Children

802 KB

Open AccessArticle

Impact of Stunting on Outcomes of Severely Wasted Children (6 Months to 5 Years) Admitted for Inpatient Treatment: A Cross-Sectional Study in an Ethiopian Referral Hospital

by Serena Pappalardo, Eleni Hagos Giday, Sisay Zeleke Jijo, Francesco Cavallin, Enzo Facci, Giovanni Putoto, Fabio Manenti, Claudia Banzato, Daniele Trevisanuto and Andrea Pietravalle

Children 2025, 12(10), 1294; https://doi.org/10.3390/children12101294 (registering DOI) - 24 Sep 2025

Abstract

Background: Undernutrition is a major public health concern, accounting for nearly half of global under-five mortalities and leading to serious long-term consequences for those who survive. Most nutritional screening programs give priority to acute undernutrition (wasting). The co-presence of chronic undernutrition (stunting) has [...] Read more.

Background: Undernutrition is a major public health concern, accounting for nearly half of global under-five mortalities and leading to serious long-term consequences for those who survive. Most nutritional screening programs give priority to acute undernutrition (wasting). The co-presence of chronic undernutrition (stunting) has been shown to have the highest risk of mortality. To date, few studies have assessed outpatient treatment outcomes of children with wasting + stunting (WaSt), with some inconsistencies in results and only one study having investigated the outcome of patients requiring hospitalization. The aim of the present study is to investigate the impact of stunting on the outcomes of severely wasted children admitted for inpatient treatment in an Ethiopian referral hospital. Methods: A retrospective cross-sectional study was conducted to compare treatment outcomes (length of hospital stay, weight gain, recovery rate, readmission rate) of wasted and WaSt children admitted to “St. Luke Catholic Hospital and College of Nursing and Midwifery” between January 2018 and February 2023. Results: The analysis comprised 616 children aged 6–60 months and stunting was diagnosed in 559 children (90.7%). Children with stunting had a longer length of stay (median difference 3 days, 95% confidence interval 0 to 5; p = 0.03) and improved weight gain (median difference 4 g/kg/day, 95% confidence interval 0 to 4; p = 0.002) compared to children without stunting. Discharge rate (p = 0.99) and readmission rate (p = 0.25) were not statistically different between children with or without stunting. Conclusions: Stunting was found to be present in most children admitted for severe wasting to the Stabilization Centers in a sub-Saharan setting. Stunting was associated with longer hospitalization and greater weight gain, but discharge and readmission rate were comparable between children with or without stunting. Full article

(This article belongs to the Section Pediatric Gastroenterology and Nutrition)

213 KB

Open AccessReview

Pediatric Heart Failure: A Practical Guide for Primary Care Providers Supporting Families Across the Care Continuum

by Shahnawaz Amdani, Kriti Puri, Julie Glickstein, Joseph A. Spinner, Jonathan N. Johnson, Ashraf S. Harahsheh, Majd Makhoul and Susan Denfield

Children 2025, 12(10), 1293; https://doi.org/10.3390/children12101293 (registering DOI) - 24 Sep 2025

Abstract

Background/Objectives: Pediatric heart failure (HF) is a complex clinical syndrome with diverse etiologies and presentations. Primary care providers (PCPs) are critical in early recognition, family education, and coordination of ongoing care in collaboration with pediatric cardiologists. This review provides a comprehensive guide [...] Read more.

Background/Objectives: Pediatric heart failure (HF) is a complex clinical syndrome with diverse etiologies and presentations. Primary care providers (PCPs) are critical in early recognition, family education, and coordination of ongoing care in collaboration with pediatric cardiologists. This review provides a comprehensive guide for PCPs to understand the causes, symptoms, treatments, and longitudinal considerations for children with HF. Methods: We conducted a narrative review synthesizing published evidence and expert consensus guidelines, focusing on the clinical presentation, treatment options, and longitudinal care strategies in children with HF. Results: HF in children most commonly results from congenital heart disease and cardiomyopathy, but includes a wide range of etiologies. Presenting symptoms differ by age, with subtle signs often mistaken for common pediatric illnesses. Treatments range from disease-modifying medications to surgical and transplant therapies. Psychosocial support, mental health, and family-centered care are critical components of long-term management. Conclusions: PCPs are essential partners in the care of children with HF. A proactive, collaborative, and informed approach can improve quality of life, reduce hospitalizations, and support families navigating this challenging diagnosis. Full article

(This article belongs to the Section Pediatric Cardiology)

828 KB

Open AccessArticle

Predictors of Problematic Internet Use Among Romanian High School Students

by Brigitte Osser, Csongor Toth, Carmen Delia Nistor-Cseppento, Mariana Cevei, Cristina Aur, Maria Orodan, Roland Fazakas and Laura Ioana Bondar

Children 2025, 12(10), 1292; https://doi.org/10.3390/children12101292 (registering DOI) - 24 Sep 2025

Abstract

Background: Problematic internet use among adolescents is linked to poorer mental health, academic performance, and social functioning, yet evidence from Eastern Europe remains limited. Methods: We conducted a school-based cross-sectional study at a Romanian high school (Arad County) including 308 students aged 15–18 [...] Read more.

Background: Problematic internet use among adolescents is linked to poorer mental health, academic performance, and social functioning, yet evidence from Eastern Europe remains limited. Methods: We conducted a school-based cross-sectional study at a Romanian high school (Arad County) including 308 students aged 15–18 years (154 males, 154 females). Students completed a demographic/behavioral questionnaire and the 20-item Internet Addiction Test (IAT), a widely used measure of problematic internet use. The prespecified primary analysis was a multivariable linear regression of IAT score on sex, age group, residence, daily screen time, prior attempts to reduce use, and main internet purpose; supporting analyses included t-tests, ANOVA, and Pearson correlation (α = 0.05). Results: In bivariable comparisons, males, older adolescents (17–18 years), and urban residents reported higher IAT scores; screen time correlated with IAT (r = 0.460, p < 0.001), and prior reduction attempts were associated with higher scores (Cohen’s d = 0.80). In the adjusted model, male sex (β = 4.97), older age (β = 5.36), greater daily screen time (β = 1.67 per hour), prior attempts to reduce use (β = 4.13), and primarily using the internet for gaming (β = 5.71) remained significant predictors (all p ≤ 0.045); urban residence was not retained (p = 0.218). The model explained 43% of IAT variance (R² = 0.43). Conclusions: Demographic and behavioral factors independently predict adolescent problematic internet use, highlighting high-risk profiles (older males, heavy screen time, gaming focus, prior reduction attempts). These findings support school-based screening and targeted digital-health interventions in underrepresented contexts. Full article

(This article belongs to the Section Pediatric Mental Health)

► Show Figures

Figure 1

310 KB

Open AccessArticle

The Impact of the 10VIDA Program on Socioemotional Adjustment and Psychological Well-Being in Adolescents with Type 1 Diabetes Mellitus: A Preliminary Study

by Pilar Rodríguez-Rubio, Javier Martín-Ávila, Esther Rodríguez-Jiménez, Selene Valero-Moreno, Inmaculada Montoya-Castilla and Marián Pérez-Marín

Children 2025, 12(10), 1291; https://doi.org/10.3390/children12101291 - 24 Sep 2025

Abstract

Background/Objectives: Type 1 diabetes mellitus (T1DM) during adolescence increases the risk of psychosocial difficulties. To address these challenges, the 10VIDA program was developed to support psychological adjustment, treatment adherence, and quality of life. This study examined socioemotional factors linked to chronic illness [...] Read more.

Background/Objectives: Type 1 diabetes mellitus (T1DM) during adolescence increases the risk of psychosocial difficulties. To address these challenges, the 10VIDA program was developed to support psychological adjustment, treatment adherence, and quality of life. This study examined socioemotional factors linked to chronic illness adjustment and psychological well-being in adolescents with T1DM, assessing the impact of the 10VIDA intervention. Methods: Adolescents with T1DM participated in two studies: (1) an inter-group design with experimental and control groups assessed pre- and post-intervention, and (2) an intra-subject longitudinal design with three assessments (two pre-intervention and one post-intervention). All participants completed the 10VIDA intervention delivered online through seven sessions: five targeted adolescents with T1DM, while two included primary caregivers. The program’s main objective was to enhance well-being and quality of life. Results: Girls reported higher anxiety and depression, while boys showed greater self-esteem and emotional well-being. The experimental group experienced significant reductions in discomfort, anxiety, depression, and perceived illness threat, alongside improvements in self-esteem and psychological well-being. Intra-subject analysis also revealed increased well-being and decreased discomfort after intervention. Conclusions: The 10VIDA program effectively addressed socioemotional challenges in adolescents with T1DM and reshaping illness perception. These findings underscore the importance of integrated psychological support to improve adjustment and quality of life in chronic illness during adolescence. Full article

(This article belongs to the Special Issue Advances in Mental Health and Well-Being in Children (2nd Edition))

348 KB

Open AccessArticle

Validation of the Italian Translation and Cultural Adaptation of the Canadian Assessment of Physical Literacy-2 (CAPL-2) Questionnaire for Children

by Alice Iannaccone, Alessandro Cudicio, Lavinia Falese, Bruno Federico, Matteo Crotti, Nicola Lovecchio, Simone Digennaro and Valeria Agosti

Children 2025, 12(10), 1290; https://doi.org/10.3390/children12101290 - 24 Sep 2025

Abstract

Background/Objectives: Physical literacy is a holistic concept promoting lifelong health by considering an individual’s lived experience within their cultural context. This necessitates context-specific conceptualizations and pedagogies, highlighting the need for valid assessment tools for physical and sport educators. The Canadian Assessment of Physical [...] Read more.

Background/Objectives: Physical literacy is a holistic concept promoting lifelong health by considering an individual’s lived experience within their cultural context. This necessitates context-specific conceptualizations and pedagogies, highlighting the need for valid assessment tools for physical and sport educators. The Canadian Assessment of Physical Literacy (CAPL-2) is a well-known validated tool. This study aimed to validate the Italian translation and cultural adaptation of the CAPL-2 questionnaire for children aged 8–12. Methods: The CAPL-2 questionnaire was translated using a forward–backward procedure by bilingual experts. Subsequently, 111 Italian children (57 females, mean BMI 17.9 kg/m²) completed the adapted CAPL-2 questionnaire twice over 10 days under supervision. The internal consistency of CAPL-2 was assessed with Cronbach’s alpha. ROC curve analysis and AUC evaluated the CAPL-2’s ability to predict adherence to WHO physical activity guidelines based on self-reported activity. Results: Results showed high internal consistency for the motivation and confidence domain (Cronbach’s α: 0.88–0.97) but lower consistency for the knowledge and understanding domain (Cronbach’s α: 0.20–0.34). Despite this, the CAPL-2 questionnaire demonstrated high predictive performance in identifying children active for at least 5 days (AUC: 0.95) or 6 days (AUC: 0.89). Conclusions: The Italian version of CAPL-2 is a reliable tool for assessing physical literacy in Italian children aged 8 to 12, addressing key aspects such as motivation, confidence, physical skills, understanding of physical activity, and daily habits. It offers a valuable and culturally adapted instrument for trainers, teachers and educators in physical activity and sport contexts. Full article

(This article belongs to the Special Issue Recent Advances in Children’s Motor Development: From Birth to Adolescence)

► Show Figures

Figure 1

1238 KB

Open AccessArticle

Morphometric Analysis of the Infraorbital Foramen in Children and Adolescents with Unilateral Cleft Lip and Palate: A CBCT Study

by Emre Haylaz, Fahrettin Kalabalık, Ismail Gumussoy, Suayip Burak Duman, Muhammet Can Eren, Seyda Say, Furkan Osman Akarçay and Emre Aytuğar

Children 2025, 12(10), 1289; https://doi.org/10.3390/children12101289 - 24 Sep 2025

Abstract

Aim: A precise understanding of the morphometric characteristics of the infraorbital foramen (IOF) is essential for ensuring safe and effective surgical interventions and regional anesthesia in children and adolescents with cleft lip and palate (CLP). This study aimed to investigate the morphometric characteristics [...] Read more.

Aim: A precise understanding of the morphometric characteristics of the infraorbital foramen (IOF) is essential for ensuring safe and effective surgical interventions and regional anesthesia in children and adolescents with cleft lip and palate (CLP). This study aimed to investigate the morphometric characteristics of the IOF using CBCT in children and adolescents with unilateral cleft lip and palate (UCLP) and to compare the cleft side (CS) with the non-cleft side (NCS). Materials and Method: CBCT scans of 48 individuals with UCLP were analyzed, evaluating a total of 96 IOFs. Reference anatomical landmarks included the supraorbital margin (SOM), infraorbital margin (IOM), nasion (N), anterior nasal spine (ANS), tuber maxilla (TM), sella (S), lateral margin of the apertura piriform (LAP), jugale (J), and midline (M). Distances from the IOF to these landmarks were measured and compared between the CS and NCS. Soft tissue thickness over the IOF was also assessed, and the IOF shape was evaluated separately for each side. Results: The V-oval form was the most common IOF shape on both sides. No significant differences were found in vertical or horizontal diameters between the CS and NCS (p > 0.05). Distances from the IOF to IOM, SOM, S, N, LAP, and midline were significantly shorter on the CS (p < 0.05), whereas distances to ANS and J were significantly longer on the CS (p < 0.05). No significant differences were observed in IOF-TM distances or soft tissue thickness (p > 0.05). Conclusions: In individuals with UCLP, the IOF exhibits significant side-specific variations relative to key anatomical landmarks. These differences should be considered in infraorbital nerve block administration and surgical planning to improve accuracy and safety. Full article

(This article belongs to the Special Issue Craniofacial Deformities and Cleft Lip and Palate: Diagnosis, Treatment and Management)

► Show Figures

Figure 1

2101 KB

Open AccessArticle

Assessment of Oral Hygiene Practices and Dental Health Conditions in School-Aged Children of 7–10 Years

by Ana-Gabriela Seni, Liana Todor, Andreea Mihaela Kis, Mădălina-Gabriela Cincu, Ramona Amina Popovici, Anca Porumb, Iustin Olariu and Monica Tarcea

Children 2025, 12(10), 1288; https://doi.org/10.3390/children12101288 - 24 Sep 2025

Abstract

Background/Objectives: The ongoing prevalence of dental issues within the school-age population continues to present significant public health challenges. This study aims to thoroughly evaluate the oral health conditions of schoolchildren aged 7–10 years, with a particular focus on identifying the prevalence and [...] Read more.

Background/Objectives: The ongoing prevalence of dental issues within the school-age population continues to present significant public health challenges. This study aims to thoroughly evaluate the oral health conditions of schoolchildren aged 7–10 years, with a particular focus on identifying the prevalence and severity of dental caries, as well as their relationship with dental hygiene and dietary habits. Methods: A cross-sectional approach was employed involving 700 children aged from 7 to 10 years, recruited from nine urban and rural educational institutions across two Romanian counties, namely Mureș and Bistrița-Năsăud. Data were collected regarding the sociodemographic characteristics of participants, including parental educational background and occupational status. Furthermore, information on dental hygiene routines was gathered, encompassing tooth brushing habits, flossing usage, frequency of brushing, along with dietary details such as daily meal count, snacking frequency, and sugar intake levels. An oral examination was performed by a trained specialist to assess the condition of the children’s teeth, documenting the number of decayed, missing, and filled teeth. The presence of plaque was evaluated using a plaque index, and the dental caries status was quantified using the Decayed, Missing, and Filled Teeth (DMFT) index. Results: The findings revealed that the average plaque score was marginally higher in boys (mean = 0.69 ± 0.36) compared to girls (mean = 0.65 ± 0.40). Additionally, children from urban environments demonstrated a mean plaque score of 0.61 ± 0.32, whereas their rural counterparts exhibited a higher score of 0.73 ± 0.38. In multivariable models, irregular brushing, higher daily sugar consumption, and ≥3 snacks/day were independently associated with both caries prevalence (DMFT > 0) and greater DMFT counts (p < 0.05). Conclusions: The evidence denotes a concerning association between poor oral hygiene practices and higher rates of tooth decay among children, particularly among those with elevated sugar intake and frequent snacking behaviors. Dental public health professionals are encouraged to incorporate considerations of oral hygiene habits when developing future health promotion strategies aimed at improving the oral health status of children. Full article

(This article belongs to the Special Issue Dental Status and Oral Health in Children and Adolescents)

► Show Figures

Figure 1

496 KB

Open AccessReview

Medical–Legal Liability and Indoor Air Pollution in Non-Industrial Environments and Perspectives for Maternal and Child Health

by Ginevra Malta, Angelo Montana, Antonina Argo, Stefania Zerbo, Fulvio Plescia and Emanuele Cannizzaro

Children 2025, 12(10), 1287; https://doi.org/10.3390/children12101287 - 24 Sep 2025

Abstract

Indoor air pollution (IAP) has emerged as a critical yet underrecognized threat to public health, particularly in non-industrial environments such as homes, schools, and healthcare facilities. As individuals spend approximately 90% of their time indoors, exposure to indoor pollutants—such as particulate matter, volatile [...] Read more.

Indoor air pollution (IAP) has emerged as a critical yet underrecognized threat to public health, particularly in non-industrial environments such as homes, schools, and healthcare facilities. As individuals spend approximately 90% of their time indoors, exposure to indoor pollutants—such as particulate matter, volatile organic compounds (VOCs), polycyclic aromatic hydrocarbons (PAHs), and microbial contaminants—can lead to significant health risks. These risks disproportionately affect vulnerable populations, including children, the elderly, and individuals with pre-existing conditions. The effects range from mild respiratory symptoms to severe outcomes like asthma, cardiovascular diseases, and cancer. This review investigates the sources, typologies, and health effects of indoor air pollutants, with a focus on their implications for maternal and child health. In particular, children’s developing systems and higher metabolic intake make them more susceptible to airborne toxins. The study also explores the legal and regulatory frameworks surrounding indoor air quality (IAQ), emphasizing how increased awareness and scientific evidence are expanding the scope of medical–legal responsibility. Legal liabilities may arise for property owners, designers, or manufacturers when poor IAQ leads to demonstrable health outcomes. Despite growing concern, there remains a significant research gap concerning the long-term health effects of chronic low-level exposure in residential settings and the efficacy of mitigation strategies. The evolution of smart building technologies and green construction practices offers promising avenues to improve IAQ while maintaining energy efficiency. However, standards and regulations often lag behind scientific findings, highlighting the need for updated, enforceable policies that prioritize human health. This work underscores the urgency of a multidisciplinary and preventive approach to IAQ, integrating public health, environmental engineering, and legal perspectives. Future research should focus on real-time IAQ monitoring, targeted interventions for high-risk populations, and the development of comprehensive legal frameworks to ensure accountability and promote healthier indoor environments. Full article

(This article belongs to the Special Issue Maternal Health and the Impact on Infant Growth)

► Show Figures

Figure 1

354 KB

Open AccessReview

Sex Steroid Priming on Growth Hormone Stimulation Test: A Scoping Review

by Ignazio Cammisa, Donato Rigante, Giorgio Sodero and Clelia Cipolla

Children 2025, 12(10), 1286; https://doi.org/10.3390/children12101286 - 24 Sep 2025

Abstract

Background/Objectives: Growth hormone (GH) secretion and activity are closely modulated by sex steroids, particularly during puberty, when GH response to stimulation tests (GHSTs) may be blunted in children with low circulating sex steroids. This systematic review evaluates the role of sex steroid priming [...] Read more.

Background/Objectives: Growth hormone (GH) secretion and activity are closely modulated by sex steroids, particularly during puberty, when GH response to stimulation tests (GHSTs) may be blunted in children with low circulating sex steroids. This systematic review evaluates the role of sex steroid priming in enhancing GH secretion during GHST and improving diagnostic accuracy especially in peripubertal children with GH deficiency (GHD). Methods: We conducted a medical literature review to assess the use of sex steroid priming in children undergoing GHST; our search was carried out via PubMed after paper selection based on strict eligibility criteria. Results: Seventeen studies published between 1969 and 2022 were analyzed overall, which corresponded to a total number of 1097 participants. Most studies reported a significant increase in GH peak levels after priming, reducing false-positive GHD diagnoses. However, protocols varied considerably in hormone type, dosage, and administration, and some studies showed no benefit in the case of a true GHD. Conclusions: While sex steroid priming appears to improve GHST specificity in GHD without negatively impacting growth outcomes, standardized guidelines about pre-administration of exogenous sex steroids are currently lacking, and further prospective studies are needed to define its diagnostic potential. Full article

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

► Show Figures

Figure 1

299 KB

Open AccessArticle

Loneliness from the Perspective of Young People with Autism and/or ADHD: A Thematic Analysis of Adolescents’ Experiences and Understanding

by Lily Verity, Suzanne Stewart, Stephen Houghton, Pamela Qualter, Leslie Macqueen and Simon Hunter

Children 2025, 12(10), 1285; https://doi.org/10.3390/children12101285 - 24 Sep 2025

Abstract

Background/Objectives: Loneliness is a common experience in adolescence, typically centered around difficulties in relationships with same-age peers and friends. It is often assumed that those diagnosed with autism and/or Attention-Deficit/Hyperactivity Disorder (ADHD) are at greater risk of loneliness than their non-diagnosed peers due [...] Read more.

Background/Objectives: Loneliness is a common experience in adolescence, typically centered around difficulties in relationships with same-age peers and friends. It is often assumed that those diagnosed with autism and/or Attention-Deficit/Hyperactivity Disorder (ADHD) are at greater risk of loneliness than their non-diagnosed peers due to documented difficulties in making and maintaining friendships. Although quantitative research on loneliness and autism exists, there remains a notable gap in studies that explore the lived experiences of loneliness from the perspective of adolescents diagnosed with autism and ADHD, particularly in relation to their peers/or peers’ experiences. Method: To address this gap in the literature, 10 focus groups were conducted with adolescents diagnosed with autism and/or ADHD to discuss their experiences of loneliness. Results: Overall, young people with autism and ADHD did not consider loneliness to be a greater issue for them compared to their neurotypical peers. Six themes with five subthemes were developed through thematic analysis of the interview data: “not feeling like you belong when socializing”, “being alone can be a good thing but not when it’s not your choice”, “social media can be a good thing, but it’s not as good as in real life”, “not having anyone you can rely on to support you through tough times”, “school support can bring young people together”, and “sometimes it’s good to be distracted from negative thinking”. Conclusions: Although these themes are comparable to those emerging from research with non-autistic and non-ADHD youth, the importance of quality relationships with friends who provided support with daily functioning was viewed differently. Full article

(This article belongs to the Section Pediatric Mental Health)

3015 KB

Open AccessArticle

Effects of Intramuscular Vasopressin on Pharmacokinetics and Pharmacodynamics in Healthy Neonatal Piglets: A Dose–Response Study

by Marwa Ramsie, Po-Yin Cheung, Raza Hyderi, Shrieya Praveen, Tze-Fun Lee, Megan O’Reilly and Georg M. Schmölzer

Children 2025, 12(10), 1284; https://doi.org/10.3390/children12101284 - 24 Sep 2025

Abstract

Background: Neonatal resuscitation guidelines recommend the use of the vasopressor epinephrine during neonatal cardiopulmonary resuscitation (CPR); however, vasopressin may be a potential alternative. Successful neonatal CPR requires rapid vasopressor administration, but the current guideline-recommended routes can take several minutes to establish and require [...] Read more.

Background: Neonatal resuscitation guidelines recommend the use of the vasopressor epinephrine during neonatal cardiopulmonary resuscitation (CPR); however, vasopressin may be a potential alternative. Successful neonatal CPR requires rapid vasopressor administration, but the current guideline-recommended routes can take several minutes to establish and require substantial skill and/or training. The intramuscular (IM) route provides rapid drug administration and does not require special skills, training, or equipment. Objective: We aimed to compare two doses of IM vasopressin to intravenous (IV) vasopressin in a healthy neonatal piglet model to examine the hemodynamic and pharmacokinetic effects. Methods: Fifteen neonatal piglets (n = 5/group; 1–3 days of age) were anesthetized, intubated via a tracheostomy, and randomized to 4 IU/kg IM vasopressin, 8 IU/kg IM vasopressin, or 0.4 IU/kg IV vasopressin. Various hemodynamic and cardiac function parameters were continuously recorded throughout the experiment. Blood was collected prior to drug administration and throughout the experiment for pharmacokinetic and pharmacodynamic analysis. Results: The 4 IU/kg IM vasopressin dose was ineffective in producing systemic changes in hemodynamics or cardiac function as it was poorly absorbed. The 8 IU/kg IM vasopressin dose had comparable results to IV vasopressin and was rapidly distributed to systemic circulation. Conclusions: The higher IM vasopressin dose of 8 IU/kg is effective in increasing systolic and diastolic blood pressure. Full article

(This article belongs to the Section Pediatric Neonatology)

► Show Figures

Figure 1

983 KB

Open AccessReview

Time and Mind: A State-of-the-Art Perspective on Time Perception and Cognitive–Motor Interactions in Children and Adolescents with Cerebral Palsy

by Giuseppe Accogli, Valentina Nicolardi, Mariangela Leucci, Luigi Macchitella, Greta Pirani, Maria Carmela Oliva and Antonio Trabacca

Children 2025, 12(10), 1283; https://doi.org/10.3390/children12101283 - 23 Sep 2025

Abstract

Background: Time perception (TP) is increasingly recognized as a key cognitive domain in children and adolescents with cerebral palsy (CP), yet existing studies are scarce, heterogeneous, and methodologically limited. Objective: To synthesize empirical evidence on TP in pediatric CP, distinguishing perceptual timing deficits [...] Read more.

Background: Time perception (TP) is increasingly recognized as a key cognitive domain in children and adolescents with cerebral palsy (CP), yet existing studies are scarce, heterogeneous, and methodologically limited. Objective: To synthesize empirical evidence on TP in pediatric CP, distinguishing perceptual timing deficits from motor-based impairments and outlining putative cognitive mechanisms. Methods: Following PRISMA where appropriate, we systematically searched Scopus, Embase, and PubMed Central for studies on TP in individuals with CP under 18 years. Four studies met inclusion criteria. Risk of bias was appraised with STROBE, AXIS, and RoB 2. Results: Available evidence suggests that TP difficulties in CP are not solely due to motor dysfunction but also reflect broader cognitive–perceptual challenges. Studies using low-motor-demand tasks sometimes report intact TP, whereas tasks requiring overt movement often confound perceptual timing with execution demands. Intervention findings are mixed: time-related supports show promising but inconsistent effects on everyday time processing, while motor-focused timing training demonstrates limited impact on TP itself. However, conclusions are constrained by the small number of studies and variability in samples, tasks, and outcomes. Conclusions: TP should be considered a distinct, clinically relevant construct in pediatric CP. Future work should employ motor-minimal paradigms, report standardized CP classifications, and adopt longitudinal designs to isolate TP deficits and guide targeted interventions. Clarifying TP profiles may improve cognitive characterization and rehabilitation planning in CP. Full article

(This article belongs to the Special Issue Children with Cerebral Palsy and Other Developmental Disabilities)

► Show Figures

Figure 1

249 KB

Open AccessArticle

Gender Differences in School Stress and Academic Satisfaction in Pre-Adolescents: The Role of Physical Activity

by Josivaldo de Souza-Lima, Gerson Ferrari, Rodrigo Yáñez-Sepúlveda, Frano Giakoni-Ramírez, Catalina Muñoz-Strale, Javiera Alarcon-Aguilar, Maribel Parra-Saldias, Daniel Duclos-Bastias, Andrés Godoy-Cumillaf, Eugenio Merellano-Navarro, José Bruneau-Chávez, Claudio Farias-Valenzuela and Pedro Valdivia-Moral

Children 2025, 12(10), 1282; https://doi.org/10.3390/children12101282 - 23 Sep 2025

Abstract

Background/Objectives: Gender differences in school stress and academic satisfaction among pre-adolescents remain underexplored, particularly in relation to physical activity as a potential protective factor. This study aimed to examine these differences and investigate the role of sports/exercise frequency in mitigating boredom and stress, [...] Read more.

Background/Objectives: Gender differences in school stress and academic satisfaction among pre-adolescents remain underexplored, particularly in relation to physical activity as a potential protective factor. This study aimed to examine these differences and investigate the role of sports/exercise frequency in mitigating boredom and stress, controlling for school safety, using a large multinational dataset. Methods: Data from the International Survey of Children’s Well-Being (ISCWeB, third wave; N = 128,184 pre-adolescents aged 6–14 from 35 countries) were analyzed. Key variables included boredom and stress (0–10 scales), sports/exercise frequency (categorized as low: 0–2 days/week, medium: 3–4, high: 5–6), and school safety (0–4 scale). Descriptive statistics were stratified by gender and sports level. Multivariate analysis of variance (MANOVA) tested combined effects of sports level, gender, and their interaction, followed by univariate ANOVAs (Type II). Results: Modest gender differences were found in stress (boys: mean = 4.05; girls: mean = 4.16) and academic satisfaction (boys: 8.50; girls: 8.66), with similar distributions in physical activity variables. Higher sports frequency was associated with lower boredom (high: 4.00 vs. low: 4.46) and stress (high: 4.03 vs. low: 4.05). MANOVA confirmed a significant multivariate effect of sports level (Wilks’ lambda = 0.9984, F = 49.74, p < 0.0001), with marginal gender effect (p = 0.0525) and significant interaction (Wilks’ lambda = 0.9998, F = 6.59, p < 0.0001); effect sizes were small (partial η² ≤ 0.014). School safety was a significant covariate (Wilks’ lambda = 0.9807, F = 1262.84, p < 0.0001, partial η² ≈ 0.013). Conclusions: Physical activity modestly protects against school-related boredom and stress in pre-adolescents, with modest gender moderation. Findings support universal school programs promoting daily exercise, with gender-sensitive adaptations, to enhance emotional well-being and academic satisfaction. Full article

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

391 KB

Open AccessReview

BioFlx Pediatric Crowns: Current Evidence on Clinical Outcomes and Material Properties

by Sanaa N. Al-Haj Ali

Children 2025, 12(10), 1281; https://doi.org/10.3390/children12101281 - 23 Sep 2025

Abstract

BioFlx crowns represent an innovative hybrid resin polymer-based alternative for pediatric full-coverage restorations, addressing the clinical dilemma between durable-but-unaesthetic stainless steel crowns (SSCs) and technique-sensitive zirconia crowns. This narrative review synthesizes current evidence of BioFlx crowns’ mechanical properties, clinical performance, and material characteristics [...] Read more.

BioFlx crowns represent an innovative hybrid resin polymer-based alternative for pediatric full-coverage restorations, addressing the clinical dilemma between durable-but-unaesthetic stainless steel crowns (SSCs) and technique-sensitive zirconia crowns. This narrative review synthesizes current evidence of BioFlx crowns’ mechanical properties, clinical performance, and material characteristics through a comprehensive literature search across PubMed, Scopus, and Web of Science from August through September 2025. The search identified 18 studies comprising four randomized controlled trials, two case reports/series, and twelve in vitro studies. In vitro analyses demonstrated favorable stress distribution under physiological loads (≤311 N) with notable brand-dependent performance variations. NuSmile BioFlx exhibited greater wear than zirconia, but superior wear resistance compared to SSCs, while Kids-e-Dental BioFlx crowns demonstrated less crown wear relative to zirconia, with both brands causing less antagonist wear than zirconia. BioFlx showed intermediate fracture resistance, comparable surface roughness to SSCs but higher than zirconia, and intermediate marginal gaps. Resin cements demonstrated superior retention compared to manufacturer-recommended glass ionomer and resin-modified glass ionomer cements. Clinical studies with a 12 month follow-up demonstrated 92–98% retention rates compared to 100% for SSCs, with significantly higher patient satisfaction and reduced plaque accumulation versus SSCs. However, a failure rate of 6.7% was observed. Color change values were lower than those of zirconia crowns; however, they remained clinically unacceptable (ΔE > 3.3), and stain resistance was lower than that of SSCs. Marginal integrity remained clinically acceptable, though some anatomic form deterioration occurred over time. Case reports highlighted clinical utility in nickel-allergic patients and for masking silver diamine fluoride discoloration. BioFlx crowns represent a clinically valuable esthetic alternative in pediatric dentistry, though evidence remains limited by recent market introduction, brand-specific performance variations (NuSmile vs. Kids-e-Dental), anterior tooth applicability constraints, and contraindications in bruxism and for the Hall technique. Future randomized controlled trials with ≥2 year follow-up periods are imperative to establish long-term performance. Until such evidence emerges, BioFlx crowns represent a viable clinical option for esthetically sensitive cases and nickel-allergic patients when applied with rigorous case selection. Full article

(This article belongs to the Special Issue New Research Progress of Clinical Pediatric Dentistry: 2nd Edition)

► Show Figures

Figure 1

233 KB

Open AccessArticle

Delivering the Parenting for Lifelong Health Programme with Parents of Young Children in Wales

by Judy Hutchings, Sarah Jones, Anwen Jones, Margiad Williams and Jamie Lachman

Children 2025, 12(10), 1280; https://doi.org/10.3390/children12101280 - 23 Sep 2025

Abstract

Background/Objectives: Based on years of work from high-income countries, the Parenting for Lifelong Health programme for parents of Young Children (PLH-YC) was developed by the first and last authors, as a freely available low-cost programme for low-income families in low- and middle-income countries [...] Read more.

Background/Objectives: Based on years of work from high-income countries, the Parenting for Lifelong Health programme for parents of Young Children (PLH-YC) was developed by the first and last authors, as a freely available low-cost programme for low-income families in low- and middle-income countries (LMICs). The initial group-based 12-session programme has since been delivered, adapted, and evaluated across many LMICs and now has a significant body of evidence. Over the last 10 years, early intervention services in the UK have been considerably reduced whilst, exacerbated by the impact of COVID-19, service demands have grown. This paper describes a feasibility trial of the 12-session PLH-YC programme in Wales to explore whether it could recruit and retain parents, and demonstrate improvements in parenting skills and reductions in child behaviour problems. Methods: Two small pre–post trials were conducted in socially disadvantaged communities in Wales, and they were delivered by local parenting practitioners. Of the 20 parents recruited across 3 groups, 17 provided pre- and post-course data and 10 completed qualitative interviews. Results: Retention was good (85%) with mean attendance of 8.7 sessions, and parental and facilitator feedback reported high levels of satisfaction with the programme, with the only recommendation being to make the programme longer and for facilitators to be given more time. Results showed significant benefits to parent-reported parenting practices, child behaviour, and parental mental wellbeing. Conclusions: These preliminary results justify work to develop a rigorous evaluation to establish whether PLH-YC could have a place among parenting-support programmes in the UK. Full article

(This article belongs to the Special Issue Advances in Mental Health and Well-Being in Children (2nd Edition))

1022 KB

Open AccessArticle

The Experience of Breastfeeding Women During the Pandemic in Romania

by Ruxandra-Gabriela Cigăran, Gheorghe Peltecu, Radu Botezatu and Nicolae Gică

Children 2025, 12(10), 1279; https://doi.org/10.3390/children12101279 - 23 Sep 2025

Abstract

Background: Evidence suggests that the uncertainty surrounding the COVID-19 pandemic and the associated changes have negatively influenced breastfeeding practices. Considering that breastfeeding women are already known to be more vulnerable in terms of emotional status, the aim of our study was to evaluate [...] Read more.

Background: Evidence suggests that the uncertainty surrounding the COVID-19 pandemic and the associated changes have negatively influenced breastfeeding practices. Considering that breastfeeding women are already known to be more vulnerable in terms of emotional status, the aim of our study was to evaluate the experiences and concerns of breastfeeding women in Romania during the pandemic. Also, we tried to identify the most effective measures for mitigating the negative impacts. Methods: A 46-item questionnaire was developed for data collection and it was shared on Facebook and Instagram, with networks of women who breastfed during the pandemic and with obstetric communities. Our cross-sectional survey recruited 261 Romanian breastfeeding women. Among general questions about basic demographic information and details about changes experienced during the COVID-19 pandemic, the survey included questions about their breastfeeding experiences during the pandemic, whether they had contracted SARS-CoV-2 while breastfeeding, their concerns, and their overall perceptions of the period. Results: In our study, we observed that women who breastfed during the pandemic—especially those who had contracted SARS-CoV-2—experienced significant fear that their newborns or children might become infected. These mothers also expressed deep concern for their own health and the wellbeing of their loved ones. The experience of contracting SARS-CoV-2 was a major source of psychological stress. Despite these challenges, the participants, especially women who contracted SARS-CoV2, reported a notably longer overall duration of breastfeeding and higher rates of exclusive breastfeeding. However, access to breastfeeding support during this period was generally limited. Conclusions: These findings highlight the negative impact of the pandemic on breastfeeding mothers and the adaptability of mothers under crisis conditions, emphasizing the need for improved support systems and targeted interventions to assist mothers during public health crises. Full article

(This article belongs to the Special Issue Recent Advances in Maternal and Fetal Health (2nd Edition))

► Show Figures

Figure 1

8 pages, 395 KB

Open AccessArticle

Operative Versus Nonoperative Treatment of Z-Type Clavicle Shaft Fractures in Adolescents: A Retrospective Study

by Iulia Dobrin, Colin Van Wagoner, Sami Azeroual, Joseph Leider and Ehab Saleh

Children 2025, 12(10), 1278; https://doi.org/10.3390/children12101278 - 23 Sep 2025

Abstract

Background: There are differing opinions in the literature regarding the optimal treatment modality for adolescents with completely displaced, complex clavicle fractures. This study aims to determine outcome differences between surgical and non-surgical treatment for adolescent Z-type clavicle fractures and to ascertain if differences [...] Read more.

Background: There are differing opinions in the literature regarding the optimal treatment modality for adolescents with completely displaced, complex clavicle fractures. This study aims to determine outcome differences between surgical and non-surgical treatment for adolescent Z-type clavicle fractures and to ascertain if differences exist in outcomes between the two interventions. Methods: This was a single-center, retrospective chart review performed at a level 1 trauma center. Inclusion criteria included pediatric patients ages 12 to 16 years who presented with a comminuted, displaced clavicle shaft fracture with a comminuted fragment more than 1 cm in length and were treated either operatively or nonoperatively between January 2019 and December 2022. The outcomes were radiographic union status (i.e., union versus non-union versus malunion), follow-up period, shoulder range of motion, return to athletic activities, and patient reported pain level. Results: Of the 24 patients, 11 were treated surgically and 13 non-surgically. Patients who were treated surgically were more likely to be older (mean 1.5 years, p = 0.039) and have a longer follow-up by 9 months average duration compared to the cohort treated non-surgically (p = 0.0009). There was no significant difference between patient reported pain, radiographic union status, return to athletic activity, or shoulder range of motion between the cohorts. The small sample size and retrospective study design limits the statistical power of our results. Conclusions: The decision between treating these complex fractures operatively versus nonoperatively should be left to a lengthy discussion between the surgeon, parents, and the patient. Full article

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

► Show Figures

Figure 1

Journal Menu

Journal Browser

Children, Volume 12, Issue 10 (October 2025) – 17 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI