Theory and Clinical Practice in Pediatrics

Background: Vitamin D deficiency has been increasingly recognised among children and adolescents with epilepsy, particularly in low-resource settings, where disease-related factors, antiepileptic treatments, and nutritional deficiencies may contribute to reduced serum levels. This study aimed to assess vitamin D status and identify associated factors in children and adolescents with epilepsy in Watsa health zone, Democratic Republic of the Congo. Methods: A cross-sectional study was conducted among 43 children and adolescents with epilepsy. Sociodemographic, clinical, nutritional, and treatment-related data were collected. Serum 25-hydroxyvitamin D [25(OH)D] and calcium levels were measured. Associations were explored using bivariate analyses, correlation tests, and multivariable linear regression models. Results: The mean age was 11.2 ± 6.3 years, and 55.8% were male. Most participants (60.5%) had uncontrolled seizures. Vitamin D insufficiency was highly prevalent (69.8%), while 25.6% had deficiency; only 4.7% had normal levels. Mean serum 25(OH)D was 23.5 ± 4.3 ng/mL. In bivariate analysis, fish (p = 0.002), milk (p < 0.001), and egg consumption (p = 0.013) were associated with higher vitamin D levels. No associations were found with age, sex, epilepsy characteristics, treatment, or calcium levels. In multivariable analysis, fish (β = 6.51; p < 0.001), milk (β = 4.32; p = 0.001), and eggs (β = 3.62; p = 0.004) remained independent predictors of higher serum 25(OH)D. Conclusion: Vitamin D insufficiency is highly prevalent among children and adolescents with epilepsy in Watsa health zone. Dietary intake of fish, milk, and eggs appears to be the main modifiable determinant of serum 25(OH)D levels, highlighting the importance of targeted nutritional interventions in this population.

Objective: To propose and analyze a playful adaptation of the Forced Expiratory Technique (FET) in children based on a mechanism-oriented framework for airway clearance.
Methods: This is a descriptive theoretical-conceptual study based on the development and analysis of a pediatric clinical protocol incorporating playful strategies into FET execution. The components of the technique were mapped to their underlying physiological mechanisms according to contemporary classifications of airway clearance techniques.
Results: The proposed model suggests that the playful adaptation of FET is theoretically capable of activating key physiological mechanisms involved in airway clearance, including airflow modulation, increased lung volumes, and secretion mobilization. The integration of these components supports a multimodal physiological approache.
Conclusion: The playful adaptation of FET may represent a feasible and physiologically grounded strategy to enhance adherence and facilitate the execution of therapeutic breathing patterns in pediatric patients.