUSION

Siblings of children with IEMs make meaningful caregiving contributions and may provide care differently than siblings of TD children. Understanding childhood caregiving roles may inform how health care providers and parents encourage sibling caregiving contributions into adulthood.