Pakistan Pediatric Journal

Comparing the Effects of Incentive Spirometry Vs Mirror-Mediated Deep Breathing On Pulmonary Function, Sleep, and Quality Of Life in Children with Spastic Diplegic Cerebral Palsy (CP): A Single-Blind Randomized Controlled Trial

Ayesha Khalid — 2026-11-09

Objective: This study aimed to examine the effect of incentive spirometer as visual feedback vs. deep breathing exercise via mirror-mediated therapy in children with cerebral palsy.

Study Design: Randomized clinical trial.

Place and Duration of Study: National Institute of Rehabilitation Medicine (NIRM), 1st September 2023 to 11th December 2023.

Materials and Methods: 54 children with spastic Cerebral Palsy were randomly assigned to an experimental group (n=29) and a control group (n=25). Both groups underwent breathing exercises in front of a mirror, with the experimental group using an additional Incentive Spirometer. Pre and post-values of forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1/FVC were measured using pulmonary function tests. Quality of life and sleep problems were assessed using CPQOL and SDSC, respectively. Data were analyzed using SPSS version 23.

Results: Between-group analysis showed non-significant results for FVC, FEV1, and SDSC (p>0.05), FEV1/FVC, CPQOL, and SDSC. However significant results were obtained on comparing mean differences of FEV1/FVC, SDSC and CPQOL in the experimental group when compared to control group (p>0.05). Within-group analysis showed significant improvements (p<0.05) in FEV1/FVC, CPQOL, FEV1, and SDSC in both groups, except for FVC which was non-significant (p>0.05) for both groups.

Conclusion: There was no significant difference in use of Incentive Spirometer as visual feedback and deep breathing exercises via mirror-mediated therapy in improving lung function, sleep problems, and quality of life in children with spastic cerebral palsy when both groups were compared to each other. However significant improvements were observed in the experimental group in sleep problems and quality of life in children with spastic cerebral palsy when mean differences of CPQOL and SDSC were compared between groups.

Key Words: Cerebral Palsy, Deep breathing, Incentive spirometer, Mirror-mediated therapy, Visual feedback.

Serum vitamin D level as a predictor of severity of chronic liver disease in children in a resource limited country

Nadira Musabbir — 2026-11-09

Objective: To determine the role of serum vitamin D level in predicting the severity of CLD in children in a resource limited country.

Study Design: Cross-sectional study.

Place and duration of study: The study was conducted at Bangladesh Medical University, Dhaka, Bangladesh, from January 1, 2023 to December 31, 2024.

Materials and Methods: This cross-sectional study was done among 75 children with CLD between January 2023 and December 2024 at Bangladesh Medical University, Dhaka, Bangladesh. Child-Pugh class was used for assessment of severity of CLD and patients were categorized into three groups as Child-Pugh class A, B, and C. Vitamin D level was checked in all patients and labeled as: deficient (<20 ng/mL), insufficient (20–30 ng/mL), and sufficient (> 30 ng/mL).

Results: This study found that 81.3% of children with CLD had either vitamin D deficiency or insufficiency. Mean vitamin D level was 21.51 ± 8.64 ng/ml. Lower vitamin D level were inversely correlated with Child-Pugh class of CLD (r = - 0.701, p = 0.000). On univariate analysis, serum vitamin D level, bilirubin, albumin, INR and Hb were found as predictor of severity of CLD, whereas in multivariate analysis, only serum vitamin D level was found as a predictor of severity (p = 0.029).

Conclusion: Most children with CLD had either vitamin D deficiency or insufficiency. Lower serum vitamin D level was found as a predictor of severity of CLD in children. Thus, all children with CLD should have routine measurement for vitamin D level.

Parenting Practices and Challenges of Parents of Children with Special Needs during COVID-19 in Pakistan: A Mixed Method Research

Dr. Naeem Zafar — 2026-11-09

Objectives: The COVID-19 pandemic is continuing to affect people in numerous ways in Pakistan and across the world. The current study intended to observe stressors along with the impact of COVID-19 lockdown on parents of children with special needs. It also examined the dynamics of screen time during the COVID-19 lockdown.

Study Design: A Mixed-Method Sequential Explanatory Design was used.

Place and duration of study: The current study was conducted in various special education institutes of Lahore. The duration of data collection was two months.

Material and Methods: A scale on Parenting Response during COVID-19 (α=.75) was used.

Results: The current study highlighted various factors that added stress to the lives of parents of children with special needs during COVID-19. Findings indicate that a lack of recreational activities was the major challenge for parents of children with special needs. Increased screen time for the child with special needs was also reported.

Conclusion: The COVID-19 pandemic brought fear, uncertainty, and stress worldwide. Parents who have children with special needs experienced increased stress due to a lack of support, recreational, and educational services. These findings call for programs specifically designed for children with disabilities during crises and support for their parents.

Keywords: COVID-19, children with disabilities, parenting practices, parental mental health, stressors

desriptive Hype or Vile? Perception, Awareness & Practice attitudes of General Practitioners about Pediatric dermatology -A national survey

Uzma Amin — 2026-11-09

Background

Pediatric care differs from adults in clinical presentations, diagnostic and treatment challenges. Up to 30% of pediatric primary care visits include a skin- related problem and referrals are avoided due to long wait time.

Pediatric Dermatology is one of most underserved sub specialities in Pakistan. General practitioners and pediatricians encountering the children may face challenges by skin problems which is one of the most common clinical presentation. Do they refer to dermatology textbook, consult their colleague, do curb side consultation or straight away refer it and where do they refer because scope of dermatological conditions is so broad as to be beyond the skills of most of general practitioners or pediatricians.

Objective

To study whether there is early referral of pediatric dermatology cases that fall outside expertise of general practitioners and their perception about the need of pediatric dermatologist.

Methods

A survey 13- questions' anonymous survey was sent to active practicing primary care physicians, general practitioners and pediatricians in Punjab electronically through Google form. Questions were about the role of pediatric dermatologists, their need in tertiary care hospital, curb side consultation and to specify who can perform minor cutaneous surgical procedures among specialists. P≤0.05 was considered statistically significant.

Results

Response rate was 38%. There were one 646 responses. 74% of respondents were in favor of pediatric Dermatologist to treat pediatric dermatosis than a dermatologist (33% responses) but curbside consultation was unfamiliar to 77%. 61% respondents preferred pediatric surgeon to do minor procedures as compared to pediatric dermatologist. 92% agreed that pediatric dermatologist is a growing need of every tertiary care hospital.

Conclusion

Our primary care physicians and general practitioners agree about the need of pediatric dermatology as an expanding sub specialty. Proper dermatological referral or curbside consultations should be encouraged to improve timely health care provision.

Key words: Pediatric dermatology, Primary care Physicians, Referral and consultation, practice patterns, Attitudes, Pakistan.

SERUM ALBUMIN AS A PREDICTOR OF SEVERITY, MORBIDITY, AND MORTALITY IN NEONATAL SEPSIS

SUMAIYA ABDULLAH — 2026-11-09

Objective: To evaluate early serum albumin levels as a predictor of disease severity, morbidity, and mortality among neonates with sepsis.

Study design: Prospective cohort study.

Place and duration of study: Neonatal Intensive Care Unit, Civil Hospital Karachi, over a six-month period.

Materials and methods: A total of 218 neonates with culture-confirmed sepsis were enrolled using consecutive sampling. Neonates with prior antibiotic exposure, hypoxic-ischemic encephalopathy, suspected inborn errors of metabolism, or prior blood transfusion were excluded. Serum albumin levels were measured at admission. Demographic, clinical, and laboratory data were recorded, and neonates were followed until discharge or death. Outcomes included morbidity, length of hospital stay, and mortality. Correlation analyses and multivariable regression models were applied.

Results: The mean gestational age was 35.1±2.9 weeks, and 55.5% were preterm. Hypoalbuminemia (<2.5 g/dL) was present in 42.2% of neonates. Overall mortality was 17.4%, and morbidity occurred in 37.2%. Mortality was significantly higher in neonates with hypoalbuminemia compared to those with normal serum albumin (30.4% vs. 7.9%, p <0.001), as was morbidity (56.5% vs. 23.0%, p <0.001). Neonates with hypoalbuminemia had a significantly longer hospital stay (12.6±5.1 vs. 7.8±3.2 days, p < 0.001). On multivariable analysis, hypoalbuminemia independently predicted mortality (AOR = 3.21) and morbidity (AOR = 2.87).

Conclusion: Early hypoalbuminemia is common in neonatal sepsis and independently predicts adverse outcomes. Serum albumin is a simple, cost-effective prognostic marker for early risk stratification.

Treatment Outcome of uncomplicated Severe acute malnutrition at Outpatient therapeutic feeding program Aged 6 Months To 59 Months Over a Period of twelve years at territory care hospital Multan

reema arshad — 2026-11-09

Abstract

Background:

Children with Severe Acute Malnutrition are immunodeficient and are at increased risk of infections. WHO guidelines recommend outpatient care for uncomplicated SAM to reduce these risks.

Objective:

This study analyzed the treatment outcome of uncomplicated Severe acute malnutrition at Outpatient Therapeutic Program in children aged 6 months to 59 months.

Study design: a retrospective cohort study design was used

Place and duration of study: Outpatient Therapeutic feeding program of Children Hospital and Institute of Child Health, Multan, from 01.01.2011-31.12.2022.

Materials and methods:

this study analyzed children diagnosed with malnutrition, screened from all the children aged 6–59 months at Outpatient Therapeutic feeding program. Data included demographics, anthropometric measurements, and treatment outcomes, with biweekly monitoring of weight, height, and response to therapeutic interventions.

Results:

Out of 17,793 children registered as malnourished, 10,733 were diagnosed with Severe Acute Malnutrition, predominantly affecting children under 36 months (85%), with 90% diagnosed as Marasmus. Moderate Acute Malnutrition was found in 7,060 children. Referrals primarily came from the hospital subspecialties (60%), with self-referrals at 30% and community referrals at 10%. The SAM recovery rate was 85%, with an average weight gain of 11 g/kg/day and a 15% defaulter rate, while the average program stay for SAM cases was approximately 8 ± 1 week.

Conclusion:

This study demonstrates the effectiveness of the Outpatient Therapeutic Program (OTP) in achieving effective recovery and weight gain. Early detection and community-based care are crucial for reducing malnutrition and enhancing pediatric health outcomes.

Frequency of different types of leukodystrophy in children using magnetic resonance spectroscopy.

iram_javed javed — 2026-11-09

ABSTRACT

Objectives: To determine the frequency of different types of leukodystrophy in children using magnetic resonance spectroscopy.

Study design: Case series study.

Place and Duration of Study: Department of Radiology, Allied hospital, Faisalabad from July 2022 to December 2022.

Methodology: Total 130 patients of age 2 months to 15 years and either sex coming for MRI examination either for diagnosis of leukodystrophy were selected. 1H-MRS was performed for all patients for diagnosis of LD.

Results:In this study, frequency of different types of leukodystrophy in children using magnetic resonance spectroscopy were as follows; Krabbes disease in 15 (11.54%), Canavan’s disease in 23 (17.69%), Adreno LD in 48 (36.92%), Leigh disease in 30 (23.08%) and Metachromatic LD in 14 (10.77%).

Conclusion: This study concluded that MRS should be used in every patient with clinical leukodystrophies because it is cost effective as compared to other available tests.

Keywords: Leukodystrophies, Magnetic resonance spectroscopy, Krabb disease, Canavan disease.

Clinical subtypes, etiology and associated comorbidities in children with cerebral palsy: a single center experience from southern region of Saudi Arabia.

Muhammad Saeed — 2026-11-09

Objective: To study the cerebral palsy subtypes and their severity and to investigate the common associated complications.

Study design: Retrospective cross-sectional study.

Place & duration of study: This study was conducted in Pediatric Neurology Department, King Fahad Armed Forces Hospital Southern Region, Khamis Mushait, Kingdom of Saudi Arabia – a tertiary hospital and referral center in region, and study utilized patient record from 1^st April 2023 to 31^st March 2026.

Methodology: We reviewed electronic medical records of pediatric patients aged between 1 to 14 years of age and having a diagnosis of cerebral palsy and under follow-up in Pediatric Neurology Department during the preceding 3 years. The study collected demographic, clinical, and imaging data, including comorbidities such as epilepsy, behavioral issues, cognitive impairment, sleep disorder, visual and hearing impairment, and constipation.

Results: The study included 106 patients with cerebral palsy, of which 55.7% were female and 44.3% were male. The majority of patients (70.75%) had spastic cerebral palsy with quadriplegia being the most common subtype.. In terms of age, the largest proportion of patients was between 5-10 years old (46.2%). Prematurity and hypoxic ischemic encephalopathy (HIE) were the most frequent diagnoses associated with cerebral palsy as seen in 25 cases each (23.58%). The 83.96% patients were identified to have seizures, while intellectual disability was witnessed in 75.47%. The 66.03% patients were bedridden (GMFCS-V). 85% have MRI findings characterized by global volume loss with structural malformation, while behavioral issues were evident in 30 patients (28.30%).

Conclusion:

The findings suggest that spastic cerebral palsy with quadriplegia is the most common subtype, with the majority of patients experiencing seizures and intellectual disability, while behavioral issues evident in significant proportion. Prematurity and HIE were the most common cause and periventricular leukomalacia was the most common MRI finding.

Impact of Sensory Integration Therapy on Gross and Fine Motor Skills in Preschool Children with Autism Spectrum Disorder: A Pre-Post Interventional Study

Dr.Naveed Anjum Naveed — 2026-11-09

Abstract

Objective: To evaluate the effectiveness of sensory integration therapy (SIT) on gross and fine motor skills in preschool children diagnosed with autism spectrum disorder (ASD).

Study Design: Quasi-experimental (Pre-post interventional) study.

Place and Duration of Study: Department of Developmental and Behavioral Pediatrics, The Children’s Hospital and Institute of Child Health, Multan, from January to December 2025.

Methodology: Forty-four children with ASD, aged 36–60 months, were enrolled. Gross and Fine Motor skills were assessed at the time of enrollment and after six months of therapy, using the Peabody Developmental Motor Scales, Second Edition (PDMS-2). The children received individualized SIT, three times per week. Data were analyzed using the paired t-test, with p value less than 0.05 considered statistically significant.

Results: The study included 44 children (26 males; mean age 49.21 ± 6.25 months). Following 72 sessions of sensory integration therapy, significant improvements were observed in all PDMS-2 domains. Gross Motor Quotient improved by 19 points, Fine Motor Quotient by 15 points, and Total Motor Quotient by 17 points. The largest gains were observed in visual-motor integration (+25 raw score points) and grasping skills (+31 months’ age-equivalent gain). All improvements reached statistical significance (p<0.001).

Conclusion: Sensory integration therapy is associated with statistically significant improvements in gross and fine motor skills among preschool children with ASD. These findings support the inclusion of SIT within multidisciplinary rehabilitation protocols. Given the quasi-experimental nature of this study and the absence of a control group, further randomized controlled trials are required to validate these clinical facts.

Keywords: Autism spectrum disorder, Motor skills, PDMS-2, Sensory Integration Therapy.

Type 2B or Pseudo-Platelet type VonWillebrand Disease – Case Report of two Pediatric Patients with Thrombocytopenia.

Aisha Shaikh — 2026-11-09

Background:

Von Willebrand Disease (VWD) is the most common inherited bleeding disorder. It typically presents with mucocutaneous bleeding, though more severe hemorrhagic episodes may occur depending on the type and severity.

Type 2B- VWD results from gain-of-function mutations in the VWF gene, which enhances the protein’s affinity for the platelet GPIb, conversely pseudo-platelet type VWD (PT-VWD) has gain of mutation of gp1b, which increases affinity to bind with VWF antigen. Both are rare subtypes with concurrent low platelet counts, accounting for approximately 5% of VWD cases.

Case Presentation: We report two cases with bleeding diathesis and thrombocytopenia. The first case was four-year-old male, diagnosed immune thrombocytopenia (ITP) for 3 years of age with recurrent epistaxis and normal bone marrow biopsy findings. Despite multiple treatment modalities, his platelet count showed no significant improvement. Second case was 6 months old male baby presented with Melena, epistaxis, Anemic failure and Malaria vivax. Initially, he was treated for malaria parasite, later evaluated for bleeding disorder due to uncontrolled bleed and thrombocytopenia.

The patients had normal platelet morphology, prolonged activated partial thromboplastin time (APTT), bleeding time (BT) and normal Factor VIII level. Both cases received platelets transfusion as routine therapy in emergency, showed no clinical response. After consultation with a hematologist, 2B-VWD considered as administration of VWF concentrates showed significant response to treatment which supported diagnosis of 2B-VWD. However, PT-VWD responds with platelets transfusion, which was not observed in both cases.

Conclusion: This report discloses the diagnostic reappraisal of Immune thrombocytopenic purpura with Von Willebrand disease qualitative defect and early diagnostic consideration in 6-month patient. Different treatment approach applies to each entity: type 2B VWD patients can be treated with supplementary VWF, while PT-VWD patients need platelet transfusions.

case report When Dysphagia Leads to Diagnosis: A Case of Triple A Syndrome in a Malnourished Child

Sadia Qasim Qasim — 2026-11-09

Allgrove Syndrome, also called Triple A syndrome (TAS), is an uncommon autosomal recessive condition. We described the case of a 12-year-old girl who developed progressively worsening dysphagia over six years, beginning with difficulty of swallowing solid foods and later progressing to liquids. Over time, she experienced significant muscle wasting and became severely malnourished. Upon hospital admission, she was also found to have adrenal insufficiency and had a history of alacrimia since early infancy. This case highlights the diagnostic challenges and delays commonly associated with TAS.

A Case of Functional Non-Retentive Fecal Incontinence Mimicking Organic Disease”

Dr.Naveed Anjum Naveed — 2026-11-09

Abstract

Background:

Functional non-retentive fecal incontinence (FNRFI) is characterized by involuntary defecation occurring ≥1/week for ≥8 weeks in children >4 years, without constipation or fecal retention. It accounts for approximately 20% of pediatric fecal incontinence (FI) cases and is closely linked to behavioral and psychosocial factors.

Case Presentation:

An 11-year-old male presented with daily fecal soiling for four years. Neurological examination and spinal MRI were normal. Digital rectal examination revealed reduced sphincter tone without fecal impaction. Colonic transit time (48 hours) was normal, confirming FNRFI per Rome IV criteria. Management involved structured toilet training (post-meal and 4 PM), behavioral reinforcement, and dietary modification (avoiding excessive fiber).

Conclusion:

Functional non-retentive fecal incontinence is a frequently misdiagnosed condition that can mimic organic and constipation-related disorders. This case emphasizes the importance of a structured diagnostic approach integrating clinical history, transit studies, and selective imaging. Early identification and behavioral management can lead to favorable outcomes while avoiding unnecessary treatments and investigations.”

Keywords: Fecal incontinence; Functional non-retentive; Children; Behavioral therapy; Rome IV criteria

Bell’s Palsy: A Rare Presentation; Arachnoid Cyst in Posterior Fossa

Dr. Sikander Ikram sikander — 2026-11-09

Facial nerve palsy in children has multiple causes, with idiopathic Bell’s palsy being the most frequent and usually self-limiting. Infectious agents such as herpes simplex, EBV, varicella-zoster, CMV, mumps, HIV, and bacterial infections like otitis media, mastoiditis, tuberculosis, and Lyme disease are important considerations. Trauma from birth injury, temporal bone fractures, or surgery can also lead to palsy. Neoplastic causes include acoustic neuroma, leukemia, lymphoma, and parotid tumors. Congenital anomalies and syndromes like Moebius syndrome may present early, while autoimmune or inflammatory conditions such as sarcoidosis and Guillain–Barré syndrome are less common. Though rare, metabolic disorders like diabetes can also contribute. A comprehensive evaluation is essential to rule out secondary causes in children. While most pediatric facial nerve palsies are idiopathic, careful evaluation is crucial to exclude secondary rare causes that may require specific management.