Metacognition-the capacity to represent and reflect upon our knowledge and its sources-is fundamental for higher cognition and learning. Developmental research suggests that the ability to make explicit metacognitive judgments emerges surprisingly late, not before school age. However, this research has assumed that metacognition is optimized for private reflection and therefore tested children's metacognitive judgments in individual settings. In contrast, recent theoretical approaches propose that explicit metacognition may have a primarily social function and should therefore become most evident in socio-communicative contexts. We tested this proposal across four pre-registered studies (N = 195). First, we conducted two studies in which 3- and 5-year-old children participated in a social version of a well-established metacognition task (partial ignorance task). Children had to communicate their uncertainty towards a cooperative partner who relied on their advice. Even 3-year-olds provided accurate metacognitive judgments under these conditions: They spontaneously and explicitly reported uncertainty when they were partially ignorant, but not when they were knowledgeable. Two control studies yielded mixed evidence regarding the question whether the enhanced metacognitive performance in the first two studies was indeed mainly due to the socio-communicative context rather than other factors. Overall, the current findings suggest that explicit metacognition manifests earlier in development than previously assumed and may be boosted in some-particularly socio-communicative-contexts.
Marlene M Meyer, Marina Proft, Jan Engelmann et al.
BACKGROUND: Speech Sound Disorder (SSD) reduces speech intelligibility, affecting a child's ability to make themselves understood. If SSD is not resolved in the early years it will negatively impact children's education and general well-being. Effective and efficient speech and language therapy is known to resolve SSD and mitigate these risks. Intervention for SSD is often provided in inadequate dosages to be effective or efficient. Quantitative dosage is an overarching term for the different aspects of intensity of intervention which may impact outcomes. Existing literature on quantitative dosage indicates that more intensive therapy approaches for SSD appear to be more effective and efficient than less intensive delivery. A scoping review of current research in this area will serve to clarify evidence-based knowledge and understanding about quantitative dosage, how it works, and how different components potentially interact to contribute to outcomes for children with phonological impairment (PI) (a sub-type of SSD), informing future service developments and research. AIMS: This scoping review investigates quantitative dosage elements in interventions for 3-8-year-olds with PI within speech and language therapy-led contexts to identify preliminary evidence and inform reflections for practice and future research. It is registered on the Open Science Framework (OSF) registry (https://osf.io/b3as4/). METHODS: The review followed the Population, Concept, Context framework (Joanna Briggs Institute) and is reported in line with PRISMA guidance for Scoping Reviews. Key information sources were searched, including MEDLINE, CINAHL, PsycInfo, EMBASE. Grey literature searching included the COSMIN, PROSPERO, FigShare and Open Science Framework, Google scholar (advanced search), and SpeechBite. Data extraction included intervention approach, quantitative dosage of intervention delivery, outcome measurement tools, and context. The PAGER framework was used for analysis and synthesis of the identified patterns. MAIN CONTRIBUTION: Seventy-six papers were extracted for the synthesis. Only four studies specifically investigated the impact of quantitative dosage on outcomes. Three patterns developed across the 76 papers: quantitative dosage is an active ingredient; issues reporting quantitative dosage; characteristics of the evidence base and are discussed in relation to advances in the field, gaps, evidence for practice and research recommendations. Preliminary evidence for practice highlights that aspects of quantitative dosage make an important contribution to effective and efficient intervention for children with SSD. However, rigour and consistency in reporting quantitative dosage should be improved to support translation of evidence to practice and replication of research. The importance of using benchmarked study designs and appropriate methodologies to support robust research to better-inform evidence-based practice is highlighted. CONCLUSIONS/IMPLICATIONS: This scoping review provides preliminary evidence for quantitative dosage in children with PI. The findings are promising, (with evidence of some stronger research designs for example, randomised controlled trials, multiple baseline SCEDs with multiple participants, and replication of findings). However, further robust research, reporting all aspects of quantitative dosage and considering the potential costs and benefits of more efficient, evidence-based quantitative dosages is urgently needed. WHAT THIS STUDY ADDS: What is already known on this subject General findings about quantitative dosage for children with SSD show that reporting on dosage is often absent. When dosage is reported it is often under specified or different aspects of dosage are conflated. Reporting standards for dosage need to be agreed. Further research is required about the specific levels of quantitative dosage optimally required before children with SSD are discharged. Previous reviews have mainly extracted evidence about session numbers, session frequency, session length, and dose of practise items per session, across subtypes of SSD. What this study adds to the existing knowledge This paper specifically considers how all aspects of quantitative dosage are reported on and explored in the literature with a focus on children with phonological impairment (PI). A novel approach following the PAGER framework synthesized the data extracted from the papers to identify Patterns and relate these to clinical practice and research. The key patterns that emerged in this scoping review were: quantitative dosage is an active ingredient; issues reporting quantitative dosage; and characteristics of the evidence base. Advances, Gaps, Evidence for practice and Research Recommendations (the AGER of PAGER) are reported for each Pattern. What are the clinical implications of this study? For children with PI, intervention delivered two to four times weekly is likely to be more cost- and clinically effective than once weekly. More sessions delivered over time with a higher dose of production trials per session are likely to be more effective and efficient than fewer sessions delivered with a lower dose (although an upper threshold may exist). Potentially, more timely intervention is more effective over the longer term, than less timely intervention. Further high-quality research is needed because study design, reporting of quantitative dosage, and exploring the cost benefits of more efficient dosages are weaknesses in current literature.
Jill Titterington, Sarah Rudd, Helen Stringer et al.
BACKGROUND: There is a higher incidence of scaphoid fractures in children with lower socioeconomic status (SES), who may be more likely to underutilize health care resources. This study investigated the association between socioeconomic factors and the clinical course of nonoperatively treated pediatric scaphoid fractures. We hypothesized that lower SES would be associated with delayed and prolonged treatment. METHODS: This retrospective study included patients <21 years old who presented to a single institution with an acute scaphoid fracture between 2012 and 2024. Demographic and clinical information were obtained from the electronic health record. SES factors included insurance status, household composition, Child Opportunity Index (COI), Area Deprivation Index (ADI), and Social Vulnerability Index (SVI). Descriptive statistics, nonparametric tests, and regression analyses examined the relationship between SES and clinical course. RESULTS: The study included 736 patients (mean age, 13.6 ± 2.5 years; 69% male). The median time from injury to rigid immobilization was 4.0 days (interquartile range [IQR], 2.0-7.3), and that to orthopaedic specialist presentation was 5.0 days (IQR, 2.0-9.0). The median duration of immobilization was 38.0 days (IQR, 28.0-43.0), with longer immobilization observed in patients with lower SES per COI (national, P < .001; state, P < .001), ADI (national, P < .001; state, P = .002), and SVI (P < .001). Children in the lowest COI national quintile presented to an orthopaedic specialist 4.5 days later (P = .024) and underwent immobilization 7.4 days longer (P < .001) than other patients. Publicly insured patients were immobilized 7.4 days longer than children with private insurance (P < .001). Children living with both biological parents were immobilized 4.4 days fewer than those in other household configurations (P < .001). SES factors were not associated with scaphoid nonunion or progression to surgery. CONCLUSIONS: In pediatric scaphoid fractures, lower SES is associated with delayed orthopaedic specialist presentation and prolonged rigid immobilization although not nonunion or progression to surgery. Treatment delays may be due to barriers that limit access to orthopaedic specialists or prevent timely follow-up. Further research is needed in this population to elucidate the relationship between SES and health care access and to understand the consequences of treatment delays. KEY CONCEPTS: (1)Lower socioeconomic status (SES) is associated with delayed orthopaedic specialist presentation and prolonged rigid immobilization in children with acute, nonoperatively treated scaphoid fractures.(2)Delays in care may be due to barriers that limit access to orthopaedic specialists after injury and prevent timely follow-up after initiation of rigid immobilization.(3)These disparities are concerning as delays in rigid immobilization and prolonged rigid immobilization may negatively impact clinical outcomes, school performance, sports participation, and social engagement.(4)SES was not associated with increased risk of nonunion or failed nonoperative treatment and progression to surgery.(5)Further research is needed to fully elucidate the relationship between SES and health care access in pediatric scaphoid fractures and to understand the consequences of delayed or prolonged treatment in this population. LEVEL OF EVIDENCE: III, Retrospective Cohort Study.
Stone R Streeter, Simon Blanchard, Dev Laungani et al.
BACKGROUND: The novel Medical Equipment Adaptable Travel Restraint (MEATR) was created by 2 critical care nurses who recognized that individuals with life-sustaining durable medical equipment (DME) did not have a safe way to travel with their DME when leaving the hospital. OBJECTIVES: This study aimed to understand the satisfaction and experience of participants utilizing the MEATR to transport their DME in a noncommercial motor vehicle. METHODS: This descriptive cohort study was conducted between June 2023 and March 2025 at 2 quaternary pediatric hospitals in the United States. To measure the satisfaction and experience of traveling with their child's DME, caregivers completed surveys before receiving the MEATR, then at 2 weeks and 2 months. RESULTS: One-hundred caregivers and their children participated. Most caregivers were 31 to 50 years of age (67.0%), female (91.0%), White (80.0%), and not Hispanic or Latino (80.0%). Most children were under 4 years of age (54.5%), male (54.5%), White (80.8%), and not Hispanic or Latino (74.7%). Before receiving the MEATR, 15.0% of caregivers reported they were satisfied with the way they transported their medical equipment. After using the MEATR, there was a significant increase in satisfaction with DME transport (92.1% and 94.1%; P<.001). Regarding experience, at the time of enrollment, most participants reported limiting their travel to certain places due to medical equipment (71.0%). This number decreased significantly after receiving the MEATR (16.9% and 17.8%; P<.001). CONCLUSIONS: Participants who utilized the MEATR to transport their DME reported improved satisfaction and experience. Thus, the MEATR could improve the quality of life for individuals who require life-sustaining DME.
Michele DeGrazia, Kathryn Gustafson, Alexandra Cole et al.
BACKGROUND: Previous studies have linked prenatal maternal inflammatory markers, including C-reactive protein (CRP), to child neurodevelopmental outcomes; however, findings are mixed. Deciduous tooth assays allow for a direct measure of CRP in the fetal milieu, and initial findings suggest that children diagnosed with autism spectrum disorder (ASD), compared with nondiagnosed control participants, have higher levels of CRP during the third trimester of gestation. METHODS: The present study attempts to replicate this finding in a nonclinical sample and test whether prenatal CRP is associated with mother-reported measures of ASD-related traits and other child behavior problems. Mother-child dyads (N = 93) were followed prospectively from pregnancy through school age. We obtained deciduous (baby) teeth and assayed them for weekly CRP levels during the perinatal period and linked these exposures to maternal reports of behavior problems on the Child Behavior Checklist. RESULTS: We showed that higher ASD-related traits, including social problems and thought problems, as well as attention and aggression problems, are associated with higher CRP levels in the third trimester. Behavior problems were also associated with elevated CRP levels in the first several months after birth and decreased CRP levels later in infancy. CONCLUSIONS: Our findings replicate and extend the findings of the case-control study of ASD. These findings suggest a possible role for perinatal inflammation in children's neurodevelopmental outcomes and a need to further probe sensitive developmental windows and potential protective factors in this association.
Vishal Midya, Brooke G McKenna, Amy L Salisbury et al.
OBJECTIVES: To characterise the magnitude of glycaemic variability and to examine the factors associated with it, with particular attention to residual beta-cell function measured by fasting C-peptide, in children, adolescents, and young adults with diabetes in Bangladesh. DESIGN AND SETTING: Prospective observational study at the BADAS Paediatric Diabetes Care and Research Centre, BIRDEM, Dhaka, using 14 days of blinded professional continuous glucose monitoring (CGM). Participants were enrolled between March and November 2024. PARTICIPANTS: Ninety-seven participants aged 1-25 years (68 with Type 1 and 29 with Type 2 diabetes) had at least seven valid CGM days and a paired HbA1c within 2 weeks of CGM initiation. Fasting C-peptide was available for 46 participants. MAIN OUTCOME MEASURES: The coefficient of variation (CV) of glucose as the primary metric of variability; time in range, time above range, and time below range as secondary metrics; and independent predictors of CV on multivariable regression. RESULTS: Mean CV was 39.4% (SD 9.2), and 59 of 97 participants (60.8%) were at or above the recommended target of 36%. CV was higher in Type 1 than Type 2 diabetes (41.9% vs. 33.3%). Lower fasting C-peptide was independently associated with higher CV after adjustment for diabetes type, age, and insulin dose (-1.94 percentage points per ng/mL, 95% CI -3.35 to -0.53; model R-squared 0.52), with a graded relationship across pre-specified C-peptide categories for CV, time in range, and time below range. CONCLUSIONS: Glycaemic variability substantially exceeds international targets in this setting. Fasting C-peptide, available for fewer than half of the cohort, showed a graded association with variability that is best regarded as hypothesis-generating; if confirmed in larger studies, it could offer a low-cost means of identifying children at highest variability risk where CGM access is limited.
Ajmina Hasan Flabe, Bedowra Zabeen, Shatil Amirat et al.
AIMS: To identify and map the evidence on allied health professional led interventions for preterm infants with feeding aversion, and to critically examine the literature to inform clinical practice and highlight research gaps. METHODS: A Joanna Briggs Institute scoping review was conducted. Systematic searches of MEDLINE, AMED, Embase, Emcare, PsycINFO, CINAHL and grey literature identified studies published between 2000 and 2024. All study designs were eligible. Data on study characteristics, interventions and outcomes were extracted and synthesised descriptively. MAIN CONTRIBUTION: Thirty-five studies were included from 4016 records, with intervention studies comprising 37.1% (n = 13). Fifty-six intervention techniques were identified, most commonly targeting infants' environments (88.6%), behaviour (80%), body structures and movements (65.7%), and physiological states (62.8%). Interventions were delivered across outpatient (68.7%), home (43.7%), community (15.6%) and educational (12.5%) settings. Outcomes most frequently related to oral intake (72%), growth (64%), mealtime behaviours (40%), oral skills (32%) and caregiver outcomes (36%). CONCLUSIONS: The evidence base for allied health interventions in this population is diverse but limited. Findings support clinical decision-making and highlight the need for more rigorous research to strengthen evidence and inform service delivery. WHAT THIS PAPER ADDS: What is already known on the subject Negative oral or feeding experiences are already known to increase the risk of feeding aversion. A range of interventions for feeding aversion are described in the literature, but no single best-practice approach has been established. Very few studies focus specifically on preterm infants and few focus on infants under 2 years more generally. What this study adds to the existing knowledge This study mapped allied health interventions for preterm infants with feeding aversion, identifying fifty-six intervention techniques across eight intervention targets: the feeding environment, infant behaviour, body structures and movements, physiological systems and state, sensory organs and/or functions, relationships, participation, and knowledge. It highlights the importance of multidisciplinary team working in feeding aversion intervention and demonstrates that the intervention can be delivered across a range of settings, including outpatient, community, and telehealth services. What are the clinical implications of the study? This study defined feeding aversion by clinical presentation rather than diagnosis, capturing infants with medical complexity and comorbid needs which better reflects the complexity of patients seen in clinical practice. By mapping allied health intervention techniques, targets, dose, and settings for improving oral feeding in preterm infants with feeding aversion, it provides professionals with a practice profile against which to reflect on their own approach. The findings also support multidisciplinary working as the gold standard for feeding aversion intervention and suggest that early intervention may yield better outcomes than delaying treatment until the child is older.
Ailish Harrison, Sarah Massey, Philip Powell et al.
Children with food allergy (FA) and their families are vulnerable to maladaptive coping patterns to managing their FA, often characterized by excessive avoidance and distress. Allergists have an important role in promoting adaptive coping with FA, identifying when anxiety has become excessive, and implementing steps to support reductions in anxiety and distress as a part of patient care in FA management. Allergists can prevent and reduce maladaptive coping with FA by providing anticipatory guidance tailored to the individual to ensure accurate perception of risk associated with their FA and by providing treatments that facilitate increased participation in activities.
The indoor air environment has become an essential environmental factor affecting children's health and safety, among which nicotine and PM2.5, two common combined factors, have become pathogenic factors in indoor area that induce lung cancer in children. In order to reveal the specific mechanism of that, we developed the model of Systematic Environmental Information Medicine Engineering (SEIME), which combines environmental engineering, bioinformatics, and computational biology multidisciplinary approaches. We initially developed a comprehensive computational fluid dynamics (CFD) model, which was subsequently integrated with data from the GEO database, TCGA database, single-cell online databases, and molecular docking analyses to enhance our research framework. CFD results revealed that indoor concentrations of PM2.5 and nicotine were significantly higher than the recommended values of 15 µg/m3 and 1 µg/m3 in the WHO Global Air Quality Guidelines. Meanwhile, bioinformatics results indicated that MAPK and PI3K-Akt were important signaling pathways for inducing non-small cell lung cancer (NSCLC) in children. In addition, GADD45A and NPAS2, as key targets affecting children's NSCLC, were identified. Subsequently, drug repositioning and molecular docking assays were conducted, and more importantly, related small molecule targeted drugs were screened. Therefore, this study has set up a new interdisciplinary analysis model-SEIME, using environmental information medicine engineering to solve environmental disease models under the influence of multiple factors, and providing theoretical basis for molecular target screening and disease treatment.
OBJECTIVE: To assess parental attitudes, beliefs, and experiences related to pediatric COVID-19 vaccination. METHODS: An online, national survey of 2005 U.S. parents aged 18 and older was conducted during August 17-25, 2023. Parental attitudes and beliefs about pediatric COVID-19 vaccination, receipt of a COVID-19 vaccination recommendation for their child, and reasons for not getting their child vaccinated against COVID-19 were assessed. Factors associated with child's COVID-19 vaccination were also assessed. RESULTS: Less than half (46.1 %) of responding parents strongly or somewhat agreed that COVID-19 vaccine is generally safe for children; agreement was higher among parents of 12-17-year-olds (54.2 %) vs. 0-4-year-olds (35.4 %), children with private (52.8 %) vs. Medicaid/CHIP health insurance (41.0 %), and those living in urban (54.2 %) vs. rural areas (29.8 %) (p-values<0.0001). Approximately 60 % of parents reported that their child's health care provider (HCP) recommended COVID-19 vaccination for their child, with higher proportions reporting a recommendation among those with 12-17-year-olds (73.1 %) vs. 0-4-year-olds (43.1 %) (p-value<0.0001), children with private (65.6 %) vs. Medicaid/CHIP health insurance (58.2 %) (p-value = 0.0013), and those living in urban (67.3 %) vs. rural areas (51.6 %) (p-value<0.0001). The top three reported reasons for not getting their child vaccinated against COVID-19 were 1) worry about serious/unknown long-term health problems from the vaccine (52.8 %), 2) a belief that COVID-19 vaccination is not effective at preventing COVID-19 (36.3 %), and 3) child/family has already had COVID-19 (19.3 %). Parents who had received COVID-19 vaccine themselves were more likely to vaccinate their child against COVID-19 (received bivalent vaccine dose: OR = 25.8 [15.9, 41.7]; received at least one dose, but not bivalent vaccine dose: OR = 11.1 [6.8, 18.2]). CONCLUSIONS: Parental concerns around serious/unknown long-term health problems related to COVID-19 vaccination were observed. In addition, a significant proportion of parents reported not having received a COVID-19 vaccination recommendation. Addressing parents' concerns regarding vaccine safety remains important, especially in rural areas.
