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Children
Volume 12
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Children, Volume 12, Issue 11 (November 2025) – 153 articles

Cover Story (view full-size image): Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are reshaping pediatric obesity and type 2 diabetes management, with approved products offering significant BMI and weight reductions. However, major knowledge gaps remain. Long-term safety and durability of effect in youth are unknown, particularly regarding bone health, lean mass preservation, and neurohormonal development. Optimal dosing, duration, and criteria for treatment discontinuation risk for weight rebound require further study. This review integrates clinical and mechanistic evidence while underscoring the urgent need for longitudinal, pediatric-specific research to inform safe and effective obesity pharmacotherapy in growing children. View this paper
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14 pages, 5488 KB  
Review
Pediatric Thoracic MRI: Safer, Sharper and Smarter Diagnostics
by Patricia Tischendorf, Laura Beck and Tobias Krähling
Children 2025, 12(11), 1576; https://doi.org/10.3390/children12111576 - 20 Nov 2025
Viewed by 296
Abstract
Background: Pediatric thoracic magnetic resonance imaging (MRI) has evolved into a valuable diagnostic modality that offers high-resolution morphological and functional assessment. While conventional radiography and computed tomography (CT) remain standard, their radiation exposure poses significant risks in children requiring repeated imaging. Technological innovations [...] Read more.
Background: Pediatric thoracic magnetic resonance imaging (MRI) has evolved into a valuable diagnostic modality that offers high-resolution morphological and functional assessment. While conventional radiography and computed tomography (CT) remain standard, their radiation exposure poses significant risks in children requiring repeated imaging. Technological innovations have addressed prior MRI limitations such as low lung proton density and motion artifacts, expanding its role in pediatric thoracic imaging. Methods: A review of the recent literature was performed, focusing on technical advancements, key MRI sequences and clinical applications in pediatric thoracic imaging. Emphasis was placed on ultrashort echo time (UTE), phase-resolved functional lung (PREFUL) MRI, hyperpolarized xenon-129 MRI, radial imaging, compressed sensing, parallel imaging and respiratory gating techniques. Results: Modern MRI sequences provide both detailed anatomic visualization and quantitative functional assessment of the pediatric thorax. UTE and PREFUL enable evaluation of lung parenchyma, ventilation, and perfusion, while hyperpolarized gas imaging offers high-resolution functional mapping. Radial, compressed sensing and parallel imaging reduce motion artifacts and acquisition times, enhancing feasibility in uncooperative children. Clinical indications include assessment of congenital malformations, chronic lung disease like cystic fibrosis, infectious and inflammatory disorders, tumors and selected traumatic injuries. Conclusions: Recent technical advances have established pediatric thoracic MRI as a versatile, patient-friendly alternative, as well as a complementary method to CT in selected clinical scenarios. Ongoing developments in acquisition speed, motion compensation and functional imaging are expected to further improve diagnostic accuracy and clinical utility, supporting broader adoption in routine pediatric thoracic evaluation. Full article
(This article belongs to the Special Issue Clinical Application of Imaging in Pediatric Cardiopulmonary Diseases)
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14 pages, 241 KB  
Article
Medical Child Abuse: A Retrospective Analysis from a Tertiary Pediatric Hospital’s Childhood and Adolescent Abuse Group
by Martina Focardi, Marta Guerini, Beatrice Defraia, Laura Nanni, Rossella Grifoni, Giovanni Castellini, Barbara Gualco, Ilenia Bianchi, Vilma Pinchi and Stefania Losi
Children 2025, 12(11), 1575; https://doi.org/10.3390/children12111575 - 20 Nov 2025
Viewed by 272
Abstract
Background: Medical child abuse (MCA), previously known as Münchausen syndrome by proxy, involves the fabrication or induction of illness by caregivers—most commonly the mother—leading to unnecessary medical interventions and potential harm to the child. Methods: This retrospective study analyzed cases of suspected or [...] Read more.
Background: Medical child abuse (MCA), previously known as Münchausen syndrome by proxy, involves the fabrication or induction of illness by caregivers—most commonly the mother—leading to unnecessary medical interventions and potential harm to the child. Methods: This retrospective study analyzed cases of suspected or confirmed MCA managed by the GAIA multidisciplinary team at Meyer Children’s Hospital, Florence, between 2010 and 2022. Cases were identified using Rosenberg diagnostic criteria and red flags outlined by the American Academy of Pediatrics (AAP) and the Royal College of Paediatrics and Child Health (RCPCH). Data were extracted from medical records and analyzed descriptively. Results: Among 816 cases of child maltreatment, 8 (0.99%) were identified as MCA. The median age of affected children was 5 years (range: 4–12 years), with a female predominance (6/8, 75%). All perpetrators were biological mothers (8/8, 100%). Children had a median of 23 emergency department visits (range: 4–44), with the most frequent presentations being fever (6/8, 75%), minor trauma (7/8, 87.5%), respiratory complaints (5/8, 62.5%), and gastrointestinal symptoms (4/8, 50%). According to Rosenberg criteria, 5 cases (62.5%) were classified as “possible diagnosis,” 1 (12.5%) as “definitive diagnosis,” 1 (12.5%) as “diagnosis by exclusion,” and 1 (12.5%) as “inconclusive.” Conclusions: Despite its low prevalence, MCA poses serious clinical and ethical challenges. Early detection requires thorough documentation, interdisciplinary collaboration, and improved access to shared medical records. The GAIA model offers a replicable framework for effective multidisciplinary management. Full article
(This article belongs to the Section Global Pediatric Health)
12 pages, 688 KB  
Article
Fractures Associated with Metabolic Bone Disease in Extremely Preterm and Extremely Low Birth Weight Infants Before and After a Bone Health Program
by Saif Alsaif, Lina Alsherbini, Talal Aljarbou, Manal Alshareef and Kamal Ali
Children 2025, 12(11), 1574; https://doi.org/10.3390/children12111574 - 19 Nov 2025
Viewed by 303
Abstract
Background: Metabolic bone disease (MBD) of prematurity predisposes extremely preterm and extremely low birth weight (ELBW) infants to atraumatic fractures. Evidence on fracture reduction after structured Bone Health Programs (BHPs) remains limited. Methods: We conducted a single-center retrospective cohort of NICU admissions (2014–2024) [...] Read more.
Background: Metabolic bone disease (MBD) of prematurity predisposes extremely preterm and extremely low birth weight (ELBW) infants to atraumatic fractures. Evidence on fracture reduction after structured Bone Health Programs (BHPs) remains limited. Methods: We conducted a single-center retrospective cohort of NICU admissions (2014–2024) with gestational age < 28 weeks and/or birth weight < 1000 g, comparing a pre-program era with a standardized BHP that incorporated protocolized biochemical surveillance, a week 4 screening radiograph, optimized mineral targets, pharmacist review of parenteral minerals, and “handle-with-care” practices. The study aimed to evaluate whether implementation of a structured BHP reduced fracture incidence and improved biochemical and clinical outcomes in extremely preterm and ELBW infants. Prespecified effect measures were risk ratio (RR), risk difference (RD) with 95% confidence intervals, Fisher’s exact p values, and number needed to treat (NNT). Among infants with fractures, we compared clinical course and biochemical context across eras. Results: Of 708 eligible infants, 221 were born pre-program and 487 post-program with similar baseline characteristics. Fracture incidence decreased from 9.5% (21/221) to 1.64% (8/487); RR 0.17 (95% CI 0.08–0.38); RD −7.86 percentage points; p < 0.001; NNT ≈ 13. Among infants who fractured, length of stay was lower post-program (104.1 ± 28.3 vs. 172.0 ± 91.5 days). Peak alkaline phosphatase and parathyroid hormone were also lower in the post-program era (ALP 501.3 ± 71.2 vs. 972.5 ± 93.5 IU/L, p = 0.032; PTH 23.1 ± 12.5 vs. 38.4 ± 21.7 pmol/L, p = 0.027), whereas serum phosphate and 25 OH vitamin D did not differ significantly. The fracture burden per infant decreased following the BHP (1.50 ± 0.53 vs. 3.19 ± 3.08, p = 0.024). Age at first fracture was earlier post-program, consistent with scheduled imaging (48.4 ± 34.9 vs. 83.9 ± 37.3 days, p = 0.031). Conclusions: A structured BHP was associated with a large reduction in fracture incidence and more favorable biochemical profiles, together with shorter hospitalization among fracture cases. Program elements that combine scheduled imaging, biochemical triggers, nutritional optimization, parenteral mineral stewardship, and standardized handling may improve skeletal outcomes. Multicenter prospective evaluations should confirm generalizability and define core components. Full article
(This article belongs to the Section Pediatric Neonatology)
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14 pages, 337 KB  
Review
MicroRNA Profiling as a Novel Tool in the Diagnostics of Late-Onset Neonatal Sepsis: A Scoping Review
by Eleni Papachatzi, Eleni Gkouti, Adamantia Kouvela, Sofia Benou, Gabriel Dimitriou, Sotiris Fouzas, Vassiliki Stamatopoulou and Despoina Gkentzi
Children 2025, 12(11), 1573; https://doi.org/10.3390/children12111573 - 19 Nov 2025
Viewed by 345
Abstract
Background/Objectives: The incidence of late-onset sepsis (LOS) has increased with improved survival rates in premature infants. Blood culture, the diagnostic “gold standard”, requires at least 36–72 h for results, leading to empiric antibiotic use and potential resistance. MicroRNAs (miRNAs) have emerged as promising [...] Read more.
Background/Objectives: The incidence of late-onset sepsis (LOS) has increased with improved survival rates in premature infants. Blood culture, the diagnostic “gold standard”, requires at least 36–72 h for results, leading to empiric antibiotic use and potential resistance. MicroRNAs (miRNAs) have emerged as promising biomarkers for sepsis in adults, but their role in neonatal LOS remains unclear. The aim of this scoping review is to identify the miRNA expression profiles of bacterial LOS in neonates. Methods: A scoping review of the literature was performed between 1 November 2023 and 31 December 2024. Results: Twelve studies fulfilled our criteria and were included in the review. Despite the considerable heterogeneity among the studies, most focused on detecting and quantifying serum microRNAs using real-time PCR, while some examined correlations with other biomarkers, such as CRP. The few microRNAs identified as common across multiple studies showed similar patterns of regulation in LOS cases. Compared to controls (no LOS), neonates with LOS exhibited significant alterations in miRNA expression. More precisely, in LOS, miRNA-181a, miRNA-23b, miRNA-181b5p, miRNA-21-5p, miRNA-34a5p, miRNA-199a3p, miRNA-1184 and miRNA-1295p were downregulated, while miRNA-16, miRNA-146a, miRNA-101, miRNA-187, miRNA-21, miRNA-15a/16 and miRNA-455-5p were upregulated. Conclusions: Currently, there is limited data regarding miRNA expression in LOS. Many studies showed altered expression of specific miRNAs in septic neonates; however, these observations need further validation in larger cohorts and/or randomized controlled trials to confirm their diagnostic potential. Full article
(This article belongs to the Section Pediatric Neonatology)
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14 pages, 259 KB  
Article
Incidence, Risk Factors and Outcomes of Junctional Ectopic Tachycardia After Tetralogy of Fallot Repair in Pediatric Patients
by Fatih Durak, Gokcen Ozcifci, Emine Pinar Kulluoglu, Ayse Berna Anil, Onur Isik, Muhammet Akyuz and Baris Guven
Children 2025, 12(11), 1572; https://doi.org/10.3390/children12111572 - 19 Nov 2025
Viewed by 279
Abstract
Background: Postoperative junctional ectopic tachycardia (JET) is a potentially life-threatening arrhythmia that may occur after congenital heart surgery, especially following tetralogy of Fallot (TOF) repair. It can cause hemodynamic instability due to atrioventricular dissociation. This study aimed to evaluate the incidence, risk factors, [...] Read more.
Background: Postoperative junctional ectopic tachycardia (JET) is a potentially life-threatening arrhythmia that may occur after congenital heart surgery, especially following tetralogy of Fallot (TOF) repair. It can cause hemodynamic instability due to atrioventricular dissociation. This study aimed to evaluate the incidence, risk factors, and outcomes of JET after TOF repair, with particular focus on management strategies and the impact of JET duration on recovery. Methods: This retrospective study included 114 pediatric patients who underwent TOF repair between 2015 and 2023. The study was approved by the institutional ethics committee (File No: 2023/09-31, Date: 10 October 2023). Postoperative JET was diagnosed based on standard electrocardiographic criteria. Perioperative variables, surgical techniques, and postoperative outcomes were analyzed. Results: JET occurred in 19 patients (16.7%). Compared with patients without JET, those with JET had higher complication rates (73.7% vs. 42.1%, p = 0.02), prolonged inotropic support, and increased mortality (15.8% vs. 2.1%, p = 0.024). Ionized calcium (p < 0.001) and pH levels (p < 0.037) were significantly lower in JET patients. Right ventricular outflow tract muscle resection was strongly associated with JET occurrence (p = 0.003). Although cardiopulmonary bypass and aortic cross-clamp times did not predict JET, both correlated with JET duration (p < 0.05). Conclusions: Postoperative JET remains a major concern following TOF repair, leading to adverse outcomes and longer recovery. Optimizing perioperative management may help reduce JET-related complications, though further multicenter prospective studies are needed to confirm these findings. Full article
(This article belongs to the Section Pediatric Cardiology)
9 pages, 883 KB  
Article
Gynecomastia Outpatient Surgical Treatment in Children Without Closed-Suction Drain Placement: Is It Safe and Effective?
by Carlos Delgado-Miguel, Ennio Fuentes, Pablo Aguado and Ricardo Díez
Children 2025, 12(11), 1571; https://doi.org/10.3390/children12111571 - 19 Nov 2025
Viewed by 278
Abstract
Introduction: Idiopathic gynecomastia is a common diagnosis among adolescents. Closed-suction drain placement after breast resection is traditionally performed to prevent complications such as seroma or hematoma, although its effectiveness remains controversial. Drains are also associated with patient discomfort and may require prolonged wound [...] Read more.
Introduction: Idiopathic gynecomastia is a common diagnosis among adolescents. Closed-suction drain placement after breast resection is traditionally performed to prevent complications such as seroma or hematoma, although its effectiveness remains controversial. Drains are also associated with patient discomfort and may require prolonged wound care. The aim of the present study is to describe our experience with the outpatient surgical treatment of adolescent gynecomastia without closed-suction drain placement and to assess its short- and long-term outcomes. Methods: We conducted a retrospective single-center cohort study including male patients under 18 years of age operated on for idiopathic gynecomastia between 2019 and 2023. Demographic data, clinical features (grade of gynecomastia according to Simon’s classification before surgery), intraoperative variables, and postoperative outcomes were collected. Patients were followed in the outpatient setting, with assessment of early (<30 days) and late complications. Results: A total of 21 consecutive patients were included, with a median age of 14.5 years (range 13.6–17.4). Sixteen patients (76.2%) underwent bilateral mastectomies, and five (23.8%) underwent unilateral subtotal mastectomies. Gynecomastia grade was I in 6 cases (28.6%), II in 12 (57.1%), and III in 3 (14.3%). No intraoperative adverse events occurred. Compressive chest bandaging was performed without closed-suction drainage. All patients were discharged on the same day. Two patients (9.5%) developed mild seroma during follow-up, both resolving spontaneously without aspiration or surgery. Conclusions: Our preliminary findings suggest that outpatient gynecomastia surgery without closed-suction drains appears to be a safe and effective option in adolescents, minimizing discomfort and avoiding hospital admission. However, larger, multicenter comparative studies are warranted to confirm these results and to further evaluate patient satisfaction and long-term cosmetic outcomes. Full article
(This article belongs to the Special Issue Advances in Pediatric Surgery: Innovative Approaches and Emerging Technologies)
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13 pages, 595 KB  
Article
Prenatal Cocaine Exposure, Perinatal Risks, and Mediators to Preadolescent Attention Deficit Hyperactivity Disorder (ADHD)
by Thitinart Sithisarn, Carla M. Bann, Barry Lester, Seetha Shankaran, Toni Whitaker, Rosemary D. Higgins and Henrietta Bada
Children 2025, 12(11), 1570; https://doi.org/10.3390/children12111570 - 19 Nov 2025
Viewed by 503
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is the most common behavioral problem in children. Multiple risk factors, including prenatal substance exposure, have been associated with this disorder. Objectives: We determined (1) the rate of ADHD in children with prenatal cocaine exposure (PCE) as compared to those [...] Read more.
Attention-deficit/hyperactivity disorder (ADHD) is the most common behavioral problem in children. Multiple risk factors, including prenatal substance exposure, have been associated with this disorder. Objectives: We determined (1) the rate of ADHD in children with prenatal cocaine exposure (PCE) as compared to those non-exposed, (2) the association of ADHD with the infant’s sex, race, and birth weight, maternal age and education, and other known risk factors, and factors that may mediate the relationship between these risk factors and ADHD. Methods: This was a secondary analysis of data from the Maternal Lifestyle Study for a long-term follow-up. ADHD was defined as any diagnosis of attention deficit, hyperactivity disorder, or the combination, from the National Institute of Mental Health Diagnostic Interview Schedule for Children (NIMH DISC) administered to children, ages 11 or 14 years. The main exposure variable was PCE. Independent variables included infant and maternal characteristics, caretaker psychopathology, and maternal–child conflict. Mediators evaluated were the child’s impulsivity at 4 years of age and attention problems at 5 years from the Child Behavior Checklist. Results: Path analysis revealed that the effects of risk variables, including PCE, were mediated through the child’s attention problems at age 5 years. Child’s impulsivity, which was significantly associated with attention problems, was also a mediator between PCE and ADHD. Male sex had a direct path to ADHD. Conclusions: Our findings lend support to early screening before 4 years of age in children with PCE or other risk factors for ADHD. Behavioral interventions provided during early childhood may mitigate the later diagnosis or severity of ADHD. Full article
(This article belongs to the Special Issue Prenatal Substance Exposure: Historical Perspective, Current Research and Future Challenges)
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14 pages, 292 KB  
Article
Between Support and Risk: The Dual Role of Peer Relationships in Adolescents’ Mental Health
by Maria João Carapeto, Inês Agostinho, Luísa Grácio and Daniela Santos
Children 2025, 12(11), 1569; https://doi.org/10.3390/children12111569 - 18 Nov 2025
Viewed by 809
Abstract
Background/Objectives: Adolescence is a developmental stage marked by profound transformations and heightened vulnerability to mental health difficulties, with peer relationships playing a central role, as they provide both protective and risk factors for adolescents’ mental health and well-being. This study aims to [...] Read more.
Background/Objectives: Adolescence is a developmental stage marked by profound transformations and heightened vulnerability to mental health difficulties, with peer relationships playing a central role, as they provide both protective and risk factors for adolescents’ mental health and well-being. This study aims to characterize Portuguese adolescents’ perceptions of how peers and friends influence their mental health, both positively and negatively. Methods: Participants were 99 adolescents aged 14–19 years old enrolled in a Portuguese secondary school. Data were collected through two open-ended questions and participants responses were analyzed using a mixed-methods approach, qualitative and quantitative. Results: Bullying and aggression were the most frequently reported negative influences, followed by peer pressure for inadequate behavior, toxic or false friendships, lack of support, criticism, and social exclusion. Conversely, social support was the most cited positive influence, alongside connection and belonging, promotion of emotional well-being, positive peer characteristics, and social learning. Conclusions: Findings support the dual role of peer relationships, which may either exacerbate vulnerability or strengthen resilience. The study underscores the importance of school-based prevention strategies that reduce bullying and peer aggression while fostering prosocial climates and supportive peer interactions. Full article
(This article belongs to the Section Pediatric Mental Health)
22 pages, 1475 KB  
Article
Concurrent Targeting of Expressive Vocabulary and Speech Comprehensibility in Pre-Schoolers with Developmental Language Disorder and Phonological Speech Sound Disorder Features: A Survey of UK Practice
by Lucy Rodgers, Nicola Botting and Ros Herman
Children 2025, 12(11), 1568; https://doi.org/10.3390/children12111568 - 18 Nov 2025
Viewed by 423
Abstract
Background/objectives: Speech sound disorder (SSD) and developmental language disorder (DLD) are common childhood disorders of communication that can also co-occur. This study investigated the reported content, format and delivery of UK speech and language therapists’ (SaLTs) practice when delivering intervention for pre-school children [...] Read more.
Background/objectives: Speech sound disorder (SSD) and developmental language disorder (DLD) are common childhood disorders of communication that can also co-occur. This study investigated the reported content, format and delivery of UK speech and language therapists’ (SaLTs) practice when delivering intervention for pre-school children with co-occurring SSD/DLD features when expressive vocabulary and speech comprehensibility are prioritised areas. The findings can be used to inform the development of future interventions and enable reflection on current practice. Methods: A quantitative online survey via Qualtrics enabled the statistical analysis of intervention components from SaLTs from across the UK. The survey questions were based on prior research and the input of an expert steering group. The data were analysed through descriptive statistics. Results: There were 108 full responses from across the UK. For both target areas, the responses highlighted a preference for functional intervention targets, holistic delivery of intervention techniques in different environments, and incorporation of techniques into a variety of activities. Most respondents (97.5%) reported that they would also target phonological awareness (PA), with syllable segmentation being the most commonly reported PA target area for inclusion. Overall, 82.4% of respondents said they would consider dosage when providing their intervention. Conclusions: The findings highlight similarities in UK SaLT practice when targeting aspects of both speech (comprehensibility) and language (expressive vocabulary) concurrently, and an emphasis on functional communication, in addition to being guided by developmental norms. The implications for clinical practice and the development of future interventions are discussed. Full article
(This article belongs to the Section Pediatric Neurology & Neurodevelopmental Disorders)
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17 pages, 1172 KB  
Article
Antibiotic Resistance Trends in Recurrent Paediatric Urinary Tract Infections: A Five-Year Single-Centre Experience
by Olivia-Oana Stanciu, Mircea Andriescu, Andreea Moga, Ruxandra Caragata, Laura Balanescu and Radu Balanescu
Children 2025, 12(11), 1567; https://doi.org/10.3390/children12111567 - 18 Nov 2025
Viewed by 368
Abstract
Background: Recurrent urinary tract infections (rUTIs) in children are increasingly complicated by antimicrobial resistance, leading to limited treatment options and challenging prophylactic management. Continuous local monitoring of resistance trends is essential for evidence-based stewardship. Methods: This retrospective study analysed recurrent paediatric [...] Read more.
Background: Recurrent urinary tract infections (rUTIs) in children are increasingly complicated by antimicrobial resistance, leading to limited treatment options and challenging prophylactic management. Continuous local monitoring of resistance trends is essential for evidence-based stewardship. Methods: This retrospective study analysed recurrent paediatric UTI recorded between 2020 and 2024 at a tertiary hospital in Romania. Data were extracted using the ICD-10 code N39.0 and included demographic, clinical, and microbiological variables. Antimicrobial susceptibility testing followed CLSI standards. Associations between multidrug resistance (MDR) and clinical factors were assessed with χ2 tests and Cramer’s V, and predictors of MDR were evaluated by multivariable logistic regression. Temporal trends in resistance were examined using logistic regression with year as a continuous variable, and results were validated with the non-parametric Cochran–Armitage linear-by-linear χ2 trend test to strengthen analytical rigour. Proportions are presented with Wilson 95% confidence intervals (CIs). Results: A total of 134 children met inclusion criteria for rUTI, of whom 130 had complete demographic and microbiological data and were included in analyses. Each episode represented a distinct culture-confirmed infection occurring ≥30 days apart. MDR occurred in 48.5% of isolates (95% CI, 40.2–56.9) and ESBL in 20.9% (95% CI, 14.9–28.5). MDR was significantly associated with urinary tract malformations (χ2 = 5.78, p = 0.016) and continuous antibiotic prophylaxis (χ2 = 4.23, p = 0.040). Neither logistic nor Cochran–Armitage trend analyses demonstrated a significant temporal increase in MDR (OR per year = 0.94; 95% CI 0.75–1.17; p = 0.566; χ2 = 0.89; p = 0.346). Conclusions: MDR and ESBL rates among children with recurrent UTIs remain high but stable. The combined use of parametric and non-parametric trend analyses confirmed the absence of a significant upward trajectory, underscoring the need for ongoing surveillance and stewardship to maintain antibiotic effectiveness in paediatric care. Full article
(This article belongs to the Section Pediatric Nephrology & Urology)
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13 pages, 534 KB  
Article
Role of Matsuda Index in Identifying Patients at Risk for Cystic Fibrosis-Related Diabetes Development
by Serpil Albayrak, Elif Arık, Özlem Keskin, Murat Karaoğlan, Mehmet Keskin, Gaye İnal, Mahmut Cesur, Ercan Küçükosmanoğlu and Ahmet Yıldırım
Children 2025, 12(11), 1566; https://doi.org/10.3390/children12111566 - 18 Nov 2025
Viewed by 282
Abstract
Background: Cystic fibrosis-related diabetes (CFRD) is a frequent comorbidity in individuals with cystic fibrosis (CF). While insulin secretion defects are the primary mechanism in CFRD pathophysiology, insulin resistance may contribute as an additional risk factor. Early detection of insulin resistance may help identify [...] Read more.
Background: Cystic fibrosis-related diabetes (CFRD) is a frequent comorbidity in individuals with cystic fibrosis (CF). While insulin secretion defects are the primary mechanism in CFRD pathophysiology, insulin resistance may contribute as an additional risk factor. Early detection of insulin resistance may help identify patients at higher risk for earlier CFRD development. Objective: The aim of this study was to evaluate the ability of the Matsuda Index to identify insulin resistance in pediatric CF patients and to compare it with HOMA-IR as complementary indicators of glucose metabolism. Methods: In this cross-sectional study, fifty children with CF aged 6–16 years were included. The study involved measuring anthropometric data, fasting insulin, fasting glucose levels, glycated hemoglobin (HbA1c), and C-peptide. An assessment of glucose and insulin levels was performed on the patients through an oral glucose tolerance test (OGTT) at 0, 60, and 120 min. The Matsuda Index was computed, wherein a threshold of ≤4.5 signifies the presence of insulin resistance. Statistical analyses were conducted to compare insulin resistance and sensitivity across groups, using t-tests, correlation, and ANOVA. Results: Among the 50 observed patients, the average Matsuda index score was 17.08 with a standard deviation of 11.16. Eleven individuals (22%) exhibited insulin resistance with a Matsuda Index ≤ 4.5. These patients showed significantly higher insulin levels at 60 and 120 min during the OGTT, with statistically significant p-values of 0.008 and 0.002, respectively. Conclusions: The Matsuda Index may serve as a useful adjunctive tool to help identify insulin resistance in pediatric CF patients, particularly during puberty. Early detection of insulin resistance through the Matsuda Index may facilitate risk stratification and enable timely interventions that could potentially delay the onset or progression of CFRD. However, it should be noted that the ≤4.5 cut-off value was derived from adult studies, and its validity in pediatric CF populations has not been established, which represents a limitation of our finding. Full article
(This article belongs to the Section Pediatric Endocrinology & Diabetes)
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13 pages, 738 KB  
Article
Antegrade Continence Enema vs. Botulinum Toxin in Pediatric Chronic Idiopathic Constipation: A 10-Year Retrospective Study at a Single Center
by Prisca C. Obidike, Trevor C. Jones, Chioma Moneme, Alexander Bills, Zoë Hemmer, Alison Jung, Lillian Wu and Lily S. Cheng
Children 2025, 12(11), 1565; https://doi.org/10.3390/children12111565 - 18 Nov 2025
Viewed by 298
Abstract
Introduction: Chronic Idiopathic Constipation (CIC) is a common pediatric gastrointestinal disorder (GI) characterized by persistent difficulty in defecation, with no identifiable underlying cause. Although most patients are successfully treated with medical therapies, surgical intervention is often needed for refractory disease. We evaluated the [...] Read more.
Introduction: Chronic Idiopathic Constipation (CIC) is a common pediatric gastrointestinal disorder (GI) characterized by persistent difficulty in defecation, with no identifiable underlying cause. Although most patients are successfully treated with medical therapies, surgical intervention is often needed for refractory disease. We evaluated the impact of Antegrade Continence Enemas (ACE) and Botulinum Toxin (BT) injection to the internal anal sphincter on laxative use, symptom resolution, and healthcare utilization. Methods: A retrospective chart review was conducted to identify patients ≤ 18 years old presenting to a pediatric surgery clinic with a chief complaint of CIC between 1 March 2014 and 1 March 2024. Patients meeting the Rome IV criteria for idiopathic constipation and fecal incontinence were included. Surgical procedures were categorized into BT injection or ACE channel creation. The primary outcome was change in daily oral laxative use at 1 year, and secondary outcomes included symptom resolution and CIC-healthcare utilization at 1 year postoperatively. Results: Of the 125 children who presented with CIC, 47 (37.6%) underwent surgery. Mean age was 6 years at the time of surgery. 17 (36.2%) had ACE channel creation, while 30 (63.8%) received BT injections. At 1 year, daily oral laxative polypharmacy decreased from 60.2% to 41.0%, p < 0.001, with a greater reduction in ACE than BT (adjusted mean difference: −1.05, 95% CI: −1.75 to 0.34, p = 0.004) after adjusting for demographics and baseline clinical factors. Overall, symptom resolution of encopresis (79.1% to 39.5%, p = 0.001), abdominal pain (88.4% to 27.9%, p < 0.001), and abdominal distension (67.4% to 27.9%, p < 0.001) was observed with no significant difference between groups at 1 year. ACE patients had significantly more postoperative outpatient CIC-related visits and no change in ED visits compared to fewer visits in BT patients. Conclusions: Both ACE and BT recipients had improvements in constipation-related symptoms and laxative use. However, ACE resulted in a significantly greater reduction in daily laxative use and more postoperative CIC-healthcare visits than BT alone. Full article
(This article belongs to the Special Issue Bowel Management in Paediatric Colorectal Disease)
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4 pages, 183 KB  
Reply
Reply to Gringras et al. Comment on “Paditz et al. The Pharmacokinetics, Dosage, Preparation Forms, and Efficacy of Orally Administered Melatonin for Non-Organic Sleep Disorders in Autism Spectrum Disorder During Childhood and Adolescence: A Systematic Review. Children 2025, 12, 648”
by Osman S. Ipsiroglu and Hans-Jürgen Gober
Children 2025, 12(11), 1564; https://doi.org/10.3390/children12111564 - 18 Nov 2025
Viewed by 351
Abstract
We read, with great interest, the Letter to the Editor of Drs [...] Full article
(This article belongs to the Section Pediatric Pulmonary and Sleep Medicine)
13 pages, 570 KB  
Article
Clinical and Molecular Spectrum of MYH9-Thrombocytopenia: Insights from a Single Centric Pediatric Cohort
by Radu Obrisca, Andreea Serbanica, Andra Marcu, Ana Bica, Cristina Jercan, Irina Avramescu, Letita Radu, Cerasela Jardan and Anca Colita
Children 2025, 12(11), 1563; https://doi.org/10.3390/children12111563 - 17 Nov 2025
Viewed by 274
Abstract
Background: MYH9-related disease (MYH9-RD) is the most common form of inherited thrombocytopenia (IT). It is caused by pathogenic variants in the MYH9 gene. It manifests as early-onset macrothrombocytopenia with variable later-onset extra-hematological features, including hearing loss, renal disease, and cataracts. In pediatric patients, [...] Read more.
Background: MYH9-related disease (MYH9-RD) is the most common form of inherited thrombocytopenia (IT). It is caused by pathogenic variants in the MYH9 gene. It manifests as early-onset macrothrombocytopenia with variable later-onset extra-hematological features, including hearing loss, renal disease, and cataracts. In pediatric patients, early recognition is critical to avoid misdiagnosis as immune thrombocytopenia (ITP) and unnecessary immunosuppressive therapy. Methods: We conducted a retrospective unicentric study at the Pediatric Oncology and Hematology Department, Fundeni Clinical Institute, Bucharest, Romania, including patients aged 0–18 years with suspected IT, tested between 2017 and 2025 by next-generation sequencing (NGS). Clinical, laboratory, and genetic data were reviewed. Results: Among 66 patients who underwent genetic testing, 31 (48.5%) had IT-associated genetic variants; 8 (25.8%) carried MYH9 mutations. Four patients (50%) had disease onset before age 1 year, three with neonatal presentation; 3 (37.5%) reported a family history of thrombocytopenia. Six variants were previously reported, and two were novel variants. Five variants (62.5%) were pathogenic, while three (37.5%) were initially classified as variants of uncertain significance (VUS). Most mutations were missense in the coiled-coil tail domain, correlating with milder thrombocytopenia and absence of extra-hematological features. No life-threatening bleeding was recorded; hemorrhagic symptoms were limited to minor mucocutaneous bleeding. Conclusions: This is the first Romanian pediatric cohort and one of the few existing pediatric cohorts describing the genetic and clinical spectrum of MYH9-RD. Early genetic confirmation enables precise diagnosis, tailored management, and family screening, while preventing inappropriate therapies. Full article
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11 pages, 635 KB  
Article
Surgical Versus Non-Surgical Treatment of Patients with Myopathic Scoliosis: Clinical, Radiological and Functional Outcomes
by Alexandra Satanovsky, Rana Hanna, Patrice L. Weiss, Amihai Rigbi, Josh E. Schroeder and Sharon Eylon
Children 2025, 12(11), 1562; https://doi.org/10.3390/children12111562 - 17 Nov 2025
Viewed by 311
Abstract
Background/Objectives: Myopathies are acquired or genetic muscle diseases causing weakness and wasting, leading to poor posture, impaired coordination, reduced daily function, and scoliosis. The objective of this ambispective study was to compare clinical, radiological, and functional outcomes of patients with myopathic scoliosis treated [...] Read more.
Background/Objectives: Myopathies are acquired or genetic muscle diseases causing weakness and wasting, leading to poor posture, impaired coordination, reduced daily function, and scoliosis. The objective of this ambispective study was to compare clinical, radiological, and functional outcomes of patients with myopathic scoliosis treated surgically or non-surgically. Methods: We identified 118 patients (55% male) with myopathy and scoliosis from ALYN Rehabilitation Hospital’s database (1990–2022). Mean age at first visit was 5.45 ± 5.27 years. Seventeen (14%) underwent scoliosis surgery; others were managed non-surgically. Due to unbalanced group sizes, comparative group analyses used propensity score matching (15 surgical, 30 non-surgical patients). Retrospective data included demographics, medical history, respiratory and mobility status, Cobb angle (CA), pelvic obliquity (PO), and surgical details when applicable. Prospective telephone interviews were conducted including SRS-22r Quality of Life (QoL), WHO-QoL, and Functional Independence Measure for Children (WeeFIM). Results: Longitudinal analysis showed significant or near-significant worsening over time in CA (p = 0.03) and PO (p = 0.08), regardless of treatment type but no significant difference between surgical and non-surgical groups in progression rates. Interview data, for 7 surgical and 6 non-surgical patients, revealed that surgical patients reported higher overall QoL, FIM, and SRS-22r self-image scores, but lower scores for SRS-22r pain, general function, and activity levels. Conclusions: Existing research and this study suggest that despite surgical risks, scoliosis correction in neuromuscular conditions generally leads to improved QoL. Findings highlight the complexity of surgical decision-making for myopathic scoliosis, where medical risks must be weighed against potential long-term functional and QoL outcomes. Full article
(This article belongs to the Special Issue Advancing Physical Rehabilitation for Children and Adolescents)
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27 pages, 1272 KB  
Review
The Pediatric Microbiota–Gut–Brain Axis: Implications for Neuropsychiatric Development and Intervention
by Giuseppe Marano, Greta Sfratta, Ester Maria Marzo, Giorgia Cozzo, Francesca Abate, Gianandrea Traversi, Osvaldo Mazza, Esmeralda Capristo, Eleonora Gaetani and Marianna Mazza
Children 2025, 12(11), 1561; https://doi.org/10.3390/children12111561 - 17 Nov 2025
Viewed by 1139
Abstract
Background: The gut microbiota plays a crucial role in brain development and function, especially in early life. Disruptions in the pediatric microbiota–gut–brain axis have been linked to neurodevelopmental and psychiatric disorders. We hypothesize that early-life dysbiosis can perturb neurodevelopment via the pediatric microbiota–gut–brain [...] Read more.
Background: The gut microbiota plays a crucial role in brain development and function, especially in early life. Disruptions in the pediatric microbiota–gut–brain axis have been linked to neurodevelopmental and psychiatric disorders. We hypothesize that early-life dysbiosis can perturb neurodevelopment via the pediatric microbiota–gut–brain axis, increasing risk and/or severity of neuropsychiatric outcomes, and that microbiota-targeted strategies may mitigate this risk. Methods: We conducted a narrative review by searching PubMed, Scopus, and Web of Science up to January 2025 for studies addressing pediatric microbiota, neuropsychiatric development, and interventions. Human and animal studies were included if they provided mechanistic or clinical insights. Results: Key determinants of microbiota development in childhood include mode of delivery, feeding practices, antibiotic exposure, diet, and environment. Altered microbial composition has been associated with autism spectrum disorder, attention-deficit/hyperactivity disorder, mood disorders, anxiety, and anorexia nervosa. Mechanistic pathways involve immune modulation, neural signaling (including the vagus nerve and enteric nervous system), and microbial metabolites such as short-chain fatty acids. Interventions targeting the microbiota—ranging from dietary strategies and probiotics to psychobiotics and fecal microbiota transplantation—show promise but require further pediatric-focused trials. Conclusions: The pediatric microbiota–gut–brain axis represents a critical window for neuropsychiatric vulnerability and intervention. Early-life strategies to support a healthy microbiota may help reduce the risk or severity of psychiatric disorders. Future research should prioritize longitudinal pediatric cohorts and clinical trials to translate mechanistic insights into precision interventions. Full article
(This article belongs to the Special Issue Children with Specific Neurodevelopmental Disorders: Assessment and Intervention (2nd Edition))
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15 pages, 712 KB  
Article
Food Pattern, Food Selectivity and Sensory Profile in Autism Spectrum Disorder: An Exploratory Analysis in Chilean Children
by Fernanda Mora, María José Manzur, David Morales-Zepeda, Oscar Flores, Constanza Schwencke and Marcell Leonario-Rodriguez
Children 2025, 12(11), 1560; https://doi.org/10.3390/children12111560 - 17 Nov 2025
Viewed by 483
Abstract
Background/Objectives: Introduction: Food selectivity is highly prevalent in children with autism spectrum disorder (ASD) and is associated with sensory hypersensitivity, particularly in oral, olfactory, and tactile domains. Although international evidence exists, little is known about this phenomenon in Latin American populations. This study [...] Read more.
Background/Objectives: Introduction: Food selectivity is highly prevalent in children with autism spectrum disorder (ASD) and is associated with sensory hypersensitivity, particularly in oral, olfactory, and tactile domains. Although international evidence exists, little is known about this phenomenon in Latin American populations. This study aimed to explore the relationship between sensory hypersensitivity and food selectivity in Chilean children with and without ASD. Methods: A cross-sectional study was conducted with 57 children aged 6–12 years, including 32 with ASD and 25 neurotypical controls. Sensory processing was assessed using the Dunn Sensory Profile 2, while food selectivity was evaluated with the Brief Autism Mealtime Behaviour Inventory (BAMBI) and a Food Frequency Questionnaire (FFQ). Statistical analyses included intergroup comparisons and correlation tests. Results: Children with ASD obtained significantly higher scores across all domains of sensory hypersensitivity (p < 0.001). Selective eating behaviours were more frequent, with texture (78%) and colour (53%) being the most common, and were strongly associated with ritualistic eating (OR 29.39; 95% CI 5.47–136.2; p < 0.0001). BAMBI scores were correlated with oral (p = 0.002), socio-emotional (p = 0.003), and somatic hypersensitivity (p = 0.025). Additionally, children with ASD reported lower intake of vegetables, dairy products, animal proteins, and legumes compared with controls. Conclusions: Food selectivity in Chilean children with ASD is closely related to sensory hypersensitivity, particularly in oral, socio-emotional, and somatic domains. These findings underscore the need for culturally adapted, sensory-based interventions to broaden dietary variety and reduce mealtime difficulties in this population. Full article
(This article belongs to the Special Issue Children with Autism Spectrum Disorder: Diagnosis and Treatment)
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25 pages, 1831 KB  
Review
Phytotherapy in Pediatric Dentistry: A Narrative Review of Clinical Applications and Evidence
by Zorela Elena Miclăuș, Rahela Tabita Moca, Ruxandra-Ilinca Matei, Abel Emanuel Moca, Adriana Țenț and Anca Porumb
Children 2025, 12(11), 1559; https://doi.org/10.3390/children12111559 - 17 Nov 2025
Viewed by 446
Abstract
Background/Objectives: Phytotherapy, the use of plant-derived bioactive compounds for therapeutic purposes, has gained increasing attention in dentistry as a natural, well-tolerated, and culturally acceptable adjunct to conventional treatments. In pediatric dentistry, its potential relevance lies in its antimicrobial, anti-inflammatory, and antioxidant properties, which [...] Read more.
Background/Objectives: Phytotherapy, the use of plant-derived bioactive compounds for therapeutic purposes, has gained increasing attention in dentistry as a natural, well-tolerated, and culturally acceptable adjunct to conventional treatments. In pediatric dentistry, its potential relevance lies in its antimicrobial, anti-inflammatory, and antioxidant properties, which may support oral health, caries prevention, pulp vitality, and gingival health. This narrative review aimed to summarize the current clinical evidence regarding the application of phytotherapeutic agents in pediatric oral care. Methods: A narrative review was conducted according to SANRA guidelines, including clinical studies on plant-based products used for preventive or therapeutic purposes in children and adolescents. Results: Forty-three clinical studies met the inclusion criteria. The most commonly investigated agents included licorice, green tea, cocoa husk, cranberry, pomegranate, Aloe vera, and miswak. These agents demonstrated antimicrobial activity against cariogenic bacteria, reduction in plaque and gingival indices, and favorable healing in pulp therapies. In endodontics, Aloe vera-derived acemannan and Ankaferd Blood Stopper® showed outcomes comparable to conventional materials, while pomegranate and apple cider vinegar exhibited partial antibacterial effects as irrigants. Conclusions: Phytotherapy shows promise as a complementary approach in pediatric dentistry, contributing to caries prevention, gingivitis control, and pulp healing. However, current evidence remains limited by small sample sizes, short-term follow-ups, and heterogeneity in formulations. Further trials are required to confirm efficacy, ensure safety, and standardize phytotherapeutic applications in pediatric oral care. Full article
(This article belongs to the Section Pediatric Dentistry & Oral Medicine)
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11 pages, 401 KB  
Article
Bedside Tracheostomy for Critically Ill Pediatric Patients in the PICU: Clinical Experience in a Single Center
by Young Tae Lim and Jung Eun Kwon
Children 2025, 12(11), 1558; https://doi.org/10.3390/children12111558 - 17 Nov 2025
Viewed by 310
Abstract
Background/Objectives: Children with neurological impairments, especially those who are non-ambulatory, may require additional care services beyond what is available for the general pediatric population, and tracheostomy may be necessary for addressing respiratory problems, but no established consensus or clear guidelines have been established [...] Read more.
Background/Objectives: Children with neurological impairments, especially those who are non-ambulatory, may require additional care services beyond what is available for the general pediatric population, and tracheostomy may be necessary for addressing respiratory problems, but no established consensus or clear guidelines have been established on the optimal timing of this procedure in the pediatric intensive care unit (PICU). Methods: We conducted a study involving 38 patients with neurological impairments who underwent tracheostomy in the PICU from January 2017 to December 2022. We collected demographic, tracheostomy, and outcome data and compared the data between two groups based on the duration of mechanical ventilation before tracheostomy. Results: The patients had heterogeneous neurological conditions, with refractory epilepsy being the most common. Almost all patients received tracheostomy for prolonged mechanical ventilation, with a median duration of 14.5 days of mechanical ventilation before the procedure. A majority of the patients (60.5%) experienced complications related to tracheostomy. The overall mortality rate was 36.8%, with 7.9% directly related to tracheostomy. When the patients were divided into two groups based on the median duration of mechanical ventilation before tracheostomy, the group that received tracheostomy earlier had significantly shorter total PICU stays and hospitalization stays compared to the group that received it later. Conclusions: Children with neurological impairments who undergo tracheostomy have substantial comorbidities and a high rate of complications and mortality. Earlier tracheostomy, based on shorter mechanical ventilation duration, was associated with significantly reduced PICU and hospital stay without increasing adverse outcomes. These findings suggest that timely tracheostomy may improve resource utilization in this medically fragile population. Full article
(This article belongs to the Section Pediatric Pulmonary and Sleep Medicine)
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17 pages, 664 KB  
Article
Clinical and Multivariate Predictors of Headaches Attributed to Rhinosinusitis in Pediatric Patients: A Comparative Study with Migraine and Tension-Type Headache
by Seung Beom Han, Eu Gene Park and Ji Yoon Han
Children 2025, 12(11), 1557; https://doi.org/10.3390/children12111557 - 17 Nov 2025
Viewed by 356
Abstract
Background/Objectives: Headache attributed to rhinosinusitis (HRS) is uncommon in children but often misdiagnosed as migraine or tension-type headache (TTH). Overlapping phenotypes, incidental sinus findings on neuroimaging, and limited communication in younger patients complicate diagnosis and lead to inappropriate treatment. Methods: We retrospectively analyzed [...] Read more.
Background/Objectives: Headache attributed to rhinosinusitis (HRS) is uncommon in children but often misdiagnosed as migraine or tension-type headache (TTH). Overlapping phenotypes, incidental sinus findings on neuroimaging, and limited communication in younger patients complicate diagnosis and lead to inappropriate treatment. Methods: We retrospectively analyzed 3065 pediatric patients (<19 years) presenting with headache at two tertiary neurology clinics (2014–2023) with ≥1 year follow-up. Headaches were classified by ICHD-3 criteria. HRS diagnosis required radiologic sinus pathology and ≥50% improvement within 72 h of antibiotic or decongestant therapy. Demographic, clinical, neuroimaging, and family history data were collected. Symptom profiling used principal component analysis (PCA) and k-means clustering; multivariate logistic regression identified independent predictors. Results: Of 3065 patients, 32.7% had migraines, 15.5% TTH, and 4.5% HRS. Nearly one-third of HRS cases were initially misclassified. Compared with migraine and TTH, HRS patients were younger (median 9 years), more often male, and enriched in preschool age. Independent predictors included shorter duration (<1 h; OR 0.62), higher intensity (OR 2.165), nasal symptoms (OR 9.836), hearing impairment (OR 22.52), allergic rhinitis (OR 8.468), and family history of HRS (OR 32.602) (all p < 0.001). PCA showed overlap but distinct clustering: HRS was characterized by sinonasal and otologic features, whereas migraine clustered around sensory hypersensitivity. Conclusions: Pediatric HRS shows distinct predictors—young age, acute severe headache, nasal and auditory symptoms, allergic history, and family history—despite overlap with migraine and TTH. Structured use of these predictors with otolaryngologic assessment may improve diagnostic accuracy, reduce misclassification, and avoid unnecessary neuroimaging or inappropriate therapy. Full article
(This article belongs to the Special Issue Pediatric Headaches: Diagnostic and Therapeutic Issues)
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15 pages, 822 KB  
Article
The Edmonton Obesity Staging System for Pediatrics (EOSS-P) in Mexican Children and Adolescents Living with Obesity: Beyond BMI Obesity Classes
by Isabel Omaña-Guzmán, Roberto Carlos Rodríguez Quintero, Arturo Ruíz-Arroyo, Edith Prado Díaz, Juan Carlos López-Alvarenga, Ana María Hernández López, Zendy Fuentes Corona, Karina Aguilar Cuarto, Karen Pedraza Escudero, Alejandra Ruíz Barranco, Erendira Villanueva-Ortega and Nayely Garibay-Nieto
Children 2025, 12(11), 1556; https://doi.org/10.3390/children12111556 - 17 Nov 2025
Viewed by 360
Abstract
Background/Objectives: The Edmonton Obesity Staging System (EOSS) was developed to stage the obesity in adult populations. Subsequently, this staging system was designed for pediatric populations (EOSS-P). This study aimed to describe obesity severity using EOSS-P and correlate it with BMI classes in Mexican [...] Read more.
Background/Objectives: The Edmonton Obesity Staging System (EOSS) was developed to stage the obesity in adult populations. Subsequently, this staging system was designed for pediatric populations (EOSS-P). This study aimed to describe obesity severity using EOSS-P and correlate it with BMI classes in Mexican children and adolescents living with obesity. Methods: This is a cross-sectional analysis carried out with data from school-age children and adolescents living with obesity who were referred to the Pediatric Obesity Clinic at the Child Welfare Unit at the General Hospital of Mexico “Dr. Eduardo Liceaga”. Obesity was staged using the EOSS-P. To evaluate the association between obesity classes and each EOSS-P domain, as well as overall EOSS-P staging, we performed Bayesian ordered logistic regression models. Results: A total of 118 participants were included; 43.2% were female and 56.8% were male. Based on the overall EOSS-P staging, 56.8% of participants were classified as stage 3, while none were categorized as stage 0. Obesity class II-III was associated with higher odds for the mechanical (OR = 2.5), metabolic (OR = 1.9), and social (OR = 1.6) domains. Conclusions: Pediatric obesity assessment should extend beyond BMI to include the evaluation of metabolic, mechanical, and psychological domains, identifying health complications and barriers that may impact treatment effectiveness and adherence. The EOSS-P is a valuable tool for staging pediatric obesity based on these domains and can guide personalized clinical decision-making. Full article
(This article belongs to the Special Issue Childhood Obesity: Prevention, Intervention and Treatment)
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10 pages, 429 KB  
Article
Efficacy of Endoscopic Retrograde Cholangiopancreatography and Frey Procedure in the Treatment of Pediatric Pancreatic Duct Stones: A Single-Center Retrospective Cohort Study
by Zhenyu Xie, Yifan Deng, Chengkun Luo, Yun Peng, Yang Chen and Jiulin Song
Children 2025, 12(11), 1555; https://doi.org/10.3390/children12111555 - 17 Nov 2025
Viewed by 339
Abstract
Objective: To compare the efficacy of endoscopic retrograde cholangiopancreatography (ERCP) and the Frey procedure in the treatment of pediatric pancreatic duct stones (PDS). Methods: A retrospective analysis was conducted on 65 pediatric patients treated for pancreatic duct stones in the Department of Pediatric [...] Read more.
Objective: To compare the efficacy of endoscopic retrograde cholangiopancreatography (ERCP) and the Frey procedure in the treatment of pediatric pancreatic duct stones (PDS). Methods: A retrospective analysis was conducted on 65 pediatric patients treated for pancreatic duct stones in the Department of Pediatric Surgery, West China Hospital of Sichuan University, between February 2018 and May 2025. Demographic data, perioperative clinical parameters, postoperative recovery, and complications were collected. The efficacy and complications of ERCP and the Frey procedure were evaluated. Results: Of the 65 patients, 37 (56.92%) were male and 28 (43.08%) were female, with a median surgical age of 14 (11, 16) years. 32 patients (49.23%) underwent ERCP, and 33 patients (50.77%) underwent the Frey procedure. Significant differences were observed between the two groups in the degree of main pancreatic duct dilation (6.45 vs. 9.11, p < 0.001), postoperative stone recurrence (13 vs. 3, p = 0.003), and number of reinterventions (3.98 vs. 1.27, p < 0.001). The 5-year intervention-free survival rate was 57.75% in the ERCP group and 88.86% in the Frey group, with a statistically significant difference between groups (p = 0.024). Conclusions: Both ERCP and the Frey procedure are effective for pediatric PDS. ERCP is preferred for patients with mild ductal dilation and first-onset stones. However, for those with significant ductal dilation or recurrent stones with suboptimal ERCP outcomes, the Frey procedure is recommended. Full article
(This article belongs to the Special Issue Advances and Controversies in Paediatric Gastrointestinal and Hepatobiliary Surgery: Update)
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18 pages, 5248 KB  
Article
Injectable Hyaluronic Acid and Amino Acids Complex for Pediatric Hard-to-Heal Wounds: A Prospective Case Series and Therapeutic Protocol
by Guido Ciprandi, Biagio Nicolosi, Gabriele Storti, Simone F. Marino, Carlotta Scarpa and Franco Bassetto
Children 2025, 12(11), 1554; https://doi.org/10.3390/children12111554 - 17 Nov 2025
Viewed by 574
Abstract
Background: Pediatric hard-to-heal wounds are rare but clinically demanding due to skin immaturity, comorbidities, and infection risk. Methods: This prospective case series evaluated the feasibility, safety, and clinical outcomes of an injectable hyaluronic acid-amino acid complex administered to fifteen children and adolescents (aged [...] Read more.
Background: Pediatric hard-to-heal wounds are rare but clinically demanding due to skin immaturity, comorbidities, and infection risk. Methods: This prospective case series evaluated the feasibility, safety, and clinical outcomes of an injectable hyaluronic acid-amino acid complex administered to fifteen children and adolescents (aged 4–16 years) with chronic hard-to-heal wounds, treated between November 2022 and August 2025 within a standardized wound-hygiene protocol. The primary outcome was time to complete re-epithelialization; secondary outcomes included pain, tolerability, and safety. Results: Complete healing was achieved in most patients within a few weeks of treatment. The injectable therapy was well tolerated, with minimal discomfort and no serious adverse events observed. Conclusions: The injectable hyaluronic acid-amino acid complex appears to be a safe, feasible, and potentially effective therapy for pediatric hard-to-heal wounds. These preliminary findings support its integration into multidisciplinary wound-care strategies, although controlled multicenter studies are warranted to confirm efficacy and define optimal protocols. Full article
(This article belongs to the Special Issue Diagnosis and Management of Injuries, Fractures, and Complications in Children)
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13 pages, 1704 KB  
Article
Effect of Abdominal Adiposity on the Impact of Plantar Force in the Foot Support of Obese and Overweight Schoolchildren
by Ana Paula Ribeiro, Daniel Borges Pereira, Gabrielle Fontura Berger, Kemely Muraiber Ismail, Maitê Duarte Morais and Mayara Slaiman Fares Martins
Children 2025, 12(11), 1553; https://doi.org/10.3390/children12111553 - 17 Nov 2025
Viewed by 285
Abstract
Background: Childhood obesity is a growing global concern associated with early-onset orthopedic complications that may persist into adulthood. Among the anthropometric indicators, abdominal adiposity plays a key role in assessing health risks during pediatric evaluations. However, the relationship between abdominal fat distribution [...] Read more.
Background: Childhood obesity is a growing global concern associated with early-onset orthopedic complications that may persist into adulthood. Among the anthropometric indicators, abdominal adiposity plays a key role in assessing health risks during pediatric evaluations. However, the relationship between abdominal fat distribution and biomechanical alterations, such as changes in posture and foot support, remains poorly understood. Ultrasonography (US) is a validated, noninvasive imaging method capable of distinguishing preperitoneal and intraperitoneal fat in children. Despite its diagnostic advantages, no study to date has directly examined ultrasound-measured abdominal adiposity-predicted pronated foot posture in children. Objective: We aimed to verify the impact of abdominal adiposity on foot support and its association with obese, overweight, and eutrophic schoolchildren. Methods: This is a cross-sectional study. Sixty-five pupils (aged 6–9 years) from a public school in São Paulo, Brazil, were divided into three groups according to nutritional status: obese (n = 25), overweight (n = 20), and eutrophic (n = 20). Anthropometric measurements and foot posture, assessed using the Foot Posture Index (FPI), were collected during the initial evaluation. Abdominal adiposity was determined by ultrasonography, measuring subcutaneous, preperitoneal, and intraperitoneal fat thickness. Statistical Analysis: Analyses compared group differences and relations between abdominal fat and foot posture, with significance set at p < 0.05. Results: Obese and overweight schoolchildren showed pronated foot posture when compared to eutrophic children, on both sides of the feet. Abdominal adiposity was a good predictor of a more pronated footrest for the right and left feet, showing a high-to-moderate association. Conclusions: Ultrasound-measured abdominal adiposity was identified as a significant predictor of pronated foot posture in schoolchildren. These findings highlight the importance of monitoring abdominal fat accumulation during pediatric evaluations, as excessive adiposity may increase the risk of musculoskeletal dysfunctions and pain in the lower limbs. Early detection of these alterations may help prevent postural and musculoskeletal disorders in overweight and obese children. Full article
(This article belongs to the Section Pediatric Endocrinology & Diabetes)
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19 pages, 4997 KB  
Article
Subtalar Arthroereisis with Calcaneus Stop Screws—Can the Angles on Pre- and Post-Surgical X-Ray Images Be Reliably Measured by Artificial Intelligence?
by Lea Alexandra Simmler, Monika Herten, Samuel Hohenberger, Cedric Rubenthaler, Heinz-Lothar Meyer, Bastian Mester, Stephanie Herbstreit, Johannes Haubold, Manuel Burggraf, Marcel Dudda and Christina Polan
Children 2025, 12(11), 1552; https://doi.org/10.3390/children12111552 - 17 Nov 2025
Viewed by 304
Abstract
Background/Objectives: Flexible symptomatic flat foot in children can be surgically treated with calcaneus stop screws. This raises the question of whether pre- and postoperative radiographs (X-ray) can be analyzed in two planes using AI. Methods: In this monocentric retrospective study, angle [...] Read more.
Background/Objectives: Flexible symptomatic flat foot in children can be surgically treated with calcaneus stop screws. This raises the question of whether pre- and postoperative radiographs (X-ray) can be analyzed in two planes using AI. Methods: In this monocentric retrospective study, angle measurements generated by Bone Metrics AI (Gleamer) were compared with manual measurements using Centricity™ (GE Healthcare). A total of 659 X-rays from 124 operated feet (2014–2024) were available, of which 422 were analyzable by AI and 299 met defined quality criteria. Bland–Altman plots were used to assess agreement. Linear and logistic regression analysis examined the influence of age, gender, accessory navicular bone, additional foot pathologies, and flat foot severity on comparability of the measurement methods and measurability by the AI. Finally, radiographs meeting and missing quality criteria were compared. Results: AI measurements were comparable to manual measurements for calcaneus inclination, hallux valgus, 1st–2nd and 1st–5th metatarsal angle both pre- and post-operatively. For the talus-1st metatarsal and medial arch angles, AI results differed significantly (p < 0.001 and p ≤ 0.013) from manual measurement. AI generated talus-1st metatarsal angle was measured larger by 6.14°, 95% [−7.14; −5.14] pre-operatively and 2.80°, 95% [−3.79; −1.81] post-operatively. Medial arch angle was smaller by 1.63° pre-operatively, 95% [1.03; 2.23] and 0.52° post-operatively, 95% CI [0.11; 0.93] with AI. Post-operative measurability was not significantly lower than pre-operative. AI measured angles on incorrectly taken radiographs as often or more often than on correctly taken ones. Discussion: Screw implantation did not negatively impair measurability or AI accuracy. However, age, gender, and flat foot severity influenced AI performance. Bad radiograph quality did not affect AI measurability negatively, indicating that AI cannot yet distinguish between X-rays suitable and unsuitable for angle measurements. Conclusions: Manual measurements are still indispensable in the diagnosis of children’s flat feet. In the future, continuous training of the AI is expected to bring it into line with manually measured radiological values. Full article
(This article belongs to the Special Issue Advances in Pediatric Surgery: Innovative Approaches and Emerging Technologies)
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12 pages, 906 KB  
Article
Comparison of the Effects of Elastic and Rigid Taping on Gross Motor Function, Balance, and Functional Capacity in Children with Hemiplegic Cerebral Palsy: A Randomized, Single-Blinded Trial
by Duygu Korkem Yorulmaz, Rıdvan Gök, Emine Handan Tüzün, Duygu Türker, Buse Birbir and Tezel Yıldırım Şahan
Children 2025, 12(11), 1551; https://doi.org/10.3390/children12111551 - 17 Nov 2025
Viewed by 301
Abstract
Background/Objectives: This randomized, single-blinded trial compared the effects of Kinesio taping (KT) and rigid taping (RT) on gross motor function, balance, and functional capacity in children with hemiplegic cerebral palsy (HCP). Methods: Fifty-two children (aged 7–16) were assessed using the Gross Motor Function [...] Read more.
Background/Objectives: This randomized, single-blinded trial compared the effects of Kinesio taping (KT) and rigid taping (RT) on gross motor function, balance, and functional capacity in children with hemiplegic cerebral palsy (HCP). Methods: Fifty-two children (aged 7–16) were assessed using the Gross Motor Function Measure (GMFM), Pediatric Berg Balance Scale (PBBS), Time-Up-and-Go (TUG), and 2-Minute Walk Test (2-MWT). Results: Both KT and RT produced significant intra-group improvements in GMFM, PBBS, TUG, and 2-MWT scores (p ≤ 0.001). Although nonparametric analysis suggested greater changes for KT in TUG and 2-MWT (p < 0.001; p = 0.036), no significant inter-group differences were found when baseline scores were adjusted using the General Linear Model (GLM) (2-MWT: p = 0.29; TUG: p = 0.087). Conclusions: KT and RT are similarly effective adjuncts to physiotherapy, improving gross motor function, balance, and functional capacity in children with HCP. Therefore, the choice between KT and RT may be guided by clinical preference, child tolerance, and therapeutic goals rather than superiority of effect. Full article
(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)
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19 pages, 2141 KB  
Review
Small Intestinal Bacterial Overgrowth in Children with Short Bowel Syndrome
by Hannah DeGonza, Thu Anh Pham, Rasha Elmaoued, Razan Alkhouri, Ricardo Orlando Castillo and Rajmohan Dharmaraj
Children 2025, 12(11), 1550; https://doi.org/10.3390/children12111550 - 16 Nov 2025
Viewed by 926
Abstract
Small Intestinal Bacterial Overgrowth (SIBO) is characterized by an abnormal proliferation of bacteria in the small intestine, leading to gastrointestinal symptoms and nutritional deficiencies. Short Bowel Syndrome (SBS), resulting from extensive surgical resection of the small intestine, predisposes children to SIBO due to [...] Read more.
Small Intestinal Bacterial Overgrowth (SIBO) is characterized by an abnormal proliferation of bacteria in the small intestine, leading to gastrointestinal symptoms and nutritional deficiencies. Short Bowel Syndrome (SBS), resulting from extensive surgical resection of the small intestine, predisposes children to SIBO due to anatomical disruptions, motility dysfunction, parenteral nutrition dependence, and immune dysregulation. Clinical manifestations of SIBO in SBS include bloating, diarrhea, malabsorption, and failure to thrive, with severe cases leading to complications such as D-lactic acidosis. Diagnosis remains challenging, with breath testing being the most commonly used method despite limitations in accuracy, especially in SBS patients. Jejunal aspiration, the gold standard, presents limitations due to contamination risks, potential for sampling error, and a relatively low diagnostic yield. Management involves antibiotics like rifaximin and metronidazole, alongside strategies to address anatomical dysfunction, optimize nutrition, and prevent recurrence. Adjunctive therapies, including probiotics and dietary modifications, show promise but require further validation in children. Emerging treatments, such as glucagon-like peptide-2 (GLP-2) analogs, may enhance mucosal integrity and reduce SIBO risk. Given the chronic and recurrent nature of SIBO in SBS, a multidisciplinary approach is essential, integrating gastroenterological, surgical, and nutritional care to effectively manage the condition. Future research should focus on improving diagnostic methods, refining treatment protocols, and exploring targeted therapies to enhance outcomes and quality of life for affected children. Full article
(This article belongs to the Special Issue Advances in Pediatric Gastroenterology (2nd Edition))
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37 pages, 514 KB  
Systematic Review
Acid–Base Status and Cerebral Oxygenation in Neonates: A Systematic Qualitative Review of the Literature
by Christian Mattersberger, Bernhard Schwaberger, Nariae Baik-Schneditz and Gerhard Pichler
Children 2025, 12(11), 1549; https://doi.org/10.3390/children12111549 - 16 Nov 2025
Viewed by 230
Abstract
Introduction: Blood gas analysis is utilized to assess parameters of oxygenation and ventilation, including acid–base status [pH value, base excess (BE) or base deficit (BD), and bicarbonate (HCO3)], to evaluate systemic metabolism status. Acid–base imbalances can have complex effects on the [...] Read more.
Introduction: Blood gas analysis is utilized to assess parameters of oxygenation and ventilation, including acid–base status [pH value, base excess (BE) or base deficit (BD), and bicarbonate (HCO3)], to evaluate systemic metabolism status. Acid–base imbalances can have complex effects on the organism, potentially impacting oxygen delivery to tissue. Cerebral oximetry is a non-invasive monitoring technique using near-infrared spectroscopy (NIRS) for the continuous measurement of cerebral tissue oxygenation. The relationship between the acid–base status and cerebral tissue oxygenation in neonates remains unclear. This systematic qualitative review aims to analyze current knowledge of the potential correlations between different acid–base status parameters and cerebral tissue oxygenation measured via NIRS in neonates. Methods: A systematic search of PubMed and Ovid Embase was performed, focusing on cerebral oxygenation, neonates, and acid–base status. Risk of bias was assessed using the ‘‘Risk of Bias for Non-randomized Studies of Exposures’’ (ROBINS-E) instrument. Results: Fifty studies that measured parameters of the acid–base status and cerebral tissue oxygenation in the neonatal period were identified. Seven studies demonstrated a correlation between pH and cerebral tissue oxygenation, while eleven studies found no such correlation. Five studies demonstrated a correlation between the BE/BD and cerebral tissue oxygenation, while six studies found no such correlation. Three studies demonstrated a correlation between HCO3 and cerebral tissue oxygenation, while five studies found no such correlation. Discussion: Associations between acid–base status parameters and cerebral tissue oxygenation remain controversial. However, studies with the lowest risk of bias mainly demonstrated no significant correlation between any of the acid–base status parameters and cerebral tissue oxygenation. Full article
(This article belongs to the Special Issue Advances in Neonatal Resuscitation and Intensive Care)
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12 pages, 212 KB  
Article
Facilitators and Barriers to the Implementation of Family Integrated Care in Ontario Level II Neonatal Intensive Care Units
by Ayah Al Bizri, Mariana Bueno, Vibhuti Shah, Fabiana Bacchini, Douglas M. Campbell, Karen M. Benzies and Karel O’Brien
Children 2025, 12(11), 1548; https://doi.org/10.3390/children12111548 - 16 Nov 2025
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Abstract
Background/Objectives: In Ontario, approximately 8% (11,000) of infants are born preterm (22–<37 weeks gestation) each year. Many of these infants are cared for in a Level II Neonatal Intensive Care Unit (NICU). Family Integrated Care (FICare), an innovative model of care, aims [...] Read more.
Background/Objectives: In Ontario, approximately 8% (11,000) of infants are born preterm (22–<37 weeks gestation) each year. Many of these infants are cared for in a Level II Neonatal Intensive Care Unit (NICU). Family Integrated Care (FICare), an innovative model of care, aims to facilitate the involvement of parents in the care of their infants in NICUs. The aim of this study was to gain a better understanding of the general and specific needs of Level II NICUs in Ontario prior to implementation of FICare. Methods: Using a cross-sectional study design, two surveys (leadership and site resources) were developed using the Consolidated Framework for Implementation Science Research’s innovation, inner setting, and outer setting constructs and distributed to Level II NICUs medical and nursing leaders. Results: The surveys were sent to 44 Level II NICUs in Ontario, of which 24 hospitals (55%) responded. Key facilitators to implementation of FICare in Level II hospitals in Ontario were leadership interest, availability of staff and parent volunteers, and existing policies to support implementation. The identified barriers were lack of financial resources for new initiatives, skepticism in FICare’s ability to save costs, need for tailored implementation due to variability in NICU characteristics, and the lack of environmental support for prolonged parental presence. Conclusions: This study has confirmed the interest of many Ontario level II NICUs in implementing FICare and variability in their readiness for implementation based on the identified facilitators and barriers. Full article
(This article belongs to the Section Pediatric Neonatology)
10 pages, 599 KB  
Article
The Use of Sternum and Sacrum Angles in the Assessment of Sitting Posture in Adolescents: A Cross-Sectional Comparison of Cohorts Assessed Before and After the COVID-19 Pandemic
by Sun-Young Ha, Arkadiusz Żurawski and Wojciech Kiebzak
Children 2025, 12(11), 1547; https://doi.org/10.3390/children12111547 - 15 Nov 2025
Viewed by 306
Abstract
Background: The COVID-19 pandemic has been associated with increased sedentary behavior in children, raising concerns about posture and spinal health. This study compared standardized measures of sitting spinal alignment in two independent cohorts assessed before (2017) and after (2024) the pandemic and [...] Read more.
Background: The COVID-19 pandemic has been associated with increased sedentary behavior in children, raising concerns about posture and spinal health. This study compared standardized measures of sitting spinal alignment in two independent cohorts assessed before (2017) and after (2024) the pandemic and examined correlations among alignment parameters across different sitting postures. Methods: This cross-sectional study included healthy children aged 9–13 years. The sternal angle, sacral angle, lumbar lordosis, thoracic kyphosis, trunk tilt, and lateral deviation were measured using a Saunders digital inclinometer and a DIERS Formetric 4D rasterstereographic system in passive, forced, and corrected sitting postures. Results: No statistically significant differences were observed between the 2017 and 2024 cohorts (p > 0.05). Within each cohort, significant posture-related differences were found for the sternal and sacral angles, lumbar lordosis, and lateral deviation (p < 0.05), while thoracic kyphosis and trunk inclination differed between passive and corrected sitting (p < 0.05). The sternal angle correlated moderately to strongly with thoracic kyphosis (r = 0.657–0.695, p < 0.001), and the sacral angle correlated with lumbar lordosis (r = 0.679–0.743, p < 0.001). Conclusions: Similar alignment parameters across time-separated cohorts suggest no major cohort-level shifts in standardized sitting posture; however, behavioral factors were not directly assessed. Strong correlations among sagittal angles emphasize the consistent geometric relationship between the sternum, sacrum, and spinal curvatures. A sternal angle of approximately 65° was consistently associated with physiologically favorable spinal alignment and may serve as a practical reference value for posture assessment and education. Full article
(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)
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