Children

15 pages, 590 KiB

Open AccessArticle

Sex/Gender Differences in the Effects of Childhood Abuse on Future Risk of Depression: Longitudinal Evidence from the Global Flourishing Study

by Shervin Assari, Babak Najand and Alexandra Donovan

Children 2025, 12(6), 754; https://doi.org/10.3390/children12060754 (registering DOI) - 11 Jun 2025

Abstract

Background: Adverse childhood experiences (ACEs) such as abuse (defined as emotional, physical, or sexual abuse without distinguishing type or severity) have long been linked to mental health challenges in adulthood. However, less is known about how these effects differ by sex/gender in global [...] Read more.

Background: Adverse childhood experiences (ACEs) such as abuse (defined as emotional, physical, or sexual abuse without distinguishing type or severity) have long been linked to mental health challenges in adulthood. However, less is known about how these effects differ by sex/gender in global samples, particularly using large-scale, multi-country panel data. Objectives: To examine whether the long-term association between childhood abuse and changes in depressive symptoms during adulthood differ between men and women, after adjusting for demographic and socioeconomic factors. Methods: We conducted a secondary analysis of Waves 1 and 2 of the Global Flourishing Study (GFS), a longitudinal panel study covering 22 diverse countries. The sample included adult participants with complete data on childhood abuse (yes/no); depression at baseline and follow-up; sex/gender; and relevant covariates (age; education; marital status; immigration status; smoking status; and employment). Depression was measured using a two-item scale. Multi-group structural equation models were used to test the effect of ACE on changes in depression over time where groups were defined based on sex/gender. Results: Overall, childhood abuse was associated with a statistically significant increase in depression scores between Wave 1 and Wave 2. This association was significant among women but not among men. Conclusions: Our findings suggest that the mental health consequences of childhood abuse extend into adulthood and disproportionately affect women. These sex/gender differences may reflect variations in stress processing; coping; and social roles. Interventions addressing early adversity may need to be tailored to recognize and respond to such sex/gender-specific vulnerabilities. Full article

(This article belongs to the Special Issue Adverse Childhood Experiences: Assessment and Long-Term Outcomes)

► Show Figures

Figure 1

18 pages, 476 KiB

Open AccessArticle

Health Behavior of Young People Aged 12–18 with Autism Spectrum Disorder and Intellectual Disabilities in Hungary

by Ágota Barabás, Renáta J. Erdei, Mariann Móré, Viktória Pázmány, Attila Sárváry, Emil Toldy-Schedel, Anita M. Grestyák, Attila Csaba Nagy, Orsolya P. Kiss and Péter Takács

Children 2025, 12(6), 753; https://doi.org/10.3390/children12060753 - 10 Jun 2025

Abstract

Introduction: People with disabilities are characterized by suboptimal health and lower self-rating health. Their need for health care is greater, they often have a higher prevalence of health problems and they have more difficulty accessing health care. The aim of this study was [...] Read more.

Introduction: People with disabilities are characterized by suboptimal health and lower self-rating health. Their need for health care is greater, they often have a higher prevalence of health problems and they have more difficulty accessing health care. The aim of this study was to assess the health behaviors and health indicators of 12–18-year-old young people with intellectual disabilities and autism spectrum disorder, and to explore their school-related perceptions in the Northern Great Plain region of Hungary. Materials and Methods: A cross-sectional questionnaire survey was conducted with the participation of 185 young people. A custom questionnaire was used, based on the Health Behavior in School-aged Children (HBSC) survey, assessing eating habits, oral care, physical activity, mental well-being, and self-reported health status. The sample was categorized into three groups: the ID1 (Intellectual Disability level 1) group, encompassing young individuals with mild intellectual disability; the ID2 group, encompassing young people with moderate intellectual disability; and the ID+ASD group, encompassing young individuals affected by both intellectual disability and autism spectrum disorder. Results: Consumption of various food types was below optimal levels. Low intake of fruits and vegetables was common, with only 21.6% of the respondents consuming fruit daily and 23.8% consuming vegetables daily. ID1 group reported significantly higher rates of nervousness several times a week (17.8% vs. 5.6% and 6.9%, p < 0.001), sleep difficulties (28.8% vs. 7.4% and 15.5%, p = 0.032), and dizziness (9.6% vs. 1.9% and 3.4%, p = 0.022) compared to the other two groups. A third school-related factor, related to negative emotions, showed a near-significant difference (p = 0.064), suggesting that students with both autism spectrum disorder and intellectual disability perceive lower levels of acceptance from teachers. On school-free days, computer usage was significantly highest in the ID+ASD group; 50% of them used a computer for at least 4 h per day. Conclusion: To improve mental well-being among affected children, psychological support and the implementation of mental health programs are recommended. In addition to teaching stress management techniques and coping mechanisms, integrating relaxation techniques into comprehensive developmental programs—both individually and in groups—is advised. For teachers, it is recommended to acquire disability-specific communication strategies. Full article

(This article belongs to the Special Issue Health Behaviour, Health Literacy and Mental Health in Children: 2nd Edition)

9 pages, 4551 KiB

Open AccessArticle

Pediatric Heterotopic Gastric Mucosa of the Cervical Esophagus (Inlet Patch): Case Series with Clinical, Endoscopic, and Histopathological Correlation

by Javier Arredondo Montero, Samuel Sáez Álvarez, Andrea Herreras Martínez, Ana Fernández-García and Cristina Iglesias Blázquez

Children 2025, 12(6), 752; https://doi.org/10.3390/children12060752 - 10 Jun 2025

Abstract

Introduction: Inlet patch (IP) is a congenital anomaly characterized by gastric heterotopia in the cervical esophagus. While extensively described in adults, it remains poorl characterized in pediatric populations. Material and Methods: This retrospective, single-center study included all pediatric patients (0–14 years) diagnosed with [...] Read more.

Introduction: Inlet patch (IP) is a congenital anomaly characterized by gastric heterotopia in the cervical esophagus. While extensively described in adults, it remains poorl characterized in pediatric populations. Material and Methods: This retrospective, single-center study included all pediatric patients (0–14 years) diagnosed with IP between 2018 and 2025. Sociodemographic and clinical data were collected. A blinded pathologist assessed the presence and severity of inflammation within the IP. Results: Nine patients (median age, 12 years; range, 6–14 years) were included, with 78% beingmale. Cervical esophageal symptoms were identified in 67%, primarily dysphagia and gastroesophageal reflux disease-related complaints, although concomitant conditions such as eosinophilic esophagitis were frequently present. Three patients had symptoms potentially attributable to IP (33%). Endoscopic examination revealed characteristic well-demarcated salmon-red plaques in all patients, with multiple lesions observed in three cases. Histology confirmed gastric heterotopia with varying degrees of chronic inflammation in all cases. A potential association was observed between the severity of gastritis in the stomach, the severity of inflammation in the IP, and the presence of H. pylori, with 75% of patients with moderate-to-severe IP inflammation also exhibiting gastric H. pylori-associated gastritis. All patients except one received proton pump inhibitors, and symptoms improved in all cases. Conclusions: A thorough and targeted examination of the cervical esophagus significantly increased IP detection at our center, with most cases (89%) being diagnosed in the last 12 months. While mostly asymptomatic and incidental, IP can be symptomatic. In this case, series, we found a possible association between the severity of inflammation in the IP, the severity of gastritis, and the presence of H. pylori. Further studies are needed to define the clinical significance of pediatric IP and optimal management. Full article

(This article belongs to the Special Issue Advances in Pediatric Gastroenterology)

► Show Figures

Figure 1

10 pages, 198 KiB

Open AccessArticle

The Use of Vasodilator Therapy in Fontan Patients: A Single-Centre Experience

by Alessia Faccini, Martina Avesani, Roberta Biffanti, Elettra Pomiato, Domenico Sirico, Alice Pozza, Alessia Cerutti, Elena Reffo, Biagio Castaldi and Giovanni Di Salvo

Children 2025, 12(6), 751; https://doi.org/10.3390/children12060751 - 10 Jun 2025

Abstract

Background: The aim of this study was to describe our centre experience in the use of pulmonary vasodilator therapy in Fontan patients. Methods: We retrospectively enrolled patients that underwent Fontan operation between 2000 and 2024, reporting demographic and operative data and noting complications [...] Read more.

Background: The aim of this study was to describe our centre experience in the use of pulmonary vasodilator therapy in Fontan patients. Methods: We retrospectively enrolled patients that underwent Fontan operation between 2000 and 2024, reporting demographic and operative data and noting complications and the use of pulmonary vasodilators. Results: A total of 117 patients were followed for a median time of 150 months (90–207). In total, 36.7% were female, and the median age during the intervention was 50 months (37–64), and 53% had a single left ventricle physiology. In 20 of these 117 patients (17.1%), at least one pulmonary vasodilator drug was used during their life for the following reasons: 6 elevated pressures in the circuit, 3 low oxygen saturation, 2 plastic bronchitis, 2 pleural effusion, 1 chylothorax, 1 persistent pericardial effusion, 1 haemoptysis, 1 protein losing enteropathy, 1 poor exercise tolerance, 1 pulmonary arterial hypertension present since birth and 1 diastolic dysfunction. They had a significantly higher prevalence of single right ventricle physiology (65% vs. 37%, p = 0.03), pulmonary hypertension (60% vs. 0, p = 0.0001), plastic bronchitis (10% vs. 0, p = 0.03) and declivous oedema in the follow-up period (10% vs. 0, p = 0.03), with a higher assumption of warfarin (35% vs. 6.2%, p = 0.001). Conclusions: We found that in the absence of a standardise protocol, we usually use pulmonary vasodilator therapy in Fontan patients, as it is guided by clinical aspects and hemodynamic conditions, which lead us to start and stop this therapy. Full article

(This article belongs to the Section Pediatric Cardiology)

14 pages, 559 KiB

Open AccessReview

Significance of Oral Care for Children with Autism Spectrum Disorder—A Narrative Literature Review

by Sirma Angelova, Desislava Konstantinova, Anna Nenova-Nogalcheva and Rouzha Pancheva

Children 2025, 12(6), 750; https://doi.org/10.3390/children12060750 - 9 Jun 2025

Abstract

Background: Autism spectrum disorder (ASD) is a neurodevelopmental condition in children that typically involves challenges in cognition, behavior, and communication. While many children with ASD exhibit significant impairments in both verbal and non-verbal communication, the severity and nature of these difficulties can vary [...] Read more.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental condition in children that typically involves challenges in cognition, behavior, and communication. While many children with ASD exhibit significant impairments in both verbal and non-verbal communication, the severity and nature of these difficulties can vary widely. In addition to its impact on overall health, ASD also affects oral health, leading to increased vulnerability to dental disease. Aim: This narrative review aims to summarize key oral health challenges and care strategies for children with ASD, focusing on clinical risks, behavioral barriers, caregiver roles, and effective interventions. Materials and Methods: A comprehensive literature search was conducted using four databases—PubMed, Scopus, Web of Science, and Google Scholar—as well as relevant study registries where applicable. Peer-reviewed articles published in English between 2010 and 2024 were identified using keywords and their synonyms, such as autism spectrum disorder, children, oral care, dental practitioners, and parents. Studies were included based on relevance to oral health challenges and interventions in children diagnosed with ASD. Results: Children with ASD experience a range of sensory sensitivities, attention deficits, hyperactivity, and behavioral resistance, which significantly hinder the performance of adequate oral hygiene practices. These challenges contribute to a lack of effective dental prophylaxis and limited access to regular preventive care, ultimately resulting in poorer oral health outcomes and reduced oral health-related quality of life. Conclusion: Due to the multifaceted characteristics of ASD, children with this condition face significant barriers in accessing appropriate and individualized oral care. This increases their risks of developing oral health disorders, underscoring the need for coordinated efforts between caregivers and dental professionals to improve oral health outcomes in this vulnerable population. Full article

(This article belongs to the Section Pediatric Dentistry & Oral Medicine)

► Show Figures

Figure 1

14 pages, 345 KiB

Open AccessArticle

Construct Validity and Internal Consistency of the Italian Version of the PedsQL^TM 4.0 Generic Core Scale and PedsQL^TM 3.0 Cerebral Palsy Module

by Ilaria Pedrinelli, Sofia Biagi, Domenico Marco Romeo, Elisa Musto, Valeria Fagiani, Martina Lanza, Erika Guastafierro, Alice Colombo, Andrea Giordano, Cristina Montomoli, Cristiana Rezzani, Tiziana Casalino, Eugenio Mercuri, Daria Riva, Matilde Leonardi, Giovanni Baranello and Emanuela Pagliano

Children 2025, 12(6), 749; https://doi.org/10.3390/children12060749 - 9 Jun 2025

Abstract

Background: Health-related quality of life (HRQoL) has emerged as a meaningful outcome measure in clinical trials and healthcare interventions in children with cerebral palsy (CwCP). We assessed the construct validity and internal consistency of the Italian version of the Paediatric QoL inventory (PedsQL [...] Read more.

Background: Health-related quality of life (HRQoL) has emerged as a meaningful outcome measure in clinical trials and healthcare interventions in children with cerebral palsy (CwCP). We assessed the construct validity and internal consistency of the Italian version of the Paediatric QoL inventory (PedsQL^TM) 4.0 Generic Core Scales (GCS) and PedsQL^TM 3.0 Cerebral Palsy Module (CPM). Methods: A total of 125 CwCP and their parents were enrolled. Participants completed both the GCS and the CPM modules, and the results were compared to those of a sample of 121 healthy peers and their parents. The dimensionality of the two modules was assessed through exploratory factor analysis. Construct validity was assessed by a known-groups method evaluating the differences between CwCP and healthy sample. Results: Only a few GCS subscales were unidimensional, while all CPM subscales proved to be unidimensional, except for the Speech and Communication subscales of child self-reports. GCS internal consistency was good for all subscales of the parent proxy-reports, as well as for the Physical Activities and Psychosocial Health subscales of child self-reports. CPM internal consistency was good for both parent proxy-reports and—with a few exceptions—child self-reports. As for the PedsQL^TM validity, the GCS proved effective in discriminating between CwCP and healthy participants; the CPM showed a significant association between lower neurofunctional abilities and lower HRQoL. Parent–child concordance shows that child self-report scores were always higher than the those of the proxy-reports for both the GCS and CPM modules. Conclusions: The present study confirms the internal consistency and construct validity of the Italian version of both PedsQL^TM modules. In CwCP, greater functional disability resulted in lower HRQoL scores, and there was significant discrepancy between the parent and child ratings. Full article

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

► Show Figures

Figure 1

10 pages, 612 KiB

Open AccessArticle

Role of Combined Use of Adiponectin and hsCRP in Cardiovascular Risk in Pediatric Neurogenic Bladder

by Joanna Bagińska-Chyży, Alicja Szymańska and Agata Korzeniecka-Kozerska

Children 2025, 12(6), 748; https://doi.org/10.3390/children12060748 - 9 Jun 2025

Abstract

Background/Objectives: Myelomeningocele (MMC) is the most severe form of spina bifida, often accompanied by impaired motor function due to paralysis of the lower limbs, as well as neurogenic bladder (NB). These factors may contribute to nutritional disorders and cardiovascular diseases (CVDs) in the [...] Read more.

Background/Objectives: Myelomeningocele (MMC) is the most severe form of spina bifida, often accompanied by impaired motor function due to paralysis of the lower limbs, as well as neurogenic bladder (NB). These factors may contribute to nutritional disorders and cardiovascular diseases (CVDs) in the future. High-sensitivity CRP (hsCRP) is a positive marker of unstable atherosclerotic plaques and is commonly used in the diagnosis of CVDs. Adiponectin has an opposite, anti-inflammatory function. The aim of this study was to assess the risk of CVDs in a group of children with NB and a control group, based on serum levels of adiponectin, hsCRP, and lipid profiles. Methods: A prospective clinical estimation based on 87 children (67 NB, 20 control group) was conducted. Data collected from medical histories included the following: sex, age, anthropometric parameters (height, weight, BMI), level of spinal lesion, and activity according to Hoffer’s scale. Lipid profile values (cholesterol, HDL, LDL, triglycerides) were assessed using standard blood sample tests. hsCRP and adiponectin were measured using an ELISA kit. Results: A comparison of adiponectin and hsCRP levels revealed statistically significant differences between the NB group and the control. Additionally, significant correlations were identified between BMI and the biomarkers: hsCRP was positively associated with BMI, whereas adiponectin exhibited a negative association. The highest concentrations of hsCRP were detected in MMC patients with a Th lesion level and in non-walker patients. Conclusions: Elevated hsCRP may reflect increased cardiovascular risk in children with NB. While adiponectin levels were also altered, their association with cardiovascular risk appears more complex and may involve additional metabolic mechanisms. Full article

(This article belongs to the Section Pediatric Nephrology & Urology)

► Show Figures

Figure 1

18 pages, 8380 KiB

Open AccessFeature PaperArticle

Sudden Infant Death Syndrome Mortality Trends and Socioeconomic Inequalities Worldwide: Evidence from the Global Burden of Disease Study

by Ze Tang, Ziwei Wang and Xinbao Wang

Children 2025, 12(6), 747; https://doi.org/10.3390/children12060747 - 9 Jun 2025

Abstract

Background: Sudden Infant Death Syndrome (SIDS) remains an important global health concern despite its decline in recent decades. This research assesses the global, regional, and national tendencies in SIDS mortality and DALYs from 1991 to 2021, highlighting the differences across various sociodemographic indexes [...] Read more.

Background: Sudden Infant Death Syndrome (SIDS) remains an important global health concern despite its decline in recent decades. This research assesses the global, regional, and national tendencies in SIDS mortality and DALYs from 1991 to 2021, highlighting the differences across various sociodemographic indexes (SDIs). Methods: Utilizing data from the Global Burden of Disease (GBD) study 2021, SIDS mortality and DALYs were evaluated across different global regions, SDI categories, and age groups. The trends over the study period were determined by conducting estimated annual percentage change (EAPC) analyses. Results: Between 1991 and 2021, the global SIDS mortality rate reduced greatly from 74,782 deaths (58.72 per 100,000 infants) to 30,608 deaths (24.16 per 100,000 infants), showing an EAPC of −3.01%. Similarly, the global DALYs decreased from 6,710,608 to 2,746,174. The biggest decline (EAPC: −5.25%) occurred in the high-SDI regions, whereas the low-SDI regions displayed a minimal decline (EAPC: −2.74%). Infants who were 1–5 months old uniformly had the highest mortality and DALY rates. Gender differences persisted, with larger rates discovered among males. The regional differences remained prominent, with the low-SDI states experiencing a much higher burden. Conclusions: Although there have been remarkable global advancements, great differences in the SIDS burden persist, mainly boosted by socioeconomic unfairness and healthcare access. Improved targeted interventions mitigating these modifiable risks and enhancing healthcare infrastructure in low-SDI regions are the keys to further reducing the global SIDS burden. Full article

(This article belongs to the Special Issue Children's Public Health and Healthcare: Global Perspective and New Trends)

► Show Figures

Figure 1

24 pages, 592 KiB

Open AccessArticle

Development of a Clinical Risk Assessment Score for Respiratory Distress Due to Respiratory Infections in Early Infancy

by Cristina Elena Singer, Cristina Popescu, Diana-Maria Trasca, Renata-Maria Varut, Rebecca-Cristiana Serban, Jaqueline Abdul-Razzak and Virginia-Maria Radulescu

Children 2025, 12(6), 746; https://doi.org/10.3390/children12060746 - 9 Jun 2025

Abstract

Background/Objectives: Neonatal and infant respiratory distress carries high morbidity, and severity can vary with gestational maturity and perinatal factors. Early risk stratification may improve outcomes, but existing assessment tools do not fully address age-related risk differences. We aimed to develop and validate a [...] Read more.

Background/Objectives: Neonatal and infant respiratory distress carries high morbidity, and severity can vary with gestational maturity and perinatal factors. Early risk stratification may improve outcomes, but existing assessment tools do not fully address age-related risk differences. We aimed to develop and validate a Neonatal Clinical Risk Assessment Score (N-CRAS) for predicting severity in neonates and young infants with respiratory distress due to respiratory infection. Methods: This pilot score was applied exclusively to a cohort of forty neonates and young infants with respiratory distress secondary to infectious causes, as defined by clinical and laboratory parameters. Clinical variables (gestational age, delivery mode, birth weight category, and APGAR score) were recorded and analyzed for associations with illness severity. We developed the N-CRAS (0–5 points) encompassing five indicators of severe illness (respiratory infection, metabolic disorder, need for symptomatic treatment, mechanical ventilation, and intubation), each contributing 1 point. Patients were stratified as low (0–1), moderate (2–3), or high (4–5) risk. Chi-square tests and Spearman correlation assessed associations, and an ROC curve evaluated the score’s predictive performance for intubation. Results: No individual perinatal factor was significantly associated with respiratory illness severity. The N-CRAS increased with infant age (p < 0.05), indicating older infants tended to have more severe disease. All study infants who required intubation fell into the high-risk category (score ≥ 4). The N-CRAS demonstrated excellent discrimination for predicting intubation (ROC area under the curve = 1.00). Conclusions: In this pilot study, the N-CRAS demonstrated a strong correlation with clinical severity and successfully identified all infants who required intubation. However, given the small cohort size and limited number of severe cases, these findings should be interpreted cautiously. Further external validation in larger and more diverse neonatal populations is essential to confirm its predictive utility. Full article

(This article belongs to the Special Issue Pulmonary Function in Children with Respiratory Symptoms)

► Show Figures

Figure 1

10 pages, 271 KiB

Open AccessArticle

The Impact of Early Cranial Doppler Ultrasonography on Prognosis in Neonates with Perinatal Asphyxia

by Leyla Sero, Duygu Tuncel, Mehmet Salih Karaca and Nilufer Okur

Children 2025, 12(6), 745; https://doi.org/10.3390/children12060745 - 9 Jun 2025

Abstract

Background: Cranial Doppler ultrasonography (DS) is a non-invasive method for evaluating cerebral hemodynamics in neonates with perinatal asphyxia (PA). This study aimed to assess whether cerebral vascular resistance indices (RIs) measured within the first 24 h of life can predict the severity of [...] Read more.

Background: Cranial Doppler ultrasonography (DS) is a non-invasive method for evaluating cerebral hemodynamics in neonates with perinatal asphyxia (PA). This study aimed to assess whether cerebral vascular resistance indices (RIs) measured within the first 24 h of life can predict the severity of brain injury. Methods: DS was performed on the anterior cerebral artery (ACA) and middle cerebral artery (MCA) between 6 and 24 h after birth in newborns diagnosed with PA. Prognostic value was evaluated by comparing RI values with cranial magnetic resonance imaging (MRI) results. Results: Of the 107 infants included in the study, 11 (10.3%) had severe brain damage, 27 (25.2%) had mild and 20 (18.7%) had moderate changes. The mean ACA RI was 0.61 ± 0.15 in the severe group and 0.70 ± 0.12 in the mild–moderate group (p = 0.023). MCA RI was 0.63 ± 0.20 and 0.71 ± 0.13, respectively. ROC analysis showed an area under the curve (AUC) of 0.901 for ACA RI with a cut-off of 0.58 (84% sensitivity and 84% specificity), and 0.874 for MCA RI with a cut-off of 0.59 (83% sensitivity and 84% specificity). Conclusions: Early ACA and MCA RI measurements via Doppler ultrasonography may serve as valuable predictors of brain injury severity in neonates with PA and should be considered alongside other clinical and imaging findings. Full article

(This article belongs to the Section Pediatric Neonatology)

► Show Figures

Figure 1

15 pages, 671 KiB

Open AccessArticle

Predictors of Static Postural Loading in Primary-School-Aged Children: Comparing Elastic Net and Multiple Regression Methods

by Mohammad Ali Mohseni Bandpei, Reza Osqueizadeh, Hamidreza Goudarzi, Nahid Rahmani and Abbas Ebadi

Children 2025, 12(6), 744; https://doi.org/10.3390/children12060744 - 8 Jun 2025

Viewed by 82

Abstract

Background/Objectives: Adverse effects of a sedentary lifestyle on an individual’s overall health are inevitable. With reference to primary-school-aged children, the establishment of effective postural hygiene is critical as it not only promotes optimal musculoskeletal development but also significantly influences their long-term well-being and [...] Read more.

Background/Objectives: Adverse effects of a sedentary lifestyle on an individual’s overall health are inevitable. With reference to primary-school-aged children, the establishment of effective postural hygiene is critical as it not only promotes optimal musculoskeletal development but also significantly influences their long-term well-being and productivity. This study aimed to develop and internally validate a regularized regression model to predict static postural loading (SPL) in primary school children. Methods: The outcome and predictors of SPL were shortlisted through a systematic review of the literature and expert panels. Data were derived from 258 primary school children. We developed regularized elastic net (EN) and used multiple linear regression (MLR) as a reference. Both models were fitted through five-fold cross-validation with 10 iterations. The grid search technique was used to find the optimal combination of hyperparameters α and λ for the EN. We conducted a permutation importance analysis to obtain and compare predictor rankings for each model. Results: Both models presented a good and comparable fit, with the EN marginally outperforming the MLR in error metrics. Postural risk, sedentary behavior, task duration, and BMI were the most important predictors of SPL in primary school children. Conclusions: The proof of a direct impact of a sedentary lifestyle on children’s overall health is both credible and alarming. Hence, proper identification and management of contributing factors to static postural loading in this age group is critical. In various clinical settings, where the objective is to develop a model that accurately forecasts the outcome, advanced regularized regression methods have evidently shown great performance. Full article

(This article belongs to the Special Issue The Promotion of Motor Behavior and Physical Activity in Children: The Present and a Challenge for Future)

► Show Figures

Figure 1

11 pages, 572 KiB

Open AccessSystematic Review

Protocols for Prone Positioning in Pediatric Patients with Hypoxemia: Impact on Oxygenation, Lung Function, and Clinical Safety

by Jose Luis Estela-Zape, Valeria Sanclemente-Cardoza and Leidy Tatiana Ordoñez-Mora

Children 2025, 12(6), 743; https://doi.org/10.3390/children12060743 - 7 Jun 2025

Viewed by 168

Abstract

Background/Objectives: This review aims to identify existing protocols and evaluate the effects of prone positioning on oxygenation and clinical outcomes in pediatric patients with hypoxemia. Methods: A systematic review was conducted in accordance with the PRISMA guidelines and registered in PROSPERO [...] Read more.

Background/Objectives: This review aims to identify existing protocols and evaluate the effects of prone positioning on oxygenation and clinical outcomes in pediatric patients with hypoxemia. Methods: A systematic review was conducted in accordance with the PRISMA guidelines and registered in PROSPERO (CRD42023457270). Literature research was performed in Scopus, PubMed, Web of Science, and ScienceDirect. The final search was completed in January 2025. Results: A total of 2033 studies were identified, with 5 meeting inclusion criteria. Forty percent applied prone positioning for 12 to 20 h, improving pulmonary function. Combined with alveolar recruitment, prone positioning increased functional residual capacity and reduced atelectasis, with SpO₂ improvements from 13% to 38% and atelectasis reduction from 8% to 47%. Another 40% focused on oxygenation, reporting PaO₂ increases from 52 to 59 mmHg and SpO₂ improvements from 93.2% to 96.2% within 2 to 4 h. One study found a significant SpO₂ difference between prone (98.3%) and supine (96.2%) positions (p = 0.003). Protocols commonly included facial tilt and pillows to reduce compression. Safety measures involved checking catheter and tube placement, suspending enteral nutrition 30 min before repositioning, and hemodynamic monitoring. Adverse events were rare, including two cases of tube obstruction and one hypercapnia. No significant differences were observed in ventilation duration, oxygen therapy length, or 28-day survival between groups. Conclusions: Prone positioning improves pulmonary function and addresses refractory hypoxemia in pediatric patients. However, the optimal duration remains unclear, underscoring the need for further research to establish standardized guidelines. Full article

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

► Show Figures

Figure 1

13 pages, 1701 KiB

Open AccessArticle

Beyond the Mainstream: Exploring Parent Protective Behaviors in Asian Families Experiencing Pediatric Chronic Pain

by Yoonhee Kristina Kim, Ryan S. Ma and Rashmi P. Bhandari

Children 2025, 12(6), 742; https://doi.org/10.3390/children12060742 - 7 Jun 2025

Viewed by 130

Abstract

Background/Objectives: Despite the striking prevalence of pediatric chronic pain (20% of youth), its impact on culturally diverse populations, particularly Asian families, remains underexplored. The existing literature on parent protective behaviors predominantly focuses on Non-Hispanic White (NHW) families, where such behaviors often exacerbate pain [...] Read more.

Background/Objectives: Despite the striking prevalence of pediatric chronic pain (20% of youth), its impact on culturally diverse populations, particularly Asian families, remains underexplored. The existing literature on parent protective behaviors predominantly focuses on Non-Hispanic White (NHW) families, where such behaviors often exacerbate pain outcomes, therefore informing a core treatment target in clinical practice. This study aims to explore the role of parent protective behaviors in relation to global and pain-related distress in Asian families in comparison to NHW counterparts. Methods: A sample of 1415 youth (Asian: n = 236; NHW: n = 1179) aged 8 to 17 completed a survey prior to their evaluation at a tertiary pain clinic. Bivariate correlations and independent-sample t-tests were conducted to assess differences in anxiety, depression, pain-related distress, and parent protective behaviors between groups. Multiple regression analyses were used to determine whether parent protective behaviors moderated the relationship between global distress and pain-related outcomes. Results: Asian youth reported significantly lower pain intensity and pain interference than NHW youth, while Asian parents reported significantly higher protective behaviors. Parent protective behaviors moderated the association between global distress (depression and anxiety) and pain catastrophizing for Asian families only. A three-way interaction (ethnicity x parent protective behaviors, global distress, B = −0.22, p < 0.001; B = −0.18, p < 0.01) revealed that protective behaviors influenced the distress–pain catastrophizing link differently by ethnicity. Conclusions: Differences were observed in the Asian youth’s experience of pain in comparison to their NHW counterparts. This study highlights the importance of considering culturally nuanced approaches in treating pediatric chronic pain, particularly when working with Asian families. Full article

(This article belongs to the Topic Diversity, Educational Inclusion, Emotional Intelligence, Coping, and Other Factors That Influence Psychological Health and Well-Being)

► Show Figures

Figure 1

15 pages, 760 KiB

Open AccessArticle

Forecasting Achievement of Inactive Disease in Juvenile Idiopathic Arthritis with Artificial Intelligence

by Ana I. Rebollo-Giménez, Francesca Ridella, Silvia Maria Orsi, Elena Aldera, Marco Burrone, Valentina Natoli, Silvia Rosina, Alessandro Consolaro, Esperanza Naredo, Angelo Ravelli and Davide Cangelosi

Children 2025, 12(6), 741; https://doi.org/10.3390/children12060741 - 7 Jun 2025

Viewed by 146

Abstract

Objective: to seek for predictors of inactive disease (ID) in juvenile idiopathic arthritis (JIA) with artificial intelligence. Methods: The clinical charts of patients seen within 6 months after disease onset between 2007 and 2019 and with follow-up visits at 6, 12, 18, and [...] Read more.

Objective: to seek for predictors of inactive disease (ID) in juvenile idiopathic arthritis (JIA) with artificial intelligence. Methods: The clinical charts of patients seen within 6 months after disease onset between 2007 and 2019 and with follow-up visits at 6, 12, 18, and 24 months were reviewed retrospectively. Sixty-eight potential predictors were recorded at each visit. The primary endpoint was ID at 24 months by 2004 Wallace criteria. Data obtained from diverse combinations of visits were examined to identify the best forecasting model. After pre-processing, the cohort was divided into training (50%) and testing (50%) cohorts. Multivariate time series forecasting, coupled with the Random Forest method, was used to train the machine learning (ML) forecasting model. Predictive performance was assessed through the Matthews correlation coefficient (MCC). Results: A total of 414 patients were included. The best performance in predicting ID at 24 months in the training cohort was provided by the 0–12 months interval (MCC = 0.68). In the testing cohort, the same ML model confirmed a high forecasting performance (MCC = 0.65). Assessment of feature importance and impact analysis showed that the most relevant predictor of ID was the physician’s global assessment (PhGA), followed by the count of active joints (AJC). Conclusions: PhGA and AJC values over the first 12 months were the strongest predictors of ID at 24 months. This finding highlights the importance of regular quantitative assessment of disease activity by the caring physician in monitoring the course of the patient toward achievement of complete disease quiescence. Full article

(This article belongs to the Special Issue Advances in Pediatric Rheumatology: Focus on Juvenile Idiopathic Arthritis)

► Show Figures

Figure 1

7 pages, 976 KiB

Open AccessCase Report

Mind the Missing Gap: A Cervical Variant of Type A Esophageal Atresia

by Marco Di Mitri, Riccardo Coletta, Edoardo Collautti, Cristian Bisanti, Annalisa Di Carmine, Roberto Lo Piccolo, Elena Rovero, Francesca Tocchioni, Elisa Severi, Marco Moroni, Ioannis Georgopoulos, Dariusz Patkowski and Mario Lima

Children 2025, 12(6), 740; https://doi.org/10.3390/children12060740 - 6 Jun 2025

Viewed by 122

Abstract

Background: Esophageal atresia (EA) type A, characterized by the absence of a tracheoesophageal fistula and typically presenting with a long esophageal gap, usually requires staged repair. Methods: We report a rare case of a newborn with type A EA in which both the [...] Read more.

Background: Esophageal atresia (EA) type A, characterized by the absence of a tracheoesophageal fistula and typically presenting with a long esophageal gap, usually requires staged repair. Methods: We report a rare case of a newborn with type A EA in which both the proximal and distal esophageal pouches were unexpectedly close and located in the cervical region. This anatomical variant allowed for a successful primary anastomosis through a cervical approach. Results: Initial imaging was misleading, and the true anatomy was clarified only through thoracoscopic exploration, underscoring the importance of intraoperative flexibility. Conclusions: To our knowledge, this is the first report of such a presentation in type A EA, with significant implications for diagnosis and surgical strategy. Full article

(This article belongs to the Special Issue Pediatric Minimal Access Surgery: Updates in Thoracic, Abdominal, and Cervical Procedures)

► Show Figures

Figure 1

14 pages, 464 KiB

Open AccessArticle

Better Lunch Boxes: Testing the Feasibility and Acceptability of a Family-Based Pilot Intervention to Support Nutritious Home-Packed Lunches

by Tamara Petresin, Jess Haines, Danielle S. Battram, Virginie Desgreniers, Ivanna Regina Pena Mascorro and Claire N. Tugault-Lafleur

Children 2025, 12(6), 739; https://doi.org/10.3390/children12060739 - 6 Jun 2025

Viewed by 119

Abstract

Background/Objectives: The majority of Canadian children bring a home-packed lunch to school, and previous research suggests lunches are of poor nutritional quality. This pilot study aimed to test the feasibility, acceptability, and preliminary impact of an eHealth family-based intervention designed to improve the [...] Read more.

Background/Objectives: The majority of Canadian children bring a home-packed lunch to school, and previous research suggests lunches are of poor nutritional quality. This pilot study aimed to test the feasibility, acceptability, and preliminary impact of an eHealth family-based intervention designed to improve the nutritional quality of home-packed lunches. Methods: In this 12-week intervention, families (n = 20 parents with children aged 4–8 years) received a toolkit which included a cookbook on tips for preparing healthy lunches and 15 tested lunch box-friendly recipes, a lunch box, text messages, and an online cooking class. Feasibility was assessed via documentation of intervention delivery and participant retention rates. Acceptability was assessed via post-intervention surveys and semi-structured interviews in a sub-sample of parents (n = 9). Preliminary impact was assessed using 3-day lunch food records. Descriptive statistics were used to assess feasibility and acceptability, and Wilcoxon signed-rank tests were used to evaluate changes in the nutritional content of packed lunches. Results: Findings indicated a high retention rate (85%), and the majority (94%) of participants reported that the intervention was helpful and that they would recommend it to another parent. Qualitative interviews suggest parents found the recipes practical and diverse, the lunch box and the cooking class helpful, and some reported increased confidence and greater awareness of the foods being packed. No changes in the nutritional content of packed lunches were observed (n = 10 children). Conclusions: In summary, a home-packed lunchbox intervention is feasible and well accepted by families, but further refinements are needed to optimize its impact before a full-scale trial. Full article

(This article belongs to the Special Issue Dietary Considerations in Childhood Obesity)

► Show Figures

Figure 1

15 pages, 466 KiB

Open AccessArticle

Nutritional Status and Health Challenges Among Schoolchildren in Nepal’s Solukhumbu Valley

by María Teresa Murillo-Llorente, Noemí Gil-Cuñat, Sara Moltó-Dominguez, Javier Pérez-Murillo, Manuel Tejeda-Adell, Miriam Martínez-Peris, Francisco Tomás-Aguirre, María Ester Legidos-García and Marcelino Pérez-Bermejo

Children 2025, 12(6), 738; https://doi.org/10.3390/children12060738 - 6 Jun 2025

Viewed by 145

Abstract

Background/Objectives: Child undernutrition remains a critical public health issue in Nepal, especially in the rural district of Solukhumbu. This study aimed to assess the prevalence and clinical characteristics of undernutrition, dietary patterns, and related health indicators in school-aged children from the Shree Saraswoti [...] Read more.

Background/Objectives: Child undernutrition remains a critical public health issue in Nepal, especially in the rural district of Solukhumbu. This study aimed to assess the prevalence and clinical characteristics of undernutrition, dietary patterns, and related health indicators in school-aged children from the Shree Saraswoti Basic School in Phuleli. Methods: A descriptive, cross-sectional study was conducted between July and August 2022. Fifty-four children (51.8% boys; mean age 9.4 ± 2.1 years) were evaluated using anthropometry, clinical examination, hemoglobin measurement, and three-day 24 h dietary recall. Data were analyzed using descriptive and inferential statistics. Results: BMI z-scores indicated that 39% of children were at risk of acute undernutrition, and 2% were at risk of moderate acute undernutrition. After adjusting for altitude, 87% were classified as anemic. Diets were dominated by cereals and vegetables, with a very low intake of fruits and proteins and no dairy consumption. Dental caries affected 59% of participants. Girls presented slightly higher subcutaneous fat percentages; however, 14.8% of the children exceeded the recommended thresholds. A dietary assessment revealed poor eating habits, including excessive intake of simple carbohydrates and insufficient nutrient diversity. Although socioeconomic data were not directly collected, the findings reflect the typical context of the vulnerability of isolated mountain communities. Undernutrition indicators (BMI, clinical signs, anemia) were associated with poorer health outcomes. An unexpected moderate inverse correlation was found between BMI and both systolic (r = −0.601) and diastolic (r = −0.550) blood pressure. Conclusions: The findings reveal a high burden of undernutrition and anemia among children in Solukhumbu, linked to poor diet and structural vulnerability. Urgent, community-based interventions—including nutrition education, agricultural diversification, and improved healthcare access—are needed. Longitudinal monitoring is essential to track progress and design sustainable, multisectoral solutions. Full article

(This article belongs to the Section Global Pediatric Health)

► Show Figures

Figure 1

14 pages, 2086 KiB

Open AccessProtocol

Orofacial Myofunctional Therapy: Investigating a Novel Therapeutic Approach for Pediatric Obstructive Sleep Apnea in Children with and Without Down Syndrome—A Study Protocol

by Jolien Verbeke, Iris Meerschman, Karlien Dhondt, Els De Leenheer, Julie Willekens, Kristiane Van Lierde and Sofie Claeys

Children 2025, 12(6), 737; https://doi.org/10.3390/children12060737 - 6 Jun 2025

Viewed by 143

Abstract

Background/Objectives: Pediatric obstructive sleep apnea (OSA) is a prevalent medical condition, affecting 1–5% of non-syndromic children and 30–90% of children with Down syndrome. Given the severity of the condition and the associated health risks, early and effective treatment is crucial. However, current treatment [...] Read more.

Background/Objectives: Pediatric obstructive sleep apnea (OSA) is a prevalent medical condition, affecting 1–5% of non-syndromic children and 30–90% of children with Down syndrome. Given the severity of the condition and the associated health risks, early and effective treatment is crucial. However, current treatment modalities are often invasive or suffer from poor patient adherence. Additionally, adenotonsillectomy, the first-line treatment in pediatric OSA, seems not to be effective in every child, leaving children with residual OSA postoperatively. These challenges are particularly pronounced in high-risk populations, such as children with Down syndrome, highlighting the need for alternative therapeutic strategies. Therefore, a protocol is presented to evaluate the effectiveness of orofacial myofunctional therapy (OMT) as a treatment for OSA in two pediatric populations: (1) Non-syndromic children aged 4–18 years: 10 weeks of OMT. (2) Children with Down syndrome aged 4–18 years: 20 weeks of OMT. Effects of the OMT program will be evaluated on: sleep parameters (e.g., obstructive Apnea–Hyponea Index (oAHI), snoring frequency); orofacial functions (e.g., breathing pattern, tongue position at rest); quality of life outcomes. Methods: A pretest–posttest design will be used to evaluate the effectiveness of OMT in both children with and without Down syndrome and OSA. Both objective measures and patient-reported outcomes are being collected. Results: OMT is expected to improve orofacial functions, reduce OSA severity and symptoms, and enhance quality of life in both non-syndromic and syndromic children. Conclusions: This multidisciplinary research protocol, involving collaboration between ENT specialists and speech-language pathologists, aims to provide a comprehensive understanding of the potential benefits of OMT in treating OSA. Full article

(This article belongs to the Special Issue Current Advances in Paediatric Sleep Medicine)

4 pages, 180 KiB

Open AccessEditorial

The Role of Global Longitudinal Strain in Detecting Early Left Ventricular Dysfunction in Pediatric Bicuspid Aortic Valve Patients

by Mohammed A. Mashali, Isabelle Deschênes, Carl V. Leier and Nancy S. Saad

Children 2025, 12(6), 736; https://doi.org/10.3390/children12060736 - 6 Jun 2025

Viewed by 116

Abstract

Global longitudinal strain (GLS), assessed via speckle tracking echocardiography (STE), is increasingly recognized as a sensitive and early indicator of left ventricular (LV) dysfunction in pediatric patients with bicuspid aortic valve (BAV) [...] Full article

(This article belongs to the Special Issue Heart Failure in Children and Adolescents)

20 pages, 297 KiB

Open AccessArticle

Twin Challenges in Türkiye: Exclusive Breastfeeding Rates and Predictors of Breastfeeding Duration in a Tertiary Care Center

by Ayça Kömürlüoğlu and Gökçe Çıplak

Children 2025, 12(6), 735; https://doi.org/10.3390/children12060735 - 6 Jun 2025

Viewed by 178

Abstract

Objectives: This study aimed to evaluate exclusive breastfeeding (EBF) rates and the duration of breastfeeding among mothers of twins and to identify the maternal, neonatal, and social factors associated with these outcomes. Methods: This retrospective cross-sectional study included 153 mothers of twin infants [...] Read more.

Objectives: This study aimed to evaluate exclusive breastfeeding (EBF) rates and the duration of breastfeeding among mothers of twins and to identify the maternal, neonatal, and social factors associated with these outcomes. Methods: This retrospective cross-sectional study included 153 mothers of twin infants who were delivered at a tertiary hospital. Data were obtained from medical records and postnatal telephone interviews. Univariate analyses were performed to assess associations with EBF and breastfeeding duration, while multiple linear regression was performed to identify the independent predictors of breastfeeding. Results: The EBF rate within the first six months was 15%, and the mean breastfeeding duration was 10.5 ± 8.3 months. Tandem breastfeeding was positively associated with breastfeeding duration (β = 5.80; 95% CI: 3.51 to 8.10; p < 0.001), whereas bottle feeding showed a strong negative association (β = −9.49; 95% CI: −12.88 to −6.10; p < 0.001). Infants born before 34 weeks had significantly shorter breastfeeding durations, higher rates of NICU admission and respiratory support, and received less skin-to-skin contact and breastfeeding counselling compared to term infants (p < 0.05). Conclusions: Exclusive breastfeeding rates among mothers of twins remain low. Encouraging tandem breastfeeding, reducing bottle use, and providing tailored lactation support—particularly for mothers of preterm infants—may improve breastfeeding outcomes. Breastfeeding support should be adapted according to gestational age in neonatal care. Full article

(This article belongs to the Section Pediatric Neonatology)

13 pages, 538 KiB

Open AccessArticle

Gut Microbiota Differences in Infants with Cow-Milk-Induced Allergic Proctocolitis: A Comparative Cross-Sectional Study

by Zeliha Haytoglu, Dilek Ozcan and Derya Ufuk Altintas

Children 2025, 12(6), 734; https://doi.org/10.3390/children12060734 - 5 Jun 2025

Viewed by 181

Abstract

Background: Cow-milk-induced allergic proctocolitis (CMIAP) is a non-IgE-mediated food hypersensitivity that often resolves spontaneously but may predispose infants to IgE-mediated allergies and eosinophilic gastrointestinal disorders. Understanding its pathophysiology is crucial for microbiota-based interventions. Methods: We enrolled 32 exclusively breastfed infants—16 with [...] Read more.

Background: Cow-milk-induced allergic proctocolitis (CMIAP) is a non-IgE-mediated food hypersensitivity that often resolves spontaneously but may predispose infants to IgE-mediated allergies and eosinophilic gastrointestinal disorders. Understanding its pathophysiology is crucial for microbiota-based interventions. Methods: We enrolled 32 exclusively breastfed infants—16 with confirmed cases of CMIAP and 16 age-matched healthy controls. The cohorts were sex-balanced (8 F/8 M), term-born (gestational age ± SD: 40 ± 1.2 vs. 39 ± 1.3 weeks), vaginally delivered, and sampled at a mean age of 2.0 ± 0.44 months (range 1.5–3.0) vs. 2.4 ± 0.66 months (range 1.5–3.5). Faecal samples underwent 16S rRNA gene sequencing on the Illumina NovaSeq platform, with diversity and differential abundance analyses. Results: The maternal dairy intake was similar (total dairy: 250 ± 80 vs. 240 ± 75 mL/day; yoghurt: 2.3 ± 1.0 vs. 2.5 ± 1.2 days/week; p = 0.72). Bray–Curtis dissimilarity assessments revealed distinct microbiota in infants with CMIAP. Infants with CMIAP had a lower abundance of Bifidobacterium (log₂FC−2.27; q = 0.022; ANCOM-BC), Collinsella (−29.35; padj < 0.0001; DESeq2), and Limosilactobacillus (−8.01; padj = 0.0285; DESeq2; q < 0.0001; ANCOM-BC) compared with controls. In contrast, Hungatella (+24.99; padj < 0.0001; DESeq2), Veillonella (+4.73; padj = 0.0221; DESeq2), Citrobacter (+10.44; padj = 0.0124; DESeq2), and Ruminococcus gnavus (+2.69; q < 0.0001; ANCOM–BC) were more abundant in the CMIAP group. Conclusions: Infants with CMIAP exhibit gut dysbiosis, which is characterised by the depletion of beneficial commensals and the enrichment of potential pathogens, independent of maternal dairy intake. Further studies should establish whether these microbiota alterations are causal or consequential in CMIAP. Full article

► Show Figures

Figure 1

14 pages, 1403 KiB

Open AccessArticle

Standardizing Neonatal Body Composition Assessment Using Air Displacement Plethysmography: Insights from the Bavarian Experience

by Lennart A. Luecke, Christoph Fusch, Gisela Adrienne Weiss, Katja Knab, Stefan Schäfer, Jasper L. Zimmermann, Anastasia Meis, Stephanie Lohmüller-Weiß, Kerstin Simon, Julia Welsch, Ursula Felderhoff-Müser and Niels Rochow

Children 2025, 12(6), 733; https://doi.org/10.3390/children12060733 - 4 Jun 2025

Viewed by 227

Abstract

Background/Objectives: Body composition plays a crucial role in neurodevelopment and the long-term health of preterm and term infants. Air displacement plethysmography (ADP), especially with the PEAPOD^® system, is well established in research and increasingly explored in clinical practice. Building on our team’s [...] Read more.

Background/Objectives: Body composition plays a crucial role in neurodevelopment and the long-term health of preterm and term infants. Air displacement plethysmography (ADP), especially with the PEAPOD^® system, is well established in research and increasingly explored in clinical practice. Building on our team’s earlier experiences, this study aimed to (1) evaluate the safety and feasibility of ADP in preterm infants, (2) identify published clinical protocols, and (3) implement and assess a standardized routine—the Bavarian Clinical Protocol (BCP). Methods: We conducted two systematic literature reviews: one on the eligibility-to-assessment rate and safety of ADP in research contexts, and a second focusing on existing clinical protocols. In addition, we retrospectively analyzed routine ADP assessments at the NICU of Nuremberg Children’s University Hospital from January 2022 to December 2024, where the BCP had been introduced. Results: The literature review included 76 studies reporting a total of 8,317 assessments without adverse events. In experimental settings, the eligibility-to-assessment rate was 41%. We identified three published clinical protocols. Following BCP implementation, 626 of 702 eligible infants (89.1%) underwent a total of 851 ADP measurements. No adverse events were observed, and repeated assessments were integrated smoothly into clinical workflows. Conclusions: ADP can be safely and effectively incorporated into neonatal routine care. The Bavarian Clinical Protocol provides a practical framework for standardized application, improves comparability across centers, and supports the clinical use of body composition data to inform individualized nutritional strategies. Full article

(This article belongs to the Section Pediatric Neonatology)

► Show Figures

Figure 1

14 pages, 286 KiB

Open AccessArticle

The Parental Blueprint: Early Childhood Lifestyle Habits and Family Factors Predict Opting for Middle Childhood Sport Involvement

by Stéfanie Routhier-Guilmette, Kianoush Harandian, Sophie-Anne Turcotte, Nairy Kazandjian, Matteo Privitera and Linda S. Pagani

Children 2025, 12(6), 732; https://doi.org/10.3390/children12060732 - 3 Jun 2025

Viewed by 269

Abstract

Background/objectives: Early childhood is marked by rapid physical and cognitive development, underscoring the critical influence of parental choices in shaping habits, pastimes, and traditions. The World Health Organization highlights habits of physical activity, sleep, and screen use as modulators of healthy development and [...] Read more.

Background/objectives: Early childhood is marked by rapid physical and cognitive development, underscoring the critical influence of parental choices in shaping habits, pastimes, and traditions. The World Health Organization highlights habits of physical activity, sleep, and screen use as modulators of healthy development and well-being in young children. As a first, this birth cohort study investigates the relationship between movement behaviors in toddlerhood and subsequent sport participation during middle childhood. Methods: Participants are 930 boys and 926 girls from the Quebec Longitudinal Study of Child Development. Using a population-based analytical approach, we examined the relationship between parent-reported active leisure, sleep, and sedentary screen time at age 2 years and trajectory of sport participation between ages 6 and 10 years using sex-stratified linear regressions that account for a range of pre-existing individual and family confounding factors. Results: Many child and family characteristics predicted early childhood movement behaviors, distinctly for boys and girls. Moreover, parental regulation of screen time during early childhood significantly influenced their decisions to enroll and encourage sport participation in sons during school age. Specifically, boys who spent more than 1 h/day on screens had 10% fewer chances of consistently participating in sport throughout middle childhood, even after accounting for adherence to other lifestyle habits. Conclusions: Our findings suggest that parental values regarding early childhood screen exposure are an effective potential target for intervention fostering healthy and active development. Future research should focus on parent and child motivations for sport involvement in the long-term. Full article

(This article belongs to the Special Issue Lifestyle and Children's Health Development)

16 pages, 284 KiB

Open AccessArticle

Final Fusion Strategies in Early-Onset Scoliosis: Does Implant Density Make a Difference After Magnetically Controlled Growing Rod Treatment?

by Paolo Brigato, Leonardo Oggiano, Sergio De Salvatore, Davide Palombi, Sergio Sessa, Umile Giuseppe Longo, Andrea Vescio and Pier Francesco Costici

Children 2025, 12(6), 731; https://doi.org/10.3390/children12060731 - 31 May 2025

Viewed by 205

Abstract

Background/Objectives: Early-onset scoliosis (EOS) frequently requires growth-friendly interventions, such as magnetically controlled growing rods (MCGRs), followed by definitive spinal fusion upon skeletal maturity. The optimal implant density (ID) for final posterior spinal fusion in these patients remains controversial. This study aimed to compare [...] Read more.

Background/Objectives: Early-onset scoliosis (EOS) frequently requires growth-friendly interventions, such as magnetically controlled growing rods (MCGRs), followed by definitive spinal fusion upon skeletal maturity. The optimal implant density (ID) for final posterior spinal fusion in these patients remains controversial. This study aimed to compare the radiographic, surgical, and economic outcomes associated with high-density (HD) versus low-density (LD) screw constructs in EOS patients previously treated with MCGRs undergoing definitive fusion. Methods: This retrospective study included 27 EOS patients who underwent definitive posterior spinal fusion between January 2017 and September 2022. Participants were categorized into two groups: HD (n = 13) and LD (n = 14). Primary outcomes included coronal and sagittal radiographic parameters assessed at early postoperative and final follow-up visits (minimum of 2 years). The secondary outcomes analyzed were major postoperative complications (grade ≥ IIIB according to Clavien–Dindo–Sink Classification [CDSC]), operative time, blood loss, hospital stay length, and total implant costs. Results: Baseline characteristics between the HD and LD groups were comparable. Early postoperative radiographic assessment demonstrated significantly greater thoracic kyphosis (16.3 ± 7.6° vs. 10.9 ± 14.4°, p = 0.021) and T1-S1 spinal height (43.3 ± 6.7 mm vs. 39.1 ± 4.3 mm, p = 0.039) in the HD group. At final follow-up, only T1-S1 spinal height remained significantly higher in the HD group (45.4 ± 7 mm vs. 39.7 ± 5.1 mm, p = 0.021). Implant costs were significantly higher in the HD group (EUR 6046.5 ± 1146.9 vs. EUR 4376.4 ± 999.4, p < 0.001), while operative time, blood loss, and hospital stay length showed no significant differences. HD constructs had three major complications requiring surgical revision, whereas LD constructs reported no perioperative complications but experienced three late-onset complications also necessitating revision surgery. Conclusions: LD constructs provided comparable long-term radiographic and clinical outcomes to HD constructs, with significantly lower implant-related costs. Despite initial superior kyphosis correction in HD constructs, this benefit diminished by the final follow-up. These findings support a selective, lower-density screw placement strategy to minimize costs and surgical complexity without compromising patient outcomes in EOS undergoing definitive spinal fusion. Full article

(This article belongs to the Special Issue Advancements in Pediatric Orthopedics: Integrating Emerging Technologies for Enhanced Care)

► Show Figures

Figure 1

17 pages, 2385 KiB

Open AccessArticle

Associations Between Eating Disorders and Sociodemographic Factors in Adolescent Patients Since the Start of the COVID-19 Pandemic

by Janet Lee, David Miller and Paulina Rugart

Children 2025, 12(6), 730; https://doi.org/10.3390/children12060730 - 31 May 2025

Viewed by 234

Abstract

Background/Objectives: The COVID-19 pandemic has been associated with significant increases in mental-health-related concerns in adolescents, including eating disorders. Disparities in screening, diagnosis, and treatment impact adolescents with eating disorders. This study aimed to describe the patterns in the prevalence and the associations between [...] Read more.

Background/Objectives: The COVID-19 pandemic has been associated with significant increases in mental-health-related concerns in adolescents, including eating disorders. Disparities in screening, diagnosis, and treatment impact adolescents with eating disorders. This study aimed to describe the patterns in the prevalence and the associations between eating disorder diagnoses and demographic factors in adolescent patients since the start of the COVID-19 pandemic. Methods: We performed a retrospective cohort study examining adolescent patients (aged 12 to 21) with an eating disorder (ED) diagnosis documented between January 2019 and July 2023 using Epic Systems Corporation’s Cosmos, a de-identified dataset aggregated from electronic health record (EHR) data. We examined the differences in demographic factors by utilizing chi-square and Kruskal–Wallis rank sum tests. Results: A total of 82,435 distinct adolescent and young adult patients with eating disorder diagnoses were included in the analytical dataset. The overall prevalence of EDs has increased since 2019. The median age of patients with an ED decreased between 2019 and 2023. There was a decrease in other eating disorder diagnoses and an increase in avoidant-restrictive food intake disorder (ARFID) during the study period. There was a decrease in the proportion of individuals who identified as White and an increase in the proportion of adolescents from historically minoritized racial and ethnic groups (i.e., African American or Black and Hispanic). There was also an increase, during this study period, in the proportion of adolescents with an ED diagnosis who were from more socially vulnerable communities. Conclusions: Our study describes the changes in the prevalence of sociodemographic factors in adolescent patients with EDs since the start of the COVID-19 pandemic. Further studies should address screening, diagnostic, and treatment barriers for EDs in historically underserved communities. Full article

(This article belongs to the Section Global Pediatric Health)

► Show Figures

Figure 1

10 pages, 755 KiB

Open AccessSystematic Review

The Seasonal Incidence of Slipped Capital Femoral Epiphysis: A Systematic Review and Meta-Analysis

by Carter J. K. White, Jacob D. Kodra, Harshavardhan Bollepalli, Kai Yang, Scott E. Van Valin and Xue-Cheng Liu

Children 2025, 12(6), 729; https://doi.org/10.3390/children12060729 - 31 May 2025

Viewed by 252

Abstract

Background/Objectives: Slipped capital femoral epiphysis (SCFE) is a common adolescent hip disorder characterized by the posterior and inferior slippage of the femoral head through the growth plate. This study aimed to assess seasonal trends in the incidence of SCFE above 40° N latitude [...] Read more.

Background/Objectives: Slipped capital femoral epiphysis (SCFE) is a common adolescent hip disorder characterized by the posterior and inferior slippage of the femoral head through the growth plate. This study aimed to assess seasonal trends in the incidence of SCFE above 40° N latitude using cosinor regression analysis. Methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registration in Prospero. A keyword search of PubMed, Scopus, Web of Science, and Ovid was conducted using terms related to SCFE and seasonal or monthly variation. Studies were included if they reported month-by-month SCFE incidence in pediatric populations. Studies were excluded if they had duplicated population cohorts. Data from studies conducted above 40° N were extracted for cosinor regression analysis. Quality assessment was performed using the JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data. Results: A total of seventeen studies were included, amassing a total of 21,428 children analyzed. Six investigations reported monthly incidence data for populations > 40° N. The highest pooled monthly incidence was observed in August (482 cases). Alternatively, February was the month with the lowest SCFE incidence (293). Cosinor regression analysis demonstrated that SCFE occurs more frequently during early summer and fall months (p < 0.0001). Conclusions: SCFE incidence follows a significant seasonal trend in higher-latitude (>40° N) populations, with a consistent late-summer peak. Recognizing seasonal variation patterns may inform early diagnosis and intervention in SCFE, improving outcomes in pediatric physeal injuries. Full article

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

► Show Figures

Figure 1

24 pages, 1131 KiB

Open AccessArticle

Impact of a Brief Family Skills Training Programme “Strong Families” in a Low–Middle-Income-Country: Cambodia

by Aala El-Khani, Dina Idriss-Wheeler, Santana Chea, Shatha Darwish and Wadih Maalouf

Children 2025, 12(6), 728; https://doi.org/10.3390/children12060728 - 31 May 2025

Viewed by 239

Abstract

Introduction: Children living in low- and middle-income countries (LMICs) are at increased risk of emotional and behavioural challenges, often linked to caregiver stress and harsh parenting practices. Strengthening family functioning through parenting interventions is a critical strategy for improving child mental health in [...] Read more.

Introduction: Children living in low- and middle-income countries (LMICs) are at increased risk of emotional and behavioural challenges, often linked to caregiver stress and harsh parenting practices. Strengthening family functioning through parenting interventions is a critical strategy for improving child mental health in these settings. The Strong Families programme was developed as a light-touch family skills intervention for high-stress, low-resource environments. Methods: A multisite pilot feasibility and acceptability study was conducted in Cambodia with 40 families. Caregivers and children (aged 8–15) participated in a 3-week intervention, with one session per week. Data were collected using the Parenting and Family Adjustment Scales (PAFAS), the Strengths and Difficulties Questionnaire (SDQ), and the Child and Youth Resilience Measure (CYRM-R) at baseline, two weeks, and six weeks post-intervention. Repeated measures ANOVA and Friedman’s ANOVA were used to assess changes over time. Results: Caregivers showed statistically significant improvements across all PAFAS subscales. For example, coercive parenting scores decreased from 8.13 at baseline to 4.00 post-intervention and 2.33 at follow-up (F(2,78) = 59.76, p < 0.001). Positive encouragement improved from 2.60 to 1.00 and 0.33, respectively (F(2,78) = 27.05, p < 0.001). In terms of child outcomes, SDQ total difficulty scores declined from 20.68 to 16.55 over time (F(2,78) = 7.58, p = 0.001). Emotional problems dropped from 5.60 to 2.38 (χ²(2) = 21.17, p < 0.001), and conduct problems from 4.33 to 2.68 (F(2,78) = 11.35, p < 0.001). Prosocial behaviours increased from 5.60 to 9.45 (F(2,78) = 69.93, p < 0.001). Personal resilience scores rose from 32.70 at baseline to 47.48 at follow-up (χ²(2) = 62.42, p < 0.001), while caregiver resilience improved from 23.63 to 33.63 (χ²(2) = 61.83, p < 0.001). Improvements were particularly pronounced among families with the highest baseline challenges. Conclusions: Findings indicate that the Strong Families programme is feasible and effective in improving parenting skills, family adjustment, child mental health, and resilience in a Cambodian LMIC context. These results reinforce the programme’s potential for integration into broader national strategies to improve psychosocial outcomes for families in high-stress, low-resource environments. Full article

(This article belongs to the Special Issue Advances in Child–Parent Attachment and Children's Peer Relations)

► Show Figures

Figure 1

12 pages, 239 KiB

Open AccessArticle

Systemic Inflammatory Indices in Transient Tachypnea of the Newborn: A Retrospective Case–Control Study

by Mustafa Törehan Aslan, İpek Güney Varal, Gaffari Tunç, Onur Bağcı and Ayşe Ören

Children 2025, 12(6), 727; https://doi.org/10.3390/children12060727 - 31 May 2025

Viewed by 225

Abstract

Background: Transient tachypnea of the newborn (TTN) is traditionally viewed as a disorder of delayed lung fluid clearance, but emerging evidence suggests inflammatory involvement. Aim: This study investigated systemic inflammatory indices [(systemic immune-inflammation index (SII-i), systemic inflammation response index (SIR-i), neutrophil-to-lymphocyte ratio (NL-r), [...] Read more.

Background: Transient tachypnea of the newborn (TTN) is traditionally viewed as a disorder of delayed lung fluid clearance, but emerging evidence suggests inflammatory involvement. Aim: This study investigated systemic inflammatory indices [(systemic immune-inflammation index (SII-i), systemic inflammation response index (SIR-i), neutrophil-to-lymphocyte ratio (NL-r), and platelet-to-lymphocyte ratio (PL-r)] and underlying mechanisms in TTN pathogenesis for the first time. Methods: This retrospective case–control study included 199 neonates (123 with TTN and 76 healthy controls) admitted between 2022 and 2025 to a tertiary care hospital. Complete blood count parameters were collected within the first two hours of life. Inflammatory indices were calculated and compared between groups. Subgroup analyses were conducted based on gestational age (late preterm vs. term) and mode of delivery (cesarean vs. vaginal). Results: Although not statistically significant, TTN infants showed a trend toward higher inflammatory indices with median NL-r (2.54 vs. 1.75, p = 0.197) and SII-i (729,307.83 vs. 373,593.50, p = 0.276). Term TTN infants had higher NL-r (3.08 vs. 2.04, p = 0.022) and SII-i (729,147.74 vs. 538,928.30, p = 0.133) than late preterm infants. SIR-i and NL-r values were higher in the full-term group than in the early-term and late-preterm groups (p = 0.014, p = 0.022, respectively). Cesarean births showed higher NL-r (3.20 vs. 2.33, p = 0.049) and SII-i (p = 0.040) than vaginal deliveries. Strong correlations existed between SII-I, NL-r (r = 0.886, p < 0.01), and SII-i, SIR-i (r = 0.817, p < 0.01). Conclusions: Elevated inflammatory indices in neonates with TTN, particularly in term infants and those delivered vaginally, suggest a supportive/potential role for systemic inflammation in TTN pathophysiology. These markers may serve as potential supplementary markers for risk stratification, though further prospective validation is required to confirm their clinical relevance. These findings suggest that the early assessment of systemic inflammatory indices may assist clinicians in identifying neonates at risk for TTN, thereby guiding initial respiratory support strategies. Full article

(This article belongs to the Section Pediatric Neonatology)

17 pages, 4135 KiB

Open AccessReview

Nursing Management in Pediatric Intensive Care in South Asia

by Daigo Hirao, Subrina Jesmin, Takehito Sugasawa, Adil Maqbool and Nobutake Shimojo

Children 2025, 12(6), 726; https://doi.org/10.3390/children12060726 - 31 May 2025

Viewed by 210

Abstract

Pediatric Intensive Care Units (PICUs) provide specialized care for critically ill children. Developing and managing these units in South Asia remains challenging. Resource limitations and infrastructural disparities are leading to challenging conditions. Above all, nurses play a pivotal role in delivering quality critical [...] Read more.

Pediatric Intensive Care Units (PICUs) provide specialized care for critically ill children. Developing and managing these units in South Asia remains challenging. Resource limitations and infrastructural disparities are leading to challenging conditions. Above all, nurses play a pivotal role in delivering quality critical care. Effective nursing practices can curb hospital-acquired infections (HAIs), ensure medication safety, and enable protocols such as the ICU Liberation Bundle. In South Asia, another challenge is the proper management of the nursing workforce. Nurse-to-patient ratios are highly disproportionate, contributing to nurse burnout. This review highlights the country-specific challenges and circumstances. There is no one-size-fits-all solution; effective strategies vary based on each country’s context. With context-specific solutions, nurses can bridge the gap between healthcare teams and families, ultimately improving patient outcomes. Full article

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

► Show Figures

Figure 1

13 pages, 813 KiB

Open AccessArticle

Impact of Symptomatic COVID-19 on the Oral Health of Pediatric Patients in Tbilisi City

by Lia Mania, Ketevan Nanobashvili, Tinatin Manjavidze, Mamuka Benashvili, Nino Bzishvili and Ia Astamadze

Children 2025, 12(6), 725; https://doi.org/10.3390/children12060725 - 31 May 2025

Viewed by 594

Abstract

Background/Purpose: Coronavirus disease 2019 (COVID-19) has become the cause of a global health crisis during the pandemic. This research aimed to study the impact of symptomatic COVID-19 on children’s oral health indices and salivary microbiome composition during the post-COVID-19 period. Methods: An observational, [...] Read more.

Background/Purpose: Coronavirus disease 2019 (COVID-19) has become the cause of a global health crisis during the pandemic. This research aimed to study the impact of symptomatic COVID-19 on children’s oral health indices and salivary microbiome composition during the post-COVID-19 period. Methods: An observational, cross-sectional study was conducted in Tbilisi (Georgia) among children aged 7–12 years. A total of 421 children included in the study had a history of laboratory-confirmed COVID-19 within one year of exposure. No participants met the criteria for comorbid conditions or for PCC. A stratified simple random selection of schools and among selected clusters was used. The selected children were divided into two groups: the exposed group, who were patients with a history of symptomatic COVID-19, and the control group, who were patients with a history of asymptomatic COVID-19. The data were collected from August 2022 to December 2023. Oral screening, microbiological examination of saliva, and administration of questionnaires were also performed. Logistic regression was used to calculate ORs with 95% confidence intervals. The statistical processing of the data was performed with SPSS 23.0. This study was approved by the Biomedical Research Ethical Council of the University of Georgia (UGREC–04–22/9 March 2022). Results: Statistically significant differences in the means of the oral health indicators between the studied groups were detected (exposed: DMFT + deft = 5.9; MGI = 0.92; S-OHI = 1.9; control: DMFT + deft = 3.8; MGI = 0.56; S-OHI = 1.4). According to the logistic regression, symptomatic COVID-19 had a significant effect on the following oral health indicators: DMFT + deft (OR = 1.26; 95% CI = 1.14–1.39), MGI (OR = 2.31; 95% CI = 1.50–3.55), and S-OHI (OR = 3.43; 95% CI = 2.03–5.76). The effect of symptomatic COVID-19 on the frequency of eradication of the studied microbiome was also significant (OR = 2.12; 95% CI = 1.23–3.63). Conclusions: A close association was established between symptomatic COVID-19 and microbiome changes in the oral saliva of children, as well as between oral health indicators and symptomatic COVID-19. Considering the research results, it is assumed that a symptomatic course of COVID-19 may be an additional risk factor associated with poor oral health in the pediatric population in the post-COVID-19 period. Full article

(This article belongs to the Section Pediatric Dentistry & Oral Medicine)

Journal Menu

Journal Browser

Children, Volume 12, Issue 6 (June 2025) – 95 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI