Children

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 (registering DOI) - 18 Oct 2025

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 (registering DOI) - 18 Oct 2025

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

Figure 1

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 (registering DOI) - 18 Oct 2025

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, 503 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

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)

16 pages, 726 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

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)

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

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

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 25

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 35

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 35

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 68

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

Figure 1

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 60

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 57

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 146

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, 640 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 194

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

Figure 1

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 130

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

Figure 1

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 124

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 152

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

12 pages, 1972 KB

Open AccessArticle

Residual Adenoid Tissue After Conventional Adenoidectomy and the Role of Intraoperative Nasal Endoscopy: A Prospective Cohort Study

by Goran Latif Omer, Aland Salih Abdullah, Sahand Soran Ali, Stefano Di Girolamo, Sveva Viola, Andrea Bravetti, Maria Grazia Maglie, Sara Maurantonio, Laura Borghesi, Othman Hussein Ahmed, Aso Khasraw Ahmed, Amanj Hamaamin Hamaamin, Hemn Hussein Othman and Giuseppe De Donato

Children 2025, 12(10), 1393; https://doi.org/10.3390/children12101393 - 16 Oct 2025

Viewed by 167

Abstract

Background/Objectives: Conventional curettage adenoidectomy is widely performed but may leave residual tissue in anatomically hidden nasopharyngeal areas. We evaluated the impact of age and revision status on residual adenoidal tissue after conventional adenoidectomy and assessed outcomes following endoscopic completion. Methods: A [...] Read more.

Background/Objectives: Conventional curettage adenoidectomy is widely performed but may leave residual tissue in anatomically hidden nasopharyngeal areas. We evaluated the impact of age and revision status on residual adenoidal tissue after conventional adenoidectomy and assessed outcomes following endoscopic completion. Methods: A prospective cohort study included 178 patients undergoing conventional adenoidectomy followed by intraoperative nasal endoscopy. Residual tissue in the nasopharyngeal roof, Fossa of Rosenmüller, and around the Eustachian tube was resected using a microdebrider. Patients were categorized into four groups based on age (<9 or ≥9 years) and surgical history (primary vs. revision). Pediatric Sleep Questionnaire (PSQ) or STOP-BANG scores were collected pre- and postoperatively. Receiver operating characteristic (ROC) and logistic regression analyses were used to identify predictors of residual tissue. Results: Residual adenoid tissue was detected in 61.8% of patients after conventional adenoidectomy, highest among those ≥9 years undergoing revision (36.4%). Age ≥ 7.5 years and revision status predicted residual tissue (AUC = 0.71). Significant postoperative symptom improvement was observed (PSQ and STOP-BANG, p < 0.001). Complication rates were low (13.5%), with no recurrences reported. Conclusions: Conventional curettage often leaves residual adenoidal tissue in older and revision cases. Endoscopic completion improves outcomes. Primary endoscopic adenoidectomy is recommended for patients aged ≥7.5 years and those undergoing revision procedures. Full article

(This article belongs to the Section Pediatric Otolaryngology)

► Show Figures

Figure 1

16 pages, 1106 KB

Open AccessArticle

Diagnostic Accuracy and Clinical Impact of Handheld Point-of-Care Ultrasound in Pediatric Odontogenic Infections: A Prospective Cohort Study

by Hanna Frid, Amir Bilder, Ahmad Hija and Omri Emodi

Children 2025, 12(10), 1392; https://doi.org/10.3390/children12101392 - 15 Oct 2025

Viewed by 124

Abstract

Background: Pediatric odontogenic infections pose significant diagnostic challenges, particularly in distinguishing between cellulitis and abscess. Accurate differentiation is crucial for guiding appropriate management—antibiotics alone for cellulitis versus surgical incision and drainage (I&D) for an abscess—but can be difficult without specialized expertise or advanced [...] Read more.

Background: Pediatric odontogenic infections pose significant diagnostic challenges, particularly in distinguishing between cellulitis and abscess. Accurate differentiation is crucial for guiding appropriate management—antibiotics alone for cellulitis versus surgical incision and drainage (I&D) for an abscess—but can be difficult without specialized expertise or advanced imaging. Objective: We aimed to evaluate the diagnostic accuracy of handheld point-of-care ultrasound (POCUS; Philips Lumify), utilized by non-specialist clinicians, in differentiating cellulitis from abscess in pediatric odontogenic infections. A secondary objective was to assess its impact on reducing hospital admissions and emergency department (ED) burden. Methods: This prospective cohort study involved 111 pediatric patients (aged 1–17 years) presenting with maxillofacial odontogenic infections to a tertiary care academic medical center. Following clinical evaluations, handheld POCUS assessments were performed by trained non-specialist clinicians. Findings from I&D or clinical resolution with antibiotics served as the reference standard. Ninety cases were included in the final diagnostic accuracy analysis after 21 exclusions. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy with 95% confidence intervals (CIs) were calculated. Hospital admission trends were compared before (2017–2021) and after POCUS implementation (January 2022–April 2025). Interpretation should consider potential verification bias from the asymmetric reference standard (I&D for abscess vs. clinical resolution for cellulitis). Results: Handheld POCUS exhibited a sensitivity of 72.97% (95% CI: 57.02–84.60%), specificity of 73.58% (95% CI: 60.42–83.56%), PPV of 65.85% (95% CI: 50.55–78.44%), NPV of 79.59% (95% CI: 66.36–88.52%), and overall accuracy of 73.33% (95% CI: 63.38–81.38%). Following POCUS implementation, the annualized hospital admission rate for pediatric facial odontogenic infections decreased from 60.0 to 19.5 admissions/year; rate ratio (RR) = 0.33 (95% CI: 0.25–0.42), p < 0.001 (Poisson regression with log-offset for period length). Conclusions: Handheld POCUS, operated by non-specialist clinicians after a defined training protocol, was associated with a lower annualized admission rate and demonstrated moderate diagnostic accuracy. Its adoption was associated with a notable reduction in hospitalizations, suggesting its potential for alleviating ED overcrowding, reducing healthcare costs, and minimizing pediatric stress. Wider adoption, supported by standardized training, could enhance healthcare efficiency and quality in managing this common pediatric condition. Full article

(This article belongs to the Special Issue Pediatric Oral and Facial Surgery: Advances and Future Challenges)

► Show Figures

Figure 1

13 pages, 461 KB

Open AccessArticle

Sex-Specific Associations Between 2D:4D Digit Ratio and Physical Fitness in Prepubertal Children: Evidence from Standardized Agility, Strength, and Endurance Assessments

by Fatih Akgül, Ahmet Kurtoğlu, Rukiye Çiftçi, Özgür Eken, Bekir Çar, Alperen Şanal and Monira I. Aldhahi

Children 2025, 12(10), 1391; https://doi.org/10.3390/children12101391 - 15 Oct 2025

Viewed by 187

Abstract

Background: The second-to-fourth digit ratio (2D:4D) serves as a non-invasive proxy for prenatal androgen exposure. While its relationship with adult athletic ability is well documented, evidence for its association with childhood physical fitness remains inconsistent, and links between 2D:4D and objective fitness measures [...] Read more.

Background: The second-to-fourth digit ratio (2D:4D) serves as a non-invasive proxy for prenatal androgen exposure. While its relationship with adult athletic ability is well documented, evidence for its association with childhood physical fitness remains inconsistent, and links between 2D:4D and objective fitness measures in prepubertal children are unclear. Methods: In this cross-sectional study, 338 prepubertal children (181 girls, 157 boys; aged 5–12 years) underwent precise measurement of right- and left-hand 2D:4D ratios (intra-class correlation coefficient = 0.94). Physical fitness was evaluated using standardized tests: the Illinois agility run, bent-arm hang, and standing long jump. Results: Among boys, higher 2D:4D ratios were modestly associated with prolonged bent-arm hang performance (β = 0.19, q = 0.04) and shorter Illinois agility times (β = −0.19, q = 0.04). No significant associations were observed in girls. All effect sizes were small, suggesting subtle, sex-dependent influences rather than robust predictors of performance. Conclusions: These findings indicate that prenatal hormonal environment may exert a limited, sex-specific influence on early physical fitness characteristics. Although biologically informative, the observed associations are insufficient for direct application in talent identification in sports. Longitudinal research incorporating direct hormonal measurements and broader populations is recommended to clarify developmental mechanisms and causal pathways. Full article

(This article belongs to the Section Global Pediatric Health)

► Show Figures

Figure 1

19 pages, 695 KB

Open AccessReview

Updates on Anti-Obesity Medications in Children and Adolescents

by Mostafa Salama, Doha Hassan and Seema Kumar

Children 2025, 12(10), 1390; https://doi.org/10.3390/children12101390 - 15 Oct 2025

Viewed by 274

Abstract

Childhood obesity has assumed epidemic proportions; it results from a complex interplay of genetic, physiological, socioeconomic, and environmental factors. It is associated with numerous short- and long-term health complications, including cardiometabolic and psychosocial consequences. While lifestyle modifications remain the cornerstone of treatment, their [...] Read more.

Childhood obesity has assumed epidemic proportions; it results from a complex interplay of genetic, physiological, socioeconomic, and environmental factors. It is associated with numerous short- and long-term health complications, including cardiometabolic and psychosocial consequences. While lifestyle modifications remain the cornerstone of treatment, their overall impact is modest. As a result, pharmacotherapy is increasingly recommended as an adjunct in selected pediatric patients, particularly those with severe or refractory obesity. In recent years, several anti-obesity medications, including glucagon-like peptide-1 (GLP-1) receptor agonists, have shown promise in pediatric populations, particularly adolescents. However, the pharmacologic options remain limited for younger children. This review summarizes current evidence on the efficacy and safety of available anti-obesity medications in children and adolescents, offering practical, age-based strategies to guide the appropriate clinical use of these medications as part of a comprehensive obesity-management plan. Full article

(This article belongs to the Section Pediatric Endocrinology & Diabetes)

► Show Figures

Figure 1

15 pages, 936 KB

Open AccessArticle

Personalized Management and Timing of Thymectomy in Juvenile Myasthenia Gravis: Insights from Routine Clinical Scale Use in a Single-Center Retrospective Cohort—A Case Series

by Gulten Ozturk, Olcay Unver, Elif Acar Arslan, Nezih Onur Ermerak, Bilgihan Bıkmazer, Hakkı Akbeyaz, Burcu Karakayali, Sermin Aksoy Ozcan, Gulcan Akyuz, Pınar Ergenekon, Yasemin Gokdemir, Ela Erdem Eralp, Pınar Kahraman Koytak, Kayıhan Uluc and Dilsad Turkdogan

Children 2025, 12(10), 1389; https://doi.org/10.3390/children12101389 - 15 Oct 2025

Viewed by 107

Abstract

Introduction: Juvenile myasthenia gravis (JMG) is a rare autoimmune disorder with a variable clinical course and limited pediatric-specific treatment guidelines. Objective clinical scales, such as the Quantitative Myasthenia Gravis (QMG) Score and the Pediatric Myasthenia Gravis Quality of Life 15 (PM-QOL15), may support [...] Read more.

Introduction: Juvenile myasthenia gravis (JMG) is a rare autoimmune disorder with a variable clinical course and limited pediatric-specific treatment guidelines. Objective clinical scales, such as the Quantitative Myasthenia Gravis (QMG) Score and the Pediatric Myasthenia Gravis Quality of Life 15 (PM-QOL15), may support individualized management, but their role in routine practice remains underexplored. Methods: We retrospectively reviewed 10 seropositive JMG patients followed at a single tertiary neuromuscular clinic between 2014 and 2024. All patients underwent a systematic assessment with QMG at each visit, while PM-QOL15 was administered at the final visit. Clinical data, comorbidities, antibody status, treatment modalities, and outcomes were analyzed. Associations between treatment strategies, comorbidities, and scale scores were explored using appropriate statistical methods. Results: Seven patients (70%) underwent thymectomy, resulting in a reduction in mean QMG scores from 7.7 to 2.4, though residual relapses were observed. Chronic intravenous immunoglobulin (IVIG) therapy, administered to 70% of patients, did not significantly reduce relapse rates or steroid exposure and was associated with higher QMG scores in the second year, suggesting use in more severe phenotypes rather than therapeutic efficacy. Prolonged corticosteroid therapy did not improve remission time or relapse frequency and was complicated by major adverse effects in two patients. Timing of azathioprine initiation showed no significant correlation with relapse frequency. PM-QOL15 correlated strongly with mean QMG (r = 0.88, p < 0.001), reflecting cumulative disease burden. Patients with comorbidities required longer stabilization, although differences were not statistically significant. Conclusions: The routine integration of QMG and PM-QOL15 into follow-up may facilitate the earlier recognition of subclinical deterioration, provide objective measures of treatment response, and guide personalized management in JMG. Thymectomy showed benefit in selected patients, while the long-term roles of IVIG and corticosteroids remain uncertain. Larger multicenter prospective studies are warranted to confirm these findings and refine evidence-based strategies for pediatric JMG. Full article

(This article belongs to the Section Pediatric Neurology & Neurodevelopmental Disorders)

► Show Figures

Figure 1

14 pages, 737 KB

Open AccessArticle

Assessment of Physical Fitness in Children and Adolescents with Simple Obesity

by Jacek Podogrodzki, Mieczysław Szalecki, Anna Wrona and Aldona Wierzbicka-Rucińska

Children 2025, 12(10), 1388; https://doi.org/10.3390/children12101388 - 15 Oct 2025

Viewed by 154

Abstract

Objectives: The systematic increase in the number of overweight and obese people in recent years has led to the recognition of this condition as a chronic, non-infectious disease of civilization, declared a global epidemic by WHO in 1997. This phenomenon is particularly dangerous [...] Read more.

Objectives: The systematic increase in the number of overweight and obese people in recent years has led to the recognition of this condition as a chronic, non-infectious disease of civilization, declared a global epidemic by WHO in 1997. This phenomenon is particularly dangerous in children, because it negatively affects their later existence in the health, mental and social spheres. This phenomenon is particularly concerning in the pediatric population, as it may have long-term adverse effects on physical health, psychological well-being, and social functioning. Objective: The aim of this study was to assess anthropometric parameters and physical fitness using the EUROFIT test in children and adolescents diagnosed with obesity. Materials and Methods: The study group consisted of 123 pediatric patients attending the Endocrinology and Diabetology Clinic and Pediatric Rehabilitation IP-CZD aged 8–16 (64 boys—52% and 59 girls—48%) with diagnosed simple obesity. Obesity was diagnosed according to the CDC standard using percentile charts from the OLAF study. Physical fitness was assessed using the EUROFIT test using 8 samples, and body mass composition was examined using the bioimpedance method with the BC 418 Tanita analyzer. Results: The results of our own research obtained in this study were compared to population standards. The total results of the EUROFIT test in the study group were statistically significantly lower than the norm. The results of the balance, upper limb movement speed, jumping, trunk strength, functional strength and agility tests were lower than the norm, the flexibility result was within the norm, and only hand strength was higher than the norm. In 4 out of 8 fitness tests, girls achieved significantly better results than boys. Conclusions: Reduced physical fitness is characteristic of children and adolescents with simple obesity. Worse physical fitness shows significant correlations with the results of anthropometric measurements. Full article

(This article belongs to the Special Issue Lifestyle and Children's Health Development)

► Show Figures

Figure 1

18 pages, 568 KB

Open AccessArticle

Uncovering the Relationship Between Bullying, Social Communication Challenges, and the Emergence of Mental Health Problems Among Saudi Children with Autism Spectrum Disorder

by Mahmoud Abdelwahab Khedr, Nada Alqarawi and Rasha Mohammed Hussein

Children 2025, 12(10), 1387; https://doi.org/10.3390/children12101387 - 14 Oct 2025

Viewed by 206

Abstract

Background/Objective: Children with ASD are particularly vulnerable to bullying, which may exacerbate mental health issues. This study aims to explore the intricate relationships between bullying, social communication challenges, and the emergence of mental health problems among Saudi children with ASD. Additionally, it examines [...] Read more.

Background/Objective: Children with ASD are particularly vulnerable to bullying, which may exacerbate mental health issues. This study aims to explore the intricate relationships between bullying, social communication challenges, and the emergence of mental health problems among Saudi children with ASD. Additionally, it examines the mediating role of social communication challenges in these associations. Methods: A cross-sectional study was conducted with 150 children diagnosed with ASD at the Abdullah Altamimi Centre. Data were collected using the Child–Adolescent Bullying Scale, Social Communication Questionnaire, and Strengths and Difficulties Questionnaire. The data collection period lasted for three months, from the beginning of December 2024 to the end of February 2025. Results: The mean child–adolescent bullying score was 46.37, indicating prevalent bullying experiences. The mean Strengths and Difficulties Questionnaire score was 21.35, revealing significant emotional and behavioral difficulties. Positive correlations were found between bullying and social challenges (r = 0.306, p < 0.001) and emotional problems (r = 0.247, p = 0.002). Mediation analysis indicated that social communication challenges significantly mediated the relationship between bullying and strengths and difficulties scores (p < 0.001). Conclusions: Bullying significantly affects the mental health of Saudi children with ASD, highlighting the need for targeted interventions to enhance social communication skills and mitigate the impacts of bullying. These findings underscore the need to address these challenges within the cultural context of Saudi Arabia to enhance the well-being of this vulnerable population. Full article

(This article belongs to the Section Pediatric Mental Health)

► Show Figures

Figure 1

19 pages, 1919 KB

Open AccessReview

Essential Concepts in Artificial Intelligence: A Guide for Pediatric Providers

by Laura Elena Mendoza Bolivar and Michael Satzer

Children 2025, 12(10), 1386; https://doi.org/10.3390/children12101386 - 14 Oct 2025

Viewed by 356

Abstract

Artificial intelligence (AI) has exploded in public awareness over recent years and is already beginning to reshape the health care sector. Yet, even as AI becomes more prevalent, it remains a mystery to many providers who lack hands-on exposure during their training or [...] Read more.

Artificial intelligence (AI) has exploded in public awareness over recent years and is already beginning to reshape the health care sector. Yet, even as AI becomes more prevalent, it remains a mystery to many providers who lack hands-on exposure during their training or on the job. Intended for medical professionals, this article defines essential concepts in AI interspersed with illustrations of how such concepts may be applied within cardiology and radiology—fields that have garnered the most approved medical AI applications to date. No experience in the field of AI is requisite before reading. To assist providers encountering novel machine learning tools, we also present an AI model checklist to empower critical assessment. We finally discuss hurdles in the path of developing pediatric AI tools—including challenges distinct from the adult setting—and discuss potential solutions, including various methods of multisite collaboration. This article aims to increase the engagement of health care professionals who may encounter AI models in practice or who seek to become involved in AI development themselves. We encourage the reader the freedom to either peruse this article in its entirety or to reference specific concepts individually. Terminology central to machine learning is emphasized in bold. Full article

(This article belongs to the Section Pediatric Cardiology)

► Show Figures

Figure 1

16 pages, 863 KB

Open AccessArticle

Maternal Overweight and Obesity Alter Neurodevelopmental Trajectories During the First Year of Life: Findings from the OBESO Cohort

by Arturo Alejandro Canul-Euan, Jonatan Alejandro Mendoza-Ortega, Juan Mario Solis-Paredes, Héctor Borboa-Olivares, Sandra Martínez-Medina, Carmen Hernández-Chávez, Gabriela Gil-Martínez, Erika Osorio-Valencia, Mariana Torres-Calapiz, Blanca Vianey Suárez-Rico, Isabel González-Ludlow, Carolina Rodríguez-Hernández, Ameyalli Rodríguez-Cano, Enrique Reyes-Muñoz, Ignacio Camacho-Arroyo, Sonia L. Hernandez, Otilia Perichart-Perera and Guadalupe Estrada-Gutierrez

Children 2025, 12(10), 1385; https://doi.org/10.3390/children12101385 - 14 Oct 2025

Viewed by 241

Abstract

Background/Objectives: Overweight and obesity during pregnancy are metabolic risk factors that may compromise offspring brain development. The first 1000 days of life represent a critical window in which neurodevelopmental trajectories are shaped by intrauterine and early-life exposures. The 6- and 12-month milestones are [...] Read more.

Background/Objectives: Overweight and obesity during pregnancy are metabolic risk factors that may compromise offspring brain development. The first 1000 days of life represent a critical window in which neurodevelopmental trajectories are shaped by intrauterine and early-life exposures. The 6- and 12-month milestones are key checkpoints where deviations may emerge, and interventions are most effective. This study evaluated the association between maternal pregestational weight status and infant neurodevelopment at 6 and 12 months of age. Methods: Mother and infant pairs from the OBESO perinatal cohort in Mexico City were included. Women in the first trimester of pregnancy were classified as normal weight and overweight/obesity according to their pregestational body mass index (pBMI), calculated from self-reported pre-pregnancy weight. Infant neurodevelopment was assessed at 6 and 12 months using the Bayley Scales of Infant Development III, Third Edition (BSID-III). Descriptive, bivariate and multiple linear regression analyses with mixed effects correction were conducted. Results: Among 97 mother–infant pairs, infants of mothers with overweight/obesity had lower language and socio-emotional scores at 12 months. Higher maternal pBMI was correlated with lower motor scores at 6 and 12 months, and with lower language scores at 12 months. Longitudinal analysis showed that maternal overweight/obesity was associated with a significant decline in language development from 6 to 12 months. (p = 0.002). Conclusions: Maternal pregestational overweight or obesity may negatively influence early neurodevelopment, particularly affecting language and cognitive domains during the first year of life. These early deficits could reflect alterations in intrauterine programming associated with maternal metabolic status. Full article

(This article belongs to the Special Issue Neurodevelopmental Disorders in Pediatrics: 2nd Edition)

► Show Figures

Figure 1

20 pages, 1180 KB

Open AccessReview

Can Functional Cognitive Assessments for Children/Adolescents Be Transformed into Digital Platforms? A Conceptual Review

by Yael Fogel, Naomi Josman, Ortal Cohen Elimelech and Sharon Zlotnik

Children 2025, 12(10), 1384; https://doi.org/10.3390/children12101384 - 14 Oct 2025

Viewed by 307

Abstract

Background/Objectives: Functional cognition, integrating cognitive abilities during real-life task performance, is essential for understanding daily functioning in children and adolescents. Traditional paper-based cognitive assessments in controlled environments often lack ecological validity. Although performance-based assessments more accurately represent functioning in natural contexts, most have [...] Read more.

Background/Objectives: Functional cognition, integrating cognitive abilities during real-life task performance, is essential for understanding daily functioning in children and adolescents. Traditional paper-based cognitive assessments in controlled environments often lack ecological validity. Although performance-based assessments more accurately represent functioning in natural contexts, most have not been transformed into digital formats. With technology increasingly embedded in education and healthcare, examining the extent/nature of adaptations, benefits, and challenges of digitizing these tools is important. This conceptual review aimed to (1) examine the extent/nature of traditional performance-based cognitive assessments adapted into digital platforms, (2) compare ecological validity/scoring metrics of traditional and digital tools, and (3) identify opportunities and propose recommendations for future development. Methods: We used an AI-based tool (Elicit Pro, Elicit Plus 2024) to conduct a literature search for publications from the past decade, focusing on transformations of traditional assessments into digital platforms for children and adolescents. This initial search yielded 240 items. After screening, 45 were retained for manual review. Studies were extracted based on their discussion of the assessments (traditional or digital) and assessment tools used. Ultimately, 13 papers that met the inclusion criteria were evaluated based on units of analysis. Results: The analysis yielded three units. The first unit focused on digital transformation trends: four assessments (31%) were converted to digital platforms, two (15%) were developed as native digital tools, and the majority (seven, 54%) remained traditional. In the second unit, assessments were evaluated according to ecological validity and digital availability, demonstrating that assessments with high ecological validity tended not to be digitally accessible. The third unit synthesized scoring metrics, identifying eight distinct cognitive domains. Conclusions: Digitizing functional cognitive assessments offers greater accessibility, precision, and scalability, but replicating real-world contexts remains challenging. Emerging technologies may enhance ecological validity and support development of effective, technology-enhanced assessment practices. Full article

(This article belongs to the Special Issue Children and Adolescents with Neurodevelopmental Disabilities: Ecological Assessment Tools and Cognitive Analysis)

► Show Figures

Figure 1

20 pages, 1324 KB

Open AccessArticle

Cardiac Manifestations and Persistent Myocardial Dysfunction in Multisystem Inflammatory Syndrome in Children: Insights from Conventional and Strain Echocardiography

by Carmen Corina Șuteu, Liliana Gozar, Nicola Șuteu, Beatrix-Julia Hack and Iolanda Muntean

Children 2025, 12(10), 1383; https://doi.org/10.3390/children12101383 - 14 Oct 2025

Viewed by 193

Abstract

Background: Multisystem inflammatory syndrome in children (MIS-C) is a severe post-infectious complication of SARS-CoV-2, often with cardiac involvement. Myocardial strain imaging may detect dysfunction missed by conventional echocardiography. The objectives of this study are to characterize cardiac manifestations of MIS-C and assess the [...] Read more.

Background: Multisystem inflammatory syndrome in children (MIS-C) is a severe post-infectious complication of SARS-CoV-2, often with cardiac involvement. Myocardial strain imaging may detect dysfunction missed by conventional echocardiography. The objectives of this study are to characterize cardiac manifestations of MIS-C and assess the value of strain imaging in children with preserved and reduced left ventricular ejection fraction (LV-EF). Methods: We retrospectively analyzed 22 MIS-C patients admitted between September 2020 and January 2024, all with cardiac involvement. Clinical, laboratory, and echocardiographic data—including 2D and speckle-tracking strain—were collected at the day of worst dysfunction (DWD) and discharge (DD) and compared with 22 matched controls. Results: Median age was 4.65 years; 59% male; 45% overweight/obese. LV systolic dysfunction (LV-EF < 50%) occurred in 54.5%, coronary abnormalities in 36.4%, and pericardial effusion in 95.5%. LV global longitudinal strain (LVGLS) was significantly lower than controls at the DWD (−15.45 ± 4.76%, p < 0.0001) and DD (−20.63 ± 4.66%, p = 0.014). Strain abnormalities persisted despite LV-EF recovery, and even patients with preserved LV-EF showed significant segmental strain reduction. LVGLS and apical infero-septal strain were strongest predictors of reduced LV-EF. Conclusions: MIS-C often causes systolic dysfunction and coronary changes, but strain imaging reveals persistent subclinical myocardial injury. Long-term cardiac monitoring is warranted. Full article

(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology: 3rd Edition)

► Show Figures

Figure 1

14 pages, 1658 KB

Open AccessSystematic Review

Music Therapy for Managing Dental Anxiety in Children: A Systematic Review and Meta-Analysis of Clinical Evidence

by Laura Marqués-Martínez, Jorge Andrés, Esther García-Miralles, Carla Borell-García, Juan Ignacio Aura-Tormos and Clara Guinot Barona

Children 2025, 12(10), 1382; https://doi.org/10.3390/children12101382 - 13 Oct 2025

Viewed by 278

Abstract

Background: Dental anxiety is a common challenge in paediatric dentistry, often leading to avoidance of treatment and compromised oral health. Non-pharmacological interventions such as music therapy have gained increasing attention as safe and cost-effective alternatives to pharmacological approaches. Although several clinical studies have [...] Read more.

Background: Dental anxiety is a common challenge in paediatric dentistry, often leading to avoidance of treatment and compromised oral health. Non-pharmacological interventions such as music therapy have gained increasing attention as safe and cost-effective alternatives to pharmacological approaches. Although several clinical studies have examined the impact of music on children’s dental anxiety, the evidence has not yet been systematically summarised with quantitative synthesis. Objective: This systematic review and meta-analysis aimed to evaluate the effectiveness of music therapy in reducing dental anxiety and fear among paediatric patients. Methods: A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library from inception to August 2025. Randomised controlled trials (RCTs) evaluating music therapy for dental anxiety in children were included. Primary outcomes were self-reported dental anxiety/fear scales and physiological measures (heart rate, blood pressure, oxygen saturation). Risk of bias was assessed using the revised Cochrane risk of bias tool (RoB 2, version 2019; Cochrane Collaboration, London, UK) Meta-analyses were performed using a random-effects model with Review Manager (RevMan, version 5.4; Cochrane Collaboration, London, UK). Results: Seven randomized controlled trials (RCTs) involving 476 children aged 4–14 years were included. Music therapy significantly reduced self-re-ported dental anxiety compared with control groups (SMD = −0.48, 95% CI: −0.72 to −0.25, p < 0.001). Heart rate was also significantly reduced (SMD = −0.42, 95% CI: −0.68 to −0.16, p = 0.002), whereas changes in blood pressure and oxygen saturation were not statistically significant. The overall risk of bias was moderate, with most concerns related to blinding. Conclusions: Music therapy is an effective non-pharmacological intervention to reduce dental anxiety in children, particularly improving subjective anxiety and physiological arousal as measured by heart rate. Its integration into paediatric dental practice may enhance cooperation and treatment outcomes, offering a safe, inexpensive, and child-friendly approach. Full article

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

► Show Figures

Figure 1

Journal Menu

Journal Browser

Children, Volume 12, Issue 10 (October 2025) – 134 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI