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Adolescent asthma is a significant contributor to youth morbidity and is known to be best managed through consistent medication use and symptom management. However, adolescents often struggle to perceive their symptoms accurately and consistently use their medication at the recommended rate, risking worsened symptoms and impaired quality of life. The Responsive Asthma Care for Teens (ReACT) system is a project aimed at identifying and and providing supporting for several barriers adolescents may face in asthma management. By integrating both software and hardware to monitor medication adherence, ReACT provides a personalized support plan to improve asthma management and, subsequently, quality of life. The objective of this study is to conduct a proof-of-concept assessment of the ReACT system following an initial pilot study and adjusting for the feedback received. In addition to assessing the acceptability and usability of the current version, this study aims to assess whether the proposed ReACT system leads to indications of improvement in medication adherence because of the personalized support plans. Participants in the study were 5 adolescents aged 15 to 17 years recruited using a combination of consent-to-contact forms delivered via an in-person asthma clinic and Qualtrics panels. As a part of this study, participants met with the study team 3 times over 1 month. After completing initial surveys on stress, problem-solving, and asthma-related quality of life, we oriented the participants to the ReACT platform and asked them to interact with it as normal. After the month, the participants were interviewed, and they discussed the system and completed surveys assessing their opinions on acceptability and usability. On a 4-point scale, participants reported high acceptability of ReACT (mean score 3, SD 0.32), willingness to use it again (mean score 4, SD 0.89), and willingness to recommend it to a friend (mean score 3.75, SD 0.55), and they considered it to be helpful (mean score 3.2, SD 0.84). Our findings suggest that ReACT is an acceptable and usable mobile health intervention to improve asthma self-management among adolescents, and it had promising results for improving self-regulation, problem-solving, and asthma control. The system continues improving based on feedback from a larger sample size of participants, and we hope that ReACT will aid adolescent development while delivering highly personalized support for each user.

\"Tyler's brain is different. Unlike his friends, he has a hard time paying attention in class. He acts out in goofy, over-the-top ways. Sometimes, he even does dangerous things--like cut up a bus seat with a pocketknife or hang out of an attic window. To the adults in his life, Tyler seems like a troublemaker. But he knows that he's not. Tyler is curious and creative. He's the best artist in his grade, and when he can focus, he gets great grades. He doesn't want to cause trouble, but sometimes he just feels like he can't control himself.\"-- Publisher's webpage.

Pediatric asthma is the most common chronic respiratory disease of childhood. Caregivers often report lacking knowledge in several aspects of asthma management at home. Although the use of mobile health (mHealth) tools, such as mobile apps, could facilitate asthma self-management and, simultaneously, the collection of data for research, few studies have explored the features that caregivers would like to see in such a tool and their perceptions on data sharing. This study evaluates caregivers' perceived knowledge gaps in asthma management; their perceptions of certain features and resources that should be included in a potential mobile app; and any concerns that they may have regarding data sharing for research, including privacy and security concerns. In this cross-sectional study, we surveyed 200 caregivers of children (aged 1-13 y) with asthma who were followed at a pediatric tertiary care center in Montreal, Canada. Anonymous data were collected through the institutional web-based survey platform. We collected the participants' answers by using a 5-category Likert scale (\"completely agree,\" \"agree,\" \"neither agree nor disagree,\" \"disagree,\" and \"completely disagree\"), multiple-choice questions, and free-text questions on the abovementioned topics. Descriptive statistics were performed, and answers were compared between caregivers of preschool-aged children and caregivers of school-aged children. Participating children's mean age was 5.9 (SD 3.4) years, with 54% (108/200) aged ≤5 years and 46% (92/200) aged >6 years. Overall, caregivers reported having adequate knowledge about asthma and asthma self-management. Nonetheless, they identified several desirable features for a mobile app focused on asthma self-management. The most frequently identified features included receiving alerts about environmental triggers of asthma (153/199, 76.9%), having videos that demonstrate symptoms of asthma (133/199, 66.8%), and being able to log children's asthma action plans in the app (133/199, 66.8%). Interestingly, more caregivers of preschool-aged children preferred textual information when compared to caregivers of school-aged children (textual information for explaining asthma: P=.008; textual information for the symptoms of asthma: P=.005). Caregivers were generally highly in favor of sharing data collected through a mobile app for research. Caregivers of children with asthma in our study identified several desirable educational and interactive features that they wanted to have in a mobile app for asthma self-management. These findings provide a foundation for designing and developing mHealth tools that are relevant to caregivers of children with asthma.

Children with medical complexity experience multiple chronic conditions that demand intensive, ongoing, and highly coordinated care, often placing a burden on their parents, who serve as primary caregivers. Digital health offers a promising solution for enhancing care coordination, monitoring, and communication. However, its effectiveness depends on it being developed as a user-centered solution that incorporates feedback from parents, who are the primary decision-makers and advocates in their children's health care. By prioritizing the voices of parents, especially those from underserved communities, during the design and implementation of digital health solutions, these tools can more effectively meet their unique needs. This ensures that digital health solutions are effective in real-world caregiving scenarios. This qualitative study explored the experiences of family caregivers of children with medical complexity, with a focus on parents from underserved communities, shedding light on the challenges they face and opportunities for future digital health innovations. Underserved communities in this study are defined as families experiencing structural barriers to accessing specialized care for children with medical complexity, often necessitating additional support from nonprofit or community-based organizations. We conducted semistructured interviews with 19 parents of children with medical complexity from underserved communities. All interviews were conducted over Zoom and were audio recorded. We conducted an inductive, reflexive thematic analysis using an iterative codebook to support analytic transparency. The children in this study had a variety of chronic conditions, each experiencing at least 3 chronic, long-lasting medical conditions. An inductive thematic analysis revealed two broader key themes: (1) virtual care and (2) consumer mobile health (mHealth) apps. The \"virtual care\" theme focused on the use of remote health care services and communication with health care providers, highlighting parents' challenges and needs for enhancing virtual care. The \"consumer mHealth apps\" theme identified needs and challenges in the care management of children with medical complexity that could be addressed through consumer mHealth apps. This study highlights several insights into the digital health needs of children with medical complexity and their family caregivers. Parents identified a clear and urgent need for telehealth features tailored to better support the unique needs of care for children with medical complexity. Despite the growing adoption of consumer mHealth apps, caregivers reported ongoing challenges, underscoring the necessity for user-centered solutions that are specifically designed with their needs in mind. Future research and development should focus on integrating user feedback to continuously refine and enhance digital health solutions. By addressing these gaps, technology can better empower caregivers and improve the overall health care experience for families of children with medical complexity. Ultimately, this study provides valuable guidance for future digital health innovations to support parents of children with medical complexity from underserved communities.

Asthma is a prevalent chronic respiratory condition among children worldwide. Inhalation therapy is the primary treatment method, but children often make errors in its use and exhibit poor adherence, which impacts treatment effectiveness. Therefore, interventions to improve inhalation techniques and enhance adherence are urgently needed. This study aimed to develop and evaluate BreatheBuddy, developed by Haoyu Zhang, a training system incorporating gamified feedback designed to enhance inhalation skills and treatment adherence in children with asthma. This study used a single-factor repeated-measures design and recruited 20 children aged 6 to 8 years (10 boys and 10 girls), all of whom had prior experience with inhalers. The experimental group used the BreatheBuddy system, which combines a physical inhaler with an interactive game-based software. The system provides real-time animated feedback based on data from inhalation, breath-holding, and exhalation to guide the rhythm and depth of inhalation. The control group used a conventional inhaler method without a gamified system. Inhalation accuracy, adherence, and satisfaction were assessed using the respiration sensor, the Player Experience of Need Satisfaction scale, the Game User Experience Satisfaction Scale (GUESS), and the System Usability Scale (SUS) scales. Statistical comparisons between the groups were conducted using paired t tests and Mann-Whitney U tests to analyze differences. The experimental group demonstrated significant improvements in inhalation accuracy, with longer breath-holding times and more stable breathing patterns compared to the control group (P<.001). The experimental group also exhibited significantly higher engagement and motivation, with Player Experience of Need Satisfaction (standardized score=93.83) and GUESS (median 87.92, IQR 86.54-88.46) scores markedly higher than those of the control group. Usability scores for the experimental group were also superior, with an SUS score of 88.96 (P<.001). Additionally, children in the experimental group showed reduced anxiety and improved focus during training. BreatheBuddy effectively optimized children's inhalation skills, boosted treatment adherence, and relieved inhalation-related anxiety. Different from conventional non-gamified training or simple game-based distraction, this study integrated breathing behaviors into core game interaction. With dynamic respiratory rhythm feedback, the system unifies skill training, motivation promotion, and emotional regulation. Combined with standard inhaler operation and immersive gamified interaction, it presents a novel behavior-oriented design paradigm. This work provides empirical evidence for gamified intervention in pediatric respiratory treatment and offers a practical auxiliary tool for clinical daily training to strengthen children's self-management. Further research will focus on personalized adjustment and wider clinical application of the system.

Pediatric to adult health service (AHS) transition is a challenging time for many adolescents and young adults with chronic illness. As the responsibility of illness management shifts from parents to the young person themselves, many young people fail to transition in a timely manner, which has important health consequences. Mobile apps show potential in assisting young people to self-manage their condition during this vulnerable time, but empirical data on app uptake as well as efficacy with respect to transition outcomes and illness control are lacking. This study aimed to evaluate the usage of a mobile app called \"TransitionMate\" (TMApp) by adolescents and young adults, which was purpose-built to support chronic illness self-management for youth undergoing transition. Secondary aims were to assess AHS attendance and changes in illness control over the first 12 months post transition. Upon demonstration of TMApp feasibility (49/70, ≥70% of participants using TMApp at least once a month), a randomized controlled trial was planned to test app efficacy in relation to transition and illness control outcomes. Young people aged 16-19 years who were transitioning out of 2 major pediatric hospitals in Sydney, New South Wales, Australia, were recruited. Just before transition, participants' demographic and clinical details were collected, and TMApp was installed on their mobile devices. Participants were contacted by telephone at 6 and 12 months for information on self-reported usage, app usefulness, and other feedback. Quantitative cohort-level usage data, including the number of times specific app features were accessed, were tracked via mobile analytics. At 12 months, electronic medical records from participants' designated AHS were accessed for data on AHS attendances, measures of illness control, and unplanned hospitalizations. In total, 73 adolescents and young adults (30 male; median age 18, IQR 17-18 y) were recruited, with 1 withdrawing participation in the first month. Participants were primarily from 3 chronic illness subgroups-diabetes mellitus (n=23), inflammatory bowel disease (n=19), and cystic fibrosis (n=9). Of the total, 50% (36/72) of participants reported using TMApp at 1 month post transition. Self-reported usage rates fell to 25% and 11% at 6 and 12 months, respectively. Mobile analytics data broadly corroborated self-reported usage. Furthermore, 8 participants who continued to use TMApp for 12 months gave a median usefulness rating of 8/10. Over two-thirds (48/72, 68%) of participants successfully transitioned to their designated AHS by 12 months. Among the successful transitioners who had illness control data available on electronic medical records, over 80% (24/30) maintained a stable or improved illness status at 12 months. TMApp was not used regularly enough by our young people to demonstrate feasibility and justify progression to a randomized controlled trial. Despite low app uptake, most participants successfully transitioned, suggesting that TMApp had minimal influence on transition outcomes.

The electronic version of the Control of Allergic Rhinitis and Asthma Test for Children (CARATKids) has the potential to enhance pediatric telemonitoring but has not yet been validated. This study aimed to validate the electronic version of CARATKids against the paper-based version. A cross-sectional study was conducted between April and December 2024 in a tertiary hospital in northern Portugal. Children with asthma or allergic rhinitis and their caregivers were recruited during pulmonology outpatient appointments. CARATKids comprises 13 yes or no questions, 8 addressed to the child and 5 to the caregiver, and the total score ranges from 0 to 13. The electronic CARATKids was made available through a mobile app. Both paper and electronic versions were administered in a randomized order before and after the appointment. In addition, participants' preferences between the two administration versions were assessed. Internal consistency (Cronbach α), reliability (intraclass correlation coefficient [ICC], Bland-Altman analysis), and convergent validity (Spearman coefficient) were analyzed following COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. A total of 51 children (median 9, IQR 8-11 years; n=29, 57% male) and respective caregivers (median 41, IQR 7-45) years were included. The CARATKids total score was similar across the paper (median 5, IQR 3-8) and electronic (median 5, IQR 3-7) versions. The internal consistency was 0.79 for the paper version and 0.83 for the electronic version. The reliability between the two versions was excellent (ICC 0.95, 95% CI 0.91-0.97). The Bland-Altman analysis showed strong agreement between the two versions, with a mean difference of 0.04 (95% CI -1.99 to 2.07). The Spearman correlation between the two versions was 0.95 (P<.001). In total, 63% (n=32) of children and 61% (n=31) of caregivers were indifferent to the version used, while 33% (n=17) and 35% (n=18), respectively, preferred the electronic version. The electronic version of CARATKids appears to be equivalent to the paper-based version of the questionnaire, with good acceptance by children and caregivers. CARATKids implementation in mobile health technologies has the potential to enhance remote child monitoring and optimize the management of asthma and allergic rhinitis.

Shared decision-making is increasingly valued worldwide in pediatric care; nonetheless, its application in Japanese clinical practice remains in its early stages, particularly in areas with substantial medical uncertainty, such as food allergy (FA) management. Although oral immunotherapy is a promising option for children with FA, its long-term effectiveness and safety remain under evaluation, providing families with limited evidence to navigate emotionally complex decisions. Despite this clinical uncertainty, decision aids (DAs) are beneficial for organizing information and supporting patients and families in making value-congruent choices. Involving children in these decisions is increasingly recognized as ethically and developmentally appropriate. DAs clarify treatment options and promote informed collaborative decisions. However, most DAs target adult users and do not explicitly encourage engagement with children's views. This study aimed to develop a culturally adapted DA for Japanese parents by considering their children's preferences and perspectives. A paper-based DA was developed through iterative alpha testing and finalized by a multidisciplinary team. In total, 9 parents of children eligible for oral immunotherapy participated in this study and received the DA. Although intended for parents, the DA was structured to prompt reflection on the children's involvement in decision-making. Parents completed structured questionnaires before and 1 week after receiving the DA to assess uncertainty, anxiety, and the burden of FA management. A total of 4 children completed the quality-of-life (QoL) questionnaire. Subsequently, all 9 parents and 4 children participated in semistructured interviews. Parents discussed how they used the DA, their perceptions of its clarity, and their interest in involving their children in decision-making. The children shared their thoughts about participating in decision-making. All 9 parents read the DA and completed the follow-up assessment (100% retention rate). Among them, 4 children participated in pediatric QoL assessments and interviews. Parents' Decisional Conflict Scale scores significantly decreased from 58.3 (SD 29.9) at baseline to 26.7 (SD 24.1) postintervention (t8=2.65; P=.03). The values clarity subscale also significantly declined, from 73.1 (SD 30.6) to 25.9 (SD 26.2) (t8=4.50; P=.002). No significant changes were observed in parental anxiety and QoL. Overall, 7 of the 9 parents explained the treatment options to their child, and 6 reported actively seeking their child's feelings. The interview results suggested that the DA was associated with a shift in the family dynamic \"from protecting to partnering.\" Culturally adapted DAs appear practical and acceptable to Japanese families when making pediatric FA treatment choices. Facilitating parent-child dialogue may promote more inclusive decision-making. Nevertheless, further research with larger samples and longer follow-up periods is warranted to confirm these findings and refine the tool.

Amblyopia is a common cause of visual impairment in children. Compliance with traditional treatments for amblyopia is challenging due to negative psychosocial impacts. Recent shifts in amblyopia treatment have moved from suppressing the dominant eye to enhancing binocular visual function. Binocular digital therapy has become a promising approach. The aim of this study was to evaluate the effects of binocular gamified digital therapy on visual acuity and stereoacuity (SA) in children with unilateral amblyopia. This pilot prospective study enrolled 11 children aged 4-6 years with unilateral amblyopia. Following at least 8 weeks of refractive correction, participants underwent binocular gamified digital therapy for 60 minutes per day, 5 days a week. The therapy used a roguelike shooting game delivered under binocular conditions through two independent channels with a real-time artificial intelligence visual engine. Assessments of distance visual acuity (DVA), near visual acuity (NVA), and SA were conducted at baseline and again at 4, 8, and 12 weeks. At 12 weeks, the following significant improvements were noted: amblyopic eye DVA improved by 1.0 line (P=.01; d=0.77), binocular DVA improved by 0.7 lines (P=.006; d=1.00), and SA improved by 0.3 logarithm (log) arcseconds (P=.01; d=0.97). At 8 weeks, improvements included amblyopic eye DVA by 0.9 lines (P=.046; d=1.00) and SA by 0.28 log arcseconds (P=.02; d=0.90). No significant adverse events were observed, although one participant developed progressive esotropia. Binocular gamified digital therapy is effective and safe for improving visual outcomes in children aged 4-6 years with unilateral amblyopia.