Children

10 pages, 580 KiB

Open AccessArticle

Sagittal Spinal Alignment in Children and Adolescents: Associations with Age, Weight Status, and Sports Participation

by Giada Annarumma, Fiore Mazza, Alessandro Ambrosi, Erica Keeling, Fredrick Fernando, Felice Sirico, Rossana Gnasso, Andrea Demeco, Marco Vecchiato, Maria Letizia Motti, Alessandro Biffi and Stefano Palermi

Children 2025, 12(5), 659; https://doi.org/10.3390/children12050659 - 21 May 2025

Viewed by 22

Abstract

Background. Poor posture is a common musculoskeletal concern in children and adolescents and may lead to spinal discomfort and long-term structural issues. While excess weight has been linked to altered sagittal alignment, the impact of sports participation on spinal posture remains unclear. [...] Read more.

Background. Poor posture is a common musculoskeletal concern in children and adolescents and may lead to spinal discomfort and long-term structural issues. While excess weight has been linked to altered sagittal alignment, the impact of sports participation on spinal posture remains unclear. This study aimed to investigate the associations between weight status, sports participation, and sagittal spinal alignment in a pediatric population. Methods. This cross-sectional study was conducted within the “Ferrari Formula Benessere” corporate wellness program and included 698 children aged 5 to 16 years. Sagittal Index (SI) was measured using a standardized plumb line technique. Body mass index (BMI) was calculated and classified according to the WHO growth standards. Sports participation was self-reported and grouped into five categories: sedentary, skill-based, power-based, mixed, and endurance sports. Results. Age was the only significant independent predictor of the SI (β = 2.45, p < 0.001), with older children exhibiting higher SI values. Although a weak correlation was observed between BMI and SI (Spearman’s r = 0.24, p < 0.001), BMI was not a significant predictor when controlling for age. No significant differences in the SI were found between active and non-active children. Among sport disciplines, the SI was lowest in power-based sports (56.7 ± 22.3 mm) and higher in endurance (62.7 ± 24.4 mm), mixed (64.5 ± 23.2 mm), skill-based (61.1 ± 22.0 mm), and non-sport (64.2 ± 24.0 mm) groups, although these differences did not reach statistical significance (ANOVA p = 0.224). Conclusions. Age appears to be the primary factor associated with sagittal spinal alignment in children, while BMI and general sports participation showed no independent effect. Although some differences emerged between sport types, these findings were not statistically significant and should be interpreted with caution. These findings underscore the need for sport-specific, longitudinal research using objective posture assessment methods. Full article

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

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15 pages, 363 KiB

Open AccessArticle

Promoting Mental Health in Adolescents Through Physical Education: Measuring Life Satisfaction for Comprehensive Development

by Santiago Gómez-Paniagua, Antonio Castillo-Paredes, Pedro R. Olivares and Jorge Rojo-Ramos

Children 2025, 12(5), 658; https://doi.org/10.3390/children12050658 - 21 May 2025

Viewed by 12

Abstract

Background: Life satisfaction serves as a preventive agent against various emotional, cognitive, and behavioral challenges, making it a crucial cognitive indicator of subjective well-being, particularly during adolescence. Accurately assessing life satisfaction is essential for understanding and promoting adolescent mental health, especially in applied [...] Read more.

Background: Life satisfaction serves as a preventive agent against various emotional, cognitive, and behavioral challenges, making it a crucial cognitive indicator of subjective well-being, particularly during adolescence. Accurately assessing life satisfaction is essential for understanding and promoting adolescent mental health, especially in applied settings such as physical education, which plays a key role in fostering psychological well-being and positive youth development. However, additional investigation is needed to confirm the tools used for this purpose. This study aimed to analyze the psychometric properties, metric invariance, and temporal stability of the Satisfaction with Life Scale (SWLS) in adolescents from a region in southeastern Spain. Thus, the present study sought to answer the following research questions: (1) Does the SWLS demonstrate adequate psychometric properties in an adolescent population? (2) Is the SWLS invariant across gender and residential environments? (3) Does the SWLS show adequate stability over time? Methods: A sample of 400 students was assessed using exploratory and confirmatory factor analyses, multigroup comparisons, and test–retest techniques. Results: The results showed significant differences in scale scores in the sex and demographic location variables. Also, a robust unifactorial model with five items demonstrated good performance in terms of goodness of fit and internal consistency. Furthermore, full metric invariance was observed across genders, while configural invariance was supported for residential environment. Concurrent validity analyses revealed significant associations with another unidimensional well-being measure, and temporal stability was confirmed through the intraclass correlation coefficient. Conclusions: The findings support the SWLS as a potentially valid, reliable, and time-effective tool for assessing adolescent life satisfaction. Its strong psychometric properties make it highly suitable for use in mental health research, longitudinal monitoring, and large-scale studies. Moreover, its ease of administration allows its integration into educational, clinical, community-based, and physical education contexts, offering insightful information for the creation of long-lasting mental health regulations and preventive measures meant to improve the well-being of adolescents. Notwithstanding these encouraging results, some restrictions must be noted. The sample was restricted to a single geographic area, and contextual or cultural factors may have an impact on how satisfied people are with their lives. Furthermore, response biases could have been introduced by using self-report measures. Full article

(This article belongs to the Special Issue Addressing Challenges in Child Mental Health: Research and Strategies for Comprehensive Development)

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17 pages, 594 KiB

Open AccessArticle

Psychological Well-Being and Life Satisfaction in Children and Adolescents with Chronic Illness: The Role of Depression, Nonproductive Thoughts, and Problematic Internet Use

by Karolina Eszter Kovács, Péter Boris and Beáta Erika Nagy

Children 2025, 12(5), 657; https://doi.org/10.3390/children12050657 - 21 May 2025

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Abstract

Theoretical background: The study of psychological well-being in children and adolescents living with chronic illness is of particular relevance, as the physical and psychosocial aspects of the illness can have a significant impact on their quality of life. Previous research has highlighted that [...] Read more.

Theoretical background: The study of psychological well-being in children and adolescents living with chronic illness is of particular relevance, as the physical and psychosocial aspects of the illness can have a significant impact on their quality of life. Previous research has highlighted that depression, nonproductive thoughts and various aspects of problematic internet use may be related to life satisfaction and ways of coping with illness. This study aims to examine how depression, nonproductive thoughts, and problematic internet use interact with illness perception and burden to affect psychological well-being and life satisfaction. Methods: A cross-sectional study was conducted with 207 chronically ill children aged 10–18 years. The children, aged between 10 and 18 years old, attended regular check-ups in different specialities (gastroenterology, pulmonology, onco-haematology, and paediatric rehabilitation). A cross-sectional study was carried out using psychological instruments to measure life satisfaction (SWLS), nonproductive thoughts (NPG-K), problematic internet use (PIU-Q), illness perception (PRISM) and illness burden (PRISM-D, IIRS), and depression (BDI-R). Spearman rank correlation analysis was used to explore the associations between variables. Results: Life satisfaction was negatively related to nonproductive thoughts (r = −0.28, p < 0.001), internet obsession (r = −0.20, p < 0.01), and internet neglect (r = −0.20, p = 0.004). Conversely, a positive correlation was found with the PRISM (r = 0.14, p = 0.042), suggesting that less dominance of illness detection is associated with higher life satisfaction. Depression and nonproductive thoughts showed a strong positive relationship (r = 0.49, p < 0.001), and depression and problematic internet use also showed significant correlations for the obsession, neglect and control subscales (r = 0.23–0.29, all p < 0.001). Cluster analysis identified three psychological profiles: ‘positive fighters’, ‘avoidant sufferers’, and ‘negative observers’, distinguished by differences in depression, nonproductive thoughts, illness burden, and well-being. Conclusions: The results suggest that the quality of life of children and adolescents with chronic illness is significantly affected by mental health factors, particularly depression, nonproductive thoughts and problematic internet use. Illness perception and illness-related distress also play a key role in shaping life satisfaction and overall psychosocial well-being. These findings underscore the need for targeted psychological interventions in pediatric chronic care to enhance well-being and promote adaptive coping and suggest that psychological interventions and targeted psychosocial support can significantly improve these children’s quality of life. Further research is needed to explore intervention options and to develop optimal support strategies. Full article

(This article belongs to the Special Issue Mental Health of Children with Special Needs)

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10 pages, 1201 KiB

Open AccessArticle

Infliximab Biosimilar Utilization in a Large Pediatric Learning Health System

by Ross M. Maltz, Shehzad A. Saeed and Jeremy Adler

Children 2025, 12(5), 656; https://doi.org/10.3390/children12050656 - 20 May 2025

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Abstract

Background/Objectives: Infliximab biosimilars entered the United States (US) market in November 2016. Uptake of infliximab biosimilars has been slow in adult studies. We aimed to assess variation in the initiation of infliximab biosimilars in a large pediatric cohort. Methods: We performed [...] Read more.

Background/Objectives: Infliximab biosimilars entered the United States (US) market in November 2016. Uptake of infliximab biosimilars has been slow in adult studies. We aimed to assess variation in the initiation of infliximab biosimilars in a large pediatric cohort. Methods: We performed a retrospective cohort study using data from 2016 to 2023 prospectively collected by the ImproveCareNow (ICN) Network, a multicenter pediatric inflammatory bowel disease (IBD) quality improvement collaborative. Pediatric patients with IBD who started any infliximab therapy were included. Descriptive statistics were used to summarize patient characteristics and changes in the use of infliximab agents. Chi-square or Fisher’s exact tests were used to evaluate differences in infliximab biosimilar initiation over time by race, age, ethnicity, and region. Results: In total, 4602 patients from 73 ICN centers started an infliximab agent. Infliximab biosimilar initiation rose steadily from 1% in 2018 to nearly 42% in 2023, with 88% of centers using biosimilars in 2023. Overall, from 2016 to 2023, the total percentage of patients who were started on an infliximab biosimilar was 17.3%. There were no differences in infliximab biosimilar initiation by age, race, or ethnicity, except in 2020 for age and race. The Midwest, West, and Southwest regions had higher initiation rates of infliximab biosimilars than the rest of the US. Conclusions: The percentage of patients with IBD initiating an infliximab biosimilar rose slowly to nearly 42% by 2023, and eight (12%) centers never recorded prescribing an infliximab biosimilar in the ICN Network. There were no differences in biosimilar initiation based on race or ethnicity. Full article

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

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15 pages, 456 KiB

Open AccessReview

Parental Perspectives on Oral Health and Access to Care in Children with Down Syndrome: A Narrative Review

by Petra Saitos, Raluca Iurcov, Abel Emanuel Moca, Teofana Bota, Rebeca Daniela Marton and Mihai Juncar

Children 2025, 12(5), 655; https://doi.org/10.3390/children12050655 - 20 May 2025

Viewed by 133

Abstract

Background/Objectives: Children with Down syndrome are predisposed to various oro-dental conditions, which can impact their oral-health-related quality of life (OHRQoL) and overall well-being. Given their critical role, parents’ and caregivers’ perceptions are essential for understanding the challenges in oral care access and [...] Read more.

Background/Objectives: Children with Down syndrome are predisposed to various oro-dental conditions, which can impact their oral-health-related quality of life (OHRQoL) and overall well-being. Given their critical role, parents’ and caregivers’ perceptions are essential for understanding the challenges in oral care access and quality. This narrative review aimed to synthesise the available evidence on parental and caregiver perceptions regarding oral health, OHRQoL, and dental care access for children with Down syndrome. Methods: A literature search was conducted in PubMed, Web of Science, and Scopus, covering studies published between January 2015 and January 2025. The search included the keywords “Down syndrome”, “oral health”, “oral health-related quality of life”, “caregivers”, “parents”, “dental care access”, and “special needs children”. Thirteen studies were included after applying eligibility criteria, which selected original research focusing on the target population and themes. Results: The findings highlighted that oral health significantly affects the quality of life of children with Down syndrome, influencing their functional, emotional, and social well-being. Caregivers often reported a gap between perceived and clinically observed oral health. Barriers to dental care access included insufficient training of dental professionals, financial constraints, systemic limitations, and perceived biases. Variations across different countries also revealed the influence of cultural and healthcare system factors. Conclusions: Oral health plays a critical role in the lives of children with Down syndrome and their families. Strengthening caregiver education, improving communication, validating adapted OHRQoL instruments, and enhancing dental professionals’ training in special needs care are crucial steps to ensure equitable and family-centred oral healthcare. Full article

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

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16 pages, 629 KiB

Open AccessArticle

Family Support, Communication with Parents, and Adolescent Health Risk Behaviour: A Case of HBSC Study from Bulgaria and Lithuania

by Elitsa Dimitrova and Apolinaras Zaborskis

Children 2025, 12(5), 654; https://doi.org/10.3390/children12050654 - 19 May 2025

Viewed by 309

Abstract

Objective: This study aimed to explore the association between adolescents’ health risk behaviours (excessive use of alcohol, (e)cigarette smoking, cannabis use) and familial factors. A special objective of this study was to compare findings between Bulgarian and Lithuanian adolescents aged 15 years. Material [...] Read more.

Objective: This study aimed to explore the association between adolescents’ health risk behaviours (excessive use of alcohol, (e)cigarette smoking, cannabis use) and familial factors. A special objective of this study was to compare findings between Bulgarian and Lithuanian adolescents aged 15 years. Material and Methods: National samples from the WHO Health Behaviour in School-aged Children (HBSC) survey in 2021/2022 were analysed. The focus was on adolescents aged 15 (n = 64,349), including those from Bulgaria (n = 793) and Lithuania (n = 1137). The set of outcome variables included drunkenness, smoked cigarettes, e-cigarettes, and used cannabis (all variables were measured during the last 30 days); their indicators were child’s talking separately to their father and separately to their mother, as well as the four-item family support scale. All variables were dichotomised and their associations were analysed using Structural Equation Modelling with a WLSMV estimator. Results: In the total sample, the prevalence of drunkenness was 14.9%, cigarette smoking at 12.6%, e-cigarette smoking at 18.4%, and cannabis use at 5.9%; while in Bulgaria, in contrast to Lithuania, these behaviours were much more prevalent, at 27.0%, 29.9%, 29.8%, and 11.1%, respectively. The use of substances was significantly associated with selected familial factors, which were more pronounced among girls than boys in most subsamples. Low family support showed the strongest association with increased substance use (in the total sample, regression weight B varied from 0.231 to 0.382). Adolescents’ difficulty in talking to mother was more pronounced (B = 0.123 to 0.204) than difficulty in talking to their father (B = 0.058 to 0.140). Comparison of data samples from Bulgaria and Lithuania showed stronger relationships in Bulgarian adolescents compared to other countries, which are more pronounced among boys. In addition, among Bulgarian adolescents, easy communication with their father had an inverse association (increasing prevalence) with cannabis use. Conclusions: Adolescent health risk behaviours, such as use of substances, are associated with familial factors, including parent–teen communication and family support. Generally, these associations are more pronounced among girls than boys, and more evident among Bulgarian adolescents than their Lithuanian counterparts. Identifying environmental factors in families helps to plan interventions to prevent development of multiple health risk behaviours in adolescents. Full article

(This article belongs to the Special Issue Parenting and Child/Adolescent Development: Current Updates and Global Perspectives (2nd Edition))

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13 pages, 580 KiB

Open AccessArticle

Short-Term Impact of Slow Maxillary Expansion on Labial Ectopic Canine Eruption Pathway in Children: A Retrospective Study

by Qian Tong, Xue Yang, Yue Fei and Jun Wang

Children 2025, 12(5), 653; https://doi.org/10.3390/children12050653 - 19 May 2025

Viewed by 149

Abstract

Objectives: This retrospective study evaluated the short-term effects of removable slow maxillary expansion (SME) on eruption patterns of labially ectopic canines in a Chinese pediatric population, comparing treated patients with untreated controls. Methods: Seventy-six patients (mean age 8.38 ± 0.88 years) underwent SME [...] Read more.

Objectives: This retrospective study evaluated the short-term effects of removable slow maxillary expansion (SME) on eruption patterns of labially ectopic canines in a Chinese pediatric population, comparing treated patients with untreated controls. Methods: Seventy-six patients (mean age 8.38 ± 0.88 years) underwent SME treatment for 11.04 ± 4.44 months. Canine positions were categorized as labial ectopic (TE: n = 40) or normally positioned (TN: n = 112). The TE group was stratified vertically: superior (TES; n = 15, canines above lateral incisors’ roots or adjacent to unerupted incisors) and inferior (TEI; n = 25, canines adjacent to erupted lateral incisors’ roots). Untreated controls (n = 58; mean age 8.46 ± 0.78 years) included labial ectopic (CE group; n = 32) and normal canines (CN group; n = 84), with CE further divided vertically into CES (n = 24) and CEI (n = 8). Panoramic radiographs at baseline (T0) and follow-up (T1) evaluated sector distribution, midline proximity (3c-ML: canine cusp to midline distance), vertical position (3c-OP: cusp to occlusal plane distance), and angular (3^ML: canine-midline angle). Results: SME significantly improved midline proximity (3c-ML increased) while reducing vertical height (3c-OP decreased) and angulation (3^ML reduced) in the TE group. Notably, TE patients revealed a significantly greater increase in 3c-ML compared to CE. Subgroup analysis showed that TEI canines exhibited significant improvements in all three parameters (3c-OP, 3c-ML, and 3^ML), whereas TES canines displayed minimal changes. The shifts in sector distribution were similar between the treatment and control groups. Conclusions: SME demonstrated short-term efficacy in guiding labially ectopic canines toward more favorable eruption trajectories, particularly when erupted beyond the roots of the lateral incisor. The observed positional improvements underscore SME’s potential to optimize eruption outcomes during early orthodontic intervention. Full article

(This article belongs to the Special Issue Behavior Intervention and Early Orthodontic Treatment in Pediatric Dentistry)

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10 pages, 216 KiB

Open AccessArticle

Gender Differences in a Cohort of Children with Eating Disorders: A Retrospective Study

by Isabella Tarissi de Jacobis, Elena Inzaghi, Elena Bozzola, Valeria Zanna, Cristina Mascolo, Sara Caterina Kupiec and Maria Rosaria Marchili

Children 2025, 12(5), 652; https://doi.org/10.3390/children12050652 - 19 May 2025

Viewed by 139

Abstract

Introduction: Eating disorders (EDs) are severe psychiatric disorders that significantly impact the psychological and physiological well-being of affected individuals. Despite increasing prevalence in males over the past few decades, EDs are mainly considered a female disease. This retrospective study aims to evaluate [...] Read more.

Introduction: Eating disorders (EDs) are severe psychiatric disorders that significantly impact the psychological and physiological well-being of affected individuals. Despite increasing prevalence in males over the past few decades, EDs are mainly considered a female disease. This retrospective study aims to evaluate the influence of gender on the clinical, laboratory, and developmental characteristics of EDs in pediatric patients. Material and methods: A retrospective study was conducted on patients referred to the EDs between 2019 and 2024 at Bambino Gesù Children’s Hospital, Rome, Italy. Gender differences were evaluated in the whole cohort and in a sub-cohort of males and females well matched for age. Results: In the whole cohort of 501 patients (age range 8–17 years), 45 were males and 456 were females. In male patients, EDs occurred at a younger age (12.65 vs. 14.65 years, p < 0.05). When considering the matched cohort, male patients showed more severe clinical conditions, as evidenced by a tendency to a lower BMI SDS at the onset, higher inflammatory parameters (ferritin and transaminase levels), and poorer nutritional status (vitamin D levels: 23.15 vs. 26.9 ng/mL, p < 0.05). However, male patients had a shorter hospital stay (14.8 vs. 19.9 days, p < 0.05) and showed a tendency to a greater clinical improvement. Differences in therapy were also observed, with fewer males receiving pharmacological treatment or nasogastric feeding. Conclusions: The results of the current study confirm the higher prevalence of EDs in females, even though they suggest EDs are not exclusively a female disease. Male gender may represent a risk factor for a worse clinical course and a younger onset. Further studies with a longer follow-up are required to understand the significant differences between females and males in this complex disorder. Full article

(This article belongs to the Special Issue Pediatric Anorexia Nervosa and Eating Disorders: Challenges in Identification, Intervention, and Recovery)

11 pages, 823 KiB

Open AccessBrief Report

by Lucía Fernanda Flores-Santy, Barbara Martina Trujillo Gutiérrez, Cristina Mileny Campaña Iza and Juan Pablo Hervás Pérez

Children 2025, 12(5), 651; https://doi.org/10.3390/children12050651 - 19 May 2025

Viewed by 373

Abstract

The General Movements Assessment provides early insight into motor development’s range of motion; however, its relationship with joint kinematics, such as hip abduction range of motion, remains underexplored. This study analyzed hip abduction kinematics during General Movements, evaluating potential sex differences and variations [...] Read more.

The General Movements Assessment provides early insight into motor development’s range of motion; however, its relationship with joint kinematics, such as hip abduction range of motion, remains underexplored. This study analyzed hip abduction kinematics during General Movements, evaluating potential sex differences and variations in movement patterns (Fidgety vs. Writhing), and aimed to provide quantitative data that complement qualitative pediatric assessments. This cross-sectional observational study analyzed video recordings of spontaneous motor activity in 32 infants under three months of corrected age. Hip abduction range of motion was extracted using biomechanical analysis during General Movements. Interrater reliability was evaluated using Fleiss’s Kappa. Correlations were assessed using Pearson’s test, and a two-way ANOVA examined the effects of sex and the type of movements on range of motion. Interrater reliability for movement classification was excellent (Kappa = 0.909, p < 0.001). No significant correlations were found between sex or General Movements type and hip abduction range of motion (p > 0.68). Two-way ANOVA showed no significant effects of sex, movement pattern, or their interaction on range of motion in either hip (right: p = 0.726, left: p = 0.823), with small effect sizes (η² < 0.013). A minor asymmetry favoring the right hip was observed but was not clinically significant. Sex and General Movements type did not significantly influence hip abduction range of motion in infants under three months. Early joint mobility appears consistent across sexes and movement patterns, supporting its reliability as a biomechanical marker of typical development. Full article

(This article belongs to the Special Issue Motor Development in Children and Adolescence)

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23 pages, 10910 KiB

Open AccessArticle

The Impact of Antenatal and Postnatal Factors on the Development of the Pulmonary Microvasculature in Preterm Infants

by Raluca Chirculescu, Ruxandra Viorica Stănculescu, Paul Cristian Bălănescu and Gheorghe Peltecu

Children 2025, 12(5), 650; https://doi.org/10.3390/children12050650 - 18 May 2025

Viewed by 116

Abstract

This research aimed to assess the influence of prenatal and postnatal factors on the remodeling of the pulmonary microvasculature. Methods: The investigation analyzed 67 cases of preterm infants, whose lifespans ranged from 1 day to 149 days. After selecting the cases from [...] Read more.

This research aimed to assess the influence of prenatal and postnatal factors on the remodeling of the pulmonary microvasculature. Methods: The investigation analyzed 67 cases of preterm infants, whose lifespans ranged from 1 day to 149 days. After selecting the cases from the autopsy database, two lung tissue microarrays were created. Histological slides were stained using the hematoxylin and eosin technique to precisely capture the microscopic details. For the assessment of pulmonary microvascularization and the media layer of the vascular walls, an immunohistochemical analysis was performed utilizing CD34 and SMA markers. Results: Following the assessment of the quantity of capillaries positive for CD34, a negative correlation was identified between the average capillary count per alveolus and the duration of oxygen therapy. Preterm infants who developed pulmonary fibrosis exhibited an average reduction of 5.43 capillaries in comparison to other newborns. Preterm neonates born to mothers with preeclampsia exhibited an average reduction of 2.82 capillaries compared to those born to mothers unaffected by this pregnancy complication. A positive correlation was evident between increased thickness of the arteriolar media, lifespan, and the duration of oxygen therapy, as well as in those preterm infants who developed pulmonary fibrosis. Conclusions: Antenatal risk factors did not exert a significant impact on pulmonary vascular remodeling, whereas postnatal influences, particularly oxygen therapy, demonstrated a detrimental effect on the density of capillary structures within the alveolocapillary membrane. Premature neonates with increased thickness of the arteriolar media had a greater susceptibility to pulmonary hypertension. Full article

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

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9 pages, 1339 KiB

Open AccessCase Report

Presumed Bartonella-Associated Spondylodiscitis in a 3-Year-Old Child: A Case Report and Review of the Literature

by Hadi El Assaad, Eckehard Schumann, Christian Klemann, Nadine Dietze-Jergus, Christoph-Eckhard Heyde and Philipp Pieroh

Children 2025, 12(5), 649; https://doi.org/10.3390/children12050649 - 16 May 2025

Viewed by 93

Abstract

With an incidence of 0.3 per 100,000, spondylodiscitis is a rare condition in children. It is typically bacterial in origin and most commonly caused by Staphylococcus aureus. Bone involvement in cat-scratch disease (CSD) due to Bartonella henselae is exceedingly rare, occurring in [...] Read more.

With an incidence of 0.3 per 100,000, spondylodiscitis is a rare condition in children. It is typically bacterial in origin and most commonly caused by Staphylococcus aureus. Bone involvement in cat-scratch disease (CSD) due to Bartonella henselae is exceedingly rare, occurring in only 0.17–0.27% of cases. We present the case of a 3-year-old boy with a two-week history of intermittent back pain and a recent onset fever. Initial laboratory findings were unremarkable, and MRI revealed spondylodiscitis at L3/4 without abscess formation. Empirical antibiotic treatment with ampicillin/sulbactam showed no clinical response. Serologic testing revealed a positive Bartonella henselae IgM (IgG negative), leading to a change in antibiotic treatment to azithromycin and rifampicin for three weeks, resulting in rapid clinical improvement. Follow-up at nine weeks showed marked clinical and radiologic improvement. Although IgM subsequently turned negative without IgG seroconversion—a pattern previously described in Bartonella infections—this does not exclude the diagnosis. Biopsy or tissue PCR was not performed due to the mild clinical course. A review of the literature identified 28 pediatric cases of Bartonella henselae spondylodiscitis, with significant variation in diagnostic and treatment approaches. This case underscores the importance of considering Bartonella in the differential diagnosis of pediatric vertebral osteomyelitis. Full article

(This article belongs to the Section Pediatric Infectious Diseases)

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25 pages, 2516 KiB

Open AccessSystematic Review

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

by Ekkehart Paditz, Bertold Renner, Rainer Koch, Barbara M. Schneider, Angelika A. Schlarb and Osman S. Ipsiroglu

Children 2025, 12(5), 648; https://doi.org/10.3390/children12050648 - 16 May 2025

Viewed by 147

Abstract

Background: To date, it remains unclear which oral doses and preparation forms of melatonin should be recommended for children and adolescents with non-organic sleep disorders and autism spectrum disorder (ASD). We reviewed the current state of knowledge on this topic based on randomised [...] Read more.

Background: To date, it remains unclear which oral doses and preparation forms of melatonin should be recommended for children and adolescents with non-organic sleep disorders and autism spectrum disorder (ASD). We reviewed the current state of knowledge on this topic based on randomised placebo-controlled trials (RCTs) and diagnosis-related blood melatonin concentrations available in this age group. Method: Two investigators independently searched PubMed, PsycINFO, MEDLINE, and Cochrane CENTRAL on 1 March 2025 for the keywords “melatonin”, “autism”, and “randomised” in titles and abstracts in all languages, including an evaluation of the references of the reviews, systematic reviews, and meta-analyses published up to that date, some of which were based on searches in numerous databases. Based on this, additional in-depth searches were carried out in PubMed for pharmacokinetic, physiological, and pathophysiological data on melatonin in children and adolescents, with a special focus on ASD. Results: To date, five RCTs on non-organic sleep disorders in children and adolescents with the sole diagnosis of ASD or with subgroup analyses in the presence of several initial diagnoses such as ADHD, epilepsy, Smith–Magenis, or Fragile X syndrome are available. In these studies, rapid-release, non-delayed preparations were administered orally. In one of these studies, the clinical efficacy of a combination preparation with a sustained-release and a non-released active substance component was tested. Pharmacokinetic data with multiple determinations of melatonin concentrations in the blood are only available for children with ASD in the form of a case series (N = 9). Discussion: RCTs comparing the efficacy of delayed melatonin preparations with non-delayed rapid-release oral preparations are not yet available. Physiological data and clinical effects documented in five RCTs indicate that non-delayed melatonin preparations with an initial rapid onset of action are effective for non-organic sleep disorders in children and adolescents with ASD. Conclusions: From a clinical, pharmacokinetic, and physiological point of view, the RCTs available to date and the data on melatonin concentrations in the blood of children with ASD, measured several times over 24 h, suggest that a low oral melatonin dose and a non-delayed preparation with rapid onset should be started in children and adolescents with non-organic sleep disorders in ASD, if sleep hygiene advice and psychotherapeutic interventions have not demonstrated sufficient effects. Full article

(This article belongs to the Section Pediatric Pulmonary and Sleep Medicine)

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14 pages, 244 KiB

Open AccessReview

Fertility Preservation in Female Children and Adolescent Cancer Patients

by Min Wang and Chao Yang

Children 2025, 12(5), 647; https://doi.org/10.3390/children12050647 - 16 May 2025

Viewed by 56

Abstract

The five-year survival rate for childhood cancer now exceeds 80%, leading to an increasing number of young women who may confront infertility in the future due to the gonadotoxic effects of surgery, chemotherapy, and radiation. Despite current guidelines advocating for fertility preservation counseling [...] Read more.

The five-year survival rate for childhood cancer now exceeds 80%, leading to an increasing number of young women who may confront infertility in the future due to the gonadotoxic effects of surgery, chemotherapy, and radiation. Despite current guidelines advocating for fertility preservation counseling and necessary reproductive protection measures for all patients, significant barriers and ethical considerations persist, particularly within the pediatric and adolescent female population. In this review, we provide an overview of the impact and mechanisms of anti-tumor therapies on ovarian function, fertility preservation strategies for pediatric and adolescent patients, and the associated costs and ethical considerations that need to be addressed. Full article

(This article belongs to the Section Pediatric Hematology & Oncology)

11 pages, 2912 KiB

Open AccessCase Report

Pediatric Medial Discoid Meniscus: Case Series and Postoperative Outcomes

by Franck Accadbled, Oliwer Sygacz, Joe Rassi and Alexandru Herdea

Children 2025, 12(5), 646; https://doi.org/10.3390/children12050646 - 16 May 2025

Viewed by 52

Abstract

Discoid medial meniscus (DMM) is a rare congenital anomaly, with bilateral cases being even more uncommon. Due to its rarity, comprehensive data on its prevalence, clinical presentation, and optimal management strategies are limited. This study aimed to evaluate the prevalence, clinical characteristics, and [...] Read more.

Discoid medial meniscus (DMM) is a rare congenital anomaly, with bilateral cases being even more uncommon. Due to its rarity, comprehensive data on its prevalence, clinical presentation, and optimal management strategies are limited. This study aimed to evaluate the prevalence, clinical characteristics, and treatment outcomes of symptomatic DMM in a pediatric population. A retrospective review was conducted on patients under 18 years of age diagnosed with symptomatic DMM. Data were extracted using ICD-10 codes Q68.6 and M23.16 and were supplemented by free-text searches. The inclusion criteria encompassed a confirmed DMM diagnosis, availability of MRI and radiographic imaging, complete clinical documentation, and a minimum of six months of postoperative follow-up. Demographic data, clinical presentations, imaging findings, surgical interventions, and outcomes were analyzed. Three patients (five knees) met the inclusion criteria. All presented with symptomatic DMM requiring surgical intervention. Arthroscopic saucerization combined with meniscal repair was performed in all cases. Postoperative follow-up revealed that two of the patients achieved excellent outcomes, while one required three reoperations due to retearing but remained symptom-free at one year post-revision. Radiographic assessments did not reveal characteristic changes typically associated with DMM. Symptomatic DMM, though rare, may be encountered more frequently than previously reported, especially when focusing on symptomatic cases. Arthroscopic saucerization with concurrent meniscal repair appears to be an effective treatment modality, yielding favorable mid-term outcomes. Given the limited number of cases and the variability in their presentations, further research with larger cohorts is essential to establish standardized management protocols and to better understand the long-term prognosis of patients with this rare condition. Full article

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

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12 pages, 631 KiB

Open AccessReview

Current and Emerging Applications of Artificial Intelligence in Medical Imaging for Paediatric Hip Disorders—A Scoping Review

by Hilde W. van Kouswijk, Hizbillah Yazid, Jan W. Schoones, M. Adhiambo Witlox, Rob G. H. H. Nelissen and Pieter Bas de Witte

Children 2025, 12(5), 645; https://doi.org/10.3390/children12050645 - 16 May 2025

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Abstract

Introduction: Paediatric hip disorders present unique challenges for artificial intelligence (AI)-aided assessments of medical imaging due to disease-related and age-dependent changes in hip morphology. This scoping review aimed to describe current and emerging applications of AI in medical imaging for paediatric hip disorders. [...] Read more.

Introduction: Paediatric hip disorders present unique challenges for artificial intelligence (AI)-aided assessments of medical imaging due to disease-related and age-dependent changes in hip morphology. This scoping review aimed to describe current and emerging applications of AI in medical imaging for paediatric hip disorders. Methods: A descriptive synthesis of articles identified through PubMed, Embase, Cochrane Library, Web of Science, Emcare, and Academic Search Premier databases was performed including articles published up until June 2024. Original research articles’ titles and abstracts were screened, followed by full-text screening. Two reviewers independently conducted article screening and data extraction (i.e., data on the article and the model and its performance). Results: Out of 871 unique articles, 40 were included. The first article was dated from 2017, with annual publication rates increasing thereafter. Research contributions were primarily from China (17 [43%]) and Canada (10 [25%]). Articles mainly focused on developing novel AI models (19 [47.5%]), applied to ultrasound images or radiographs of developmental dysplasia of the hip (DDH; 37 [93%]). The three remaining articles addressed Legg–Calvé–Perthes disease, neuromuscular hip dysplasia in cerebral palsy, or hip arthritis/osteomyelitis. External validation was performed in eight articles (20%). Models were mainly applied to the diagnosis/grading of the disorder (22 [55%]), or on screening/detection (17 [42.5%]). AI models were 17 to 124 times faster (median 30) in performing a specific task than experienced human assessors, with an accuracy of 86–100%. Conclusions: Research interest in AI applied to medical imaging of paediatric hip disorders has expanded significantly since 2017, though the scope remains restricted to developing novel models for DDH imaging. Future studies should focus on (1) the external validation of existing models, (2) implementation into clinical practice, addressing the current lack of implementation efforts, and (3) paediatric hip disorders other than DDH. Full article

(This article belongs to the Special Issue The Role of Artificial Intelligence in Pediatric Orthopedics: Useful Tool or Hype)

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12 pages, 2727 KiB

Open AccessArticle

Evaluation of Anthropometric Measurements of 17,693 Newborns: Have Percentile Cut-Off Values Changed?

by Nursu Kara, Didem Arman, Adem Gül, Kudret Ebru Erol and Serdar Cömert

Children 2025, 12(5), 644; https://doi.org/10.3390/children12050644 - 16 May 2025

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Abstract

Objective: The aim of our study was to develop current local anthropometric measurement percentiles for newborns and to compare these values with national and international growth chart percentiles. Methods: This retrospective cross-sectional study evaluated the birth records of 17,693 infants born between 24 [...] Read more.

Objective: The aim of our study was to develop current local anthropometric measurement percentiles for newborns and to compare these values with national and international growth chart percentiles. Methods: This retrospective cross-sectional study evaluated the birth records of 17,693 infants born between 24 and 42 weeks of gestation at the Health Sciences University Istanbul Training and Research Hospital between January 2018 and December 2023. The following data were collected from the birth records: type of delivery, gender, gestational week, birth weight, birth length, head circumference, and the nationality of the infants. Percentile charts for weight, length, and head circumference were generated according to gender and gestational week. The 10th, 50th, and 90th percentiles of the local anthropometric measurement percentiles were compared with the national and the international growth charts. Results: The anthropometric measurements of 17,693 newborns were evaluated in this study. Of the included infants, 9589 (54.2%) were born by normal spontaneous delivery and 8104 (45.8%) by cesarean section. A total of 4955 (28%) of the infants were preterm and 12,738 (72%) were term; 8700 (49.2%) were female and 8993 (50.8%) male. When compared by gender, it was observed that the birth weights of boys were higher than girls at all gestational weeks, but the lengths and head circumferences of both genders were similar. When our weight, length, and head circumference percentiles by gestational week were compared with the Fenton growth charts, we found that our babies had higher average values in all percentiles. When compared with national growth charts, the weight, length, and head circumference measurements of our girls and boys were higher, especially under 38 weeks, and they had similar anthropometric measurements from 38 weeks onwards. When compared with the Fenton growth chart, the ranges of difference from the current values used in each week of pregnancy for the SGA cut-off values for girls and boys were found to be 30–290 g and 30–230 g, respectively, and those for the LGA cut-off values for girls and boys were 80–300 g and 95–230 g, respectively. Conclusions: Our study reveals the current birth weight, length, and head circumference percentile values in infants, including a large number of infants in our region. Notably, the generated regional growth curves differ from existing international standards, which may have significant implications for the accurate diagnosis and follow-up of SGA and LGA infants. We suppose that our current national data can serve as a valuable reference for future multicenter studies involving larger populations and contribute to the optimal assessment of growth parameters in pediatric health surveillance. Full article

(This article belongs to the Section Pediatric Neonatology)

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16 pages, 3076 KiB

Open AccessArticle

Study of the Variability of Transcutaneous Bilirubin Determinations Between Different Ethnic Groups

by Laia Plaza, Neus Roca Saladrigues, Meritxell Torrabías, Fina Bueno, Marina Damas, Carmina Parès, Jacint Altimiras and Marta Rodríguez González

Children 2025, 12(5), 643; https://doi.org/10.3390/children12050643 - 16 May 2025

Viewed by 53

Abstract

Background: Pathological hyperbilirubinemia often leads to hospital readmission within the first week of life, with increased risk of neurological damage if untreated. Transcutaneous bilirubin (TcB) measurement was integrated into neonatal screening to estimate total serum bilirubin (SB) concentrations. Despite TcB and SB generally [...] Read more.

Background: Pathological hyperbilirubinemia often leads to hospital readmission within the first week of life, with increased risk of neurological damage if untreated. Transcutaneous bilirubin (TcB) measurement was integrated into neonatal screening to estimate total serum bilirubin (SB) concentrations. Despite TcB and SB generally correlating well, discrepancies can occur based on race/ethnicity. Falsely elevated TcB readings may be obtained in darker skin pigmentation. Aims: This study compared TcB and SB across different ethnic groups to assess correlation patterns and identify the best TcB measurement method in neonates. Methods: Term and late preterm neonates delivered at the University Hospital of Vic were included. Each newborn underwent TcB assessment (in the forehead, sternum, and both sites simultaneously) concomitantly with SB measurement. The correlations between both parameters were analyzed. Results: A total of 148 neonates were categorized as White/Caucasian (58), Chinese (3), Indian (17), Black/African (22), Latino (11), Arab (25), or mixed (12). The groups were homogeneous, with statistical differences in delivery and feeding (p = 0.032 and p < 0.001). Differences between TcB and SB were −0.19 for White/Caucasian, 0.90 for Chinese, 1.12 for Indian, 2.47 for Black/African, 0.42 for Latino, and −0.08 for Arab (p < 0.001). A high association between TcB and SB was obtained with all measurement methods: r = 0.836 in forehead, r = 0.869 in midsternum, and r = 0.863 when both locations were combined (p < 0.001). Conclusions: TcB correlated well with SB, but accuracy varied among ethnic groups. An individualized interpretation of TcB based on skin pigmentation is supported. Mid-sternum determination was the best TcB measurement method. Full article

(This article belongs to the Section Pediatric Neonatology)

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13 pages, 689 KiB

Open AccessArticle

Hip Involvement in Pediatric Scurvy: Early Magnetic Imaging Signs

by Lisa Gamalero, Anna Perrone, Chiara Macucci, Alessandra Meneghel, Marta Balzarin, Sandra Trapani, Giuseppe Indolfi, Giorgia Martini and Teresa Giani

Children 2025, 12(5), 642; https://doi.org/10.3390/children12050642 - 16 May 2025

Viewed by 56

Abstract

Background: Scurvy is an uncommon and often underrecognized disease. However, conditions associated with a restrictive and/or selective diet and inadequate absorption still pose a high risk for developing vitamin C deficiency. Musculoskeletal symptoms are among the most characteristic manifestations of scurvy, often requiring [...] Read more.

Background: Scurvy is an uncommon and often underrecognized disease. However, conditions associated with a restrictive and/or selective diet and inadequate absorption still pose a high risk for developing vitamin C deficiency. Musculoskeletal symptoms are among the most characteristic manifestations of scurvy, often requiring radiological investigations. Objective: This study aims to describe the radiological signs of scurvy on pelvic magnetic resonance imaging (MRI) in children presenting with musculoskeletal symptoms and to highlight features that may help differentiate it from other conditions with similar presentations. Methods: We conducted a retrospective study including children admitted for musculoskeletal symptoms requiring a pelvic MRI and who were subsequently diagnosed with scurvy. Demographic, clinical, laboratory, and radiological data were extracted from electronic medical records. Results: We identified ten patients with a median age at disease onset of 45 months (range 17–133 months) admitted between 2016 and 2022. All ten patients included in the study were male. All had at least one of the following symptoms: limping, pain in the lower limbs, or refusal to walk, in addition to gum bleeding (7/10), hypertrophic gums (5/10), purpura (3/10), irritability (3/10), and fever (2/10). In all patients, pelvic MRI showed a bilateral, patchy, abnormal, water-like signal intensity pattern in the sacroiliac area. Sacroiliitis was detected in three children and hip effusion in another child. Seven out of these ten patients had a previous pelvis X-ray that was negative. Conclusions: In scurvy, the pelvis is often prematurely affected, with bone marrow accumulating water and joints showing inflammatory changes, particularly at the hips and sacroiliac joints. Due to its ability to assess soft tissues and its high sensitivity to water content, MRI is the ideal imaging tool to assess these changes. In contrast, plain radiography is less sensitive and specific and may be uninformative in the early stages of the disease. Full article

(This article belongs to the Section Pediatric Neonatology)

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19 pages, 2280 KiB

Open AccessReview

Addressing Stunting in Children Under Five: Insights and Opportunities from Nepal, Bangladesh, and Vietnam—A Review of Literature

by Muhammad Yazid Jalaludin, Moretta Damayanti Fauzi, I Gusti Lanang Sidiartha, Collins John, Shamira Aviella, Edy Novery, Annisa Permatasari and Leilani Muhardi

Children 2025, 12(5), 641; https://doi.org/10.3390/children12050641 - 16 May 2025

Viewed by 95

Abstract

Background: Stunting remains a significant global health issue, particularly in low- and middle-income countries (LMICs). Globally, around 22% of children under five are affected, with high rates persisting in South and Southeast Asia. This review examines government-led programs in high-performing LMICs (Nepal, [...] Read more.

Background: Stunting remains a significant global health issue, particularly in low- and middle-income countries (LMICs). Globally, around 22% of children under five are affected, with high rates persisting in South and Southeast Asia. This review examines government-led programs in high-performing LMICs (Nepal, Bangladesh, and Vietnam) to identify key strategies and opportunities for effective intervention. Methods: A literature search was conducted on PubMed using keywords and Medical Subject Heading terms, including “stunting”, “child undernutrition”, “malnutrition” and the names of the three specified countries. Articles were evaluated for relevance based on their focus on stunting prevalence, risk factors, and interventions in these countries, without restrictions on publication date or language. Results: Stunting prevalence among children under five has significantly declined in Nepal, Bangladesh, and Vietnam over the past two decades, reflecting the impact of sustained nutrition and health interventions. Nepal reduced stunting from 55.8% in 2000 to 26.7% in 2022, Bangladesh from 54.7% to 26.4%, and Vietnam from 41.5% to 19.3%. Successful strategies included multisectoral approaches integrating nutrition-specific and nutrition-sensitive interventions, enhanced policy frameworks, and strong governance. Despite progress, challenges remain, such as high wasting prevalence in Nepal and disparities among marginalized communities in Vietnam, emphasizing the need for targeted, context-specific interventions. Conclusions: Effective stunting reduction requires multisectoral strategies addressing underlying, intermediate, and immediate determinants. Insights from Nepal, Bangladesh, and Vietnam highlight the importance of sustained government commitment, robust policies, and coordinated interventions. Adapting these successful strategies to local contexts can support stunting prevention and management, promoting healthier and more resilient communities. Full article

(This article belongs to the Section Global Pediatric Health)

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27 pages, 330 KiB

Open AccessArticle

A Nutritional and Anthropometric Analysis of the Double Burden of Malnutrition in Children Under Two in Madagascar

by Rosita Rotella, María Morales-Suarez-Varela, Agustín Llopis-Gonzalez and Jose M. Soriano

Children 2025, 12(5), 640; https://doi.org/10.3390/children12050640 - 15 May 2025

Viewed by 137

Abstract

Background: Almost half of all deaths worldwide in children under five are related to malnutrition. Malnutrition encompasses a wide array of nutritional conditions and emerging evidence indicates a growing overlap of these different forms of malnutrition. Nutrimetry, which combines assessments of height-for-age [...] Read more.

Background: Almost half of all deaths worldwide in children under five are related to malnutrition. Malnutrition encompasses a wide array of nutritional conditions and emerging evidence indicates a growing overlap of these different forms of malnutrition. Nutrimetry, which combines assessments of height-for-age (HAZ) with BMI-for-age (BMIZ) to offer a more integrated assessment of nutritional status, can be particularly useful in low-resource settings to correctly reflect the complex interplay of stunting and overweight. Objective: The objective of this study is to explore the impact of malnutrition on children in Madagascar and demonstrate how integrating HAZ assessments with BMIZ can reveal the double burden of malnutrition—encompassing both undernutrition and overnutrition—within the same population. Methods: This cross-sectional observational study employing Nutrimetry was carried out in rural communities in the Itasy region of Madagascar. A systematic random sampling method was used to choose the 500 women to invite to participate from the approximately 5000 who formed the pool of potential participants. A total of 437 were able to be invited and all invited women agreed to participate, resulting in 437 mother–child (0–24 months) pairs being included in the study. Results: Chronic undernutrition or thinness (31.6%), overweight and obesity (21.3%), and stunting (57.6%) were prevalent among the children included in the study. Among children with chronic undernutrition, 55.06% were identified as stunted. Among children with overweight or obese, 61.03% were identified as stunted. This highlights a significant overlap between inadequate weight and stunting. A socioeconomic analysis revealed significant barriers, including limited financial resources and poor dietary diversity, exacerbating malnutrition. Maternal nutritional status and breastfeeding practices also emerged as critical determinants of child nutritional outcomes. Conclusions: The study underscores the importance of prioritizing height assessments as a preliminary step in nutritional evaluations to prevent undetected acute malnutrition. Full article

(This article belongs to the Special Issue Childhood Malnutrition: 2nd Edition)

9 pages, 1795 KiB

Open AccessArticle

Cumulative Ambient Light Exposure Affects Outpatient Transcutaneous Bilirubinometer Readings

by Emily Zhang, Tzong-Jin Wu, Mark L. Hudak, Ke Yan and Ru-Jeng Teng

Children 2025, 12(5), 639; https://doi.org/10.3390/children12050639 - 15 May 2025

Viewed by 131

Abstract

Background: We recently reported that the transcutaneous bilirubinometer (TCB) tends to underestimate the severity of neonatal jaundice (NJ). We hypothesize that the cumulative ambient light exposure contributes to the discrepancy. Objectives: This study aimed to identify factors that affect the TCB underestimation. Methods: [...] Read more.

Background: We recently reported that the transcutaneous bilirubinometer (TCB) tends to underestimate the severity of neonatal jaundice (NJ). We hypothesize that the cumulative ambient light exposure contributes to the discrepancy. Objectives: This study aimed to identify factors that affect the TCB underestimation. Methods: We analyzed prospectively collected data over a twenty-month period at a level III medical facility. Neonates at risk for NJ who couldn’t secure an appointment with the primary practitioner were followed by the nursery team. Neonates who had phototherapy or forehead bruises were excluded. Concurrently collected total serum bilirubin (TSB) was determined by the diazo method. The primary endpoint was the discrepancy between TCB and the corresponding TSB (TCB-TSB). A mixed-effects model was used to assess the correlation between (TCB-TSB) and potential contributors, including visit age (in hours), gestational age (GA), sex, TSB, season, birth weight, and race. Results: There were 795 visits for 559 neonates, including 341 males, 179 white, 235 black, 103 Hispanic, 41 Asian, and one unrecorded race. The TSB ranged between 1.8 and 33.9 mg/dL. The (TCB-TSB) ranged between −20.0 and 6.4 mg/dL. The median GA and birth weight were 38.7 weeks and 3214.5 g. The visits occurred between 48 and 381 h of age. 133, 148, 132, and 146 visits were in Spring, Summer, Autumn, and Winter, respectively. Fifty-four neonates (9.7%) were admitted for management. 500 sternum TCB readings were also collected from 350 neonates together with the corresponding forehead TCBs. We found that the forehead (TCB-TSB) was significantly less in winter than in spring and summer (p = 0.0014 and 0.0003, respectively). There was a negative correlation between forehead (TCB-TSB) and visit age in hours (p = 0.0006). After adjusting for visit age and season, the (TCB-TSB) is significantly correlated with TSB (p < 0.0001). Similar findings were also seen in the sternum (TCB-TSB) except for the season (p = 0.0808). Conclusions: Cumulative ambient light exposure and the severity of NJ may contribute to (TCB-TSB). Full article

(This article belongs to the Section Pediatric Neonatology)

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14 pages, 453 KiB

Open AccessArticle

The Evaluation of Anemia Among Stunted Children Aged 6–24 Months in Bandung District, West Java, Indonesia

by Susi Susanah, David Marcelius, Lulu Eva Rakhmilla, Rini Rossanti, Sindy Amalia Febrianti, Siti Sakinah, Winyarti Winyarti, Safira Satyani Lutfia, Raden Tina Dewi Judistiani, Dida Akhmad Gurnida and Budi Setiabudiawan

Children 2025, 12(5), 638; https://doi.org/10.3390/children12050638 - 15 May 2025

Viewed by 177

Abstract

Background/Objectives: Anemia, particularly iron-deficiency anemia (IDA), and stunting remain notable early childhood public health challenges in Indonesia; however, studies are still scarce. This study aimed to determine the co-occurrence of anemia and stunting (CAS), their prevalence, and the associated factors, as well [...] Read more.

Background/Objectives: Anemia, particularly iron-deficiency anemia (IDA), and stunting remain notable early childhood public health challenges in Indonesia; however, studies are still scarce. This study aimed to determine the co-occurrence of anemia and stunting (CAS), their prevalence, and the associated factors, as well as to describe the erythrocyte parameters. Methods: Approximately 2200 children aged 6–24 months were identified by midwives to have problematic nutritional status at Bandung Regency, West Java, Indonesia. These children were included in the population frame for a cohort study of vitamin D deficiency, vitamin D binding protein, and its impact on neurodevelopmental functions. A cross-sectional study was nested in the cohort study. The subjects were selected by stratified random sampling of 270 villages to meet the required number of samples. Medical doctors reassessed the anthropometric measurements and performed guided interviews to collect associated factors for IDA and CAS. Erythrocyte profiles of the children were examined from venous blood. Results: One hundred and ninety-four subjects were included in the analysis, among which 54.1% were stunted. Anemia was present in 40.7% of the subjects, largely due to IDA (87.3%). A wasting child and the factor of low paternal education (up to elementary school) were associated with IDA (aOR of 7.12 and aOR of 3.32, p < 0.05, respectively). Co-occurrence of anemia and stunting was found in 41/194 (21.1%) subjects, but it did not show significant association. Conclusions: Anemia and stunting were prevalent among children aged 6–24 months, but no associations were found between anemia and stunting in this study. Iron deficiency was the main cause of anemia, and it was associated with wasting and low paternal education. Full article

(This article belongs to the Section Global Pediatric Health)

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15 pages, 6269 KiB

Open AccessReview

Pediatric Tracheotomy: Modern Surgical Techniques, Challenges, and Clinical Considerations

by Stoyan S. Markov, Petya P. Markova and Kalina I. Madzarova-Nikolova

Children 2025, 12(5), 637; https://doi.org/10.3390/children12050637 - 15 May 2025

Viewed by 160

Abstract

Introduction: Tracheotomy as a surgical procedure has existed and evolved since ancient times. In modern medicine, surgical techniques for performing this procedure in adults and children have reached a high level of perfection. However, pediatric tracheotomy remains a challenging surgical intervention, performed [...] Read more.

Introduction: Tracheotomy as a surgical procedure has existed and evolved since ancient times. In modern medicine, surgical techniques for performing this procedure in adults and children have reached a high level of perfection. However, pediatric tracheotomy remains a challenging surgical intervention, performed in only a limited number of centers by a small number of surgeons. This is due to several unresolved issues related to the procedure—such as indications, timing, decannulation protocols, and the care of tracheotomized children—which are still usually left to the individual judgment of the physician. Additionally, there is a significant psychological barrier associated with performing tracheostomy in a child (particularly in those under the age of one). Aim: This article aims to present in detail the modern surgical approach to performing tracheotomy in pediatric patients, examine the different types of tracheotomy, and highlight its specific features related to the anatomical differences between children and adults. Discussion: After the decision to perform a tracheotomy is made, the exact surgical technique and type of tracheostomy to be created are selected alongside the patient’s preoperative preparation. Factors such as the child’s age, the surgeon’s experience, and the underlying disease for tracheotomy play crucial roles in determining the appropriate approach. Conclusions: Pediatric tracheotomy has undergone significant development over the years. Nowadays, the exact type of surgical intervention depends on the individual needs of young patients. Full article

(This article belongs to the Section Pediatric Surgery)

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Graphical abstract

10 pages, 215 KiB

Open AccessArticle

Features of Clinical Manifestations and Heart Rate Variability in Children with Malignant Vasovagal Syncope

by Wenrui Xu, Chunyu Zhang, Junbao Du, Hongfang Jin and Ying Liao

Children 2025, 12(5), 636; https://doi.org/10.3390/children12050636 - 15 May 2025

Viewed by 122

Abstract

Background: This study aimed to identify the risk factors associated with malignant vasovagal syncope (VVS), a rare yet clinically significant subtype of VVS. Methods: This single-center case–control study enrolled children diagnosed with malignant VVS, and the malignant VVS patients were matched in a [...] Read more.

Background: This study aimed to identify the risk factors associated with malignant vasovagal syncope (VVS), a rare yet clinically significant subtype of VVS. Methods: This single-center case–control study enrolled children diagnosed with malignant VVS, and the malignant VVS patients were matched in a 1:4 ratio with non-asystolic VVS children as a control group through age and sex stratification. Clinical characteristics and heart rate variability (HRV) parameters were analyzed. Binary logistic regression analyses were used to identify the risk factors significantly associated with malignant VVS. Results: A total of 10 patients in the malignant group and 40 children in the control group were included. The malignant group exhibited earlier symptom onset (7.0 ± 2.7 vs. 9.7 ± 2.7 years, p < 0.05) than the control group, and children in the malignant group had a higher prevalence of central triggers (60.0% vs. 17.5%, p < 0.05) and convulsive/incontinence episodes (80.0% vs. 17.5%, p < 0.05) than the control group. Additionally, the malignant group demonstrated significantly elevated HRV parameters, including very low frequency (VLF), low frequency (LF), and high frequency (HF), indicating substantial autonomic dysregulation characterized by parasympathetic predominance. Central triggers (OR = 7.16, 95%CI 1.10–46.73) and convulsive/incontinence manifestations (OR = 19.02, 95%CI 2.81–128.64) were independent risk factors of malignant VVS. Conclusions: The age at syncope onset was significantly earlier in children with malignant VVS, and children with malignant VVS exhibited profound autonomic dysregulation characterized by significant parasympathetic predominance. Finally, children with episodes induced by central triggers and accompanied by incontinence or convulsions were at a higher risk of asystole. Full article

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

13 pages, 260 KiB

Open AccessArticle

Protective Factors Against Social Exclusion in Adolescents: Physical Condition and Physical Activity

by Josune Rodríguez-Negro, Javier Murillo-Moraño, Ángel Garrido, Antonio J. Rodríguez-Hidalgo and Juan de Dios Benítez-Sillero

Children 2025, 12(5), 635; https://doi.org/10.3390/children12050635 - 15 May 2025

Viewed by 189

Abstract

Background: Social exclusion in children and adolescents can lead to negative effects such as anxiety, low self-esteem, and academic difficulties. Physical activity and good physical condition could act as protective factors by promoting social integration and emotional well-being. Methods: The aim of this [...] Read more.

Background: Social exclusion in children and adolescents can lead to negative effects such as anxiety, low self-esteem, and academic difficulties. Physical activity and good physical condition could act as protective factors by promoting social integration and emotional well-being. Methods: The aim of this study was to analyse whether participation in physical activity and good physical fitness test protect against social exclusion in adolescents aged 12 to 19. A cross-sectional descriptive study was conducted with 876 adolescents, assessing physical activity, physical fitness test (EUROFIT), BMI, and social exclusion (both subtle and manifest) through questionnaires and physical tests. Spearman correlations, ANOVA, and stepwise regression analysis were applied. Results: Adolescents who participated in organised physical activities, such as team sports, opposition, or contact sports, showed lower levels of both manifest and subtle exclusion. Aerobic endurance, age, abdominal strength, and gender were predictors of manifest exclusion, while aerobic endurance, age, and participation in organised physical activities predicted subtle exclusion. Conclusions: Physical condition and participation in physical activity protect against social exclusion. Taking part in competitive team activities involving contact and opposition is associated with lower levels of exclusion. It is essential to promote strategies that enhance inclusion and well-being among young people. Full article

(This article belongs to the Special Issue Physical Activity and Sedentary Behaviors in Children and Adolescents)

9 pages, 202 KiB

Open AccessReview

The Role of Genetic Testing in Palliative Care Decisions for Critically Ill Newborns

by Ashley Mowery and Luca Brunelli

Children 2025, 12(5), 634; https://doi.org/10.3390/children12050634 - 15 May 2025

Viewed by 94

Abstract

Genetic testing is rapidly becoming standard practice in the care of critically ill newborns within NICUs. Numerous studies have demonstrated the utility of genetic testing, including changes in clinical care, improved diagnostic certainty, and cost savings, related to a reduced length of hospital [...] Read more.

Genetic testing is rapidly becoming standard practice in the care of critically ill newborns within NICUs. Numerous studies have demonstrated the utility of genetic testing, including changes in clinical care, improved diagnostic certainty, and cost savings, related to a reduced length of hospital stay. Changes in clinical management reported in previous studies also included redirection to comfort or end-of-life care. However, it has been difficult to study the influence of genetic testing in the redirection of care decisions within the NICU because of the complexity of the medical decision-making process. Redirection of care decisions are deeply personal for each individual family and often must be made in the setting of clinical instability and diagnostic and prognostic uncertainty. A recent study exploring the impact of genetic testing in redirection of care decisions by surveying palliative care providers suggested genetic testing plays a minor role in decisions to redirect to end-of-life care or in the implementation of DNR/DNI orders. However, factors such inadequate treatment options were found to be important in redirection of care decisions, implying the need for further investigation to clarify the role of genetic testing. Future studies will need to focus on how genetic information affects healthcare provider recommendations regarding palliative care and how families use this information to make end-of-life care decisions. Full article

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

18 pages, 1049 KiB

Open AccessReview

Early Mobilization Protocols in Critically Ill Pediatric Patients: A Scoping Review of Strategies, Tools and Perceived Barriers

by Lizeth Dayana Noreña-Buitrón, Valeria Sanclemente-Cardoza, Maria Alejandra Espinosa-Cifuentes, Harold Andrés Payán-Salcedo and Jose Luis Estela-Zape

Children 2025, 12(5), 633; https://doi.org/10.3390/children12050633 - 14 May 2025

Viewed by 203

Abstract

Background/Objectives: We will describe the early mobilization protocols applied to critically ill pediatric patients in PICUs, analyzing the strategies employed, the tools used, and the barriers perceived by the healthcare team during their implementation. Methods: The scoping review followed the guidelines established by [...] Read more.

Background/Objectives: We will describe the early mobilization protocols applied to critically ill pediatric patients in PICUs, analyzing the strategies employed, the tools used, and the barriers perceived by the healthcare team during their implementation. Methods: The scoping review followed the guidelines established by PRISMA-ScR. A search was conducted across five electronic databases: PubMed, Scopus, Web of Science, Dimensions AI, and ScienceDirect. Articles published in English that focused on pediatric patients aged 0 to 18 years were included. Results: A total of 3508 records were initially identified, of which 3422 articles were evaluated after duplicate removal. Subsequently, 12 studies that met the inclusion criteria were included. The methodological quality of the studies was mostly adequate, with 71.43% achieving scores between eight and nine on the Newcastle–Ottawa scale and 50% of the randomized clinical trials obtaining the maximum score of 7/7 on the Jadad scale. The interventions analyzed, including active bed mobility, bed cycling, and virtual reality, showed positive results in terms of feasibility and safety. The most frequently reported barriers to mobilization were hemodynamic instability, excessive sedation, pain, and lack of personnel and equipment. Conclusions: Early mobilization in pediatric PICUs is linked to improvements in mobility, reduced hospital stays, and shorter mechanical ventilation duration. However, its implementation is limited by barriers such as hemodynamic instability, excessive sedation, and lack of personnel and equipment. Further research is needed to establish uniform protocols, reduce these barriers, and optimize their effectiveness. Full article

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

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13 pages, 877 KiB

Open AccessCase Report

Life-Threatening Anemia and Thrombocytopenia in a Toddler with Influenza B: Case Report and Literature Review

by Irina Profir, Cristina-Mihaela Popescu and Iuliana Moraru

Children 2025, 12(5), 632; https://doi.org/10.3390/children12050632 - 14 May 2025

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Abstract

Background: Seasonal influenza viruses are primarily known for causing respiratory illness, but rare hematologic complications can occur, especially in young children. While influenza A is more commonly linked to severe manifestations, influenza B can similarly precipitate life-threatening cytopenias, particularly in toddlers. Case [...] Read more.

Background: Seasonal influenza viruses are primarily known for causing respiratory illness, but rare hematologic complications can occur, especially in young children. While influenza A is more commonly linked to severe manifestations, influenza B can similarly precipitate life-threatening cytopenias, particularly in toddlers. Case Presentation: We report the case of a previously healthy 1-year-and-8-months-old girl who presented with a high fever, cough, and marked pallor during peak influenza season. Laboratory tests revealed significant microcytic, hypochromic anemia and severe thrombocytopenia. Rapid antigen testing was positive for influenza B. An extensive workup for other causes of bicytopenia, including leukemia, hemolysis, aplastic anemia, and other viral infections, yielded negative results. The child was managed with urgent red blood cell and platelet transfusions, oseltamivir antiviral therapy, broad-spectrum antibiotics, corticosteroids, and supportive care. Bone marrow aspiration was deferred in light of the rapid hematologic recovery. Her hemoglobin greatly improved, and her platelet count reached normal values at discharge. Conclusions: Our case underscores the need to consider influenza in the differential diagnosis of unexplained cytopenias during flu season. This case illustrates that influenza B can mimic hematologic malignancies. Rapid diagnosis and supportive treatment are essential to avoid fatal outcomes. Influenza vaccination plays a significant role in preventing severe complications, such as those we encountered. Full article

(This article belongs to the Section Pediatric Pulmonary and Sleep Medicine)

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16 pages, 1838 KiB

Open AccessArticle

Pediatric-Onset Multiple Sclerosis (POMS) and Epilepsy: Exploring Etiological Complexity—Outcomes from a Single-Center Experience

by Alice Denisa Dică, Dana Craiu, Catrinel Iliescu, Marcel-Alexandru Găină, Carmen Sandu, Cristina Pomeran, Diana Bârcă, Niculina Butoianu, Carmen Burloiu, Ioana Minciu, Alexandra-Maria Găină, Dana Șurlică, Cristina Moțoescu, Oana Tarța-Arsene, Cristina Cazacu, Andreea Badea, Alexandru Ștefan Niculae and Daniela Adriana Ion

Children 2025, 12(5), 631; https://doi.org/10.3390/children12050631 - 14 May 2025

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Abstract

This article examines the complex relationship between seizures, epilepsy, and multiple sclerosis (MS) in pediatric patients, based on detailed findings from a single-center study. Background: Although multiple sclerosis is primarily recognized as an adult-onset disease, its occurrence in children presents distinctive challenges, [...] Read more.

This article examines the complex relationship between seizures, epilepsy, and multiple sclerosis (MS) in pediatric patients, based on detailed findings from a single-center study. Background: Although multiple sclerosis is primarily recognized as an adult-onset disease, its occurrence in children presents distinctive challenges, especially related to seizure disorders. Methods: We reviewed 120 pediatric MS patients evaluated over 7 years; six of these (5%) experienced seizures (including one case of acute status epilepticus), and five were diagnosed with epilepsy according to the latest International League Against Epilepsy (ILAE) classification. This study aimed to evaluate the occurrence rates and types of seizures while investigating their management strategies in this specific group. Results: Through a detailed case analysis and patient follow-up, we identified key factors contributing to seizure onset and explored implications for treatment and care. In our cohort, children with MS and seizures showed a higher risk for disease progression and greater cumulative disability, evidenced by a significantly higher last Expanded Disability Status Scale (EDSS) score (after a minimum 2-year follow-up) in the seizure group (p < 0.006). The analysis recognized early MS onset and highly active disease types as further risk factors that led to worse health outcomes. Conclusions: Genetic causes of epilepsy in children are common and may interact with MS-related inflammation in the same patient; our observations underscore the need to investigate how these two conditions interact. This work contributes to the broader understanding of epilepsy comorbid with MS among pediatric patients, seeking to facilitate the creation of improved interdisciplinary clinical practices in pediatric neurology. Full article

(This article belongs to the Special Issue Recent Advances in Pediatric-Onset Multiple Sclerosis)

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15 pages, 2859 KiB

Open AccessCase Report

Overtime Challenges of Diagnosis and Treatment in Two Pediatric Patients with Extensive Cerebral Tumefactive Lesions Indicative of Baló’s Type Multiple Sclerosis

by Alice Denisa Dică, Dana Craiu, Catrinel Iliescu, Marcel-Alexandru Găină, Carmen Sandu, Cristina Pomeran, Carmen Burloiu, Alexandra-Maria Găină and Daniela Adriana Ion

Children 2025, 12(5), 630; https://doi.org/10.3390/children12050630 - 14 May 2025

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Abstract

Background: Baló’s concentric sclerosis stands out as a rare form of multiple sclerosis that features large tumor-like demyelinating lesions, which resemble brain tumors and create significant diagnostic and therapeutic obstacles for pediatric patients. Case Presentations: We present two case studies of pediatric patients, [...] Read more.

Background: Baló’s concentric sclerosis stands out as a rare form of multiple sclerosis that features large tumor-like demyelinating lesions, which resemble brain tumors and create significant diagnostic and therapeutic obstacles for pediatric patients. Case Presentations: We present two case studies of pediatric patients, aged 11 and 15, diagnosed with extensive cerebral tumefactive inflammatory lesions indicative of Balo’s type multiple sclerosis (MS). Both cases highlight the unique challenges faced in the diagnosis and treatment of this rare form of MS, characterized by the presence of large, tumor-like lesions that can mimic primary brain tumors. We will explore the diagnostic complexities, including the need for advanced imaging techniques, MR (Magnetic Resonance) spectroscopy, along with the time needed for differential diagnoses, which might delay the start of proper treatment. Current therapies, such as corticosteroids and immunomodulators, require customization to individual patients, carefully monitoring of clinical outcomes and possible side effects. This paper emphasizes that handling these cases requires a multidisciplinary approach, addressing not only the medical treatment but also the psychosocial needs of affected children and their families. By sharing these experiences, we aim to increase awareness about Balo’s type MS in pediatric populations and provide clinical insights into effective management strategies for similar cases in clinical practice. Conclusions: Timely detection of atypical demyelinating lesions together with immediate treatment intervention plays a crucial role in pediatric Baló-type MS. These cases demonstrate the essential role of advanced imaging and immunological testing in precise diagnosis while showcasing successful treatment approaches through corticosteroids and second-line immunotherapies, which improve patient outcomes in this atypical MS variant. Full article

(This article belongs to the Special Issue Recent Advances in Pediatric-Onset Multiple Sclerosis)

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Children, Volume 12, Issue 5 (May 2025) – 130 articles

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