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Fulltext A comparative evaluation of dengue diagnostic tests based on single-acute serum samples for laboratory confirmation of acute dengue

Chua KB, Mustafa B, Abdul Wahab AH, Chem YK, Khairul AH, Kumarasamy V, et al.

Malays J Pathol, 2011 Jun;33(1):13-20.
PMID: 21874746

A prospective study was carried out to evaluate the sensitivity of dengue NS1 antigen-capture ELISA in comparison with dengue virus isolation, conventional RT-PCR and real-time RT-PCR for laboratory confirmation of acute dengue based on single-acute serum samples. Four primary healthcare centres were involved to recruit patients with clinical diagnosis of dengue illness. Patient's demographic, epidemiological and clinical information were collected on a standardized data entry form and 5 ml of venous blood was collected upon consent. In the laboratory, six types of laboratory tests were performed on each of the collected acute serum sample. Of the 558 acute serum samples collected from 558 patients with clinical diagnosis of dengue from mid-August 2006 to March 2009, 174 serum samples were tested positive by the dengue NS1 antigen-capture ELISA, 77 by virus isolation, 92 by RT-PCR and 112 by real-time RT-PCR. A total of 190 serum samples were tested positive by either one or a combination of the four methods whereas, only 59 serum samples were tested positive by all four methods. Thus, based on single-acute serum samples, 190 of the 558 patients (34.1%) were laboratory-confirmed acute dengue. The overall test sensitivity was 91.6%, 40.5%, 48.4% and 58.9% for dengue NS1 antigen-capture ELISA, virus isolation, conventional RT-PCR and real-time RT-PCR respectively. Statistically, dengue NS1 antigen-capture ELISA was the most sensitive and virus isolation was the least sensitive test for the laboratory confirmation of acute dengue based on single-acute serum specimens. Real-time RT-PCR was significantly more sensitive than the conventional RT-PCR.

Matched MeSH terms: Child; Child, Preschool
Spitz tumour with ALK rearrangement: A case report and literature review

Lai SK, Bakrin IH, Abd Rauf N, Abdul Raub SH

Malays J Pathol, 2024 Apr;46(1):103-108.
PMID: 38682850

Spitz tumour with ALK rearrangement is a recently described entity and a rare tumour. The incidence of Spitz tumour was estimated at 3.63 per 100,000 persons in American paediatric population; while there is no data in Asian population. Here we reported a case of an eleven-year-old Asian boy who presented with a left shin nodule of two months' duration. The skin biopsy revealed a Spitz tumour with predominantly spindle cell morphology arranged in fascicles, vertically orientated nests and radial growth pattern. Junctional component, melanin pigment or Kamino bodies were not identified. Immunohistochemical study displayed homogenous cytoplasmic staining for ALK. Fluorescence in-situ hybridisation (FISH) analysis confirmed ALK rearrangement. Review of the literatures demonstrated that positive ALK immunohistochemistry may not correlate with ALK rearrangement. ALK-rearranged Spitz tumour confirmed with FISH analysis favour clinically benign behaviour despite atypical histomorphology or positive sentinel lymph node. Therefore, correlation of histomorphology, immunohistochemical stain and molecular study are important for the definitive diagnosis of this entity.

Matched MeSH terms: Child
Ethnic variations of sweet preferences in Malaysian children: a pilot study

Jaafar N, Abdul Razak I

J Pedod, 1990;14(3):147-9.
PMID: 2081132

Diet and sugar eating habits, in particular sweet preference levels, are gradually nurtured over time by culturally accepted dietary norms. The dietary habits of Malaysia's three main ethnic groups are distinctively different from each other and expectedly, many studies have discovered significant ethnic variations in caries experience. In order to guide further research work into the causes of these variations, this pilot study was designed to establish whether ethnic variations exist in sweet preference levels. This study found that although the difference in sweet preference between boys and girls in this sample was not statistically significant, the ethnic variation was statistically significant. The implications of this study and suggestions for further research in this field are discussed.

Matched MeSH terms: Child
Toothbrushing effectiveness of a group of six-year-old uninstructed schoolchildren

Abdul Razak I

Dent J Malays, 1985 Apr;8(2):27-30.
PMID: 3917002

The main purpose of this study was to evaluate the effectiveness of toothbrushing in 124 six year-old uninstructed schoolchildren. The toothbrushing conditions were made to closely simulate the toothbrushing procedure carried out at home. The amount of plaque before and after toothbrushing was assessed using the Modified Personal Hygiene Performance Index. An overall reduction of 54.0 per cent in plaque score was observed following toothbrushing. This reduction was much more favourable than other reported studies using subjects of similar age group. However most of the plaque that remained following brushing were accumulated in the gingival areas. The highest prebrushing score and the least effective toothbrushing ability was observed among the Malay schoolchildren. The pre and postbrushing scores among the Chinese and Indians were comparable. There was no statistically significant difference in toothbrushing ability between boys and girls at this age. The children brushed their anterior teeth better than their posterior and the facial surfaces better than the lingual. The greatest percentage reduction in plaque score was observed in the occlusal/incisal areas with the gingival areas being the least accessible. The conclusions of this study points to the lack of manual dexterity of children of this age group to effectively brush their teeth and the need for proper parental supervision in assisting them to carry out the toothbrushing procedure.

Matched MeSH terms: Child
Caries experience and increment in a cohort of Malaysian schoolchildren of different racial origin

Abdul Razak I

Odontostomatol Trop, 1984 Sep;7(3):129-32.
PMID: 6597927
Matched MeSH terms: Child
Fulltext Myalgia Cruris Epidemica: an unusual presentation of dengue fever

Ahmad R, Abdul Latiff AK, Abdul Razak S

Southeast Asian J. Trop. Med. Public Health, 2007 Nov;38(6):1084-7.
PMID: 18613550

We describe a 5-year-old girl who had sudden onset difficulty in walking after 3 days of febrile illness. In the emergency department her creatine kinase level was elevated but urine myoglobin was normal. She was diagnosed as having benign acute childhood myositis. Because of poor oral intake and dehydration, she was admitted to the pediatric ward. The next day she had a petechial rash over the antecubital fossa, and dengue IgM back was positive. She was treated conservatively and recovered uneventfully. Despite dengue fever being endemic in Malaysia, this is the first case report of myositis following dengue infection in Malaysia.

Matched MeSH terms: Child, Preschool
Ball-bearing in ear

Abdul Wahab A

Br Med J, 1955;2:439.

I would like to report the case of a Chinese boy of 5 years old who came to see me with a ball-bearing in one of his ears. Repeated attempts were made to extricate it under general anaesthesia by means of several kinds of aural apparatus, but they all failed. While about to give up hope and hand him over to a specialist, I managed to borrow a pair of magnetic forceps from a radio mechanic. The ball-bearing was immediately attracted to the point of the forceps and drawn out with ease. It would not be a bad idea to design a magnetic aural (or nasal) forceps based upon the above principles with a view to avoiding unnecessary pain and misery to the young victims.

Matched MeSH terms: Child
Fulltext The bacteriology of perforated appendix

Lim VKE, Hussin Z, Abdul Wahab Y

Med J Malaysia, 1983 Dec;38(4):275-8.
PMID: 6599982

Perforated appendix is a serious surgical condition that carries a high morbidity. Antibiotic treatment is often started before the availability of bacteriological reports. The choice of antibiotics would depend on the bacteriology associated with perforated appendix. In a retrospective survey of the bacteriology of peritoneal pus obtained from cases of perforated appendix at the General Hospital, Kuala Lumpur, E. coli was found to be the most commonly encountered organism. This was followed in order of decreasing frequency by streptococci, Bacteroides species, Klebsiella-Enterobacter group and Pseudomonas aeruginosa. From the results of the antibiotic sensitivities an antibiotic regimen comprising of a combination of gentamicin, metronidazole and penicillin is recommended as appropriate chemotherapy in perforated appendix.

Matched MeSH terms: Child; Child, Preschool
Congenital bilateral facial nerve hypoplasia with sensorineural hearing loss: a case report

Hamizan AW, Yean KT, Abdullah A

Int J Pediatr Otorhinolaryngol, 2012 Mar;76(3):455-9.
PMID: 22281372 DOI: 10.1016/j.ijporl.2012.01.002

A 3-year-old child presented with congenital bilateral facial nerve palsy with bilateral profound sensorineural hearing loss. High Resolution Computed Tomogram (HRCT) of the temporal bones found bilateral atresia of cochlear nerve canals, incomplete partition of the cochleae and narrow facial nerve canals. Magnetic resonance imaging (MRI) revealed bilateral hypoplasia of facial nerves and aplasia of both vestibulocochlear nerves. There have been no other reported cases with this presentation. The possible aetiology and treatment options for the patient are discussed. We highlighted the review of aplasia/hypoplasia of the facial nerve and hypoplasia of cochlear nerve canal.

Matched MeSH terms: Child, Preschool
Community Palliative Care Nurses' Challenges and Coping Strategies on Delivering Home-Based Pediatric Palliative Care

Chong L, Abdullah A

Am J Hosp Palliat Care, 2017 Mar;34(2):125-131.
PMID: 26424764 DOI: 10.1177/1049909115607296

OBJECTIVE: The aim of this study was to explore the experience of community palliative care nurses providing home care to children.
METHOD: A qualitative study was conducted at the 3 community palliative care provider organizations in greater Kuala Lumpur from August to October 2014. Data were collected with semistructured interviews with 16 nurses who have provided care to children and was analyzed using thematic analysis. Two categories were identified: (1) challenges nurses faced and (2) coping strategies. The themes identified from the categories are (1) communication challenges, (2) inadequate training and knowledge, (3) personal suffering, (4) challenges of the system, (5) intrapersonal coping skills, (6) interpersonal coping strategies, and (7) systemic supports.
CONCLUSIONS: These results reinforces the need for integration of pediatric palliative care teaching and communication skills training into all undergraduate health care programs. Provider organizational support to meet the specific needs of the nurses in the community can help retain them in their role. It will also be important to develop standards for current and new palliative care services to ensure delivery of quality pediatric palliative care.

Matched MeSH terms: Child
Lead exposure among Malaysian school children using delta-aminolevulinic acid as an indicator

Ming LO, Surif S, Abdullah A

Sci Total Environ, 1997 Jan 30;193(3):207-13.
PMID: 9092077

A study on lead exposure among school children aged between 7 and 12 years from Kajang and Sepang in the state of Selangor, Malaysia was carried out using delta-aminolevulinic acid (delta-ALA) levels in the urine as an index. The delta-ALA levels in urine were linked to variables which could contribute to lead exposure. Out of 1628 school children studied [Kajang (43.5%) and Sepang (56.5%)], only 194 subjects (16 and 8.8% from Kajang and Sepang, respectively) had urinary delta-ALA levels between 0.6 and 2.0 mg/100 ml. However, chi 2 analysis demonstrated significant association between delta-ALA of this group to some of the variables. The strongest association was found in the habit of biting fingernails (P < 0.025). Other statistically significant correlations were found between delta-ALA and father's occupation (P < 0.05) and the amount of time spent playing in the field (P < 0.01). Generally, this study indicates that school children in Kajang and Sepang are still relatively safe from excessively high lead exposure. However, a more sensitive indicator, which is based on a lower tolerable lead limits, such as lead in blood, are necessary to affirm this finding.

Matched MeSH terms: Child
Cochlear nerve canal stenosis and associated semicircular canal abnormalities in paediatric sensorineural hearing loss: a single centre study

Zainol Abidin Z, Mohd Zaki F, Kew TY, Goh BS, Abdullah A

J Laryngol Otol, 2020 Jul;134(7):603-609.
PMID: 32713375 DOI: 10.1017/S0022215120001334

OBJECTIVE: This study aimed to evaluate the association between cochlear nerve canal dimensions and semicircular canal abnormalities and to determine the distribution of bony labyrinth anomalies in patients with cochlear nerve canal stenosis.
METHOD: This was a retrospective study in which high-resolution computed tomography images of paediatric patients with severe-to-profound sensorineural hearing loss were reviewed. A cochlear nerve canal diameter of 1.5 mm or less in the axial plane was classified as stenotic. Semicircular canals and other bony labyrinth morphology and abnormality were evaluated.
RESULTS: Cochlear nerve canal stenosis was detected in 65 out of 265 ears (24 per cent). Of the 65 ears, 17 ears had abnormal semicircular canals (26 per cent). Significant correlation was demonstrated between cochlear nerve canal stenosis and semicircular canal abnormalities (p < 0.01). Incomplete partition type II was the most common accompanying abnormality of cochlear nerve canal stenosis (15 out of 65, 23 per cent).
CONCLUSION: Cochlear nerve canal stenosis is statistically associated with semicircular canal abnormalities. Whenever a cochlear nerve canal stenosis is present in a patient with sensorineural hearing loss, the semicircular canal should be scrutinised for presence of abnormalities.

Matched MeSH terms: Child; Child, Preschool
Fulltext A Rare Case of an Undiagnosed Middle Ear Tumor Due to Late Referral

Ng JJ, Ong HY, Nasseri Z, Azmi MI, Abdullah A

Cureus, 2021 Jan 08;13(1):e12584.
PMID: 33457146 DOI: 10.7759/cureus.12584

Facial nerve tumors constitute about 5% of all facial nerve paralysis. As it is relatively uncommon, it could be misdiagnosed. We encountered an 18-year-old girl who had right facial weakness since the age of four, referred to otorhinolaryngology clinic for further evaluation only when her hearing deteriorated and the facial weakness worsened. Further investigation revealed facial nerve schwannoma. Facial nerve paralysis in the pediatric age group is uncommon and should be examined in detail to rule out other possible etiologies besides Bell's palsy.

Matched MeSH terms: Child
Reliability and Accuracy of Chirp Based Multiple Auditory Steady State Response (MSSR) and Auditory Brainstem Response (ABR) in Children

Woei TJ, Mazlan R, Tamil AM, Rosli NSM, Hasbi SM, Hashim ND, et al.

Int Tinnitus J, 2023 Dec 04;27(1):75-81.
PMID: 38050889 DOI: 10.5935/0946-5448.20230013

OBJECTIVE: The purpose of this study was to compare the reliability and accuracy of chirp-based Multiple Auditory Steady State Response (MSSR) and Auditory Brainstem Response (ABR) in children.
METHODS: The prospective clinical study was conducted at Selayang Hospital (SH) and Hospital Canselor Tuanku Muhriz (HCTM) within one year. A total of 38 children ranging from 3 to 18 years old underwent hearing evaluation using ABR tests and MSSR under sedation. The duration of both tests were then compared.
RESULTS: The estimated hearing threshold of frequency specific chirp MSSR showed good correlation with ABR especially in higher frequencies such as 2000 Hz and 4000Hz with the value of cronbach alpha of 0.890, 0.933, 0.970 and 0.969 on 500Hz, 1000Hz, 2000Hz and 4000Hz. The sensitivity of MSSR is 0.786, 0.75, 0.957 and 0.889 and specificity is 0.85, 0.882, 0.979 and 0.966 over 500Hz, 1000Hz, 2000Hz and 4000Hz. The duration of MSSR tests were shorter than ABR tests in normal hearing children with an average of 35.3 minutes for MSSR tests and 46.4 minutes for ABR tests. This can also be seen in children with hearing loss where the average duration for MSSR tests is 40.0 minutes and 52.0 minutes for ABR tests.
CONCLUSION: MSSR showed good correlation and reliability in comparison with ABR especially on higher frequencies. Hence, MSSR is a good clinical test to diagnose children with hearing loss.

Matched MeSH terms: Child; Child, Preschool
Fulltext Outcomes of Bone Anchored Hearing Aid Implant at Universiti Kebangsaan Malaysia Medical Centre (UKMMC)

Rahim SA, Goh BS, Zainor S, Rahman RA, Abdullah A

Indian J Otolaryngol Head Neck Surg, 2018 Mar;70(1):28-32.
PMID: 29456939 DOI: 10.1007/s12070-017-1193-3

The cross sectional study was conducted in Universiti Kebangsaan Malaysia Medical Center (UKMMC), Malaysia from August 2012 to December 2013. All patients implanted with in UKMMC from December 2001 until December 2012 was included. Glasgow Benefit Inventory (GBI) questionnaires and UKMMC questionnaires were used as part of the assessment tool. The GBI is a scoring which measures the change in health status produced by surgical interventions. UKMMC questionnaires was invented by our department to assess questions related to social and life style of patients and also the cosmetic perspective Baha implant and other daily related activities. The audiological assessment was assessed using hearing aid gain threshold. Complication with regards to skin reaction was graded using Holger Skin Classification. A total of 40 patients underwent Baha implant were recruited but only 35 patients fulfilled the criteria and included in this study for analysis. Age of patients ranged from 5 year old to 38 year old, with median of 13 years old. There were 22 patients (62.8%) were male and 13 patients (37.1%) were females. Almost all cases were canal atresia except one adult patient was a case of bilateral chronic discharging ear with chronic irritation with ear mould. Majority of patients 21 (60%) have hearing level of moderate to severe hearing loss (40-89 dB) and 14 patients (40%) have mild to moderate hearing loss (20-39 dB). The level of hearing was retested post operatively. All of the patients have improvement in their aided hearing with the range of 10-25 dBL which is statistically significant at p value of <0.05. The GBI was scored positively in all subscales. Majority of patients (91.4%) used BAHA more than 4 h per day and 88.6% agreed that BAHA is cosmetically acceptable. All patients experienced some form of skin irritation (Holger grade 1-2) however only 20% required surgical intervention. All our patients have range of 10-25 dB improvement of their aided hearing which is statistically significant at p value of <0.05. BAHA has been proven to show significant benefit in audiological improvement and quality of life.

Matched MeSH terms: Child, Preschool
Recurrent Cholesteatoma: Why it occurs?

Mohamed FS, Lokman FL, Mansoor WNBW, Shakri NBM, Hussain RI, Abdullah A

Int Tinnitus J, 2024 Mar 21;27(2):242-246.
PMID: 38512871 DOI: 10.5935/0946-5448.20230037

A cholesteatoma is an expansion of keratinizing squamous epithelium that enters the middle ear cleft from the outer layer of the tympanic membrane or ear canal. Choleatomas are always treated surgically. Recurrence of the illness presents another challenge for the patient and the surgeon, though. There have been reports of recurrence rates as high as 30% in adults and as high as 70% in children. Here, we describe a case of persistent recurrent otorrhea following revision surgery, along with acquired recurrent cholesteatoma following canal wall down surgery. A 38-year -male with underlying Diabetes Mellitus and Hypertension presented with left scanty and foul-smelling ear discharge for 2 years and left reduced hearing. He was diagnosed with left chronic active otitis media with cholesteatoma for which he underwent left modified radical mastoidectomy, meatoplasty and tympanoplasty in 2017. Five months post operatively, he presented with left otorrhea. However, he defaulted followed up and presented in April 2018 for similar complaints. Otoscopy examination revealed left tympanic membrane perforation at poster superior quadrant of pars tensa and bluish discoloration behind pars flacida. He was diagnosed as recurrent left cholesteatoma and subsequently he underwent left mastoid exploration under general anesthesia in June 2018. Postsurgery, he developed recurrent ear discharge which was treated with topical antibiotics and ear toileting. We report a case of recurrent Cholesteatoma despite canal wall down procedure requiring a second redo procedure and with persistent recurrent otorrhea after the redo procedure.However, this case demonstrates the need for regular follow ups even after a canal wall down procedure for detecting recurrence of disease. Moreover, this case denotes some of the patient factors and surgeon factors involved in disease recurrence. Furthermore, importance of opting for an imaging study in case of high suspicion of the disease.

Matched MeSH terms: Child
Children's knowledge and beliefs about medicines

Dawood OT, Mohamed Ibrahim MI, Abdullah AC

J Child Health Care, 2015 Mar;19(1):73-83.
PMID: 23975718 DOI: 10.1177/1367493513496911

Minor illnesses in children are often cured at home with over the counter medicines. Even though there is a wide use of medicines among children, they rarely receive medical advice about their medications from doctors or pharmacists. The aim of this study is to evaluate children's beliefs about medicines as well as to explain what children know about medicines. A cross-sectional survey was used to collect data from four primary schools in Penang Island, Malaysia. The target population of this research was schoolchildren of 11 and 12 years old regardless of their gender and social status. A self-administration questionnaire was used to obtain the data from schoolchildren and their parents. After including all schoolchildren in grades five and six, the total sample size was 1000 children in addition to 1000 parents. This study found that most children have inadequate knowledge and false beliefs about the efficacy of medicines. Children's beliefs about the efficacy of medicines were affected by their age group, gender and race (p

Matched MeSH terms: Child; Child, Preschool
Acquisition of Consonant Clusters and Acceptable Variants in Chinese-Influenced Malaysian English-Speaking Children

Phoon HS, Maclagan M, Abdullah AC

Am J Speech Lang Pathol, 2015 Aug;24(3):517-32.
PMID: 26125520 DOI: 10.1044/2015_AJSLP-14-0037

This study investigated consonant cluster acquisition in Chinese-influenced Malaysian English (ChME)-speaking children.

Matched MeSH terms: Child; Child, Preschool
Fulltext Mometasone furoate intranasal spray is effective in reducing symptoms and adenoid size in children and adolescents with adenoid hypertrophy

Ghafar MHA, Mohamed H, Mohammad NMY, Mohammad ZW, Madiadipoera T, Wang Y, et al.

Acta Otorrinolaringol Esp (Engl Ed), 2019 08 07;71(3):147-153.
PMID: 31400807 DOI: 10.1016/j.otorri.2019.04.004

INTRODUCTION: The use of mometasone furoate (MF) intranasal spray in treating adenoid hypertrophy (AH) has a variable outcome due the different methods of adenoid size evaluation. The aim of our study was to evaluate the effect of MF intranasal spray in children and adolescents with AH using a reliable and consistent endoscopic evaluation.
MATERIAL AND METHOD: A prospective interventional study was conducted. Evaluation took place during the first visit (week 0) and second visit (week 12). Symptoms of nasal obstruction, rhinorrhoea, cough and snoring were assessed, and an overall total symptoms score was obtained. A rigid nasoendoscopic examination using a four-grading system of adenoid size from 1 to 4 was performed. Patients were treated with MF intranasal spray for 12 weeks. Patients' aged 7-11-years old used 1 spray in each nostril once daily, while patients aged 12-17 used two sprays in each nostril once daily. Reassessment was carried out during the second visit (week 12).
RESULTS: A total of 74 patients was recruited. There were significant improvements from week 0 to week 12 in the symptoms' score for nose obstruction, rhinorrhoea, cough, snoring including the total nasal symptoms' score (p<0.001). AH significantly reduced in size from week 0 (2.89±.87) to week 12 (1.88±.83) (p<0.001).
CONCLUSION: MF intranasal spray is effective in improving the symptoms attributed to AH as well as reducing the adenoid size. MF intranasal spray is advocated as a treatment option before adenoidectomy is considered.

Matched MeSH terms: Child
Fulltext The Use of Stents in Children with Nasolacrimal Duct Obstruction Requiring Surgical Intervention: A Systematic Review

Tai ELM, Kueh YC, Abdullah B

Int J Environ Res Public Health, 2020 02 07;17(3).
PMID: 32046207 DOI: 10.3390/ijerph17031067

Nasolacrimal duct obstruction (NLDO) is the most common cause of childhood epiphora. It is managed conservatively in the first year of life, after which surgical treatment is classically based on a stepwise paradigm of probing, intubation, and dacryocystorhinostomy. This systematic review aims to present the current role of intubation in the management of children with NLDO requiring surgical intervention. A search for English-language articles from the electronic databases PubMed, SCOPUS, and the COCHRANE library was conducted over a period of five months in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook. The following keywords were used to aid retrieval: stents, children, lacrimal intubation, endoscopic dacryocystorhinostomy, external dacryocystorhinostomy, NLDO, dacryocystitis, congenital, acquired. The primary outcome was defined as the success of the intervention, determined by resolution of symptoms and patency of the lacrimal anatomy confirmed by the fluorescein dye disappearance test or syringing. Secondary outcomes included the presence of complications. A total of 144 articles were identified; of these, 35 fulfilled the study criteria. The majority of the included studies involved lacrimal intubation alone, followed by intubation as an adjunctive procedure to balloon dacryoplasty and dacryocystorhinostomy. The overall success rate of these procedures ranged from 41.1% to 100%. Post-operative complications were reported in 65.7% of the included studies. Lacrimal intubation was most commonly performed as a primary procedure in children with NLDO, with high success rates. The main complication was stent dislodgement. There is lack of evidence regarding the benefit of intubation over probing as primary treatment of congenital NLDO. In the absence of high-quality evidence, the decision of whether to perform lacrimal intubation in children with NLDO requiring surgical intervention depends on clinical judgement and other low-level evidence, such as observational non-randomised trials.

Matched MeSH terms: Child

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