This study investigated the effects of therapeutic play on angiography in children aged 4–10.

Our study was conducted as a randomised controlled experimental trial with 70 (experimental: 35, control: 35) children undergoing angiography at the paediatric cardiology clinic of a university hospital between 1 January 2022 and 31 August 2022. The “Child Information Form”, “Wong-Baker Faces Pain Rating Scale”, “Children’s Fear Scale”, “Children’s Anxiety Meter-State” and “Doll Model” were used for data collection. Percentage, mean, pearson correlation, ANOVA were used in the evaluation of the data.

It was found that 57.1% of the children who participated in our study were female, their mean age was 6.48±2.36 years, 45.7% had the diagnosis of Atrial Septal Defect (ASD), 78.6% had not undergone any surgery before and 60% were hospitalised for follow-up. It was found that the difference between pain, fear and anxiety scores of the children after the therapeutic play programme was statistically significant (p ˂ 0.05).

Our study found that therapeutic play programmes can reduce pain, fear and anxiety in children. These findings demonstrate that negative experiences during invasive procedures affect children not only physiologically, but also psychologically and behaviourally. Therapeutic play can therefore be a powerful supportive intervention. Therefore, we recommend integrating therapeutic play into nursing clinical guidelines and care protocols, and providing paediatric nurses with training in this area.

In children, oxygen support in the prone position may be preferred for certain conditions such as acute respiratory distress syndrome. However, it is very difficult to place such patients in the supine position to obtain an electrocardiogram. We aimed to determine the effectiveness of prone back 12-lead electrocardiogram and detect electrocardiogram changes in healthy children.

The present study comprised 50 healthy children aged between 3 and 7 years. The patients first underwent a supine electrocardiogram test used in routine practice. Back electrocardiogram in prone position was obtained by placing six of the precordial leads (prone V1–prone V6) to the back of the patient.

The average P wave, Q wave, R wave, S wave, and T wave amplitudes were significantly smaller in prone back leads (prone V1–prone V5) compared to supine precordial leads (supine V1–supine V5) (p < 0.001). The only exceptions were that the mean T wave amplitude in prone V3 and supine V3 was similar, and the mean Q wave amplitude in prone V5 and supine V5 was similar. The average P wave, Q wave, S wave, and T wave amplitudes were similar when prone V6 was compared with supine V6.

A back electrocardiogram in the prone position is a useful and practical approach that provides valuable information to the clinician.

Carditis, the main determinant of long-term morbidity in acute rheumatic fever, may be detected by echocardiography even in the absence of clinical signs. This study aimed to determine the prevalence of silent carditis in asymptomatic children with elevated antistreptolysin O titers and to evaluate associations with demographic and laboratory parameters.

In this cross-sectional study, 61 asymptomatic children with incidentally detected elevated antistreptolysin O titers between September 2020 and September 2021 were evaluated. Demographic characteristics, inflammatory markers, and standardised Doppler echocardiographic assessments based on World Heart Federation criteria were analysed.

Silent carditis was identified in 8 of 61 patients (13.1%; 95% confidence interval 6.9 to 23.3). In the silent carditis group, 75% were female, and the median age was 12 years (interquartile range 9 to 14). Echocardiographic findings showed isolated mitral regurgitation in four patients and combined mitral and aortic regurgitation in four. Erythrocyte sedimentation rate was the only parameter that differed significantly between patients with and without silent carditis (p = 0.001). Antistreptolysin O levels showed weak negative correlations with haemoglobin (rho = −0.322, p = 0.011) and left ventricular posterior wall thickness (rho = −0.270, p = 0.036).

Some asymptomatic children with elevated antistreptolysin O titers had echocardiographic findings consistent with silent carditis. However, antistreptolysin O levels and most inflammatory markers were not reliable predictors of valvular involvement. Echocardiography in selected cases may help detect subclinical cardiac involvement. Findings should be interpreted cautiously due to the limited sample size and cross-sectional design.

Supernumerary nostril with an accessory nasal fistula is an exceptionally rare congenital anomaly with no standardised reconstructive protocol, especially with nasolacrimal involvement.

A nine-year-old boy presented with a complete supernumerary nostril and synchronous accessory nasal fistula at the right alar base, persistent epiphora and prior endoscopic dacryocystorhinostomy. Imaging demonstrated a cystic tract communicating with the nasolacrimal system. Definitive management utilised a modified alar wedge excision type 2, incorporating both orifices into a single reconstructive unit. Three-month follow up demonstrated excellent aesthetic and functional outcomes with minimal scarring.

A review of 12 previously published cases (2001–2025) revealed heterogeneous, largely non-standardised techniques, often relying on simple excision that may not correct alar asymmetry.

Complete tract eradication and restoration of alar symmetry were achieved. Alar wedge excision type 2 offers a reproducible technique for complex supernumerary nostril–accessory nasal fistula anomalies, particularly in Asian patients where tension-free closure minimises hypertrophic scarring.

To investigate whether socioeconomic deprivation is associated with residual or recurrent cholesteatoma following primary mastoidectomy.

A retrospective cohort study included all patients undergoing primary mastoidectomy for cholesteatoma in National Health Service Tayside between 2012 and 2020. Socioeconomic status was assessed using the Scottish Index of Multiple Deprivation 2020 and divided into quintiles. Patients were stratified into paediatric (≤16 years) and adult (>16 years) groups. Recurrence/residual rates across Scottish Index of Multiple Deprivation quintiles were compared using Fisher’s exact tests, and time to recurrence was analysed using Kaplan–Meier survival curves.

One hundred eighty-four patients were included (59 children, 125 adults). Recurrence/residual occurred in 39 per cent of children and 24 per cent of adults. In children, higher deprivation was significantly associated with risk of recurrence/residual disease (p = 0.0013). No significant association was observed in adults.

Socioeconomic deprivation is linked to higher recurrence/residual in children, highlighting disparities in postoperative outcomes and the importance of targeted follow-up.

Early integration of pediatric palliative care (PPC) offers significant benefits for children with cancer, yet referrals often occur late in the child’s cancer trajectory.

As part of a larger project looking at barriers and facilitators to early integration of PPC, this study explored the perspectives of healthcare providers (HCPs) on the pros and cons of a universal referral system where all children with cancer are referred to PPC at diagnosis.

Using the grounded theory method, semi-structured interviews were conducted with 66 oncology and PPC providers across 4 tertiary cancer centers in Canada. Interviews were coded line-by-line to explore patterns and themes across the dataset.

Three key benefits emerged that included: reducing stigma and normalizing PPC as standard care, fostering early relationship building with patients and families, and minimizing HCP subjectivity in making PPC referrals. Cons included the idea that universal referral was a poor use of resources, particularly for children with curable cancers, and that this system lacked usefulness for patients and families.

Universal referral can promote equitable, timely, and family-centered integration of PPC in pediatric oncology. However, these types of referral systems face substantial challenges, particularly around resources. There was also wide variation of opinions and acceptability of universal referral among providers. The adoption of standardized or tiered referral criteria, guided by disease risk, prognosis, or symptom burden, may represent a practical middle ground. Future work should evaluate the impact of such criteria-based referral models on patient and family outcomes, provider experiences, and healthcare resource use.

Practice guidelines for Australian primary health professionals (PHPs) highlight their crucial role in preventive care. However, PHPs report a lack of knowledge and skills regarding early childhood obesity prevention. This study aimed to identify the training needs of Australian PHPs – including child and family health nurses (CFHNs), general practitioners, general practice nurses and other community-based health professionals – to support early childhood health promotion and obesity prevention.

From August 2022 to July 2023, PHPs were recruited to participate in an online survey and semi-structured interviews. Quantitative data was analysed descriptively and qualitative data analysed using reflexive thematic analysis.

227 PHPs returned a survey (46% CFHNs) and 28 were interviewed (13 CFHNs). Almost a quarter (23%) of participants had not received any continuing education regarding early childhood health behaviours and obesity prevention, with general practice professionals less likely to have participated in such education. PHPs identified a need to develop skills in growth assessment and working with children at risk of obesity. Digital and visual parent-facing resources were required to support PHPs’ discussions of child health behaviours. Important components of education were case studies, self-paced learning, and live interactive discussions (37–46% of PHPs rated as highly important). PHPs sought interactive education activities from reputable service providers and reported time and cost were barriers to education.

Australian PHPs require access to evidence-based education and resources to support early childhood health promotion and obesity prevention. Professional education providers should prioritize interactive and flexible modes of delivery.

In the Netherlands, around 750 children (0–21 year) die annually from potentially palliative conditions. The majority of these children reside at home, receiving care from hospital services and primary care. This study aims to examine general practice utilization for pediatric palliative care patients in the last 2 years of life.

A retrospective cohort study was performed using the routine healthcare database of the Julius General Practitioners’ Network. The main outcome for general practitioner (GP) utilization was the number of GP consultations for children in the last 3 months of life. Participants were included who were children (0–21 years), and deceased in the period 01-01-2013 to 31-12-2022 from an underlying chronic condition. Data were analyzed using descriptive statistics and tested for differences in provided care between children who died in hospital and who died at home.

Forty-eight children from 32 GP practices met inclusion criteria. Median age was 10.0 years (interquartile range [IQR] 1.5–17.1). Common diagnoses were oncological (29%), congenital (29%), and metabolic conditions (23%). Ninety-six percent of children had contact with their GP in the last 3 months (median 7 consultations, IQR 3.0–10.0), i.e. 26 children who died in hospital had median 3.5 GP consultations compared to 20 children who died at home median 9.5 GP consultations (p < 0.001). Thirty-five percent of children were documented as being palliative, with 54% having some form of advance care planning discussions documented.

These results demonstrate that GPs are highly involved in providing pediatric palliative care. The palliative nature of these children and advance care planning discussions are not routinely documented and/or performed by GPs. Further insights into guidance that supports GPs, in collaboration with other healthcare professionals, in providing palliative care for children at home and their families are needed.

To evaluate food marketing techniques used in Canadian recreation and sport facilities and assess the healthfulness of foods and beverages marketed by the techniques.

Cross-sectional content analysis of photographed food marketing instances coded for marketing techniques according to Health Canada’s Monitoring Protocol, developed for monitoring food marketing techniques across settings, supplemented with new inductively identified codes and sport-related marketing techniques. Healthfulness was classified as ‘of concern’ or ‘not of concern’ according to cut-offs of sodium, sugar and saturated fat established by Health Canada.

Recreation and sport facilities in Canada

134 facilities with 2576 food marketing instances

91·4 % of food marketing instances included at least one general marketing technique. Branded infrastructure, displays and furniture was the most prevalent (87·9 %) and appeared with another technique half of the time. Sport-related marketing appeared in 12·2 % of marketing instances, with most referring to sponsors. Most (86·5 %) marketing instances were ‘of concern’. Food marketing instances with sport-related marketing (97·6 %) were significantly more likely to be ‘of concern’ than without sport-related marketing (84·6 %) (χ2 = 20·54, P < 0·001). Three new indicators – appeals to taste, appeals to emotion, and cross-channel references – captured persuasive elements not addressed by the current monitoring protocol.

This study highlights the presence of food branding and the use of sport-related marketing to promote unhealthy products/brands in recreation and sports facilities. Monitoring protocols may underestimate exposure to persuasive food marketing by overlooking subtle, symbolic and cross-channel techniques. Future research can be improved by including subtle techniques and reinforced messages across marketing channels.

Internet-delivered parent-led interventions can be useful for treating anxiety in children and adolescents, and they also help increase access to services while reducing time and cost.

This review aimed to investigate the effects of internet-delivered parent-led interventions on reducing anxiety in children and adolescents.

A search of PubMed, PsycArticles, Cochrane Library, and Google Scholar databases identified 13 studies published between 2013 and 2024, which examined internet-delivered, parent-led interventions targeting anxiety in children.

Internet-delivered parent-led interventions had overall positive effects on reduced anxiety in children and adolescents that could be maintained through follow-up. Interventions directly targeting anxiety symptoms had significant treatment effects.

Internet-delivered parent-led interventions may be effective in reducing anxiety symptoms in children and adolescents, particularly when the intervention directly targets anxiety rather than focusing solely on parenting approaches. Interventions supplemented with therapist support, such as telephone consultations, appear to enhance treatment outcomes and help maintain effects over time. Two-thirds of the included studies had a moderate risk of bias, and one-third had a serious risk of bias. Further studies using rigorous methodologies are needed to strengthen the evidence base.

This study aims to identify the factors affecting the development of complications and to present the necessary data to the literature in order to reduce the frequency of complications as a result of some measures that can be taken against them.

This retrospective study included 609 patients between the ages of 0 and 18 who underwent cardiac catheterisation between 2012 and 2020 by our Department of Paediatric Cardiology. The patient’s demographic data, cardiac catheterisation-related data, laboratory results, and all data in the post-procedure records are scanned and evaluated.

Of the patients aged between 0 and 216 months (mean 67.1 ± 55.8 months), 371 were female (60.9%). Interventional catheterisation was performed in 419 (68.4%) of the patients, and diagnostic catheterisation was performed in 193 (31.6%). Complications were detected in 39 patients (6.4%). The most frequent complications were vascular complications in 16 patients (41%), bleeding in 5 patients (12.8%), anaemia in 4 patients (10.3%), and arrhythmia in 3 patients (7.7%). Mortality occurred in 2 patients (0.3%). Risk factors for the development of complications were determined as <10 kg (p = 0.001) and <1 year of age (p = 0.002).

The most common complications were vascular complications, followed by bleeding and anaemia. Low body weight (<10 kg) and being under 12 months of age are risk factors for the development of complications. Considering that most studies only include certain age groups or certain types of procedures, our study will make a significant contribution to the literature as it includes a larger scale and different types of procedures.