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Children
Volume 12
Issue 7
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Children, Volume 12, Issue 7 (July 2025) – 118 articles

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25 pages, 4400 KiB  
Article
Early Childhood Anemia in Ghana: Prevalence and Predictors Using Machine Learning Techniques
by Maryam Siddiqa, Gulzar Shah, Mahnoor Shahid Butt, Asifa Kamal and Samuel T. Opoku
Children 2025, 12(7), 924; https://doi.org/10.3390/children12070924 (registering DOI) - 12 Jul 2025
Abstract
Background/Objectives: Early childhood anemia is a severe public health concern and the most common blood disorder worldwide, especially in emerging countries. This study examines the sources of childhood anemia in Ghana through various societal, parental, and child characteristics. Methods: This research [...] Read more.
Background/Objectives: Early childhood anemia is a severe public health concern and the most common blood disorder worldwide, especially in emerging countries. This study examines the sources of childhood anemia in Ghana through various societal, parental, and child characteristics. Methods: This research used data from the 2022 Ghana Demographic and Health Survey (GDHS-2022), which comprised 9353 children. Using STATA 13 and R 4.4.2 software, we analyzed maternal, social, and child factors using a model-building procedure, logistic regression analysis, and machine learning (ML) algorithms. The analyses comprised machine learning methods including decision trees, K-nearest neighbor (KNN), logistic regression, and random forest (RF). We used discrimination and calibration parameters to evaluate the performance of each machine learning algorithm. Results: Key predictors of childhood anemia are the father’s education, socioeconomic status, iron intake during pregnancy, the mother’s education, and the baby’s postnatal checkup within two months. With accuracy (94.74%), sensitivity (82.5%), specificity (50.78%), and AUC (86.62%), the random forest model was proven to be the most effective machine learning predictive model. The logistic regression model appeared second with accuracy (67.35%), sensitivity (76.16%), specificity (56.05%), and AUC (72.47%). Conclusions: Machine learning can accurately predict childhood anemia based on child and paternal characteristics. Focused interventions to enhance maternal health, parental education, and family economic status could reduce the prevalence of early childhood anemia and improve long-term pediatric health in Ghana. Early intervention and identifying high-risk youngsters may be made easier with the application of machine learning techniques, which will eventually lead to a healthier generation in the future. Full article
(This article belongs to the Special Issue Nutritional Status and Eating Patterns in Children and Adolescents: Tackling Vulnerabilities, Gender Gaps and Nutritional Disparities)
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9 pages, 515 KiB  
Article
Immediate Versus Semi-Elective Treatment of Stable Slipped Capital Femoral Epiphyses (SCFE)
by Andrew G. Dubina, Alexandra M. Dunham, Julia L. Conroy, Karli M. Funk, Julio J. Jauregui, Paul D. Sponseller and Joshua M. Abzug
Children 2025, 12(7), 923; https://doi.org/10.3390/children12070923 (registering DOI) - 11 Jul 2025
Abstract
Background/Objectives: Timing of fixation of stable slipped capital femoral epiphysis (SCFE) is controversial. As pressure mounts to limit inpatient admissions and procedures, our aim was to investigate whether treatment of SCFE in a delayed manner is a safe alternative to immediate fixation. [...] Read more.
Background/Objectives: Timing of fixation of stable slipped capital femoral epiphysis (SCFE) is controversial. As pressure mounts to limit inpatient admissions and procedures, our aim was to investigate whether treatment of SCFE in a delayed manner is a safe alternative to immediate fixation. Our hypothesis was that there would be no difference in complications for stable slips treated immediately (<24 h) versus semi-electively (>24 h) with screw fixation. Methods: A retrospective review was performed at two academic institutions during a 10-year-period yielding 91 SCFEs. Data collected included patient demographics, time to treatment, radiographic measurements (Southwick angle), and complications. Between-group analysis was performed using Welch’s t-test and Fisher’s exact test. Results: 91 stable SCFEs were identified with a median age of 12.3 years (IQR: 11.4–13.3). A total of 62 (68%) slips were treated immediately while 29 (32%) were treated in a semi-elective manner with a median time from diagnosis to surgery of 4 days (range: 2–11 days). There were no instances of >18° increase in Southwick angle in either group or conversion from stable to unstable slips during the semi-elective period. Overall, 12 (13%) patients experienced complications, but no difference in complication rate was observed between groups (15% vs. 10%, p = 0.75). However, the complication profile varied between groups. Of note, two patients (2%, 2/91) experienced AVN, both of which were treated in a semi-elective manner and underwent in situ pinning. Conclusions: There was no difference in complication rate between stable SCFEs treated immediately or semi-electively; however, the complication profile differed by group. No SCFEs in either group had >18° worsening of the Southwick angle between the time of diagnosis and the time of fixation and there were no conversions of stables slips to unstable slips while waiting for semi-elective surgery. These findings suggest that performing semi-elective surgical fixation within 11 days of diagnosing stable, mild SCFEs appears to be a safe alternative to inpatient admission at the time of diagnosis. Full article
(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)
25 pages, 658 KiB  
Article
Parenting Under Pressure: The Transformative Impact of PCIT on Caregiver Depression and Anxiety and Child Outcomes
by Abigail Peskin, Alexis Landa, Juliana Acosta, William Andrew Rothenberg, Rachel Levi, Eileen Davis, Dainelys Garcia, Jason F. Jent and Elana Mansoor
Children 2025, 12(7), 922; https://doi.org/10.3390/children12070922 - 11 Jul 2025
Abstract
Background Objectives: Parental anxiety and depression demonstrate bidirectional connections with child developmental outcomes (e.g., disruptive behavior). Directly targeting child development through behavioral parent training (BPT) has potential for reversing this cycle. Parent–Child Interaction Therapy (PCIT), a BPT with robust research evidence for decreasing [...] Read more.
Background Objectives: Parental anxiety and depression demonstrate bidirectional connections with child developmental outcomes (e.g., disruptive behavior). Directly targeting child development through behavioral parent training (BPT) has potential for reversing this cycle. Parent–Child Interaction Therapy (PCIT), a BPT with robust research evidence for decreasing child disruptive behaviors, has demonstrated promise in also decreasing caregiver anxiety and depression. However, the mechanisms that explain this relationship are less understood. Methods: The current study examined whether caregivers (N = 840) completing time-limited PCIT experienced significant reductions in depression and anxiety symptoms and improvements in child disruptive behaviors at each time point. Generalized estimate equation analyses assessed whether caregiver anxiety and depression moderated changes in child disruptive behavior. Mediation analyses explored the extent that changes in caregiver–child interactions over time explained changes in family outcomes. Results: Child disruptive behavior and caregiver depression and anxiety symptoms improved significantly at each time point of PCIT. Change in child behavioral outcomes was significantly moderated by caregiver race. Caregivers with higher anxiety reported fewer improvements in child disruptive behavior compared to other caregivers. Changes in caregiver anxiety and depression over the course of treatment were partially mediated by improvement in caregiver–child interaction skills. Changes in child disruptive behavior were not mediated by improvement in caregiver–child interaction skills. Conclusions: Results demonstrate that time-limited PCIT could significantly improve caregiver anxiety and depression, and some PCIT-taught parenting skills are direct drivers of this process. Further research is needed to understand other mechanisms underlying the relationship between PCIT and improved family outcomes. Full article
(This article belongs to the Special Issue Parental Mental Health and Child Development)
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17 pages, 930 KiB  
Article
Development of Language and Pragmatic Communication Skills in Preschool Children with Developmental Language Disorder in a Speech Therapy Kindergarten—A Real-World Study
by Dieter Ullrich and Magret Marten
Children 2025, 12(7), 921; https://doi.org/10.3390/children12070921 - 11 Jul 2025
Abstract
Background: Several studies document the importance of communicative abilities for children’s development. Especially in recent years verbal communication in preschool children with developmental language disorder (DLD) has been studied, relying heavily on statistical analysis, outcome measures, or/and parents’ reports. Purpose: This explorative study [...] Read more.
Background: Several studies document the importance of communicative abilities for children’s development. Especially in recent years verbal communication in preschool children with developmental language disorder (DLD) has been studied, relying heavily on statistical analysis, outcome measures, or/and parents’ reports. Purpose: This explorative study investigates the effects of speech therapy on the development of language and verbal communication skills in preschool children with DLD within their peer group in a day-to-day setting using objective video-documentation. Hypothesis: Speech therapy leads to improvement of language, communication, and possibly to concurrent development of both language and verbal communication skills in preschool children. Methods: Preliminary prospective study to assess language and verbal communications skills of nine preschool children (seven boys, two girls, 4–6 y) with DLD in a speech therapy kindergarten using video recordings over a one-year therapy period. The communicative participation of the members of the peer group was assessed and included the verbal address (Av) and the ratio of “verbal address/verbal reaction” (Av/Rv). Results: The investigation results in evidence for two outcome groups: One group with suspected preferential verbal communication disorders (n = 4) was characterised by a high Av/Rv value, meaning they were scored to have a normal or high verbal address (Av) and a low verbal response (Rv) (predominantly interpersonal communication related disorder). This group showed minimal changes in the short term but demonstrated improvement after 5 years of schooling; thus, pedagogical activities seemed to be particularly effective for these children. The second group showed a balanced Av/Rv ratio (predominantly language related disorder) (n = 5); but after five years they demonstrated a partial need for special school support measures. This group may therefore particularly benefit from speech therapy. Conclusions: The present study clearly shows that even with speech-language therapy, the linguistic ability of DLD-disturbed children does not necessarily develop simultaneously with their communication ability. Rather, the investigations provide evidence for two groups of preschool children with DLD and communication disorder: One group demonstrated a predominantly verbal communication related disorder, where pedagogical intervention might be the more important treatment. The second group showed predominantly DLD, therefore making speech therapy the more effective intervention. In this study, all children expressed their desire to communicate with their peers. To the authors’ best knowledge, this is the first study determining the ability to communicate in a preschool cohort with DLD using characterisation with video documentation in a follow-up for 1 year. Full article
(This article belongs to the Special Issue Addressing Challenges in Child Mental Health: Research and Strategies for Comprehensive Development)
12 pages, 1450 KiB  
Article
Polyhydramnios at Term in Gestational Diabetes: Should We Be Concerned?
by Mercedes Horcas-Martín, Tania Luque-Patiño, Claudia Usandizaga-Prat, Elena Díaz-Fernández, Victoria Melero-Jiménez, Luis Vázquez-Fonseca, Francisco Visiedo, José Román Broullón-Molanes, Rocío Quintero-Prado and Fernando Bugatto
Children 2025, 12(7), 920; https://doi.org/10.3390/children12070920 - 11 Jul 2025
Abstract
Background/Objectives: Pregnancies complicated by idiopathic polyhydramnios are linked to a heightened risk of numerous maternal and perinatal complications. We aim to study the implications of polyhydramnios in term pregnancies complicated with gestational diabetes mellitus (GDM). Methods: A prospective cohort study including 340 GDM [...] Read more.
Background/Objectives: Pregnancies complicated by idiopathic polyhydramnios are linked to a heightened risk of numerous maternal and perinatal complications. We aim to study the implications of polyhydramnios in term pregnancies complicated with gestational diabetes mellitus (GDM). Methods: A prospective cohort study including 340 GDM cases was conducted. An ultrasound scan was conducted at term between 37 and 40 weeks and amniotic fluid volume (AFV) was assessed by measuring the amniotic fluid index (AFI) and the single deepest pocket (SDP). Maternal demographics and obstetric and perinatal outcomes were evaluated after delivery. We performed comparisons between groups with normal AFV and polyhydramnios (AFI ≥ 24 cm or SDP ≥ 8 cm), and between groups with normal and increased AFV (AFI or SDP ≥ 75th centile). A multivariate logistic regression analysis was performed to study association between AVF measurements and adverse maternal and perinatal outcomes. Results: We found that women with GDM and polyhydramnios at term had a higher risk of maternal (54.3 vs. 27.5%, p < 0.001) and perinatal adverse outcomes (65.7% vs. 46.5%, p < 0.03). The increased AFV group showed a higher risk of fetal overgrowth (LGA: 21.4% vs. 8.2%, p < 0.001 and macrosomia: 19.8% vs. 5.4%, p < 0.001, respectively) and a lesser risk of delivering an SGA fetus (6.3% vs. 13.6%, respectively). Both AFI and SDP showed a significant correlation with newborn weight (r = 0.27; p < 0.001 and r = 0.28; p < 0.001, respectively) and newborn centile (r = 0.26; p < 0.001 and r = 0.26 for both). Subsequent to conducting a multivariate logistic regression analysis adjusted for pregestational BMI, nulliparity, and insulin treatment, both AFI and SDP were significantly associated with perinatal complications, but AFI showed a stronger association with fetal overgrowth (aOR 1.11; p = 0.004 for a LGA fetus and aOR 1.12; p = 0.002 for macrosomia) and with lower risk of delivering an SGA fetus (aOR 0.89; p = 0.009) or IUGR fetus (aOR 0.86; p = 0.03). ROC analysis showed a poor diagnostic performance of both AFI and SDP for identifying macrosomia (AUC 0.68 for AFI, and 0.65 for SDP). Conclusions: Detection of polyhydramnios at term, whether using AFI or SDP, identifies a subgroup of women with gestational diabetes with higher risks of obstetric and perinatal complications. Cases with increased AFV (AFI ≥ 18 cm or SDP ≥ 6.5 cm) are also associated with an increased risk of fetal overgrowth and may require more intensive monitoring for management and optimal delivery timing, with the aim of improve perinatal outcomes. Full article
(This article belongs to the Special Issue Advances in Prenatal Diagnosis and Their Impact on Neonatal Outcomes)
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21 pages, 1759 KiB  
Review
Three Decades of Managing Pediatric Obstructive Sleep Apnea Syndrome: What’s Old, What’s New
by Beatrice Panetti, Claudia Federico, Giuseppe Francesco Sferrazza Papa, Paola Di Filippo, Armando Di Ludovico, Sabrina Di Pillo, Francesco Chiarelli, Alessandra Scaparrotta and Marina Attanasi
Children 2025, 12(7), 919; https://doi.org/10.3390/children12070919 - 11 Jul 2025
Abstract
Obstructive sleep apnea syndrome (OSAS) in children and adolescents is a prevalent and multifactorial disorder associated with significant short- and long-term health consequences. While adenotonsillectomy (AT) remains the first-line treatment, a substantial proportion of patients—especially those with obesity, craniofacial anomalies, or comorbid conditions—exhibit [...] Read more.
Obstructive sleep apnea syndrome (OSAS) in children and adolescents is a prevalent and multifactorial disorder associated with significant short- and long-term health consequences. While adenotonsillectomy (AT) remains the first-line treatment, a substantial proportion of patients—especially those with obesity, craniofacial anomalies, or comorbid conditions—exhibit persistent or recurrent symptoms, underscoring the need for individualized and multimodal approaches. This review provides an updated and comprehensive overview of current and emerging treatments for pediatric OSAS, with a focus on both surgical and non-surgical options, including pharmacological, orthodontic, and myofunctional therapies. A narrative synthesis of recent literature was conducted, including systematic reviews, randomized controlled trials, and large cohort studies published in the last 10 years. The review emphasizes evidence-based indications, mechanisms of action, efficacy outcomes, safety profiles, and limitations of each therapeutic modality. Adjunctive and alternative treatments such as rapid maxillary expansion, mandibular advancement devices, myofunctional therapy, intranasal corticosteroids, leukotriene receptor antagonists, and hypoglossal nerve stimulation show promising results in selected patient populations. Personalized treatment plans based on anatomical, functional, and developmental characteristics are essential to optimize outcomes. Combination therapies appear particularly effective in children with residual disease after AT or with specific phenotypes such as Down syndrome or maxillary constriction. Pediatric OSAS requires a tailored, multidisciplinary approach that evolves with the child’s growth and clinical profile. Understanding the full spectrum of available therapies allows clinicians to move beyond a one-size-fits-all model, offering more precise and durable treatment pathways. Emerging strategies may further redefine the therapeutic landscape in the coming years. Full article
(This article belongs to the Special Issue Clinical Presentation, Evaluation, and Treatment of Sleep-Disorders in Children and Adolescents)
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19 pages, 333 KiB  
Review
The Challenges of Diagnosing, Managing, and Preventing Pediatric Delirium
by Juliana Patrícia Chaves de Almeida, Yu Kawai, Arnaldo Prata-Barbosa and Roberta Esteves Vieira de Castro
Children 2025, 12(7), 918; https://doi.org/10.3390/children12070918 - 11 Jul 2025
Abstract
Pediatric delirium (PD) is an acute neuropsychiatric syndrome marked by fluctuating disturbances in attention and cognition, frequently observed in pediatric intensive care units (PICUs) and associated with increased morbidity, mortality, and long-term cognitive impairment. Despite its clinical significance, PD remains underdiagnosed due to [...] Read more.
Pediatric delirium (PD) is an acute neuropsychiatric syndrome marked by fluctuating disturbances in attention and cognition, frequently observed in pediatric intensive care units (PICUs) and associated with increased morbidity, mortality, and long-term cognitive impairment. Despite its clinical significance, PD remains underdiagnosed due to challenges inherent in assessing consciousness and cognition in children at varying developmental stages. Several bedside tools have been developed and validated in recent years, including the Cornell Assessment of Pediatric Delirium (CAPD), PreSchool Confusion Assessment Method for the Intensive Care Unit (psCAM-ICU); Pediatric Confusion Assessment Method for the Intensive Care Unit (pCAM-ICU), and Sophia Observation Withdrawal Symptoms—Pediatric Delirium Scale (SOS-PD), enhancing early recognition and management of PD in critically ill children. This narrative review explores the historical background, epidemiology, risk factors, pathophysiology, clinical subtypes, diagnostic tools, and current prevention and treatment strategies for PD from newborns to 21 years old. The screening tools available and the integration of non-pharmacological interventions, such as environmental modifications and family-centered care, as well as cautious and selective pharmacological management, are emphasized in this review. Early identification and targeted interventions are essential to mitigate the adverse outcomes associated with PD. Full article
(This article belongs to the Section Pediatric Emergency Medicine & Intensive Care Medicine)
11 pages, 534 KiB  
Review
Care Beyond the Bedside: Creating Space for Families of Hospitalized Children with Medical Complexity
by Claire E. Wallace, Patrick G. Hogan and Nicholas A. Holekamp
Children 2025, 12(7), 917; https://doi.org/10.3390/children12070917 - 11 Jul 2025
Abstract
Prolonged hospital stays separate children from their families and adversely impact the well-being of both. Children with medical complexity (CMC) often have long hospital stays and sometimes spend months to years missing their childhoods, often alone in their rooms. Caregivers of CMC must [...] Read more.
Prolonged hospital stays separate children from their families and adversely impact the well-being of both. Children with medical complexity (CMC) often have long hospital stays and sometimes spend months to years missing their childhoods, often alone in their rooms. Caregivers of CMC must navigate many barriers to discharge during long hospital stays, which further strains the family system. In this review, we summarize the developmental vulnerabilities of chronically hospitalized CMC and propose that the hospital environment itself confers additional risk for poor neurodevelopmental outcomes. We will discuss the opportunities for pediatric post-acute care (PPAC) hospitals to create spaces where medical treatment, developmental recovery, and family integration in care can exist simultaneously. We then describe how the Care Beyond the Bedside model developed by one PPAC hospital aims to diminish the detrimental effects of prolonged hospitalization on CMC and their families by prioritizing developmental opportunity alongside medical stability. Critical components of this care model are patient and family spaces designed for community, safety training to supervise patients away from the bedside, and investment in staffing and programming to support the model. This care model acknowledges that play and healing are inextricably linked and that children develop best when they are out of bed, participating in life with their families. Full article
(This article belongs to the Special Issue Living beyond Medical Complexity: Factors That Shape Family Health and Wellbeing)
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12 pages, 361 KiB  
Article
Mothers with Concurrent Opioid and Cocaine Use and Neonatal Opioid Withdrawal Syndrome
by Divya Rana, Linda DeBaer and Massroor Pourcyrous
Children 2025, 12(7), 916; https://doi.org/10.3390/children12070916 - 11 Jul 2025
Abstract
Background: Polysubstance use, particularly combining opioids with stimulants such as cocaine, is rising among individuals with substance use disorders. This practice aims to balance cocaine’s stimulant effects with opioids’ sedative effect, potentially decreasing adverse outcomes. We hypothesized that concurrent exposure to cocaine and [...] Read more.
Background: Polysubstance use, particularly combining opioids with stimulants such as cocaine, is rising among individuals with substance use disorders. This practice aims to balance cocaine’s stimulant effects with opioids’ sedative effect, potentially decreasing adverse outcomes. We hypothesized that concurrent exposure to cocaine and opioids would reduce the risk of neonatal opioid withdrawal syndrome (NOWS) compared to opioid use alone. Methods: This analysis draws from an ongoing prospective study of maternal substance use (SUD) at Regional One Health’s perinatal center in Memphis, TN, and included mothers and their infants born between 2018 and 2022. Maternal SUD was identified via screening questionnaires, urine toxicology, or umbilical cord tissue analysis. Participants were grouped into using (a) opioids with cocaine (OwC) and (b) opioids without cocaine (OwoC). Univariate and regression analyses were conducted to assess the risk of NOWS. Results: A total of 353 infants were born to 342 mothers, with 31% (110/353) of the infants born to women who used cocaine along with opioids. While maternal demographics were similar, the OwC group had significantly lower rates of prenatal care, chronic pain history, and MOUD enrollment (p = 0.03). Infants in the OwC group had significantly higher rates of NOWS (p < 0.01), longer hospital stays (p < 0.01), and 6.5 times greater odds of developing NOWS (p < 0.001). NOWS was associated with an average 15-day increase in the length of stay for term infants (95% CI: 11.2, 18.8; p < 0.001). Conclusions: Contrary to our hypothesis, our study highlights the significant impact of maternal cocaine use on the increased likelihood of NOWS and extended hospital stays for affected infants. Full article
(This article belongs to the Special Issue Prenatal Substance Exposure: Historical Perspective, Current Research and Future Challenges)
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16 pages, 821 KiB  
Review
Main Processed Hypoallergenic Foods: A Potential Tool to Improve Informed Dietary Choices in Children with IgE-Mediated Food Allergies
by Luca Pecoraro, Simona Barni, Francesca Mori, Mattia Giovannini, Riccardo Castagnoli, Stefania Arasi, Carla Mastrorilli, Francesca Saretta, Lucia Liotti, Lucia Caminiti, Angela Klain, Mariannita Gelsomino, Michele Miraglia Del Giudice, Gian Luigi Marseglia and Elio Novembre
Children 2025, 12(7), 915; https://doi.org/10.3390/children12070915 - 11 Jul 2025
Abstract
In the context of IgE-mediated food allergies in children, the use of hypoallergenic foods may offer an appropriate solution for enabling informed dietary choices and reducing reactivity to allergenic foods. It is well established that certain foods can alter their allergenicity depending on [...] Read more.
In the context of IgE-mediated food allergies in children, the use of hypoallergenic foods may offer an appropriate solution for enabling informed dietary choices and reducing reactivity to allergenic foods. It is well established that certain foods can alter their allergenicity depending on the method of processing. As such, processed foods may serve both as an alternative dietary option and as a useful tool in oral immunotherapy for children with IgE-mediated food allergies. Nevertheless, an oral food challenge is always recommended when a pediatric allergist considers incorporating processed foods into a child’s diet. This review aims to explore the potential use of processed forms of the nine major food allergens in IgE-mediated food allergies, supporting pediatric allergists in partially liberalizing children’s diets and facilitating the development of tolerance. Full article
(This article belongs to the Section Pediatric Allergy and Immunology)
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10 pages, 198 KiB  
Article
ADHD Reporting in Developmental Age: The Role of the Informants
by Dario Esposito, Federica Gigliotti, Beatrice Colotti, Carlo Di Brina, Francesco Pisani and Maria Romani
Children 2025, 12(7), 914; https://doi.org/10.3390/children12070914 - 11 Jul 2025
Abstract
Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is a complex neurodevelopmental condition typically requiring information from multiple informants for accurate diagnosis. However, the consistency and diagnostic value of reports from teachers, parents, primary care providers (PCPs), and other professionals remain debated. This study aimed to examine [...] Read more.
Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is a complex neurodevelopmental condition typically requiring information from multiple informants for accurate diagnosis. However, the consistency and diagnostic value of reports from teachers, parents, primary care providers (PCPs), and other professionals remain debated. This study aimed to examine the role and diagnostic accuracy of different informants in the referral and diagnostic process for ADHD in children aged 3–11. Methods: This retrospective study analyzed data from 120 children referred for suspected ADHD. Initial reports were obtained from teachers, parents, PCPs, and other professionals, and final diagnoses were determined through comprehensive neuropsychiatric evaluations. Diagnostic concordance and informant-specific contributions were assessed. Results: Of the 120 children, 64 (53.3%) received an ADHD diagnosis. Teachers were the most frequent informants, followed by parents, with fewer referrals from PCPs and other professionals. No significant differences in diagnostic accuracy were found among informants, aligning with previous studies suggesting that no single informant is superior in identifying ADHD. Notably, over 93% of referred children were diagnosed with a neuropsychiatric disorder, though not necessarily ADHD. Conclusions: The findings underscore the importance of combining reports from parents and teachers to capture symptom expression across different environments, which is essential for accurate ADHD diagnosis. Enhanced training for informants and a multidisciplinary approach is recommended to improve diagnostic accuracy and support early identification and intervention efforts. These results support nuanced evaluation strategies that account for informant variability and help mitigate potential misinterpretations of ADHD symptoms. Full article
(This article belongs to the Special Issue Children and Adolescents with Neurodevelopmental Disabilities: Ecological Assessment Tools and Cognitive Analysis)
12 pages, 1044 KiB  
Article
Validation of the Korean Pediatric Emergency Tape with Two National Anthropometric Surveys in Korean Children
by Dongbum Suh, Jin Hee Lee and Hyuksool Kwon
Children 2025, 12(7), 913; https://doi.org/10.3390/children12070913 - 10 Jul 2025
Abstract
Background: The Korean Pediatric Emergency Tape (KPET), developed using 2005 anthropometric data, aims to improve weight estimation in Korean children. However, its validity has not been evaluated using recent large-scale data. This study evaluates the accuracy of the KPET compared with the [...] Read more.
Background: The Korean Pediatric Emergency Tape (KPET), developed using 2005 anthropometric data, aims to improve weight estimation in Korean children. However, its validity has not been evaluated using recent large-scale data. This study evaluates the accuracy of the KPET compared with the latest version of the Broselow Tape (BT) using contemporary national anthropometric datasets. Methods: A cross-sectional analysis was conducted using pooled data from the 2019 National Health Screening Program for Infants and Children (NHSPIC, age 0–5) and the 2018–2019 Student Health Examination Sample Survey in Korea (SHESS, age 6–12). Accuracy was assessed by the proportion of estimates within 10% (PW10) and 20% (PW20) of measured weight, and by concordance between estimated and measured weight color zones. Results: Data from 1,992,646 (KPET) and 1,987,504 (BT) children were analyzed. In NHSPIC, the KPET showed slightly lower overall accuracy than the BT (PW10: 72.7% vs. 74.0%) but outperformed the BT in infants (PW10: 72.1% vs. 67.4%). In SHESS, the KPET consistently underperformed compared with the BT (PW10: 49.5% vs. 52.9%). The KPET showed higher concordance only in infants. Both tapes showed a trend of underestimation with increasing age, more pronounced in the KPET. Conclusion: The KPET showed lower overall performance than the BT but outperformed the BT in infants. Its accuracy declines in older children and tends to underestimate weight. Regular updates using recent anthropometric data are necessary to ensure accurate weight estimation and reflect current growth trends in Korean children. Full article
(This article belongs to the Special Issue Emergency Management and Treatment Strategies in Children Cardiac Arrest)
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25 pages, 2026 KiB  
Review
Mapping the Fat: How Childhood Obesity and Body Composition Shape Obstructive Sleep Apnoea
by Marco Zaffanello, Angelo Pietrobelli, Giorgio Piacentini, Thomas Zoller, Luana Nosetti, Alessandra Guzzo and Franco Antoniazzi
Children 2025, 12(7), 912; https://doi.org/10.3390/children12070912 - 10 Jul 2025
Abstract
Background/Objectives: Childhood obesity represents a growing public health concern. It is closely associated with obstructive sleep apnoea (OSA), which impairs nocturnal breathing and significantly affects neurocognitive and cardiovascular health. This review aims to analyse differences in fat distribution, anthropometric parameters, and [...] Read more.
Background/Objectives: Childhood obesity represents a growing public health concern. It is closely associated with obstructive sleep apnoea (OSA), which impairs nocturnal breathing and significantly affects neurocognitive and cardiovascular health. This review aims to analyse differences in fat distribution, anthropometric parameters, and instrumental assessments of paediatric OSA compared to adult OSA to improve the diagnostic characterisation of obese children. Methods: narrative review. Results: While adenotonsillar hypertrophy (ATH) remains a primary cause of paediatric OSA, the increasing prevalence of obesity has introduced distinct pathophysiological mechanisms, including fat accumulation around the pharynx, reduced respiratory muscle tone, and systemic inflammation. Children exhibit different fat distribution patterns compared to adults, with a greater proportion of subcutaneous fat relative to visceral fat. Nevertheless, cervical and abdominal adiposity are crucial in increasing upper airway collapsibility. Recent evidence highlights the predictive value of anthropometric and body composition indicators such as neck circumference (NC), neck-to-height ratio (NHR), neck-to-waist ratio (NWR), fat-to-muscle ratio (FMR), and the neck-to-abdominal-fat percentage ratio (NAF%). In addition, ultrasound assessment of lateral pharyngeal wall (LPW) thickness and abdominal fat distribution provides clinically relevant information regarding anatomical contributions to OSA severity. Among imaging modalities, dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA), and air displacement plethysmography (ADP) have proven valuable tools for evaluating body fat distribution. Conclusions: Despite advances in the topic, a validated predictive model that integrates these parameters is still lacking in clinical practice. Polysomnography (PSG) remains the gold standard for diagnosis; however, its limited accessibility underscores the need for complementary tools to prioritise the identification of children at high risk. A multimodal approach integrating clinical, anthropometric, and imaging data could support the early identification and personalised management of paediatric OSA in obesity. Full article
(This article belongs to the Section Translational Pediatrics)
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24 pages, 281 KiB  
Article
Balancing Care and Sacrifice: Lived Experiences and Support Needs of Primary Caregivers in Pediatric Chronic Pain Across Canada and Australia
by Nicole Pope, Nicole Drumm, Kathryn A. Birnie, Melanie Noel, Carolyn Berryman, Nicki Ferencz, Tieghan Killackey, Megan Macneil, Darrel Zientek, Victoria Surry and Jennifer N. Stinson
Children 2025, 12(7), 911; https://doi.org/10.3390/children12070911 - 10 Jul 2025
Abstract
Background: Chronic pain affects one in five youth globally and is frequently accompanied by mental health challenges that extend into adulthood. Caregivers play a vital role in supporting youth with chronic pain, yet their own mental and physical health needs are often overlooked. [...] Read more.
Background: Chronic pain affects one in five youth globally and is frequently accompanied by mental health challenges that extend into adulthood. Caregivers play a vital role in supporting youth with chronic pain, yet their own mental and physical health needs are often overlooked. While caregiver well-being is linked to child outcomes, few interventions directly address caregivers’ health, especially among those facing systemic barriers. This study explored the lived experiences of caregivers to better understand their unmet needs and inform the co-design of a supportive digital health solution. Methods: We conducted a qualitative exploratory study involving 32 caregivers of youth with chronic pain across Canada and Australia. Semi-structured interviews were co-facilitated by caregiver partners. Thematic analysis was applied to interview data. Results: Two overarching themes were identified: (1) bearing the weight and sacrifice of caregiving and (2) deep interrelatedness and blurred boundaries. Caregivers reported profound emotional, physical, and financial burdens; strained relationships; and social isolation. Many struggled with self-neglect, prioritizing their child’s needs over their own. Fathers’ evolving caregiving roles challenged traditional gender norms, though mothers continued to bear a disproportionate load. Despite challenges, caregivers demonstrated resilience and recognized their well-being as interconnected with their child’s health. Conclusions: Findings underscore the need for systemic investment in caregiver well-being. Digital health solutions, including virtual peer networks, mental health resources, and tailored education, offer scalable, accessible pathways for support. These insights will inform the development of Power over Pain for Primary Caregivers, a digital solution and knowledge hub aimed at improving caregiver well-being and family outcomes, aligning with global efforts to enhance family-centred pediatric pain care. Full article
(This article belongs to the Section Pediatric Anesthesiology, Perioperative and Pain Medicine)
10 pages, 194 KiB  
Article
Evaluation of a Pilot Program to Increase Mental Health Care Access for Youth—The Interprofessional Child-Centered Integrated Care (ICX2) Model
by Nicole Klaus, Evelyn English, Elizabeth Lewis, Jordan Camp, Sarah Krogman and Kari Harris
Children 2025, 12(7), 910; https://doi.org/10.3390/children12070910 - 10 Jul 2025
Abstract
Background/Objectives: The pediatric mental health crisis in the United States has reached unprecedented levels. Severe shortages in specialized health care professionals, particularly child and adolescent psychiatrists (CAPs), exacerbate the challenge of delivering timely and quality mental health care, especially in rural areas like [...] Read more.
Background/Objectives: The pediatric mental health crisis in the United States has reached unprecedented levels. Severe shortages in specialized health care professionals, particularly child and adolescent psychiatrists (CAPs), exacerbate the challenge of delivering timely and quality mental health care, especially in rural areas like Kansas. Innovative models such as Pediatric Mental Health Care Access (PMHCA) programs and School-Based Health Clinics (SBHCs) aim to integrate mental health expertise into primary care settings to address this gap. Methods: This paper examines an integrated care model to support SBHCs developed by the Kansas PMHCA. The Interprofessional Child-Centered Integrated Care Model (ICX2) was implemented within an SBHC in Haysville, KS. ICX2 utilizes biweekly collaborative team meetings (CTMs) via zoom involving primary care, psychology, child psychiatry, social work, and school resource coordinators to discuss patient cases and enhance the primary care management of pediatric mental health. This descriptive study analyzes data from January 2023 to June 2023, focusing on patient demographics, case characteristics discussed during CTMs, and recommendations made by the interprofessional team. Results: Findings illustrate the complex biopsychosocial needs of patients seen and define themes of case consultation and recommendations. Conclusions: Integrated care programs like ICX2 can be feasibly implemented through PMHCA programs and may be an efficient intervention to bridge resource gaps. Full article
(This article belongs to the Special Issue Health Behaviour, Health Literacy and Mental Health in Children: 2nd Edition)
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25 pages, 839 KiB  
Systematic Review
Molecular and Neurobiological Imbalance from the Use of Technological Devices During Early Child Development Stages
by Roberta Rizzo, Gaia Fusto, Serena Marino, Iside Castagnola, Claudia Parano, Xena Giada Pappalardo and Enrico Parano
Children 2025, 12(7), 909; https://doi.org/10.3390/children12070909 - 10 Jul 2025
Abstract
Background/Objectives: Digital technologies have become increasingly integrated into the daily lives of children and adolescents, largely because their interactive and visually engaging design is particularly suited to the younger users. The COVID-19 pandemic further accelerated this trend, significantly lowering the average age of [...] Read more.
Background/Objectives: Digital technologies have become increasingly integrated into the daily lives of children and adolescents, largely because their interactive and visually engaging design is particularly suited to the younger users. The COVID-19 pandemic further accelerated this trend, significantly lowering the average age of access to the digital devices. However, scientific consensus remains divided regarding the developmental impact of digital media use—particularly its cognitive, motor, and emotional consequences—depending on whether the use is passive or active. This review aims to explore these effects across developmental stages, focusing on both behavioral and neurobiological dimensions, and to identify emerging risks and protective factors associated with digital engagement. Methods: A PRISMA review was conducted on the impact of digital media use among pre-school children and adolescents. Behavioral, psychosocial, and neurobiological aspects were examined, with specific attention to epigenetic changes, techno-stress, digital overstimulation, and immersive technologies (e.g., virtual and augmented reality). Results: The findings suggest that passive digital consumption is more often associated with negative outcomes, such as impaired attention and emotional regulation, especially in younger children. Active and guided use may offer cognitive benefits. Neurobiological research indicates that chronic exposure to digital stimuli may affect stress regulation and neural development, possibly via epigenetic mechanisms. Effects vary across developmental stages and individual vulnerabilities. Conclusions: A nuanced understanding of digital engagement is essential. While certain technologies can support development, excessive or unguided use may pose risks. This review provides age-specific recommendations to foster balanced and healthy technology use in children and adolescents. Full article
(This article belongs to the Section Global Pediatric Health)
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15 pages, 1449 KiB  
Article
Cochlear Implant in Children with Congenital CMV Infection: Long-Term Results from an Italian Multicentric Study
by Francesca Forli, Silvia Capobianco, Stefano Berrettini, Francesco Lazzerini, Rita Malesci, Anna Rita Fetoni, Serena Salomè, Davide Brotto, Patrizia Trevisi, Leonardo Franz, Elisabetta Genovese, Andrea Ciorba and Silvia Palma
Children 2025, 12(7), 908; https://doi.org/10.3390/children12070908 - 10 Jul 2025
Abstract
Background/Objectives: Congenital cytomegalovirus (cCMV) infection is the most common non-genetic cause of sensorineural hearing loss (SNHL) in children. In cases of severe-to-profound SNHL, cochlear implantation (CI) is a widely used intervention, but outcomes remain variable due to possible neurodevelopmental comorbidities. This study [...] Read more.
Background/Objectives: Congenital cytomegalovirus (cCMV) infection is the most common non-genetic cause of sensorineural hearing loss (SNHL) in children. In cases of severe-to-profound SNHL, cochlear implantation (CI) is a widely used intervention, but outcomes remain variable due to possible neurodevelopmental comorbidities. This study aimed to evaluate the long-term auditory and language outcomes in children with cCMV after CI and to explore clinical and radiological predictors of post-CI performance. Methods: Fifty-three children with cCMV and bilateral severe-to-profound SNHL who underwent CI at five tertiary referral centers in Italy were included in the study. Auditory and language outcomes were assessed pre- and post-implantation using the Categories of Auditory Performance II (CAP-II) scale, the Nottingham 3-Level Classification, and the Bates Language Development Scale. Brain MRI abnormalities were classified according to the Alarcón classification. Correlations were explored between outcome scores and symptomatic status at birth, MRI findings, and neurodevelopmental comorbidities. Results: At birth, 40 children (75.5%) were symptomatic and 13 (24.5%) asymptomatic. Neurodevelopmental comorbidities were present in 19 children (35.8%). MRI was normal in 15 (28.3%), mildly abnormal in 26 (49%), and moderately to severely abnormal in 12 (22.6%). Auditory and language outcomes improved significantly post-CI (p < 0.001), though the outcomes varied widely. Twenty-five children (47%) reached CAP level ≥ 6, and thirteen (23%) reached Bates Level 6. Symptomatic status at birth correlated weakly with worse CAP (ρ = −0.291, p = 0.038) and Bates (ρ = −0.310, p = 0.028) scores. Higher Alarcón scores were significantly associated with neurodevelopmental comorbidities, though not directly with post-CI auditory and language outcomes. Finally, the presence of neurodevelopmental disabilities was generally associated with lower results, even if without statistical significance. Conclusions: CI provides substantial auditory and language benefit in children with cCMV, even in cases of severe neurodevelopmental comorbidities. MRI and developmental assessments, as well as perinatal history for clinical signs and symptoms, are helpful in guiding expectations and personalizing post-implantation support. Full article
(This article belongs to the Special Issue Treatment Strategies for Hearing Loss in Children)
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23 pages, 1023 KiB  
Review
Short- and Long-Term Consequences of Late-Preterm and Early-Term Birth
by Muhammad Arham and Katarzyna Wróblewska-Seniuk
Children 2025, 12(7), 907; https://doi.org/10.3390/children12070907 - 9 Jul 2025
Viewed by 60
Abstract
Late-preterm (340/7–366/7 weeks) and early-term (370/7–386/7 weeks) newborns were, up until recently, erroneously categorized as low-risk and were conflated with full-term (390/7–406/7 weeks) deliveries. However, emerging evidence refuted this notion and demonstrated that late-preterm [...] Read more.
Late-preterm (340/7–366/7 weeks) and early-term (370/7–386/7 weeks) newborns were, up until recently, erroneously categorized as low-risk and were conflated with full-term (390/7–406/7 weeks) deliveries. However, emerging evidence refuted this notion and demonstrated that late-preterm and, to a lesser extent, early-term newborns have a significantly higher risk of experiencing various neonatal morbidities, including respiratory distress syndrome, transient tachypnea of the newborn, pneumonia, jaundice, hypoglycemia, and breastfeeding difficulties, compared to their full-term counterparts—reflecting their relative physiologic and developmental immaturity. Recent evidence also unravels the lingering adverse effects of late-preterm and early-term delivery up until mid-adulthood, with the increased susceptibility of these newborns to neurodevelopmental delays, behavioral and neuropsychiatric problems, and adult chronic diseases. Moreover, apart from increased neonatal and infant mortality rates, these newborns continue to encounter a heightened risk of mortality even up to mid-adulthood. As the full spectrum of the complications these newborns face is gradually being unveiled, this review presents and discusses the current knowledge base, identifies gaps in the literature, and highlights future research implications. Full article
(This article belongs to the Special Issue Late-Preterm and Early-Term Newborns: Risk Factors, Outcomes and New Challenges)
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14 pages, 254 KiB  
Article
The Relationship Between Familial Functioning and Social Media Use Among Children with Depression and Attention Deficit Hyperactivity Disorder: A Comparative Study with Healthy Controls
by Mutlu Muhammed Özbek, Doğa Sevinçok and Emre Mısır
Children 2025, 12(7), 906; https://doi.org/10.3390/children12070906 - 9 Jul 2025
Viewed by 59
Abstract
Objective: This study aimed to investigate the relationship between social media use (SMU) in children diagnosed with major depression (MD) or attention deficit hyperactivity disorder (ADHD) and various psychosocial factors, including familial functioning, parental SMU, and parent-reported internalizing and externalizing symptoms. A healthy [...] Read more.
Objective: This study aimed to investigate the relationship between social media use (SMU) in children diagnosed with major depression (MD) or attention deficit hyperactivity disorder (ADHD) and various psychosocial factors, including familial functioning, parental SMU, and parent-reported internalizing and externalizing symptoms. A healthy control group was included for comparison. Methods: The study included 121 children and adolescents aged 10–18 years (36 with MD, 41 with ADHD, and 44 healthy controls). The Social Media Addiction Scale—Short Form (SMDS) was administered to all participants, while mothers completed the McMaster Family Assessment Scale (FAS), the Social Media Addiction Scale—Adult Form (SMAS-AF), and the Child Behavior Checklist (CBCL). Psychiatric diagnoses were made using the K-SADS-PL DSM-5-T. Correlation and linear regression analyses were used to assess associations among variables. Results: SMU scores were significantly higher in the ADHD group compared to both the depression and control groups. Parental SMU was also higher in the ADHD group. In the depression group, child SMU was significantly associated with internalizing symptoms and impaired family communication. In the ADHD group, child SMU was predicted by poor family problem-solving and communication. Regression analyses showed that internalizing symptoms and family communication predicted SMU in the depression group (R2 = 0.335), while family problem-solving and communication predicted SMU in the ADHD group (R2 = 0.709). Conclusion: The findings suggest that social media use in children with depression and ADHD is associated with different psychosocial factors. While internalizing symptoms and family communication are more prominent in depressed children, family functioning—particularly problem-solving and communication—plays a larger role in children with ADHD. These results emphasize the need for targeted family-based interventions to mitigate problematic SMU in clinical populations. Full article
(This article belongs to the Section Pediatric Mental Health)
14 pages, 242 KiB  
Article
Current Practices and Recommendations for Children with Food Allergies and Feeding Behaviours: Insights from a Survey Among Australian Health Professionals
by Jennifer Kefford, Rebecca L. Packer, Merryn Netting, Elizabeth C. Ward and Jeanne Marshall
Children 2025, 12(7), 905; https://doi.org/10.3390/children12070905 - 9 Jul 2025
Viewed by 57
Abstract
Background: Children with food allergies can present with paediatric feeding disorder (PFD). However, access to coordinated multidisciplinary services to support these children in Australia is inconsistent. To date, the availability of services or the perceived care needs of Australian health professionals working [...] Read more.
Background: Children with food allergies can present with paediatric feeding disorder (PFD). However, access to coordinated multidisciplinary services to support these children in Australia is inconsistent. To date, the availability of services or the perceived care needs of Australian health professionals working with this population have not been formally explored. Methods: A web-based survey was distributed to health professionals in Australia. Quantitative demographic data were summarised using descriptive statistics, and open-ended responses were analysed using content analysis. Results: The final sample comprised 98 responses, with speech pathologists representing the largest professional group (n = 39; 40%). A majority (59%) worked in hospital-based services. Open-ended responses were coded utilising content analysis. Three categories were developed including (1) service delivery, (2) intervention, and (3) resources. Services were commonly impacted by long wait times, limited staff training, and inconsistencies between hospital and community care. Additionally, mental health support was frequently reported as insufficient. Conclusions: The findings from this study underscore the need for integrated services for children with food allergies and paediatric feeding disorder. Recommended areas for future research include exploring caregiver perspectives and the impact of food allergies and paediatric feeding disorder, and consideration of co-designed studies to inform service improvement initiatives. Full article
(This article belongs to the Section Pediatric Gastroenterology and Nutrition)
13 pages, 1184 KiB  
Case Report
Reconceptualizing Pediatric Strabismus as a Condition Rooted in Sensory Processing Disorder: A Novel Case-Based Hypothesis
by Mirjana Bjeloš, Ana Ćurić, Mladen Bušić, Katja Rončević and Adrian Elabjer
Children 2025, 12(7), 904; https://doi.org/10.3390/children12070904 - 9 Jul 2025
Viewed by 51
Abstract
Background/Objectives: A direct link between sensory processing disorder (SPD) and strabismus has not been systematically investigated, though prior studies suggest sensory modulation may influence visual behaviors. Traditional approaches view strabismus through a binary lens—either normal or pathological motor deviation. This report presents a [...] Read more.
Background/Objectives: A direct link between sensory processing disorder (SPD) and strabismus has not been systematically investigated, though prior studies suggest sensory modulation may influence visual behaviors. Traditional approaches view strabismus through a binary lens—either normal or pathological motor deviation. This report presents a proof-of-concept case suggesting strabismus may represent a neurobehavioral manifestation of sensory processing imbalance, rooted within the broader framework of SPD. Methods: We report a pediatric case marked by episodic monocular eye closure triggered by environmental stimuli, without identifiable ophthalmologic or neurologic pathology. The child’s symptoms were most consistent with sensory over-responsivity (SOR), a subtype of SPD, manifesting as stimulus-bound monocular eye closure and secondary self-regulatory behaviors. Results: We propose the Fusion Dysregulation Hypothesis, suggesting that exotropia and esotropia represent opposing outcomes along a continuum of sensory connectivity: exotropia arising from neural underwiring (hyporesponsivity and fusion instability), and esotropia from overwiring (hyperresponsivity and excessive fusion drive). Our case, marked by sensory hyperresponsivity, showed frequent monocular eye closure that briefly disrupted but did not impair fusion. This suggests an “overwired” binocular system maintaining single vision despite sensory triggers. In early-onset esotropia, such overconnectivity may become maladaptive, leading to sustained convergence. Conversely, autism spectrum disorder, typically associated with hypoconnectivity, may predispose to exotropia through reduced fusion maintenance. Conclusions: These findings highlight the need for interdisciplinary evaluation. We advocate for structured sensory profiling in children presenting with strabismus and, conversely, for ophthalmologic assessment in those diagnosed with SPD. While our findings remain preliminary, they support a bidirectional screening approach and suggest that sensory modulation may play a previously under-recognized role in the spectrum of pediatric strabismus presentations. Full article
(This article belongs to the Special Issue Children with Specific Neurodevelopmental Disorders: Assessment and Intervention (2nd Edition))
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11 pages, 414 KiB  
Article
Evaluation of Pediatric Patients’ General Health Status Prior to Dental Treatment Under General Anesthesia: A Retrospective Study
by Enes Bardakçı, Şemsettin Yıldız, Betül Yazmacı, Mehmet Emin Doğan, Kübra Mumcu and Mehmet Sinan Doğan
Children 2025, 12(7), 903; https://doi.org/10.3390/children12070903 - 8 Jul 2025
Viewed by 95
Abstract
Background/Aim: Dental treatment is typically performed under general anesthesia for children who have difficulty cooperating, as well as for those with mental or physical disabilities requiring special care. This study aims to categorize and evaluate the systemic disease or syndrome status, age, [...] Read more.
Background/Aim: Dental treatment is typically performed under general anesthesia for children who have difficulty cooperating, as well as for those with mental or physical disabilities requiring special care. This study aims to categorize and evaluate the systemic disease or syndrome status, age, and gender of children who require dental treatment under general anesthesia. Materials and Methods: In this study, the ages, sexes, disabilities (if any), and systemic diseases of patients requiring dental treatment under general anesthesia (GA) between the ages of 1 and 15 were analyzed. The patients were categorized based on having difficulties cooperating or having mental or physical disabilities that require special care. Results: In this study, data from 1666 patients were examined. A total of 955 patients (57.32%) were male, while 711 (42.67%) were female. Overall, 232 (13.9%) patients with disabilities or systemic diseases visited the clinic, including 49 who had epilepsy (2.9%), the highest number among the systemic disease group. This finding was statistically significant in the 4–6 age group (p < 0.00). Conclusions: Among patients with special needs, epilepsy emerged as a disorder that requires the most dental treatment. We believe that providing dental treatment for children with neurological diseases, such as epilepsy, in a fully equipped operating room will be beneficial in managing complications that may arise during treatment. Full article
(This article belongs to the Section Pediatric Dentistry & Oral Medicine)
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12 pages, 216 KiB  
Article
Use of Electronic and Conventional Cigarettes and Self-Rated Mental Health in High School Students
by Payam Sheikhattari, Rifath Ara Alam Barsha, Chidubem Egboluche and Shervin Assari
Children 2025, 12(7), 902; https://doi.org/10.3390/children12070902 - 8 Jul 2025
Viewed by 152
Abstract
Background: Youth tobacco use remains a significant public health concern, particularly in urban communities disproportionately burdened by health disparities. In Baltimore City, where tobacco-related harms are elevated, understanding the relationship between tobacco use—including e-cigarettes—and mental health among high school students is essential for [...] Read more.
Background: Youth tobacco use remains a significant public health concern, particularly in urban communities disproportionately burdened by health disparities. In Baltimore City, where tobacco-related harms are elevated, understanding the relationship between tobacco use—including e-cigarettes—and mental health among high school students is essential for guiding equitable prevention and cessation strategies. The CEASE (Communities Engaged and Advocating for a Smoke-free Environment) program, in collaboration with the American Lung Association’s Not On Tobacco (N-O-T) initiative, developed an online school-based survey to inform community-responsive interventions. Aims: This study aimed to examine the associations between cigarette use, including conventional cigarette use, and self-rated mental health among high school students in Baltimore City. Methods: High school students in Baltimore City completed an anonymous online survey that assessed demographic characteristics, tobacco knowledge and use, mental health, and related behaviors. Self-rated mental health was dichotomized as poor versus fair/good. Tobacco use categories included current use of e-cigarettes and conventional cigarettes. Logistic regression models were used to examine associations between tobacco use and self-rated mental health, adjusting for age, gender, race, and parental education. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported. Results: No statistically significant associations were found between self-rated mental health and e-cigarette use and conventional tobacco use after adjusting for covariates. Conclusions: The absence of a significant association may reflect unique aspects of the social context in Baltimore City, where youth may not use tobacco products as a coping mechanism for mental health challenges. Alternatively, it may be due to limitations in measurement, particularly the use of a single-item mental health assessment. These findings should be considered preliminary. Future research using more comprehensive mental health measures and larger samples is warranted to further explore these complex relationships. Full article
(This article belongs to the Special Issue Child and Adolescent Health in Urban Environments)
11 pages, 224 KiB  
Review
Platinum-Induced Ototoxicity in Pediatric Cancer Patients: A Comprehensive Approach to Monitoring Strategies, Management Interventions, and Future Directions
by Antonio Ruggiero, Alberto Romano, Palma Maurizi, Dario Talloa, Fernando Fuccillo, Stefano Mastrangelo and Giorgio Attinà
Children 2025, 12(7), 901; https://doi.org/10.3390/children12070901 - 8 Jul 2025
Viewed by 130
Abstract
Platinum-induced ototoxicity constitutes a significant adverse effect in pediatric oncology, frequently resulting in permanent hearing impairment with profound implications for quality of life, language acquisition, and scholastic performance. This comprehensive review critically evaluates contemporary ototoxicity monitoring practices across various pediatric oncology settings, analyzes [...] Read more.
Platinum-induced ototoxicity constitutes a significant adverse effect in pediatric oncology, frequently resulting in permanent hearing impairment with profound implications for quality of life, language acquisition, and scholastic performance. This comprehensive review critically evaluates contemporary ototoxicity monitoring practices across various pediatric oncology settings, analyzes current guideline recommendations, and formulates strategies for implementing standardized surveillance protocols. Through examination of recent literature—encompassing retrospective cohort investigations, international consensus recommendations, and functional outcome assessments—we present an integrated analysis of challenges and opportunities in managing chemotherapy-associated hearing loss among childhood cancer survivors. Our findings demonstrate marked heterogeneity in monitoring methodologies, substantial implementation obstacles, and considerable impact on survivors’ functional status across multiple domains. Particularly concerning is the persistent absence of an evidence-based consensus regarding the appropriate duration of audiological surveillance for this vulnerable population. We propose a structured framework for comprehensive ototoxicity management emphasizing prompt detection, standardized assessment techniques, and integrated long-term follow-up care to minimize the developmental consequences of platinum-induced hearing impairment. This approach addresses critical gaps in current practice while acknowledging resource limitations across diverse healthcare environments. Full article
(This article belongs to the Section Pediatric Hematology & Oncology)
15 pages, 229 KiB  
Case Report
Clinical Presentation of Postnatally Acquired Cytomegalovirus Infection in Preterm Infants—A Case Series Report
by Dobrochna Wojciechowska, Dominika Galli, Justyna Kowalczewska, Tomasz Szczapa and Katarzyna Ewa Wróblewska-Seniuk
Children 2025, 12(7), 900; https://doi.org/10.3390/children12070900 - 8 Jul 2025
Viewed by 166
Abstract
Background: Human cytomegalovirus (HCMV) is the leading cause of congenital and acquired viral infections in newborns. While acquired infections are often asymptomatic, premature infants—especially those born before 30 weeks of gestation or with a very low birth weight (<1500 g)—are at an [...] Read more.
Background: Human cytomegalovirus (HCMV) is the leading cause of congenital and acquired viral infections in newborns. While acquired infections are often asymptomatic, premature infants—especially those born before 30 weeks of gestation or with a very low birth weight (<1500 g)—are at an increased risk for severe infections. These can manifest as thrombocytopenia, liver failure, sepsis-like symptoms, and, in rare cases, death. HCMV is transmitted through various human secretions, including breast milk, which is the optimal feeding method for premature infants. Methods: We present five premature neonates, born between 23 and 26 weeks of gestation, each with a distinct clinical presentation of acquired HCMV infection. Results: All infants tested negative for congenital CMV infection via molecular urine testing within the first three weeks of life. Acquired infection was diagnosed between the second and third month of life, with symptoms such as septic shock, persistent thrombocytopenia, and signs of liver failure. Each infant received antiviral treatment along with regular viral load monitoring. Unfortunately, one patient died due to complications of prematurity. The remaining infants were discharged and continue to receive follow-up care in an outpatient clinic. Conclusions: These cases of postnatally acquired CMV infection aim to increase awareness of its highly heterogeneous and nonspecific clinical presentation, which may result in an incorrect, delayed, or concealed diagnosis. Currently, there are no clear guidelines on how to manage the presence of the virus in maternal breast milk, particularly for premature infants. It should be recommended to perform a molecular CMV test in all breast-fed preterm infants who present with sepsis-like symptoms, thrombocytopenia, liver failure, or other organ involvement. In case of a confirmed aCMV diagnosis, appropriate treatment should be introduced. Full article
(This article belongs to the Special Issue Diagnosis and Treatment of Viral Infections in Children: HIV and Cytomegalovirus)
13 pages, 349 KiB  
Article
Gender Differences in Lower Limb Strength and Endurance Among Saudi Adolescents: A Cross-Sectional Study on the Limited Role of Body Mass Index
by Asma Alonazi, Fay Alsunaid, Latifa Alofaisan, Mohammed Ghassan Alqarni, Jasem Alhumoud and Faizan Kashoo
Children 2025, 12(7), 899; https://doi.org/10.3390/children12070899 - 8 Jul 2025
Viewed by 266
Abstract
Background: Understanding the relationship between physical fitness and body mass index (BMI) is critical for promoting adolescent health, particularly in Saudi Arabia, where cultural norms and rising obesity rates present unique challenges. This study aimed to investigate the impact of BMI, gender, [...] Read more.
Background: Understanding the relationship between physical fitness and body mass index (BMI) is critical for promoting adolescent health, particularly in Saudi Arabia, where cultural norms and rising obesity rates present unique challenges. This study aimed to investigate the impact of BMI, gender, and physical activity levels on lower limb strength and endurance, as measured by the Standing Long Jump (SLJ) and the 1 min Sit-to-Stand (STS) test, respectively. Methods: This cross-sectional study included 100 healthy Saudi adolescents (44 boys, 56 girls) aged 10–18 years. Lower limb strength and endurance were assessed using SLJ (cm) and STS (repetitions/min). Anthropometric measurements included BMI (kg/m2), weight (kg), and height (cm), while physical activity was assessed using the Physical Activity Questionnaire for Adolescents (PAQ-A). Mediation analysis was conducted to examine the potential indirect effects of BMI, PAQ-A score, and age on the relationship between SLJ and STS performance. Results: Boys significantly outperformed girls in both the STS (mean difference = 25.2 repetitions/min; p < 0.001) and SLJ (mean difference = 73.4 cm; p < 0.001). No significant gender differences were found in PAQ-A scores (p = 0.987). A strong positive correlation was observed between SLJ and STS performance (r = 0.768; p < 0.01). BMI was not significantly correlated with SLJ or STS performance. STS repetitions predicted superior SLJ performance both before (β = 0.55, p < 0.001) and after (β = 0.47, p = 0.004) adjustment for BMI, age, PAQ score, and gender. BMI transmitted only a small, non-significant share of this link (indirect β = 0.08, p = 0.122), indicating that the STS–SLJ association is largely direct (model R2 for SLJ = 0.84). Conclusions: Explosive lower limb strength and gender were significant predictors of lower-body endurance, whereas BMI showed a limited association with performance. These findings underscore the importance of incorporating gender-specific strategies in adolescent fitness assessments and interventions, with a cautionary interpretation of BMI as a performance indicator. Full article
(This article belongs to the Section Global Pediatric Health)
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5 pages, 161 KiB  
Editorial
Integration of Adjunctive Therapy for Congenital Adrenal Hyperplasia
by Phyllis W. Speiser
Children 2025, 12(7), 898; https://doi.org/10.3390/children12070898 - 8 Jul 2025
Viewed by 154
Abstract
CAH represents a prototypical enzyme deficiency disorder, most commonly affecting steroid 21-hydroxylase, in which the critical adrenal pathway from cholesterol to cortisol is blocked [...] Full article
(This article belongs to the Section Pediatric Endocrinology & Diabetes)
19 pages, 1513 KiB  
Systematic Review
Effectiveness and Clinical Indications of 2 × 4 Fixed Orthodontic Therapy in Regard to Mixed Dentition: A Systematic Review
by Gianna Dipalma, Grazia Marinelli, Lucia Casamassima, Paola Nardelli, Danilo Ciccarese, Paolo De Sena, Francesco Inchingolo, Vito Crincoli, Andrea Palermo, Ioana Roxana Bordea, Andrea Carbonara, Angelo Michele Inchingolo and Alessio Danilo Inchingolo
Children 2025, 12(7), 897; https://doi.org/10.3390/children12070897 - 7 Jul 2025
Viewed by 163
Abstract
Background/Objectives: This systematic review examines the effectiveness and clinical indications of the 2 × 4 fixed orthodontic appliance for interceptive treatment in children with mixed dentition, aiming to simplify future orthodontic needs. Methods: Following the PRISMA guidelines, a search was conducted across PubMed, [...] Read more.
Background/Objectives: This systematic review examines the effectiveness and clinical indications of the 2 × 4 fixed orthodontic appliance for interceptive treatment in children with mixed dentition, aiming to simplify future orthodontic needs. Methods: Following the PRISMA guidelines, a search was conducted across PubMed, Web of Science, and Scopus (May 2000–May 2025). The inclusion criteria focused on open-access, in vivo/human studies, case–control studies, cohort studies, and RCTs in English. Risk of bias was assessed using Rob 2.0. Results: Out of 362 initial records, 7 studies were included. Most of the included studies showed a low risk of bias, with some moderate risk in terms of confounding variables and participant selection, but no high risk was identified. Conclusions: The 2 × 4 fixed orthodontic appliance is an effective interceptive therapy for mixed dentition. Clinicians can optimize outcomes by understanding its biomechanics and clinical applications. Further research is needed to understand long-term impacts and improve efficiency. Full article
(This article belongs to the Collection Advance in Pediatric Dentistry)
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16 pages, 272 KiB  
Article
Nurturing Healthy Smiles: Brazilian Immigrant Parents’ Perceptions and Parenting Practices of Healthy Eating to Promote Oral Health in Preschool-Aged Children: A Qualitative Study
by Ana Cristina Lindsay, Maria Gabriela Miranda Fontenele, Adriana Bento, Steven A. Cohen, Mary L. Greaney and Denise Lima Nogueira
Children 2025, 12(7), 896; https://doi.org/10.3390/children12070896 - 7 Jul 2025
Viewed by 173
Abstract
Background/Objectives: Oral health (OH) in early childhood is a key determinant of long-term well-being, shaped by parenting-related dietary and hygiene habits. While these influences are well-documented, they remain underexplored among Brazilian immigrant families in the United States (U.S.). Therefore, this study was designed [...] Read more.
Background/Objectives: Oral health (OH) in early childhood is a key determinant of long-term well-being, shaped by parenting-related dietary and hygiene habits. While these influences are well-documented, they remain underexplored among Brazilian immigrant families in the United States (U.S.). Therefore, this study was designed to examine how Brazilian immigrant parents’ perceptions and practices regarding diet and oral hygiene affect their preschool-aged children’s OH. Methods: This qualitative study consisted of in-depth interviews with Brazilian immigrant parents of preschool-aged children (ages 2–5) living in the U.S. Individual, in-depth interviews were conducted via Zoom, recorded, and transcribed in Brazilian Portuguese. Two native Brazilian researchers experienced in qualitative methods conducted a thematic analysis of the transcripts in Brazilian Portuguese using MAXQDA, a qualitative data analysis software. The analysis focused on identifying key perceptions, parenting practices, and barriers related to children’s diet and OH. Results: Parents strongly associated sugary foods with poor OH, identifying sugar as a major contributor to dental issues. Both mothers and fathers reported limiting sugar intake and encouraging good oral hygiene practices. While parents prioritized educating their children on healthy habits, barriers such as time constraints, reliance on external childcare, and economic limitations affected the consistent implementation of strategies. Conclusions: Brazilian immigrant parents understand the importance of diet and oral hygiene in in supporting their children’s early OH but face barriers in broader social contexts, such as daycare, preschools, and communities. Interventions should aim to support parents in their caregiving roles while simultaneously addressing systemic and environmental obstacles. Public health efforts should account for cultural, economic, and contextual factors to more effectively support Brazilian immigrant families in promoting their children’s OH. Full article
(This article belongs to the Special Issue Oral Heath Disparities in Children and Adolescents: Determinants and Challenges)
19 pages, 545 KiB  
Article
Supporting Indigenous Family Caregivers of Children with Life-Threatening and Life-Limiting Illness in One Canadian Province: Healthcare Providers’ Perspectives
by Jill M. G. Bally, Meridith Burles, Amaya Widyaratne, Victoria A. Spurr, Heather Hodgson-Viden and Roona Sinha
Children 2025, 12(7), 895; https://doi.org/10.3390/children12070895 - 7 Jul 2025
Viewed by 148
Abstract
Background: Indigenous peoples in Canada endure lasting effects of colonialism including racism, marginalization, and social, political, and geographic inequities resulting in disproportionate rates of disease and inequitable healthcare. Indigenous infants and children in Canada experience a high incidence of birth complications and illnesses, [...] Read more.
Background: Indigenous peoples in Canada endure lasting effects of colonialism including racism, marginalization, and social, political, and geographic inequities resulting in disproportionate rates of disease and inequitable healthcare. Indigenous infants and children in Canada experience a high incidence of birth complications and illnesses, and families are often left to navigate the care of their child with limited resources. Accordingly, improved, culturally responsive and safe healthcare is needed to enhance child outcomes and optimize family well-being. Purpose and Methods: A qualitative study was conducted by our research team including family members of Indigenous children with serious illnesses, a Cultural Advisor, researchers, and pediatric clinicians. In one component of the study, we explored pediatric healthcare providers’ (HCPs) experiences of caring for Indigenous families of children with serious illness. A purposive sample of 19 pediatric healthcare providers took part in semi-structured qualitative interviews or one focus group. The data were analyzed thematically to identify common experiences and priorities for improved supportive healthcare. Findings: Five themes were identified representing insights from pediatric HCPs, with a focus on barriers to effective healthcare at the interpersonal, institutional, and system levels for seriously ill Indigenous children and their families. Ideas for enhancing the social and cultural responsiveness and safety of supportive healthcare were identified. Implications and Conclusions: The findings offer valuable insights and strategies for HCPs to support holistic, comprehensive, and culturally safe and responsive healthcare. Full article
(This article belongs to the Section Pediatric Nursing)
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