An office-based fix-and-follow grading system assessing visual function in preverbal children

Background Assessing visual function in infants is usually challenging. Fix-and-Follow is a simple and popular method for assessing early development of visual perception in infants, currently however, there is no formal reproducible method for grading the capacity of fix-and-follow. This study was to develop and validate a new fix-and-follow grading system for assessing visual function development in preverbal children. Methods In this cross-sectional study, the fix-and-follow grades was evaluated in 21 consecutive preverbal children. Fixation was categorised as grade 1 if there was no response to the target and grade 2 if there was a response but only for < 3 s. Grades of 3 and 4 were assigned based capacities to (1) fix on a moving target for ≥3 s, and (2) shift fixation from one target to another. If only one of these two criteria was met, grade 3 was assigned. If both were met, grade 4 was assigned. Following was evaluated using smooth pursuit movement, where grade 1 indicated no movement, grade 2 partial movement, and grade 3 complete movement. Two ophthalmologists independently applied the grading method in all patients. Then one of two examiners repeated the examinations to investigate the intra-observer agreement of the grading system. Results Intra-observer agreement was excellent (Kappa coefficient = 0.823) and inter-observer agreement was good (Kappa coefficient = 0.625). All patients who exhibited abnormal ocular movement had score discrepancy between a new fix-and-following grading examination. Conclusions The new fix-and-follow grading scale can be applied easily in preverbal children in an office setting, and it proved reliable and reproducible.

So You Think This Baby Has Appendicitis? The Subtle Clues and Deceptive Signs

Diagnosing appendicitis in infants is challenging due to varied and heterogenous presentations. Whilst the condition is uncommon, the consequences of missing this in a busy Emergency Department (ED) can be catastrophic. We report an 8-month-old infant who presented to ED with a brief history of reduced feeding, lethargy and vomiting with normal observations. Excessive crying was noted when the child was supine, he was consolable when placed prone. Due to these paroxysms of crying which varied with position, investigations were commenced. He had a good clinical outcome. A high degree of suspicion is needed in preverbal children. Clinical examination, observation of the behaviour of the child and parental concern remain key to diagnosis. Through this paper we aim to explore the clinical conundrum of making the diagnosis in this age group and the modalities which help in decision making.

Automated visual acuity evaluation based on preferential looking technique and controlled with remote eye tracking

Objective. To establish an automated visual acuity test (AVAT) for infants, based on preferential looking technique and controlled with remote eye tracking. To validate the AVAT in a group of healthy children. To compare AVAT visual acuity (VA) values with corresponding VA values, acquired with standard tests (ST). Methods. ST, adapted for age (Keeler acuity cards in preverbal children, LEA symbols in verbal children), was performed to obtain monocular VA in a group of 36 healthy children. During AVAT, nine different stimuli with grating circles that matched spatial frequencies of nine Keeler acuity cards (raging between 0.29–14.5 cycles per degree) were projected on a screen. Three repetitions of each stimulus were showed during nine-second intervals, interchanging with an attention grabber. The remote eye tracker was used to evaluate the proportion of time a child spent looking at each grating circle compared to a homogenous grey background that matched the grating stimuli in average luminance. From this proportion of time child's binocular VA was evaluated. Results. 97 % (35/36) of healthy children successfully completed ST and AVAT. There was an agreement between the results of a ST and AVAT, Lin’s concordance coefficient being 0,53 (95% CI= 0,31–0,72). A tendency was observed towards VA overestimation on AVAT for children with VA> 0.4 logMAR on ST and towards VA underestimation on AVAT for children with VA ≤ 0.4 logMAR on ST. Conclusions. AVAT requires a minimally skilled investigator. The evaluation of better eye monocular VA on ST and binocular VA on AVAT were comparable for healthy children.

Endocrine Emergencies

Diabetic emergencies are commonly seen in children presenting for emergency care; whereas other endocrine emergencies, such as myxedema coma, are much less frequently encountered. In some cases, the lack of specific or sensitive signs and symptoms, even more challenging in young or preverbal children, can result in treatment delays and clinical deterioration. Despite the complexities of the endocrine system, clinical endocrinology can be approached simply by learning to recognize the signs and symptoms of hormone excesses and deficiencies. In this chapter, the most common pediatric endocrine emergencies are discussed, and a practical approach to diagnosis and management is also presented.

Preverbal children as co-researchers: Exploring subjectivity in everyday living

This article theoretically refines the rendering of a conceptual framework suitable for including preverbal subjects, i.e., infants, in research. It is argued that the theoretical framework “psychology from the standpoint of the subject” is useful, as its conceptualization of the human–world relationship is a dialectical one that emphasizes how children are active subjects in their own lives. Nevertheless, key concepts such as subjective reasons for action and first-person perspective, do not sufficiently encompass bodily and emotional activity. The article discusses the framework’s inadequacies and, by extension, proposes the notion of Befindlichkeit, a German word translated here as embodied orientation, as a key concept that allows the inclusion of infants and toddlers as co-researchers. Befindlichkeit contributes to the analysis of the human–world relationship by situating bodily and emotional activities in processes of orientating in social practice.