Forgiveness plays an important role in restoring and maintaining cooperative relationships. Previous studies have demonstrated that young children could forgive transgressors both as a third party and as a victim. However, the research on young children\'s understanding of forgiveness is scant. This study focused on the two main functions of forgiveness-the restoration of a damaged relationship between the victim and the transgressor and the positive emotional change in the victim toward the transgressor. In this study, 48 4-year-olds (25 girls), 50 5-year-olds (21 girls), and 50 6-year-olds (21 girls) in Japan heard stories in which a victim either did or did not forgive a transgressor. They answered questions about the relationship between the victim and the transgressor and the victim\'s feelings toward the transgressor. Regarding the restoration of a damaged relationship, 4- to 6-year-olds understood that the restoration could occur in the presence of forgiveness. Yet, 6-year-olds showed more distinctive belief than 4- and 5-year-olds that the damaged relationship remains unrestored without forgiveness from the victim. For emotional changes, 6-year-olds understood that the forgiving victim would experience positive emotional changes, whereas the unforgiving victim would not. However, 4- and 5-year-olds expected positive emotional changes even without forgiveness, although they anticipated greater changes after forgiveness. The results show that the understanding of the important functions of forgiveness is present at 4 years of age and matures by 6 years of age. Children may develop a sophisticated understanding of the functions of forgiveness later than the actual forgiving behavior.

Communimetric screening tools help clinicians identify and communicate their patient\'s areas of need and the corresponding level of action. However, few tools exist to identify mental health (MH) and developmental needs in young children. We aimed to implement and evaluate a new communimetric MH and developmental screening tool for children under 6 (HEADS-ED Under 6) in a community MH agency in Ontario, Canada. Using a prospective cohort design, we explored how intake workers used the HEADS-ED Under 6 screening tool from November 2019 to March 2021. 94.5% of children (n = 535/566) were screened with the HEADS-ED at intake. Total HEADS-ED scores and domains were used to inform the intensity of recommended services. Three clinical domains (Eating & sleeping, Development, speech/language/motor, and Emotions & behaviors) also independently predicted a priority recommendation. The tool showed good concordance with the InterRAI Early Years for children under 4 years old. The HEADS-ED Under 6 was a brief, easy, and valid screening tool, and can be used to identify important MH and developmental domains early, rate level of action/impairment, communicate severity of needs, and help determine intensity of service required.
تساعد أدوات الفحص المجتمعي الأطباء الاكلينيكيين على تحديد مجالات احتياجات مرضاهم ومستوى التدخل المناسب. ومع ذلك، يوجد عدد قليل من الأدوات لتحديد احتياجات الصحة النفسية واحتياجات النمو لدى الأطفال الصغار. تهدف هذه الدراسة إلى تنفيذ وتقييم أداة فحص مجتمعية جديدة للصحة النفسية والنمو للأطفال دون سن السادسة ((HEADS‐ED في هيئة مجتمعية للصحة النفسية في أونتاريو، كندا. باستخدام تصميم المجموعة الاستطلاعية، استكشفنا كيف استخدم العاملون في الاستقبال أداة الفحص HEADS‐ED تحت سن 6 سنوات من نوفمبر 2019 إلى مارس 2021. تم فحص 94.5٪ من الأطفال (العدد = 535/566) باستخدام أداة HEADS‐ED عند الاستقبال. وتم استخدام مجموع درجات HEADS‐ED ومجالاته للإبلاغ عن كم الخدمات الموصى بها. كما تنبأت ثلاثة مجالات إكلينيكية (الأكل والنوم، والنمو/النطق/اللغة/الحركة، والعواطف والسلوكيات) بشكل مستقل بأولويات الخدمات الموصى بها. أظهرت الأداة تطابقًا جيدًا مع مؤشر (InterRAI) للسنوات المبكرة للأطفال دون سن 4 سنوات. كانت أداة HEADS‐ED لأقل من 6 سنوات أداة فحص مختصرة وسهلة وصحيحة، ويمكن استخدامها لتحديد مجالات الصحة النفسية والنمو المهمة في وقت مبكر، وتقييم مستوى الفعل/العجز، وتوضيح شدة الاحتياجات، والمساعدة في تحديد حجم الخدمة المطلوبة.
“社区测量”筛查工具有助于临床医生识别和传达患者的需求领域及相应的行动水平。然而, 目前很少有工具能够识别幼儿的心理健康(MH)和发育需求。我们的目标是在加拿大安大略省的一家社区心理健康机构实施并评估一种新的针对6岁以下儿童的“社区测量”心理健康和发育筛查工具(针对6岁以下儿童的HEADS‐ED)。我们采用前瞻性队列设计, 研究了接诊工作人员在2019年11月至2021年3月期间, 如何使用针对6岁以下儿童的HEADS‐ED筛查工具。94.5%的儿童(n = 535/566)在接诊时使用HEADS‐ED进行了筛查。总的HEADS‐ED评分及各个领域评分被用于指导推荐服务的强度。三个临床领域(饮食与睡眠、发育/语言/运动、情绪与行为)也单独预测评估了优先推荐的需求。该工具与“InterRAI早期儿童版”(适用于4岁以下儿童)显示出良好的一致性。针对6岁以下儿童的HEADS‐ED是一种简便、易用且有效的筛查工具, 可用于早期识别重要的心理健康和发育领域问题、评估行动或损伤水平、传达需求的严重程度, 并有助于确定所需服务的强度。.
Les outils de dépistage communimétrique aident les cliniciens à identifier et à communicer les besoins et le niveau d\'action correspondant de leur patient. Cependant il existe peu d\'outil pour identifier les besoins en Santé Mentale (SM en français) et les besoins développentaux chez les jeunes enfants. Nous nous sommes donné pour but d\'appliquer et d’évaluer un nouveal outil communimétrique de SM et développemental pour les enfants de moins de 6 ans (HEADS‐ED de moins de 6 ans) dans une agence communautaire de SM dans l\'Ontario au Canada. En utilisant une conception de cohorte prospective nous avons exploré la manière dont les préposés à l\'accueil ont utilisé le HEADS‐ED de moins de six ans de novembre 219 à mars 2021. 94,5% des enfants (n = 535‐566) ont été dépister avec le HEADS‐ED à l\'accueil. Tous les scores et domaines HEADS‐ED ont été utilisé pour éclairer l\'intensité des services recommandés. Trois domaines cliniques (Manger et dormir, Développement/parole/langage/moteur, et les Emotions, comportements ont aussi prédit une recommandation de priorité indépendamment. L\'outil a fait preuve d\'une bonne concordance avec le InterRAI Early Years pour les enfants de moins de 4 ans. Le HEADS‐ED de moins de 6 ans s\'est avéré être un outil de dépistage valide, bref et facile, et peut être utiliser pour identifier des domaines de SM et des domaines du développement importants tôt, d’évaluer un niveau d\'action/de dépréciation, de communiquer la sévérité de besoins, et aider à déterminer l\'intensité des services requis. Kommunimetrische Screening‐Instrumente helfen klinisch Tätigen dabei, die Bedürfnisse ihrer Patienten zu erkennen, zu kommunizieren und die entsprechenden Maßnahmen zu ergreifen. Es gibt jedoch nur wenige Instrumente welche die Bedürfnisse von Kleinkindern hinsichtlich ihrer psychischen Gesundheit und Entwicklung ermitteln. Unser Ziel war es, ein neues kommunimetrisches Screening‐Instrument für die psychische Gesundheit und Entwicklung von Kindern unter 6 Jahren (HEADS‐ED unter 6 Jahren) in einer kommunalen Einrichtung der psychischen Gesundheitsversorgung in Ontario, Kanada, einzuführen und zu evaluieren. In einer prospektiven Kohortenstudie untersuchten wir von November 2019 bis März 2021 wie die Mitarbeitenden der Einrichtung bei Aufnahmen das HEADS‐ED‐Screening‐Tool für Kinder unter 6 Jahren einsetzten. 94,5 % der Kinder (n = 535/566) wurden bei Aufnahme mit dem HEADS‐ED gescreent. Die HEADS‐ED‐Gesamtergebnisse und ‐Domänen wurden verwendet, um die Intensität der empfohlenen Gesundheitsleistungen zu bestimmen. Ebenfalls sagten drei klinische Domänen (Essen und Schlafen, Entwicklung/Sprechen/Sprache/Motorik und Emotionen/Verhaltensweisen) unabhängig voneinander eine prioritäre Empfehlung voraus. Das Instrument zeigte eine gute Übereinstimmung mit dem InterRAI Early Years für Kinder unter 4 Jahren. Das HEADS‐ED für Kinder unter 6 Jahren erwies sich als ein kurzes, einfaches und valides Screening‐Instrument, das eingesetzt werden kann, um frühzeitig wichtige Bereiche psychischer Gesundheit und Entwicklung zu identifizieren, das Ausmaß von Interventionen/Beeinträchtigungen einzuschätzen, die Stärke dahingehender Bedürfnisse mitzuteilen und die notwendige Intensität von Gesundheitsleistungen zu bestimmen. コミュニメトリックスクリーニングツールは、臨床医が患者の必要な領域とそれに対応する行動レベルを特定し、伝えるのに役立つ。しかし、幼児のメンタルヘルス(MH)と発達のニーズを特定するツールはほとんど存在しない。本研究は、カナダ・オンタリオ州の地域MH機関において、6歳未満児を対象とした新しいコミュニメトリックMHおよび発達スクリーニングツール(HEADS‐ED under 6)の導入および評価を目的とした。前向きコホートデザインを用いて、2019年11月から2021年3月に、インテイク担当者が6歳未満児スクリーニングツールHEADS‐EDをどのように使用したかを調査した。94.5％の子ども(n = 535/566)がインテーク時にHEADS‐EDでスクリーニングを受けた。HEADS‐EDの総スコアと領域は、推奨されるサービスの程度を知るために使用された。また、3つの臨床領域(食欲と睡眠、発達・発語・言語・運動、感情/行動)が、個別の優先順位を予測した。このツールは、4歳未満児を対象とするInterRAI Early Yearsと良好な一致を示した。HEADS‐ED Under 6は、簡潔で、簡単で、有効なスクリーニングツールであり、早期に重要な精神保健および発達領域を特定し、活動/障害のレベルを評価し、ニーズの重症度を伝え、必要なサービスの強度を決定するために使用することができる。.
Las herramientas de examinación comunimétricas ayudan a los profesionales clínicos a identificar y comunicar las áreas de necesidad de sus pacientes y los niveles correspondientes de acción. Sin embargo, pocas herramientas existen para identificar la salud mental (MH) y las necesidades del desarrollo en niños pequeños. Nos propusimos implementar y evaluar una nueva herramienta comunimétrica de evaluación de salud mental (MH) y del desarrollo para niños menores de 6 años (HEADS‐ED para menores de 6) en una agencia de salud mental (MH) comunitaria en Ontario, Canadá. Usando un potencial diseño de grupo, exploramos cómo los trabajadores de admisión usaban la herramienta de evaluación HEADS‐ED para menores de 6, de noviembre de 2019 a marzo de 2021. 94.5% de los niños (n = 535/566) fueron evaluados con HEADS‐ED al momento de admisión. Se usaron los puntajes totales de HEADS‐ED y los dominios para determinar la intensidad de los servicios recomendados. Tres dominios clínicos (Comer y dormir, desarrollo/habla/lenguaje/movimiento, así como Emociones, comportamientos) también predijeron independientemente una recomendación prioritaria. La herramienta mostró buena concordancia con InterRAI en los Primeros Años para niños menores de 4 años. HEADS‐ED para menores de 6 fue una herramienta de evaluación breve, fácil y válida, y puede usarse para identificar tempranamente importantes dominios de salud mental (MH) y de desarrollo, clasificar el nivel de acción/daño, comunicar la severidad de las necesidades, así como ayudar a determinar la intensidad del servicio que se requiere.

The introduction of complementary food plays a fundamental role in dietary behaviours later in life. Little is known about the influences of age on food texture acceptance in young Indian children. Thus, the objective of this cross-sectional study was to describe the relationship between age and food texture experiences in young children aged 4-36 months in India from urban areas using a parental-reported survey. This study relies on a face-to-face parent survey, which was conducted comprising 306 children categorised into 9 age groups. Questions focussed on food texture experience considering 16 textures were analysed. Textures such as dissolvable, sticky, and soupy/liquidy were already accepted by more than half of 4-5-month-old infants. In India, soupy/liquidy is a more common base texture than pureed. Indeed, pureed was found to be introduced to a majority of infants only from 8 to 9 months onwards. Food textures such as rubbery, slippery, and foods with skin were more likely rejected by the youngest children. With increasing age, the refusal probability of food textures decreased. Our survey showed food texture experiences in Indian children aged from 4 to 36 months. It provides useful insights for parents and healthcare professionals by contributing to the understanding of texture acceptance during the transition to complementary foods.

BACKGROUND: Effective physical activity (PA) interventions are needed to counter the insufficient and declining levels of PA in youth. These require an updated, comprehensive planning framework that consolidates recent decades of progress in promoting PA in young children, children, and adolescents. Effective PA interventions require program planning and conceptual model development that target a coordinated and multilevel set of age-specific PA determinants. Accordingly, this paper presents a comprehensive planning framework that researchers can use to design intervention research to promote PA in youth.
METHODS: The first author conducted targeted searches through Google Scholar to compile PA models/frameworks/guides applicable to youth, a comprehensive set of PA determinants, and determinant-linked strategies to promote PA focusing on review articles. The information was summarized in tables, synthesized, and used to create a planning framework, all of which were reviewed by coauthors.
RESULTS: The APPLE Framework for Planning PA Opportunities for Youth (APPLE = Age, PA focus, Place and time, Leverage relevant influences and strategies, and ensure Enjoyable PA opportunities) incorporated all core elements from targeted reviews to create a comprehensive planning framework. The APPLE Planning Framework has a set of questions/prompts that guide the intervention planning process and conceptual model templates to organize planning efforts for designing intervention research.
CONCLUSIONS: The APPLE Framework for Planning PA Opportunities for Youth will enable researchers to develop comprehensive conceptual models to guide the design of PA interventions for youth. Future research should refine the model and its components to enable PA intervention research in youth to move forward.

OBJECTIVE: The aim of this study is to identify risk factors associated with acute complicated appendicitis (CA) in children aged three years or younger, providing a theoretical foundation for the management and treatment of acute appendicitis (AA).
METHODS: A retrospective analysis was conducted on 135 pediatric patients with AA, admitted to the Department of General Surgery at Anhui Children\'s Hospital between December 2020 and December 2023, who underwent successful surgical treatment. Based on the intraoperative and postoperative pathological findings, patients were categorized into two groups: complicated appendicitis (CA) (n = 97 cases) and uncomplicated appendicitis (UA) (n = 38 cases). Clinical data including gender, age, weight, disease duration, preoperative white blood cell count (WCC), neutrophil granulocyte (NEUT) count, C-reactive protein (CRP) levels, total bilirubin (TBil) levels, procalcitonin (PCT) levels, calprotectin (Cal) levels, preoperative ultrasound results indicating the presence or absence of fecaliths, maximum appendix diameter, and pediatric appendicitis sore (PAS) were collected and analyzed. Comparative analysis was performed to investigate the differences between the groups and identify risk factors of CA.
RESULTS: The CA group exhibited significantly higher values in disease duration, CRP levels, PCT, Cal, presence of appendiceal fecaliths, maximum appendix diameter, and PAS compared to the UA group (P < 0.05). Multivariate analysis identified CRP levels, maximum appendix diameter, and PAS as independent risk factors for CA. Specifically, differences in CRP level (OR = 1.045, 95% CI:1.024 ~ 1.067, P < 0.001), PAS (OR = 1.768, 95% CI:1.086 ~ 2.879, P = 0.022), and maximum appendix diameter (OR = 1.860, 95% CI:1.085 ~ 3.191, P = 0.024) were significant. The area under the receiver operating characteristic curve values were 0.6776 for the PAS, 0.7663 for CRP, and 0.5604 for the maximum appendix diameter.
CONCLUSIONS: CRP levels, PAS, and maximum appendix diameter are independent risk factors for CA in children under three years of age. These parameters are valuable for the early diagnosis of CA.

The aims of this study were to evaluate the exposure to permethrin and cypermethrin of young children aged between 2 and 5 years in Nakhon Pathom and Sing Buri provinces, Thailand. A questionnaire that included general demographic information, household characteristics, insecticide usage and exposure-related behavior in children was used to interview parents or family caregivers. Permethrin and cypermethrin concentrations on floor surfaces and children\'s hands, as well as their urinary metabolites, were analyzed by gas chromatography coupled with mass spectrometry. The results showed that permethrin and cypermethrin were detected in 62% and 83% of the children\'s hand wipe samples, with geometric mean (GM) levels of 0.02 µg and 0.04 µg, respectively. Permethrin and cypermethrin were detected in 79% and 93% of floor surface wipe samples, with GM levels of 0.90 µg/m2, and 1.49 µg/m2, respectively. For children\'s urine, the GM concentrations of cis- and trans-DCCA, 3-PBA, and total pyrethroid metabolites were 0.84, 0.31 and 1.23 nmol/g creatinine, respectively. This study found that household insecticide product usage and having a tile floor were associated with increased permethrin concentrations on the children\'s hands and floor surfaces. However, cypermethrin concentrations on floor surfaces were significantly higher in families using aerosol insecticide sprays and insecticide products in the living room and bedroom. The predictors of the total pyrethroid, DCCA and 3-PBA metabolites are permethrin on children\'s hands or floor surfaces and cypermethrin on floor surfaces.

UNASSIGNED: Evidence points toward the early life being crucial for preventing nutrition-related diseases. As promotion of healthier food preferences in toddlerhood and preschool age might still modulate the trajectories of disease risk, understanding diet in these age groups is necessary. The objective was to analyze food consumption and diet quality of 1-5-year-old children living in Germany in relation to age and sex.
UNASSIGNED: Data from 890 children, a subsample of the representative, cross-sectional Children\'s Nutrition Survey to Record Food Consumption (KiESEL) conducted by the German Federal Institute for Risk Assessment in 2014-2017, were analyzed. Dietary data were collected using food records (3 consecutive plus 1 independent day). Diet quality was evaluated against the German food-based dietary guidelines (FBDG).
UNASSIGNED: Consumption of unfavorable foods (e.g., sweets, soft drinks) exceeded the recommended maximum of 10% of energy intake (E%) by a multiple in all age and sex groups (medians: 24.8-35.8 E%). Preschoolers consumed more unfavorable foods than toddlers and boys more than girls. More than half of the children exceeded the recommendation for meat intake (medians: 2.3-3.2% of the total food consumption (%TFC) vs. 2 %TFC), especially preschoolers. In nearly all children, vegetable consumption was too low (medians: 4.2-4.5 %TFC vs. 12 %TFC). Also, milk/milk product consumption was below recommendations, more so in preschoolers (median: 12.0 %TFC ♂, 11.9 %TFC ♀ vs. 18 %TFC) than in toddlers (median: 16.1 %TFC ♂, 19.6 %TFC ♀). In toddlers and preschoolers with overweight or obesity, adherence to dietary recommendations of these food groups was largely similar to that of the total sample. Overall, 5-year-olds showed an unhealthier dietary pattern than 1-year-olds, which already emerged at age 2 years and became more evident at age 3 years.
UNASSIGNED: An adverse dietary pattern arises and even deteriorates at a very young age, showing sex-specific aspects. High attention from public health and research needs to be given to toddlerhood and even earlier life phases, e.g., to develop more age-specific FBDGs, aiming at reducing unhealthy food consumption.

BACKGROUND: Children\'s participation in research is a rights-based principle. However, young children are often excluded from research on sensitive topics, due to gatekeepers concerns that participation would cause distress/re-traumatization and conflict with the principle of providing adequate protection from harm.
OBJECTIVE: To provide evidence around young children\'s feelings, including potential distress, and beliefs in mixed-method interviews about violence and difficult experiences.
METHODS: Data were collected from South African interviewer focus group discussions and young child (age 6-10) interviews, along with observations and fieldnotes from young child (age 6-17) interviews.
METHODS: We collected and analyzed qualitative data focused on children\'s displayed and reported emotions and beliefs in violence-focused interviews.
RESULTS: Findings showed the quantitative interview was frequently a positive experience for young children, and children who became upset or emotional stated their feelings were due to violence they experienced. The interviewer seemed to represent a safe person to whom the child could disclose. The play- and arts-based methods of the interview were useful in building this safety and providing space for children to regulate difficult emotions.
CONCLUSIONS: In a carefully managed interview environment using developmentally appropriate methods, young children are enthusiastic participants and do not appear to experience undue distress or trauma when asked about violence and other sensitive topics. Findings demonstrate that young children can be safely included in research about violence and issues that impact them and can exercise their right to participation when research methods, environments, and safeguards are appropriately adapted to their needs.

OBJECTIVE: This study was conducted to determine the factors predictive of technology addiction in young children (aged 2-5 years). The study examined the effects of digital parenting awareness, parental stress, family demographic characteristics and parents\' technology use habits on technology addiction in young children.
METHODS: This cross-sectional study was conducted between October 2023 and February 2024 with 401 volunteer parents of children aged 2-5 years in a province in the Western Mediterranean region of Turkey. Data were collected using the Technology Addiction Scale for Ages 2-5, the Digital Parental Awareness Scale, and the Parental Stress Scale.
RESULTS: Digital parenting awareness, negative modeling and digital neglect, and parental stress positively and directly affect technology addiction in young children (β1 = 0.166, β2 = 0.443, β3 = 0.087, all p < 0.05). Additionally, parental gender (β = 0.095), parental marital status (β = 0.092), and household income (β = 0.088) were significant predictors of technology addiction in young children (p < 0.05). The level of technology addiction is significantly higher in children who use devices without parental controls (Z = -6.187, p < 0.001).
CONCLUSIONS: Low digital parenting awareness, high parental stress, male caregivers, low household income and single-parent families in digital tools increase the risk of technology addiction in young children (2-5 years). Multidisciplinary, family-oriented intervention programs, incorporating consideration of parental risk factors, should be developed to prevent and reduce technology addiction in this group.

Introduction: Minimum meal frequency is the number of times children eat in a day. Without adequate meal frequency, infants and young children are prone to malnutrition. There is little information on the spatial distribution and determinants of inadequate meal frequency at the national level. Therefore, we aimed to investigate the spatial distribution and determinants of inadequate meal frequency among young children in Ethiopia. Methods: The most recent Ethiopian demographic and health survey data was used. The analysis was conducted using a weighted sample of 1,610 children aged 6-23 months old. The Global Moran\'s I was estimated to assess the regional variation in minimum meal frequency. Further, a multivariable multilevel logistic regression model was fitted to identify factors associated with inadequate meal frequency. The AOR (adjusted odds ratio) at 95% CI (confidence interval) was computed to assess the strength and significance of the relationship between explanatory variables and the outcome variable. Factors with a p-value of <0.05 are declared statistically significant. Results: This study revealed that the prevalence of inadequate meal frequency was found to be 30.56% (95% CI: 28.33-32.88). We identified statistically significant clusters of high inadequate meal frequency, notably observed in Somalia, northern Amhara, the eastern part of southern nations and nationalities, and the southwestern Oromia regions. Child age, antenatal care (ANC) visit, marital status, and community level illiteracy were significant factors that were associated with inadequate meal frequency. Conclusion: According to the study findings, the proportion of inadequate meal frequency among young children in Ethiopia was higher and also distributed non-randomly across Ethiopian regions. As a result, policymakers and other concerned bodies should prioritize risky areas in designing intervention. Thus, special attention should be given to the Somalia region, the northern part of Amhara, the eastern part of Southern nations and nationalities, and southwestern Oromia.