Children

21 pages, 1456 KB

Open AccessArticle

Randomized Trial of Bioceramic Apical Barrier Methods in Necrotic Immature Incisors: Effects on Pain, Extrusion, and Procedure Duration

by Yasser Alsayed Tolibah, Nada Bshara, Osama Aljabban, Mohammad Tamer Abbara, Marwan Alhaji, Imad-Addin Almasri and Ziad D. Baghdadi

Children 2025, 12(10), 1423; https://doi.org/10.3390/children12101423 - 21 Oct 2025

Viewed by 1872

Abstract

Objective: This randomized controlled trial evaluated postoperative pain (PP), bioceramic extrusion, and procedure duration in necrotic immature incisors treated with three apical barrier methods (ABMs): Bioceramic Putty Apical Plug (BPAP), Single Cone with Bioceramic Sealer (SBS), and Bioceramic Putty–Sealer Mixture (BPSM). Case-related [...] Read more.

Objective: This randomized controlled trial evaluated postoperative pain (PP), bioceramic extrusion, and procedure duration in necrotic immature incisors treated with three apical barrier methods (ABMs): Bioceramic Putty Apical Plug (BPAP), Single Cone with Bioceramic Sealer (SBS), and Bioceramic Putty–Sealer Mixture (BPSM). Case-related factors influencing these outcomes were also examined. Methods: Ninety-nine children (8–11 years) with necrotic maxillary incisors and moderate periapical lesions were randomly assigned (1:1:1) to BPAP, SBS, or BPSM groups. Standardized protocols included calcium hydroxide dressing and XP-Endo Finisher irrigation. Pain (VAS) was recorded at 1-, 3-, 7-, and 14-day post-treatment. Extrusion (yes/no) and procedure duration were documented. Regression analyses identified predictors of outcomes. Results: At day 1, pain was highest in the BPAP group (mean 3.5) and lowest in the SBS group (mean 1.05; p < 0.001). Pain decreased substantially by day 3 and resolved in all groups by day 14. Extrusion was most frequent in SBS (60.6%) and least frequent in BPAP (21.2%; p = 0.002). Treatment duration was longest in BPAP (25.8 min) and shortest in SBS (12.6 min; p < 0.001). Regression showed that preoperative pain and pulpal diagnosis were the strongest predictors of postoperative pain. Apical size and ABM predicted extrusion, while apical size and child behavior significantly influenced duration. Conclusions: The apical barrier method had a significant impact on short-term outcomes. SBS offered reduced pain and shorter chair time but carried a higher risk of extrusion, while BPAP minimized extrusion but caused more pain and required more extended visits. Clinical selection should balance patient comfort, apical anatomy, behavior, and operator expertise. Longer-term outcomes on periapical healing remain to be evaluated. Full article

(This article belongs to the Collection Advance in Pediatric Dentistry)

► Show Figures

Figure 1

12 pages, 694 KB

Open AccessSystematic Review

Therapeutic Hypothermia in Sudden Unexpected Postnatal Collapse: Feasibility, Risks, and Long-Term Outcomes—A Systematic Review

by Enrico Cocchi, Aurora Brighi and Gina Ancora

Children 2025, 12(10), 1422; https://doi.org/10.3390/children12101422 - 21 Oct 2025

Viewed by 609

Abstract

Background/Objectives: Sudden unexpected postnatal collapse (SUPC) is a rare but catastrophic event affecting apparently healthy neonates during the first days of life. Therapeutic hypothermia has been increasingly applied in this setting due to pathophysiological overlap with hypoxic–ischemic encephalopathy, but its effectiveness remains [...] Read more.

Background/Objectives: Sudden unexpected postnatal collapse (SUPC) is a rare but catastrophic event affecting apparently healthy neonates during the first days of life. Therapeutic hypothermia has been increasingly applied in this setting due to pathophysiological overlap with hypoxic–ischemic encephalopathy, but its effectiveness remains uncertain. The aim of this review is to systematically identify, appraise, and synthesize the evidence on therapeutic hypothermia for SUPC. Methods: We searched MEDLINE, Scopus, Embase, Web of Science, and Cochrane up to February 2025. Eligible studies included term or near-term infants with SUPC within seven days of life who underwent therapeutic hypothermia. Data were extracted on demographics, collapse circumstances, therapeutic hypothermia protocol, mortality, seizures, neuroimaging, and neurodevelopment. Results: Thirteen studies were included, encompassing 70 infants. Most events occurred within two hours of life, during skin-to-skin or breastfeeding, and were strongly associated with primiparity. Therapeutic hypothermia was typically initiated within six hours of collapse, using whole-body cooling at 33–34 °C for 72 h. Mortality was approximately 10% (widely ranging from 0 to 50%). Seizures were frequent (70–90%), and MRI abnormalities were reported in about half of cases. Approximately half of survivors demonstrated normal neurodevelopment at one year. Study quality was low to moderate, and risk of bias substantial. Conclusions: Therapeutic hypothermia is feasible in SUPC and survival with favorable outcomes has been documented, but the certainty of evidence is very low. Given recurrent risk factors such as primiparity and early skin-to-skin/breastfeeding, enhanced vigilance and preventive strategies are essential. Therapeutic hypothermia should be considered case by case, ideally within specialized centers and supported by registries. Full article

(This article belongs to the Special Issue Advances in Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment (Second Edition))

► Show Figures

Graphical abstract

9 pages, 397 KB

Open AccessArticle

Evaluation of the Effects of Lipoxin A4 and Resolvin D1 on the Severity of Transient Tachypnea of the Newborn: A Prospective Study

by Emrah Çığrı, Funda Çatan İnan, Sedat Gülten, Mehmet Akif Bildirici, Ayşe Ece Gökkaya, Metin Asıleren, Fethiye Yıldız and Hilmi Onur Kabukcu

Children 2025, 12(10), 1421; https://doi.org/10.3390/children12101421 - 21 Oct 2025

Viewed by 387

Abstract

Objective: Transient tachypnea of the newborn (TTN) is a common condition observed in neonates. Since its management often requires intensive care and leads to maternal–infant separation, it is a major source of parental concern. The present study aimed to evaluate the effects of [...] Read more.

Objective: Transient tachypnea of the newborn (TTN) is a common condition observed in neonates. Since its management often requires intensive care and leads to maternal–infant separation, it is a major source of parental concern. The present study aimed to evaluate the effects of lipoxin A4 and resolvin D1 on the clinical course of TTN and to determine whether complete blood count parameters could serve as predictors of disease severity. Materials and Methods: A total of 62 neonates admitted to the neonatal intensive care unit with a diagnosis of TTN were included. According to Silverman scoring, infants were divided into a mild group (n = 31) and a severe group (n = 31). Lipoxin A4 and resolvin D1 levels, together with complete blood count parameters, were compared between the two groups. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess the predictive value of these parameters for the clinical course. Results: Serum lipoxin A4 (p = 0.005) and resolvin D1 (p = 0.002) levels were significantly higher in the mild group compared with the severe group, whereas the neutrophil-to-lymphocyte ratio (p = 0.044) and platelet-to-lymphocyte ratio (p = 0.027) were significantly lower. Resolvin D1 and the platelet-to-lymphocyte ratio were identified as significant predictors of severe disease. In predicting a mild course, lipoxin A4 demonstrated the highest sensitivity (80.6%), while resolvin D1 exhibited the highest specificity (87.1%). Conclusions: Lipoxin A4 and resolvin D1 appear to play a protective role in preventing severe clinical progression of transient tachypnea of the newborn. Full article

(This article belongs to the Section Pediatric Neonatology)

► Show Figures

Figure 1

12 pages, 250 KB

Open AccessArticle

Parental Adverse Childhood Experiences (ACEs) in an Early Childhood Mental Health Outpatient Clinic in Germany: Prevalence and Associations with Child Psychiatric Diagnoses

by Franziska Laqua, Eva Möhler, Jens Joas and Frank W. Paulus

Children 2025, 12(10), 1420; https://doi.org/10.3390/children12101420 - 21 Oct 2025

Viewed by 588

Abstract

Parental adverse childhood experiences (ACEs) are linked to negative outcomes in children, including emotional and behavioral problems, developmental delays, and higher risk for psychopathology. Most research focuses on school-aged children or community samples, with few studies examining preschool-aged children in child psychiatric care. [...] Read more.

Parental adverse childhood experiences (ACEs) are linked to negative outcomes in children, including emotional and behavioral problems, developmental delays, and higher risk for psychopathology. Most research focuses on school-aged children or community samples, with few studies examining preschool-aged children in child psychiatric care. Understanding parental ACEs in this population is crucial, as early childhood is a sensitive developmental period, and intergenerational effects may be particularly pronounced in children already presenting with psychiatric symptoms. Background/Objectives: The goal of this study was to analyze how parents of patients in an early childhood (0–5.9 yrs) mental health outpatient clinic differ from the general population in terms of the frequency of ACEs. In addition, we investigated the connection between mental health disorders in young children and the specific ACE scores of their parents. Methods: A total of 116 caregivers (34.45 years (SD = 5.28)) and their children (71.6% boys, 28.4% girls) at an average age of 3.99 years (SD = 1.35, range = 0.31–5.95) were included in the analysis. The legal guardians completed the 10-item ACE questionnaire. The young children were diagnosed as part of outpatient treatment using the DC:0–5 classification system. We analyzed the ACE scores and diagnoses descriptively and in comparison to a community sample. Results: An average value of 2.38 parental ACEs was reported by our sample, and 68.1% (n = 79) reported at least one ACE. The high-risk group with four or more ACEs comprised 30.2% (n = 35). The most common diagnosis in young children was the Disorder of Dysregulated Anger and Aggression of Early Childhood, followed by global developmental delay. Adjustment disorder was third in terms of frequency. Among the examined child psychiatric diagnoses, adjustment disorder showed a significant correlation with parents being affected by the ACE category of neglect (OR = 2.54; 95% CI: 1.012–6.369; p = 0.047). Conclusions: Parents who presented their children at an early childhood mental health outpatient clinic reported significantly more ACEs as compared to representative data on ACEs in adulthood. These results highlight the need for further studies with larger samples to enable a more in-depth analysis of the general intergenerational transmission processes and the differential transmission of specific ACEs to specific diagnoses in preschool-aged children. Full article

(This article belongs to the Special Issue Child Maltreatment: Etiology, Prevention, Neurobiological and Psychosocial Consequences, and Intervention Strategies)

11 pages, 378 KB

Open AccessArticle

Clinical Profile, Renal Involvement, and Relapse Patterns in Pediatric Henoch–Schönlein Purpura: A Retrospective Observational Study from a Tertiary Care Centre in South India

by Shrikiran A. Hebbar, Subramanyam Sheshadri, Praveen C. Samuel, Juanitha George, Suneel C. Mundkur, Pushpa Kini, Ramesh Bhat Y. and Leslie Edward S. Lewis

Children 2025, 12(10), 1419; https://doi.org/10.3390/children12101419 - 21 Oct 2025

Viewed by 635

Abstract

Background/Objectives: Henoch–Schönlein purpura (HSP), or IgA vasculitis, is the most common small-vessel vasculitis in children, yet Indian cohort data remain limited. We aimed to describe the clinical profile, renal involvement, treatment patterns, relapse, and outcomes of pediatric HSP at a tertiary centre [...] Read more.

Background/Objectives: Henoch–Schönlein purpura (HSP), or IgA vasculitis, is the most common small-vessel vasculitis in children, yet Indian cohort data remain limited. We aimed to describe the clinical profile, renal involvement, treatment patterns, relapse, and outcomes of pediatric HSP at a tertiary centre in South India. Methods: We conducted a retrospective review of children <18 years diagnosed with HSP (January 2013–October 2018) using EULAR/PRINTO/PRES criteria. Demographics, clinical features, laboratory parameters, treatments, and outcomes were abstracted from records and analyzed in SPSS (descriptive statistics; Chi-square/Fisher’s exact and t/non-parametric tests as appropriate). Subgroup comparisons included renal vs. non-renal disease and age <6 vs. ≥6 years. An exploratory analysis examined predictors of nephritis. Results: Of 43 children identified, 2 were excluded (misclassified as systemic lupus erythematosus); 41 were analyzed. Mean age was 8.5 years (range 3–17), male: female 1.4:1. A preceding febrile illness or upper respiratory tract infection was noted in 41.4% and 17%, respectively. Palpable purpura was universal; joint involvement 73.1%, abdominal pain 61.0%, vomiting 41.5%. Renal involvement 17% occurred only in children ≥6 years; exploratory testing supported a strong age-linked signal for nephritis. Laboratory abnormalities included anemia (48.7%), thrombocytosis (19.5%), and elevated ESR (51.2%). Skin biopsy (n = 29) showed IgA and complement deposition; renal biopsy (n = 2) showed ISKDC grades II–III. Treatments included NSAIDs 71.6%, corticosteroids 31.7%, and dapsone 24.4% (used for severe systemic/persistent cutaneous disease). Rash relapse 7.3% clustered with joint plus abdominal symptoms and was not observed among children with nephritis. At a mean 18.9-month follow-up, one child required long-term antihypertensives; no child progressed to end-stage renal disease. Conclusions: Pediatric HSP in this South-Indian cohort followed a largely self-limited course with favourable renal outcomes. Age ≥6 years flagged higher renal risk, supporting age-targeted urine and blood-pressure surveillance, while relapse appeared to follow a non-renal trajectory (joint/abdominal clustering). Steroid and dapsone use reflected clinical severity rather than relapse risk. Findings align with Indian series and suggest lower renal morbidity than some East-Asian reports, adding region-specific evidence to guide monitoring and counselling. Full article

(This article belongs to the Section Pediatric Allergy and Immunology)

► Show Figures

Figure 1

18 pages, 456 KB

Open AccessReview

Allogeneic Hematopoietic Stem Cell Transplantation for Infant Leukemia: A Single-Center Case Series and Narrative Review

by Irina Kostareva, Kirill Kirgizov, Irina Shubina, Nara Stepanyan, Nataliya Batmanova, Timur Valiev, Mihail Kiselevsky and Svetlana Varfolomeeva

Children 2025, 12(10), 1418; https://doi.org/10.3390/children12101418 - 20 Oct 2025

Viewed by 692

Abstract

Background/Objectives: Acute leukemias (AL) in children under 1-year-old are combined under the term “infant leukemia” and are a very rare malignancies, accounting for up to 5% of all childhood AL cases. The predominance of unfavorable clinical and laboratory characteristics leads to unsatisfactory treatment [...] Read more.

Background/Objectives: Acute leukemias (AL) in children under 1-year-old are combined under the term “infant leukemia” and are a very rare malignancies, accounting for up to 5% of all childhood AL cases. The predominance of unfavorable clinical and laboratory characteristics leads to unsatisfactory treatment results, even with the use of modern treatment protocols. Patients/Methods: A comprehensive search through MEDLINE, PubMed, Scopus, and ScienceDirect using infant leukemia-related keywords was performed and included a final set of 52 academic articles. Our own experience included 11 patients with infant leukemia underwent allo-HSCT (allogeneic hematopoietic stem cell transplantation) at the NN Blokhin National Medical Research Center of Oncology in 2021–2023. Types of leukemia included acute myeloid leukemia, lymphoblastic leukemia, and mixed-phenotype acute leukemia. The most frequent cytogenetic aberration was KMT2A. All patients were in clinical and hematological remission, but four had positive MRD status (minimal residual disease). Donors: haploidentical—5 (45.4%), matched unrelated donor—5 (45.4%), and matched related donor—1 (9.2%). Graft manipulations: post-transplant cyclophosphamide was given to three patients with haplo-HSCT, and TCRαβ/CD19 depletion was performed in two patients. The type of immunosuppressive therapy (IST) varied based on the donor. Conditioning regimens were myeloablative. Results: Median follow-up was 23.5 months. Acute GVHD grade I–II developed in two patients (18%) and grade III–IV in three patients (27%). The overall survival rate was 54.5% (n = 6). The relapse rate after allo-HSCT was 18% (n = 2). The most common cause of treatment failure was infectious complications in the early post-transplant period (70%). Conclusions: Our center’s experience demonstrated acceptable transplant-related mortality and satisfactory relapse rates after allo-HSCT in patients with infant leukemia. The treatment of acute leukemia in infants is challenging, and optimal protocols are being developed around the world specifically for these patients. Taking into account the characteristics of this age group, the choice of chemotherapy drug doses should be carefully considered, and the indications for allo-HSCT should be balanced. Full article

(This article belongs to the Special Issue Revolutionizing Pediatric Blood Cancer Treatment: Advances in Targeted Immunotherapy for Leukemia and Lymphomas)

► Show Figures

Figure 1

8 pages, 614 KB

Open AccessArticle

Radicular Pathology in Zirconia and Stainless-Steel Crowns in Primary Posterior Teeth: A Retrospective Comparative Longitudinal Study

by Diana Ram, Maayan Sherman, David Polak and Esti Davidovich

Children 2025, 12(10), 1417; https://doi.org/10.3390/children12101417 - 20 Oct 2025

Viewed by 793

Abstract

Background: Zirconia crowns (ZCs) are increasingly used in pediatric dentistry for their esthetic advantages, but evidence regarding their long-term outcomes compared with stainless steel crowns (SSCs) is limited. Methods: This retrospective cohort study evaluated 138 primary molars in 89 children (mean age: 5.1 [...] Read more.

Background: Zirconia crowns (ZCs) are increasingly used in pediatric dentistry for their esthetic advantages, but evidence regarding their long-term outcomes compared with stainless steel crowns (SSCs) is limited. Methods: This retrospective cohort study evaluated 138 primary molars in 89 children (mean age: 5.1 ± 1.6 years) restored with ZCs (n = 69) or SSCs (n = 69). Radiographic and clinical follow-up averaged 27.7 months. Outcomes included radicular pathology, crown retention, and survival. Statistical analyses examined associations with patient age, tooth type, and pulp therapy. Results: Both groups demonstrated high overall success (87%). However, pathology developed more frequently in ZCs compared with SSCs (18% vs. 9%, p = 0.0025). Loss of retention was also higher in ZCs (16% vs. 3%, p = 0.009). No significant associations were found between pathology and patient age, tooth type, or pulp therapy. SSCs demonstrated longer survival (29.1 vs. 25.1 months, p = 0.034) and later onset of pathology (29.1 vs. 12.5 months, p = 0.003). Crowns offer an esthetic alternative for restoring primary molars but are associated with higher rates of radicular pathology and retention loss. Careful case selection, optimal isolation, and appropriate cementation are essential for clinical success. Stainless steel crowns remain the more durable option, particularly in complex clinical cases. Full article

(This article belongs to the Section Pediatric Dentistry & Oral Medicine)

► Show Figures

Figure 1

13 pages, 803 KB

Open AccessArticle

Panoramic Assessment of Root Development in Immature Maxillary Incisors After Treatment with Prefabricated Functional Appliances

by Wonbin Seo, Soyoung Park, Eungyung Lee, Taesung Jeong and Jonghyun Shin

Children 2025, 12(10), 1416; https://doi.org/10.3390/children12101416 - 20 Oct 2025

Viewed by 422

Abstract

Background: Prefabricated functional appliances (PFAs) are widely used for interceptive orthodontic treatment in children, delivering intermittent forces with potential advantages for oral function. This study evaluated the effects of PFA treatment on the root development of maxillary central incisors in children during the [...] Read more.

Background: Prefabricated functional appliances (PFAs) are widely used for interceptive orthodontic treatment in children, delivering intermittent forces with potential advantages for oral function. This study evaluated the effects of PFA treatment on the root development of maxillary central incisors in children during the mixed dentition stage using panoramic radiographs. Methods: A retrospective review was conducted on 77 children in the mixed dentition phase (2020–2025). These were divided into three groups: untreated controls (n = 33); skeletal Class II malocclusion group, treated with the Pre-Ortho^® Type 1 appliance (Group 1, n = 25); and functional anterior crossbite group treated with a Type 3 appliance (Group 2, n = 19). All participants underwent at least two panoramic radiographs; treatment was initiated when the maxillary central incisors were at Nolla stages 8 or 9. Following root completion, panoramic images were analyzed using the modified Lind method to measure crown length, root length, and root-to-crown ratio. Results: Mean final root lengths of the maxillary central incisors were 14.11 ± 1.40 mm (controls), 14.46 ± 1.42 mm (Group 1), and 13.89 ± 1.04 mm (Group 2) (p > 0.05). The mean root–crown ratios showed no significant variation (p > 0.05). Root development was unaffected by wear duration, with limited sex differences. Conclusions: PFA treatment may not adversely affect the root development of maxillary central incisors and indicates a safe intervention in children. Full article

(This article belongs to the Section Pediatric Dentistry & Oral Medicine)

► Show Figures

Figure 1

15 pages, 3409 KB

Open AccessArticle

by Ioli Panidi, Gregory C. Bogdanis, Anastasia Donti, Vasiliki Gaspari, Dimitra Kanna, Gerasimos Terzis and Olyvia Donti

Children 2025, 12(10), 1415; https://doi.org/10.3390/children12101415 - 20 Oct 2025

Viewed by 503

Abstract

Background/Objectives: This cross-sectional study examined gastrocnemius medialis (GM) and vastus lateralis (VL) muscle architecture in pre-, circa- and post-peak height velocity (PHV) female volleyball athletes. Methods: Muscle architecture (fascicle length: FL; pennation angle: PA; muscle thickness: TH) was assessed in 144 athletes [...] Read more.

Background/Objectives: This cross-sectional study examined gastrocnemius medialis (GM) and vastus lateralis (VL) muscle architecture in pre-, circa- and post-peak height velocity (PHV) female volleyball athletes. Methods: Muscle architecture (fascicle length: FL; pennation angle: PA; muscle thickness: TH) was assessed in 144 athletes using ultrasonography. Stature, body mass, femur and calf length were measured. Maturity index was calculated from anthropometrics. Athletes were classified as pre-PHV, circa-PHV and post-PHV. Results: Fascicle length of the GM and VL was longer in post-PHV compared to pre-PHV athletes (d = 1.50 and d = 2.22, respectively, p < 0.001). Differences between circa and post-PHV athletes were observed only in GM (d = 0.84, p = 0.005). TH showed progressively greater values in both muscles across maturity stages (p < 0.001). PA was larger in post- compared to pre-PHV athletes, only in GM (p = 0.009). When all athletes were examined as one group, correlations were found between anthropometrics, maturity index and muscle architecture (r = 0.164–0.744 and 0.284–0.622, respectively, p < 0.05). In addition, in the GM, body mass and training experience accounted for 40% of the variance in FL (p < 0.001), whereas body mass and FL explained 66% of the variance in TH (p < 0.001). In the VL, stature and body mass explained 49% of the variance in FL (p < 0.001), while body mass, fascicle length, and maturity index explained 68% of the variance in TH, with maturity exhibiting a negative coefficient (p < 0.001). Conclusions: FL and TH of both muscles demonstrated larger values between pre- and post-PHV. GM and VL exhibited different morphological patterns, probably due to bone development and loading. Athletes’ body mass best predicted FL in both muscles, whereas the greater values in TH in post- compared to pre-PHV athletes appear to be associated with body mass and FL. The influence of maturity on VL thickness diminishes at more advanced stages of development. Full article

(This article belongs to the Special Issue Health Benefits of Physical Activity for Children and Adolescents: 2nd Edition)

► Show Figures

Figure 1

17 pages, 412 KB

Open AccessArticle

Water Matters More: Unequal Effects of Water and Sanitation on Child Growth in Mozambique

by Jailene P. Castillo, Christina A. Molinaro, William E. Pater and Santosh K. Gautam

Children 2025, 12(10), 1414; https://doi.org/10.3390/children12101414 - 20 Oct 2025

Cited by 1 | Viewed by 560 | Correction

Abstract

Background: Child stunting and wasting persist at alarmingly high rates in Mozambique, yet little is known about whether the improved sources of water and sanitation affect these outcomes differently. This study aims to disentangle the distinct contributions of improved water sources and [...] Read more.

Background: Child stunting and wasting persist at alarmingly high rates in Mozambique, yet little is known about whether the improved sources of water and sanitation affect these outcomes differently. This study aims to disentangle the distinct contributions of improved water sources and sanitation facilities to child stunting and wasting at the national level, addressing a critical evidence gap in the WASH–nutrition literature in Mozambique. Methods: Using data from 3690 children under five in the 2022–2023 Mozambique Demographic and Health Survey, we applied stepwise logistic regression models to estimate the independent and combined associations of improved drinking water and sanitation facilities with child stunting and wasting, adjusting for child-, household-, and region-level factors. Results: Improved water access was significantly associated with a lower risk of stunting (odds ratio = 0.80, 95% CI: 0.67–0.94, p < 0.01), while sanitation showed only weak and inconsistent associations with stunting. In the fully adjusted model, neither improved water nor sanitation was associated with wasting. Wealth, gender, religion, and region were also significant predictors of stunting as well as wasting. Conclusions: These findings indicate that WASH components protect against child malnutrition through different pathways, with water being more protective against chronic undernutrition and sanitation less clearly linked to acute malnutrition. Broader socioeconomic and cultural factors—such as wealth, religion, and geography—play critical roles, highlighting the need for integrated, context-specific interventions. Full article

(This article belongs to the Section Global Pediatric Health)

► Show Figures

Figure 1

11 pages, 1046 KB

Open AccessArticle

Neural Network-Based Prediction of Post-Operative Visual Outcomes Following Secondary Pediatric Intraocular Lens Implantation

by Andrew Farah, Raheem Remtulla and Robert K. Koenekoop

Children 2025, 12(10), 1413; https://doi.org/10.3390/children12101413 - 20 Oct 2025

Viewed by 473

Abstract

Objectives: To develop a proof-of-concept machine learning (ML) neural network model to predict post-operative visual outcomes in children with congenital cataracts undergoing intraocular lens (IOL) implantation, thereby guiding the optimal timing for IOL insertion. Determining the ideal timing and predicting outcomes for IOL [...] Read more.

Objectives: To develop a proof-of-concept machine learning (ML) neural network model to predict post-operative visual outcomes in children with congenital cataracts undergoing intraocular lens (IOL) implantation, thereby guiding the optimal timing for IOL insertion. Determining the ideal timing and predicting outcomes for IOL implantation in children remains clinically complex due to variability in eye development and measurement accuracy. Methods: Retrospective analysis using a publicly available dataset from 110 children diagnosed with congenital cataracts, who underwent IOL implantation at the Eye and ENT Hospital of Fudan University. A neural network model with a hidden layer of 10 nodes was developed in MATLAB 2024a using the scaled conjugate gradient algorithm. Input variables included demographic and clinical features; the target was achieving visual acuity greater than 20/40. Performance metrics were evaluated using cross-entropy loss, sensitivity, specificity, and accuracy. Results: Training completed after 14 epochs with the test set reaching the highest performance metrics: 88.2% accuracy, 88.9% sensitivity, and 87.5% specificity. ROC curve analysis showed AUC values of 0.942 (training), 0.920 (validation), 0.885 (test), and 0.917 (overall). Conclusions: The neural network effectively predicted post-operative visual outcomes, offering potential clinical utility in guiding IOL implantation decisions. Despite limitations in dataset diversity, this study lays the foundation for future development of personalized strategies in pediatric cataract care. Full article

(This article belongs to the Section Pediatric Ophthalmology)

► Show Figures

Figure 1

18 pages, 511 KB

Open AccessArticle

Linking Motor Competence to Children’s Self-Perceptions: The Mediating Role of Physical Fitness

by Ivan Šerbetar, Jan Morten Loftesnes and Asgeir Mamen

Children 2025, 12(10), 1412; https://doi.org/10.3390/children12101412 - 20 Oct 2025

Viewed by 491

Abstract

Background/Objectives: Self-perceptions in childhood shape motivation, behavior, and well-being; however, their relationship to motor competence and physical fitness remains unclear. We tested whether physical fitness mediates the association between motor competence and domain-specific self-perceptions in middle childhood. Methods: In a school-based sample of [...] Read more.

Background/Objectives: Self-perceptions in childhood shape motivation, behavior, and well-being; however, their relationship to motor competence and physical fitness remains unclear. We tested whether physical fitness mediates the association between motor competence and domain-specific self-perceptions in middle childhood. Methods: In a school-based sample of 100 ten-year-olds (59 girls, 41 boys; 3 exclusions ≤ 5th MABC-2 percentile), children completed MABC-2 (motor competence), EUROFIT (physical fitness), and SPPC (self-perceptions). Principal component analysis of the nine EUROFIT tests yielded two factors: Motor Fitness (agility/endurance/flexibility/muscular endurance) and Strength/Size (handgrip and BMI). Parallel mediation models (MABC-2 → [Motor Fitness, Strength/Size] → SPPC) were estimated with maximum likelihood and 5000 bias-corrected bootstrap resamples. Benjamini–Hochberg FDR (q = 0.05) was applied within each path family across the six SPPC domains. Results: In baseline models (no covariates), Motor Fitness → Athletic Competence was significant after FDR (β = 0.263, p = 0.003, FDR p = 0.018). Associations with Scholastic (β = 0.217, p = 0.039, FDR p = 0.090) and Social (β = 0.212, p = 0.046, FDR p = 0.090) were positive but did not meet the FDR threshold. Strength/Size showed no associations with any SPPC domain. Direct effects from MABC-2 to SPPC were non-significant. Indirect effects via Motor Fitness were minor and not supported after FDR (e.g., Athletic: β = 0.067, p = 0.106, 95% CI [0.007, 0.174], FDR p = 0.251). In BMIz-adjusted sensitivity models, Motor Fitness remained significantly related to Athletic (β = 0.285, p = 0.008, FDR p = 0.035), Scholastic (β = 0.252, p = 0.018, FDR p = 0.035), and Social (β = 0.257, p = 0.015, FDR p = 0.035); MABC-2 → Motor Fitness was β = 0.235, p = 0.020. Some paths reached unadjusted significance but were not significant after FDR correction (all FDR p-values = 0.120 for indirect effects). Conclusions: Functional Motor Fitness, but not Strength/Size, showed small-to-moderate, domain-specific links with children’s Athletic (and, when adjusting for adiposity, Scholastic/Social) self-perceptions; mediated effects were small and not FDR-supported. Findings highlight the salience of visible, functional performances (e.g., agility/endurance tasks) for children’s self-views and support PE approaches that foster diverse motor skills and motor fitness. Because the study is cross-sectional and BMI-adjusted analyses are presented as robustness checks, caution should be exercised when interpreting the results causally. Full article

(This article belongs to the Section Global Pediatric Health)

► Show Figures

Figure 1

17 pages, 750 KB

Open AccessArticle

Children with Cerebral Palsy Across the Gross Motor Function Classification System Levels Requiring Orthopaedic Surgery: The Lived Experiences of Parents

by Maria Juricic, Stacey D. Miller, Emily K. Schaeffer, Kishore Mulpuri and Lesley Bainbridge

Children 2025, 12(10), 1411; https://doi.org/10.3390/children12101411 - 18 Oct 2025

Cited by 1 | Viewed by 634 | Correction

Abstract

Background/Objectives: Orthopaedic surgery is often recommended for children with cerebral palsy (CP) across all Gross Motor Function Classification System (GMFCS) levels. Despite this, little is known about the experience of parents during their child’s surgery and recovery. Methods: This topic was explored using [...] Read more.

Background/Objectives: Orthopaedic surgery is often recommended for children with cerebral palsy (CP) across all Gross Motor Function Classification System (GMFCS) levels. Despite this, little is known about the experience of parents during their child’s surgery and recovery. Methods: This topic was explored using a mixed-methods research design. Using an interpretive description methodology, in-depth interviews with parents of children with CP who had undergone orthopaedic surgery were completed by a physical therapist within an interdisciplinary clinical context in an acute care orthopaedic surgery clinic. Transcripts were reviewed by inductive thematic analysis. Resulting themes were used to inform the development of a self-administered survey, which was distributed to a separate cluster sample of parents. Results: From interviews with six parents, four themes were identified: (1) preparing and being prepared, (2) feeling known and recognized, (3) knowing and advocating for your child, and (4) feeling stressed and coping. The results of surveys completed by 25 parents were analyzed using descriptive statistics. When asked whether their child’s surgery was a stressful experience, 80% (20/25) agreed. However, 60% (15/25) indicated that the surgery was not a negative experience. Forty-four percent (11/25) felt their child’s recovery was longer than expected. Survey responses to questions related to the qualitative themes were similar across GMFCS levels and surgical procedures. Conclusions: The findings identify the importance of recognizing the needs of parents and suggest opportunities for collaboration between the healthcare team and families in caring for children across the spectrum of functional mobility and orthopaedic procedures. Full article

(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)

► Show Figures

Figure 1

19 pages, 682 KB

Open AccessReview

Infant Viability in Severe Preeclampsia: Management Strategies and the Potential Role of Calprotectin—A Narrative Review

by Oala Ioan Emilian, Adrian Apostol, Viviana Mihaela Ivan and Lucian Pușcașiu

Children 2025, 12(10), 1410; https://doi.org/10.3390/children12101410 - 18 Oct 2025

Viewed by 512

Abstract

Preeclampsia (PE) is a vascular-related pregnancy disorder characterized by high blood pressure and proteinuria after 20 weeks’ gestation. Defective placentation, together with endothelial dysfunction, has a crucial role in the development of PE. Current evidence suggests that calprotectin is a potential marker for [...] Read more.

Preeclampsia (PE) is a vascular-related pregnancy disorder characterized by high blood pressure and proteinuria after 20 weeks’ gestation. Defective placentation, together with endothelial dysfunction, has a crucial role in the development of PE. Current evidence suggests that calprotectin is a potential marker for screening, even if it is not yet a standard diagnostic tool. The aim of our study is to the review monitoring methods for severe preeclampsia, which endangers neonatal viability. Starting from here, we look for ways to safely prolong pregnancy and also evaluate calprotectin as a potential biomarker of this pathology. Current issues and future perspectives are analyzed. As a solution, multidisciplinary management should be offered in tertiary-level units by maternal–fetal medicine specialists and neonatology units to increase fetal/neonatal viability. Based on the severity of preeclampsia and intrauterine growth restriction, cardiotocography and Doppler ultrasound monitoring should be scheduled. Delivery is also taken into consideration based on gestational age and maternal condition. Placental histological findings appear to be crucial in understanding this disease. The elevated calprotectin levels in preeclampsia suggest underlying inflammatory processes in the mother, which potentially contribute to the development of the condition; however, more research is needed to clarify calprotectin’s role. Conclusion: Early-stage preeclampsia remains a significant risk to maternal and neonatal health, with significant impacts on neonatal viability. Further elucidation of a role for calprotectin in the development of preeclampsia and its relevance for fetal viability are necessary. Calprotectin could be a potential biomarker in preeclampsia, as an important inflammation marker. But, so far, calprotectin has failed to prove its role as a marker of fetal viability, and thus, more studies are needed. Full article

(This article belongs to the Section Pediatric Neonatology)

► Show Figures

Graphical abstract

10 pages, 1671 KB

Open AccessArticle

Assessment and Management of Pain and Fever in Pediatric Patients in the Emergency Setting: A Proposed Flowchart for the Triage Nurse

by Franca Benini, Stefano Masi, Luigi Martemucci, Patrizia Botarelli, Vincenzo Tipo and Tiziana Zangardi

Children 2025, 12(10), 1409; https://doi.org/10.3390/children12101409 - 18 Oct 2025

Viewed by 636

Abstract

Background: The nurse-initiated administration of medications, such as paracetamol and ibuprofen, at the time of triage may provide the opportunity to treat pediatric patients more quickly. We aimed to create practical flowcharts that can be used by all EDs with a specific [...] Read more.

Background: The nurse-initiated administration of medications, such as paracetamol and ibuprofen, at the time of triage may provide the opportunity to treat pediatric patients more quickly. We aimed to create practical flowcharts that can be used by all EDs with a specific focus on the nurse-initiated administration of medications to optimize the assessment and management of pain and fever in pediatric patients. Methods: Three regional expert meetings were held with a restricted working group composed of three chairmen and a wider working group composed of Directors of Pediatric EDs and Directors of Pediatric Departments, along with the main regional key experts for child healthcare management. Existing protocols were collected in the main centers belonging to the three regions and a unique recommendation was elaborated by the restricted group. This was then discussed and revised during discussion in a wider group. Results: Two protocols were developed for the triage nurse, one for pain and one for fever present. Both are initiated with assessment of the child’s pain or fever, followed by a caregiver interview to determine eligibility for the administration of an analgesic/antipyretic. In the case of pediatric pain, an analgesic is administered by the nurse only when the pain is rated as 4–6 and in the absence of specific contraindications. For pediatric fever, an antipyretic should only be administered if the child’s temperature is ≥37.5 °C and in the presence of at least 1 sign of discomfort. If an analgesic/antipyretic is administered, patients should be re-assessed after 1 h, and pediatrician evaluation requested as appropriate. Conclusions: The proposed flowcharts for pediatric pain and fever combine stratification by risk and severity and incorporate the possibility for the prompt administration of an antipyretic/analgesic when indicated. Full article

(This article belongs to the Section Pediatric Emergency Medicine & Intensive Care Medicine)

► Show Figures

Figure 1

16 pages, 701 KB

Open AccessSystematic Review

Interventions to Minimize Unnecessary Antibiotic Use for Acute Otitis Media: A Meta-Analysis

by Theresa L. Morin, Amy B. Stein, Rana E. El Feghaly, Amanda C. Nedved, Sophie E. Katz, Amy Keith, Heather E. Laferriere, Timothy C. Jenkins and Holly M. Frost

Children 2025, 12(10), 1408; https://doi.org/10.3390/children12101408 - 17 Oct 2025

Viewed by 1702

Abstract

Backgrounds/Objectives: Acute otitis media (AOM) is the leading reason antibiotics are prescribed to children. Despite guidelines advocating for watchful waiting and shorter antibiotic durations, overprescribing remains a concern. This meta-analysis aims to quantify potential reduction in antibiotic days of therapy (DOT) for AOM [...] Read more.

Backgrounds/Objectives: Acute otitis media (AOM) is the leading reason antibiotics are prescribed to children. Despite guidelines advocating for watchful waiting and shorter antibiotic durations, overprescribing remains a concern. This meta-analysis aims to quantify potential reduction in antibiotic days of therapy (DOT) for AOM if prescribers adhered to guidelines. Methods: Cochrane databases were sourced for studies on ear infections, diagnostic accuracy, antibiotic duration, and watchful waiting. Randomized clinical trials, observational studies, and quality improvement reports of children aged 6 months–17 years with uncomplicated AOM published between 2000 and 2024 from the U.S., Canada, and Europe. Of 4187 studies, 425 met selection criteria. PRISMA guidelines were adhered to for independent extraction by multiple reviewers. Pooled prevalence of AOM outcomes and odds ratios (OR) for effectiveness interventions were calculated using the DerSimonian-Laird random effects model. A simulation study compared current practice to national guidelines. Results: Eighty-six studies found an estimated 107 million DOT prescribed to children in the U.S. annually for AOM. Following the American Academy of Pediatrics’ guidelines could reduce DOT by 57.9 million days (54%). Adherence to NICE guidelines could reduce DOT by 74.1 million days (70%). Watchful waiting and short-course antibiotic interventions had pooled Ors of 4.35 and 7.12, respectively, for decreasing DOT. Conclusions: Adherence to guidelines for AOM management could avert millions of antibiotic DOT. Watchful waiting and short-duration interventions are most impactful on antibiotic overprescribing. Full article

(This article belongs to the Special Issue Antibiotic Prescribing Practices and Stewardship in Pediatrics)

► Show Figures

Figure 1

15 pages, 1192 KB

Open AccessArticle

Development of the Medial Longitudinal Arch of the Foot in Czech Pre- and Primary School Children—A Cross-Sectional and Longitudinal Approach

by Jakub Novák, Jan Novák, Anna Vážná and Petr Sedlak

Children 2025, 12(10), 1407; https://doi.org/10.3390/children12101407 - 17 Oct 2025

Viewed by 529

Abstract

Background/Objectives: The medial longitudinal arch (MLA) is initially masked by a fat pad that makes the foot appear flat. In preschool age, this fat pad resorbs, and the arch becomes more defined. The exact age at which the arch attains its final [...] Read more.

Background/Objectives: The medial longitudinal arch (MLA) is initially masked by a fat pad that makes the foot appear flat. In preschool age, this fat pad resorbs, and the arch becomes more defined. The exact age at which the arch attains its final form remains uncertain due to high inter-individual variability and differing assessment methods, which complicates the distinction between physiological development and potential abnormalities. Moreover, commonly used classification terms such as “flat” or “normal” do not adequately reflect the developmental progression and may be misleading in young children. This study aimed to describe the MLA developmental patterns and propose an adjusted classification terminology to improve clinical differentiation between feet undergoing normal developmental changes and cases requiring intervention. Methods: The present study employs both cross-sectional (285 children aged 4.00–8.99 years) and longitudinal (50 children measured annually between ages 4–6) designs. Foot dimensions were assessed using standard anthropometry, and the MLA was assessed via podograms using the Chippaux–Smirak index (CSI). To better reflect the developmental nature of the MLA, the arch was categorized as “formed” and “unformed”. Cross-sectional data were analyzed with ANOVA and visualized using LOESS regression, longitudinal data with linear mixed models, and relationships between CSI and foot dimensions with Spearman’s correlation. Results: MLA development showed significant changes up to age 6, with the most pronounced changes occurring between ages 4 and 5 and slowing thereafter. Children with an unformed arch at age 4 exhibited a steeper developmental trajectory than those with an already advanced arch form. Correlations between arch shape and foot dimensions were statistically significant but weak. No significant between-sex differences were observed. Conclusions: The timing of the most pronounced phase of medial longitudinal arch (MLA) development varies between individuals and is typically completed by 6 years of age, with no sex-dependent differences. Age 6 therefore represents a practical milestone for reliable clinical assessment, since earlier classifications risk misinterpreting normal developmental variation as pathology. Full article

(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)

► Show Figures

Figure 1

21 pages, 756 KB

Open AccessReview

Fundamental Movement/Motor Skills as an Important Component of Physical Literacy and Bridge to Physical Activity: A Scoping Review

by Tomasz Piotrowski, Hubert Makaruk, Edyta Tekień, Wojciech Feleszko, Maciej Kołodziej, Katarzyna Albrecht, Krystyna Grela, Robert Makuch, Bożena Werner and Jakub S. Gąsior

Children 2025, 12(10), 1406; https://doi.org/10.3390/children12101406 - 17 Oct 2025

Viewed by 2570

Abstract

Background: Movement is crucial for human development, particularly during childhood. Fundamental movement skills (FMSs) are essential movement patterns that support physical, cognitive, and social development. Recent studies indicate an alarming worldwide decline in FMS acquisition, potentially impacting children’s long-term physical fitness and health. [...] Read more.

Background: Movement is crucial for human development, particularly during childhood. Fundamental movement skills (FMSs) are essential movement patterns that support physical, cognitive, and social development. Recent studies indicate an alarming worldwide decline in FMS acquisition, potentially impacting children’s long-term physical fitness and health. This scoping review explored FMSs, their relationship to motor competence and physical literacy, associations with physical activity and fitness, assessment methods, and effective interventions. Methods: A comprehensive literature review was conducted using the PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases. The search utilized key phrases related to FMSs, motor competence, and physical literacy. Initially, 2251 publications were identified. Results: After rigorous screening, 95 English-language literature reviews and meta-analyses focusing on FMSs in healthy children were selected for detailed analysis. The accepted publications were categorized into five thematic areas: FMSs and motor development (11 publications), conceptual terms in FMS context (8 publications), relationships between FMSs and other parameters (15 publications), FMS assessment tools (14 publications), and intervention effects on FMSs (47 publications). Conclusions: Effective FMS acquisition requires collaborative interventions involving teachers, parents, sports professionals, and healthcare providers. Future research should focus on developing standardized assessment tools, interpreting FMSs as part of physical literacy to understand their association with PA level and design efficient intervention strategies. Full article

(This article belongs to the Special Issue Fundamental Movement/Motor Skills—the Bridging Element Between Motor Development Milestones and Physical Activity)

► Show Figures

Figure 1

16 pages, 424 KB

Open AccessArticle

Mini-Trampoline Training Enhances Executive Functions and Motor Skills in Preschoolers

by Mohamed Amine Ltifi, Yosser Cherni, Elena Adelina Panaet, Cristina Ioana Alexe, Helmi Ben Saad, Ana Maria Vulpe, Dan Iulian Alexe and Mohamed-Souhaiel Chelly

Children 2025, 12(10), 1405; https://doi.org/10.3390/children12101405 - 17 Oct 2025

Viewed by 804

Abstract

Background: Early childhood is crucial for motor and cognitive development, with physical activity playing a key role. Mini-trampoline exercises may offer an effective approach to enhance these domains. Methods: This study assessed the effects of a mini-trampoline program on executive functions [...] Read more.

Background: Early childhood is crucial for motor and cognitive development, with physical activity playing a key role. Mini-trampoline exercises may offer an effective approach to enhance these domains. Methods: This study assessed the effects of a mini-trampoline program on executive functions and motor skills in Tunisian preschoolers. Fifty-four children (age 3.87 ± 0.47 years) participated in a 12-week intervention, divided into a control group (n = 27), following standard activities, and an experimental group (n = 27), engaging in mini-trampoline exercises. Pre- and post-tests measured motor skills like postural steadiness, balance, and coordination, as well as cognitive functions, including working memory (WM) and inhibition. Results: Significant improvements were observed in the experimental group for functional mobility, postural steadiness, lower body strength, and inhibition (p < 0.001), whereas the control group showed minimal changes. ANOVA revealed no significant group × time effects, except for a trend in postural steadiness (p = 0.062), suggesting a potential benefit of the intervention. Conclusions: These findings highlight the potential of mini-trampoline exercises to enhance motor skills and specific executive functions in preschoolers, supporting their overall development. Full article

(This article belongs to the Special Issue Fundamental Movement/Motor Skills—the Bridging Element Between Motor Development Milestones and Physical Activity)

► Show Figures

Figure 1

11 pages, 526 KB

Open AccessArticle

Sex-Based Anatomical Variations and Complication Risks in Pediatric Both-Bone Forearm Fractures: A Level of Evidence IV Retrospective Analysis

by Onur Cetin, Ali Can Koluman, Mesut Demirkoparan, Ali Yucesan, Gokhan Karahan and Erhan Coskunol

Children 2025, 12(10), 1404; https://doi.org/10.3390/children12101404 - 17 Oct 2025

Viewed by 368

Abstract

Background: Both-bone forearm fractures (BBFF) are among the most common pediatric injuries. While most cases in younger children can be managed non-operatively, older children and adolescents exhibit less predictable remodeling and longer healing times, potentially leading to higher complication rates. This study aimed [...] Read more.

Background: Both-bone forearm fractures (BBFF) are among the most common pediatric injuries. While most cases in younger children can be managed non-operatively, older children and adolescents exhibit less predictable remodeling and longer healing times, potentially leading to higher complication rates. This study aimed to evaluate sex-based anatomical differences in BBFF and their association with complications. Methods: We retrospectively reviewed 163 patients (129 boys, 34 girls; age range: boys > 10 years, girls > 8 years, both < 16 years) with unilateral BBFF treated between 2017 and 2020. All underwent biplanar radiographs of both forearms pre-reduction, post-reduction, and at 8-week follow-up. Measurements included radius and ulna angulation, bone length, maximum radial bow (%), and location of maximum bow (mm). Complications and surgical interventions were recorded. Results: Boys demonstrated significantly greater initial radius angulation on the lateral view (p < 0.05) and longer radius and ulna lengths on the unaffected side (p < 0.05). Maximum radial bow (%) did not differ between sexes; however, the location of maximum bow varied between unaffected and fractured sides within each sex (p < 0.05). Twenty boys (15.5%) required surgery, compared with none of the girls (p = 0.007). Overall complication rates were 44.8% (n = 73) with no significant sex difference (p = 0.074). Conclusions: In older children and adolescents with BBFF, boys exhibit anatomical characteristics—such as longer forearms and greater initial angulation—associated with unstable fracture patterns and higher surgical intervention rates. Recognizing these differences may improve early risk stratification and management strategies. Level of Evidence: IV. Full article

(This article belongs to the Special Issue Diagnosis and Management of Injuries, Fractures, and Complications in Children)

► Show Figures

Figure 1

10 pages, 624 KB

Open AccessArticle

Risk Factors for Postoperative Pulmonary Compromise in a Pediatric Population: A Retrospective Review of a Single Institution Cohort

by Alison Robles, Mehul V. Raval, Chunyi Wu, Heather A. Ballard, Mitchell Phillips, Nicholas E. Burjek and Eric C. Cheon

Children 2025, 12(10), 1403; https://doi.org/10.3390/children12101403 - 17 Oct 2025

Viewed by 449

Abstract

Background/Objectives: Pediatric postoperative pulmonary complication is a major event associated with increased in-hospital morbidity and mortality. However, data is limited regarding the specific timing and spectrum of postoperative pulmonary complications in the pediatric population. Utilizing data in a cohort of high-risk patients aged [...] Read more.

Background/Objectives: Pediatric postoperative pulmonary complication is a major event associated with increased in-hospital morbidity and mortality. However, data is limited regarding the specific timing and spectrum of postoperative pulmonary complications in the pediatric population. Utilizing data in a cohort of high-risk patients aged ≤ 6 years, we sought to evaluate the timing and incidence of a composite of postoperative pulmonary complications. We hypothesized that ASA physical status, emergent case type, and procedure duration would be associated with pulmonary complications in high-risk children and that these complications would, in turn, be associated with a prolonged length of stay. Methods: Data from patients ≤ 6 years of age who were intubated for major abdominal surgery at the authors’ institution were collected from 1 January 2019 to 28 March 2022. The primary outcome was postoperative pulmonary complication, defined as the occurrence/use of reintubation, non-invasive positive pressure ventilation, high-flow nasal cannula, mask, or nasal cannula beyond phase 1 of recovery after anesthesia and within 7 postoperative days. The secondary outcome was hospital length of stay. We performed multivariable logistic regression with backward selection to identify independent predictors for postoperative pulmonary complications after adjusting for covariates. For hospital length of stay, a multivariate linear regression model was used after adjusting for covariates. Results: A total of 88 (26.1%) patients experienced 117 occurrences of postoperative oxygen dependence events, and 80 (90.9%) experienced this event in the first 48 h after surgery. The results of this model demonstrated independent associations between patients with an ASA class of IV (OR 9.86, 95% CI: 1.22–79, p-value = 0.03202) and longer operative time (OR: 1.05, 95% CI: 1.03–1.08, p = 0.00001) and postoperative pulmonary complication. On adjusted analysis, the occurrence of a postoperative pulmonary complication was associated with prolonged postoperative length of stay (adjusted geometric mean ratio of 1.39 (95% CI 1.10–1.75, p = 0.0062). Conclusions: Pediatric postoperative pulmonary complication remains a significant event for many patients and results in a prolonged length of stay. This study lays the groundwork for further investigations of interventions targeted at optimizing and monitoring at-risk individuals. Full article

(This article belongs to the Special Issue New Insights into Pain Management and Sedation in Children)

► Show Figures

Figure 1

15 pages, 422 KB

Open AccessArticle

The Potential Mediating Role of Good Mental Health on the Relationship Between Low Physical Activity and High Screen Time with Executive Functions in Chilean Children and Adolescents

by Felipe Caamaño-Navarrete, Carlos Arriagada-Hernández, Roberto Lagos-Hernández, Gerardo Fuentes-Vilugrón, Lorena Jara-Tomckowiack, Eduardo Sandoval-Obando, Guido Contreras-Díaz, Daniel Jerez-Mayorga, Claudio Hernández-Mosqueira and Pedro Delgado-Floody

Children 2025, 12(10), 1402; https://doi.org/10.3390/children12101402 - 17 Oct 2025

Viewed by 852

Abstract

Background: Childhood and adolescence are increasingly recognized as life stages that pose specific challenges for treating and promoting mental health and cognitive development. Objective: The objective of the present study was to determine the potential mediating role of good mental health in the [...] Read more.

Background: Childhood and adolescence are increasingly recognized as life stages that pose specific challenges for treating and promoting mental health and cognitive development. Objective: The objective of the present study was to determine the potential mediating role of good mental health in the association between an unhealthy lifestyle (i.e., low physical activity (PA) and high screen time (ST)) with executive functions (EFs) (i.e., attention, inhibition, cognitive flexibility, and working memory) in children and adolescents. Methods: A cross-sectional investigation with 625 students aged 10–17 years participated. The Krece Plus questionnaire (lifestyle, PA, and ST), Depression Anxiety and Stress Scale (DASS-21, metal health), and CogniFit (EFs) were used in the present study. Results: Good mental health presented a partial mediating role in the relationship between a bad lifestyle and EFs. Likewise, a bad lifestyle was linked inversely to attention (β −37.45, p = 0.002), the executive function of cognitive flexibility (β −85.91, p < 0.001), inhibition (β −60.16, p < 0.001), and working memory (β −75.73, p < 0.001). Conclusions: Good mental health acts as a relevant mediator in child and adolescent cognitive development. These results reinforce the need to promote active and healthy lifestyles, as well as strategies that promote psychological wellbeing from an early age. Schools and families play an important role as protective agents and promoters of integral development; it is therefore recommended to implement intervention programmes that strategically address the physical activity, mental health, and digital habits of this population. Full article

(This article belongs to the Section Pediatric Mental Health)

► Show Figures

Figure 1

14 pages, 1939 KB

Open AccessArticle

Age-Dependent Burst Suppression During Anesthesia in Young Children with Congenital Heart Disease: The Impact of Anesthetic Depth

by Annelie Augustinsson, Carina Sjöberg, Johan Holmén, Anders Hjärpe and Pether Jildenstål

Children 2025, 12(10), 1401; https://doi.org/10.3390/children12101401 - 17 Oct 2025

Viewed by 555

Abstract

Background/Objectives: Electroencephalography (EEG) is increasingly used in pediatric anesthesia to detect abnormal brain activity such as burst suppression (BS), a marker of profound cortical inactivation. The objective of this study was to assess anesthetic depth using bilateral spectral edge frequency (SEF) and [...] Read more.

Background/Objectives: Electroencephalography (EEG) is increasingly used in pediatric anesthesia to detect abnormal brain activity such as burst suppression (BS), a marker of profound cortical inactivation. The objective of this study was to assess anesthetic depth using bilateral spectral edge frequency (SEF) and to determine the incidence of frontal cortical BS in young children undergoing cardiac surgery with extracorporeal circulation (ECC) under sevoflurane anesthesia. Methods: Twelve children, divided into two age groups (<12 months and 12–36 months), were included. EEG sensors were placed on the forehead and continuously monitored with SedLine^®. BS and SEF were analyzed using linear mixed-effects models, accounting for age group and repeated measurements across the procedure. Results: BS did not differ significantly over time. Across the full surgical procedure, higher SEF was associated with lower BS. However, children <12 months exhibited a stronger SEF–BS relationship, suggesting greater susceptibility to BS compared to older children. Before and during ECC, SEF and age group were not significantly related to BS. Random effects indicated moderate to substantial between-subject variability. Scatterplots showed a negative SEF–BS relationship overall, but weak and inconsistent associations during specific perioperative phases, underscoring the phase-dependent nature of SEF–BS dynamics. Conclusions: SEF is an age-sensitive marker of anesthetic depth during sevoflurane anesthesia with ECC, with children <12 months showing greater susceptibility to BS. These findings highlight the importance of individualized, age-adjusted anesthesia monitoring strategies in pediatric cardiac surgery. Full article

(This article belongs to the Section Pediatric Anesthesiology, Pain Medicine and Palliative Care)

► Show Figures

Graphical abstract

10 pages, 2940 KB

Open AccessArticle

Interleukin-12 as a Predictor for Unresponsiveness to the Hepatitis B Vaccine: A Novel Cut-Off Point in Children

by Yudith Setiati Ermaya, Yunia Sribudiani, Reni Ghrahani, Quak Seng Hock and Dwi Prasetyo

Children 2025, 12(10), 1400; https://doi.org/10.3390/children12101400 - 17 Oct 2025

Viewed by 398

Abstract

Background: Despite the widespread implementation of Hepatitis B vaccination, some children fail to develop protective immunity. Thus, identifying markers for vaccine unresponsiveness is crucial for optimizing current strategies. As interleukin-12 (IL-12), a central cytokine in Th 1 immune activation, has shown potential [...] Read more.

Background: Despite the widespread implementation of Hepatitis B vaccination, some children fail to develop protective immunity. Thus, identifying markers for vaccine unresponsiveness is crucial for optimizing current strategies. As interleukin-12 (IL-12), a central cytokine in Th 1 immune activation, has shown potential as a predictive biomarker, the aim of this study was to determine its role in the Hepatitis B vaccine response, highlighting novel findings regarding the threshold level of IL-12 in the pediatric population in doing so. Methods: A cross-sectional study was conducted on a community in Bandung City. The subjects were 7–12-month-old babies who had completed primary Hepatitis B vaccination (0, 2, 3, and 4 months of age). Blood tests for anti-HB examination were performed with a Chemiluminescent Microparticle Immunoassay (CMIA) to determine the response and non-response groups, and an Enzyme Immunosorbent Assay (ELISA) was used for IL-12 detection. Data were analyzed using the Kruskal–Wallis test, Chi-square test, Spearman Correlation, and Receiver Operating Characteristics. Statistical analysis was conducted with SPSS version 18.0. Results: The results of this study indicate that 4.5% of the subjects were unresponsive to the Hepatitis B vaccine. The most important finding was a significant correlation between IL-12 and the presence of anti-HB titers in the responsive and non-responsive groups (p = 0.016). The Receiver Operating Characteristics (ROC) curve for IL-12 identified a cut-off point of ≥10.65 pg/mL (>100 mIU/mL in anti-HBs), with a sensitivity of 64.23%, specificity of 68.75%, and accuracy of 65.2%. Conclusions: Interleukin-12 can be considered as an early candidate biomarker for responsiveness to the Hepatitis B vaccine in children. Full article

(This article belongs to the Section Pediatric Infectious Diseases)

► Show Figures

Figure 1

13 pages, 787 KB

Open AccessArticle

Relationship Between Short Sleep, Exercise Frequency and Media Use with Oral Health in Korean Elementary School Children: A Cross-Sectional Study

by Chae-Eun Kim and So-Youn An

Children 2025, 12(10), 1399; https://doi.org/10.3390/children12101399 - 17 Oct 2025

Viewed by 516

Abstract

Background: Dental caries, periodontal disease, and malocclusion are common childhood oral diseases strongly influenced by lifestyle factors, including sleep, exercise, and media use. In Korea, the prevalence of dental caries among elementary school children is approximately 20–25%, periodontal disease 1–2%, and malocclusion 12–18%. [...] Read more.

Background: Dental caries, periodontal disease, and malocclusion are common childhood oral diseases strongly influenced by lifestyle factors, including sleep, exercise, and media use. In Korea, the prevalence of dental caries among elementary school children is approximately 20–25%, periodontal disease 1–2%, and malocclusion 12–18%. Sleep is a key determinant of child health; insufficient sleep is linked to weakened immunity, higher systemic inflammation, and greater susceptibility to cariogenic bacteria, suggesting a potential pathway to poor oral health. This study aimed to analyze the combined effects of sleep duration, exercise frequency, and media use on oral health indicators in Korean elementary school students. Methods: We analyzed Student Health Examination data from the Ministry of Education (2021–2023) for 93,220 children aged 6–12 years. Oral health indicators included dental caries prevalence (DCP), required rate of improved oral hygiene (RRIOH), periodontal disease prevalence (PDP), and malocclusion prevalence (MP). Sleep duration was categorized as short (<8 h) or adequate (≥8 h). Exercise (≥3 times/week) and media use (>2 h/day) were assessed as lifestyle factors. Associations were examined using the Rao-Scott χ² test and logistic regression. Results: Short sleep was significantly associated with a higher prevalence of all oral health indicators, with particularly strong associations for DCP and PDP. Low exercise frequency and excessive media use were also linked to increased DCP and RRIOH. These lifestyle factors were closely interrelated with sleep duration. Conclusions: Short sleep, infrequent exercise, and high media use form a lifestyle pattern associated with poor oral health in children. Improving sleep and lifestyle habits should be emphasized as a preventive strategy in pediatric dentistry. Full article

(This article belongs to the Section Pediatric Dentistry & Oral Medicine)

► Show Figures

Figure 1

15 pages, 449 KB

Open AccessArticle

The Role of Spirometry and MMEF in Pediatric Asthma Monitoring and Prediction of Exacerbations

by Paraschiva Chereches-Panta, Ioana Marica, Valentina Sas, Alina Petronela Bouari-Coblișan and Sorin Claudiu Man

Children 2025, 12(10), 1398; https://doi.org/10.3390/children12101398 - 16 Oct 2025

Viewed by 633

Abstract

Background: Asthma is the most common chronic disease during childhood. Spirometry is recommended as a reliable lung function test. Several studies have demonstrated the lack of use of spirometry for both diagnostic confirmation and monitoring. Using subjective symptom control tests alone may [...] Read more.

Background: Asthma is the most common chronic disease during childhood. Spirometry is recommended as a reliable lung function test. Several studies have demonstrated the lack of use of spirometry for both diagnostic confirmation and monitoring. Using subjective symptom control tests alone may underestimate the risk for future asthma attacks. Methods/Objectives: We conducted a retrospective, observational study in a single pediatric centre in Romania. The main objectives of the study were to analyse the quality of spirometry in children and to emphasise the importance of performing accurate spirometry for asthma monitoring. The secondary objective was to evaluate if forced expiratory volume in the first second (FEV1) and mid-maximum expiratory flow (MMEF) values are predictive markers for future exacerbations in children with asthma. Results: The study group included 416 patients between 5 and 18 years who performed at least one spirometry. The success rate for spirometry in our study was 66.3%. In a subsequent study group of 88 patients we monitored spirometry initially and after 12 months. We found a statistically significant difference between FEV1 and MMEF in the controlled, partially controlled and uncontrolled groups (p = 0.0102 and p = 0.0001). Our study showed no association between FEV1 and risk for exacerbations (Rs = −0.156, p = 0.146) and an acceptably negative (Rs = −0.30) and statistically significant (p = 0.040) correlation between initial MMEF values and the number of exacerbations. Conclusions: Low initial MMEF values correlate with the number of exacerbations in a 12-month follow-up period. This suggests that evaluating MMEF alongside FEV1 in children with asthma could contribute to better identification of the risk of exacerbation. Full article

(This article belongs to the Special Issue Pulmonary Function in Children with Respiratory Symptoms)

► Show Figures

Figure 1

16 pages, 493 KB

Open AccessArticle

Quality of Life and Mental Health Problems in Pediatric Cardiac Arrest Survivors

by Tina Schwartz, Michael Weidenbach, Ingo Dähnert, Christian Paech and Franziska Markel

Children 2025, 12(10), 1397; https://doi.org/10.3390/children12101397 - 16 Oct 2025

Viewed by 637

Abstract

Background: Current research is paying more attention to neurological outcomes and quality of life after life-threatening events. Children with heart disease are particularly vulnerable, especially after resuscitation events. While newer data show that adults with heart failure and a left-ventricular assist device suffer [...] Read more.

Background: Current research is paying more attention to neurological outcomes and quality of life after life-threatening events. Children with heart disease are particularly vulnerable, especially after resuscitation events. While newer data show that adults with heart failure and a left-ventricular assist device suffer from a higher incidence of depression, mental health in pediatric heart disease patients is poorly understood. This is the first study in Germany to examine the quality of life and psychological burden in cardiac arrest survivors with congenital or acquired heart disease. Methods: This monocentric study retrospectively analyzed survival outcomes of pediatric heart disease patients who underwent in-hospital resuscitation between 2008 and 2022. The PedsQL and Strength and difficulties questionnaires were prospectively administered to survivors to assess quality of life and emotional/behavioral problems, while academic achievements were additionally documented. Results: Of 127 patients experiencing cardiac arrest, 91 (71.7%) survived to discharge. Most had complex congenital heart diseases; mean cardiopulmonary resuscitation duration was 14 min. Five patients received extracorporeal cardiopulmonary resuscitation. Of the 22 patients who were receiving follow-up care at the pediatric cardiology outpatient clinic at the time of the study, 14 completed questionnaires were received. Overall quality of life was comparable to healthy controls, though those with prolonged or multiple resuscitations showed lower physical, emotional, social, and school functioning scores. The Strengths and Difficulties Questionnaire revealed no pathological scores but elevated average values for hyperactivity and emotional problems in parent reports, and emotional and peer difficulties in self-reports, indicating increased psychological burden. Conclusions: While survival rates are comparable to international data, gaps exist in structured follow-up and neuropsychological care, especially for high-risk subgroups like ECMO survivors. Routine neuropsychological screening and multidisciplinary outpatient programs are essential to improve long-term follow-up care. Full article

(This article belongs to the Special Issue Evaluation and Management of Children with Congenital Heart Disease)

► Show Figures

Graphical abstract

12 pages, 925 KB

Open AccessArticle

Screen Time and Sleep Bruxism—A Comparison Between the Present Time and the COVID-19 Pandemic

by Nadezhda Mitova and Marianna Dimitrova

Children 2025, 12(10), 1396; https://doi.org/10.3390/children12101396 - 16 Oct 2025

Viewed by 958

Abstract

Objectives: The aim of this study is to assess the impact of screen time on the incidence of sleep bruxism in children during the COVID-19 pandemic. Methods: The parents of 266 children, aged 3–14 years, participated in the present study. They [...] Read more.

Objectives: The aim of this study is to assess the impact of screen time on the incidence of sleep bruxism in children during the COVID-19 pandemic. Methods: The parents of 266 children, aged 3–14 years, participated in the present study. They were provided with a 36-item questionnaire in order to collect data about their child’s personal information, general health, sleep bruxism, and the effects of the COVID-19 pandemic on them. The collected data were analyzed statistically using a chi-square (χ²) test, ANOVA with post hoc analysis (Tukey’s HSD), and a t-test. Results: Screen time increased significantly during the pandemic, especially among children using screens ≥180 min/day. The proportion of children spending 180–360 min/day doubled to 24.4%. Lower secondary school children had the highest screen time, with an increase of ~60 min/day during the pandemic. Smartphones were the most used device (50.8%), and on average, children with bruxism spent 32 min longer in front of screens than children without bruxism (p < 0.05). Conclusions: Daily screen use is common in children, and this increased during the COVID-19 pandemic. Children with sleep bruxism exhibit longer screen time than those without bruxism, suggesting that the former is a potential risk factor for the latter. Full article

(This article belongs to the Section Pediatric Dentistry & Oral Medicine)

► Show Figures

Graphical abstract

13 pages, 350 KB

Open AccessArticle

Navigating Parenting in Pediatric Oncology: Merging Psychodynamic Theory and Evidence-Based Practice

by Yael L. E. Ankri and Amichai Ben-Ari

Children 2025, 12(10), 1395; https://doi.org/10.3390/children12101395 - 16 Oct 2025

Viewed by 427

Abstract

Background/Objectives: Parenting a child with a chronic illness such as cancer presents distinct psychological challenges that often disrupt normative parenting patterns. Parents frequently struggle to maintain boundaries in response to their child’s heightened emotional needs, leading to overprotective or permissive behaviors. This study [...] Read more.

Background/Objectives: Parenting a child with a chronic illness such as cancer presents distinct psychological challenges that often disrupt normative parenting patterns. Parents frequently struggle to maintain boundaries in response to their child’s heightened emotional needs, leading to overprotective or permissive behaviors. This study revisits Winnicott’s theory of the “good enough parent” and explores its application in the context of pediatric oncology. We aim to examine how a psychodynamic framework can be integrated with evidence-based practices to support parental functioning and promote child resilience during cancer treatment. Methods: This conceptual paper employs a qualitative, theory-driven case study approach. We analyze the case of a 6.5-year-old girl diagnosed with acute lymphoblastic leukemia (ALL), focusing on the evolving dynamics between the child’s regressive behaviors and the parents’ emotional responses. Winnicott’s developmental model is expanded to conceptualize parenting as a continuous balance between responsiveness and structure. Clinical dialogues illustrate the therapeutic process of guiding parents toward a more adaptive stance. Results: The analysis highlights how permissive parenting, driven by parental guilt and fear, may initially reduce child distress, but can inadvertently reinforce emotional dysregulation and dependency. The application of a dialectical interpretation of Winnicott’s theory allowed for a therapeutic shift, supporting parents in setting empathic yet firm boundaries. Conclusions: A balanced, dialectical approach to parenting—one that integrates emotional attunement with appropriate demands—can enhance a child’s psychological resilience during cancer treatment. Incorporating psychodynamic insights into clinical practice can help professionals guide families toward more adaptive, developmentally supportive caregiving strategies. Full article

(This article belongs to the Special Issue Medical Trauma in Children: Actual Challenges)

► Show Figures

Figure 1

14 pages, 591 KB

Open AccessArticle

The Impact of Expressive Arts Therapy on Alexithymia Levels in Adolescent Inpatients with Severe Anorexia Nervosa

by Flavia Cirillo, Giulia Spina, Mariangela Irrera, Elena Bozzola, Cristina Mascolo, Livia Gargiullo, Valentina Burla, Marco Roversi, Carla Maria Carlevaris, Stefania Dusi, Italo Pretelli and Maria Rosaria Marchili

Children 2025, 12(10), 1394; https://doi.org/10.3390/children12101394 - 16 Oct 2025

Viewed by 506

Abstract

Background: Anorexia nervosa (AN) is a complex psychiatric disorder that requires a multidisciplinary approach. The World Health Organization recognizes the therapeutic value of expressive arts, including drama, in enhancing emotional, cognitive, and relational domains in severe mental illnesses such as AN. Expressive arts [...] Read more.

Background: Anorexia nervosa (AN) is a complex psychiatric disorder that requires a multidisciplinary approach. The World Health Organization recognizes the therapeutic value of expressive arts, including drama, in enhancing emotional, cognitive, and relational domains in severe mental illnesses such as AN. Expressive arts interventions may improve emotional intelligence, empathy, and self-awareness while reducing anxiety and alexithymia. This study evaluated the impact of an adjunctive expressive arts program on alexithymia in pediatric inpatients with AN. Methods: We enrolled patients aged 11–18 years hospitalized for AN, according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, at the Pediatric Unit of Bambino Gesù Children’s Hospital, Rome. The study period ran from December 2024 to April 2025. Participants attended drama therapy sessions and expressive arts workshops in a dedicated recreational space integrated into a multidisciplinary treatment plan. Alexithymia was assessed at admission and discharge using the Toronto Alexithymia Scale (TAS-20), with scores ≥ 61 indicating alexithymia. At the end of the program, participants completed a semi-structured satisfaction questionnaire to evaluate subjective experiences and mood. Results: Thirty patients met inclusion criteria. The TAS-20 scores were statistically different between pre-/post-theater activity (p < 0.001). The proportion of alexithymic participants declined from 73.3% at baseline to 26.7% at discharge. Most participants reported mood improvements: 66.6% “somewhat” and 26.7% “greatly.” Additionally, 90% reported improved peer relationships. Conclusions: Expressive arts, particularly drama-based interventions, may represent an effective adjunctive therapy for adolescents with AN, supporting emotional awareness, self-regulation, and social connectedness. Arts-based interventions are associated with nonverbal avenues for emotional processing and may promote neuroplasticity, representing valuable complementary strategies for AN treatment. Full article

(This article belongs to the Special Issue Prevention and Treatment of Diet-Related Diseases Among Children and Adolescents)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Children, Volume 12, Issue 10 (October 2025) – 146 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI