BMJ Paediatrics Open最新文献

{"title":"Comparison of methylprednisolone alone versus intravenous immunoglobulin plus methylprednisolone for multisystem inflammatory syndrome in children (MIS-C).","authors":"Phuc Huu Phan, Canh Ngoc Hoang, Ha Thu T Nguyen, Tung Viet Cao, Chi Quynh Le, Dien Minh Tran","doi":"10.1136/bmjpo-2024-003148","DOIUrl":"10.1136/bmjpo-2024-003148","url":null,"abstract":"<p><strong>Background: </strong>As a first-line therapeutic option for multisystem inflammatory syndrome in children (MIS-C) with surging demand, intravenous immunoglobulin (IVIG) is associated with escalating costs and supply shortages, particularly in low-income and middle-income countries. This study compares the effectiveness of methylprednisolone alone versus IVIG combined with methylprednisolone for managing MIS-C.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study from January 2022 to June 2023 at Vietnam National Children's Hospital. We used propensity score matching to compare the short-term outcomes based on immunomodulatory therapy with methylprednisolone alone or IVIG plus methylprednisolone.</p><p><strong>Results: </strong>We included 391 patients, comprising 255 boys and 136 girls, who fulfilled the MIS-C case definition of the US Centers for Disease Control and Prevention. Most patients (80.8%) received intravenous methylprednisolone monotherapy, and 19.2% were administered IVIG in addition to methylprednisolone. In general, the laboratory values indicative of hyperinflammatory and hyperthrombotic states displayed significant early response within 2-3 days after initial treatment, including white cell count (SE=1.77, p<0.001), NEU (SE=0.76, p=0.03), C reactive protein (SE=-46.51, p<0.001), PLT (SE=38.05, p=0.002), fibrinogen (SE=-0.37, p=0.002), d-dimer (SE=-849.8, p=0.02)); while subsequent improvement in cardiac markers was also observed, with pro-B-type natriuretic peptide (SE=-165.2, p<0.001) on day 5 and troponin I (SE=-0.05, p=0.004) on day 7. After propensity score weighting, there were 41 patients in each treatment group. Notably, there were no significant differences in the incidence of cardiac events between treatment groups regarding left ventricular dysfunction and coronary artery dilation or aneurysms (10.3% vs 20.7%, p=0.074 and 63.4% vs 56.1%, p=0.653, respectively). While the median paediatric intensive care unit length of stay (LOS) and hospital LOS were slightly lengthier in the IVIG and methylprednisolone group compared with those of the methylprednisolone group, these differences were not statistically significant ((5 vs 4, p=0.782) and (9 vs 7, p=0.725), respectively).</p><p><strong>Conclusions: </strong>Initial treatment with methylprednisolone monotherapy appears not inferior in effectiveness to adjunctive IVIG plus methylprednisolone in MIS-C. Further investigations in randomised controlled trials deserve to be undergone to clarify if IVIG-sparing glucocorticoids are a viable option for achieving favourable outcomes in MIS-C, particularly in resource-limited settings with barriers approaching IVIG therapy.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143566064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of probiotic supplements on behavioural and gastrointestinal symptoms in children with autism spectrum disorder: A randomised controlled trial.","authors":"Himani Narula Khanna, Sushovan Roy, Aqsa Shaikh, Rajiv Chhabra, Azhar Uddin","doi":"10.1136/bmjpo-2024-003045","DOIUrl":"10.1136/bmjpo-2024-003045","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether probiotic supplementation can improve behavioural and gastrointestinal (GI) symptoms in children with autism spectrum disorder (ASD) aged 2-9 years and further explore the correlation between these symptoms.</p><p><strong>Design: </strong>Single-blinded, randomised, placebo-controlled study.</p><p><strong>Setting: </strong>Five developmental paediatric outpatient clinics of 'Continua Kids'.</p><p><strong>Patients: </strong>Children aged 2-9 years diagnosed with ASD along with their caregivers.</p><p><strong>Interventions: </strong>Probiotic or placebo sachet reconstituted in 50 mL of lukewarm milk/water, taken two times per day for 3 months.</p><p><strong>Main outcome measures: </strong>Change in behavioural (measured by Social Responsiveness Scale-2 (SRS-2) and Aberrant Behaviour Checklist-2 (ABC-2) tools) and GI (measured by GI Severity Index (GSI) score) symptoms after receiving intervention for 3 months.</p><p><strong>Results: </strong>A total of 180 children with ASD were enrolled in the study (probiotic group: 90 and placebo group: 90). All children completed the study. The probiotic group showed a significant reduction in behavioural symptom severity as measured by the SRS-2 tool (47.77% vs 23.33%; p=0.000) compared with the placebo. Probiotic-treated children demonstrated significant reductions in severe symptoms, including social withdrawal/lethargy (40%), stereotypic behaviour (37.77%), hyperactivity (34.44%) and inappropriate speech (32.22%) post-intervention (p=0.000). They also had marked improvements in constipation (p=0.003) and diarrhoea (p=0.043) compared with the placebo group. Both groups exhibited a statistically significant correlation between behavioural and GI symptoms.</p><p><strong>Conclusions: </strong>Probiotic supplementation improved behavioural and GI symptoms in children with ASD with no adverse effects. Both symptoms were significantly correlated. However, these results need to be validated in a larger sample size.</p><p><strong>Trial registration number: </strong>CTRI/2021/11/038213.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A comparative analysis of INTERGROWTH-21st and the World Health Organisation fetal growth chart in detection of term small for gestational age newborns and prediction of short-term adverse perinatal outcomes.","authors":"Anum Rahim, Rozina Nuruddin, Iqbal Azam, Komal Abdul Rahim, Shiyam Sunder Tikmani, Nuruddin Mohammed","doi":"10.1136/bmjpo-2024-003230","DOIUrl":"10.1136/bmjpo-2024-003230","url":null,"abstract":"<p><strong>Objectives: </strong>To compare the INTERGROWTH-21st and the WHO fetal growth chart in detecting term small for gestational age (SGA) neonates and predicting short-term adverse perinatal outcomes.</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Setting: </strong>Department of Obstetrics and Gynaecology at the Aga Khan University Hospital Karachi.</p><p><strong>Subjects: </strong>Term singleton pregnancies between July and December 2018 with ultrasound growth scan done within 4 weeks of delivery. Pregnancies with structural and chromosomal abnormalities and multiple gestations were excluded.</p><p><strong>Outcome: </strong>The estimated fetal weight (EFW) was calculated using the INTERGROWTH-21st and the WHO fetal growth chart based on ultrasound measurements. Fetuses with EFW below the 10th percentile were classified as SGA. Neonates were confirmed as SGA based on similar postnatal weight percentile. Short-term adverse perinatal outcomes were also analysed.</p><p><strong>Results: </strong>A total of 932 records were screened, and 478 were included in the analysis. The sensitivity of the WHO fetal growth chart (70.2%; 95% CI: 60.4%, 78.8%) was higher than the INTERGROWTH-21st (45.2%; 95% CI: 35.4%, 55.3%) for predicting neonatal SGA. The WHO fetal growth chart predicted more SGA neonates when compared with the INTERGROWTH-21st (AUC=0.75, 95% CI: 0.71, 0.80 and AUC=0.63, 95% CI: 0.58, 0.68, respectively). Both charts were similar in predicting the short-term adverse perinatal outcomes; AUC (95% CI) was 0.77 (0.70, 0.83) for INTERGROWTH-21st and 0.78 (0.72, 0.85) for the WHO fetal growth chart.</p><p><strong>Conclusion: </strong>The WHO fetal growth chart demonstrates significantly better accuracy in predicting term SGA neonates compared with INTERGROWTH-21st. Further, both charts have similar prediction abilities for short-term adverse perinatal outcomes.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11881175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of non-operative management of uncomplicated acute appendicitis: initial experience in a resource-limited setting.","authors":"Ana Gabriela Barría Rodríguez, Emilio Romero, Alan Guillen, Lorena Fábrega, Paulette Serrano Fernández","doi":"10.1136/bmjpo-2024-003141","DOIUrl":"10.1136/bmjpo-2024-003141","url":null,"abstract":"<p><p>Although appendectomy remains the standard treatment for acute appendicitis, non-operative management has gained interest as a safe and effective alternative. However, its implementation in resource-limited hospitals like ours is hindered by insufficient staffing, high bed occupancy, lack of digital records and limited specialist access. Despite these challenges, we present our centre's initial experience. Between July 2022 and December 2023, 24 children with uncomplicated acute appendicitis were treated non-surgically, with an equal gender distribution. The initial success rate was 100%, with only three cases (12.5%) of treatment failure during 12 months of follow-up.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uptake of core outcome sets in paediatric clinical trials: a protocol.","authors":"Ruobing Lei, Janne Estill, Ivan D Florez, Qiu Li, Yaolong Chen, Paula Williamson","doi":"10.1136/bmjpo-2024-003054","DOIUrl":"10.1136/bmjpo-2024-003054","url":null,"abstract":"<p><strong>Introduction: </strong>A growing number of paediatric core outcome sets (COS) have been developed in the past 20 years. Previous studies have provided many useful insights into the uptake of COS. In addition to the awareness of COS among clinical trialists, the COS development process (especially patient participation) and the actions of the developers can promote COS uptake. However, the uptake of COS in paediatric clinical trials needs to be further explored. The aim of this study is to provide information on the rationale and use of paediatric COS in clinical trials, and to analyse in depth the awareness and views of COS developers and clinical trialists about the development and use of COS.</p><p><strong>Methods and analysis: </strong>We will include all paediatric COS identified in our previous systematic review and those subsequently included in the Core Outcome Measures in Effectiveness Trials (COMET) database. We will extract the target condition, population, intervention, list of core outcomes and the details of patient involvement. Next, we will search the Clinicaltrials.gov and WHO International Clinical Trials Registry Platform for trials on health conditions addressed by the identified COS. We will assess the comparability of the scopes in each COS-trial pair and determine for the outcomes in each clinical trial if they match exactly or generally, or if they do not match, with the outcomes of their respective COS. Finally, we will conduct a survey and semistructured interviews among COS developers and clinical trialists to examine their views.</p><p><strong>Ethics and dissemination: </strong>Ethical approval for the study has been granted by the ethics committee of the Institute of Health Data Science, Lanzhou University (No. HDS-202405-01). This study was registered on COMET (https://www.comet-initiative.org/Studies/Details/3122).</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating ChatGPT-4omni in paediatric developmental screening: direct versus sequential prompts.","authors":"Pathrada Traipidok, Papichaya Srisombundit, Nattaporn Tassanakijpanich, Pattra Charleowsak, Therdpong Thongseiratch","doi":"10.1136/bmjpo-2024-002809","DOIUrl":"10.1136/bmjpo-2024-002809","url":null,"abstract":"<p><p>Integrating Large Language Models like ChatGPT-4omni (ChatGPT-4o) into paediatric healthcare could revolutionise developmental screening. This study evaluated ChatGPT-4o's efficacy in paediatric developmental screening using Direct and Sequential Prompting methods compared with the Bayley Scales of Infant Development, Third Edition. Among 106 paediatric cases, Direct Prompting showed a sensitivity of 73.42% and overall accuracy of 69.81%, while Sequential Prompting had a specificity of 62.96% and overall accuracy of 67.92%. Both methods demonstrate potential for improving the efficiency and accessibility of paediatric developmental screening, with Direct Prompts being more sensitive and Sequential Prompts more specific.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Profiting from death: the arms trade.","authors":"Imti Choonara","doi":"10.1136/bmjpo-2025-003372","DOIUrl":"10.1136/bmjpo-2025-003372","url":null,"abstract":"","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143540077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Admission temperature in very preterm infants 2012-2021: a Nationwide Quality Registry Study, Norway.","authors":"Thale Amalie Westre Solvang, Vilde Bråten Herstad, Ketil Størdal, Lars Tveiten, Astri Lang, Beate Horsberg Eriksen, Arild Rønnestad, Hans Jørgen Stensvold","doi":"10.1136/bmjpo-2024-003263","DOIUrl":"10.1136/bmjpo-2024-003263","url":null,"abstract":"<p><strong>Objective: </strong>To examine the distribution and time trends of admission temperature in very preterm infants, effects of temperature-preserving interventions and associations between hypothermia and outcomes.</p><p><strong>Methods: </strong>Population-based cohort study of infants <32 gestational weeks without lethal malformations admitted to a neonatal intensive care unit within 2 hours of birth between 1 January 2012 and 31 December 2021. Hypothermia was defined as mild (36.0°C-36.4°C), moderate (34.5°C-35.9°C) or severe (<34.5°C). Associations between admission temperature and outcomes were investigated using multivariate logistic regression, adjusting for sex, weight Z-score, gestational age, antenatal steroids, surfactant and hospital.</p><p><strong>Results: </strong>In total, 2457/4879 (50.4%) had normal admission temperatures between 36.5°C and 37.5℃, 1314 (26.9%) had mild hypothermia and 886 (18.2%) had moderate to severe hypothermia, with a significant interhospital variance of 7%-40%. Moderate to severe hypothermia decreased from 24% in 2012 to 16% in 2021 (p_trend<0.001). Measuring temperature before leaving the delivery unit correlated with lower incidence of moderate to severe hypothermia (42% vs 58%, p<0.001). Admission temperature was inversely associated with mortality (adjusted OR 1.5, 95% CI 1.1 to 2.0 for moderate and 2.4, 95% CI 1.1 to 4.9 for severe hypothermia) and with surgical necrotising enterocolitis or intestinal perforation (adjusted OR 1.7, 95% CI 1.1 to 2.7 for moderate and 3.1, 95% CI 1.3 to 7.7 for severe hypothermia).</p><p><strong>Conclusions: </strong>Although the incidence of hypothermia decreased during the study period, it remains a concern due to significant associations with adverse outcomes. Areas for further improvement include addressing interhospital variance and enhancing temperature monitoring in the delivery unit.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143514592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cultural adaptation and reliability of the Turkish version of the Children's Assessment of Participation with Hands scale in children with physical disabilities.","authors":"Sebahat Yaprak Cetin, Hasan Atacan Tonak, Ozgun Kaya Kara, Hande Senol, Koray Kara","doi":"10.1136/bmjpo-2024-002879","DOIUrl":"10.1136/bmjpo-2024-002879","url":null,"abstract":"<p><strong>Background: </strong>The 'Children's Assessment of Participation with Hands (CAP-H)' scale is a parent report questionnaire that can be used to measure participation in life situations that require hand use for children with disabilities. The aim of this study was to examine the reliability of a Turkish version of the CAP-H scale in order to evaluate the hand participation of children with physical disabilities and compare them with typically developing children.</p><p><strong>Methods: </strong>Evaluation was made of a total of 182 physically disabled children (8.53±3.94 years) and 90 typically developing children (9.40±3.04 years). The CAP-H scale was used to evaluate children's hand participation, compare with typically developing children and to examine the reliability of the Turkish version. Cronbach's alpha and intraclass correlation coefficients (ICCs) were evaluated for internal consistency and test-retest reliability, respectively.</p><p><strong>Results: </strong>Cronbach's alpha value used for all subscores was found to be excellent in all domains for internal consistency (Cronbach's α: 0.84-1). According to the test-retest reliability, it was found to be perfectly reliable in all domains (ICC: 0.81-1). There was a significant difference in all items of CAP-H (p=0.00) except for participation in self-care, frequency of recreational activities and frequency of educational domain in favour of typically developing children.</p><p><strong>Conclusions: </strong>The results of this study demonstrated that the Turkish translation of CAP-H is a reliable evaluation for children's participation in life requiring hand use. In addition, hand participation of children with physical disabilities is lower compared with typically developing children.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"School participation, supports and barriers of children with and without attention deficit hyperactivity disorder.","authors":"Koray Kara, Ozgun Kaya Kara, Barkin Kose, Mert Doğan, Sebahat Yaprak Cetin, Sedef Sahin, Dana Anaby","doi":"10.1136/bmjpo-2024-002917","DOIUrl":"10.1136/bmjpo-2024-002917","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate the differences in participation patterns, environmental barriers and supports across specific activities typically done at school between children with attention deficit hyperactivity disorder (ADHD) and without ADHD.</p><p><strong>Design: </strong>Prospective cross-sectional study.</p><p><strong>Setting: </strong>The children and adolescents with ADHD were selected from those routinely referred to the Health Sciences University Research and Training Hospital's child and adolescent psychiatry department, which is a reference centre for the region.</p><p><strong>Participants: </strong>A total of 365 children (n _{children with ADHD} =175, n _{children without ADHD} =190, mean age 11.66 years, SD 2.96 years) and their primary caregivers were included in the study.</p><p><strong>Primary outcome measures: </strong>Participation and Environment Measure for Children and Youth was used to evaluate children.</p><p><strong>Results: </strong>The mean frequency of participation in five different school activities was significantly lower in children with ADHD than in children without ADHD, with moderate to large effect sizes. Children with ADHD were less likely to be involved in any activity type than children without ADHD, with moderate to large effect sizes. The characteristics of the school environment typically made it more challenging for children with ADHD to participate than for children without ADHD, with moderate effect sizes.</p><p><strong>Conclusions: </strong>Children with ADHD have challenges in classroom activities and with socialising with peers outside class, cognitive demands, sensorial qualities and safety. Relationships with friends, cultural acceptance and support could improve the school participation of children with ADHD.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"9 1","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11840899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143456891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}