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THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
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Vol.129, No.12, December 2025
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Original Article
Title
Characteristics of Children Who Visited a Hospital after Well-child Visits for Young Children and Their Adaptation at School
Author
Hirokazu Yamagishi1)2) Yukifumi Monden2) Hiroshi Watanabe1) Marie Sekido1) and Hideo Shimoizumi1)
1)Department of Pediatrics, Nasu Institute for Developmental Disabilities, International University of Health and Welfare
2)Department of Pediatrics, Jichi Medical University
Abstract
Since 2004, 5-year-old well-child visits have been conducted in Otawara, Tochigi Prefecture, Japan, to identify children who have difficulties in daily and/or group living and provide them with the appropriate support for starting school. We retrospectively analyzed 302 children who visited the Nasu Institute for Developmental Disabilities after undergoing well-child visits for young children and discussed the significance of the 5-year-old well-child visits.
In the group in which problems were identified before the 3-year-old well-child visits, many children received speech-language therapy because of language immaturity. On the other hand, in the group in which problems were first pointed out in the 5-year-old well-child visits, many received occupational therapy owing to behavioral problems and/or motor immaturity. Many of the children in the group whose problems were first identified during the 5-year-old well-child visits were enrolled in a regular school. Many children who experienced difficulties in learning and/or school life had behavioral problems, required drug therapy before starting school. Written reports regarding the issues faced by these children were submitted to the educational committee, and required continued medical follow-up even after starting school.
The 5-year-old well-child visits were able to identify children with the potential to develop difficulties after starting school. In addition, even if difficulties occurred after starting school, the children were able to respond quickly because information was shared with relevant institutions in advance, and medical follow-up was continued.
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Original Article
Title
Development and Implementation of a Human Genetics Education Program for Primary School Students, and Evaluation by Participants and Parents
Author
Sayoko Haruyama1) Takahito Wada1)2) and Masako Torishima1)2)
1)Department of Clinical Genetics Units, Kyoto University Hospital
2)Department of Genomic Medicine, Kyoto University School of Public Health
Abstract
In the era of advancing genomic medicine, improving public genetic literacy is an urgent challenge. We developed a genetics education program for elementary school students, focusing on the "diversity and heredity" of humans. The goal was to dispel negative images of "genetics" and promote understanding of ancestry, personal identity, diversity, and the interaction of genes and environment.
Between 2015 and 2024, we conducted 28 workshops for 4th-6th grade students. An anonymous questionnaire survey was administered to both the students and their attending parents. The data were analyzed using descriptive statistics and qualitative inductive methods.
Among the 548 students, 545 responded (99.5%), with 93.9% saying they understood the content. Over 90% reported understanding why siblings differ, why people have strengths and weaknesses, and why everyone is unique. Among 246 parents, 88.2% found the content easy for children to understand. Open-ended responses praised messages such as "everyone is different, and everyone is good" and "genetics does not determine everything."
The results suggest that the program's content and structure were appropriate and that the concept of human genetic diversity was effectively communicated. Additionally, the program may help parents learn alongside their children. We hope this program raises interest in human genetics education among pediatric healthcare and educational professionals, contributing to greater genetic literacy in Japan.
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Case Report
Title
Regression of Atrial Septal Aneurysm with Narrowing of the Foramen Ovale Reflecting Postnatal Hemodynamic Adaptation
Author
Yuta Azuma1) Hirokuni Yamazawa2) Takuma Akimoto1) Manaki Sasaki1) Mika Nakajima1) and Atushi Manabe2)
1)Department of Pediatrics, Hakodate Central General Hospital
2)Department of Pediatrics, Faculty of Medicine and Graduate School of Medicine, Hokkaido University
Abstract
Atrial septal aneurysm (ASA) can be observed in the fetal period or shortly after birth; however, its natural history remains largely unclear. We encountered a case of a full-term neonate who had not been prenatally diagnosed with any abnormalities but was found to have severe narrowing of the foramen ovale along with an ASA after birth. Although findings suggestive of left heart maladaptation to the postnatal decrease in pulmonary vascular resistance were observed, the patient exhibited no overt clinical symptoms. Under fluid restriction and diuretic therapy, the left heart gradually adapted to neonatal circulation over time. Concurrently, the ASA underwent morphological changes and regressed along with closure of the foramen ovale. ASA may serve as an indicator reflecting the hemodynamic transition from fetal to neonatal circulation. Moreover, as it has been associated with an increased risk of cerebral infarction in adulthood, our findings suggest the importance of continued echocardiographic follow-up from childhood in patients diagnosed with ASA.
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Case Report
Title
Pediatric Vitamin D Toxicity Due to Inadequate Quality Control and Lack of Ingredient Labelling of a Domestic Supplement
Author
Kentaro Suzuki1) Soichiro Ishimaru1) Saki Imai1) Yuka Ohashi1) Arika Murase1) Masayuki Hirai1) Yuka Mihara1) Hiroshi Kawaguchi1) Satoru Kisohara1) Haruo Mizuno2) and Tetsushi Yoshikawa2)
1)Department of Pediatrics, Kariya Toyota General Hospital
2)Department of Pediatrics, Fujita Health University School of Medicine
Abstract
Although imported supplement misuse-related vitamin D toxicity has already been reported, no previous cases in Japan have involved domestically manufactured supplements taken within the recommended dosages. Hereby, we present the case of a 7-year-old boy, admitted to our hospital due to fatigue and significant hypercalcemia. His serum 25-hydroxyvitamin D level was markedly increased (727 ng/mL). Interviews revealed that he had been taking two vitamin D-containing supplements from Company X (two capsules daily) for six months. These supplements lacked ingredient labelling. Upon inquiry, Company X disclosed that the capsules contained 200 and 25 μg of vitamin D, respectively, resulting in a daily intake of 450 μg, well above the highest tolerable intake level for children (40 μg/day). Therefore, the patient was diagnosed with vitamin D Toxicity. After discontinuing the supplements and starting pamidronate therapy, his serum calcium levels normalized, and the patient was discharged from the hospital without complications. Third-party analysis revealed large discrepancies between the declared and actual vitamin D contents, with certain capsules containing more than 12 times the stated amount, suggesting poor quality control during manufacturing. This is the first reported case of vitamin D toxicity caused by a domestic supplement within the labelled range in Japan. The lack of ingredient labelling and inadequate quality control contributed to unintentional overdose. This case highlights the need for stricter dietary supplement labelling-related regulations and quality control to prevent similar incidents.
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Case Report
Title
Polyarteritis Nodosa with Persistent Fever and Erythematous Nodosum-like Rash Diagnosed by Skin Biopsy
Author
Meika Nambu1) Zenshiro Tamaki2) Kayoko Ichimura3) and Satoshi Sato1)
1)Division of Infectious Diseases, Immunology and Allergy, Saitama Children's Medical Center
2)Division of Dermatology, Saitama Children's Medical Center
3)Division of Pathology, Saitama Children's Medical Center
Abstract
Polyarteritis nodosa (PAN) is a rare disease that causes necrotizing vasculitis in small and medium-sized arteries, presenting with systemic symptoms and various organ involvement. The diagnosis is made by identifying necrotizing vasculitis through histological findings or angiographic examination, while excluding other causes of vasculitis. Although the etiology of PAN is unknown, there are several reports suggesting an association with group A beta-hemolytic streptococcus (GAS) in children. We report a case of pediatric polyarteritis nodosa with persistent fever and erythema nodosum-like rash associated with GAS, which was diagnosed by skin biopsy.
A 10-year-old girl was diagnosed with group A streptococcal pharyngitis and was started on amoxicillin one week before admission. However, she visited our hospital due to persistent fever, lethargy, erythematous nodosum-like rash on the extremities, and arthralgia. The patient was treated with antibiotics and NSAIDs, but symptoms did not improve. A skin biopsy was performed and showed findings of necrotizing vasculitis. During treatment, mitral regurgitation and stenosis at the roots of the celiac artery and superior mesenteric artery were observed. After prednisolone was initiated, the fever resolved promptly, and other symptoms gradually improved. Secondary prophylactic antibiotics were started after discharge.
Since PAN can cause serious organ damage and sequelae, early diagnosis and appropriate treatment are important. In cases of erythematous nodosum-like rash, we should keep PAN in mind as a differential diagnosis.
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