Children with cancer are at increased risk for poor overall health and elevated symptoms, however, the potential influence of rural residence on these outcomes remains understudied. This exploratory study examined associations between rurality and self-reported symptoms and overall health among pediatric oncology patients. Children receiving active cancer treatment or within six months of treatment completion were recruited from two children's hospitals in the Midwestern United States. Residential addresses were used to classify participants as rural or non-rural and to calculate travel distance to the oncology clinic. Symptoms were assessed using the Memorial Symptom Assessment Scale, and overall health was measured using the PROMIS Pediatric Global Health Scale. Descriptive statistics, correlations, chi-square tests, one-samples and independent samples t-tests were conducted. Seventy-six children aged 8-17 years (M = 13.4, SD = 3.2) participated, with 67% residing in non-rural and 33% in rural areas. Participants were predominantly White (88%), male (65%), and diagnosed with hematologic malignancies (53%). In this pilot study, rural participants reported lower perceived overall health, t(74) = 4.32, p < .001 compared with non-rural. These preliminary findings suggest that rural residence may be associated with poorer perceived overall health among children with cancer. Larger studies are needed to better understand potential geographic disparities in pediatric oncology outcomes.
Screen time has become an integral part of children's daily lives, raising concerns about its potential effects on mental, emotional, developmental, and behavioral health. Excessive screen use during sensitive developmental periods has been linked to difficulties with attention, sleep, and emotional regulation. This study examined the association between weekday screen time and the prevalence of MEDB disorders among children aged 0-17 years in the United States. Data were drawn from the 2021-2022 National Survey of Children's Health, a nationally representative dataset that provides comprehensive insights into child well-being. Multivariable analyses adjusted for age, sex, and race/ethnicity to account for potential confounders. Results showed a dose-response relationship: children who spent four or more hours per day on screens had 2.30 (95% CI: 2.15-2.47) times higher odds of being diagnosed with a MEDB disorder compared to peers with less than one hour. Elevated risks were also identified for three hours (OR = 1.58, 95% CI: 1.47-1.70) and two hours (OR = 1.24, 95% CI: 1.15-1.32) of daily screen use. These findings highlight the need for targeted public health strategies that promote healthy screen habits and embed evidence-based guidelines into schools, pediatric care, and community programs.
This study aimed to identify distinct profiles of conduct problems and callous-unemotional (CU) traits in a non-clinical child population using a person-centered approach. A total of 462 children (42% girls; mean age = 4.73 +/- 2.84 years) were assessed through parent reports. Standardized instruments included the Inventory of Callous-Unemotional Traits, the Strengths and Difficulties Questionnaire, the Emotionality, Activity, and Sociability Temperament Survey, and the Parental Stress Scale. Latent class analysis was conducted to explore behavioral profiles. This bottom-up, person-centered methodology allows for a more nuanced understanding of heterogeneous behavioral trajectories compared to traditional categorical classifications. Three profiles emerged: Profile 1 (normal, N = 361, 46% girls) presented low difficulties and high prosocial behavior. Profile 2 (hot conduct problems, N = 26, 35% girls) showed elevated emotional symptoms and moderate conduct problems, reflecting emotional reactivity and poor regulation. Profile 3 (cold conduct problems, N = 75, 29% girls) displayed high CU traits and low prosocial behavior, suggesting lack of empathy and emotional expression. Predictive analyses revealed that hot profiles were associated with higher emotionality, maternal stress during pregnancy, single-parent families, and bullying victimization. Cold profiles were linked to lower sociability, higher parental stress, male gender, and bullying perpetration. These findings highlight the importance of early identification of distinct pathways to conduct problems and their family correlates.
Pediatric Acquired Brain Injury (ABI) profoundly impacts individuals and families, underscoring the critical role of parental well-being in the child's rehabilitation. This study explores the relationship between Post-Traumatic Stress (PTS) and Post-Traumatic Growth (PTG) among parents of children with ABI, focusing on attachment styles and injury severity. A cross-sectional study was conducted with parents of 35 children after ABI. Data collection of attachment style, PTS, PTG and injury severity, utilized questionnaires and medical records. Analyses through Pearson correlations and linear regression revealed a positive association between parental PTG and PTS, with attachment styles and injury severity independently associated with these outcomes. Both avoidant and anxious attachment styles, along with injury severity, were significantly associated with PTS severity, while injury severity alone was associated with PTG. Increased injury severity correlated with elevated PTS symptoms and PTG manifestations. These findings suggest pediatric ABI may lead to both adverse and positive psychological outcomes for parents. Results highlight the importance of identifying parents at risk for PTS and providing appropriate support. Furthermore, promoting PTG may benefit parents, and in turn may enhance the child's rehabilitation process. Tailored interventions, considering attachment styles and injury severity, are critical for addressing parental needs and promoting overall well-being.
Millions of children in the United States attend residential summer camp each year. Within these settings, healthcare providers are tasked with complex workflows that include medication management, chronic and acute disease management, and support for camper and staff MESH concerns, yet lack quality metrics and benchmarking of traditional healthcare settings. The aim of this study was to identify a core set of priority quality metrics for pediatric residential summer camp health services to guide quality improvement, inform practice, and establish a foundation for future research. Using e-Delphi methodology, camp experts participated in iterative survey rounds, evaluating the importance of proposed metrics on a Likert scale. Survey rounds continued until consensus was reached on a finalized list of core quality metrics. Experts were then asked to rank each metric on four qualities to establish a priority ranking of the list. Eleven core quality metrics were identified based on expert consensus. In the final ranking survey, mean scores ranged from 2.23 to 2.55, with pre-camp health form completion, documentation reliability, and illness-related health center visits identified as the highest priority metrics. The finalized list highlighted the importance of health service processes over clinically driven outcomes. This perspective suggests experts view reliable systems and support as foundational to quality care in the residential camp setting.
School-aged children (5-17 years) constitute nearly 70% of Nigeria's child population, yet hardly any child health legislation is enforced for this group, and their healthcare-seeking behaviors are seldom comprehensively evidenced in empirical studies. This study examined the multilevel factors influencing healthcare-seeking behaviors among school-aged children in an urban setting in Nigeria, using the socioecological model as an analytical framework. Data were collected across slums (poor, congested urban neighborhoods lacking amenities) and non-slums (well-off urban neighborhoods) through 39 in-depth interviews with school children, teachers, school administrators, policymakers, and program managers. We also conducted four sex-disaggregated focus group discussions with caregivers. Thematic analysis revealed a dynamic interplay of influences, ranging from child-level attributes such as age and gender to caregivers' financial capacity and occupation. Broader cultural beliefs, religious practices, gaps in enforcement of existing child health legislation, and limited access to formal healthcare, often reinforced by negative and condescending attitudes from health workers, further encouraged unlawful and inappropriate healthcare-seeking behaviors by and for school-aged children. At the same time, although still largely unexplored, schools have emerged as promising platforms for fostering health awareness and supporting more informed healthcare among children. These findings highlight the need for culturally sensitive, legally binding health and child protection interventions that include school-based or school-linked health services, as well as a more responsive urban health system. Such measures are essential to encourage safer, more equitable healthcare-seeking behaviors among school-aged children.
Little is known about the friendship quality among survivors of pediatric brain tumors (SPBTs), despite its importance to critical outcomes. This study evaluated friendship quality with an identified friend among SPBTs and survivors of non-central nervous system solid tumors (SNCNSTs). Survivors, ages 7-14 and within 6 months of finishing tumor-directed treatment, identified a friend, and both completed a measure of friendship quality. Survivors also completed measures of cognitive function, social information processing, and family functioning. Caregivers reported on survivor physical function. Analyses compared survivor- and friend-reported closeness between SPBTs and SNCNSTs and identified factors associated with closeness. In a general linear model analysis controlling for sex and age at diagnosis, SPBTs and SNCNSTs no longer differed on closeness. SPBTs and SNCNSTs did not differ on friend-reported closeness. Level of agreement between survivor- and friend-reported closeness was low. Regression analysis indicated that survivor sex, survivor processing speed, and parent-reported survivor physical function were significantly associated with survivor-reported closeness. Factors outside of diagnosis (brain v. non-brain) are important to friendship quality in early survivorship. Longitudinal research is needed to evaluate friendship quality when late effects emerge. Efforts to improve survivor physical function may promote enhanced connections with friends.
In this preliminary study, we examined post-treatment adolescent cancer patients facing a triple challenge: developmental demands, cancer recovery, and ongoing war. Guided by the transactional model of stress and coping and conservation of resources theory, we examined how resilience and perceived social support are associated with cancer- and war-related adjustment (i.e. having fewer disorder symptoms). In a cross-sectional design, 78 Israeli adolescent cancer survivors (ages 11-18) completed standardized self-report measures regarding resilience, parental and peer support, and adjustment disorder symptoms in both contexts. Results revealed that resilience was positively associated with cancer-related adjustment (beta = .53, p < .001), which in turn was associated with war-related adjustment (beta = .67, p < .001). Age was negatively associated with cancer-related adjustment (beta = -.23, p = .021) but was unrelated to war-related adjustment (beta = -.03, p = .679). Parental and friend support were not related to cancer-related adjustment, but friend support was directly associated with war-related adjustment (i.e. fewer symptoms) (beta = .19, p = .040). We may conclude that fostering resilience and enhancing peer support are essential for helping adolescent cancer survivors cope with cancer and war-related challenges and strengthen psychological adjustment. These preliminary findings underscore the need for resilience-focused interventions and peer-support initiatives within psycho-oncology care for adolescents in conflict zones, informing future programs and mental health policies.
Body image dissatisfaction and distortion are common in contemporary culture, often beginning in childhood, and continuing in adolescence and adulthood. Proper evaluation of body image may predict and prevent physical and mental health issues in children and adolescents. Therefore, using reliable and standardized instruments is essential in clinical practice. This study aimed to assess the reproducibility (reliability) of a mobile application developed to evaluate body image satisfaction in children and adolescents aged 5 to 14 years, by comparing it to the analog version of the Brazilian Silhouette Scale for Children and examining body satisfaction levels between sexes. A cross-sectional study was conducted in public schools with 269 children and adolescents of both sexes from Midwest Brazil. Anthropometric characteristics and body image were calculated. The Brazilian Silhouette Scale was applied in both digital (mobile app) and analog formats. The intraclass correlation coefficient was calculated for each age. Both versions of the scale showed moderate reliability for the total sample (ICC = 0.70 and 0.74), except for the 5- and 6-year-old group, which showed low reliability (ICC = 0.38). Over 70% reported body image dissatisfaction, and more than 40% wanted a smaller silhouette. Both versions of the scale showed moderate reliability. No difference in the level of body satisfaction was observed between the sexes across all ages. The findings indicate moderate reproducibility between the scale versions, with greater accuracy in evaluating older children and adolescents, as well as ease of administration and interpretation when using the app.
Research suggests a high prevalence of disordered eating in adolescents with celiac disease (CD); however, research on vulnerability factors is limited. This study hypothesized that a higher level of body image dissatisfaction, greater severity of anxiety symptoms, greater severity of depression symptoms, and poorer quality of family eating environment would predict greater disordered eating behaviors, attitudes, and feelings in U.S. adolescents with CD. A correlational design with a convenience sample of N = 187 was used. Participants were U.S. adolescents aged 13 to 18, with self-reported CD. Data was collected via a one-time, online survey. Measures included Celiac Dietary Adherence Test, Eating Attitudes Test-26, Appearance and Weight subscales of the Body Esteem Scale for Adolescents and Adults, Revised Child Anxiety and Depression Scale-25, and Family Eating Habits survey. Multiple regression analyses were used to test hypotheses. Findings partially supported hypotheses, indicating weight dissatisfaction, depression symptoms, and poor family eating environment atmosphere predicted greater disordered eating when measured as 1. dieting; 2. bulimia and food preoccupation; and 3. composite of behaviors, attitudes, and feelings about dieting, bulimia and food preoccupation, and oral control. Results enhance understanding of psychosocial vulnerabilities for disordered eating in adolescents with CD, informing targeted assessments and interventions.
This article presents the development of Up Routines, a parent training program aimed at strengthening sensory integration and promoting child participation in early childhood. Designed for caregivers of children aged 0 to 3, the program emerged from qualitative data collected from healthcare professionals (n = 13) and caregivers (n = 14) and is grounded in a family-centered, preventive care perspective. Key challenges in daily routines, such as feeding, sleep, regulation, and play, were identified as priority targets for intervention. Drawing on developmental science and early intervention literature, the program was structured into ten hybrid-format sessions combining online and in-person delivery. Rather than focusing on diagnostic treatment, Up Routines promotes caregiver understanding and implementation of practical, relationship-based strategies that enhance the child's engagement in daily routines and the development of sensory integration. This article outlines the rationale, design, and structure of the program, demonstrating how parent and professional input shaped its content and delivery. The discussion reflects on the use of sensory-informed practices and the potential integration of such programs into pediatric and primary care services.
In July 2021, North Carolina Medicaid transitioned to a managed care (MMC) system. We investigated how MMC transformation changed acute and routine care visits among youth with sickle cell disease (SCD) and other chronic conditions. We identified patients with SCD enrolled in Medicaid 2 years before and after MMC transformation and followed by a pediatric hematology/oncology clinic. Comparator groups included children in the same health system and diagnosed with chronic kidney disease (CKD), type 1 diabetes mellitus (T1DM), and hemophilia. The primary outcome was the number of acute care visits per patient in each period. The secondary outcome was the likelihood of missing routine visits at the subspecialty clinic. We identified 197 patients with SCD, 59 with CKD, 169 with DM, and 18 with hemophilia. After MMC transformation, analysis revealed the number of acute care visits for the SCD cohort increased by 19% 95% CI [8%-32%], with no improvement in completing routine clinic visits. Acute care visits increased in the T1DM cohort, although routine visit completion improved among patients with CKD. After MMC transformation, acute care visits increased among SCD patients. Targeted efforts are needed to realize the potential of MMC transformation for improving care.
The increasing use of screen-based devices in children's daily lives has raised concerns about their effects on health behaviors such as sleep and feeding. This study investigated the relationship between leisure screen time and sleep and feeding problems in primary school children. A cross-sectional survey was conducted with 322 children aged 7-10 years and their parents. Parents completed questionnaires measuring children's daily leisure screen time, sleep patterns, and feeding behaviors. Results showed that weekend leisure screen time (M = 149.4 minutes/day) was higher than weekdays. Significant positive correlations were found between leisure screen time and both total feeding problem scores (weekdays: r = 0.22; weekends: r = 0.25, p < .01) and sleep disturbances (weekdays: r = 0.29; weekends: r = 0.32, p < .01). The most affected areas were selective eating and sleep initiation/maintenance. Regression analysis revealed that weekend leisure screen time significantly predicted feeding problems (beta = 0.22, p = .001) and sleep disturbances (beta = 0.27, p < .001), explaining 8% and 12% of the variance, respectively. The findings indicate the importance of managing children's screen time - particularly on weekends - to support healthier sleep and eating patterns and guide family-based interventions.
Electronic media (EM) is an integral part of adolescents' lives, significantly influencing their health and development. In China, sociocultural factors such as hierarchical family dynamics may shape distinctive EM usage patterns. However, structured, multi-informant assessments are rarely applied in non-Western contexts. The Media Activity Form (MAF) is a dual-informant instrument designed to capture EM use and perceived impacts from both adolescents and their parents. This study aimed to (1) examine the psychometric properties of the MAF in a Chinese context, and (2) explore patterns in EM use and perceptions across informants. Data were collected from 404 adolescent - parent dyads in Nanjing and Jintan, China. Analyses included descriptive statistics, exploratory and confirmatory factor analyses (EFA/CFA), and comparison tests. Adolescents reported significantly higher screen time than parents, with boys reporting slightly higher usage than girls (8.63 vs. 7.50 hrs/week). EFA and CFA supported a three-factor structure for adolescents and a two-factor structure for parents (alpha = 0.71-0.94). This study is the first to validate the MAF in a non-Western context using a dual-informant approach. Findings highlight significant discrepancies between parent and adolescent perceptions of EM use and the need for culturally and developmentally informed assessment and intervention strategies.
