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Children
Volume 12
Issue 6
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Children, Volume 12, Issue 6 (June 2025) – 147 articles

Cover Story (view full-size image): This study evaluates pediatric speech and language therapy services provided by students at the Cyprus University of Technology’s rehabilitation clinic. Conducted with children accessing services, it explores service accessibility, developmental speech–language disorders, and educational outcomes. The study presents quantitative and qualitative analyses of referral patterns, intervention processes, and therapy efficacy. It highlights barriers families encounter and implications for training in effective evidence‑based practices. This clinic‑based model informs both academic curricula and community service delivery in Cyprus. View this paper
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10 pages, 531 KiB  
Article
Histological Grade, Tumor Breadth, and Hypertension Predict Early Recurrence in Pediatric Sarcoma: A LASSO-Regularized Micro-Cohort Study
by Alexander Fiedler, Mehran Dadras, Marius Drysch, Sonja Verena Schmidt, Flemming Puscz, Felix Reinkemeier, Marcus Lehnhardt and Christoph Wallner
Children 2025, 12(6), 806; https://doi.org/10.3390/children12060806 - 19 Jun 2025
Viewed by 189
Abstract
Background/Objectives: Pediatric sarcomas are a biologically diverse group of mesenchymal tumors associated with morbidity due to recurrence, despite aggressive multimodal treatment. Reliable predictors of early recurrence remain limited. This exploratory study aimed to identify clinical features associated with first tumor recurrence using [...] Read more.
Background/Objectives: Pediatric sarcomas are a biologically diverse group of mesenchymal tumors associated with morbidity due to recurrence, despite aggressive multimodal treatment. Reliable predictors of early recurrence remain limited. This exploratory study aimed to identify clinical features associated with first tumor recurrence using a machine learning approach tailored to low-event settings. Methods: We conducted a retrospective, single-center cohort study of 23 pediatric patients with histologically confirmed sarcoma. Forty-six baseline variables were extracted per patient, including clinical, histological, and comorbidity data. Tumor recurrence was the primary binary endpoint. A LASSO-regularized logistic regression model was developed using leave-one-out cross-validation (LOOCV) to identify the most informative predictors. Dimensionality reduction (PCA) and SHAP-value analyses were used to visualize patient clustering and interpret variable contributions. Results: The model identified a four-variable risk signature comprising histological grade, primary tumor width, arterial hypertension, and extremity localization. Each additional tumor grade or centimeter of width approximately doubled the odds of recurrence (OR 2.18 and 2.04, respectively). Hypertension and limb location were associated with a 1.7 and 1.9 odds ratio of recurrence, respectively. The model achieved a balanced accuracy of 0.61 ± 0.08 and AUROC of 0.47 ± 0.12, reflecting limited discriminative power. PCA mapping revealed distinct outlier patterns correlating with high-risk profiles. Conclusions: Even in a small cohort, classical prognostic markers, such as tumor grade and size, retained predictive relevance, while hypertension emerged as a novel, potentially modifiable cofactor or indicator for recurrence. Although model performance was modest, the findings are hypothesis-generating and warrant validation in larger prospective datasets. Full article
(This article belongs to the Section Pediatric Hematology & Oncology)
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14 pages, 510 KiB  
Article
The Role of Fundamental Movement Skills and Health-Related Fitness on Physical Activity During Guided Active Play for 8- to 10-Year-Old Children
by Glory Madu, Victoria Kwong, Dusan Calic, Taylor Cleworth and Angelo Belcastro
Children 2025, 12(6), 805; https://doi.org/10.3390/children12060805 - 19 Jun 2025
Viewed by 157
Abstract
Background: Active play has been proposed to complement school-based physical activity (PA) and promote increased movement-related activities relevant for the development of motor competence. Guided active play (GAP) paired with cooperative games provides sufficient moderate-to-vigorous physical activity (MVPA) to improve motor competence for [...] Read more.
Background: Active play has been proposed to complement school-based physical activity (PA) and promote increased movement-related activities relevant for the development of motor competence. Guided active play (GAP) paired with cooperative games provides sufficient moderate-to-vigorous physical activity (MVPA) to improve motor competence for younger children. Whether guided active play exhibits physical activity outputs that are related to motor competence is uncertain. This study assessed the strength of relationships between play-based physical activity and movement skills by comparing linear regression and chi-square analyses. Methods: Forty-two children (Mage = 8.8 ± 0.8 years) participated in a community center program. PA was measured via accelerometry for GAP, alongside assessments of anthropometrics, fitness (leg power, strength, VO2max), and FMS (Test of Gross Motor Development-2). Multiple linear regression analysis examined reciprocal relationships. Chi-square and cross-tabulations analyzed categorical variables based on lab percentiles (low < 33%, high > 66%) for PA energy expenditure (PAEE), intensity (MVPA), FMS, and fitness. Results: GAP MVPA and object control skills (OC) showed positive reciprocal pathways (β = 0.308, β = 0.394; p ≤ 0.05). VO2max predicted MVPA (β = 0.408; p < 0.01), with leg power related to PAEE (β = 0.456; p ≤ 0.01). Chi-square analysis revealed significant associations between high OC skills and high PAEE (X2 = 15.12, p ≤ 0.05), and high individual average scores of OC with high MVPA (X2 = 11.90, p < 0.05. The high performance of AP and LP was associated with MVPA and PAEE, respectively. Conclusions: Findings support a positive feedback loop between MVPA and OC skills for GAP. GAP is an effective strategy for program interventions for children 8 to 10-year old. Full article
(This article belongs to the Special Issue Fundamental Movement/Motor Skills—the Bridging Element Between Motor Development Milestones and Physical Activity)
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23 pages, 3755 KiB  
Systematic Review
Constraint-Induced Movement Therapy Versus Bimanual Training to Improve Upper Limb Function in Cerebral Palsy: A Systematic Review and Meta-Analysis of Follow-Ups
by Gabriel Martin-Moreno, Marta Moreno-Ligero, Alejandro Salazar, David Lucena-Anton and Jose A. Moral-Munoz
Children 2025, 12(6), 804; https://doi.org/10.3390/children12060804 - 19 Jun 2025
Viewed by 201
Abstract
Background/Objectives: Constraint-induced movement therapy (CIMT) and bimanual training (BIT) have been commonly used to improve upper limb (ULF) in paediatric populations. This study aimed to compare the efficacy of CIMT and BIT for the recovery of ULF in youth with unilateral cerebral [...] Read more.
Background/Objectives: Constraint-induced movement therapy (CIMT) and bimanual training (BIT) have been commonly used to improve upper limb (ULF) in paediatric populations. This study aimed to compare the efficacy of CIMT and BIT for the recovery of ULF in youth with unilateral cerebral palsy (CP) in the immediate, short, and long term. Methods: A systematic review with a meta-analysis of randomised controlled trials (RCTs) from the PubMed/Medline, Scopus, Web of Science, and PEDro databases was conducted. The primary outcomes were the immediate, short-, and long-term effects on ULF, and the secondary outcomes were related to occupational performance and disability. The risk of bias was assessed using the Cochrane RoB 2.0 tool by two researchers independently. Meta-analyses were performed using RevMan 5.3. Results: From the 174 records obtained, 10 RTCs comprising 418 participants were included. Favourable results were observed immediately after intervention for CIMT regarding unimanual ULF using the Quality of Upper Extremity Test (QUEST) (SMD = 1.08; 95% CI = (0.66;1.50)) and Jebsen–Taylor Hand Function Test (JTHFT) (SMD = −0.62; 95% CI = (−1.23;0.00)). These results were maintained in the short term for the QUEST for dissociated movements (SMD = 1.19; 95% CI = (0.40;1.99)) and in the long term for the JTHFT (SMD = −0.38; 95% CI = (−1;0.24)). Conversely, favourable results were obtained immediately after the intervention for BIT regarding bimanual ULF using the Assisting Hand Assessment (SMD = −0.42; 95% CI = (−0.78–0.05)). Conclusions: CIMT could be more effective for improving unimanual ULF and BIT in youth with unilateral CP. The differences between the interventions decreased in the long term. Nevertheless, these findings should be interpreted with caution due to the variability in the intervention programmes. Further research with standardised protocols is needed. Full article
(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)
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12 pages, 821 KiB  
Article
The Effect of the COVID-19 Pandemic and the Establishment of a Ronald McDonald House on Skin-to-Skin Times in the Neonatal Intensive Care Unit: A Retrospective Study
by Stephanie Schaible, Edda Hofstätter, Wanda Lauth and Martin Wald
Children 2025, 12(6), 803; https://doi.org/10.3390/children12060803 - 19 Jun 2025
Viewed by 201
Abstract
Objectives: Kangaroo care is vital for the development of premature and low-birthweight infants. However, detailed data on skin-to-skin times, especially for extremely preterm infants in NICUs, is lacking. This study quantifies skin-to-skin times for these infants at the neonatology department in Salzburg, [...] Read more.
Objectives: Kangaroo care is vital for the development of premature and low-birthweight infants. However, detailed data on skin-to-skin times, especially for extremely preterm infants in NICUs, is lacking. This study quantifies skin-to-skin times for these infants at the neonatology department in Salzburg, considering factors like the COVID-19 pandemic, the opening of Ronald McDonald House, and sibling presence. Methods: We retrospectively analyzed data from the first eight weeks of life of 93 extremely preterm infants (<28 gestational weeks, <1500 g birth weight) treated at the Salzburg NICU from 2019 to 2023. Skin-to-skin times were recorded to the minute. Results: The mean value skin-to-skin time per visiting day was 241 min (±83), skin-to-skin was performed on 79.0% (±16.8) of the days of stay examined. During the pandemic, skin-to-skin care was performed on 64% of visit days, after the pandemic on 91% (p < 0.001). Before the Ronald McDonald House opened, the skin-to-skin time per visiting day was 215 min (±57.9), afterwards it was 273 min (±97) (p = 0.001). For Primipara the Kangaroo-Care time per day of visit was 257 min (±93), for Multipara 217 min (±52) (p = 0.043). Conclusions: Skin-to-skin is crucial for extremely premature infants and can be implemented for many hours a day. It is an integral part of parent-child interaction in a neonatal intensive care unit. External factors such as infrastructure, pandemic restrictions or siblings have a significant impact on skin-to-skin. Full article
(This article belongs to the Special Issue Providing Care for Preterm Infants)
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12 pages, 396 KiB  
Article
Network Coordinator Perceptions of Early Childhood Community Systems Building and Development Efforts
by Tuyet Mai Ha Hoang, Brandie Bentley, Karen V. Jenkins, Crystal A. Reinhart, Gloria A. Sugg and Karen M. Tabb
Children 2025, 12(6), 802; https://doi.org/10.3390/children12060802 - 19 Jun 2025
Viewed by 141
Abstract
Background: Networks for building and developing community systems to support early childhood rely on the volunteer efforts of organizations and the leadership of coordinators to unite relevant stakeholders. Aims: The purpose of this study was to explore the perspectives of network coordinators [...] Read more.
Background: Networks for building and developing community systems to support early childhood rely on the volunteer efforts of organizations and the leadership of coordinators to unite relevant stakeholders. Aims: The purpose of this study was to explore the perspectives of network coordinators from 10 different communities participating in the All Our Kids Early Childhood Networks (AOK Networks) to identify the successes and barriers involved in implementing effective early childhood systems. Methods: We conducted two focus group interviews with 10 participants who worked as network coordinators in public health district offices. A semi-structured focus group interview guide was used to examine community coordinators’ perceptions related to lessons learned with community systems development efforts around early childhood outcomes. All interviews were audio recorded and transcribed verbatim. Thematic network analysis was used to analyze all focus group data. Results: Three salient themes were identified from interviews with network coordinators: (1) respective strengths of the AOK Networks system building efforts; (2) challenges for coordinators, such as burnout; and (3) the importance of the networks’ role within the community. Conclusions: This study contributes to the existing literature by identifying supportive and hindering factors that impact the implementation process to sustain long-term impact of early child community systems building. The findings can be useful for other ongoing government partnerships and community-based programs that use networks and system building strategies across the US. Full article
(This article belongs to the Section Global Pediatric Health)
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12 pages, 1329 KiB  
Brief Report
Rapid, Safe, and Tolerable Healing of Pediatric Skin Injuries with Blue Light Therapy: An Observational Case Series
by Nicolosi Biagio, Bastarelli Eleonora, Gregorini Mirco and Ciprandi Guido
Children 2025, 12(6), 801; https://doi.org/10.3390/children12060801 - 19 Jun 2025
Viewed by 317
Abstract
Background/Objectives: Pediatric skin injuries represent a clinical challenge, especially in cases with complex etiology or with severe pain. Blue light is an emerging technology with potential application in pediatric wound care. The aim of this case series was to describe the clinical use [...] Read more.
Background/Objectives: Pediatric skin injuries represent a clinical challenge, especially in cases with complex etiology or with severe pain. Blue light is an emerging technology with potential application in pediatric wound care. The aim of this case series was to describe the clinical use of blue light in pediatric patients with injuries of varying etiologies and mechanisms, and to assess its long-term effectiveness and sustainability in treatment. Methods: Twelve hospitalized pediatric patients (0–12 years old) with skin injuries were included in this case series. The etiologies of wounds treated with photobiomodulation were incontinence-associated dermatitis, peristomal injuries, and pressure injuries. The injuries were assessed using specific classification tools and pain scales. The wounds were treated every three days using a medical device that emits blue light (410–430 nm). When necessary, wounds were also treated with appropriate dressings. Results: All injuries responded positively to photobiomodulation therapy and showed a rapid resolution of inflammation. Complete wound resolution was achieved in 11 of 12 cases. The average healing time was 3.7 days. Four injuries achieved resolution with only one application of blue light. Scores from the pain perception scales showed that the blue light treatment was well tolerated by pediatric patients, showing high parental compliance. No side effects or adverse events were observed. Conclusions: Blue light photobiomodulation proved to be a safe, well-tolerated, and effective technology in the treatment of pediatric skin injuries, with good acceptance by young patients and families. More structured clinical trials would be needed to validate the efficacy of blue light in pediatric injuries. Full article
(This article belongs to the Special Issue Pediatric Palliative Care and Pain Management)
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25 pages, 680 KiB  
Article
Efficacy, Feasibility, and Utility of a Mental Health Consultation Mobile Application in Early Care and Education Programs
by Ruby Natale, Yue Pan, Yaray Agosto, Carolina Velasquez, Karen Granja, Emperatriz Guzmán Garcia and Jason Jent
Children 2025, 12(6), 800; https://doi.org/10.3390/children12060800 - 19 Jun 2025
Viewed by 263
Abstract
Background/Objectives: Preschool children from low-income, ethnically diverse communities face disproportionate rates of behavioral challenges and early expulsion from early care and education (ECE) programs. This study evaluated the efficacy, feasibility, and utility of Jump Start on the Go (JS Go), a bilingual, AI-enabled [...] Read more.
Background/Objectives: Preschool children from low-income, ethnically diverse communities face disproportionate rates of behavioral challenges and early expulsion from early care and education (ECE) programs. This study evaluated the efficacy, feasibility, and utility of Jump Start on the Go (JS Go), a bilingual, AI-enabled mobile application. JS Go is designed to deliver a 14-week early childhood mental health consultation model in under-resourced ECE settings. Methods: This mixed-methods study compared JS Go to the standard in-person Jump Start (JS) program. Participants included 28 teachers and 114 children from six centers (three JS Go, three JS). Quantitative measures assessed teacher classroom practices and child psychosocial outcomes at baseline and post-intervention. App usability and acceptability were only evaluated post-intervention. Seven semi-structured interviews were conducted post-intervention with JS Go directors/teachers to assess the app’s feasibility for implementing the four program pillars: safety, behavior support, self-care, and communication. Results: JS Go was more effective than JS in promoting teacher classroom practices related to behavior support and resiliency. Both programs were similar in improving children’s protective factors and reducing internalizing behaviors, with consistent effects across English and Spanish-speaking children. Teachers rated the JS Go app with high acceptability, though predicted future usage showed greater variability. Rapid qualitative analysis showed that participants found the app easy to use, frequently accessed its resources, and considered it helpful for reinforcing key strategies across the four program pillars. Conclusions: JS Go is a novel approach to providing mental health consultation. It represents a promising mobile adaptation of the established JS consultation model, with important implications for future practice and research. 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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8 pages, 331 KiB  
Article
The Relationship Between Prematurity and Mode of Delivery with Disorders of Gut–Brain Interaction in Children
by Carlos Alberto Velasco-Benitez, Daniela Alejandra Velasco-Suarez, Natalia Palma, Samantha Arrizabalo and Miguel Saps
Children 2025, 12(6), 799; https://doi.org/10.3390/children12060799 - 18 Jun 2025
Viewed by 243
Abstract
Background: Disorders of gut–brain interaction (DGBI) are multifactorial. Early-life events are proposed as factors involved in their etiopathogenesis. The relationship between mode of delivery, prematurity, and DGBI development remains unclear. This study examines whether cesarean delivery and prematurity contribute to early childhood DGBI. [...] Read more.
Background: Disorders of gut–brain interaction (DGBI) are multifactorial. Early-life events are proposed as factors involved in their etiopathogenesis. The relationship between mode of delivery, prematurity, and DGBI development remains unclear. This study examines whether cesarean delivery and prematurity contribute to early childhood DGBI. Methods: Caregivers of children aged 1 month to 4 years from four Colombian cities participated in a cross-sectional study. Pediatricians completed the Spanish-validated Questionnaire of Pediatric Gastrointestinal Symptoms Rome IV (QPGS-IV). Data of children born by cesarean delivery and prematurity were compared with controls. Categorical data were analyzed using Fisher’s exact test, and odds ratios (ORs) with 95% confidence intervals (CIs). Results: DGBIs were identified in 26.6% of children, with functional constipation (FC) being the most prevalent (22.3%). Among children born via cesarean section (54.3%), 30.4% of them had a DGBI (OR = 1.54, 95% CI = 1.20–1.96, p = 0.00), and 26.3% had FC (OR = 1.67, 95% CI = 1.29–2.18, p = 0.00). Prematurity was observed in 12.6% of children and was associated with a higher prevalence of DGBI (35.7%, (OR = 1.64, 95% CI = 1.16–2.29, p = 0.00), with FC affecting 30.8% (OR = 1.66, 95% CI = 1.16–2.35, p = 0.00). Conclusions: Cesarean delivery and prematurity were found to be associated with DGBI in early childhood, particularly FC. These findings highlight the need for further research to explore potential mechanisms and confirm these associations. Full article
(This article belongs to the Special Issue Gut-Brain Interaction Disorders in Children: Emerging Insights in the 21st Century)
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17 pages, 333 KiB  
Article
ADHD Children Take More Time to Inhibit Automatic Responses: A Comparison with Anxiety Disorders Using NEPSY-II
by Fabiola Panvino, Valerio Zaccaria, Michela Pica, Nunzia Amitrano, Francesco Pisani and Carlo Di Brina
Children 2025, 12(6), 798; https://doi.org/10.3390/children12060798 - 18 Jun 2025
Viewed by 351
Abstract
Background/Objectives: Attention deficit hyperactivity disorder (ADHD) and anxiety disorders (AD) are prevalent in childhood and adolescence, often presenting with overlapping symptoms. This study aimed to assess cognitive and executive functions—specifically attention, inhibition, and working memory—in children with ADHD, AD, and comorbid ADHD + [...] Read more.
Background/Objectives: Attention deficit hyperactivity disorder (ADHD) and anxiety disorders (AD) are prevalent in childhood and adolescence, often presenting with overlapping symptoms. This study aimed to assess cognitive and executive functions—specifically attention, inhibition, and working memory—in children with ADHD, AD, and comorbid ADHD + AD. It also sought to identify potential neuropsychological markers that differentiate ADHD from AD and ADHD + AD comorbidity. Methods: Cognitive and executive functions were assessed in a sample of 48 school-age children and adolescents (aged 8–15 years) using the Wechsler Intelligence Scale for Children—Fourth Edition (WISC-IV) and the NEPSY-II battery. The MASC 2 self-report questionnaire was also used to assess anxiety symptoms. The participants were divided into three groups based on clinical diagnoses: ADHD, AD, and ADHD + AD. Results: No significant group differences emerged in cognitive performance, attention, or working memory. Significant differences emerged in inhibition performance, with children in the AD group demonstrating more efficient inhibition compared to both the ADHD and ADHD + AD groups. Children with ADHD showed longer response times. Better performance on inhibition tasks was associated with more severe anxiety symptoms. Conclusions: These findings suggest that anxiety may modulate specific aspects of executive functioning during tasks requiring attentional and inhibitory control. However, the complex interaction between ADHD and anxiety requires further investigation. This study underscores the importance of distinguishing ADHD from AD based on cognitive and executive profiles, particularly inhibition. In this context, it supports the routine use of the NEPSY-II in combination with the MASC 2 questionnaire to facilitate differential diagnosis in clinical practice. Full article
(This article belongs to the Special Issue Neurodevelopmental Disorders in Pediatrics: 2nd Edition)
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17 pages, 294 KiB  
Review
The Many Faces of Child Abuse: How Clinical, Genetic and Epigenetic Correlates Help Us See the Full Picture
by Enrico Parano, Vito Pavone, Martino Ruggieri, Iside Castagnola, Giuseppe Ettore, Gaia Fusto, Roberta Rizzo and Piero Pavone
Children 2025, 12(6), 797; https://doi.org/10.3390/children12060797 - 18 Jun 2025
Viewed by 379
Abstract
Background/Objectives: Child abuse is a pervasive global issue with significant implications for the physical, emotional, and psychological well-being of victims. This review highlights the clinical, molecular, and therapeutic dimensions of child abuse, emphasizing its long-term impact and the need for interdisciplinary approaches. Early [...] Read more.
Background/Objectives: Child abuse is a pervasive global issue with significant implications for the physical, emotional, and psychological well-being of victims. This review highlights the clinical, molecular, and therapeutic dimensions of child abuse, emphasizing its long-term impact and the need for interdisciplinary approaches. Early exposure to abuse activates the hypothalamic-pituitary-adrenal (HPA) axis, leading to chronic cortisol release and subsequent neuroplastic changes in brain regions such as the hippocampus, amygdala, and prefrontal cortex. These molecular alterations, including epigenetic modifications and inflammatory responses, contribute to the heightened risk of psychiatric disorders and chronic illnesses in survivors. Clinically, child abuse presents with diverse manifestations ranging from physical injuries to psychological and developmental disorders, making timely diagnosis challenging. Methods: A multidisciplinary approach involving thorough clinical evaluation, detailed histories, and collaboration with child protection services is essential for accurate diagnosis and effective intervention. Results: Recent advances in molecular biology have identified biomarkers, such as stress-related hormones and epigenetic changes, which provide novel insights into the physiological impact of abuse and potential targets for therapeutic intervention. Current treatment strategies prioritize the child’s safety, psychological well-being, and prevention of further abuse. Trauma-focused cognitive behavioral therapy and family-centered interventions are pivotal in promoting recovery and resilience. Conclusions: Emerging research focuses on integrating molecular findings with clinical practice, utilizing digital health tools, and leveraging big data to develop predictive models and personalized treatments. Interdisciplinary collaboration remains crucial to translating research into policy and practice, ultimately aiming to mitigate the impact of child abuse and improve outcomes for survivors. Full article
(This article belongs to the Section Pediatric Mental Health)
15 pages, 768 KiB  
Article
Movement Variability and Perceived Motor Competence in Children with High or Low Risk Willingness in a Virtual Playground
by Lise Storli and Håvard Lorås
Children 2025, 12(6), 796; https://doi.org/10.3390/children12060796 - 18 Jun 2025
Viewed by 242
Abstract
Background: The current study explores the relationship between children’s risk willingness and their motor behavior in a virtual playground setting and its association with perceived gross motor competence. Methods: A total of 96 children aged seven to ten participated. They were categorized into [...] Read more.
Background: The current study explores the relationship between children’s risk willingness and their motor behavior in a virtual playground setting and its association with perceived gross motor competence. Methods: A total of 96 children aged seven to ten participated. They were categorized into high-risk-willingness (HRW) and low-risk-willingness (LRW) groups based on their exploratory behavior and engagement with riskier zones and tasks in the playground. Using whole-body motion capture and virtual reality data, the children’s motor behavior and variability were analyzed alongside self-reported perceived gross motor competence. Results: The results indicated that HRW children displayed significantly greater movement variability, including higher joint movement variability and increased exploration of challenging areas compared to LRW children. HRW children also covered greater distances, moved faster, and exhibited more frequent acceleration changes. Conclusions: These findings suggest that higher risk willingness is associated with greater adaptability and flexibility in motor behavior, aligned with the concept of freeing degrees of freedom. In contrast, no significant differences were found in perceived gross motor competence ratings between HRW and LRW groups. This indicates that perceived motor competence may not directly influence children’s willingness to take risks or their motor behavior in exploratory play. These findings emphasize the importance of studying dynamic interactions between risk-taking, motor behavior, and self-perception to understand the development of adaptive motor skills through risky play. Full article
(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)
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15 pages, 1127 KiB  
Article
Detecting Disordered Eating Behaviors in Greek Youth with Type 1 Diabetes Mellitus by Using the Diabetes Eating Problem Survey—Revised (DEPS-R): Associations with Insulin Restriction, Glycemic Control, and Anthropometric Parameters
by Anastasia Oikonomou, Athanasios Christoforidis, Eleni P. Kotanidou, Ioanna Giannopoulou, Eleni Paschalidou, Vasiliki Rengina Tsinopoulou, Georgia Sotiriou, Kyriaki Tsiroukidou and Assimina Galli-Tsinopoulou
Children 2025, 12(6), 795; https://doi.org/10.3390/children12060795 - 18 Jun 2025
Viewed by 283
Abstract
Background/Objectives: This study assesses the prevalence of diabulimia in Greek children and adolescents with Type 1 Diabetes Mellitus (T1DM) by using the Diabetes Eating Problem Survey—Revised (DEPS-R) questionnaire and addresses a gap in the literature on eating disorders (EDs) and disordered eating [...] Read more.
Background/Objectives: This study assesses the prevalence of diabulimia in Greek children and adolescents with Type 1 Diabetes Mellitus (T1DM) by using the Diabetes Eating Problem Survey—Revised (DEPS-R) questionnaire and addresses a gap in the literature on eating disorders (EDs) and disordered eating behaviors (DEBs) in this population. The DEPS-R threshold score of ≥20, although originally established in international studies, has also been applied in Greek adult validation studies. However, it has not yet been formally validated in Greek youth. Methods: Participants aged 9–18 years, diagnosed with T1DM a minimum of one year before the start of the study, were recruited from three pediatric departments in Thessaloniki and were asked to complete the Greek version of the DEPS-R questionnaire. Appropriate statistical analysis was employed to investigate the association of the DEPS-R score with anthropometric, demographic, and glycemic variables derived from the clinical assessment and the patient’s medical records. Results: Girls had significantly higher DEPS-R scores compared with boys. Significant positive associations were observed between the DEPS-R score and both age (r = 0.212, p = 0.020) and Body Mass Index (BMI) (r = 0.419, p < 0.001). A significant association with Glycated Hemoglobin (HbA1c) (r = 0.182, p = 0.047) suggested that poorer glycemic control may be linked to disordered eating, although no significant associations were identified with physical activity or type of insulin therapy. Conclusions: Older age, higher Body Mass Index (BMI) and elevated Glycated Hemoglobin (HbA1c) levels are associated with increased risk of disordered eating in youth with T1DM, especially in girls. Therefore, the implementation of early screening and targeted interventions is imperative. Full article
(This article belongs to the Special Issue Innovative Psychosocial Interventions in Children and Adolescents Living with Type 1 Diabetes)
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11 pages, 211 KiB  
Article
Education Improves Perceived Control but Not Risk Identification in Adolescents Regarding Fentanyl
by Christine Bakos-Block, Francine R. Vega, Marylou Cardenas-Turanzas, Bhanumathi Gopal and Tiffany Champagne-Langabeer
Children 2025, 12(6), 794; https://doi.org/10.3390/children12060794 - 17 Jun 2025
Viewed by 311
Abstract
Background/Objectives: In 2022, 2.2 million adolescents were diagnosed with substance use disorders, including 265,000 with opioid use disorder. The National Survey on Drug Use and Health revealed that 130,000 adolescents misused prescription pain medications, often obtaining them from friends or relatives. This age [...] Read more.
Background/Objectives: In 2022, 2.2 million adolescents were diagnosed with substance use disorders, including 265,000 with opioid use disorder. The National Survey on Drug Use and Health revealed that 130,000 adolescents misused prescription pain medications, often obtaining them from friends or relatives. This age group perceives weekly heroin use as less risky than those younger or older. Methods: A questionnaire was developed for 7th to 12th graders in a rural Texas school district as part of a fentanyl awareness curriculum. The questionnaire included Likert scale, multiple choice, and yes/no questions. The participants were categorized into younger (grades 7th and 8th) and older students (grades 9th through 12th), and associations were explored between demographic characteristics, responses, and grade groups using chi-square tests. To assess confidence, behavior, and the impact of education, we used chi-square and Fisher’s exact tests. Results: The participants (n = 94; 85.11%) identified as Hispanic or Latino, with a smaller percentage identifying as White or more than one race. An association was found between feeling more in control of actions related to substances and fentanyl (p-value = 0.04) after receiving education. No association was found between education and confidence in identifying fentanyl. Conclusions: This study aligns with a surge in fentanyl-related overdose deaths in a high-intensity drug trafficking region. Recent fentanyl overdoses among school-age children prompted legislative changes in 2023, making this study valuable for understanding the epidemic within the geographical context. These results suggest that school-based education may play a role in strengthening adolescents’ behavioral intentions to fentanyl exposure, though additional efforts are needed to improve risk identification. Full article
(This article belongs to the Special Issue Problematic Substance Use in Children and Adolescents: Intervention and Prevention)
26 pages, 1559 KiB  
Article
Language Comprehension Developmental Milestones in Typically Developing Children Assessed by the New Language Phenotype Assessment (LPA)
by Andrey Vyshedskiy, Ariella Pevzner, Brigid Mack, Eva Shrayer, Miranda Zea, Sasha Bunner, Nichole Wong, Elena Baskina, Amira Sheikh, Alessandro Tagliavia, Andriane Schmiedel Fucks, Andressa Schmiedel Sanches Santos, Lucas Ernesto Pavoski Poloni, Elielton Fucks, Yudit Bolotovsky and Sung Jin (Sam) Kang
Children 2025, 12(6), 793; https://doi.org/10.3390/children12060793 - 17 Jun 2025
Viewed by 332
Abstract
Background/Objectives: Three distinct language comprehension phenotypes have previously been identified in individuals with language deficits: (1) individuals with the Command Phenotype are limited to understanding simple commands; (2) individuals with the Modifier Phenotype demonstrate additional comprehension of combinations of nouns and adjectives; [...] Read more.
Background/Objectives: Three distinct language comprehension phenotypes have previously been identified in individuals with language deficits: (1) individuals with the Command Phenotype are limited to understanding simple commands; (2) individuals with the Modifier Phenotype demonstrate additional comprehension of combinations of nouns and adjectives; and (3) individuals with the Syntactic Phenotype possess full syntactic comprehension. We hypothesized that typically developing children progress through these same three language comprehension phenotypes and aimed to determine the typical age at which each phenotype emerges. Methods: To assess comprehension in young children, we developed the 15-item Language Phenotype Assessment (LPA). This tool uses toy-animal manipulatives to avoid reliance on picture interpretation and employs brief instructions to reduce auditory memory load. LPA items incorporate elements such as colors, sizes, numbers, spatial prepositions, and other syntactic components, posing novel combinations of words that children had not previously encountered. The LPA was administered to 116 typically-developing children aged 1.5–7 years, recruited by approaching parents in local parks and inviting them to participate. Results: Findings revealed a developmental trajectory consistent with the three previously described phenotypes: 50% of children attained the Command Phenotype by 1.6 years of age, the Modifier Phenotype by 3.0 years of age, and the Syntactic Phenotype by 3.7 years of age. All children acquired the Command Phenotype by 3, the Modifier Phenotype by 4, and the Syntactic Phenotype by 5 years of age. Conclusions: The LPA is an effective tool for assessing comprehension in children aged 1.5–5 years. It allows for the early identification of comprehension difficulties, supporting the timely initiation of appropriate language interventions. Full article
(This article belongs to the Section Pediatric Mental Health)
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13 pages, 976 KiB  
Article
From Inactivity to Activity: Passive Wheelchair Bike Rides Increase Trapezius Muscle Activity in Non-Ambulant Youth with Disabilities
by Lisa Musso-Daury, Celia García-Chico, Susana López-Ortiz, Saúl Peñín-Grandes, Diego del Pozo-González, Rosa Ana Sánchez-García, Laura Marín-Varela, Carmen Matey-Rodríguez and Alejandro Santos-Lozano
Children 2025, 12(6), 792; https://doi.org/10.3390/children12060792 - 17 Jun 2025
Viewed by 284
Abstract
Background/Objectives: Children at Gross Motor Function Classification System (GMFCS) levels IV and V experience severe motor impairments, yet the effects of passive wheelchair rides on their physiological parameters remain unexplored. This study aimed to examine the acute physiological response to passive bike [...] Read more.
Background/Objectives: Children at Gross Motor Function Classification System (GMFCS) levels IV and V experience severe motor impairments, yet the effects of passive wheelchair rides on their physiological parameters remain unexplored. This study aimed to examine the acute physiological response to passive bike in non-ambulant children with physical disabilities. Methods: This quasi-experimental study included 24 non-ambulant participants with cognitive impairments (6–21 years old, 50% female). After a 10-min rest, participants underwent a 10-min passive wheelchair bike. Muscle activity, oxygen consumption, and heart rate variability were assessed. Results: Passive bike rides significantly increased muscle activity in the right upper (p = 0.050), left upper (p = 0.008), and left lower trapezius (p = 0.038), with increases of 97–112%. However, no significant changes were observed in oxygen consumption or cardiorespiratory parameters. Conclusions: This study suggests that passive wheelchair bike rides increase trapezius muscle activity in children with severe disabilities at GMFCS levels IV and V, offering potential benefits for this population. Full article
(This article belongs to the Section Pediatric Neurology & Neurodevelopmental Disorders)
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8 pages, 361 KiB  
Brief Report
Impact of Absence Seizures on Physical Activity Levels in Children: A Cross-Sectional Study
by Martina Gnazzo, Valentina Baldini, Marco Carotenuto, Giulia Pisanò, Giovanni Messina, Fiorenzo Moscatelli and Maria Ruberto
Children 2025, 12(6), 791; https://doi.org/10.3390/children12060791 - 17 Jun 2025
Viewed by 239
Abstract
Background: Physical activity is essential for the physical and psychological development of children, contributing to both fitness and overall well-being. However, children with neurological conditions such as childhood absence seizures (CAE), a type of epilepsy characterized by brief episodes of impaired consciousness, may [...] Read more.
Background: Physical activity is essential for the physical and psychological development of children, contributing to both fitness and overall well-being. However, children with neurological conditions such as childhood absence seizures (CAE), a type of epilepsy characterized by brief episodes of impaired consciousness, may face barriers to participating in regular physical activities. This limitation can negatively affect their quality of life, motor coordination, and cognitive function. Despite this, there is limited research focusing on the physical activity levels of children with absence seizures in comparison to healthy children. Methods: This study aims to compare physical activity levels in children with absence seizures and healthy controls, using the Physical Activity Questionnaire for Children (PAQ-C), a validated tool for assessing children’s engagement in physical activity. The sample included 125 children with absence seizures and 125 healthy controls. The study also assessed anxious–depressive traits using the Children’s Depression Inventory (CDI-2) and the Multidimensional Anxiety Scale for Children (MASC-2). Additionally, seizure frequency and severity were documented for the seizure group, and the impact of different treatment regimens (levetiracetam, valproate, lamotrigine) was explored. Results: The results revealed that children with absence seizures exhibited lower physical activity levels compared to healthy children, although the difference did not reach statistical significance. Furthermore, they had higher scores for anxious–depressive traits. There were no significant differences in physical activity levels between the different treatment groups. The study also found that lower physical activity was correlated with poorer quality of life and increased psychological distress in the seizure group. Conclusion: Children with absence seizures face significant barriers to physical activity, which may be further compounded by psychological distress. These findings emphasize the need for targeted interventions to improve physical activity and address mental health concerns in this population. By enhancing physical activity levels and supporting psychological well-being, interventions can improve the quality of life and overall health of children with absence seizures. Additionally, the results highlight the importance of promoting inclusive physical activity programs for children with neurological conditions. Full article
(This article belongs to the Section Pediatric Neurology & Neurodevelopmental Disorders)
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15 pages, 249 KiB  
Article
Mouth Breathing and Orthodontic Referral in Pediatric Practice: A Cross-Sectional Survey
by Tulca Büyükpatır Türk, Barış Erkut Türk and Yeşim Kaya
Children 2025, 12(6), 790; https://doi.org/10.3390/children12060790 - 17 Jun 2025
Viewed by 252
Abstract
Objectives: Mouth breathing in children may lead to craniofacial anomalies such as maxillary constriction. Pediatricians play a crucial role in recognizing early signs and making timely referrals. This study aimed to evaluate the awareness of pediatricians regarding mouth breathing and its orthodontic [...] Read more.
Objectives: Mouth breathing in children may lead to craniofacial anomalies such as maxillary constriction. Pediatricians play a crucial role in recognizing early signs and making timely referrals. This study aimed to evaluate the awareness of pediatricians regarding mouth breathing and its orthodontic implications and to assess the impact of their treatment attitudes and clinical experience on referral practices. Methods: A 20-item online questionnaire was completed by 110 volunteer pediatricians from various regions of Türkiye via professional networks. The survey included items on awareness, treatment attitudes, referral behaviors, and demographics. Composite scores for awareness and orthodontic treatment attitude were calculated and included in the analysis. Data were analyzed using chi-square tests, Spearman correlation, and binary logistic regression. Results: Most pediatricians were aware of the link between mouth breathing and craniofacial issues (awareness rate: 73.6%), yet only 14.5% were familiar with specific orthodontic treatment approaches such as maxillary expansion. Although 70.9% expressed a desire for further training, only 25.5% reported frequently referring patients for orthodontic evaluation. Referral behavior was significantly associated with both clinical experience (p = 0.004) and orthodontic treatment attitude scores (p = 0.004) but not with awareness scores (p = 0.12). Conclusions: Although pediatricians in Türkiye demonstrate relatively high awareness regarding the consequences of mouth breathing, referral practices remain limited. Attitudinal orientation toward orthodontic treatment may play a more influential role in referral behavior than awareness alone. Full article
(This article belongs to the Section Pediatric Dentistry & Oral Medicine)
13 pages, 513 KiB  
Systematic Review
Adherence to the Mediterranean Diet and Its Association with Cognitive Function in Children and Adolescents: A Systematic Review of Observational Studies
by Guillermo García-Pérez-de-Sevilla and Rafael Zapata-Lamana
Children 2025, 12(6), 789; https://doi.org/10.3390/children12060789 - 17 Jun 2025
Viewed by 400
Abstract
Objectives: This study aimed to analyze the associations between cognitive functions and adherence to the Mediterranean diet (MedDiet) in children and adolescents. Methods: A systematic review was conducted in three databases: Pubmed, Scopus, and Web of Science. The inclusion criteria of the studies [...] Read more.
Objectives: This study aimed to analyze the associations between cognitive functions and adherence to the Mediterranean diet (MedDiet) in children and adolescents. Methods: A systematic review was conducted in three databases: Pubmed, Scopus, and Web of Science. The inclusion criteria of the studies were (i) population: healthy children or adolescents; (ii) exposure: adherence to the MedDiet; (iii) outcomes: cognitive performance; and (iv) study design: observational studies only. The quality of the studies was assessed through the Newcastle–Ottawa Scale. Results: This systematic review included 12 cross-sectional, observational studies including a total of 6378 children aged 4–17 years from different countries, analyzing diet characteristics and cognitive functions. The quality of the studies was high (Newcastle–Ottawa Scale mean score = 7.42). Positive associations were found between adherence to the MedDiet and multiple cognitive functions: memory, attention, creativity, language skills, and executive functions. However, the wide variety of instruments assessing the adherence to the MedDiet and cognitive functions did not allow us to perform a meta-analysis. Conclusions: he MedDiet should be further considered and promoted among children and adolescents, as it shows promise as a dietary pattern that may support cognitive development in youth. Full article
(This article belongs to the Topic Influence of Physical Activity, Nutrition, Educators and Parents on Children's Health Development)
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12 pages, 233 KiB  
Review
Recurrent Infections in Allergic Pediatric Patients: An Immune System Problem? A Narrative Review
by César Galván, Rafael Durán, Cristian Matos, Cristiana Indolfi and Angela Klain
Children 2025, 12(6), 788; https://doi.org/10.3390/children12060788 - 17 Jun 2025
Viewed by 320
Abstract
Background/Objectives: Recurring infections in children with allergies pose significant clinical challenges, with these conditions often exacerbating each other through complex immunological interactions. This narrative review examines the connection between recurring infections and allergic conditions in pediatric patients, focusing on how immune system dysfunction [...] Read more.
Background/Objectives: Recurring infections in children with allergies pose significant clinical challenges, with these conditions often exacerbating each other through complex immunological interactions. This narrative review examines the connection between recurring infections and allergic conditions in pediatric patients, focusing on how immune system dysfunction influences infection susceptibility in respiratory allergies. Methods: A comprehensive literature search across PubMed, Web of Science, and SciELO databases was conducted from January 2014 to May 2024. Studies involving children and adolescents up to 18 years old with diagnosed respiratory allergies were included, while reviews, opinion pieces, case reports, and studies not addressing immune–infection interactions were excluded. Results: Analysis reveals significant immune dysfunction in allergic children, affecting both innate and adaptive immunity components. Children with allergic rhinitis and asthma demonstrate decreased interferon-gamma production, increasing vulnerability to viral infections (particularly rhinovirus) and bacterial infections such as Mycoplasma pneumoniae. Rhinovirus represents the most common pathogen, present in 75% of asthma exacerbations. Atopic children exhibit markedly higher bacterial infection rates, with 27.1% showing Mycoplasma pneumoniae involvement versus 4.9% in non-atopic children. Conclusions: Recurring infections in allergic pediatric patients result from significant immune dysfunction involving altered cytokine production and immune cell function. These complex interactions highlight the need for targeted therapeutic approaches that enhance immune responses and reduce infection risks. Future research should focus on identifying specific biomarkers and immune mechanisms for developing more effective interventions. Full article
(This article belongs to the Special Issue Diagnosis, Treatment and Care of Pediatric Allergy)
15 pages, 523 KiB  
Article
The Role of Caregivers in Supporting Personal Recovery in Youth with Mental Health Concerns
by Denise B. McKern, Govind Krishnamoorthy, Vicki C. Dallinger, Diane Heart and Darryl Maybery
Children 2025, 12(6), 787; https://doi.org/10.3390/children12060787 - 17 Jun 2025
Viewed by 264
Abstract
Background/Objectives: Mental disorders that emerge during adolescence frequently extend into adulthood, predicting poor academic and employment outcomes and heavy societal burdens. Novel efforts to improve youth mental health have transitioned from clinical recovery, typically focused on a cure, to a strength-based approach to [...] Read more.
Background/Objectives: Mental disorders that emerge during adolescence frequently extend into adulthood, predicting poor academic and employment outcomes and heavy societal burdens. Novel efforts to improve youth mental health have transitioned from clinical recovery, typically focused on a cure, to a strength-based approach to wellbeing in supporting youth within mental health services. Mental health scholars have appealed for interventions to adopt an ecological system of care approach that integrates the principal caregivers in a young person’s life. Despite preliminary literature indicating the importance of caregivers, little research has focused on the caregiver’s role in supporting personal recovery in youth. Methods: This study sought to understand the role of caregivers in youth recovery by employing a qualitative design to inductively analyze the narratives from nine semi-structured interviews with caregivers. Additionally, deductive analysis explored the core five underpinnings of personal recovery connectedness, hope, identity, meaning, and empowerment (CHIME). Results: A thematic analysis of the literature identified five themes: providing unconditional love and positive regard; encouraging connection with peers; co-creating a sense of purpose, meaning, and hope; supporting assertiveness and advocacy; and promoting strength and opportunity for mastery aligning with the CHIME framework. The findings will allow health services to understand caregivers’ roles better, thus providing information to guide recovery-oriented and family-centered care. Full article
(This article belongs to the Special Issue Mental Health and Resilience in Young People Experiencing Childhood Adversity)
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14 pages, 1162 KiB  
Systematic Review
Hemodynamic Response to Tracheal Intubation Using Indirect and Direct Laryngoscopes in Pediatric Patients: A Systematic Review and Network Meta-Analysis
by Risa Takeuchi, Hiroshi Hoshijima, Masanori Tsukamoto, Shinichi Kokubu, Takahiro Mihara and Toshiya Shiga
Children 2025, 12(6), 786; https://doi.org/10.3390/children12060786 - 16 Jun 2025
Viewed by 330
Abstract
Purpose: Hemodynamic response, particularly increased heart rate (HR) and blood pressure, can occur during tracheal intubation and is an adverse event to be avoided. The aim of this study was to use a network meta-analysis (NMA) to develop a ranking of hemodynamic responses [...] Read more.
Purpose: Hemodynamic response, particularly increased heart rate (HR) and blood pressure, can occur during tracheal intubation and is an adverse event to be avoided. The aim of this study was to use a network meta-analysis (NMA) to develop a ranking of hemodynamic responses (HR and mean blood pressure, MBP) after intubation of indirect and direct laryngoscopes in pediatric patients. Method: Studies were eligible for inclusion if they had a prospective randomized design, compared hemodynamic response (HR and MBP) to tracheal intubation between indirect and/or direct laryngoscopes, and were conducted in pediatric patients. The pooled difference between each intubation device’s intubation time is expressed as a weighted mean difference (WMD) of a 95% confidence interval (CI). The intubation time of the device was evaluated using P-scores calculated from the network point estimates and standard errors. A random-effects model was used when pooling effect sizes. We also analyzed intubation time as a related factor to hemodynamic responses. Results: From the electronic databases, we selected 16 trials for review. In a Macintosh-referenced analysis, Airtraq suppressed an increase of HR and MBP during tracheal intubation in pediatric patients significantly more than a Macintosh laryngoscope. (HR; WMD = −16.7, 95%CI −22.5 to −10.9, MBP; WMD = −8.57, 95%CI −10.9 to −6.27). Airtraq also topped the HR and MBP P-score rankings. The results of this study showed similar laryngoscopes in the top five rankings of P-scores (Airtraq, Coopdech video laryngoscope, Miller, C-MAC, Wis-Hipple) for HR and intubation time. Conclusions: We applied a network meta-analysis to create a consistent ranking of intubation devices that prevent hemodynamic changes during tracheal intubation in pediatric patients. In this NMA, Airtraq proved to be the best laryngoscope for preventing hemodynamic responses during tracheal intubation in pediatric patients. In the analysis of intubation time, Airtraq showed the shortest intubation time. Full article
(This article belongs to the Section Pediatric Anesthesiology, Perioperative and Pain Medicine)
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10 pages, 514 KiB  
Article
Red Cell Distribution Width as a Predictive Biomarker for Early Lung Injury in Pediatric Patients Following Cardiopulmonary Bypass
by Hui Liu, Jie Cheng, Kaicheng Peng, Lin Chen, Zhenxuan Kong, Yan Zhao and Zhengxiu Luo
Children 2025, 12(6), 785; https://doi.org/10.3390/children12060785 - 16 Jun 2025
Viewed by 236
Abstract
Background: Red cell distribution width (RDW) has emerged as a prognostic biomarker in various clinical contexts. This retrospective study evaluated the predictive utility of RDW for cardiopulmonary bypass-associated acute lung injury (CPB-ALI) in pediatric patients undergoing cardiac surgery. Methods: A total of 166 [...] Read more.
Background: Red cell distribution width (RDW) has emerged as a prognostic biomarker in various clinical contexts. This retrospective study evaluated the predictive utility of RDW for cardiopulmonary bypass-associated acute lung injury (CPB-ALI) in pediatric patients undergoing cardiac surgery. Methods: A total of 166 children were enrolled and classified into CPB-ALI and non-ALI groups. Preoperative and postoperative RDW values were analyzed. Results: Postoperative RDW was significantly higher in the CPB-ALI group (15.40% vs. 13.78%, p < 0.001). Multivariate logistic regression identified postoperative RDW as an independent predictor of CPB-ALI (OR: 1.35, 95% CI: 1.10–1.64, p = 0.003). Receiver operating characteristic analyses yielded an AUC of 0.732, and restricted cubic spline analyses revealed a nonlinear association between RDW and CPB-ALI risks (p < 0.001). Higher postoperative RDW levels were positively correlated with prolonged mechanical ventilation duration, ICU stay, and total hospital stay (p < 0.001 for all). Conclusions: These findings suggest that postoperative RDW is a cost-effective and accessible biomarker for the early identification of CPB-ALI and may inform individualized perioperative management in pediatric cardiac surgery. Full article
(This article belongs to the Section Pediatric Cardiology)
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9 pages, 183 KiB  
Case Report
Sprains, Strains and Growing Pains: Managing Cognitive Bias to Facilitate Timely Diagnosis in Pediatric Sports Medicine
by Parker Scott, Leslie Sim, David Soma, Bo E. Madsen and Bjorg Thorsteinsdottir
Children 2025, 12(6), 784; https://doi.org/10.3390/children12060784 - 16 Jun 2025
Viewed by 264
Abstract
Background: Diagnostic delay and error represent pervasive problems in healthcare with grave implications for treatment and prognosis. Though characteristic of human cognition, cognitive biases commonly contribute to delays in the physician decision-making process, particularly in atypical or complex presentations in youth. Methods: We [...] Read more.
Background: Diagnostic delay and error represent pervasive problems in healthcare with grave implications for treatment and prognosis. Though characteristic of human cognition, cognitive biases commonly contribute to delays in the physician decision-making process, particularly in atypical or complex presentations in youth. Methods: We present a case series of three adolescent athletes with varied clinical presentations whose diagnostic conceptualization and treatment were delayed in part due to cognitive biases with consequences for overall health and development, as well as return to sport. Results: The first case depicts how an atypical presentation of celiac disease was attributed to growing pains, illustrating the contribution of anchoring bias and confirmation bias in medical decision making. The second case represents the misattribution of chronic exertional compartment syndrome pain to growing pains and post-exercise soreness, highlighting the influence of ascertainment bias on the initial misdiagnosis. The third case describes how a vertebral mass was misdiagnosed as a left shoulder strain from weightlifting, depicting the contribution of anchoring bias and ascertainment bias in medical decision making. Conclusions: Early recognition of cognitive biases, including confirmation bias, anchoring bias, and ascertainment bias, is crucial for improving medical decision making, particularly in cases of rare or atypical presentations, reducing unnecessary diagnostic delays, and setting more realistic patient expectations. Through discussion of these cases, we highlight concrete steps to manage bias to facilitate timely diagnosis within the primary care and sports medicine setting. Full article
(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)
18 pages, 541 KiB  
Review
Developmental-Centered Care in Preterm Newborns: Scoping Review
by Jina M. Velasco Arias, Aida M. Peres, Francisco M. Escandell Rico, M. Carmen Solano-Ruiz, Vicente F. Gil-Guillen and Ana Noreña-Peña
Children 2025, 12(6), 783; https://doi.org/10.3390/children12060783 - 16 Jun 2025
Viewed by 317
Abstract
Background/Objectives: Preterm newborns often require specialized care and management. However, exposure to multiple stimuli during hospitalization can adversely affect their neurological development. Developmental-centered care integrates evidence-based practices and neuroprotective strategies to create an optimal care environment that minimizes harmful stimuli in the neonatal [...] Read more.
Background/Objectives: Preterm newborns often require specialized care and management. However, exposure to multiple stimuli during hospitalization can adversely affect their neurological development. Developmental-centered care integrates evidence-based practices and neuroprotective strategies to create an optimal care environment that minimizes harmful stimuli in the neonatal intensive care unit (NICU) and supports the neurological development of preterm infants. To identify interventions related to developmental-centered care that support preterm newborns in the NICU. Methods: A scoping review was conducted following the guidelines of the Joanna Briggs Institute and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. A comprehensive search was performed in MEDLINE, CINAHL, and Web of Science databases. The results were categorized based on the general characteristics of the studies and the main interventions related to developmental-centered care. Results: Out of 163 potentially relevant sources identified, 19 studies met the inclusion criteria. A total of 52 interventions were identified and classified into three thematic categories related to the benefits of the kangaroo care method, the family-centered care model, and the neonatal individualized developmental care and assessment program. Conclusions: The findings underscore the importance of integrating developmental-centered care practices, such as skin-to-skin contact, specialized feeding, and active parental involvement, into clinical practice to support neurodevelopment and improve health outcomes in preterm infants. Full article
(This article belongs to the Section Pediatric Neonatology)
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13 pages, 4749 KiB  
Review
A Staged Biventricular Approach Combining the Starnes and Cone Procedures in Ebstein’s Anomaly: A Case Report and Literature Review
by Paul Linnenbank, Daniel Biermann, Eike Philipp Schneider, Ida Hüners, Nora Lang, Fridrike Stute, Thomas S. Mir, Michael Hübler, Rainer Kozlik-Feldmann and Jakob Olfe
Children 2025, 12(6), 782; https://doi.org/10.3390/children12060782 - 16 Jun 2025
Viewed by 230
Abstract
Background: Severe neonatal Ebstein’s anomaly (EA) is associated with a high risk of mortality. A new therapeutic approach aims to combine the advantages of Starnes’ procedure in stabilizing critically ill neonates with the long-term superiority of biventricular physiology after cone reconstruction. Case report [...] Read more.
Background: Severe neonatal Ebstein’s anomaly (EA) is associated with a high risk of mortality. A new therapeutic approach aims to combine the advantages of Starnes’ procedure in stabilizing critically ill neonates with the long-term superiority of biventricular physiology after cone reconstruction. Case report: The echocardiography of a male preterm (36 weeks’ gestation; birth weight 2400 g) demonstrated EA Carpentier type C, membranous pulmonary atresia, and hypoplastic pulmonary arteries (PAs). After undergoing the Starnes procedure postnatally, multiple dilatations of the AP shunt and the Starnes fenestration followed. Cone reconstruction was performed at 15 months of age. Surgical revision addressed tricuspid and pulmonary valve insufficiency and PA bifurcation stenosis. Subsequently, PA branch stenosis with severe impairment of right ventricular function and dilatation required stent implantation. At the last follow-up, at 3 years of age, the patient was asymptomatic with sufficient exercise tolerance. Discussion: The American Association for Thoracic Surgery recently recommended evaluating all Starnes patients for potential conversion to cone. Consequently, the Starnes procedure should be modified to facilitate subsequent biventricular correction. Both the optimal timing of conversion and the appropriate assessment to reliably evaluate feasibility and the prospects for success require further investigation. Conclusions: Conversion from Starnes to cone is technically feasible, even in cases of severe EA, prematurity, low birth weight, and additional cardiac comorbidities, and provides promising initial results. Further research is needed to define candidacy and the optimal timing of conversion, and to assess long-term outcomes. The high therapeutic effort and complexity make this treatment approach suitable only for quaternary centers. Full article
(This article belongs to the Special Issue Current Developments and Future Trends in Congenital Heart Diseases Interventional Cardiology and Cardiac Surgery)
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17 pages, 360 KiB  
Review
Influence of Sensory Needs on Sleep and Neurodevelopmental Care in At-Risk Neonates
by Axel Hübler
Children 2025, 12(6), 781; https://doi.org/10.3390/children12060781 - 16 Jun 2025
Viewed by 453
Abstract
Objective: The development of a normal sleep–wake rhythm in the first weeks of life depends on the physiological sensory needs of the newborn as well as the environment surrounding them. This includes, for example, avoiding pain, exposure to bright light at night and [...] Read more.
Objective: The development of a normal sleep–wake rhythm in the first weeks of life depends on the physiological sensory needs of the newborn as well as the environment surrounding them. This includes, for example, avoiding pain, exposure to bright light at night and high noise levels. In high-risk newborns, this process can be influenced by immaturity of the central and peripheral nervous systems, therapeutic strategies and the work organization of an intensive care unit. Methods: This study used a narrative review to examine the literature on the interrelationship of sensory modalities on sleep–wake behavior in the context of neonatal intensive care. The current Cochrane reviews on cycled lighting’s effect on premature infants’ circadian rhythm development and noise or sound management in the neonatal intensive care unit, as well as the World Health Organization (WHO) global position paper on kangaroo mother care, were included. Results: An extensive body of literature relates to fetal and neonatal development of the five sensory modalities: touch, taste, smell, hearing and sight. In contrast, there is a lack of evidence regarding the choice of optimal lighting and suitable measures for noise reduction. Since 2023, the WHO has recommended that, from the moment of birth, every “small and sick” newborn should remain in skin-to-skin contact (SSC) with their mother. Developmental support pursues a multimodal approach with the goal of fostering early parent–child bonding, including the child’s needs and environmental conditions. Discussion: The implementation of early SSC and attention to the sleep–wake cycle require systemic changes in both the obstetric and neonatal settings to ensure seamless perinatal management and subsequent neonatal intensive care. Since there is a lack of evidence on the optimal sensory environment, well-designed, well-conducted and fully reported randomized controlled trials are needed that analyze short-term effects and long-term neurodevelopmental outcomes. Full article
(This article belongs to the Special Issue Current Advances in Paediatric Sleep Medicine)
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16 pages, 8040 KiB  
Review
Tetralogy of Fallot: The Burden of Pulmonary Atresia in the NICU Set-Up: Two Case Reports and a Literature Review
by Ion Dragomir, Diana Iulia Vasilescu, Adriana Mihaela Dan, Diana Voicu, Sorin Liviu Vasilescu, Laura Andreea Stefan, Alin Nicolescu and Monica Mihaela Cîrstoiu
Children 2025, 12(6), 780; https://doi.org/10.3390/children12060780 - 14 Jun 2025
Viewed by 491
Abstract
Tetralogy of Fallot (ToF) with pulmonary atresia (PA) and complete right ventricular outflow tract obstruction (RVOTO) represents one of the most critical forms of congenital heart disease in neonates. These cases require complex and timely interventions to ensure survival and optimize long-term outcomes. [...] Read more.
Tetralogy of Fallot (ToF) with pulmonary atresia (PA) and complete right ventricular outflow tract obstruction (RVOTO) represents one of the most critical forms of congenital heart disease in neonates. These cases require complex and timely interventions to ensure survival and optimize long-term outcomes. While surgical correction offers a favorable prognosis, the period from birth to surgery is often marked by significant hemodynamic, respiratory and nutritional challenges, particularly in neonatal intensive care units (NICUs). This study aims to outline a structured, physiology-guided approach to the preoperative management of neonates with ToF and complete RVOTO, emphasizing stabilization strategies, hemodynamic support, ventilatory management and nutritional optimization. We performed a focused literature review of practices in neonatal ToF management and illustrated our experience through two case reports highlighting divergent outcomes in infants with the same anatomical diagnosis. The management strategies covered include delivery room stabilization, the use of prostaglandins, mechanical ventilation techniques, nutritional interventions and the timing of surgical intervention. A phased, physiology-guided management strategy is the key to the successful preoperative treatment of ToF with pulmonary atresia. Optimizing hemodynamics, ensuring adequate pulmonary blood flow and supporting nutritional needs are the main drivers for growth and may reduce the time from diagnosis to surgical correction. Full article
(This article belongs to the Special Issue Ultrasonography Interventions in Neonatal and Perinatal Medicine)
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23 pages, 290 KiB  
Article
Assessment of Romanian School-Aged Children’s Lifestyle and Associated Factors: A Longitudinal Study Performed Before and During COVID-19 Pandemic
by Lucia Maria Lotrean, Anda Valentina Trandafir and Florina Gabor-Harosa
Children 2025, 12(6), 779; https://doi.org/10.3390/children12060779 - 14 Jun 2025
Viewed by 269
Abstract
Background and Objectives: The COVID-19 pandemic affected children’s lifestyle, due to strict lockdown restrictions. This study evaluated Romanian children’s lifestyle prior to and during the pandemic and their associated factors. Materials and Methods: A longitudinal study was performed in 7 urban schools from [...] Read more.
Background and Objectives: The COVID-19 pandemic affected children’s lifestyle, due to strict lockdown restrictions. This study evaluated Romanian children’s lifestyle prior to and during the pandemic and their associated factors. Materials and Methods: A longitudinal study was performed in 7 urban schools from Romania. Data were gathered at baseline (T1), from October to November 2019, and follow-up (T2), from December 2020 to February 2021. Results: A total of 880 children were enrolled at baseline, 484 at T2, and 350 in both evaluations. Initially, 66.3% did not perform at least one hour of physical activity per day, two thirds did not sleep at least 9 h per night during the week, and more than one third used the internet more than 2 h daily. Investigating changes before and during COVID-19 among students participating at both evaluations, a statistically significant drop in physical activity and sleep time during the week was recorded, while weekend sleep and internet use increased. Several gender- and age-related differences were noted. Physical activity and sleep patterns as well as internet use behavior at T1 predicted the same behavior at T2. Reduced sleep during the week and internet overuse were positively associated at both waves as well as longitudinally. Conclusions: These findings highlight calls for combined strategies that include parents, schools, and community, aiming to enhance a healthier lifestyle among children. Full article
(This article belongs to the Special Issue Childhood and Teenage Learning, Lifestyle, Health Factors and Physical Activity in Children)
13 pages, 490 KiB  
Article
Clinical Significance of the 5T;12TG Genotype in Pediatric CFSPID: A Retrospective Study
by Ana Morales-Tirado, Enrique Blitz-Castro, Saioa Vicente-Santamaría, Carmen Luna-Paredes, Enrique Salcedo-Lobato, Ana Tabares-González, Celia Gascón-Galindo, Simon Boutry and Adelaida Lamas-Ferreiro
Children 2025, 12(6), 778; https://doi.org/10.3390/children12060778 - 14 Jun 2025
Viewed by 297
Abstract
Background: One of the most common genetic variants among individuals with cystic fibrosis screen-positive inconclusive diagnosis (CFSPID) is 5T;12TG. Classified as having “varying clinical consequences” (VVCC), it may produce a wide spectrum of CF phenotypes when combined in trans with a pathogenic variant [...] Read more.
Background: One of the most common genetic variants among individuals with cystic fibrosis screen-positive inconclusive diagnosis (CFSPID) is 5T;12TG. Classified as having “varying clinical consequences” (VVCC), it may produce a wide spectrum of CF phenotypes when combined in trans with a pathogenic variant on the other CFTR allele, ranging from asymptomatic cases to CFTR-related disorders (CFTR-RD) or classical cystic fibrosis (CF). The 5T;12TG variant is currently eligible for modulator treatment in the United States. Methods: We conducted a retrospective analysis of CFSPID children born between July 2009 and June 2023 in the Community of Madrid (Spain) who carried at least one 5T;12TG variant in trans with another CFTR variant. Data collected included trends in sweat chloride (SC) values, respiratory and digestive symptoms, lung function by spirometry, microbiological findings in nasopharyngeal aspirates, anthropometric data, and fecal elastase levels. Results: Twenty-one children (52.3% females; median age: 4.66 years [IQR 3.6–6.9]) were included. Eighteen had 5T;12TG in trans with a CF-causing variant (CFc), two had another VVCC variant, and one had a variant of unknown significance (VUS). After a median follow-up of 3.45 years [IQR 1.4–4.3], all the children remained asymptomatic. However, SC values rose to intermediate levels in nine (42.8%) of the children. No isolates of Pseudomonas aeruginosa were identified. Lung function and pancreatic markers remained normal. Conclusions: This is the first Spanish cohort of children with CFSPID and the 5T;12TG allele. Although clinical symptoms did not manifest during childhood, the SC value increased to intermediate values in 42.8% of the cohort, so these may require long-term follow-up to observe conversions to CFTR-RD or CF. The potential initiation of modulator therapy based solely on SC levels or emerging symptoms warrants careful consideration. Full article
(This article belongs to the Section Pediatric Pulmonary and Sleep Medicine)
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Article
Nationwide Prevalence of Dental Caries in Turkish Children: A Meta-Analysis
by Ezgi Eroğlu Çakmakoğlu and Ayşe Günay
Children 2025, 12(6), 777; https://doi.org/10.3390/children12060777 - 14 Jun 2025
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Abstract
Objectives: This meta-analysis aims to estimate the pooled prevalence of dental caries among children in Turkey by synthesizing national evidence from theses and peer-reviewed articles published between 2000 and 2024. Methods: Studies were retrieved from the YÖK Thesis Database and Google [...] Read more.
Objectives: This meta-analysis aims to estimate the pooled prevalence of dental caries among children in Turkey by synthesizing national evidence from theses and peer-reviewed articles published between 2000 and 2024. Methods: Studies were retrieved from the YÖK Thesis Database and Google Scholar using keywords such as ‘Caries Prevalence’ and ‘Primary Tooth.’ PubMed was used to cross-check peer-reviewed articles. A total of 28 studies and 29 data points including 40,244 children aged approximately 2 to 15 years were included. PRISMA guidelines were followed. Heterogeneity was assessed using the I2 index, and publication bias was evaluated with an Egger’s test and funnel plots. Results: The pooled prevalence of dental caries among Turkish children was 75.6% (95% CI: 70.8–79.8%). Substantial heterogeneity was observed (I2 = 98.4%), but no significant publication bias was detected. Conclusions: Dental caries remains a significant public health issue among children in Turkey. Targeted preventive measures—such as nationwide dental screenings and school-based fluoride programs—are urgently needed. Full article
(This article belongs to the Section Pediatric Dentistry & Oral Medicine)
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