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

INTRODUCTION

Sleep problems are frequent in children with attention-deficit/hyperactivity disorder (ADHD). Some authors have tried to characterize paediatric sleep habits in Portugal, but none has focused on preschool-age children nor attempted to establish their association with ADHD. We aimed to assess the prevalence of ADHD symptoms in preschool-age children and to study their association with sleep habits.

MATERIAL AND METHODS

We conducted a cross-sectional study. We distributed questionnaires to a random sample of caregivers of children enrolled in early childhood education centres in Porto. We collected data on sociodemographic characteristics, television watching and outdoor activities. We assessed ADHD symptoms and sleep habits with the Portuguese versions of the Conners' Parents Rating Scale, Revised and the Children's Sleep Habits Questionnaire (CSHQ-PT), respectively.

RESULTS

The study included 381 preschoolers (50.90% male). We found high scores for ADHD symptoms in 13.10%, with a higher prevalence in girls (14.40% vs. 11.85%; P = 0.276). In the CSHQ-PT, 45.70% of participants had a mean total score greater than 48, which is the cut-off point applied in the screening of sleep disturbances in the Portuguese population. There was a significant association between high scores for ADHD symptoms and a lower maternal education level (P < 0.001), a shorter sleep duration (P = 0.049), and higher scores on parasomnias (P = 0.019) and sleep disordered breathing (P = 0.002) in CSHQ-PT subscales.

CONCLUSIONS

ADHD and sleep disorders are common in preschoolers, in Porto, and this study suggests some clinical correlations between them. Since these interactions are complex and far from being elucidated, further studies are paramount to provide guidance for prevention and managing strategies in younger children at risk for ADHD.

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

INTRODUCTION AND OBJECTIVE

Studies that assess the association between excess weight and screen time in childhood and adolescence are methodologically heterogeneous, and few studies have analysed the exposure to smartphones and tablets. Our study aimed to assess the association between daily recreational screen time and excess weight (overweight+obesity) and obesity in children aged 2-14 years residing in Spain using different sets of standards.

METHODS

We conducted a cross-sectional study using data from the 2017 Spanish National Health Survey (N=4528). We assessed the prevalence of overweight and obesity applying the criteria of the World Health Organization (WHO), International Obesity Task Force (IOTF), and Orbegozo 2011 study. We categorised daily recreational screen time in minutes as 0-59, 60-119, 120-179, and ≥180. We calculated crude and adjusted prevalence ratios (aPR) of excess weight and obesity based on the daily minutes of recreational screen time with the corresponding 95% confidence intervals (95%CI). Moreover, we calculated crude and adjusted change (aΔ) in the expected number of fulfilled excess weight/obesity criteria based on the minutes of daily recreational screen time with the corresponding 95% CI. We adjusted the association analyses for potential confounders.

RESULTS

We found that spending 180min or more a day of recreational screen time was associated with an increase in the adjusted prevalence of excess weight (e.g. Orbegozo 2011 aPR_≥180, 1.20; 95% CI, 1.02-1.42) and of obesity (e.g. IOTF aPR_≥180, 1.41; 95% CI, 1.06-1.86) as well as an increase in the adjusted number of fulfilled criteria for excess weight (aΔ_≥180, 1.18; 95% CI, 1.06-1.31).

CONCLUSIONS

Longer periods of recreational screen time were associated with excess weight and obesity in children aged 2-14 years. Cohort studies are required to confirm these findings, as this may be a determinant of health in children.

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

INTRODUCTION

The use of nonpharmacological measures to reduce pain during vaccination has been studied extensively in infants, but there are fewer studies on its effectiveness in older children and on the parental perception of pain in children.

METHODS

We conducted a multicentre, quasi-experimental interventional study with a control group.

PATIENTS

infants aged 2-11 months and children aged 4 years that attended routine vaccination appointments.

SETTING

Primary care. Intervention during vaccination: infants were breastfed and 4-year-old children blew a party horn.

CONTROL

vaccination performed following routine practice.

MEASUREMENT

NIPS (Neonatal Infant Pain Scale) and duration of crying in infants, Wong-Baker FACES pain rating scale in older children and parents.

RESULTS

The study included 125 children (intervention: 60; control: 65). There was a significant decrease in perceived pain in the intervention groups: NIPS score in infants, 3.8 ± 1.1 compared to 5.2 ± 0.7 (P < .001); Wong-Baker FACES score at 4 years of 3.3 ± 1.7 compared to 4.2 ± 1.6 (P = .042). These same differences in support of the intervention were reflected in the parental assessments (3.4 ± 1.3 vs 4.5 ± 1.5; P < .001). The correlation between child and parent scores was strongly positive: 0.7 (95% CI, 0.59-0.78). However, the duration of crying was longer in the intervention group.

CONCLUSION

The use of distraction techniques reduces pain in children and the pain perceived by parents in their children, thus increasing their satisfaction with the procedure.

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

BACKGROUND

Growth and development reflect the child's health condition. Currently, child care is supported in daycare centers. In this context, this article aimed to identify the differences in growth and psychomotor development in children according to their attendance at daycare centers.

METHODS

We conducted an analytical cross-sectional study in children aged 25 to 48 months. Two groups were identified: 68 children attended daycare, and 68 children did not attend daycare. Growth was assessed with weight-for-height curves, and psychomotor development was evaluated with the child developmental assessment instrument (psychosocial, language, psychomotor, and cognitive area). The X² test was used for statistical analysis.

RESULTS

The percentage of daycare children with ideal weight was higher than those not attending in daycare (p = 0.035). Psychomotor development was significantly higher in daycare children: in the psychosocial (p = 0.000), language (p = 0.000), motor (p = 0.000), and cognitive development (p = 0.000) areas.

CONCLUSIONS

The psychomotor development of children attending daycare centers is superior to that of children not in daycare centers.

[Family influences on maternal feeding practices of preschool children from vulnerable families in the Metropolitan Region of Chile]

Objetivo

Explorar las influencias de integrantes del grupo familiar en las prácticas de alimentación de madres hacia preescolares, en familias de barrios vulnerables en la Región Metropolitana de Santiago, Chile.

Diseño

Estudio cualitativo.

Lugar

Nueve jardines infantiles de la Región Metropolitana, Santiago, Chile.

Participantes

Veinticuatro madres y un padre de hijos preescolares.

Método

Se realizaron 25 entrevistas semiestructuradas con técnica de foto-elicitación y su posterior análisis temático inductivo de las influencias familiares.

Resultados

Las participantes describieron que las influencias familiares sobre las prácticas de alimentación que aplicaban en sus hijos preescolares dependían de la estructura familiar y de la cercanía entre familiares. Algunas de estas influencias afectan directamente la conducta alimentaria del niño, especialmente en familiares que cohabitan juntos, mientras que otras estaban mediadas por las relaciones generadas entre padres y otros miembros de la familia. El padre, en familias biparentales, y abuelos del preescolar son los familiares más influyentes. Los padres participan en la alimentación del niño y generalmente se alinean a las prácticas de alimentación con la madre. Los abuelos enriquecen la experiencia alimentaria de preescolares ofreciendo preparaciones caseras, expresando afecto con los alimentos, incluso opciones poco saludables, y apoyando a padres a diversificar y estructurar la alimentación del niño.

Conclusiones

El impacto de familiares y sus dinámicas en las prácticas alimentarias parentales y la alimentación de preescolares varían según la cercanía o cohabitación entre familiares. El desarrollo de estrategias de prevención y tratamiento de obesidad infantil debería considerar un enfoque familiar en familias vulnerables.

[Family functioning, parental rearing and its relationship to nutritional status in preschoolers]

Objetivo

Analizar la asociación entre funcionalidad familiar, crianza parental y estado nutricional en preescolares.

Diseño

Estudio cuantitativo, descriptivo correlacional y transversal.

Emplazamiento

Instituciones públicas de educación preescolar en el estado de Nuevo León, México. Atención Primaria.

Participantes

Muestra compuesta por 228 diadas (madre o padre y preescolar); se tomó como único criterio de inclusión ser el responsable principal de la crianza del preescolar.

Mediciones principales

Se empleó un cuaderno de recogida datos sociodemográficos, el estado nutricional se determinó basándose en recomendaciones de la Organización Mundial de la Salud, se utilizaron la Escala de Evaluación de la Cohesión y la Adaptabilidad Familiar y el cuestionario de Estilos de Crianza Parental. Se obtuvo estadística descriptiva y el coeficiente de correlación de Spearman.

Resultados

El promedio de edad de los padres fue de 32,09 años, el 60,5% de las madres se dedican al hogar y el 100% de los padres trabaja; la media de escolaridad en años fue de 12,16; el 68,9% de los participantes son casados; referente a los preescolares, el 29,4% presentó sobrepeso u obesidad. En cuanto a la funcionalidad familiar, se identificó que en la dimensión de cohesión es semirrelacionada el 44,3%. El estilo de crianza parental que predominó en los padres fue el permisivo con el 62,3%.

Conclusiones

La mayoría de los padres de familia presentaron desequilibrio en la funcionalidad familiar. No se encontró significación estadística entre funcionalidad familiar y crianza parental con estado nutricional en preescolares (p < 0,05).

Epidemiological characteristics and strategies for the prevention of diarrheal disease in indigenous children: A scoping review

AIM

The aim of the present scoping review was to map the scientific evidence about diarrheal disease in indigenous children and the strategies that can be used to prevent it.

METHODS

The subject headings were indigenous population; child; diarrhea; dysentery; epidemiology; and prevention, primary; also the following keywords characteristic, epidemiologic study; and children. The databases consulted were Latin American and Caribbean Health Sciences Literature, MEDLINE via the US National Library of Medicine/National Institutes of Health, and Web of Science. Initially, 268 studies were identified, and after being screened using the eligibility criteria, six were selected. Finally, via reference tracking, five more were identified. The final sample was made up of eleven articles.

RESULTS

The results confirmed higher mortality rates due to diarrheal disease among indigenous children who are socially disadvantaged and living in poor hygienic and basic sanitation conditions. Among the primary prevention strategies are basic sanitation, health education better hygiene habits, animal control, breastfeeding, supplementing the diet with zinc, vitamins, and the rotavirus vaccine. The preventive strategies included the use of oral rehydration solutions, adequate nutrition, prescribed antimicrobials, and intravenous fluid replacement with glycaemic and electrolyte correction in severe cases.

CONCLUSION

In conclusion, public policies regarding the indigenous population and cross-cultural care should be strengthened. The present study confirmed that, at a global level, there is a lack of publications studying this issue.

[Which variables influence compliance with physical activity recommendations in young children?]

INTRODUCTION

There are established European guidelines for physical activity in childhood. The main goal of our study was to determine the factors that may influence compliance with European recommendations for physical activity in young children.

METHODS

We included 136 children (aged 2-8 years) classified by weight status, calculated based on the body mass index z-score using the growth standards of the World Health Organization. We measured physical activity over 5 consecutive days with accelerometers and recorded the food intake.

RESULTS

A greater level of physical activity was associated with a lower weight status category (B=-1.55; 95% CI: -2.02 to -1.08; P<.001), lower age (B=-1.33; 95% CI: -1.72 to -0.93; P<.001) and greater energy expenditure (B=0.02; 95% CI: 0.02 to 0.03; P<.001). The overall physical activity in the sample was light (mean=589 cpm/day). Children with overweight and obesity spent less time engaged in moderate to vigorous physical activity (P=.005) and more time engaged in sedentary activities (P=.005) compared to children with normal weight. All groups spent between 90 and 130minutes a day in sedentary activities, with a mean time spent that amounted to 15.5% of their time (excluding time spent sleeping). The adherence to European recommendations varied in association with sex (P=.010) and weight status (P=.038).

CONCLUSION

Young children spent more than 100minutes a day engaged in sedentary activities. Most of the sample met the European recommendations for daily moderate to vigorous physical activity. However, the degree of adherence depended on sex and weight status.

[Effect of changing reference growth charts on the prevalence of short stature]

INTRODUCTION

Short stature is a family concern, and is a common reason for consultations in paediatrics. Growth charts are an essential diagnostic tool. The objective of this study is to evaluate the impact of changing reference charts in the diagnosis of short stature in a health area.

SUBJECTS AND METHODS

A population-based-cross-sectional-descriptive-study was performed in which the height of children of 4, 6, 10 and 13 years-old were compared with the growth charts of the Fundación Orbegozo 2004 Longitudinal and 2011. The prevalence of short stature and the 3rd percentile of the study sample were calculated.

RESULTS

There were 12,256 valid records (89% of the population). The prevalence of short stature increased at all ages with the change in the growth charts, with differences of prevalence of 3.6% (95% CI: 2.8 to 4.5) at 4 years; 1.8% (95% CI: 1.3 to 2.3) at 6 years; 2.8% (95% CI: 2.2 to 3.4) at 10 years, and 1.4% (95% CI: 0.8 to 1.9) at 13 years. In absolute numbers, it went from 58 diagnoses of short stature with the 2004 Longitudinal charts (34 boys and 24 girls) to 352 with the 2011 (155 boys and 197 girls).

CONCLUSIONS

The change in reference growth charts has increased by 6-fold the number of diagnoses of short stature. The pathological condition found in the cases diagnosed with the 2011 growth charts that had not been diagnosed with the previous charts will allow us to evaluate the suitability of the change.

[Adaptation and study of the measurement properties of a sleep questionnaire for infants and pre-school children]

INTRODUCTION

Although sleep disturbances in infants and toddlers are common, there is no suitable validated tool in Spanish to evaluate sleep disorders. The Brief Infant Sleep Questionnaire (BISQ) is a well-established multidimensional questionnaire widely used internationally.

OBJECTIVES

To adapt the BISQ questionnaire to Spanish and analyse its reliability and validity. To explore its feasibility, both in the clinical context, and in epidemiological research.

METHODS

Participants were parents of children between 3 and 30 months of age. The adaptation to Spanish (BISQ-E) was achieved by using both back translation and consensus, following the international guidelines.Reliability was determined by means of test-retest and measurement of agreement (Kappa value) between 2forms of administration of the questionnaire (self-administration and clinical interview). Construct validity was established by analysing its correlation with a sleep diary.

RESULTS

A total of 87 families/children participated. The test-retest reliability undertaken in 60 subjects was excellent; r = 0.848 (P<0.001). The kappa value was 0.939 (95% CI: 0.858-1.00, P<0.001).The agreement between BISQ-E and the sleep diary was analysed in 27 families/children, with statistically significant values being obtained for the following variables: bedtime (r = 0.731), hours of night sleep (r = 0.726), hours of daytime sleep (r = 0.867), and number of nocturnal awakenings (r = 0.888) (P < 0.001).

CONCLUSIONS

The Spanish adaptation of the BISQ shows overall adequate validity and reliability for the evaluation of sleep in infants and pre-school children. Its use as a clinical tool, or for clinical-epidemiological research studies, is feasible.

[Validity of anthropometric measurements and weight perceptions reported by relatives of children under 4 years old]

OBJECTIVE

To assess the validity of weight and height measurements reported by parents and the perception of their children's weight status in order to assess the prevalence of overweight children under 4 years old.

METHODS

Cross-sectional study. Anthropometric data was collected by self-report questionnaires completed by parents of children 3-45 months old: 1) information from paediatric check-ups (gold standard); 2) information reported from the home environment; and 3) data from individual perceptions. WHO standards were used.

RESULTS

Reported height was underestimated, thus reported weight/height and BMI/age were overestimated. Overweight prevalence according to paediatric check-ups was 18.6%, compared to 26.5% reported prevalence, showing a moderate concordance (Kappa: 0.47 [0.34-0.60]), 70% sensitivity and 84% specificity. Subjective perception was 11.2%, representing 30% sensitivity and 93% specificity.

CONCLUSIONS

The reported information has little validity for population-based studies, as height is underestimated and overweight status is not correctly perceived due to distortion of individual perception. Questionnaires must be validated and awareness raised among families.

[Retroperitoneal malignant peripheral nerve sheath tumor a preschool child]

BACKGROUND

Malignant tumors of peripheral nerve sheath (MPNSTs for its acronym in English) are aggressive sarcomas that occur generally in adulthood and are located mainly on the trunk and lower limbs, with a high association with neurofibromatosis type 1 (NF1).

CASE REPORT

A 34-months-old female infant without NF1 with a palpable abdominal mass is described. The mass corresponded to a retroperitoneal MPNST. The diagnostic approach and management are presented, highlighting the complications and sequelae that occurred during evolution.

CONCLUSIONS

MPNSTs are important despite their low incidence because of their aggressiveness, and should be considered upon the detection of a mass located at paravertebral level or limbs, especially in patients with NF1. The cornerstone of the treatment lies in a complete surgical resection due to the high rate of recurrence, with limited therapeutic response to radiotherapy and chemotherapy. This case presents the clinical manifestations and complications that can be expected with these tumors and their harmful behaviour. The absence of NF1 does not exclude the diagnosis.

[Urinary iodine levels and dairy consumption in pre-school children in Southwest Asturias (Spain)]

INTRODUCTION

For decades dairy products have been a major source of iodine for decades. The purpose of this study was to determine the iodine nutritional status and its relationship with dairy consumption in pre-schooler children between 2 to 5 years old in a rural area with 27,847 inhabitants.

PATIENTS AND METHODS

It was planned to study 200 participants, selected by random sampling, proportional to the size of the municipality, age, and sex. Parents provided urine samples to analyse urinary iodine, as well as the nutritional information through an interview. A glass of milk or a slice of cheese was considered as a ration, and a portion of other milk derivatives were considered as half rations. The nutritional status of iodine was interpreted with the median (P[percentile]₅₀) of the urinary iodine levels, and iodine intake was estimated using the mean of ration/day of milk and dairy products, fish, and eggs.

RESULTS

Of the total of 198 subjects that took part, 193 provide urine specimens for the determination of iodine levels. The mean dairy ration/day was 3.8 (SD:1.4). More than two-thirds (69.9%) drank ≥ 2 glasses of milk/day, and 88.1% consumed a dairy ration of another dairy product. The median urinary iodine level was 184 μg/l, but was dependent on glasses of milk/day (282.5 μg/l ≥ 4 glasses) and/or the type of milk (233.0 μg/l in semi-skimmed). An intake of 115.1 μg/day to 170.2 μg/day of iodine was estimated, and that milk was the food which provided more iodine (89.9 μg/day).

CONCLUSIONS

Iodine intake was adequate, although higher than necessary when four or more glasses of milk were consumed, and/or when the milk was skimmed. The consumption of dairy products should be monitored to prevent both excessive and deficient intake of iodine.

Factors associated with early childhood caries in Chile

OBJECTIVE

To determine the prevalence of caries and identify the associated factors among children aged 2 and 4 years in southern Chile.

METHODS

A cross-sectional study was conducted in a random sample of 2,987 children. Dental examinations were performed in all participating children and a self-administered survey was administered to their primary caregivers. The statistical analysis included a zero inflated negative binomial regression model.

RESULTS

The prevalence of caries was 20.3% for 2-year-olds and 52.7% for 4-year-olds. The factors associated with caries included the following: living in the Bio-Bío region, PR 2 year-old: 1.65 (1.10-2.47), PR 4 year-old: 1.44 (1.18-1.75) and having a low socioeconomic position, PR 2 year-old: 5.39 (2.14-13.57), PR 4 year-old: 3.71 (2.68-5.13) or a medium socioeconomic position, PR 2 year-old: 2.79 (1.06-7.33), PR 4 year-old: 2.70 (1.92-3.79). In 4-year-olds, a high frequency of consuming sugary drinks at bedtime (PR: 1.30; 1.06-1.59), not brushing teeth daily (PR: 1.37; 1.18-1.60), and the presence of gingivitis (PR: 1.64; 1.28-2.09) were also associated with caries.

CONCLUSIONS

The high prevalence of caries in this young group is concerning. The factors associated with caries identified in this study could help in the design of preventive interventions at early ages.

[Children with minor head injury in the emergency department: Is skull radiography necessary for children under 2 years?]

BACKGROUND

Current guidelines on the management of mild head trauma (traumatic brain injury/TBI) do not include the presence of a skull fracture in determining the risk of intracranial injury. However, in our setting cranial radiography is still performed frequently to rule out the presence of skull fracture.

OBJECTIVE

To estimate the prevalence of clinically-important traumatic brain injuries (ciTBI) in children younger than two years of age with mild TBI.

PATIENTS AND METHODS

Descriptive observational study. All children attended in emergency department with mild TBI (Glasgow ≥14 points) for a year were included. We defined ciTBI as intracranial injuries that caused death or required neurosurgery, intubation for more than 24 hours, inotropic drugs or mechanical ventilation.

RESULTS

The study included 854 children, of which 457 (53.5%) were male. The median patient age was 11.0 months (P25-75: 7.5-17.0 months). In 741 cases (86.8%) the mechanism of TBI was a fall. In 438 cases (51.3%) skull radiography was performed. Eleven children (1.3%) had intracranial injury, but none met the criteria for ciTBI (estimated prevalence of ciTBI was 0%; CI 95%: 0%-0.4%).

CONCLUSION

Children younger than two years of age with mild TBI have low prevalence of ciTBI. Consequently, it is possible to monitor children younger than two years with a TBI without performing skull radiography.