Children

15 pages, 1341 KiB

Open AccessArticle

Ambulatory Blood Pressure Monitoring in Children: A Cross-Sectional Study of Blood Pressure Indices

by Sulaiman K. Abdullah, Ibrahim A. Sandokji, Aisha K. Al-Ansari, Hadeel A. Alsubhi, Abdulaziz Bahassan, Esraa Nawawi, Fawziah H. Alqahtani, Marwan N. Flimban, Mohamed A. Shalaby and Jameela A. Kari

Children 2025, 12(7), 939; https://doi.org/10.3390/children12070939 (registering DOI) - 16 Jul 2025

Abstract

Background: Ambulatory blood pressure monitoring (ABPM) is increasingly recognized as a more reliable indicator of blood pressure status in children than clinic-based measurements, with superior predictive value for cardiovascular morbidity and mortality. However, evidence on the clinical utility of ABPM-derived indices, such as [...] Read more.

Background: Ambulatory blood pressure monitoring (ABPM) is increasingly recognized as a more reliable indicator of blood pressure status in children than clinic-based measurements, with superior predictive value for cardiovascular morbidity and mortality. However, evidence on the clinical utility of ABPM-derived indices, such as pulse pressure (PP), pulse pressure index (PPI), rate pressure product (RPP), ambulatory arterial stiffness index (AASI), and average real variability (ARV), remains underexplored in the pediatric population, particularly among children with chronic kidney disease (CKD). Objective: To evaluate the correlation between ABPM-derived indices in children, with a subgroup analysis comparing those with and without CKD. Secondary objectives included identifying factors associated with AASI and ARV and assessing their utility in cardiovascular risk stratification. Methods: In this bicentric cross-sectional study, 70 children (41 with CKD and 29 controls) were enrolled. ABPM indices (PP, PPI, RPP, AASI, and ARV) were calculated, and both descriptive and inferential statistical analyses, including linear regression, were performed. Results: Systolic and diastolic hypertension were significant predictors of elevated ARV (p < 0.05), while body mass index (BMI) and glomerular filtration rate (GFR) were positively associated with AASI (p < 0.05). Use of angiotensin-converting enzyme inhibitors (ACEIs) was associated with reduced arterial stiffness (p = 0.02). Significant differences were observed in weight, BMI, PP, and PPI between the CKD and non-CKD groups, with ABPM demonstrating greater sensitivity in detecting vascular health markers. Conclusions: ABPM-derived indices, particularly PP, PPI, and ARV, show promise in improving cardiovascular risk assessment in children. These findings support the broader use of ABPM metrics for refined cardiovascular evaluation, especially in pediatric CKD. Full article

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

12 pages, 438 KiB

Open AccessArticle

Non-Invasive Capnography Versus Pulse Oximetry for Early Detection of Respiratory Depression During Pediatric Procedural Sedation: A Prospective Observational Study

by Laura Català Altarriba, Sean Yeh Hsi, Aude Marie Ravit, Sònia Brió Sanagustín and Xoan González-Rioja

Children 2025, 12(7), 938; https://doi.org/10.3390/children12070938 (registering DOI) - 16 Jul 2025

Abstract

Background/Objectives: Continuous ventilation monitoring during pediatric sedation is essential, as respiratory depression may occur silently and may not be detected promptly by conventional methods such as pulse oximetry. Non-invasive capnography has been proposed to improve early detection of respiratory compromise. This prospective observational [...] Read more.

Background/Objectives: Continuous ventilation monitoring during pediatric sedation is essential, as respiratory depression may occur silently and may not be detected promptly by conventional methods such as pulse oximetry. Non-invasive capnography has been proposed to improve early detection of respiratory compromise. This prospective observational study evaluated the diagnostic accuracy of non-invasive capnography, compared to pulse oximetry, for detecting respiratory depression in pediatric patients undergoing sedation. Methods: We conducted a single-center, prospective observational study at a tertiary pediatric hospital, enrolling 101 patients (ages 1–17 years) undergoing sedation for diagnostic or therapeutic procedures. Patients were monitored using both pulse oximetry and non-invasive capnography. Episodes of respiratory depression—defined as apnea, hypopneic hypoventilation, bradypneic hypoventilation, and desaturation—were recorded. We compared the diagnostic performance and time to detection between capnography and pulse oximetry. Results: We identified 93 episodes of respiratory depression in 52 patients (51.1%). Capnography detected all apnea episodes and 76.9% of hypopneic hypoventilation episodes that were not identified by pulse oximetry. The median time advantage of capnography over pulse oximetry was 35 s (p = 0.0055). Combining capnography and pulse oximetry identified more events than pulse oximetry alone (93 vs. 53 episodes). Conclusions: Non-invasive capnography improves the early detection of respiratory depression compared to conventional monitoring with pulse oximetry in pediatric procedural sedation. While these findings support its routine use to enhance patient safety, larger multicenter studies are needed to demonstrate its diagnostic accuracy and impact on clinical outcomes. Full article

(This article belongs to the Section Pediatric Anesthesiology, Pain Medicine and Palliative Care)

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11 pages, 219 KiB

Open AccessArticle

Diagnostic Accuracy of a Machine Learning-Derived Appendicitis Score in Children: A Multicenter Validation Study

by Emrah Aydın, Taha Eren Sarnıç, İnan Utku Türkmen, Narmina Khanmammadova, Ufuk Ateş, Mustafa Onur Öztan, Tamer Sekmenli, Necip Fazıl Aras, Tülin Öztaş, Ali Yalçınkaya, Murat Özbek, Deniz Gökçe, Hatice Sonay Yalçın Cömert, Osman Uzunlu, Aliye Kandırıcı, Nazile Ertürk, Alev Süzen, Fatih Akova, Mehmet Paşaoğlu, Egemen Eroğlu, Gülnur Göllü Bahadır, Ahmet Murat Çakmak, Salim Bilici, Ramazan Karabulut, Mustafa İmamoğlu, Haluk Sarıhan and Süleyman Cüneyt Karakuş Show full author list Hide full author list

Children 2025, 12(7), 937; https://doi.org/10.3390/children12070937 (registering DOI) - 16 Jul 2025

Abstract

Background: Accurate diagnosis of acute appendicitis in children remains challenging due to variable presentations and limitations of existing clinical scoring systems. While machine learning (ML) offers a promising approach to enhance diagnostic precision, most prior studies have been limited by small sample [...] Read more.

Background: Accurate diagnosis of acute appendicitis in children remains challenging due to variable presentations and limitations of existing clinical scoring systems. While machine learning (ML) offers a promising approach to enhance diagnostic precision, most prior studies have been limited by small sample sizes, single-center data, or a lack of external validation. Methods: This prospective, multicenter study included 8586 pediatric patients to develop a machine learning-based diagnostic model using routinely available clinical and hematological parameters. A separate, prospectively collected external validation cohort of 3000 patients was used to assess model performance. The Random Forest algorithm was selected based on its superior performance during model comparison. Diagnostic accuracy, sensitivity, specificity, Area Under Curve (AUC), and calibration metrics were evaluated and compared with traditional scoring systems such as Pediatric Appendicitis Score (PAS), Alvarado, and Appendicitis Inflammatory Response Score (AIRS). Results: The ML model outperformed traditional clinical scores in both development and validation cohorts. In the external validation set, the Random Forest model achieved an AUC of 0.996, accuracy of 0.992, sensitivity of 0.998, and specificity of 0.993. Feature-importance analysis identified white blood cell count, red blood cell count, and mean platelet volume as key predictors. Conclusions: This large, prospectively validated study demonstrates that a machine learning-based scoring system using commonly accessible data can significantly improve the diagnosis of pediatric appendicitis. The model offers high accuracy and clinical interpretability and has the potential to reduce diagnostic delays and unnecessary imaging. Full article

(This article belongs to the Section Global Pediatric Health)

9 pages, 292 KiB

Open AccessArticle

Clinical and Echocardiographic Factors Influencing Patent Ductus Arteriosus Treatment in Preterm Neonates

by Mi Ae Chu, So Young Shin, Jae Hyun Park and Hee Joung Choi

Children 2025, 12(7), 936; https://doi.org/10.3390/children12070936 (registering DOI) - 16 Jul 2025

Abstract

Objective: We evaluated how pre-treatment clinical and echocardiographic findings influence treatment decisions for patent ductus arteriosus (PDA) in preterm neonates. Study Design: Preterm neonates weighing < 1500 g and diagnosed with PDA were enrolled. They were categorized into conservative, medical, and [...] Read more.

Objective: We evaluated how pre-treatment clinical and echocardiographic findings influence treatment decisions for patent ductus arteriosus (PDA) in preterm neonates. Study Design: Preterm neonates weighing < 1500 g and diagnosed with PDA were enrolled. They were categorized into conservative, medical, and surgical groups based on treatment. Results: A total of 242 preterm neonates (120 boys and 122 girls) participated, with a mean gestational age of 27.9 ± 2.2 weeks and a birth weight of 1034.3 ± 239.3 g. Multivariate logistic regression revealed that oliguria (p < 0.001), inotropic drug use (p = 0.049), low PDA flow velocity (p = 0.039), and left atrial enlargement (p = 0.002) were significantly associated with medical or surgical treatment decisions. Additionally, a low base deficit prior to medical therapy was associated with the decision to proceed with surgical intervention after medical treatment failure (p = 0.006). Conclusions: Oliguria, inotropic drug use, low PDA flow velocity, and left atrial enlargement were significantly associated with aggressive treatment decisions in preterm neonates with PDA. Furthermore, a low base deficit influenced the need for surgery following medical therapy failure. Our findings suggest that comprehensive monitoring of both clinical and echocardiographic factors may support treatment decision-making in PDA management in preterm neonates. Full article

(This article belongs to the Section Pediatric Cardiology)

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12 pages, 3647 KiB

Open AccessArticle

Impact of Intracystic Hemorrhage on Therapeutic Outcomes in Macro/Mixed Cystic Lymphatic Malformation: A Retrospective Cohort Study

by Tao Han, Daolin Ye, Jie Cui, Songming Huang and Weimin Shen

Children 2025, 12(7), 935; https://doi.org/10.3390/children12070935 (registering DOI) - 16 Jul 2025

Abstract

Objectives: This research aims to examine the impact of intracystic hemorrhage (ICH) on therapeutic outcomes in children with macro or mixed cystic lymphatic malformation (cLM). Methods: This retrospective study included macro/mixed cLM cases with or without ICH who underwent treatment between [...] Read more.

Objectives: This research aims to examine the impact of intracystic hemorrhage (ICH) on therapeutic outcomes in children with macro or mixed cystic lymphatic malformation (cLM). Methods: This retrospective study included macro/mixed cLM cases with or without ICH who underwent treatment between January 2019 and June 2024. All patients were diagnosed using preoperative imaging findings and intraoperative indocyanine green (ICG) lymphography. The baseline data of enrolled cases were retrospectively collected. The clinical characteristics were documented, including gender, age, histological typing, location, maximum diameter, and intracystic condition. Patients with or without ICH were divided into two groups. The dependent variables for predicting an excellent outcome were analyzed using multivariable logistic regression models after adjusting for potential factors using a univariable regression model. Postoperative variables, including duration of negative drainage, local infection, scar hyperplasia, and follow-up, were compared between the two groups. Results: A total of 83 cLM patients were included (ICH group: n = 36 and without ICH group: n = 47). A complete absence of afferent lymphatic vessels was demonstrated using intraoperative ICG lymphography, suggesting the isolated nature of ICH cases. ICH (p = 031; OR, 2.560; 95% CI, 1.089–6.020) was identified as the main predictor, and younger patients (p = 035; OR, 0.415; 95% CI, 0.183–0.940) had a lower potential for excellent outcomes. For the postoperative variables, the ICH group exhibited a shorter duration of negative drainage than the without ICH group (p < 0.001), while no significant differences were found regarding local infection (p = 0.693) and scar hypertrophy (p = 0.648). Conclusions: Although characterized by aggressive progression and compressive symptoms, ICH emerges as an independent favorable prognostic predictor in macro/mixed cLM management, potentially attributable to its isolated nature. Full article

(This article belongs to the Special Issue Advances in Pediatric Surgery: Innovative Approaches and Emerging Technologies)

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14 pages, 2345 KiB

Open AccessArticle

Clinical Experience in the Management of a Series of Fetal–Neonatal Ovarian Cysts

by Constantin-Cristian Văduva, Laurentiu Dira, Dominic Iliescu, Dan Ruican, Anișoara-Mirela Siminel, George Alin Stoica, Mircea-Sebastian Şerbănescu and Andreea Carp-Velișcu

Children 2025, 12(7), 934; https://doi.org/10.3390/children12070934 (registering DOI) - 16 Jul 2025

Abstract

Introduction: Fetal ovarian cysts are known to be a common form of fetal abdominal masses in female fetuses, often resulting from hormonal stimulation in utero. Although many resolve spontaneously without sequelae, others can develop into more complex pathologies, such as intracystic hemorrhage or [...] Read more.

Introduction: Fetal ovarian cysts are known to be a common form of fetal abdominal masses in female fetuses, often resulting from hormonal stimulation in utero. Although many resolve spontaneously without sequelae, others can develop into more complex pathologies, such as intracystic hemorrhage or torsion, which can compromise ovarian integrity and long-term reproductive outcomes. Early detection and appropriate follow-up evaluation are therefore crucial for optimal perinatal management. Materials and Methods: We conducted a retrospective study of 12 cases of fetal ovarian cysts diagnosed by routine prenatal ultrasound examinations over a two-year period at our institution. Inclusion criteria were the presence of a cystic adnexal lesion detected in utero, detailed prenatal ultrasound documentation, and a comprehensive postnatal examination. Sonographic features such as cyst size, internal echogenicity, and signs of vascular compromise were recorded. The mother’s clinical variables, including gestational age at diagnosis and relevant medical conditions, were noted. Postnatal follow-up evaluation consisted of ultrasound examinations and, if indicated, pediatric surgical consultation. Results: Of the 12 cases, 9 were characterized by a simple cystic morphology. All spontaneously regressed postnatally and did not require surgical intervention. Three were defined as complex cysts showing septations or echogenic deposits; one of these cysts required immediate surgical exploration for suspected torsion. No cases with a malignant background were identified. All infants showed a favorable course with normal growth and development until follow-up evaluation. Conclusions: This series emphasizes that most fetal ovarian cysts are benign and often resolve without intervention, highlighting the benefit of systematic prenatal imaging. Nevertheless, complex or large cysts require close prenatal and neonatal monitoring to diagnose complications such as torsion. Full article

(This article belongs to the Special Issue Advances in Prenatal Diagnosis and Their Impact on Neonatal Outcomes)

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16 pages, 278 KiB

Open AccessReview

Component-Resolved and Multiplex-Specific IgE Diagnostics: Utility in Anaphylaxis and Beyond

by Mirjana Turkalj, Ivana Banić and Gordana Fressl Juroš

Children 2025, 12(7), 933; https://doi.org/10.3390/children12070933 (registering DOI) - 16 Jul 2025

Abstract

The diagnosis of allergic diseases and anaphylaxis is complex and encompasses a broad spectrum of in vitro and in vivo diagnostic tests. The choice of diagnostic tests is related to the presumed pathophysiological mechanism of the allergic reaction. In the past decade the [...] Read more.

The diagnosis of allergic diseases and anaphylaxis is complex and encompasses a broad spectrum of in vitro and in vivo diagnostic tests. The choice of diagnostic tests is related to the presumed pathophysiological mechanism of the allergic reaction. In the past decade the implementation of component-resolved diagnostics (CRD) into clinical practice has significantly improved the depicting of sensitization profiles, which has aided in the assessment of clinically relevant allergen components that are associated with true allergy, as well as the levels of risk of severe anaphylactic reactions. Recently, multiplex-specific immunoglobulin E (IgE) platforms have emerged for better selection of patients at risk for anaphylaxis and have improved the selection criteria for patients undergoing allergen immunotherapy, including novel regimes such as oral immunotherapy. This review describes the advantages of the utilization of component-resolved diagnostics and multiplex assays in clinical settings, especially in cases of anaphylaxis when no clear trigger is recognized or where multiple culprits are suspected. As multiplex component-resolved diagnostics becomes more readily available globally and with the use of novel approaches, CRD will certainly be a crucial tool in personalized and individually tailored management plans and reduce the financial burden of anaphylaxis. Full article

(This article belongs to the Special Issue Genomic Medicine and Rare Undiagnosed Diseases in Children: New Developments in Precision Healthcare)

17 pages, 768 KiB

Open AccessArticle

Interrelationship of Preschoolers’ Gross Motor Skills, Digital Game Addiction Tendency, and Parents’ Parenting Styles

by Savaş Aydın, Ramazan Sak and İkbal Tuba Şahin-Sak

Children 2025, 12(7), 932; https://doi.org/10.3390/children12070932 (registering DOI) - 16 Jul 2025

Abstract

Background: Motor performance in childhood predicts physical fitness, cognitive capacity, socio-emotional development, and academic success. Parenting styles are especially important to such performance in the preschool period, as children’s gross motor abilities are shaped in part by their interactions with parents. Young children’s [...] Read more.

Background: Motor performance in childhood predicts physical fitness, cognitive capacity, socio-emotional development, and academic success. Parenting styles are especially important to such performance in the preschool period, as children’s gross motor abilities are shaped in part by their interactions with parents. Young children’s physical activity is also declining as they spend more time on screens. Methods: This quantitative survey-based study examined the relationships among 252 preschoolers’ gross motor skills, their tendency to become addicted to digital games, and their parents’ parenting styles. Results: The sampled preschoolers’ gross motor skill development and game addiction tendencies were both low, while the participating parents reported high levels of democratic and overprotective parenting attitudes, low levels of authoritarian ones, and moderate levels of permissive ones. Motor skills were not associated with children’s addiction tendency or parents’ democratic (also known as authoritative), authoritarian, or permissive styles. However, overprotective parenting was positively and significantly associated with gross motor skill scores. While no significant relationship was found between children’s digital game addiction tendencies and their parents’ adoption of a democratic parenting style, such tendencies were positively and statistically correlated with the authoritarian and permissive parenting styles. One dimension of such tendencies, constant gameplay, was also positively and significantly correlated with overprotective parenting. Conclusions: Although the participating children’s digital game addiction tendencies were low, the findings indicate that parents and carers should guide children to reduce their screen time and promote increased interaction with their surroundings and other people to mitigate screen time’s known negative effects on gross motor coordination. Full article

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

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16 pages, 745 KiB

Open AccessArticle

Immature Platelet Fraction as a Sensitive Biomarker in Neonatal Sepsis: Diagnostic Performance Preceding Thrombocytopenia

by Ilkay Er and Medeni Arpa

Children 2025, 12(7), 931; https://doi.org/10.3390/children12070931 (registering DOI) - 15 Jul 2025

Abstract

Background: Early and accurate diagnosis of neonatal sepsis remains a clinical challenge due to nonspecific signs and limitations of conventional biomarkers. The immature platelet fraction (IPF), a novel hematologic parameter reflecting thrombopoietic activity, has emerged as a potential early sepsis indicator. This [...] Read more.

Background: Early and accurate diagnosis of neonatal sepsis remains a clinical challenge due to nonspecific signs and limitations of conventional biomarkers. The immature platelet fraction (IPF), a novel hematologic parameter reflecting thrombopoietic activity, has emerged as a potential early sepsis indicator. This study aimed to evaluate the diagnostic value of IPF in neonatal sepsis prior to the onset of thrombocytopenia. Methods: This prospective study enrolled neonates with early-onset sepsis (EOS), late-onset sepsis (LOS), and healthy controls. IPF, C-reactive protein (CRP), procalcitonin (PCT), and hematologic indices were measured at diagnosis and 48–72 h post-treatment. Diagnostic performance was evaluated via ROC curve analysis, and correlations between IPF and inflammatory/hematologic markers were examined. IPF levels were also compared based on blood culture results. Results: IPF levels were significantly higher in both EOS (n: 56) and LOS (n: 50) groups compared to controls (n: 44) (p < 0.001). ROC analysis showed excellent diagnostic performance, with AUCs of 0.98 (EOS) and 0.99 (LOS). Following antibiotic treatment, IPF levels declined significantly (p < 0.001), supporting its dynamic value. Strong and moderate correlations were found with MPV and CRP, respectively, and an inverse association with platelet count, but not with PCT. Moreover, IPF levels were higher in culture-positive cases compared to culture-negative ones (13.1% vs. 9.8%; p = 0.017) and exhibited diagnostic performance comparable to CRP in predicting blood culture positivity. Conclusions: This study presents original and clinically relevant data supporting IPF as a promising and practical hematologic biomarker for early detection and treatment monitoring of neonatal sepsis. Its integration into standard sepsis evaluation protocols may improve early risk stratification and clinical decision-making in neonatal intensive care settings. Full article

(This article belongs to the Special Issue Providing Care for Preterm Infants)

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16 pages, 539 KiB

Open AccessArticle

Virtual Reality as a Non-Pharmacological Aid for Reducing Anxiety in Pediatric Dental Procedures

by Laria-Maria Trusculescu, Dana Emanuela Pitic, Andreea Sălcudean, Ramona Amina Popovici, Norina Forna, Silviu Constantin Badoiu, Alexandra Enache, Sorina Enasoni, Andreea Kiș, Raluca Mioara Cosoroabă, Cristina Ioana Talpos-Niculescu, Corneliu Constantin Zeicu, Maria-Melania Cozma and Liana Todor

Children 2025, 12(7), 930; https://doi.org/10.3390/children12070930 (registering DOI) - 14 Jul 2025

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Abstract

Background/Objectives: Dental anxiety in children is a common issue that can hinder the delivery of effective dental care. Traditional approaches to managing this are often insufficient or involve pharmacological interventions. This study shows the potential of virtual reality (VR) to aid in reducing [...] Read more.

Background/Objectives: Dental anxiety in children is a common issue that can hinder the delivery of effective dental care. Traditional approaches to managing this are often insufficient or involve pharmacological interventions. This study shows the potential of virtual reality (VR) to aid in reducing anxiety in children undergoing simple dental procedures. By immersing children in relaxing VR environments (such as beaches, forests, mountains, or underwater scenes with calm music), the objective is to assess VR’s effectiveness in calming pediatrics patients during these procedures. Methods: Children scheduled for minor dental treatments wore a wearable device that monitored pulse, perspiration, and stress levels. Each child’s baseline data was collected without the VR headset, followed by data collection during VR exposure before and during dental procedures. VR scenarios ranged from soothing nature scenes to animated cartoons, designed to foster relaxation. Results: The data collected showed a reduction in physiological indicators of stress, such as lower heart rate and reduced perspiration, when the VR headset was used. Children appeared more relaxed, with a calmer response during the procedure itself, compared to baseline levels without VR. Conclusions: This study provides preliminary evidence supporting VR as an effective tool for reducing anxiety and stress in pediatric dental patients. By offering an engaging, immersive experience, VR can serve as an alternative or complementary approach to traditional anxiety management strategies in pediatric dentistry, potentially improving patient comfort and cooperation during dental procedures. Further research could determine if VR may serve as an alternative to local anesthesia for non-intrusive pediatric dental procedures. Full article

(This article belongs to the Special Issue Children’s Behaviour and Social-Emotional Competence)

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9 pages, 301 KiB

Open AccessArticle

Impaction of Deciduous and Permanent Teeth Related to Local Obstacles: A Retrospective Study of 10 Years of Institutional Experience

by Luisa Limongelli, Giuseppe Barile, Giusy Fanelli, Tommaso Corsalini, Saverio Capodiferro and Massimo Corsalini

Children 2025, 12(7), 929; https://doi.org/10.3390/children12070929 (registering DOI) - 14 Jul 2025

Viewed by 95

Abstract

Background: Dental eruption pathways could be influenced by several factors, both general and local, with different prevalence and morbidity. This study aims to report our experience of pediatric impacted teeth due to local factors, with the exclusion of the third molars, illustrating [...] Read more.

Background: Dental eruption pathways could be influenced by several factors, both general and local, with different prevalence and morbidity. This study aims to report our experience of pediatric impacted teeth due to local factors, with the exclusion of the third molars, illustrating their prevalence, diagnostic and therapeutic pathways, and treatment outcomes. Methods: The inclusion criteria were minor age (<18 years) and the presence of impacted teeth due to a local cause, excluding wisdom teeth. The complete diagnostic and therapeutic procedures and their outcomes were described. The relationship between the treatment and the outcomes was assessed with a chi-square test. Results: One hundred twelve patients with a single impaction were included in the study. The local causes of single impaction were: 63 odontogenic cysts (57%), 24 supernumerary teeth (21%), 17 odontogenic tumors (15%), and eight primary bone lesions (7%). During the follow-up period, 83 teeth erupted spontaneously 12–36 months following surgery (74%), 12 were extracted during surgery (11%), and 17 needed orthodontic traction to achieve their aesthetic and functional position (15%). The relationship between mini-invasive surgery and spontaneous eruption was significant (p < 0.00001). Conclusions: Within the limitations of this study, mini-invasive surgical treatment preceded by a correct diagnosis may lead to a spontaneous eruption of permanent teeth, avoiding further orthodontic intervention and premature loss of permanent teeth. Full article

(This article belongs to the Collection Advance in Pediatric Dentistry)

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28 pages, 2227 KiB

Open AccessArticle

At-School Telerehabilitation for Rett Syndrome: Support Teachers Driving Cognitive and Communication Progress in a Randomized Trial

by Rosa Angela Fabio, Samantha Giannatiempo and Michela Perina

Children 2025, 12(7), 928; https://doi.org/10.3390/children12070928 (registering DOI) - 14 Jul 2025

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Abstract

Background/Objectives: This exploratory study examined the potential effectiveness of cognitive enhancement interventions targeting basic cognitive prerequisites and communicative abilities in girls with Rett syndrome. Special attention was given to evaluating telerehabilitation as a feasible alternative to traditional in-person therapy, particularly for individuals with [...] Read more.

Background/Objectives: This exploratory study examined the potential effectiveness of cognitive enhancement interventions targeting basic cognitive prerequisites and communicative abilities in girls with Rett syndrome. Special attention was given to evaluating telerehabilitation as a feasible alternative to traditional in-person therapy, particularly for individuals with severe impairments and limited access to care. Methods: Twenty-four girls diagnosed with Rett syndrome (mean age = 13.7 years, SD = 7.1), all meeting the basic cognitive prerequisites defined by the GAIRS scale, were randomly assigned to two groups: a telerehabilitation group (n = 12) and an in-person rehabilitation group (n = 12). Interventions were delivered in school settings and focused on two core areas: basic cognitive skills (e.g., object recognition, spatial and temporal concepts, form and color discrimination, and cause–effect reasoning) and communication skills (e.g., comprehension and expression through gestures, images, or verbal output). Results: Both groups showed significant improvements in the cognitive and communicative domains, with generally comparable outcomes. Notably, the telerehabilitation group demonstrated relatively greater gains in verbal expression and cause–effect understanding. Correlational analyses indicated positive associations between the cognitive and communicative improvements, particularly between spatial understanding and expressive abilities. However, these findings should be interpreted with caution due to the sample size and study design limitations. Conclusions: These preliminary findings suggest that cognitive enhancement programs may support developmental gains in girls with Rett syndrome and that telerehabilitation could represent a viable alternative for those unable to access in-person care. Given the limited sample size and absence of qualitative measures, further research is necessary to validate its effectiveness and understand its role within comprehensive care models. Full article

(This article belongs to the Special Issue Advances in Child Neuropsychiatric Disorders)

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14 pages, 667 KiB

Open AccessSystematic Review

The Role of Mobile Applications in Enhancing the Health-Related Quality of Life of Children with Cancer: A Systematic Review and Meta-Analysis

by Ana González-Díaz, Bibiana Pérez-Ardanaz, Nora Suleiman-Martos, José L. Gómez-Urquiza, Cristina Canals Garzón and Juan Gómez-Salgado

Children 2025, 12(7), 927; https://doi.org/10.3390/children12070927 (registering DOI) - 14 Jul 2025

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Abstract

Background/Objectives: Childhood cancer, although relatively rare, has a profound impact on the quality of life of affected children and their families. Technological advances have facilitated the development of mobile applications (apps) aimed at enhancing symptom monitoring and improving communication with healthcare teams. [...] Read more.

Background/Objectives: Childhood cancer, although relatively rare, has a profound impact on the quality of life of affected children and their families. Technological advances have facilitated the development of mobile applications (apps) aimed at enhancing symptom monitoring and improving communication with healthcare teams. This systematic review aimed to analyse the effect of mobile applications on the health of children with cancer, with a specific focus on health-related quality of life (HRQoL). Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. Searches were performed in PubMed (Medline), CINAHL, Cochrane and Scopus databases using MeSH terms such as Smartphone, Mobile Applications, Child Health, Neoplasms, and Digital Health, with no date restrictions, and including studies published in English, Spanish or Portuguese. We included original research studies that examined the use of mobile apps in paediatric oncology patients. The search was completed in January 2025. Results: Of the 324 records initially identified, 14 studies (mainly pilot studies, early-phase clinical trials, and observational designs) met the inclusion criteria. Interventions commonly focused on symptom tracking (pain, nausea, fatigue), promoting treatment adherence, and delivering educational content. Several studies reported high user acceptance and a potential positive impact on HRQoL, particularly when gamification strategies were incorporated to sustain children’s engagement. Conclusions: Despite the preliminary nature and small sample sizes of most studies, mobile applications appear to be effective in supporting symptom management, communication, and health education in paediatric oncology. Their use may contribute to improvements in HRQoL. Further high-quality research involving younger children and diverse socio-cultural contexts is required to confirm their effectiveness. Full article

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

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20 pages, 1069 KiB

Open AccessArticle

Cognitive, Behavioral, and Learning Profiles of Children with Above-Average Cognitive Functioning: Insights from an Italian Clinical Sample

by Daniela Pia Rosaria Chieffo, Valentina Arcangeli, Valentina Delle Donne, Giulia Settimi, Valentina Massaroni, Angelica Marfoli, Monia Pellizzari, Ida Turrini, Elisa Marconi, Laura Monti, Federica Moriconi, Delfina Janiri, Gabriele Sani and Eugenio Maria Mercuri

Children 2025, 12(7), 926; https://doi.org/10.3390/children12070926 (registering DOI) - 13 Jul 2025

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Abstract

Background/Objectives: Children with above-average cognitive functioning often present complex developmental profiles, combining high cognitive potential with heterogeneous socio-emotional and learning trajectories. Although the cognitive and behavioral characteristics of giftedness have been widely studied in Anglophone countries, evidence remains limited in Southern Europe. This [...] Read more.

Background/Objectives: Children with above-average cognitive functioning often present complex developmental profiles, combining high cognitive potential with heterogeneous socio-emotional and learning trajectories. Although the cognitive and behavioral characteristics of giftedness have been widely studied in Anglophone countries, evidence remains limited in Southern Europe. This study aimed to investigate the cognitive, academic, and emotional–behavioral profiles of Italian children and adolescents with above-average cognitive functioning, using an inclusive, dimensional approach (IQ > 114). Methods: We analyzed a cross-sectional sample of 331 children and adolescents (ages 2.11–16.5 years), referred for clinical cognitive or behavioral evaluations. Participants were assessed using the WPPSI-III or WISC-IV for cognitive functioning, the MT battery for academic achievement, and the Child Behavior Checklist (CBCL) for emotional and behavioral symptoms. Comparative and correlational analyses were performed across age, gender, and functional domains. A correction for multiple testing was applied using the Benjamini–Hochberg procedure. Results: Gifted participants showed strong verbal comprehension (mean VCI: preschoolers = 118; school-aged = 121) and relative weaknesses in working memory (WM = 106) and processing speed (PS = 109). Males outperformed females in perceptual reasoning (PR = 121 vs. 118; p = 0.032), while females scored higher in processing speed (112 vs. 106; p = 0.021). Difficulties in writing and arithmetic were observed in 47.3% and 41.8% of school-aged participants, respectively. Subclinical internalizing problems were common in preschool and school-aged groups (mean CBCL T = 56.2–56.7). Working memory negatively correlated with total behavioral problems (r = −0.13, p = 0.046). Conclusions: These findings confirm the heterogeneity of gifted profiles and underscore the need for personalized educational and psychological interventions to support both strengths and vulnerabilities in gifted children. Caution is warranted when interpreting these associations, given their modest effect sizes and the exploratory nature of the study. Full article

(This article belongs to the Section Pediatric Mental Health)

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12 pages, 1016 KiB

Open AccessArticle

Clinical Characteristics and Outcomes for Neonates with Respiratory Failure Referred for Extracorporeal Membrane Oxygenator (ECMO) Support

by Pooja Musuku, Keith Meyer, Felipe E. Pedroso, Fuad Alkhoury and Balagangadhar R. Totapally

Children 2025, 12(7), 925; https://doi.org/10.3390/children12070925 (registering DOI) - 13 Jul 2025

Viewed by 117

Abstract

Objective: The aim of this study was to describe the presenting characteristics and outcomes of neonates with respiratory failure referred for extracorporeal membrane oxygenation (ECMO) support, compare those who received ECMO support (ECMO group) to those who did not (non-ECMO group), and [...] Read more.

Objective: The aim of this study was to describe the presenting characteristics and outcomes of neonates with respiratory failure referred for extracorporeal membrane oxygenation (ECMO) support, compare those who received ECMO support (ECMO group) to those who did not (non-ECMO group), and evaluate the predictive variables requiring ECMO support. Methods: All neonates (<15 days) with respiratory failure (without congenital diaphragmatic hernia or congenital heart disease) referred to our regional ECMO center from 2014 to 2023 were included in this retrospective study. Patient demographics, birth history, and clinical and outcome variables were analyzed. Oxygenation indices and vasoactive–inotropic scores obtained at PICU arrival and four hours after arrival were compared between the two groups using ROC analysis, with ECMO initiation as an outcome variable. Youden’s index was used for optimal threshold values. Chi-square, Mann–Whitney U, and binary logistic regression were used for comparative analyses. Results: Out of the 147 neonates, 96 (65%) required ECMO support. The two groups significantly differed in the prevalence of pulmonary hypertension (pHTN; systemic or suprasystemic pulmonary pressures), lactate level, and oxygenation indices. Mortality was not different between the two groups. Presence of oxygen saturation index (OSI) ≥ 10 had a sensitivity 96.8% in predicting the need for ECMO support. On regression analysis, OSI and pHTN were independent predictors of ECMO support. Conclusions: Oxygenation indices and echo findings predict the need for ECMO support in neonatal hypoxemic respiratory failure. These findings help non-ECMO centers make appropriate and timely transfers of neonates with respiratory failure to ECMO centers. Full article

(This article belongs to the Special Issue Diagnosis and Management of Newborn Respiratory Distress Syndrome)

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25 pages, 4400 KiB

Open AccessArticle

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

Viewed by 175

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, 191 KiB

Open AccessArticle

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

Viewed by 74

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

Open AccessArticle

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

Viewed by 185

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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16 pages, 1200 KiB

Open AccessArticle

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

Viewed by 193

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)

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12 pages, 1450 KiB

Open AccessArticle

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

Viewed by 188

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

Open AccessReview

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

Viewed by 293

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

Open AccessReview

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

Viewed by 400

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

Open AccessReview

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

Viewed by 201

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

Open AccessArticle

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

Viewed by 159

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, 513 KiB

Open AccessReview

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

Viewed by 262

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

Open AccessArticle

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

Viewed by 201

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

Open AccessArticle

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

Viewed by 141

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

Open AccessReview

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

Viewed by 237

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

Open AccessArticle

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

Viewed by 204

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

Open AccessArticle

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

Viewed by 152

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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