As new evidence on the evaluation and management of patients with acute ischemic stroke continues to emerge, the American Heart Association/ American Stroke Association released its latest guidelines for the early management of acute ischemic stroke. These guidelines, for the first time, incorporate evidence-based recommendations for assessment and interventional management of pediatric patients with acute ischemic stroke. This update emphasizes on the new pediatric-specific recommendations and also discusses key differences from other pediatric stroke guidelines.

BACKGROUND:Parents of children with Autism Spectrum Disorder (ASD) often exhibit subclinical autistic traits, known as the Broad Autism Phenotype (BAP). While BAP is recognized as a familial characteristic associated with ASD, limited evidence exists regarding how specific parental traits relate to children's behavioral, adaptive, and developmental outcomes in low- and middle-income clinical settings. Understanding these associations may be relevant for developmental and neurorehabilitation contexts in which parent - child interaction plays an important role in the child's learning environment. METHODS:This descriptive cross-sectional study included 95 children (aged 2-12 years) newly diagnosed with ASD and both biological parents, recruited from a tertiary Child Development Center. Child autism severity was assessed using the Childhood Autism Rating Scale-2 (CARS-2); adaptive functioning using the Vineland Adaptive Behavior Scales - II (VABS-II); behavioral problems using the Child Behavior Checklist (CBCL); and developmental level using the Developmental Profile-3. Parental autistic traits were measured using the Autism-Spectrum Quotient (AQ). Correlation and regression analyses were used to examine associations between parental AQ traits and child outcomes. RESULTS:BAP (AQ ≥ 23) was present in 50% of mothers and 47% of fathers. Total parental AQ scores were not associated with child autism severity. However, higher parental communication-trait scores were associated with greater externalizing behavior in children (p < .05). Certain parental AQ subdomains, particularly communication and attention-to-detail traits, showed modest negative correlations with children's motor functioning and developmental level. In multivariable analysis, paternal communication traits remained independently associated with poorer motor skills (β =  -0.276, p = .034). CONCLUSIONS:Parental BAP traits, particularly those related to communication and social reciprocity, may be associated with variability in behavioral, motor, and developmental outcomes in children with ASD. Although parental traits were not associated with autism severity, these findings suggest that considering family phenotype may be relevant when examining child developmental profiles within family-centered neurodevelopmental and rehabilitation frameworks. Further longitudinal research is needed to clarify the nature and direction of these relationships.

To assess the behavioral adverse effects associated with the use of levetiracetam in drug-naïve children with epilepsy, either as monotherapy or as part of anti-seizure medications polytherapy. This prospective cohort study was conducted in the pediatrics department of a public hospital from October 3, 2024, to July 26, 2025. Typically developing children aged 4–12 years with epilepsy were consecutively enrolled, if they were being planned to be initiated on levetiracetam therapy, either as monotherapy or as an add-on therapy. Behavioral problems were assessed prior to starting levetiracetam using Strength and Difficulties Questionnaire (SDQ) and Child Behavior Checklist (CBCL) and repeated at 14 (+ 3) days and 6 (+ 1) weeks of follow-up. The study included 60 children with mean (SD) age of 7.75 (2.48) years. At enrollment, behavioral problems were not observed in any child (scores in the normal range). Proportion of those with behavioral problems in any sub-domain in either of the tools at follow-up was 3.3

Background and aims:We studied changes in nutritional status from baseline, as measured by serial skinfold thickness measurements and their association with patient factors, disease factors, and biochemical factors, as well as time to the start of enteral feeds. Patients and methods:We enrolled 50 consecutive children aged 2-5 years from the pediatric intensive care unit (PICU) of a public sector hospital in India between 14 February, 2024 and 31 August, 2024. Baseline demographic and clinical data were recorded. Serial anthropometric parameters were measured for all children at the time of admission (+4 hours), day 3, day 7, and day 14 or at hospital discharge, if earlier. We used the World Health Organization (WHO) growth charts to interpret the anthropometric data. Results:Of the 50 children enrolled (mean age 3.17 ± 1.22 years; 46% females), 58% were underweight, 52% had wasting, and 52% had short stature at admission. Only 10% children (n = 5) had triceps skinfold thickness for age <-2 standard deviation (SD) at baseline. 32 (64%) of the children demonstrated a reduction in triceps skinfold thickness, 72% (n = 36) experienced weight loss, and 58% (n = 29) showed a decrease in mid-upper arm circumference (MUAC). However, we did not find a statistically significant association of change in triceps skinfold thickness with age, severity of illness, outcome, duration of stay, and early start of enteral feeds. Conclusion:This study shows the feasibility of skinfold calipers as a serial monitoring tool in the PICU. Nutritional status worsens during the initial 2 weeks of PICU stay, despite early enteral feeding policies.

This hospital-based study evaluated the magnitude and characteristics of musculoskeletal anomalies in children with Down syndrome. Children aged 3 months to 14 years, diagnosed to have Down syndrome by karyotyping, were evaluated for musculoskeletal anomalies. We excluded children diagnosed with another chronic condition affecting musculoskeletal health (e.g., cerebral palsy, muscular diseases); and those with any acute illness, which is likely to affect evaluation for musculoskeletal anomalies. A detailed history was taken, and clinical examination was performed by a pediatrician and an orthopedic surgeon. Detailed joint examination was done using pGALS (pediatric Gait Arms Legs and Spine), and Beighton Hypermobility Score was used to assess hypermobility in those aged 6 year or more. X-ray cervical spine (lateral view in neutral, flexion and extension) was done for all children to determine atlantoaxial instability. Additionally, in children with any suspected musculoskeletal anomaly on clinical examination, relevant radiological investigations were performed under the guidance of an orthopedic surgeon. The median (IQR) age of the study population (n = 75) was 5 (2.5, 8) years with 56

ObjectiveTo describe the clinical profile, etiology and outcome of children with hospital-onset seizures (HOS) in a tertiary care public hospital.MethodsIn this prospective study, consecutive children aged 3 months to 12 years admitted for at least 24 hours in the Department of Pediatrics of a tertiary care public hospital between 1 February, 2021 and 15 September, 2021, were followed-up during hospital stay till death/discharge. Any child admitted within 7 days following head trauma, or admitted for seizure control during the current illness was excluded. All patients were followed up daily for the occurrence of seizures during hospital stay. Outcomes were assessed using Glasgow Outcome Scale (GOS).ResultsOut of the 1050 children (635 boys), 25 (2.38%) children with a median (IQR) age of 12 (4,60) months developed seizures during the hospital stay. Seizures occurred at a median (IQR) interval of 21 hour (8 hour, 5 days) from admission; seizures progressed to status epilepticus in 3 (12%) children. Majority of those with seizures had an underlying neurological disorder/disease at admission. Majority of patients (68%) had generalized tonic-clonic seizures. After neuro-infections, metabolic derangements were the second most common etiological group for HOS (32%). A poor outcome, defined as death/severe disability as per GOS, was seen in 8 (32%) children with HOS. Children with HOS had a 2.76 times higher risk of a poor outcome as compared to those with no seizures during the hospital stay [RR (95% CI) 2.76 (1.07, 7.11), P = 0.035].ConclusionPhysicians need to be aware of the risk factors for HOS in children so as to provide adequate monitoring and emergent treatment.

To determine the factors associated with discharge against medical advice (DAMA), and the readmission and mortality rate at one-month follow-up among these children. This prospective cohort study enrolled consecutive children (6 months–12 years) from one designated inpatient ward. Clinical and demographic data, and information about reasons for DAMA were collected using a structured interview. Outcome of DAMA patients was assessed telephonically at one month after discharge. Out of 538 children, 28 (5.2

To assess the opportunities and limitations of self-directed learning (SDL) among pediatric postgraduate trainees. A semi-structured anonymized questionnaire was administered to pediatric postgraduate trainees to assess their readiness towards SDL, current practices, opportunities and limitations of SDL. Closed ended questions were scored using a five-point Likert scale. Thematic analysis of responses was conducted followed by focus-group discussion to ascertain the barriers and enablers of SDL. One hundred ten trainees responded; majority (67.7

Background and Purpose: The timeline of alteration of vitamin D and calcium levels in those receiving anti-seizure medication (ASM) remains to be elucidated. To determine the changes in vitamin D levels over a period of 6 months among children receiving monotherapy with commonly used ASM.Methods: The baseline serum levels of vitamin D, parathyroid hormone (PTH), calcium, alkaline phosphatase (ALP), phosphorus were measured in 32 children (median age 8 years) with newly diagnosed epilepsy. An appropriate ASM monotherapy was started. Those found to be deficient were treated with vitamin D supplementation. Children were reassessed after 90 days and 180 days for drug compliance and drug side-effects. All the baseline investigations were repeated.Results: At baseline, 21.9% of children were vitamin D-deficient, with a median serum level of 19.8 ng/mL. For children who were not vitamin D-deficient (VDD) at baseline (n=25), the median (interquartile range [IQR]) vitamin D levels were found to be significantly lower than baseline after 90 days of ASM use (23.0 [18.0 to 28.9] vs. 22.0 [12.0 to 24.0]; p<0.001). After 90 days, ASMs caused notable decreases in vitamin D levels from baseline for children who were not VDD at baseline (n=25) (23.0 [18.0 to 28.9] vs. 22.0 [12.0 to 24.0]; p<0.001), alongside changes in calcium, phosphorus, PTH and ALP levels. Similarly, in children who were non-deficient at 90 days follow-up (n=20), median (IQR) vitamin D levels were found to be significantly lower at 180 days than at 90 days (24.5 [21.0 to 28.9] vs. 18.4 [13.6 to 20.6]; p<0.001).Conclusions: The study noted vitamin D deficiency in children on ASM monotherapy for 3-6 months, emphasizing regular monitoring by clinicians.

We determined the burden of concomitant chronic non-epilepsy drug use in 100 consecutive outpatient children with a diagnosis of epilepsy (mean (SD) age 7.38 (3.24) y), taking anti-seizure medications (ASM) for at least 6 months. Majority (n = 68) of the children had comorbidities; most commonly global developmental delay (27%). 61 children were receiving chronic non-epilepsy drugs; most common being calcium (38%), multivitamins (18%) and folic acid (16%). Of these, 50 children (82%) were prescribed drugs without any documented indication. Another 24 children (39.4%) were using complementary and alternative medications. The observed chronic non-epilepsy drug use, many of which were not indicated, reiterates the need to limit the burden of medications in children with epilepsy.

Over the years, survival of children with chronic diseases has significantly improved and a large proportion of them now are entering into adulthood. Transition of Care (ToC) of such patients with having childhood onset of chronic diseases to the adult health care system is well organized in developed countries, although it is an emerging concept in India. In situations where the systems for ToC are not in place, such cases are fraught with unsatisfactory health outcomes. With proper ToC in place, these patients are likely to receive uninterrupted care by the adult care physicians and hence reach their full potential. This document highlights the need, rationale and way forward for ToC of youth with special health care needs (YSHCN) across the country. It also describes the standard operating procedures to develop the ToC at a hospital level for clinicians and administrators.

To compare the efficacy of propranolol prophylaxis with placebo on headache frequency in children with migraine over the 3-mo follow-up. In this randomized, double-blind, placebo-controlled trial children aged 6–12 y with newly diagnosed migraine without aura as per the International Classification for Headache Disorders, 3rd edition (ICHD-3) criteria were enroled. They were randomized to the intervention group receiving oral propranolol (1–3 mg/kg/d, BID) and the control group receiving a similar looking, inert, oral placebo for migraine prophylaxis for 3 mo. The number of migraine attacks over the 3-mo follow-up (using a headache diary) was the primary outcome. Pediatric Migraine Disability Assessment Scale (PedMIDAS) was used for assessing disability and Visual analogue scale was used for assessing headache severity. Analysis was done on intention-to-treat basis. Twenty children (10 in each group) completed the study. The two groups were similar at baseline. Both the study drugs produced significant reduction of headache frequency after the study intervention (p = 0.002). However, there was no difference between the two groups with respect to either the median (IQR) number of headache attacks [22 (20, 25) vs. 14 (10, 20); p = 0.05], headache severity [1 (0, 1) vs. 0.5 (0, 1); p = 0.48] or migraine disability [39.5 (28, 44) vs. 35 (22, 38); p = 0.27]. Adverse effects were higher in the intervention group (p = 0.52). Propranolol was effective for migraine prophylaxis in children but the effect was not higher than placebo. Larger placebo-controlled trials of propranolol need to be conducted to decide its place in migraine prophylaxis in children. Thailand Clinical Trials Registry; TCTR20200621001.

Objective Pulmonary sequelae post SARS - CoV-2 infection have been reported in adults; however, there is scant literature regarding pulmonary dysfunction following SARS-CoV-2 infection in children. We studied the long term pulmonary sequelae in children who had SARS-CoV-2 infection. Methods This single center descriptive study conducted in a public sector tertiary care hospital in Northern India, from June, 2020 to October, 2021. We enrolled children aged 7-18 years admitted with SARS-CoV-2 infection and followed them up for 6 months. A detailed interval history was taken and pulmonary function tests were performed after 6 months, using a spirometer. A convenience sample of 40 children was enrolled. There were 21 males and the median (IQR) age was 13 (10.75, 17) years. Results Thirty percent of children ( n =12) had pulmonary function abnormalities, which was of restrictive pattern in all. Children who were underweight had higher odds of developing pulmonary dysfunction following SARS-CoV-2 infection [OR (95% CI) 5.13 (1.19, 22.11); P =0.028]. There were no significant association with age, sex, severity of initial infection and oxygen requirement during the initial infection. Three children had persistence of dyspnea during follow up. Conclusion This study is the one of the first Indian studies regarding the pulmonary sequelae in children. A possibility of long term sequelae should be considered in children with history of SARS-CoV-2, presenting with suggestive complaints.

To compare the change in serum vitamin D levels and to compare the changes in serum levels of calcium, phosphate, alkaline phosphatase and parathyroid hormone in vitamin D supplemented and unsupplemented groups after 3 mo. In this randomized, parallel group, nonblinded, controlled trial, 40 children, 2–12 y of age with newly diagnosed epilepsy, and vitamin D sufficient status, and started on valproate monotherapy, were randomized into the intervention group (n = 20), which was given daily oral 600 IU vitamin D supplementation, and the control group (n = 20), which was not given any supplementation. Changes in the biochemical parameters was measured in the two groups after 3 mo. There was a significant reduction in the median (IQR) vitamin D levels in the control group as compared to an increase seen in the intervention group [−6.64 (−8.4, −2.65) vs. 5.66 (1.81, 7.12); p < 0.001]. In the control group, 37.5

To compare the quality of life (QoL) of adolescent siblings of children with autism spectrum disorder (ASD-Sibs) with siblings of typically developing children (TD-Sibs), and study the factors affecting the QoL. Between 1 February, 2021 and 31 September, 2021, 40 children aged 10–18 years, whose sibling was suffering from ASD, were enrolled (Study group). 40 age- and sex-matched siblings of children with no clinically apparent neurodevelopmental abnormality or behavioral problem were also enrolled (Control group). Severity of autism was assessed by using the childhood autism rating scale 2 (CARS-2) score. QoL was assessed by a validated version of the World Health Organi-zation Quality of Life questionnaire Brief version (WHO QoL BREF), and compared between cases and controls using Wilcoxon rank sum test. The mean (SD) age of study participants was 13.55 (2.75) years. The mean (SD) CARS-2 score of our sample was 35.78 (5.23). Mild to moderate autism was seen in 23 (57.5