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Children
Volume 12
Issue 3
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Children, Volume 12, Issue 3 (March 2025) – 138 articles

Cover Story (view full-size image): Children in pediatric oncology report unmet needs related to communication, information, and psychosocial support. Supporting the whole family involves challenges, with the risk that children’s voices are not heard above those of the adults. This study explored how children with cancer and their siblings experienced participation in a family-centered psychosocial support intervention, the Family Talk Intervention (FTI). Interviews were held with 35 children, both ill and siblings, from 26 families in pediatric oncology after participation in FTI. The interviews were analyzed using combined deductive and inductive qualitative content analysis, guided by the Lundy model of child participation. View this paper
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13 pages, 519 KiB  
Review
Vipera Snakebite in Children: A Focus on Europe
by Greta Orlandi, Nadia Rossi, Francesco Chiarelli and Paola Di Filippo
Children 2025, 12(3), 393; https://doi.org/10.3390/children12030393 - 20 Mar 2025
Viewed by 258
Abstract
Although there are over 5 million cases of snakebites each year, up-to-date data on epidemiology and management in European children are lacking in literature. Snakebite envenoming is a rare but potentially life-threatening event, and children are more susceptible due to their lower weight-to-venom [...] Read more.
Although there are over 5 million cases of snakebites each year, up-to-date data on epidemiology and management in European children are lacking in literature. Snakebite envenoming is a rare but potentially life-threatening event, and children are more susceptible due to their lower weight-to-venom ratio. Symptoms of viper envenomation in children are mainly local, but the lymphatic and blood diffusion of the venom may cause systemic symptoms, mainly hemotoxic and cytotoxic symptoms. Immunotherapy with anti-viper serums is the cornerstone of treatment for viper bites, while the use of antibiotics, steroids and analgesics is still unclear and unstandardized. Recently, efforts have been made to improve the pediatric approach to viper envenomation in European children. Several pediatric case reports in children were reported in literature, and a pediatric grading severity score and electronic clinical tool (VipGrade®) were created to better manage this issue. However, larger studies are needed to validate these pediatric tools. This narrative review focuses on the clinical characteristics and management of European snake envenomation in children. Full article
(This article belongs to the Section Global Pediatric Health)
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31 pages, 453 KiB  
Review
Vitamin D: What We Know and What We Still Do Not Know About Vitamin D in Preterm Infants—A Literature Review
by Ioana Andrada Radu, Maria Livia Ognean, Laura Ștef, Doina Ileana Giurgiu, Manuela Cucerea and Cristian Gheonea
Children 2025, 12(3), 392; https://doi.org/10.3390/children12030392 - 20 Mar 2025
Viewed by 890
Abstract
Background/Objectives: Preterm infants represent a population group at increased risk for vitamin D deficiency (VDD) and for its negative impact on various outcomes like metabolic bone disease or rickets, respiratory complications like respiratory distress syndrome and the development of bronchopulmonary dysplasia, necrotizing enterocolitis, [...] Read more.
Background/Objectives: Preterm infants represent a population group at increased risk for vitamin D deficiency (VDD) and for its negative impact on various outcomes like metabolic bone disease or rickets, respiratory complications like respiratory distress syndrome and the development of bronchopulmonary dysplasia, necrotizing enterocolitis, or retinopathy of prematurity. Methods: Despite the growing interest in vitamin D research, there is still uncertainty regarding clear recommendations for each high-risk category of premature infants concerning the optimal dosage, optimal product, and timing for initiating vitamin D supplementation to prevent VDD. Results: An analysis of the literature suggests that early intervention for the optimal enteral supplementation of vitamin D is not only successful in achieving higher 25-hydroxi-vitamin D (25(OH)D) at one month but is also linked with improved outcomes. Conclusions: The traditional concepts and current recommendations for assessing vitamin D status and optimal supplementation need to be revised. Since parenteral nutrition, fortified mothers’ own milk, and special formula for preterm infants cannot provide adequate vitamin D levels, initiating oral supplementation soon after birth is essential to correct VDD in preterm infants. Full article
(This article belongs to the Special Issue Nutrition Intake and Outcomes for Premature Infants)
9 pages, 817 KiB  
Perspective
Nutritional Management for Pediatric Biliary Atresia Patients Preparing for Liver Transplantation
by Uyory Choe
Children 2025, 12(3), 391; https://doi.org/10.3390/children12030391 - 20 Mar 2025
Viewed by 388
Abstract
Biliary atresia, a rare pediatric liver condition, results in blocked bile ducts, impeding bile secretion and causing significant nutritional challenges. This perspective emphasizes the critical role of nutrition in supporting children with biliary atresia awaiting liver transplantation. The liver’s multifaceted functions in energy [...] Read more.
Biliary atresia, a rare pediatric liver condition, results in blocked bile ducts, impeding bile secretion and causing significant nutritional challenges. This perspective emphasizes the critical role of nutrition in supporting children with biliary atresia awaiting liver transplantation. The liver’s multifaceted functions in energy metabolism, vitamin storage, and waste excretion emphasize the importance of tailored dietary interventions. Medium-chain triglyceride (MCT) oil serves as a crucial energy source, addressing fat malabsorption, while specialized water-soluble formulations deliver essential fat-soluble vitamins. Additionally, weaning strategies and developmental food practices are discussed to ensure optimal growth and development despite dietary restrictions. Feeding assistance through nasogastric or gastrostomy tubes is explored as a means to combat malnutrition and support liver function. The collective efforts of caregivers and healthcare providers are pivotal in preparing these children for successful liver transplantation, aiming to secure their future health and quality of life. Full article
(This article belongs to the Section Pediatric Gastroenterology and Nutrition)
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10 pages, 214 KiB  
Article
Nutritional Status, Social Determinants of Health and Clinical Outcomes in Critically Ill Children
by Yash Desai, Andrea Marroquín, Paola Hong-Zhu, Nicole Knebusch, Stephanie Vazquez, Marwa Mansour, Thomas P. Fogarty, M. Hossein Tcharmtchi, Fernando Stein and Jorge A. Coss-Bu
Children 2025, 12(3), 390; https://doi.org/10.3390/children12030390 - 20 Mar 2025
Viewed by 393
Abstract
Introduction: Childhood malnutrition remains a risk factor for morbidity and mortality. Children admitted to the Pediatric Intensive Care Unit (PICU) are at a higher risk of worsening nutritional status with adverse clinical outcomes. The burden of malnutrition is strongly linked to various well-defined [...] Read more.
Introduction: Childhood malnutrition remains a risk factor for morbidity and mortality. Children admitted to the Pediatric Intensive Care Unit (PICU) are at a higher risk of worsening nutritional status with adverse clinical outcomes. The burden of malnutrition is strongly linked to various well-defined social determinants of health, including race, socioeconomic status, and geography, as these factors influence household food insecurity. This study aimed to analyze the interrelationships of nutritional status, social determinants of health, and health outcomes in critically ill children. Methods: Retrospective cohort study of 6418 critically ill children admitted to PICU from January 2014 to December 2017. Demographic and anthropometric measurements were collected upon admission and outcomes. Based on the patient’s zip code, and median household income, we estimated the percentage of the population living in poverty, and the percentage of the population experiencing food insecurity for 5912 children. Results: The prevalence of underweight, chronic, and acute malnutrition was 13.2%, 17.9%, and 5.6%, respectively. Malnourished children had longer duration of mechanical ventilation and longer PICU and hospital lengths of stay (LOS) compared to nourished children. Underweight and chronic malnutrition were associated with higher mortality. Hispanic children had the highest prevalence of poverty level, while non-Hispanic Black children had the highest food insecurity level and lowest median income. Ethnicity was not associated with mortality. Conclusions: Malnourished critically ill children who were disproportionately non-Hispanic Black, Hispanic, and Asian had worse hospital outcomes, including prolonged hospital and PICU length of stay, increased time on mechanical ventilation, and a higher risk of mortality. Full article
(This article belongs to the Special Issue Infant and Early Childhood Nutrition)
11 pages, 210 KiB  
Article
A Randomized Crossover Trial to Evaluate the Effect of Positioning on Obstructive Sleep Apnea in Infants with Robin Sequence
by Cornelia Wiechers, Simon Goetz, Karen Kreutzer, Christina Weismann, Jessica LeClair, Glen McGee, Christian F. Poets and Mirja Quante
Children 2025, 12(3), 389; https://doi.org/10.3390/children12030389 - 20 Mar 2025
Viewed by 274
Abstract
Background: The prone position is one of the most frequently used treatment options for infants with Robin sequence (RS), but its effect and its safety regarding the increased risk of sudden infant death syndrome are controversial. Methods: In a prospective randomized crossover study, [...] Read more.
Background: The prone position is one of the most frequently used treatment options for infants with Robin sequence (RS), but its effect and its safety regarding the increased risk of sudden infant death syndrome are controversial. Methods: In a prospective randomized crossover study, we investigated the effects of the prone versus supine position on obstructive sleep apnea (OSA) using polygraphy. Infants with RS admitted to the University Hospital Tuebingen between 4/2021 and 5/2023 were analyzed for their obstructive apnea index (OAI), oxygen desaturation index < 80%, minimum and basal oxygen saturation, basal and highest transcutaneous carbon dioxide level, and respiratory and heart rate in both sleep positions. Results: A total of 29 children were analyzed. A total of 21/29 children were measured in both positions, while 6/29 children were only measured in the supine position and 2/29 only in the prone position. We found no significant difference in the OAI for the supine versus prone position in main effects analyses. In unadjusted linear model analysis, infants in the supine position had an OAI of 9.9 (95% CI, −2.4, 22.3) events/h higher than those in the prone position. A total of 13/21 infants benefitted from the prone position, whilst 8/21 had a worsening of their OSA. We found no evidence of a significant interaction between sleeping position and syndromic status. Conclusions: Prone positioning improves, but does not eliminate, OSA symptoms in infants with RS, and severe OSA may often persist. There are infants in whom a change to the prone position leads to a worsening of their OSA. Full article
(This article belongs to the Section Pediatric Pulmonary and Sleep Medicine)
16 pages, 453 KiB  
Review
A Narrative Review of Multifactorial Determinants of Childhood Eating Behaviors: Insights and Interventions Using the Social Ecological Model
by Qutaibah Oudat, Sarah E. Messiah, Alia Dawlat Ghoneum and Anas Okour
Children 2025, 12(3), 388; https://doi.org/10.3390/children12030388 - 20 Mar 2025
Viewed by 743
Abstract
Background/Objectives: Childhood eating behaviors result from a complex interplay of familial, social, and environmental factors, influenced by socioeconomic and cultural contexts. These behaviors impact dietary habits, nutritional status, and long-term health. Using the Social Ecological Model (SEM), this narrative review synthesizes evidence [...] Read more.
Background/Objectives: Childhood eating behaviors result from a complex interplay of familial, social, and environmental factors, influenced by socioeconomic and cultural contexts. These behaviors impact dietary habits, nutritional status, and long-term health. Using the Social Ecological Model (SEM), this narrative review synthesizes evidence on key determinants of childhood eating behaviors and proposes a framework for multi-level interventions. Methods: A structured literature search was conducted across PubMed, PsycINFO, and CINAHL, focusing on studies published between January 2014 and September 2024. Keywords related to childhood eating behaviors, familial determinants, and social influences were used to identify relevant studies. Inclusion criteria centered on empirical research examining how social and familial factors impact childhood eating behaviors within the SEM framework. Results: The review highlights critical determinants, including parental feeding practices, home food environments, peer influences, screen time, school meal programs, and socioeconomic disparities. These factors interact across multiple levels, emphasizing the importance of holistic interventions that target both individual behaviors and broader systemic influences. Conclusions: Addressing childhood eating behaviors requires a multi-level approach that integrates caregiver education, peer-led interventions, improved food environments, and supportive policies. Healthcare providers and policymakers play a crucial role in implementing strategies that foster healthier dietary behaviors and mitigate childhood obesity risks. Full article
(This article belongs to the Section Pediatric Gastroenterology and Nutrition)
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14 pages, 3121 KiB  
Article
Application of Radiomics in Predicting the Prognosis of Medulloblastoma in Children
by Jiashu Chen, Wei Yang, Zesheng Ying, Ping Yang, Yuting Liang, Chen Liang, Baojin Shang, Hong Zhang, Yingjie Cai, Xiaojiao Peng, Hailang Sun, Wenping Ma and Ming Ge
Children 2025, 12(3), 387; https://doi.org/10.3390/children12030387 - 20 Mar 2025
Viewed by 300
Abstract
Background and Purpose: Medulloblastoma (MB) represents the predominant intracranial neoplasm observed in pediatric populations, characterized by a five-year survival rate ranging from 60% to 80%. Anticipating the prognostic outcome of medulloblastoma in children prior to surgical intervention holds paramount significance for informing treatment [...] Read more.
Background and Purpose: Medulloblastoma (MB) represents the predominant intracranial neoplasm observed in pediatric populations, characterized by a five-year survival rate ranging from 60% to 80%. Anticipating the prognostic outcome of medulloblastoma in children prior to surgical intervention holds paramount significance for informing treatment modalities effectively. Radiomics has emerged as a pervasive tool in both prognostic anticipation and therapeutic management across diverse tumor spectra. This study aims to develop a radiomics-based prediction model for the prognosis of children with MB and to validate the contribution of radiomic features in predicting the prognosis of MB when combined with clinical features. Materials and Methods: Patients diagnosed with medulloblastoma at our hospital from December 2012 to March 2022 were randomly divided into a training cohort (n = 40) and a test cohort (n = 41). Regions of interest (ROIs) were manually drawn on T1-weighted images (T1WI) along the boundary of the tumor, and radiomic features were extracted. Radiomic features related to survival prognosis were selected and used to construct a radiomics model. The patients were classified into two different risk stratifications according to the Risk-score calculated from the radiomics model. The log-rank test was used to test the difference in survival between the two stratifications to verify the classification value of the radiomics model. Clinical features related to the prognosis were used to construct a clinical model or clinical–radiomics model together with the radiomic features. Then, the clinical model, radiomics model, and clinical–radiomics model were compared to validate the improvement of radiomics in predicting the prognosis of medulloblastoma. The performance of the three models was evaluated with the C-index and the time-dependent AUC. Overall survival (OS) was defined as the time from receiving the operation to death or last follow-up. Results: A total of 81 children were included in this study. A total of five prognostic radiomic features were selected. The radiomics model could discriminate different risk hierarchies with good performance power in the training and testing datasets (training set p= 0.0009; test set p = 0.0286). Six clinical features associated with prognosis (duration of disease, risk hierarchy, dissemination, radiology, chemotherapy, and last postoperative white blood cell (WBC) level in CSF) were selected. The radiomic–clinical molecular features had better predictive value for OS (C-index = 0.860; Brier score: 0.087) than the radiomic features (C-index = 0.762; Brier score: 0.073) or clinical molecular characteristics (C-index = 0.806; Brier score: 0.092). Conclusions: Radiomic features based on T1-weighted imaging have predictive value for pediatric medulloblastoma. Radiomics has incremental value in predicting the prognosis of MB, and clinical–radiomics models have a better predictive effect than clinical models. Full article
(This article belongs to the Section Pediatric Surgery)
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16 pages, 465 KiB  
Review
Neglect of Children with Disabilities: A Scoping Review
by Siwar Makhoul Khoury, Ayala Cohen, Matteo Angelo Fabris and Ayelet Gur
Children 2025, 12(3), 386; https://doi.org/10.3390/children12030386 - 20 Mar 2025
Viewed by 765
Abstract
Background: Children with disabilities face an increased risk of neglect and maltreatment due to their dependence on caregivers, social isolation, and challenges in seeking help. While extensive research has examined child abuse, neglect remains an underexplored yet pervasive issue affecting this vulnerable population. [...] Read more.
Background: Children with disabilities face an increased risk of neglect and maltreatment due to their dependence on caregivers, social isolation, and challenges in seeking help. While extensive research has examined child abuse, neglect remains an underexplored yet pervasive issue affecting this vulnerable population. Objective: This scoping review synthesizes literature from the past decade to assess the prevalence, characteristics, and risk factors of neglect among children with disabilities, aiming to identify gaps in research and inform policy and intervention efforts. Methods: Following the PRISMA-ScR guidelines, a systematic search was conducted across multiple electronic databases, including PsycNET, Social Services Abstracts, ERIC, PubMed, and EBSCO. Studies were included if they focused on neglect among children with disabilities and were published in English within the last ten years. Thematic analysis was employed to extract and categorize findings. Results: Sixteen studies met the inclusion criteria, revealing a significantly higher prevalence of neglect among children with disabilities compared to their typically developing peers. The type and severity of disability influenced the likelihood and nature of neglect, with children with intellectual disabilities (ID), autism spectrum disorder (ASD), and sensory impairments facing particularly high risks. Key risk factors included parental stress, economic hardship, limited access to resources, and systemic failures in early identification and intervention. Despite the severity of neglect, evidence-based preventive strategies remain scarce, and existing child protection frameworks often fail to account for the unique needs of children with disabilities. Conclusions: The findings underscore the urgent need for targeted interventions, specialized training for professionals, and policy reforms to address the neglect of children with disabilities. Future research should focus on developing and evaluating culturally sensitive and disability-specific support systems to mitigate the long-term consequences of neglect. Full article
(This article belongs to the Special Issue The Challenges of Identifying and Reporting of Children Suffering from Neglect)
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17 pages, 1124 KiB  
Article
From Childhood Experiences to Social Media Addiction: Unraveling the Impact on Adolescents
by Demet Aydın and Halide Bengü Göncü
Children 2025, 12(3), 385; https://doi.org/10.3390/children12030385 - 19 Mar 2025
Viewed by 715
Abstract
Social media usage among adolescents has significantly increased in recent years, playing a crucial role in contemporary youth culture. The increasing adoption of the internet across all age groups has led to numerous benefits, but also concerns regarding its misuse, particularly among adolescents. [...] Read more.
Social media usage among adolescents has significantly increased in recent years, playing a crucial role in contemporary youth culture. The increasing adoption of the internet across all age groups has led to numerous benefits, but also concerns regarding its misuse, particularly among adolescents. However, alongside these benefits, problems related to internet misuse have also escalated. Background/Objectives: A review of the literature reveals a lack of studies examining the long-term effects of childhood experiences on later social media addiction. This study aims to investigate the impact of childhood experiences on social media addiction during adolescence. Methods: This study employs a relational survey model, a quantitative research method. Data were collected using the Childhood Experiences Scale and the Social Media Addiction Scale for Adolescents. This study’s participants included 371 adolescents attending secondary education institutions under the Ministry of National Education of Türkiye during the 2024–2025 academic year. Participants were selected through simple random sampling. Relationship and impact tests were used to analyze the data. Results: This study found that adolescents with adverse school experiences exhibited social media addiction. A significant relationship was found between adverse school experiences and the time spent on social media. Furthermore, in terms of the gender variable, it was found that females scored significantly higher on the Social Media Addiction Scale for Adolescents compared to males. Conclusions: Based on the results of this study, it is observed that adverse experiences encountered in children’s school life may influence social media addiction in their future lives. In future studies, researchers may identify different childhood experiences that impact social media addiction. Full article
(This article belongs to the Special Issue Screen Time, Adverse Childhood Experiences and Childhood Mental Health on Child and Adolescent Development: Current Research and Future Directions)
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16 pages, 319 KiB  
Article
Impact of Fortified Whole Grain Infant Cereal on the Nutrient Density of the Diet in Brazil, the UAE, and the USA: A Dietary Modeling Study
by Lynda O’Neill, Maria F. Vasiloglou, Fanny Salesse, Regan Bailey, Carlos Alberto Nogueira-de-Almeida, Ayesha Al Dhaheri, Leila Cheikh Ismail, Nahla Hwalla and Tsz Ning Mak
Children 2025, 12(3), 384; https://doi.org/10.3390/children12030384 - 19 Mar 2025
Viewed by 421
Abstract
Background/Objectives: Complementary feeding (CF) influences future health outcomes. The aim of this study was to evaluate the impact of fortified whole grain infant cereal (WGIC), a complementary food, among 6- to 12-month-old infants on the nutrient density of the diet in three diverse [...] Read more.
Background/Objectives: Complementary feeding (CF) influences future health outcomes. The aim of this study was to evaluate the impact of fortified whole grain infant cereal (WGIC), a complementary food, among 6- to 12-month-old infants on the nutrient density of the diet in three diverse settings: Brazil, the United Arab Emirates (UAE), and the US. Methods: Data from the Feeding Infants and Toddler Study (FITS), a collection of dietary intake studies based on 24-h-dietary recalls, from said countries was utilized. Nutrient intakes were calculated for infant cereal (IC) consumers and non-consumers. Diet modeling was applied to IC consumers to substitute their regular fortified IC with WGIC with improved fortifications. The study estimated the average nutrient density, mean adequacy ratio (MAR), and percentage inadequacy of the diet in both IC consumers and non-consumers. Results: The analyses indicated that infants who consumed IC had higher intakes of calcium, zinc, magnesium, iron, and vitamin D in the three countries. Reduced micronutrient inadequacies were observed among IC consumers, particularly in Brazil and the U.S. Diet modeling with WGIC revealed a significantly higher density of choline, magnesium, zinc, iron, fiber, and protein, as well as reduced inadequacies. The MAR was significantly improved in the three countries. Conclusions: This study underscores the potential of fortified WGIC in increasing the nutrient density of the complementary diet. The intrinsic nutrients in whole grain infant cereals (WGICs) significantly enhance the nutrient density of the complementary diet. Given that whole grains play a role in preventing childhood obesity, their inclusion during CF may be crucial. Full article
(This article belongs to the Special Issue The State of the Art in Obesity, Eating Habits and Nutrition among Children and Adolescents)
14 pages, 455 KiB  
Article
Influence of Urban and Rural Areas, Type of School, and Parents’ Education Level on Nutrition Habits and Their Relationship with Dental Caries in Schoolchildren in Mallorca
by Daniela Vallejos, Irene Coll and Nora López-Safont
Children 2025, 12(3), 383; https://doi.org/10.3390/children12030383 - 19 Mar 2025
Viewed by 302
Abstract
Background/Objectives: Habits such as a diet high in sugars and poor dental biofilm control are linked to a higher prevalence of caries and low socioeconomic status. This study aimed to analyze the nutrition habits of schoolchildren in Mallorca and their relationship with [...] Read more.
Background/Objectives: Habits such as a diet high in sugars and poor dental biofilm control are linked to a higher prevalence of caries and low socioeconomic status. This study aimed to analyze the nutrition habits of schoolchildren in Mallorca and their relationship with the presence of dental caries, depending on the type of school, geographic location, and parents’ education level. Methods: A cross-sectional study was conducted to examine the prevalence of dental caries based on World Health Organization (WHO) standards and nutritional practices following guidelines from the Food and Agriculture Organization of the United Nations (FAO) and the European Food Safety Authority (EFSA). This study included 718 students from three age groups: first-year elementary students (ages 5–6), sixth-year elementary students (age 12), and fourth-year secondary school students (age 15). Relevant sociodemographic factors were also considered in the analysis. Results: In schoolchildren aged 5–6 years, higher monthly consumption of processed and sugary foods, such as sweets (rural: 24.66 (CI 95%: 20.30–29.02); urban: 19.29 (CI 95%:16.27–22.304); p = 0.044), was noted in schoolchildren from rural sectors compared to those residing in urban areas. At 15 years of age, there was a higher consumption of potato chips in public schools than in subsidized/private schools (public: 26.95 (CI 95%: 24.42–29.49); subsidized/private: 18.29 (CI 95%: 13.92–22.65) p = 0.004). A high consumption of sweets is associated with an increased risk of caries (OR sweets: 1.76 CI: 1.04–2.98; p = 0.035). Fewer students with mothers with a lower education level eat dinner (elementary: 75%; secondary 91%; higher: 98%; p = 0.003). Conclusions: Higher consumption of sweets in rural areas and potato chips in public schools, along with the association between sweet consumption and caries risk, highlight how geographic location, school type, and parents’ education level influence children’s nutrition habits and caries. Full article
(This article belongs to the Section Pediatric Dentistry & Oral Medicine)
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19 pages, 1465 KiB  
Article
The Effectiveness of Leg- and Arm-Powered Trike Training Among Children with Impaired Walking Ability—A Pilot Study
by Loredana Tschenett and Heiner Baur
Children 2025, 12(3), 382; https://doi.org/10.3390/children12030382 - 19 Mar 2025
Viewed by 287
Abstract
Background/Objectives: The GO-TRYKE® Kid (GTK®) is an arm- and leg-powered tricycle which, in addition to promoting strength, endurance, and coordination, aims to reactivate the central pattern generators of the spine for locomotion through cyclical movements. The present study investigated the [...] Read more.
Background/Objectives: The GO-TRYKE® Kid (GTK®) is an arm- and leg-powered tricycle which, in addition to promoting strength, endurance, and coordination, aims to reactivate the central pattern generators of the spine for locomotion through cyclical movements. The present study investigated the effects of GTK® training on walking ability, GTK® riding performance, and health-related quality of life in children with walking disabilities. Methods: Nine children trained with the device twice a week for nine weeks. Short- and long-term effects on walking ability were measured using the timed up and go test (TUG) and the two-minute walk test (2MWT). GTK® riding performance and health-related quality of life were compared before and after the intervention period. Results: While no long-term effect on walking was found, a significant short-term effect on functional walking ability was observed (p = 0.009). GTK® riding performance improved significantly over the training period (p = 0.004). There were no significant changes in health-related quality of life. Conclusions: GTK® enables children with walking disabilities to participate in cycling as part of play and sport. Further research is required to investigate its functional and participatory effects, as there is significant potential to improve physical activity and overall well-being in this population. Full article
(This article belongs to the Special Issue Physical Activity in Children with Disabilities)
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10 pages, 426 KiB  
Article
Validation of a Rapid Host-Protein Score to Discriminate Bacterial from Viral Infections in Hospitalized Febrile Pediatric Patients
by Maria Noni, Eleni Kalogera, Athina Xydia, Georgios Paradeisis, Kalliopi Spyridopoulou, Levantia Zachariadou and Evanthia Botsa
Children 2025, 12(3), 381; https://doi.org/10.3390/children12030381 - 19 Mar 2025
Viewed by 362
Abstract
Background: The MeMed BV® BV score is a novel, promising host-protein score, differentiating bacterial from viral infections, that combines the expression levels of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), interferon gamma-induced protein-10 (IP-10), and C-reactive protein (CRP). The aim of our study [...] Read more.
Background: The MeMed BV® BV score is a novel, promising host-protein score, differentiating bacterial from viral infections, that combines the expression levels of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), interferon gamma-induced protein-10 (IP-10), and C-reactive protein (CRP). The aim of our study was to determine its diagnostic accuracy in hospitalized febrile children. Methods: A prospective study was performed from December 2023 to April 2024 in two pediatric clinics at “Aghia Sophia” Children’s Hospital, Athens, Greece. Patients > 3 months old, presenting with fever, clinical suspicion of acute infection, and symptoms onset up to 7 days prior were considered eligible. Patients with cancer, Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Tuberculosis (TB), and immunodeficiency were excluded. Two pediatricians reviewed the clinical, laboratory, microbiological, and radiological data and assigned the final diagnosis. The experts were blinded to the BV scores. Results: One hundred and thirty-five patients were enrolled. The predominant medical condition was respiratory tract infection (59.3% lower, 26.7% upper). Twenty-nine (21.5%) patients were diagnosed with bacterial infections. The BV score demonstrated a sensitivity of 96.2%, specificity of 88.7%, and negative predictive value (NPV) of 98.9% for bacterial infections. Equivocal BV scores were reported in 8.9% of cases and were excluded from calculations. The area under the curve was 0.96 (95% CI: 0.93–0.99). A ROC curve analysis was performed, and the optimal cut-off score was estimated at 60, providing a sensitivity of 93.1%, specificity of 88.7%, and NPV of 97.9%. Conclusions: In our study population, the BV score showed high sensitivity and NPV in bacterial infection diagnosis. Further studies are needed to assess the possibility of replacing the “equivocal” range with a narrower one or a specific cut-off value. Full article
(This article belongs to the Special Issue Infectious Disease Epidemiology in Children: Latest Developments and Treatments)
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10 pages, 806 KiB  
Article
Child Opportunity Index Predicts Outcomes in Pediatric Spine Trauma: A Novel Application of Social Determinants of Health
by Gabriel Urreola, Omar Ortuno, Michael Juma and Jose Castillo
Children 2025, 12(3), 380; https://doi.org/10.3390/children12030380 - 19 Mar 2025
Viewed by 279
Abstract
Objectives: Social factors play a crucial role in health outcomes for pediatric patients, yet in the neurosurgery pediatric literature, these factors are rarely reported. To develop a deeper understanding of pediatric spine trauma outcomes, we investigate demographic and social factors measured by the [...] Read more.
Objectives: Social factors play a crucial role in health outcomes for pediatric patients, yet in the neurosurgery pediatric literature, these factors are rarely reported. To develop a deeper understanding of pediatric spine trauma outcomes, we investigate demographic and social factors measured by the Child Opportunity Index (COI) and Social Deprivation Index (SDI). We hypothesize that social factors predict clinical presentation, injury severity, and clinical outcomes. Methods: We conducted a retrospective cohort study of pediatric patients treated for spinal trauma at a Level 1 trauma center in Sacramento, California. We collected patient clinical data such as mechanisms of injury (MOIs), length of stay (LOS), treatment type, hospital disposition, polytrauma incidence, and follow-up attendance. Each patient’s social environment was characterized using COI and SDI metrics. Statistical comparisons were performed to assess associations between social factors and clinical outcomes. Results: Patients with worse childhood opportunity (lower COI and higher SDI) were more likely to be insured through Medi-Cal, identify as Hispanic, and experience violent MOI. Female patients were more likely to sustain polytrauma and had a higher likelihood of requiring surgical intervention. Additionally, patients from underserved communities demonstrated longer hospital stays and poorer follow-up adherence, with COI and SDI scores correlating with these disparities. Conclusion: Social disparities are associated with worse outcomes in pediatric spine trauma. We found COI and SDI to be valuable clinical metrics, motivating further research to be carried out at the state and national levels. These findings highlight health disparities in pediatric spine trauma. Full article
(This article belongs to the Special Issue Advancements in Pediatric Orthopedics: Integrating Emerging Technologies for Enhanced Care)
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9 pages, 1872 KiB  
Case Report
Early Intervention with a Preformed Eruption Guidance Appliance After the Excision of Cemento-Ossifying Fibroma: A Case Report
by Yeonjin Ju, Soyoung Park, Jonghyun Shin, Taesung Jeong and Eungyung Lee
Children 2025, 12(3), 379; https://doi.org/10.3390/children12030379 - 18 Mar 2025
Viewed by 238
Abstract
Background: Cemento-ossifying fibroma (COF) is a benign, non-aggressive fibro-osseous tumor in which normal bone is replaced by fibrous tissue containing collagen fibers, bone, or cementum-like material. Although COF is rare in children, its occurrence requires careful management due to its potential impact on [...] Read more.
Background: Cemento-ossifying fibroma (COF) is a benign, non-aggressive fibro-osseous tumor in which normal bone is replaced by fibrous tissue containing collagen fibers, bone, or cementum-like material. Although COF is rare in children, its occurrence requires careful management due to its potential impact on tooth development and occlusion. Surgical excision is the widely used treatment; however, post-operative occlusal guidance is crucial, particularly in pediatric patients. Case report: This case report presents the early intervention using a preformed eruption guidance appliance (EGA) following the excision of COF in a 5-year-old boy. The patient exhibited premature loss of the primary canine and displacement of the devel-oping permanent tooth bud. After surgical excision, an EGA was applied to facilitate proper eruption of the successor teeth and optimize oral muscle function. Over a four-year follow-up period, the permanent teeth in the affected area erupted favorably, and intercuspal relationships improved during the transition from primary to mixed dentition. Conclusions: Given the limited research on the long-term effects of COF on developing dentition, long-term follow-up and additional studies are necessary to further evaluate its impact and the effectiveness of eruption guidance appliances in pediatric patients. Full article
(This article belongs to the Special Issue Oral Disease Prevention and Treatment for Children and Adolescents)
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13 pages, 354 KiB  
Article
Conventional Cardiopulmonary Resuscitation Versus Extracorporeal Membrane Oxygenation-Assisted CPR in Children: A Retrospective Analysis of Outcomes and Factors Associated with Conversion from the Former to the Latter
by Adrian C. Mattke, Eugene Slaughter, Kerry Johnson, Michelle Low, Kim Betts, Kristen S. Gibbons, Renate Le Marsney and Supreet Marathe
Children 2025, 12(3), 378; https://doi.org/10.3390/children12030378 - 18 Mar 2025
Viewed by 264
Abstract
Background/Objectives: Conventional cardiopulmonary resuscitation (CCPR) has been the foundational resuscitation approach for decades. Where CCPR is unsuccessful, extracorporeal membrane oxygenation-assisted CPR (ECPR) may improve outcomes. Predicting failure of CCPR and immediate need for ECPR is difficult, and data are lacking. In this retrospective [...] Read more.
Background/Objectives: Conventional cardiopulmonary resuscitation (CCPR) has been the foundational resuscitation approach for decades. Where CCPR is unsuccessful, extracorporeal membrane oxygenation-assisted CPR (ECPR) may improve outcomes. Predicting failure of CCPR and immediate need for ECPR is difficult, and data are lacking. In this retrospective analysis, we analysed both factors that are associated with conversion from CCPR to ECPR and survival outcomes for each event. Methods: Patients having a CPR event that occurred in the PICU between 2016 and 2022 were included. Pre-CPR-event clinical and laboratory data were collected. We recorded whether CPR was converted to ECPR and documented patient outcomes. Results: 201 CPR events occurred in 164 children, with 45 events converted from CCPR to ECPR. Time to ROSC or time to ECMO flow was (median [IQR]) 2 (1.5) min for CCPR events and 37 (21.60) min for ECPR events. The maximum pre-CPR-event lactate values were 1.8 mmol/L for CCPR and 4.5 mmol/L for ECPR events. Respiratory arrest preceded 35.3% of CCPR and 4.4% of ECPR events. PICU mortality was 27.8% for CCPR and 50% for ECPR events. Most deaths occurred because of withdrawal of life-sustaining treatments. In a multivariable analysis, cardiac surgical diagnosis, pre-CPR-event lactate, as well as duration of CPR were associated with conversion from CCPR to ECPR. Conclusions: Our study demonstrates that pre-CPR-event lactate concentrations and duration of arrest should alert clinicians to a high likelihood of needing ECPR, while a preceding respiratory arrest may indicate a low likelihood. Mortality post CCPR is significant, mainly due to overall illness severity rather than the consequences of the CPR event. Full article
(This article belongs to the Section Pediatric Emergency Medicine & Intensive Care Medicine)
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17 pages, 598 KiB  
Systematic Review
Obesity and Overweight Conditions in Children and Adolescents (6–18 Years) and Their Impact on Craniofacial Morphology: A Systematic Review
by Alessio Verdecchia, Carlota Suárez-Fernández, Ivan Menéndez Diaz, Veronica García Sanz, Enrico Spinas and Teresa Cobo
Children 2025, 12(3), 377; https://doi.org/10.3390/children12030377 - 18 Mar 2025
Viewed by 386
Abstract
Background: Childhood obesity and overweight conditions impact systemic health and craniofacial development. Objectives: This review assessed the influence of elevated body mass index (BMI) on craniofacial morphology, considering age, sex, and ethnicity. Methods: A comprehensive search of Scopus, Web of [...] Read more.
Background: Childhood obesity and overweight conditions impact systemic health and craniofacial development. Objectives: This review assessed the influence of elevated body mass index (BMI) on craniofacial morphology, considering age, sex, and ethnicity. Methods: A comprehensive search of Scopus, Web of Science, Embase, Cochrane, PubMed, and OpenGrey was conducted following PRISMA guidelines. Ten cross-sectional studies involving 1383 individuals aged 6 to 18 years were included. The sample comprised 812 females and 571 males, with most studies focusing on adolescents aged 12–18 years of different ethnicities depending on the study. Craniofacial structures were compared between overweight/obese and normal weight groups through cephalometric analysis. Study quality was assessed using the Newcastle–Ottawa Scale (NOS). Results: Overweight and obese individuals showed significant craniofacial changes, including increased anterior cranial base length, maxillary and mandibular dimensions, bimaxillary prognathism, and greater soft tissue thickness. These alterations may be influenced by differences in tissue composition, hormonal fluctuations, fat-to-bone ratio, and metabolic disorders. Variations in skeletal divergence, dental alignment, and airway space were also observed. The methodological quality ranged from moderate to high. Conclusions: Excess weight during growth is linked to distinct craniofacial alterations. Orthodontic diagnostics should integrate metabolic and hormonal considerations to optimize treatment outcomes. These changes should be carefully considered by orthodontists and pediatric dentists. Longitudinal studies are needed to understand the long-term effects of obesity on craniofacial development. Full article
(This article belongs to the Special Issue Prevention and Orthodontic Treatment of Malocclusion in Children)
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14 pages, 1480 KiB  
Article
The Impact of COVID-19 on the Language Skills of Preschool Children: Data from a School Screening Project for Language Disorders in Greece
by Eleni Kyvrakidou, Giannis Kyvrakidis, Anastasia S. Stefanaki, Asterios Asimenios, Athanasios Gazanis and Asterios Kampouras
Children 2025, 12(3), 376; https://doi.org/10.3390/children12030376 - 18 Mar 2025
Viewed by 433
Abstract
Background/Objectives: The COVID-19 pandemic has significantly affected children’s lives, particularly preschool-aged children who undergo rapid biological and psychosocial development. This study aimed to investigate the effects of the COVID-19 pandemic on the language skills of preschool children in Greece. Methods: To that end, [...] Read more.
Background/Objectives: The COVID-19 pandemic has significantly affected children’s lives, particularly preschool-aged children who undergo rapid biological and psychosocial development. This study aimed to investigate the effects of the COVID-19 pandemic on the language skills of preschool children in Greece. Methods: To that end, a widely used screening tool was applied in a screening project involving 213 preschoolers. Language skills were assessed in three groups of children aged 2–4 years old before, during and after the pandemic. Results: A significant increase in the number of children with atypical language skills profile was identified in relation to the preschoolers after the pandemic versus those before or during the pandemic period. A higher prevalence of atypical profiles was observed in girls than in boys. Interestingly, an increase in the number of successfully produced or repeated words and pseudowords, along with enhanced expressive abilities, was observed during the pandemic compared to the periods before and after. Conclusions:Our findings suggest that post-pandemic preschool children exhibit higher rates of atypical language skill profiles compared to those assessed before and during the pan-demic. Given the importance of language development as a critical aspect of children’s overall personality and well-being, further research is needed to explore the impact of specific pandemic-related factors on language competency. These factors include mask-wearing, increased screen time, reduced social interaction and exposure to language-rich environments, as well as impaired mental health and parental distress. Additionally, personalized interventions should be developed to support healthier developmental outcomes. Full article
(This article belongs to the Section Pediatric Mental Health)
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50 pages, 2397 KiB  
Systematic Review
Periodontal Status and Herpesiviridae, Bacteria, and Fungi in Gingivitis and Periodontitis of Systemically Compromised Pediatric Subjects: A Systematic Review
by Federica Di Spirito, Massimo Pisano, Maria Pia Di Palo, Giuseppina De Benedetto, Iman Rizki, Gianluigi Franci and Massimo Amato
Children 2025, 12(3), 375; https://doi.org/10.3390/children12030375 - 17 Mar 2025
Viewed by 376
Abstract
Background: Gingivitis and periodontitis are microbially associated diseases, with some features characteristic of pediatric age and others linked to systemic diseases. While the role of periodontal pathogenic bacteria is well recognized, the contribution of fungi and viruses, particularly Herpesviridae, remains controversial. Studies [...] Read more.
Background: Gingivitis and periodontitis are microbially associated diseases, with some features characteristic of pediatric age and others linked to systemic diseases. While the role of periodontal pathogenic bacteria is well recognized, the contribution of fungi and viruses, particularly Herpesviridae, remains controversial. Studies in adults have highlighted the presence of Herpesviridae, but evidence in pediatric subjects, especially systemically compromised, is limited. This systematic review aimed to assess periodontal status (e.g., health, gingivitis, periodontitis, necrotizing gingivitis, and/or periodontitis) and the subgingival and/or salivary microbial (bacterial, viral, and fungal) profile in systemically compromised pediatric (≤18 years) subjects with gingivitis and/or periodontitis compared to clinical periodontal health. Methods: The review protocol was registered on PROSPERO (CRD42024597695) and followed the PRISMA statement. Data from eight studies were descriptively analyzed and qualitatively assessed through ROBINS-I and JBI tools. Results: CMV was frequently detected, particularly in necrotizing gingivitis (19.40%). EBV was found in necrotizing gingivitis (20.69%) and periodontitis (10.34%); HSV was mainly associated with gingivitis and necrotizing gingivitis. Bacteria species in periodontitis included Porphyromonas gingivalis, Tannerella forsythia, Fusobacterium, and Campylobacter species. Candida albicans was detected in periodontitis, suggesting a fungal involvement in the disease’s pathogenesis. Although the bacterial and fungal profile was not investigated, limited viral presence was noted in subjects with healthy periodontium, indicating a stable microbiome. Conclusions: These findings underscore the dynamics of microbial interactions in the progression of periodontal disease in systemically compromised pediatric subjects. Full article
(This article belongs to the Collection Advance in Pediatric Dentistry)
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16 pages, 458 KiB  
Systematic Review
A Focus on the Role of Dietary Treatment in the Prevention of Retinal Dysfunction in Patients with Long-Chain 3-Hydroxyacyl-CoA Dehydrogenase Deficiency: A Systematic Review
by Evelina Maines, Giorgia Gugelmo, Nicola Vitturi, Alice Dianin, Laura Rubert, Giovanni Piccoli, Massimo Soffiati, Vittoria Cauvin and Roberto Franceschi
Children 2025, 12(3), 374; https://doi.org/10.3390/children12030374 - 17 Mar 2025
Viewed by 248
Abstract
Background: Long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD) is an inborn error affecting fatty acid β-oxidation (FAO). Differently than other FAO deficiencies, LCHADD patients may develop progressive retinopathy and peripheral neuropathy. The pathogenesis of retinopathy is not completely understood, and the role of dietary [...] Read more.
Background: Long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD) is an inborn error affecting fatty acid β-oxidation (FAO). Differently than other FAO deficiencies, LCHADD patients may develop progressive retinopathy and peripheral neuropathy. The pathogenesis of retinopathy is not completely understood, and the role of dietary interventions in preventing the development of retinopathy remains uncertain. We examined the literature to assess the impact of the dietary management of LCHADD patients on retinopathy prevention. Methods: Our systematic search included studies published in the last 20 years according to PRISMA guidelines. The aims of the review were to analyze the correlation between retinopathy and the following: (1) age at first metabolic decompensation and/or at the start of the dietary treatment, (2) chronic dietary treatment, (3) emergency regimens, (4) other nutritional supplements. The protocol was registered in PROSPERO, and evidence was assessed using the GRADE system. Results: Seven full papers were identified according to search criteria, with only four including meaningful data. Early presentation of the disease, acute neonatal symptoms, and a suboptimal chronic treatment control were associated with more aggressive retinopathy and a poorer sight outcome. The number of metabolic decompensations and/or hospitalizations were also positively correlated with vision loss. Chronic fat modulation in the diet had less impact than emergency treatments. The role of other nutritional supplements was not well defined. Conclusions: Newborn screening may improve retinal outcomes. Nevertheless, early treatment adopting the current LCHADD therapeutic regimen can often only delay the onset of retinopathy. Clearly, our current treatment strategies are not adequate and retina-specific treatments are needed. The optimal composition of the diet, the role of fasting limitation, and the benefits of some nutritional supplements deserve further investigations. Full article
(This article belongs to the Special Issue Supporting Children with Chronic Illness and Their Families)
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16 pages, 824 KiB  
Article
Methodological Components for Evaluating Intervention Effectiveness of SOS Feeding Approach: A Feasibility Study
by Sarah A. Schoen, Rachel Balderrama, Emma Dopheide, Ariel Harris, Laura Hoffman and Samantha Sasse
Children 2025, 12(3), 373; https://doi.org/10.3390/children12030373 - 17 Mar 2025
Viewed by 385
Abstract
Background/Objectives: There is a paucity of research that explores the effectiveness of the Sequential Oral Sensory (SOS) Approach to Feeding. The purpose of this feasibility study was to evaluate the necessary components for the implementation of a treatment effectiveness study on the [...] Read more.
Background/Objectives: There is a paucity of research that explores the effectiveness of the Sequential Oral Sensory (SOS) Approach to Feeding. The purpose of this feasibility study was to evaluate the necessary components for the implementation of a treatment effectiveness study on the Sequential Oral Sensory (SOS) Approach to Feeding. The primary aims were to develop a fidelity measure, determine the feasibility of video coding, create an observational coding scheme, and determine if the outcome measures were sensitive to change. Methods: Over a 4-year period, data were collected from twelve participants aged 4 to 8 years with developmental disorders, with the assistance of four occupational therapy doctoral students. A fidelity measure was created, and inter-rater reliability was established among the four coders. Videotapes were collected at home and in the clinic. A behavioral coding system, consistent with the SOS Steps to Eating hierarchy, was developed for scoring feeding behaviors. Results: The preliminary inter-rater reliability was reported, and the coding results were represented graphically. Two additional outcome measures were piloted—a visual analog scale (VAS) and the Parenting Stress Index (PSI). The VAS was sensitive to changes in each parent’s ability to support their child, as well as in each client’s progress. The PSI also showed sensitivity to changes in the decline of parent-reported stress and child stress indices. Conclusions: Findings demonstrate fidelity to the SOS Approach, as well as sensitive outcomes, using behavioral coding and parent-reported measures. These evidence-based tools and procedures offer researchers and clinicians objective and meaningful feeding outcomes. Full article
(This article belongs to the Section Global Pediatric Health)
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12 pages, 727 KiB  
Article
Verifying the Japanese Version of Pediatric Delirium and Withdrawal Syndrome Assessment Scale: SOS-PD Validation Study for Iatrogenic Withdrawal Syndrome
by Yujiro Matsuishi, Haruhiko Hoshino, Yuki Enomoto, Takahiro Kido, Nobutake Shimojo, Bryan J. Mathis, Erwin Ista and Yoshiaki Inoue
Children 2025, 12(3), 372; https://doi.org/10.3390/children12030372 - 17 Mar 2025
Viewed by 301
Abstract
Background: Iatrogenic withdrawal syndrome (IWS) poses a significant clinical challenge in pediatric intensive care units (PICUs) within Japan. Despite the existing availability of tools to assess pain and delirium, a validated instrument specifically designed for IWS has been notably absent in Japanese clinical [...] Read more.
Background: Iatrogenic withdrawal syndrome (IWS) poses a significant clinical challenge in pediatric intensive care units (PICUs) within Japan. Despite the existing availability of tools to assess pain and delirium, a validated instrument specifically designed for IWS has been notably absent in Japanese clinical practice. The Sophia Observation withdrawal Symptoms-Paediatric Delirium (SOS-PD) scale is globally recognized as an effective tool for IWS evaluation. To bridge this gap, this study aimed to validate the Japanese version of the SOS-PD scale. Methods: A prospective, cohort, observational study was undertaken in a single-center PICU in Japan. Participants ranged from neonates to children aged 20 years, excluding those with pre-existing neurological conditions or coma. Criterion validity was evaluated by comparing Japanese SOS-PD scale scores between a Weaning Group (WEAN) undergoing sedative/opioid tapering and a Maintenance Group (MAIN) receiving stable medication. Correlation analysis was also conducted against pediatric intensivists’ observational NRS (NRSobs). Inter-rater reliability of the Japanese SOS-PD scale was assessed utilizing kappa statistics and intraclass correlation coefficient (ICC). Results: In support of criterion validity, the WEAN group demonstrated significantly higher scores in both NRSobs and the IWS component of the Japanese SOS-PD scale compared to the MAIN group (p < 0.001). A strong correlation was observed between the Japanese SOS-PD IWS component and NRSobs (r = 0.91, p < 0.001). Inter-rater reliability was also robust, with a kappa coefficient of 0.95 and an ICC of 0.98. Conclusions: The Japanese version of the SOS-PD scale exhibits strong validity and inter-rater reliability for IWS assessment within Japanese PICUs. This validated instrument can support the early detection and appropriate management of pediatric IWS in Japan, with the potential to enhance the quality of patient care. Full article
(This article belongs to the Special Issue Nursing Management in Pediatric Intensive Care)
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25 pages, 2179 KiB  
Article
Study of Ovarian Damage in Piglets in an Experimental Model of Neonatal Asphyxia
by Efstathia-Danai Bikouli, Rozeta Sokou, Monica Piras, Abraham Pouliakis, Eleftheria Karampela, Styliani Paliatsiou, Paraskevi Volaki, Gavino Faa, Theodoros Xanthos, Christos Salakos and Nicoletta M. Iacovidou
Children 2025, 12(3), 371; https://doi.org/10.3390/children12030371 - 17 Mar 2025
Viewed by 391
Abstract
Background/Objectives: Perinatal asphyxia constitutes a major complication of the perinatal period with well-described effects on multiple organs and systems of the neonate; its impact, though, on the ovaries is hardly known. The objective of the present study was to investigate potential histological [...] Read more.
Background/Objectives: Perinatal asphyxia constitutes a major complication of the perinatal period with well-described effects on multiple organs and systems of the neonate; its impact, though, on the ovaries is hardly known. The objective of the present study was to investigate potential histological alterations of the ovaries in an animal model of perinatal asphyxia with or without resuscitation. Methods: This was a prospective, randomized animal study; 26 female Large White/Landrace piglets, aged 1–4 days, were the study subjects and were randomly allocated in 3 groups. In Group A (control), the animals had their ovaries surgically removed without any manipulation other than the basic preparation and mechanical ventilation. The other 2 groups, B (asphyxia) and C (asphyxia/resuscitation), underwent asphyxia until bradycardia and/or severe hypotension occurred. At the hemodynamic compromise, animals in group B had their ovaries surgically removed, while animals in group C were resuscitated. Following return of spontaneous circulation (ROSC), the latter were left for 30 min to stabilize and subsequently had their ovaries surgically removed. The ovarian tissues were assessed by the pathologists for the presence of apoptosis, balloon cells, vacuolated oocytes, and hyperplasia of the stroma. The histological parameters were graded from 0 (absence) to 3 (abundant presence). Results: The presence of balloon cells and apoptosis was found to be more prominent in the ovaries of animals in groups B and C, compared to that of the control group at a statistically significant degree (p = 0.0487 and p = 0.036, respectively). A significant differentiation in balloon cell presence was observed in cases with higher grading (2–3) in the asphyxia group (with or without resuscitation) (p value: 0.0214, OR: 9, 95% CI: 1.39–58.4). Although no statistically significant difference was noted regarding the other 2 histological parameters that were studied, there was a marked negative correlation between the duration of asphyxia and grade of vacuoles in oocytes when the potential effect of the duration of asphyxia or resuscitation on the histological findings was investigated (r = −0.54, p = 0.039). Conclusions: We aimed at investigating the potential effect on the neonatal ovaries in our animal model of perinatal asphyxia. Given that the presence of apoptosis and balloon cells was more prominent in cases of asphyxia, it can be speculated that perinatal asphyxia might have an impact on the neonatal ovaries in addition to the other, better-studied systemic effects. More research is needed in order to clarify the potential effect of perinatal asphyxia on the ovaries. Full article
(This article belongs to the Special Issue Infant Feeding: Advances and Future Challenges: 2nd Edition)
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9 pages, 12300 KiB  
Case Report
Autotransplantation of Impacted Third Molars to DCIA Free Flap in Adolescent Patient: A Case Report
by Benjamin Walch, Alexander Gaggl, Katharina Zeman-Kuhnert and Christian Brandtner
Children 2025, 12(3), 370; https://doi.org/10.3390/children12030370 - 16 Mar 2025
Viewed by 389
Abstract
Introduction: Tooth autotransplantation is a well-established dental surgical procedure. However, third molar autotransplantation to bony free flaps is rarely performed. We present a case of two impacted wisdom teeth that were transplanted to a DCIA free flap using 3D printing technologies. Case report: [...] Read more.
Introduction: Tooth autotransplantation is a well-established dental surgical procedure. However, third molar autotransplantation to bony free flaps is rarely performed. We present a case of two impacted wisdom teeth that were transplanted to a DCIA free flap using 3D printing technologies. Case report: A 10-year-old girl was diagnosed with ossifying fibroma. She underwent a segmental mandibular resection with nerve preservation and reconstruction using a DCIA free flap. Six years later, due to edentulism, wisdom tooth autotransplantation was performed with digital planning, thermoplastic vacuum-formed guides, and 3D-printed replicas. Postoperatively, splint fixation was required for 12 weeks due to mobility, and a minor wound complication resolved spontaneously. At the one-year follow-up, the transplanted teeth integrated successfully without resorption or ankylosis. Orthodontic treatment was initiated to optimize alignment. Conclusions: This case of an impacted third molar autotransplantation to a DCIA free flap in an adolescent patient after a non-malignant mandibular tumor resection and reconstruction demonstrates promising results. The application of 3D printing technology significantly enhances the feasibility of dental transplantation in challenging cases, particularly for suboptimal donor teeth such as impacted wisdom teeth, by enabling precise surgical planning and optimized recipient site preparation while also reducing damage to the grafted teeth during transplantation. Further research is needed to assess the role of tooth autotransplantation in bony free flaps. Full article
(This article belongs to the Section Pediatric Dentistry & Oral Medicine)
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11 pages, 692 KiB  
Article
Impact of Kinesio Taping on Oral Feeding and Swallowing Functions: Acoustic Analysis of Swallowing Sounds in Late Preterm Infants—A Randomized Clinical Trial
by Nilay Comuk Balci, Deniz Anuk Ince, Ayşe Ecevit, Balkar Erdoğan, Ilknur Ezgi Doğan, Ozden Turan and Aylin Tarcan
Children 2025, 12(3), 369; https://doi.org/10.3390/children12030369 - 15 Mar 2025
Viewed by 514
Abstract
Background/Objectives: Feeding difficulties in late preterm infants are a major factor contributing to prolonged hospitalization and re-admission. Early support for the sucking and swallowing muscles may accelerate their maturation, facilitating safe and early discharge. This study aims to evaluate the effects of [...] Read more.
Background/Objectives: Feeding difficulties in late preterm infants are a major factor contributing to prolonged hospitalization and re-admission. Early support for the sucking and swallowing muscles may accelerate their maturation, facilitating safe and early discharge. This study aims to evaluate the effects of the Kinesio-taping technique on feeding muscles and assess feeding and swallowing function in late preterm infants through the acoustic analysis of swallowing sounds. Methods: Seventy-four late preterm infants (mean gestational age 35.30 ± 0.81 weeks) were randomly assigned to either a Kinesio-taping group or a control group. A single physiotherapist applied Kinesio taping to support the masseter and hyoid muscles, using a facilitatory technique to enhance muscle function. The Kinesio taping was removed two days after its application. The amount of milk intake, the time for milk intake, oxygen saturation during milk intake, the number of days required for transition to full oral feeding, the length of hospital stay, the duration of oxygen requirement, the maximum number of rhythmic swallows, and the heart rate during milk intake were recorded using a digital stethoscope before and two days after Kinesio-taping application. The collected data were assessed through acoustic analysis. Results: No statistically significant differences were observed between the Kinesio-taping and control groups regarding milk intake amount, feeding duration, oxygen saturation during feeding, the transition time to full oral feeding, the length of hospital stay, or the duration of oxygen support (p > 0.05). However, a significant difference was found between the groups in the maximum number of rhythmic swallows during feeding and the heart rate during milk intake (p < 0.05). Conclusions: The application of the Kinesio-taping technique showed no adverse effects on preterm infants in the NICU during the feeding skills intervention. The assessment of acoustic analysis revealed a significant difference in the maximum number of rhythmic swallows and heart stabilization during feeding in the Kinesio-taping group. Further studies are warranted, incorporating different application types and techniques with larger sample sizes, especially among preterm infants with an early gestational age in the NICU, to stabilize the suck and swallow muscles. Full article
(This article belongs to the Section Pediatric Neonatology)
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30 pages, 3002 KiB  
Review
Autism Spectrum Disorder, Oral Implications, and Oral Microbiota
by Emiliana D’Angelo, Fausto Fiori, Giuseppe A. Ferraro, Assunta Tessitore, Luca Nazzaro, Rosario Serpico and Maria Contaldo
Children 2025, 12(3), 368; https://doi.org/10.3390/children12030368 - 15 Mar 2025
Viewed by 1163
Abstract
Background/Objectives: Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by difficulties in social interaction, communication, and repetitive behaviors. Recent evidence indicates a significant relationship between ASD and imbalances in microbiota, particularly in the oral and gastrointestinal areas. This review examines [...] Read more.
Background/Objectives: Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by difficulties in social interaction, communication, and repetitive behaviors. Recent evidence indicates a significant relationship between ASD and imbalances in microbiota, particularly in the oral and gastrointestinal areas. This review examines the impact of oral microbiota, self-injurious behaviors (SIB), sensory sensitivity, and dietary choices on the comorbidities associated with ASD. Methods: An extensive literature review was conducted using PubMed and Scopus. The focus was on human studies with full-text availability, utilizing search terms related to ASD, oral health, oral microbiota, and neurodevelopmental disorders. The research was evaluated for methodological quality and its relevance to the connections between microbiota, oral health, and ASD. Results: Individuals with ASD face unique oral health challenges, including injuries from self-injurious behaviors and increased sensory sensitivity, which complicate oral hygiene and care. Selective eating can lead to nutritional deficiencies and worsen oral health issues. Dysbiosis in oral and gut microbiota, marked by altered levels of acetate, propionate, and butyrate, interferes with gut-brain and oral-brain connections, contributing to behavioral and neurological symptoms. Treatment options such as probiotics, fecal microbiota transfer, and sensory integration therapies can potentially alleviate symptoms and improve quality of life. Conclusions: The relationship between ASD, oral health, and microbiota suggests a bidirectional influence through neuroinflammatory mechanisms and metabolic disturbances. Proactive strategies focusing on microbiota and dental health may help reduce comorbidities and enhance the overall management of ASD, underscoring the need for further research into microbiota–host interactions and their therapeutic potential. Full article
(This article belongs to the Special Issue Oral, Dental and Periodontal Manifestations of Infectious Diseases in Children)
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11 pages, 1050 KiB  
Article
A Novel Method to Study Hip Growth and Development in Children with Cerebral Palsy
by Luiz Carlos Almeida da Silva, Yusuke Hori, Burak Kaymaz, Jason J. Howard, Arianna Trionfo, Michael Wade Shrader and Freeman Miller
Children 2025, 12(3), 367; https://doi.org/10.3390/children12030367 - 15 Mar 2025
Viewed by 445
Abstract
Background: Knowledge of the relative contributions to different growth areas in the proximal femur and acetabulum is limited due to the complex anatomy and lack of growth markers in children. There is increasing interest in using guided growth to improve hip joint stability [...] Read more.
Background: Knowledge of the relative contributions to different growth areas in the proximal femur and acetabulum is limited due to the complex anatomy and lack of growth markers in children. There is increasing interest in using guided growth to improve hip joint stability and decrease dysplasia in children with neurological disability. Some children with cerebral palsy (CP) are treated with bisphosphonates for bone insufficiency, which leaves a dense growth arrest band in the bone at the time of treatment. The aim of this study was to develop a novel approach to understand the growth and maturation impact on hip development in children with CP using this growth arrest band. Methods: Pelvic radiographs of children with CP Gross Motor Function Classification System (GMFCS) level IV/V treated with bisphosphonate were analyzed. We measured neck–shaft angle (NSA), head–shaft angle (HSA), and migration percentage (MP) based on pamidronate bands (PamMP), NSA based on pamidronate bands (PamNSA), and HSA based on pamidronate bands (PamHSA). These measurements were compared using t-test. Results: Seven children (two GMFCS IV and five GMFCS V) were included. The mean age of the radiographic assessment was 11.4 ± 1.3 (range, 8.6–12.5) years, mean MP 22 ± 7% (range, 13–39%), PamMP 33 ± 7% (range, 18–46%), NSA 151 ± 7° (range, 140–161°), PamNSA 153 ± 4° (range, 142–163°), HSA 164 ± 12° (range, 142–175°), and PamHSA 169 ± 8° (range, 154–175°). MP decreased by 10.5% compared with PamMP (p < 0.001). NSA compared with PamNSA (p = 0.117) and HSA compared with PamHSA (p = 0.325) were not statistically different. Conclusions: This novel assessment method demonstrates that ossification of the lateral acetabulum and femoral head in children with CP GMFCS IV/V from age 8 to 12 years undergoes a mean decrease of 10% MP. A decrease of 10% MP after proximal femoral-guided growth has been reported as a positive outcome. However, based on the current measurements, this may be due to normal development. HSA and NSA remained unchanged. Full article
(This article belongs to the Special Issue Pediatric Bone Disorders: Focus on Children's Bone Health)
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17 pages, 301 KiB  
Review
Missed or Delayed Diagnosis of Heart Disease by the General Pediatrician
by Ageliki A. Karatza, Sotirios Fouzas, Despoina Gkentzi, Eirini Kostopoulou, Christina Loukopoulou, Gabriel Dimitriou and Xenophon Sinopidis
Children 2025, 12(3), 366; https://doi.org/10.3390/children12030366 - 15 Mar 2025
Viewed by 661
Abstract
Missed or delayed heart disease diagnoses pose a major challenge in pediatric primary care. Many cardiac conditions present with subtle or nonspecific symptoms that resemble benign childhood illnesses, making their prompt recognition difficult. This review describes congenital and acquired heart diseases prone to [...] Read more.
Missed or delayed heart disease diagnoses pose a major challenge in pediatric primary care. Many cardiac conditions present with subtle or nonspecific symptoms that resemble benign childhood illnesses, making their prompt recognition difficult. This review describes congenital and acquired heart diseases prone to diagnostic delays, including critical congenital heart disease, coarctation of the aorta, atrial and ventricular septal defects, myocarditis, Kawasaki disease, heart failure, and pulmonary arterial hypertension. The atypical presentations of these disorders and the associated diagnostic pitfalls are emphasized. Furthermore, the importance of alarming symptoms and signs, such as chest pain, palpitations, syncope, and abnormal heart murmurs, is underscored. A structured approach to these red flags is presented to assist primary care pediatricians in identifying children at risk, initiating appropriate management, and referring them for specialized evaluation. The importance of preparticipation screening for athletes is also discussed, highlighting how it can be applied to all children during routine health visits to identify those with heart disease. Appropriate training is essential to increase pediatricians’ ability to recognize and manage cardiac patients. Full article
(This article belongs to the Section Pediatric Cardiology)
12 pages, 236 KiB  
Article
Health-Related Quality of Life of Individuals with Physical Disabilities in Childhood
by Chris Church, Sana Patil, Stephanie Butler, Freeman Miller, Jose J. Salazar-Torres, Nancy Lennon, M. Wade Shrader, Maureen Donohoe, Faithe Kalisperis, W. G. Stuart Mackenzie and Louise Reid Nichols
Children 2025, 12(3), 365; https://doi.org/10.3390/children12030365 - 15 Mar 2025
Viewed by 516
Abstract
Background: The use of patient-reported outcomes is essential to understand and manage health-related quality of life (HRQOL) in youth with lifelong disabilities. This study evaluated HRQOL in youth with physical disorders and examined its relationship with mobility. Methods: We conducted an IRB-approved [...] Read more.
Background: The use of patient-reported outcomes is essential to understand and manage health-related quality of life (HRQOL) in youth with lifelong disabilities. This study evaluated HRQOL in youth with physical disorders and examined its relationship with mobility. Methods: We conducted an IRB-approved retrospective study in which we administered the parent-reported Pediatric Outcomes Data Collection Instrument (PODCI) and Gross Motor Function Measure section D (GMFM-D) to ambulatory youth aged 2–18 years with cerebral palsy (CP; Gross Motor Function Classification System II; n = 258), arthrogryposis (n = 138), achondroplasia (n = 102), and Morquio syndrome (n = 52) during clinical visits to a gait lab. The PODCI has two validated versions, child and adolescent, that assess perceptions about mobility, happiness, and pain. Differences in HRQOL between diagnostic groups, between age groups, and compared with non-disabled youth were examined using non-parametric tests. The relationship between GMFM-D and PODCI scores was analyzed with Pearson’s correlations. Results: Both age cohorts within all diagnosis groups demonstrated higher pain and lower mobility compared with non-disabled youth (p < 0.015). Happiness was lower for both age groups with CP and arthrogryposis, and for the child group with Morquio syndrome compared with non-disabled youth (p < 0.002). In diagnostic groups in both age spans, Global Function was higher (p < 0.0001) for those with achondroplasia compared with other groups. Despite functional differences, there were no significant differences between diagnostic groups in pain scores (p > 0.10). Happiness was lower in the group with CP compared with that with achondroplasia (p = 0.01). GMFM-D was related to PODCI mobility scores for all diagnoses (r = 0.31 to 0.79, p < 0.03) but was not correlated with happiness (r = −0.16 to 0.092; p > 0.14); GMFM-D and PODCI pain scores were associated only for the child group with achondroplasia (r = 0.355; p < 0.001). Conclusions: Significant limitations in HRQOL are present in youth with physical disabilities. Pain levels were higher than those of non-disabled youth, but pain was not related to lower motor function. Happiness was not related to gross motor function, suggesting the need to examine other factors when mental health concerns are present in youth with disabilities. Full article
(This article belongs to the Special Issue Cerebral Palsy in Children: Improving Quality of Life and Preventing Painful Musculoskeletal Disorders)
17 pages, 5264 KiB  
Case Report
A Novel Missense Variant in LHX4 in Three Children with Multiple Pituitary Hormone Deficiency Belonging to Two Unrelated Families and Contribution of Additional GLI2 and IGFR1 Variant
by Claudia Santoro, Francesca Aiello, Antonella Farina, Emanuele Miraglia del Giudice, Filomena Pascarella, Maria Rosaria Licenziati, Nicola Improda, Giulio Piluso, Annalaura Torella, Francesca Del Vecchio Blanco, Mario Cirillo, Vincenzo Nigro and Anna Grandone
Children 2025, 12(3), 364; https://doi.org/10.3390/children12030364 - 14 Mar 2025
Viewed by 431
Abstract
Background: Multiple genes can disrupt hypothalamic–pituitary axis development, causing multiple pituitary hormone deficiencies (MPHD). Despite advances in next-generation sequencing (NGS) identifying over 30 key genes, 85% of cases remain unsolved, indicating complex genotype–phenotype correlations and variable inheritance patterns. Objective: This study aimed to [...] Read more.
Background: Multiple genes can disrupt hypothalamic–pituitary axis development, causing multiple pituitary hormone deficiencies (MPHD). Despite advances in next-generation sequencing (NGS) identifying over 30 key genes, 85% of cases remain unsolved, indicating complex genotype–phenotype correlations and variable inheritance patterns. Objective: This study aimed to identify the MPHD genetics in three probands from two unrelated families. Methods: Family A had one affected child, while Family B had two affected siblings. All probands exhibited poor growth since birth, and family B’s probands were born small for gestational age. Growth hormone deficiency was confirmed in all subjects. Family B’s probands responded poorly to growth hormone treatment compared to the first patient. Furthermore, Family A’s proband and Family B’s younger sibling developed central hypothyroidism, while Family B’s older sibling presented hypogonadotropic hypogonadism. Brain magnetic resonance imaging (MRI) revealed pituitary hypoplasia, ectopic posterior pituitary gland, and small sella turcica in all probands. Patients and their available relatives underwent NGS. Results: NGS identified the same novel and likely pathogenic LHX4 variant (c.481C>G) in all probands despite the families being unrelated. Additionally, Family A’s proband carried a GLI2 variant (c.2105C>A), and Family B’s probands carried an IGF1R variant (c.166G>A), both interpreted as being of uncertain significance. Conclusions: This study confirms that heterozygous pathogenic variants of LHX4 can cause MPHD associated with a specific neuroradiological triad of abnormalities despite incomplete penetrance and variable phenotype. Moreover, the co-occurrence of the other two gene variants was debated. The IGF1R variant could explain the unusually poor response to growth hormone therapy in Family B, suggesting an oligogenic mechanism underlying the phenotype. Full article
(This article belongs to the Special Issue Pediatric Growth and Skeletal Disorders)
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