Introduction

This article describes the meaning of Autism Spectrum Disorders (ASD), the characteristics of ASD, the diagnosis process of ASD, ASD diagnosis instruments, and the strengths and interests of children with ASD. The article also presents supporting and educating techniques, behaviour management strategies and communicating strategies for students with ASD.

Understanding Autism Spectrum Disorders

Before the publication of the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) (APA, 2013), various terms were used to refer to children with complex neurodevelopmental conditions (e.g., ASD, atypical autism, childhood psychosis, childhood schizophrenia, and autism). The term “autism” was defined differently from childhood schizophrenia and other psychoses, such as “pervasive developmental disorders” (PDDs), after the publication of DSM-III. Moreover, DSM-IV included several subtypes of PDD: autism, AS, PDDNOS, Rett syndrome, and disintegrative disorder (APA, 2013). After the DSM-5, the subcategories were eliminated and replaced with the single diagnosis of “ASD” and the DSM-5 revised the diagnostic criteria for children with autism spectrum disorders (APA, 2013). The term ‘ASD’ is used throughout this article – consistent with DSM-5 diagnostic criteria.

Characteristics of students with ASD

Students with autism may experience difficulties in the following areas. Table 1 presents characteristics of students with autism.

Table 1 characteristics of students with autism

(Altogether Autism, 2023; APA, 2013).

Strengths and interests of students with ASD

Students with ASD excel in various learning styles, including acquiring knowledge. Specifically, they may be good at:

• rote learning
• remembering information for extended periods
• detailed and chunk-based learning
• paying close attention to small details
• concentrating on narrow topics of interest
• using visual information meaningfully
• using concrete information, understanding and following rules
• actions and thought logical processes
• follow strict rules

Diagnosis process for students with ASD

There are several theories about the causes of ASD, but none of them have been scientifically proven (Autism New Zealand, 2020; Thapaliya, 2023a, 2023b). Researchers are still investigating varied factors that might contribute to the development of ASD. Some studies suggest that people with ASD may have genetic predispositions, whereas other research signals viral infections, structural and functional brain abnormalities, and dysfunctional immune systems (APA, 2013).

The diagnostic process requires input from multiple professionals (e.g., child psychologists, educational psychologists, pediatricians, clinical psychologists, audiologists, and teachers) and parents (APA, 2013). Professionals also involve an evaluation process. Specifically, the following criteria are commonly used to diagnose ASD:

• assessments of multiple areas of functioning (e.g., intellectual and communication skills, a review of developmental history)
• parental input
• medical tests (a loss of hearing test and eye test before considering a diagnosis of ASD)
• assess multiple areas of functioning
• collect information from a variety of settings
• provide a single coherent view
• provide implications for adaptation and learning
• liaison with schools and other agencies to support the implementation of recommendations
• developmental history
• diagnostic assessment of speech, language and communication
• sensory and motor skills assessments
• medical evaluations

Figure 1 presents the two diagnosis domains of ASD based on DSM-5:  communication and repetitive patterns of behaviour (APA, 2013).

(APA, 2013)

Diagnostic instruments

The following diagnostic tools may be used to diagnose autism spectrum disorder.

• Diagnostic and Statistical Manual of Mental Disorders (DSM)- 5
• Asperger Syndrome Diagnostic Interview (ASDI)​
• Asperger Syndrome Screening Questionnaire (ASSQ)​
• Australian Scale for Asperger syndrome (ASAS)​
• Autism Behaviour Checklist (ABC)​
• Autism Diagnostic Observation Schedule (ADOS) and ADOS-G​
• Autism Screening Questionnaire (ASQ)​
• Autistic Diagnostic Interview (ADI, and also ADI-R)​
• Childhood Asperger Syndrome Test (CAST)​
• Childhood Autism Rating Scale (CARS)​
• Child Communication Checklist (CCC)​
• Checklist for Autism in Toddlers (CHAT)​
• Diagnostic Interview for Social Communication Disorders (DISCO)​
• Gilliam Autism Rating Scale (GARS)​
• Parent Interview for Autism​ (PIR)
• Pervasive Developmental Disorders – mental retardation (PDD-MR)​
• Social Response Scale (SRS)​
• Treatment and Education of Autistic and related Communications Handicapped Children (TEACCH) checklist​
• Wing Autistic Disorder Interview Checklist​ (WADIC)

Teaching and learning strategies for students with ASD

Researchers recommend a wide range of teaching approaches, methods, and techniques to teach students with autism, such as structured teaching programmes, social stories, visual cues, sensory corners in the classroom, and using assistive technology to deliver course content in the classroom (Autism New Zealand, 2020; Bevan-Brown & Dharan, 2016; Thapaliya, 2023). The following section describes key teaching strategies for students with ASD.

Rules of 5 (Fewer than 5 words, wait 5 seconds)

In this strategy, teachers have to present the information in sentences that only have five words. Teachers can give students five seconds to comprehend each statement so they can focus on and understand what you said. For example,

• Stay in your seat
• Hand on pencils only
• Use friendly words
• Raise your hand to speak
• Focus on your task

Use the student’s name first

Saying the student’s name first gets the students’ attention and allows them to work out that the teacher is speaking to them. For instance, teachers can frequently remind them to do the task. Tom, time for math.

Giving positive direction

Teachers need to give positive direction while instructing students with autism in the classroom because students with autism may have trouble when they hear the word ‘no’. For example, ‘Please use a tissue, instead of saying ‘Stop picking your nose!’.

First-then strategies

A first-then strategy may provide the students with a visual means of introducing a new task in a way that they can understand. This technique helps to establish a routine and controlled environment for students with autism. Specifically, teachers can use a first-then strategy to increase independence, provide predictable environments/activities, clarify expectations while providing sequencing of events, support transitions (activity to activity or between locations), reduce verbal information (prompts) provided to a child and increase motivation for completing an adult-directed task/activity (MoE, 2023). For example, first reading a passage, then having a break time.

Give warnings before an activity finish

It is recommended to give students prior warnings before ending a favourite activity to prevent anger. Three warnings, accompanied by visual cues, are the usual practice (Autism New Zealand, 2020; MoE, 2023). For example,

• Hunter, you have ten minutes left to complete your math task.
• Hunter, you have five minutes left to complete your math task.
• Hunter, math time is finished.

Use assistive technology

Using assistive technology (e.g., computers, iPads), can help reduce learning barriers in the classroom while teaching students with autism spectrum disorders (Autism New Zealand, 2020; MoE, 2023; Thapaliya, 2023a). Using computers can be a useful tool for teaching literacy and language skills (e.g., listening, speaking, reading, and writing) and numeracy skills. Jacklin and Farr (2005) reported the benefit of using computers with students with autism spectrum disorders in the classroom because they provide a “visual impact on what they are learning” (p. 208). While completing academic tasks, students with autism spectrum disorders may gain a sense of predictability, confidence, and self-control (Murray, 2015).

Learner profile

A learner profile includes everything about students’ learning needs, strengths, and individual needs in the classroom. In other words, the learner profile can assist schoolteachers, school psychologists, and school staff in understanding the perspectives of ākonga (student) and their whānau/parent), forging relationships with them, and tailoring instruction to fit the needs of individual students (MoE, 2023). Specifically, a learner profile can provide information about students (e.g., how to communicate with students, likes, and dislikes) (Thapaliya, 2023b).

Provide visual support

Visual support refers to a shared set of tools that are employed for a variety of tasks and are more permanent than words. Visual support consists of objects that are used to visually enhance a person’s understanding of the information, physical environment, social situation, and abstract concepts (Rutherford, et al., 2020).

Visual support may assist expressive communication by serving as a substitute for words, signs, gestures, and physical acts. Visual support can support people in meeting their developmental stage by offering a variety of skills (e.g., skill acquisition, motivation to learn, and utilizing their new learning). Similarly, visual support can offer students with ASD the structure, routine, and sequence they need to participate in everyday tasks (Thapaliya, 2023b).

. For instance,

Social story support

Researchers claim that social skills are the most effective way to manage students with ASD behavioural issues if they are taught within the natural environment (Fleury et al., 2014; Murray, 2015; Ostmeyer & Scarpa, 2012). Social skills can provide an opportunity for imitative skills and observation skills for students with autism spectrum disorders, as well as help them get support from their peers and tutors.

There are three types of story support (Autism New Zealand, 2020) to improve students with ASD behaviour:

1. Story for self-esteem provides a positive story of student’s behaviour and learning. Also, it was applied to enhance students’ self-esteem and confidence.
2. Story for information offers practical information (e.g., how to brush teeth), calming strategies to reduce their anxiety, and a new classroom timetable.
3. Story for understanding is used to explain misunderstood communication and enhance students’ comprehension of course content.

Sensory regulation

Sensory overload sensitivity is a component of the autism spectrum diagnosis. This does not imply that all autistic students will be sensitive to sensory stimuli (APA, 2013). Students with ASD may have sensitivities to sights, sounds, smells, tastes, touch, and balance. They can experience both hyper- and hyposensitivity (under-reactivity) to a variety of stimuli. Most people combine the two in some way.

Acoustics, lighting, noise-cancellation headphones, low-arousal workspace, and scheduling regular breaks are some suggested strategies to prevent sensory overload for students with autism (Autism New Zealand, 2022). If teachers provide frequent breakout time throughout the day and calming and self-managing activities for students with autism, these activities will help students with autism cope with the classroom environment (e.g., prevent overload anxiety issues). For instance,

• Give students frequent break
• Check in- and check-out times
• Curate a reading corner and breakout space with toys and sensory cushions

Lego therapy

LEGO-based therapy may help to develop social skills in children with autism spectrum disorder (Autism New Zealand, 2020; MoE, 2023; Thapaliya, 2023). Initially, Lego- therapy was designed to help children with ASD, but now it has been used to help kids with various social and communicative issues. In Lego-based therapy, there will be three people:

Engineer: reads the visual instructions and designs

Supplier: finds the pieces as directed by the engineer

Builder: builds the pieces

Lego-based therapy may help to:

• promote social interaction
• develop turn-taking skills and share with others
• collaborate with others for problem-solving
• develop language and motor skills
• increase motivation and self-esteem
• improve participation and engagement skills
• feel calm and relaxed

Universal Design for Learning

Universal support approach refers to the Universal Design for Learning (UDL). The UDL has three principles and guidelines that assist in enhancing learning, including for students with ASD. According to students’ interests and learner variability, teachers can select certain guidelines to apply in their teaching and learning activities (Rao & Torres, 2016). The UDL framework has three principles: i) multiple means of engagement; ii) multiple means of representation; and iii) multiple means of action and expression (CAST, 2018)

The multiple means of engagement principle offer choices for developing likes, purposes, and self-regulation among students. The multiple means of representation principle is structured to assist learning through recognition networks and provide multiple ways of representing the curriculum. The multiple means of action and expression connect to strategic networks in the brain, and they play a key role in language learning and skill development (CAST, 2018).

Behaviour managing strategies

Students with ASD might display problematic, challenging, and aggressive behaviour (e.g., difficulty in listening to their teachers and following instructions, self-harm, difficulty following classroom rules, and repetitive disruptive behaviour). Instructional and behavioural support from behavioural therapists, educational psychologists, and clinical psychologists is put in place to assist students with spectrum disorders (Fleury et al., 2014). The use of technological interventions such as iPads is an effective intervention for decreasing challenging behaviours in the classroom. The following section describes Applied Behaviour Analysis (ABA), Functional Behavioural Analysis (FBA), and Cognitive Behaviour Therapy (CBT) to manage behaviour of students with autism spectrum disorders.

Communication managing strategies

Augmentative and Alternative Communication (AAC)

Augmentative Alternative and Communication (ACC) refers to a range of tools and techniques that assist people with complex communication needs. Students with cerebral palsy, autism spectrum disorders, developmental disabilities, childhood apraxia of speech, language delays, and other medical conditions that result in speech loss can benefit from the use of augmentative and alternative communication (ACC) (Mitchell & Sutherland, 2020).

In other words, the term ‘augmentative’ refers to resources that support and improve the existing communication abilities of a student. For instance, a student with ASD may use an iPad with communication software that produces a synthetic voice in response to a selected image. ‘Alternative’ describes communication systems that are designed to substitute for learners’ lost language and speech or are unlikely to develop in the future. For example, communicating effectively with students who have severe ASD can be challenging, especially in social situations, classrooms, and in their future endeavours where speech is a necessity. However, a high-tech system with speech output could be a temporary solution to serve as their primary means of communication.

There are three types of ACC solutions: No-tech, low-tech, and high-tech.

• No-tech AAC is widely known for utilizing voluntary motor movements (e.g., sign language and facial expression analysis) to convey non-verbal messages.
• Low-tech AAC utilizes simple resources such as books and whiteboards with large lexicons of words and images to support communication. For example, Pictogram Ideogram Communication (PIC), Rebus Signs, Picture Communication Symbols (PCS) and Picture Exchange Communication System (PECS) are some examples of low-tech ACC. In preschools and schools, PECS is very popular. PECS is a functional communication system that is used as a communication tool for students with speech and language difficulties. PECS teaches students to select cards with line drawings, symbols, or photos of desired items or activities and then give them to another person (e.g., communicative partner, peer, teacher, or parent) to receive the object or task.
• High-tech AAC involves the use of electronic devices (e.g., iPads, laptops, computer applications and mobile phones) and speech generating devices (e.g., Proloquo2go) to achieve an AAC goal. Similarly, students with a range of difficulties (e.g., people with visual impairment) and neurological conditions may benefit from software programmes such as text- to- speech output options.

Conclusion

This article explored the meaning of autism, characteristics of students with ASD, and the diagnosis process for ASD. It presented supporting and teaching strategies. managing challenging behaviour and communication strategies for students with ASD.

Pediatric hydrocephalus presents a formidable challenge to healthcare systems worldwide, and nowhere is this more evident than in resource-limited regions like Nepal. In these settings, the standard treatment often involves ventriculoperitoneal (VP) shunt surgery, a procedure that offers hope but also comes with its share of risks. Imagine the plight of a young child in Nepal diagnosed with hydrocephalus, whose journey towards recovery hinges on the success of this surgery. Now, let’s delve deeper into the complexities of this treatment landscape and explore how healthcare providers in Nepal are navigating these challenges to ensure the best possible outcomes for their patients.

Hydrocephalus, characterized by the abnormal accumulation of cerebrospinal fluid in the brain, can result from various underlying causes such as infection, bleeding, tumors, or congenital anomalies. In Nepal, where healthcare resources are scarce, the management of pediatric hydrocephalus poses unique challenges. Access to specialized care, post-operative support, and long-term follow-up are crucial factors that influence the trajectory of a child’s recovery journey.

The cornerstone of treatment for pediatric hydrocephalus in Nepal is VP shunt surgery, a procedure aimed at alleviating symptoms and improving the quality of life for affected children. However, this surgery is not without risks. Complications such as infection and shunt malfunction can occur, posing significant hurdles to successful outcomes. The lack of comprehensive data on complication rates and associated risk factors in low-resource settings like Nepal further complicates the picture.

To shed light on this issue, the author; principal investigator and colleagues from Bir Hospital embarked on a journey to analyze a cohort of pediatric hydrocephalus patients who underwent VP shunt surgery at a prominent hospital in Kathmandu between 2014 and 2017. Through meticulous data collection and analysis, we sought to identify key determinants of complication rates and inform strategies for improving the safety and efficacy of VP shunt surgery in resource-limited settings. During this retrospective analysis, a total of 133 children who underwent VP shunt surgery at the hospital were included in the study. We meticulously examined the medical records and follow-up data of these patients to gather comprehensive information on patient demographics, surgical variables, and postoperative outcomes.

The inclusion criteria for the study comprised pediatric patients aged 15 years or younger who underwent their first VP shunt surgery at the hospital within the specified time frame. This ensured a focused analysis on patients undergoing the initial intervention for hydrocephalus. To ensure consistency and accuracy in data collection, researchers utilized a standardized data collection form. This form likely included fields for recording patient demographics (such as age and gender), details of the surgical procedure (such as duration and surgeon experience), characteristics of the VP shunt (such as type and material), and postoperative outcomes (including complications such as infection and shunt malfunction).

Statistical analyses were then performed on the collected data to identify factors associated with complication rates following VP shunt surgery. These analyses likely included chi-square tests to assess the association between categorical variables (e.g., surgeon experience) and complication rates, as well as Cox proportional hazards regression to evaluate the impact of time-related factors (e.g., surgery duration) on complication rates.

The findings of the study revealed several key insights into the factors influencing complication rates in pediatric hydrocephalus patients undergoing VP shunt surgery in Nepal. For example, the overall complication rate was found to be 26.7%, with shunt malfunction being more common (21.7%) than infection (5%). Factors such as longer surgery times (>1 hour), surgeries performed by less experienced surgeons, and surgeries classified as urgent were associated with higher complication rates. However, demographic factors, tube characteristics, and hospital-related factors did not significantly affect complication rates.

Findings were both enlightening and sobering. Of the children who underwent VP shunt surgery during the study period, a significant proportion experienced complications, with shunt malfunction emerging as a predominant issue. Factors such as longer surgery times, surgeries performed by less experienced surgeons, and urgent procedures were associated with higher complication rates. These insights underscored the critical role of surgical expertise and efficient perioperative management in mitigating adverse outcomes.

However, amidst the challenges, there were also glimmers of hope. The relatively low rate of infection suggested that current antibiotic protocols and wound care practices may be effective in reducing postoperative infections. This finding speaks to the resilience and resourcefulness of healthcare providers in Nepal who are working tirelessly to optimize patient care despite limited resources.

But the journey does not end here. The road ahead is fraught with obstacles, yet filled with opportunities for innovation and improvement. By leveraging the insights gleaned from this study and embracing a holistic approach to care that addresses not only the medical but also the social and economic determinants of health, healthcare providers in Nepal can continue to make strides towards better outcomes for pediatric hydrocephalus patients.

In conclusion, navigating the landscape of pediatric hydrocephalus treatment in Nepal is a journey filled with challenges, but also with hope and resilience. By understanding the complexities of this treatment landscape, healthcare providers can better tailor interventions to meet the unique needs of their patients and ultimately improve the quality of life for children affected by this condition. Together, we can chart a course towards a brighter future for pediatric hydrocephalus care in Nepal and beyond.

Take away: This study investigated the complication rates and risk factors of VP shunt surgery in children with hydrocephalus in Nepal. We found that younger age, longer surgery duration, and lower surgeon experience increased the risk of complications, such as infection and shunt malfunction. These findings suggest that improving surgical skills, reducing operative time, and selecting appropriate candidates for VP shunt surgery may enhance the outcomes of pediatric hydrocephalus patients in Nepal. This study provides valuable insights for healthcare providers and policymakers in low-resource settings, where VP shunt surgery is a common and critical intervention for pediatric hydrocephalus. Future research should explore the role of other factors, such as shunt quality, postoperative care, and follow-up, in determining the long-term outcomes of VP shunt surgery in Nepal. 

Childhood obesity is a significant public health concern that can have long-term consequences for a child’s physical and mental well-being. This article explores research-backed strategies and tips to prevent childhood obesity, focusing on promoting healthy lifestyles and creating supportive environments for children.

Encourage Healthy Eating Habits:

Promoting healthy eating habits is crucial in preventing childhood obesity. Research suggests the following practices:

a. Provide a balanced diet: Offer a variety of nutritious foods, including fruits, vegetables, whole grains, lean proteins, and low-fat dairy products (1).

b. Limit sugary drinks and snacks: Restrict the consumption of sugary beverages and high-calorie snacks, as they contribute to excessive calorie intake (2).

c. Practice portion control: Teach children to recognize appropriate portion sizes and avoid overeating (3).

d. Eat meals together as a family: Family meals provide an opportunity to model healthy eating habits, promote positive food choices, and foster social connections (4).

Promote Regular Physical Activity:

Regular physical activity is essential for preventing obesity in children. Research supports the following recommendations:

a. Encourage daily exercise: Children should engage in at least 60 minutes of moderate to vigorous physical activity each day (5).

b. Limit sedentary behaviors: Reduce screen time and encourage children to engage in active play or participate in sports and recreational activities (6).

c. Make physical activity enjoyable: Offer a variety of activities that children enjoy and involve the whole family to promote participation (7).

Foster a Supportive Environment:

Creating an environment that supports healthy behaviors is critical in preventing childhood obesity. Research suggests the following approaches:

a. Limit access to unhealthy foods: Reduce the availability of sugary snacks and beverages at home and encourage the consumption of healthy alternatives (8).

b. Provide access to healthy foods: Ensure that nutritious foods are readily available at home, school, and community settings (9).

c. Promote breastfeeding: Encourage and support breastfeeding, as it has been associated with a reduced risk of childhood obesity (10).

d. Support school-based interventions: Advocate for comprehensive school programs that promote healthy eating, physical activity, and education about nutrition (11).

e. Involve healthcare professionals: Collaborate with healthcare providers to monitor growth, provide guidance on nutrition and physical activity, and identify early signs of obesity (12).

It is important to note that prevention efforts should involve a multidisciplinary approach, including parents, caregivers, educators, healthcare professionals, and policymakers, to create a supportive and healthy environment for children.

Research findings on allergies in children have contributed to a better understanding of their causes, symptoms, and effective management strategies. This article explores some of these research-backed findings and recommendations for managing allergies in children, supported by references.

Understanding Allergies in Children:

Allergies occur when the immune system reacts abnormally to harmless substances, such as pollen, pet dander, or certain foods. Research has identified the following key aspects of allergies in children:

Common Allergens: Common allergens in children include pollen, dust mites, mold spores, pet dander, certain foods (e.g., peanuts, milk, eggs), and insect stings (1).

Allergic Rhinitis: Allergic rhinitis, commonly known as hay fever, is a common allergic condition characterized by symptoms such as sneezing, nasal congestion, itching, and runny nose. Research highlights the impact of allergic rhinitis on children’s quality of life and academic performance (2).

Food Allergies: Food allergies can lead to severe allergic reactions and can be life- threatening. Research has provided insights into the prevalence, common food allergens, and management of food allergies in children (3).

Managing Allergies in Children:

Allergen Avoidance: The primary strategy for managing allergies is to avoid exposure to allergens. Research suggests the following measures:

Implementing dust mite-proof covers on mattresses and pillows to reduce exposure to dust mites (4).

Regularly cleaning and vacuuming the home to minimize dust and pet dander (5).

Reading food labels carefully and avoiding allergenic foods (6).

Medications:

Antihistamines: Antihistamines are commonly used to relieve symptoms such as itching, sneezing, and runny nose. Research supports the effectiveness of antihistamines in managing allergic rhinitis symptoms in children (7).

Intranasal Corticosteroids: These medications are effective in reducing nasal inflammation and are recommended for children with persistent allergic rhinitis (8).

Epinephrine Auto-injectors: Children with severe allergic reactions, such as anaphylaxis, may require an epinephrine auto-injector for emergency treatment. Research emphasizes the importance of timely administration of epinephrine during severe allergic reactions (9).

Immunotherapy:

Sublingual Immunotherapy (SLIT): SLIT involves administering allergens under the tongue to desensitize the immune system. Research supports the use of SLIT in reducing symptoms and improving quality of life in children with allergic rhinitis (10).

Allergen-specific Immunotherapy (AIT): AIT, commonly known as allergy shots, involves regular injections of gradually increasing doses of allergens. Research demonstrates the long-term effectiveness of AIT in reducing symptoms and preventing the progression of allergies (11).

Education and Support:

Educating children, parents, and caregivers about allergens, avoidance strategies, and emergency response plans (12).

Engaging with healthcare professionals and allergy specialists to develop personalized management plans based on each child’s specific allergies and needs (13).

It is important to consult with healthcare professionals for accurate diagnosis, personalized treatment plans, and guidance in managing allergies in children.

Teaching children healthy habits from an early age is important for their overall well-being and sets the foundation for a healthy lifestyle in the future. Here are some tips on healthy habits you can teach children:

Balanced Diet: Encourage a balanced and nutritious diet by offering a variety of fruits, vegetables, whole grains, lean proteins, and low-fat dairy products. Teach them about the importance of eating a rainbow of colors and limit the consumption of sugary snacks and beverages.

Regular Meals and Snacks: Teach children the importance of regular meals and snacks. Encourage them to eat breakfast every day and plan healthy snacks between meals to keep their energy levels stable.

Hydration: Teach children the importance of drinking water throughout the day to stay hydrated. Limit their intake of sugary drinks such as sodas and juices.

Physical Activity: Encourage regular physical activity and make it fun for children. Encourage outdoor play, participate in family activities like bike rides or walks, and limit sedentary screen time. Aim for at least 60 minutes of moderate to vigorous physical activity every day.

Proper Hand Hygiene: Teach children proper handwashing techniques with soap and water for at least 20 seconds. Encourage them to wash their hands before meals, after using the bathroom, and after playing outside.

Sufficient Sleep: Establish a consistent sleep routine and emphasize the importance of sufficient sleep for their growth and development. Set regular bedtimes and create a calming bedtime routine to promote good sleep habits.

Oral Health: Teach children the importance of oral hygiene. Encourage them to brush their teeth twice a day and floss regularly. Limit sugary snacks and drinks that can contribute to tooth decay.

Emotional Well-being: Promote emotional well-being by teaching children to express their feelings, manage stress, and engage in activities they enjoy. Encourage open communication and provide a supportive and nurturing environment.

Limit Screen Time: Set limits on screen time and encourage children to engage in other activities such as reading, arts and crafts, playing outdoors, or pursuing hobbies. Be a positive role model by practicing healthy screen habits yourself.

Safety Awareness: Teach children about basic safety measures such as wearing seatbelts, wearing helmets when biking, and looking both ways before crossing the street. Teach them to be cautious around strangers and to follow safety rules at home and in public places.

Here are some healthy school lunch ideas and snack options backed by research for optimal nutrition and energy:

School Lunch Ideas:

Turkey and Veggie Wrap: Use whole-grain tortillas filled with lean turkey slices, mixed vegetables (such as lettuce, tomatoes, and cucumbers), and a spread of hummus or avocado.

Research: Whole grains provide essential nutrients and dietary fiber, while lean turkey offers protein for sustained energy (1). Including vegetables adds vitamins, minerals, and fiber (2).

Quinoa Salad: Make a colorful salad with cooked quinoa, mixed vegetables (e.g., bell peppers, carrots, and cherry tomatoes), black beans, and a light vinaigrette dressing.

Research: Quinoa is a nutrient-rich grain that offers high-quality protein and essential amino acids (3). Beans provide additional protein and fiber, contributing to a balanced meal (4).

Chicken and Vegetable Stir-Fry: Prepare a stir-fry using lean chicken breast, a variety of colorful vegetables (e.g., broccoli, bell peppers, and snap peas), and a light soy or teriyaki sauce. Serve with brown rice.

Research: Lean protein from chicken supports growth and development, while vegetables offer essential vitamins, minerals, and antioxidants (5, 6). Brown rice provides complex carbohydrates for sustained energy (7).

Snack Options:

Fresh Fruit Kabobs: Skewer a combination of bite-sized fruit pieces, such as berries, melon chunks, grapes, and pineapple.

Research: Fresh fruits are nutrient-dense, supplying essential vitamins, minerals, and dietary fiber (8).

Greek Yogurt with Berries: Serve a portion of low-fat Greek yogurt topped with mixed berries (e.g., strawberries, blueberries, and raspberries).

Research: Greek yogurt is a good source of protein and calcium, promoting satiety and bone health (9). Berries are rich in antioxidants and provide natural sweetness (8).

Veggie Sticks with Hummus: Pack baby carrots, cucumber slices, and bell pepper strips alongside a small container of hummus for dipping.

Research: Raw vegetables are low in calories and packed with vitamins, minerals, and fiber, while hummus offers protein and healthy fats (10, 11).

School Lunch Ideas:

Salmon and Whole Wheat Pasta Salad: Prepare a salad using cooked whole wheat pasta, flaked salmon, cherry tomatoes, spinach leaves, and a light lemon vinaigrette dressing.

Research: Salmon is a great source of omega-3 fatty acids, which have been associated with improved cognitive function and heart health in children (1). Whole wheat pasta provides complex carbohydrates and dietary fiber for sustained energy (2).

Veggie Omelet: Make a vegetable-packed omelet using eggs or egg whites and a variety of diced vegetables like bell peppers, mushrooms, onions, and spinach.

Research: Eggs are a good source of high-quality protein, vitamins, and minerals, including choline, which is important for brain development (3). Vegetables add fiber, vitamins, and antioxidants (4).

Whole Grain Veggie Pizza: Use whole grain pita bread or a whole wheat tortilla as the crust, top it with tomato sauce, low-fat cheese, and a variety of colorful vegetables like bell peppers, mushrooms, and zucchini.

Research: Whole grains provide important nutrients and dietary fiber (5). Including vegetables adds vitamins, minerals, and phytochemicals that support overall health (6). Snack Options:

Homemade Trail Mix: Mix together unsalted nuts (e.g., almonds, walnuts), seeds (e.g., pumpkin seeds, sunflower seeds), and dried fruits (e.g., raisins, apricots) for a nutrient-rich and satisfying snack.

Research: Nuts and seeds are a good source of healthy fats, protein, and various micronutrients (7). Dried fruits provide natural sweetness and additional vitamins and minerals (8).

Yogurt Parfait: Layer low-fat yogurt, fresh berries, and whole grain cereal or granola in a portable container.

Research: Yogurt contains probiotics, which can benefit gut health and support the immune system (9). Berries offer antioxidants and dietary fiber (8).

Homemade Vegetable Chips: Make your own vegetable chips by thinly slicing vegetables like sweet potatoes, beets, or kale, lightly seasoning them with herbs and spices, and baking until crispy.

Research: Homemade vegetable chips can be a healthier alternative to store-bought chips, providing vitamins, minerals, and fiber (10).

It’s important to note that individual dietary needs and preferences may vary. Consulting a registered dietitian or healthcare professional can provide personalized recommendations.

Diagnosing childrens mental health and promoting their well-being requires a comprehensive approach that considers various factors. While a formal diagnosis should be made by qualified healthcare professionals, there are research-based findings and strategies to assess and promote children’s mental health and well- being. This article explores some of these findings and strategies, supported by references.

Assessment of Children’s Mental Health:

Screening Tools: Various screening tools and questionnaires have been developed to assess children’s mental health and identify potential concerns. Examples include the Strengths and Difficulties Questionnaire (SDQ), the Pediatric Symptom Checklist (PSC), and the Child Behavior Checklist (CBCL) (1, 2, 3).

Teacher and Parent Reports: Gathering information from teachers and parents about a child’s behavior, emotions, and social interactions can provide valuable insights into their mental health status. Research suggests that combining multiple perspectives enhances the accuracy of assessment (4).

Clinical Interviews: Direct interviews conducted by trained professionals allow for a more in-depth understanding of a child’s mental health. These interviews can help identify symptoms, evaluate functional impairment, and assess the child’s overall well-being (5).

Promoting Children’s Mental Health and Well-being:

Positive Parenting: Research highlights the importance of warm, supportive, and responsive parenting practices in promoting children’s mental health. Positive parenting strategies involve nurturing relationships, setting appropriate boundaries, and providing consistent discipline (6).

Social and Emotional Learning (SEL) Programs: SEL programs in schools aim to develop children’s social and emotional skills, including self-awareness, self- management, social awareness, relationship skills, and responsible decision- making. Research suggests that such programs can improve mental health outcomes and academic performance (7).

Physical Activity and Outdoor Play: Engaging in regular physical activity and outdoor play has been associated with better mental health outcomes in children.

Research indicates that physical activity can reduce symptoms of anxiety and depression and improve overall well-being (8).

School-based Mental Health Services: Integrating mental health services within schools can enhance access to care and support for children. Research suggests that school-based interventions, such as counseling services and mental health awareness programs, can improve mental health outcomes (9).

Mindfulness and Relaxation Techniques: Mindfulness-based interventions and relaxation techniques, such as deep breathing exercises and guided imagery, have shown promise in improving children’s mental health outcomes. Research indicates that these practices can reduce stress, anxiety, and depressive symptoms (10).

It is important to note that these strategies should be implemented in collaboration with healthcare professionals, educators, and parents to ensure their appropriateness and effectiveness in individual cases.

Research on common childhood illnesses has provided valuable insights into their treatment and management. This article highlights some of these findings, along with recommended treatments for specific childhood illnesses, supported by references.

Upper Respiratory Tract Infections (URTIs): URTIs, such as the common cold and flu, are prevalent in children. Research suggests the following treatment approaches:

a. Supportive care: Encourage rest, hydration, and adequate nutrition to help the child recover (1).

b. Symptom relief: Administer over-the-counter pain relievers, such as acetaminophen or ibuprofen, to alleviate fever, pain, and discomfort (2).

c. Nasal saline drops or sprays: These can help relieve nasal congestion in children who are unable to blow their noses effectively (3).

Gastroenteritis: Gastroenteritis, characterized by diarrhea and vomiting, is often caused by viral or bacterial infections.

Research supports the following treatment measures:

a. Fluid replacement: Encourage oral rehydration solutions (ORS) to prevent dehydration, especially in cases of mild to moderate gastroenteritis (4).

b. Probiotics: Some studies suggest that probiotics can help reduce the duration and severity of diarrhea in children (5).

c. Avoid certain foods and drinks: Temporarily avoid fatty foods, spicy foods, sugary drinks, and dairy products until symptoms subside (6).

Asthma: Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways. Research has provided insights into effective asthma management:

a. Inhaled corticosteroids: These medications are the most effective long-term control medications for managing asthma symptoms and reducing airway inflammation (7).

b. Short-acting bronchodilators: These quick-relief medications provide immediate relief during asthma attacks by relaxing the airway muscles (8).

c. Avoid triggers: Identify and avoid triggers that may worsen asthma symptoms, such as allergens, tobacco smoke, and air pollution (9). Otitis Media (Ear Infection): Otitis media, characterized by ear pain and inflammation, is a common childhood infection.

Research suggests the following treatment options:

a. Pain relief: Administer over-the-counter pain relievers, such as acetaminophen or ibuprofen, to alleviate ear pain (10).

b. Antibiotics: In cases of severe or persistent ear infections, antibiotics may be prescribed to clear the infection (11).

c. Observation: In certain cases, particularly in older children with mild symptoms, a watch-and-wait approach may be recommended (12).

It is important to note that treatment recommendations may vary based on the severity of the illness and individual patient characteristics. Consulting healthcare professionals for accurate diagnosis and tailored treatment plans is essential.

Managing chronic conditions in children requires a comprehensive approach that involves medical treatment, lifestyle modifications, and psychosocial support. Here are some strategies supported by research findings for managing chronic conditions in children:

Medical Treatment:

a. Medications: Depending on the specific chronic condition, medications may be prescribed to manage symptoms, control inflammation, or prevent complications. Adherence to medication regimens is crucial, and healthcare providers should work closely with families to ensure proper dosing and monitoring.

b. Regular Medical Follow-up: Regular check-ups with healthcare providers are important to monitor the progress of the chronic condition, adjust treatment plans as needed, and address any concerns or complications that may arise.

Lifestyle Modifications:

a. Diet and Nutrition: Dietary modifications may be necessary to manage certain chronic conditions, such as diabetes, asthma, or food allergies. Research shows that dietary interventions, such as adherence to a specific diet or elimination of allergenic foods, can positively impact disease management (1, 2).

b. Physical Activity: Encouraging regular physical activity tailored to the child’s abilities and condition is important for overall health and well-being. Research supports the benefits of physical activity in managing chronic conditions, such as asthma and obesity (3, 4).

c. Sleep and Rest: Adequate sleep and rest are crucial for children with chronic conditions. Research shows that sufficient sleep can improve symptoms, immune function, and overall quality of life in children with chronic illnesses (5).

Psychosocial Support:

a. Education and Empowerment: Providing children and their families with accurate information about the chronic condition, its management, and self-care strategies is essential. Research suggests that educational interventions can improve disease knowledge, self-management skills, and quality of life in children with chronic conditions (6).

b. Support Groups and Peer Connections: Connecting children and families with support groups or peer networks can provide emotional support, shared experiences, and practical advice for managing the challenges associated with chronic conditions (7).

c. Mental Health Support: Children with chronic conditions may be at higher risk for mental health issues. Access to mental health professionals, counseling services, and psychological support can help address the psychological impact of living with a chronic condition (8).

Care Coordination:

Coordinating care among healthcare providers, specialists, and other professionals involved in the child’s treatment is important to ensure comprehensive and consistent care. Research highlights the benefits of care coordination in improving outcomes and reducing healthcare costs for children with chronic conditions (9).

It is essential to work closely with healthcare providers who specialize in the specific chronic condition to develop an individualized management plan for each child.