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Children, Volume 12, Issue 8 (August 2025) – 113 articles

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9 pages, 275 KiB  
Article
Sex Differences in Wheezing During the First Three Years of Life After Delivery via Caesarean Section
by Evangelia Papathoma, Theodore Dassios, Maria Triga, Sotirios Fouzas and Gabriel Dimitriou
Children 2025, 12(8), 1071; https://doi.org/10.3390/children12081071 (registering DOI) - 14 Aug 2025
Abstract
Background: Emerging evidence suggests that delivery by caesarean section predisposes to wheezing in early childhood, but the effect may differ between boys and girls. Such sex-specific differences remain insufficiently explored to date, particularly considering the wide range of perinatal and antenatal confounding factors. [...] Read more.
Background: Emerging evidence suggests that delivery by caesarean section predisposes to wheezing in early childhood, but the effect may differ between boys and girls. Such sex-specific differences remain insufficiently explored to date, particularly considering the wide range of perinatal and antenatal confounding factors. In this study, we aimed to investigate sex-specific differences in the association between delivery by caesarean section and preschool wheezing. Methods: This is a secondary analysis of a population of 470 children (53% boys), born and cared for between August 2009 and March 2011 at the maternity services of the University Hospital of Patras, Greece. Participants were followed up regularly until the age of 36 months. Wheezing was defined as at least one episode of doctor-diagnosed wheezing per year during the surveillance period of three years. Multivariable regression models were used to explore possible associations and adjust for confounders. Results: The rate of caesarean section was 51% (N = 240). Wheezing was reported in 144 (31%) of the children. Following delivery by caesarean section, 52 of 137 (38%) of the boys and 33 of 103 (32%) of the girls developed wheezing. In the whole cohort, development of wheezing was significantly associated with male sex [odds ratio: 1.83 (95% CI: 1.22–2.75), adjusted p = 0.004], but not with caesarean section or gestational age. In girls, the development of wheezing was significantly associated with caesarean section [odds ratio: 2.48 (95% CI: 1.28–4.83), adjusted p = 0.007]. In boys, the development of wheezing was not significantly associated with delivery by caesarean section. Conclusions: Girls born by caesarean section developed wheezing more frequently than their vaginally born counterparts during the first three years of life. Although male sex proved an overall predisposing factor to preschool wheezing, boys born by caesarean section were not diagnosed with wheezing more frequently than those delivered vaginally. Full article
(This article belongs to the Section Pediatric Neonatology)
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11 pages, 249 KiB  
Article
The Psychological Impact of Experiencing Sexual Abuse Revictimization by a Different Perpetrator in Childhood
by Elizabeth L. Jeglic, Georgia M. Winters, Benjamin N. Johnson and Emma Fisher
Children 2025, 12(8), 1070; https://doi.org/10.3390/children12081070 - 14 Aug 2025
Abstract
Background/Objectives: Research has shown that those who experience childhood sexual abuse (CSA) are at increased risk of subsequent sexual revictimization. Multiple sexual victimizations can lead to higher rates of depression, anxiety, trauma, and suicidality. Prior research has yielded varying definitions of revictimization, including [...] Read more.
Background/Objectives: Research has shown that those who experience childhood sexual abuse (CSA) are at increased risk of subsequent sexual revictimization. Multiple sexual victimizations can lead to higher rates of depression, anxiety, trauma, and suicidality. Prior research has yielded varying definitions of revictimization, including only accounting for revictimization that occurred in adulthood or multiple CSA episodes by the same perpetrator, or it has broadly assessed maltreatment without a specific focus on CSA. This study examined mental health outcomes in survivors of CSA who experienced sexual revictimization in childhood from a different perpetrator, comparing their mental health outcomes (i.e., depression, suicidal ideation, post-traumatic stress disorder (PSTD), hopelessness, guilt, and shame) to those who reported CSA by one perpetrator. Methods: Adult survivors of CSA (n = 627) completed an online survey describing their CSA experience, whether they experienced CSA by one or multiple perpetrators in childhood, and a series of mental health questionnaires. Results: Almost half of the sample reported CSA by more than one perpetrator in childhood (n = 267; 42.58%). Survivors who reported multiple CSA perpetrators reported significantly higher levels of depression, suicidal thoughts, PTSD, hopelessness, shame, and some facets of guilt in adulthood compared to those who reported CSA by a single perpetrator. Conclusions: Experiencing CSA by multiple perpetrators in childhood may lead to more negative mental health outcomes in adulthood. The findings emphasize the importance of early identification and intervention for individuals who experienced CSA. Full article
(This article belongs to the Section Pediatric Mental Health)
13 pages, 1166 KiB  
Article
Psychometric Properties of the Experience of Cognitive Intrusion of Pain (ECIP) Scale in Pediatric Chronic Pain
by Cherish Heard, Keri R. Hainsworth and Kristen E. Jastrowski Mano
Children 2025, 12(8), 1069; https://doi.org/10.3390/children12081069 - 14 Aug 2025
Abstract
Background/Objectives: Chronic pain symptoms can disrupt cognitive processes. Such interruptions may negatively impact one’s overall functioning, causing frustration and distress when engaging in important tasks. This experience has been referred to as cognitive intrusion of pain. To date, only one adult [...] Read more.
Background/Objectives: Chronic pain symptoms can disrupt cognitive processes. Such interruptions may negatively impact one’s overall functioning, causing frustration and distress when engaging in important tasks. This experience has been referred to as cognitive intrusion of pain. To date, only one adult self-report measure of cognitive intrusion of pain exists: the Experience of Cognitive Intrusion of Pain (ECIP). The purpose of the current study was to examine the psychometric properties of the ECIP in a sample of pediatric patients with chronic pain. Methods: The internal consistency reliability, factor structure, and validity of the ECIP were evaluated in a sample (N = 182) of youth ages 11 to 18 who presented to a multidisciplinary chronic pain clinic at a large Midwestern children’s hospital in the United States. Results: Results suggest excellent reliability (α = 0.94). Confirmatory factor analysis results supported a one-factor model, with excellent model fit. The ECIP demonstrated evidence of convergent validity, with moderate and positive correlations with measures of pain-related limitations in functioning, pain symptoms, anxiety, and depression. Regarding discriminant validity evidence, the ECIP was minimally and inversely related to measures of readiness to transition to self-managed care and global health. Conclusions: Overall, the ECIP demonstrated strong initial reliability and validity evidence for use in pediatric chronic pain. Further research is recommended in more diverse samples and to evaluate the clinical utility of the ECIP. Full article
(This article belongs to the Section Pediatric Anesthesiology, Perioperative and Pain Medicine)
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24 pages, 2467 KiB  
Article
The Voice of Families: Perceptions of Family-Centred Practices and Natural Environments in Early Intervention in Spain
by Mónica Montaño-Merchán, Roberto Sanz-Ponce, Laura Padilla-Bautista and Joana Calero-Plaza
Children 2025, 12(8), 1068; https://doi.org/10.3390/children12081068 - 14 Aug 2025
Abstract
The family-centred Early Intervention model based on routines and natural environments has been widely supported by international evidence in recent decades. Within this framework, Family-Centred Practices (FCP) and their development in natural environments have emerged as an evidence-based intervention model of reference, promoting [...] Read more.
The family-centred Early Intervention model based on routines and natural environments has been widely supported by international evidence in recent decades. Within this framework, Family-Centred Practices (FCP) and their development in natural environments have emerged as an evidence-based intervention model of reference, promoting parental empowerment, shared decision-making, and functional intervention through daily routines. However, its effective implementation in real contexts presents multiple challenges, especially from the perspective of families receiving the service. Background/Objectives: This study explores the experiences, meanings, and assessments of Spanish families with children who have disabilities or developmental difficulties in relation to the application of these professional practices. This study is carried out in the Spanish context, since Campus Capacitas (Campus Capacitas—Catholic University of Valencia, Spain) has been implementing, in recent years, the family-centred model as a model of early intervention. Methods: A qualitative, descriptive, and interpretative methodology was used. Data collection was carried out through semi-structured interviews and discussion groups with 30 families from the 17 Spanish autonomous communities. Data analysis was carried out through thematic coding following criteria of qualitative rigour such as triangulation and theoretical saturation. Results: The findings show a significant gap between the theoretical model of family-centred practices and their practical application. Families who have experienced a clinical model criticise the absence of personalised intervention, unidirectional communication, as well as lack of participation in decision-making. In that sense, it is the different specialists of the early intervention team who are responsible for making intervention decisions. Therefore, these families demand more emotional and educational support. On the other hand, other families report positive experiences associated with collaborative, transdisciplinary, and home-based models based on a family-centred model. Conclusions: The results highlight the urgent need to move towards early intervention that strengthens the active role of families, promotes professional co-responsibility, and adapts to real child development environments, in line with international recommendations. Regarding future lines of research, we are committed to the development of longitudinal studies on the sustainable effects of interventions centred on families and on the global development of children and families. To carry out comparative studies between autonomous communities, to assess the influence of regulatory factors and regional resources on the practices implemented, as well as to carry out triangulation studies of the professional practices implemented, incorporating the perspectives of professionals and other intervention agents to enrich the analysis. Full article
(This article belongs to the Section Global Pediatric Health)
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14 pages, 410 KiB  
Article
Validation of the Brief Autism Mealtime Behavior Inventory in Parents of Children in Cyprus
by Andri Papaleontiou, Vassiliki Siafaka, Louiza Voniati, Alexandros Gryparis, Rafaella Georgiou and Dionysios Tafiadis
Children 2025, 12(8), 1067; https://doi.org/10.3390/children12081067 - 14 Aug 2025
Abstract
Background/Objectives: Autism Spectrum Disorder (ASD) includes significant feeding difficulties, behavioral issues, and communication deficits that are linked to serious medical complications and developmental challenges. The Brief Autism Mealtime Behavior Inventory (BAMBI) is a commonly used tool to screen for mealtime behavior problems in [...] Read more.
Background/Objectives: Autism Spectrum Disorder (ASD) includes significant feeding difficulties, behavioral issues, and communication deficits that are linked to serious medical complications and developmental challenges. The Brief Autism Mealtime Behavior Inventory (BAMBI) is a commonly used tool to screen for mealtime behavior problems in children with ASD; however, it lacks validation for use within the Greek-Cypriot population. The current study sought to present the translation, cultural adaptation, and validation of the BAMBI for Greek-Cypriot parents of children with ASD. Methods: Three bilingual experts translated the inventory into Greek, following the translation guidelines by the World Health Organization. The inventory was then administered to 117 parents: 42 children with ASD and 75 typically developing children. Principal Component Analysis was used to obtain the tool’s statistical reliability and validity. Results: BAMBI-Gr demonstrated strong internal consistency, as indicated by a Cronbach’s alpha of 0.755, and showed excellent test–retest reliability, with an intraclass correlation coefficient of 0.999. PCA identified three key factors: General Refusals, Refusing Food, and Autism-Related Features. Significant differences in BAMBI-Gr scores of the comparative group of parents of children with ASD and parents of typically developing children highlighted the tool’s sensitivity in detecting mealtime behavior problems. Receiver Operating Characteristics analysis set the cut-off points for optimum distinguishing of feeding problems at 46.00 (sensitivity 0.738, 1-specificity 0.000). Conclusions: The Greek-translated version of the BAMBI demonstrates validity and effectiveness as a parent-reported assessment tool for identifying feeding and mealtime difficulties in children with ASD. Full article
(This article belongs to the Section Pediatric Neurology & Neurodevelopmental Disorders)
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32 pages, 3096 KiB  
Review
Orthodontic Perspectives in the Interdisciplinary Management of Pediatric Obstructive Sleep Apnea
by Silvia Müller-Hagedorn, Véronique Abadie and Theodosia Bartzela
Children 2025, 12(8), 1066; https://doi.org/10.3390/children12081066 - 14 Aug 2025
Abstract
Pediatric obstructive sleep apnea (OSA) is a highly prevalent, multifactorial, and often underdiagnosed condition with significant consequences for cognitive and behavioral development. Early detection and timely multidisciplinary interventions are essential, particularly in children with craniofacial anomalies or syndromes associated with increased OSA risks, [...] Read more.
Pediatric obstructive sleep apnea (OSA) is a highly prevalent, multifactorial, and often underdiagnosed condition with significant consequences for cognitive and behavioral development. Early detection and timely multidisciplinary interventions are essential, particularly in children with craniofacial anomalies or syndromes associated with increased OSA risks, to prevent long-term complications. This narrative review explores the orthodontists’ role in the interdisciplinary management of pediatric OSA, focusing on early screening for craniofacial risk factors and implementing interceptive orthodontic interventions that support favorable airway development and growth modulation. Through early and frequent interaction with pediatric patients, orthodontists are well-positioned to identify clinical signs of airway-related abnormalities and craniofacial risk factors such as mandibular and maxillary retrognathism, maxillary constriction, and high-arched palatal vaults. Orthodontic interventions such as rapid maxillary expansion (RME), mandibular advancement, and myofunctional therapy may improve airway patency in selected cases. These approaches should be coordinated and integrated within the multidisciplinary team, including orthodontists, pediatricians, sleep specialists, ENT specialists, and speech-language pathologists. Furthermore, caregivers’ involvement and patients’ compliance are keys to success. Despite encouraging clinical observations, current evidence is limited by heterogeneity and a lack of long-term outcome data. Future research should prioritize well-designed prospective trials, explore the effectiveness of combined therapeutic strategies, and support the development of standard diagnostic protocols. Equally important is a stronger focus on early diagnosis and preventive measures to enhance patient outcomes and long-term treatment strategies. Integrating orthodontists into early OSA care is essential for optimizing outcomes and reducing long-term morbidity. Full article
(This article belongs to the Special Issue Current Advances in Paediatric Sleep Medicine)
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20 pages, 1893 KiB  
Systematic Review
Association Between Endotype of Prematurity and Cystic Periventricular Leukomalacia: A Bayesian Model-Averaged Meta-Analysis
by Neirude P. A. Lissone, Tamara M. Hundscheid, Gloria M. Galán-Henríquez, Gema E. González-Luis, František Bartoš and Eduardo Villamor
Children 2025, 12(8), 1065; https://doi.org/10.3390/children12081065 - 13 Aug 2025
Abstract
Introduction: Pathophysiological pathways—or endotypes—leading to prematurity can be clustered into two groups: infection/inflammation and dysfunctional placentation. We aimed to perform a systematic review and meta-analysis of studies exploring the association between these endotypes and cystic periventricular leukomalacia (cPVL). Methods: PubMed and Embase were [...] Read more.
Introduction: Pathophysiological pathways—or endotypes—leading to prematurity can be clustered into two groups: infection/inflammation and dysfunctional placentation. We aimed to perform a systematic review and meta-analysis of studies exploring the association between these endotypes and cystic periventricular leukomalacia (cPVL). Methods: PubMed and Embase were searched for observational studies examining preterm infants and reporting data on the association between endotype of prematurity and cPVL. Chorioamnionitis represented the infectious–inflammatory endotype, while dysfunctional placentation proxies were hypertensive disorders of pregnancy (HDPs) and small for gestational age (SGA)/intrauterine growth restriction (IUGR). Bayesian model-averaged (BMA) meta-analysis was used to calculate Bayes factors (BFs). The BF10 is the ratio of the probability of the data under the alternative hypothesis (H1; presence of association) over the probability of the data under the null hypothesis (H0; absence of association). Results: Of 1141 potentially relevant studies; 67 (108,571 infants) were included. The BMA analysis showed strong evidence in favor of a positive association between chorioamnionitis and cPVL (OR 1.58; 95% CrI 1.12 to 2.20; BF10 = 20.5) and extreme evidence in favor of a negative association between HDPs and cPVL (OR 0.63; 95% CrI 0.54 to 0.75; BF10 = 2937). The evidence for the SGA/IUGR group was inconclusive (OR 0.87; 95% CrI 0.75 to 1.01; BF10 = 1.41). Conclusions: This Bayesian meta-analysis provides evidence indicative of an association between antenatal infection–inflammation and an increased risk of developing cPVL in preterm infants. Conversely, infants exposed to HDPs are less likely to develop cPVL. Full article
(This article belongs to the Special Issue Recent Advances in Maternal and Fetal Health (2nd Edition))
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26 pages, 2865 KiB  
Systematic Review
Effectiveness of Intravenous and Nebulized MgSO4 in Children with Asthma Exacerbation: A Systematic Review and Meta-Analysis of Clinical Trials
by Víctor Hugo Estupiñán Pérez, Freiser Eceomo Cruz Mosquera, Mayerli de la Rosa Caldas, Olmer Alexander Pantoja Rodríguez and Yamil Liscano
Children 2025, 12(8), 1064; https://doi.org/10.3390/children12081064 - 13 Aug 2025
Abstract
Background/Objectives: Moderate or severe asthma exacerbations may require pharmacological interventions in addition to standard treatment. In this context, magnesium sulfate has been proposed as a second-line therapeutic option, owing to its physiological effects on bronchial smooth muscle. Therefore, the objective of this meta-analysis [...] Read more.
Background/Objectives: Moderate or severe asthma exacerbations may require pharmacological interventions in addition to standard treatment. In this context, magnesium sulfate has been proposed as a second-line therapeutic option, owing to its physiological effects on bronchial smooth muscle. Therefore, the objective of this meta-analysis is to determine the effectiveness of intravenous or nebulized magnesium sulfate in patients with a moderate-to-severe asthmatic crisis. Methods: This systematic review and meta-analysis included randomized controlled trials published between 1990 and 2024, using the PubMed, Scopus, Science Direct, Web of Science, LILACS, Cochrane Library, Springer, and Scielo databases. The risk of bias was assessed using the RoB 2 tool, the quality of evidence with the Jadad scale, and the certainty of the evidence per outcome was evaluated following the GRADE guidelines. The meta-analysis was developed using the statistical software Jamovi 2.3.28® and RevMan 5.4®. Results: Fourteen studies with a total of 2242 patients with a moderate-to-severe asthmatic crisis were included. Of these, ten studies evaluated the severity score, eight evaluated hospitalization, five evaluated the length of the hospital stay, and three evaluated intensive care unit admission. The meta-analysis demonstrates that the use of magnesium sulfate is associated with a statistically significant reduction in the risk of hospitalization (RR: 0.79, 95% CI: from 0.67 to 0.94, p = 0.02). However, no effects were observed on the severity score (SMD: −0.37, 95% CI: from −0.92 to 0.17, p = 0.16), the length of the hospital stay (SMD: −0.75, 95% CI: from −1.90 to 0.40, p = 0.14), or admission to intensive care units (RR: 0.62, 95% CI: from 0.28 to 1.36, p = 0.23). Subgroup and sensitivity analyses did not yield significant findings or produce any modification of the effect. Conclusions: Magnesium sulfate reduces hospitalizations in moderate-to-severe pediatric asthma, although it does not improve other relevant clinical outcomes. Full article
(This article belongs to the Section Pediatric Emergency Medicine & Intensive Care Medicine)
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47 pages, 1390 KiB  
Review
Biological, Psychosocial, and Microbial Determinants of Childhood-Onset Obsessive–Compulsive Disorder: A Narrative Review
by Alejandro Borrego-Ruiz and Juan J. Borrego
Children 2025, 12(8), 1063; https://doi.org/10.3390/children12081063 - 13 Aug 2025
Abstract
The etiology of obsessive–compulsive disorder (OCD) remains incompletely understood, but it is widely recognized as the result of a complex interplay among multiple contributing mechanisms, often emerging during childhood. This narrative review synthesizes current evidence on the etiology of childhood-onset OCD, with particular [...] Read more.
The etiology of obsessive–compulsive disorder (OCD) remains incompletely understood, but it is widely recognized as the result of a complex interplay among multiple contributing mechanisms, often emerging during childhood. This narrative review synthesizes current evidence on the etiology of childhood-onset OCD, with particular focus on whether GM alterations are involved in the pathophysiological mechanisms underlying the disorder. Specifically, the review first examines both biological and psychosocial determinants of OCD, and then explores the role of the gut microbiome (GM), including the potential of psychobiotics as a novel therapeutic approach. OCD has a strong hereditary component, involving both common polygenic variants and rare mutations. Epigenetic mechanisms such as DNA methylation and microRNA play a role in mediating gene–environment interactions and influencing OCD risk. Dysfunction and hyperactivity within cortico-striato-thalamo-cortical circuits underlie one of the neurobiological bases of OCD. Infections and autoimmune reactions can trigger or exacerbate OCD, particularly in pediatric populations. A range of psychosocial factors have been implicated in the onset of OCD, often in interaction with underlying neurobiological vulnerabilities. Current evidence indicates that GM alterations may also contribute to OCD pathophysiology through immune-mediated neuroinflammation, disrupted gut–brain signaling, and neurotransmitter imbalance. Individuals with OCD present reduced microbial diversity and lower abundance of butyrate-producing taxa, as well as altered IgA levels and increased infection susceptibility. These shifts may affect dopaminergic, glutamatergic, and serotonergic pathways, particularly via tryptophan metabolism and compromised gut integrity. Thus, the GM plays a pivotal role in OCD, constituting a promising approach for understanding its etiology and highlighting the significant clinical potential of microbial-based treatments such as psychobiotics. Nevertheless, despite progress, gaps remain in understanding childhood-onset OCD determinants, including limited longitudinal studies, incomplete characterization of the GM, scarce psychobiotic trials, and a need for integrated multidisciplinary approaches. Moreover, epidemiological evidence is compromised by reliance on lay diagnoses, questionable assessment validity, and insufficient distinction from related disorders. Full article
(This article belongs to the Section Pediatric Mental Health)
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8 pages, 544 KiB  
Article
Resilience in Pediatric-Onset Inflammatory Bowel Disease: Associations with Age, Therapy Change, and Health-Related Quality of Life
by Elizabeth Hilow, Jessica Barry, Nila Mistry Ambani, Kate Eshleman, Sarah Worley, Wei Liu and Jacob A. Kurowski
Children 2025, 12(8), 1062; https://doi.org/10.3390/children12081062 - 13 Aug 2025
Abstract
Background: Resilience is associated with improved outcomes in adult inflammatory bowel disease (IBD), yet little is known about its relationship to health-related quality of life and disease characteristics in pediatric-onset IBD. Methods: This prospective, cross-sectional study enrolled pediatric-onset IBD patients (≥12 years) at [...] Read more.
Background: Resilience is associated with improved outcomes in adult inflammatory bowel disease (IBD), yet little is known about its relationship to health-related quality of life and disease characteristics in pediatric-onset IBD. Methods: This prospective, cross-sectional study enrolled pediatric-onset IBD patients (≥12 years) at Cleveland Clinic Children’s. Participants completed the Connor–Davidson Resilience Scale (CD-RISC-10) and an age-appropriate health-related quality of life (HRQOL) survey. Measure: IMPACT-III (ages 12–17) or SF-36 (≥18). Demographic and clinical data were collected via chart review. Associations between resilience, HRQOL, and clinical variables were analyzed. Results: Seventy participants completed the study (35 adolescents and 35 young adults). Young adults had significantly higher resilience scores than adolescents (31 ± 4.6 vs. 27 ± 5.3; p = 0.007). Resilience scores were significantly lower among patients who had experienced a change in IBD therapy within the prior year (27 vs. 30; p = 0.045). No significant associations were found between resilience and age at diagnosis, disease duration, HRQOL, or prior surgery. Use of pharmacologic treatment for mental health conditions was higher in young adults compared to adolescents (22.9% vs. 14.3%; p = 0.015), despite similar rates of diagnosed mental health comorbidities. Conclusions: Resilience in pediatric-onset IBD patients varies by age and is lower in the context of recent therapy changes, suggesting a potential vulnerability during periods of disease instability. Routine assessment of resilience may help identify patients who could benefit from early psychosocial intervention to support coping and improve long-term outcomes. Full article
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23 pages, 1455 KiB  
Article
COVID-19 and Its Aftermath on Pediatric Oral Health: A Study of Dental Caries and Hygiene in Romanian Children
by Maximilian Ilea, Alina-Ioana Forray, Nausica Bianca Petrescu, Ioana-Codruta Mirica, Alina Ormenişan, Mine Betül Üçtaşli, Adriana Melnic and Ondine Patricia Lucaciu
Children 2025, 12(8), 1061; https://doi.org/10.3390/children12081061 - 12 Aug 2025
Abstract
Background/Objectives: Official data on the oral health of young children in Romania are limited, especially concerning the societal shifts following the COVID-19 pandemic. This study aimed to compare the oral health status, hygiene habits, diet, and dental care patterns of 6-year-old children [...] Read more.
Background/Objectives: Official data on the oral health of young children in Romania are limited, especially concerning the societal shifts following the COVID-19 pandemic. This study aimed to compare the oral health status, hygiene habits, diet, and dental care patterns of 6-year-old children in a rural Romanian region before and after the pandemic. Methods: A cross-sectional survey studied two groups of 6-year-olds from rural Transylvania: Group 1 (n = 77), assessed 2018–2020 pre-pandemic, and Group 2 (n = 136), assessed in 2024 post-pandemic. Clinical data used the Decayed, Missing, and Filled Teeth (DMFT) index. Parents completed questionnaires on oral hygiene, diet, dental visits, and pandemic-related topics for Group 2. Chi-square, Student’s t-tests, and a multiple linear regression were used to analyze the data. Results: Post-pandemic, 70% of children brushed twice daily, up from 26%. Despite this, negative outcomes increased: the number of affected teeth rose from 6.8% to 29.6% (p < 0.001), sugar intake increased, and dental visits became more reactive, with pain being the main reason for 61% of post-pandemic visits, compared to 17% pre-pandemic. Conclusions: This study reveals a significant oral health paradox: despite a three-fold increase in recommended toothbrushing, caries experience in permanent teeth increased four-fold. This outcome was driven by a high-risk environment of more cariogenic diets and reduced preventive care, with lower maternal education also identified as a key independent risk factor. These findings show that promoting hygiene alone is insufficient, underscoring the urgent need for public health programs that integrate nutritional counseling, improve access to preventive care, and address underlying socioeconomic disparities. Full article
(This article belongs to the Section Pediatric Dentistry & Oral Medicine)
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14 pages, 257 KiB  
Article
Parents’ Perspectives on Participation Among Gifted and Typically Developing Children: A Pilot Study
by Yael Fogel and Miri Ben Amram
Children 2025, 12(8), 1060; https://doi.org/10.3390/children12081060 - 12 Aug 2025
Viewed by 34
Abstract
Background/Objectives: Despite growing interest in giftedness, the differences in daily participation between gifted and typically developing children remain understudied and insufficiently understood. Exploring these differences may provide valuable insights into the unique needs and support required for gifted children compared to their [...] Read more.
Background/Objectives: Despite growing interest in giftedness, the differences in daily participation between gifted and typically developing children remain understudied and insufficiently understood. Exploring these differences may provide valuable insights into the unique needs and support required for gifted children compared to their typically developing peers. This comparative exploratory study aims to examine the differences between gifted and typically developing children’s daily participation patterns in home, school, and community environments and their parents’ perspectives and explore underlying developmental characteristics that may predict their participation. Methods: Parents of 215 children (8–18 years; 53% boys) in a gifted group (n = 136) and a matched typically developing children group (n = 79) completed the Five-to-Fifteen-revised questionnaire and the Child and Adolescent Scale of Participation. Results: We found no significant between-group differences in daily participation. However, we noted significant correlations in each group between the questionnaires’ participation domains (r = −0.243 to −0.460 in the gifted group, and r = −0.57 to −0.78 in the typically developing children group). Social and memory skills predicted 24% of the gifted children’s participation, and social and mental skills predicted 65% of the typically developing children’s participation. Conclusions: The results indicate similar participation patterns of gifted children and typically developing children. Social skills are a key element enabling daily participation among children in both groups. Full article
(This article belongs to the Section Pediatric Neurology & Neurodevelopmental Disorders)
15 pages, 234 KiB  
Article
A Closer Look at Parental Narratives: A Qualitative Analysis of Parental Entries in Neonatal Research Diaries of Preterm Infants Participating in the REPORT-BPD Feasibility Study
by Wisam Muhsen, Ana Guillot Lozano and Jos M. Latour
Children 2025, 12(8), 1059; https://doi.org/10.3390/children12081059 - 12 Aug 2025
Viewed by 109
Abstract
Background/Objectives: Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting preterm infants, often resulting in prolonged neonatal intensive care unit (NICU) stays and significant parental stress. The experiences of parents navigating their preterm infant’s early NICU journey are important to support clinical trials [...] Read more.
Background/Objectives: Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting preterm infants, often resulting in prolonged neonatal intensive care unit (NICU) stays and significant parental stress. The experiences of parents navigating their preterm infant’s early NICU journey are important to support clinical trials to improve infant outcomes. Aim: The aim of this study was to explore parental perceptions of their infant’s health progression during the first 10 days of life through personal diary entries and their correlation with the echo scans assessments, as part of the Exploring Right vEntricular function applicability in a Prediction mOdel to identify pReterm infanTs with early BronchoPulmonary Dysplasia (REPORT-BPD) feasibility study. Methods: An embedded qualitative design was employed, utilising thematic analysis of 17 parent diaries. Parents of preterm infants (<32 weeks of gestation) admitted to a NICU documented their daily experiences. Thematic analysis was applied to ensure a rigorous, inductive examination of emerging themes. Findings: Four main themes were identified: (1) developing parent–infant relationships, highlighting the emotional impact of separation and the significance of bonding; (2) health and well-being of premature infants and family, reflecting parental vigilance, cautious optimism, and emotional distress; (3) parents navigating support and the NICU environment, describing challenges related to medical procedures, communication with staff, and adapting to a highly technical setting; and (4) emotions and protective gestures, illustrating parental resilience, coping mechanisms, and the innate drive to protect their child. Conclusions: Parental experiences in the NICU were shaped by emotional turmoil, uncertainty, and the need for support in navigating their infant’s care. Diaries provided an effective means for parents to express their experiences; they could serve as a communication tool in clinical trials to provide a deeper understanding of the development of the recruited preterm infants. Full article
(This article belongs to the Section Pediatric Neonatology)
9 pages, 227 KiB  
Article
Sleep Disorders in Infants and Toddlers with Hypoxic Ischemic Encephalopathy Treated with Therapeutic Hypothermia: A Case–Control Study Using the SDSC
by Domenico M. Romeo, Chiara Arpaia, Maria Rosaria Lala, Giorga Cordaro, Claudia Brogna, Marianna Moro, Francesca Gallini, Giovanni Vento and Eugenio Mercuri
Children 2025, 12(8), 1058; https://doi.org/10.3390/children12081058 - 12 Aug 2025
Viewed by 48
Abstract
Background and Objectives: Sleep complaints are particularly relevant in the development of children, affecting cognitive development, neuropsychological functioning, and learning abilities. The aims of this study were as follows: (i) to determine the incidence of sleep disorders in low-risk infants and toddlers with [...] Read more.
Background and Objectives: Sleep complaints are particularly relevant in the development of children, affecting cognitive development, neuropsychological functioning, and learning abilities. The aims of this study were as follows: (i) to determine the incidence of sleep disorders in low-risk infants and toddlers with hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH), using the Italian version of the Sleep Disturbance Scale for Children (SDSC); and (ii) to compare the data with those of a healthy control group. Materials and Methods: This is a cross-sectional case–control study involving a total of 167 infants and toddlers (aged 6–36 months) with HIE treated with TH and 160 typically developing infants assessed using the SDSC filled out by the mother. A neurocognitive assessment was also performed. Exclusion criteria were mild perinatal asphyxia, major brain lesions, congenital malformations, severe postnatal infectious diseases, metabolic complications, cerebral palsy, neurodevelopmental impairment, and epilepsy. Results: In the study group, an abnormal total SDSC score was found in 1.8% of infants; 10% of infants had an abnormal score on at least one of the SDSC factors. No specific differences in the SDSC total and the factor scores were observed between the study and control group, with the exception of difficulties in maintaining sleep and sleep hyperhidrosis, with higher scores in HIE infants. Conclusions: Low-risk infants and toddlers with HIE showed a low incidence of sleep disorders, similar to those observed in control group, with some exceptions. As these incidences may increase significantly with age, further clinical assessments will be needed to confirm these data at older ages. Full article
(This article belongs to the Section Pediatric Neurology & Neurodevelopmental Disorders)
14 pages, 9863 KiB  
Article
Examination of Behavioral and Neuropsychological Characteristics of Hungarian Patients with Juvenile Idiopathic Arthritis: A Cross-Sectional Analysis
by Diána Garan, Lilla Lengvári, Andrea Ponyi, Márton Szabados, Gyurgyinka Gergev, Imre Bozi, Wouter Wijker and Tamás Constantin
Children 2025, 12(8), 1057; https://doi.org/10.3390/children12081057 - 12 Aug 2025
Viewed by 118
Abstract
Background: Children with juvenile idiopathic arthritis (JIA) may experience chronic pain, contributing to psychological distress. Objective: The objective was to assess neuropsychological functions and behavioral skills in patients with JIA and identify demographic and disease-related factors influencing these outcomes. Methods: This cross-sectional study [...] Read more.
Background: Children with juvenile idiopathic arthritis (JIA) may experience chronic pain, contributing to psychological distress. Objective: The objective was to assess neuropsychological functions and behavioral skills in patients with JIA and identify demographic and disease-related factors influencing these outcomes. Methods: This cross-sectional study evaluated 112 patients at the Division of Pediatric Rheumatology, Semmelweis University (2015–2016). Participants completed psychological assessments using the Child Behavior Checklist and Woodcock–Johnson III Tests. Examined variables included demographic (age and sex), clinical (age at diagnosis and disease activity), and treatment-related factors (therapy type and duration). Treatment groups comprised (a) combination therapy with TNF inhibitor and methotrexate (MTX) (n = 60), (b) MTX monotherapy (n = 34), and (c) TNF inhibitor monotherapy (n = 18). Results: Neuropsychological variables showed no clinically significant differences between treatment groups. These skills were unaffected by age, sex, therapy duration, or disease activity. Pathological behavioral scores were significantly higher (p < 0.05) in younger patients (<7 years), with females showing greater susceptibility to anxiety and depression (p < 0.05). Conclusions: No clinically significant psychological impairments were observed in our cohort. Further research is warranted to clarify the significance of abnormal behavioral scores. Psychological care provision remains vital for improving the quality of life in JIA patients. Full article
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12 pages, 1134 KiB  
Article
Relationship Between Personality of Parents and Pediatric Post-Intensive Care Syndrome for a Family in the PICU: A Prospective, Observational Cohort Pilot Study
by Misaki Kotani, Mitsuki Ikeda, Gen Aikawa, Hideaki Sakuramoto, Akira Ouchi, Haruhiko Hoshino, Keishun Boku, Yuki Enomoto, Nobutake Shimojo and Yoshiaki Inoue
Children 2025, 12(8), 1056; https://doi.org/10.3390/children12081056 - 12 Aug 2025
Viewed by 130
Abstract
Introduction: Post-Intensive Care Syndrome in Pediatrics (PICS-P) for families is a growing concern as receiving care in the Pediatric Intensive Care Unit (PICU) improves child survival. PICU parental stress may cause post-discharge psychiatric symptoms. Understanding personality-related distress is key for early intervention. This [...] Read more.
Introduction: Post-Intensive Care Syndrome in Pediatrics (PICS-P) for families is a growing concern as receiving care in the Pediatric Intensive Care Unit (PICU) improves child survival. PICU parental stress may cause post-discharge psychiatric symptoms. Understanding personality-related distress is key for early intervention. This study examined whether parental personality traits correlate with such symptoms for PICS-P prevention. Methods: A cohort pilot study was conducted at a Japanese university hospital PICU (eight beds, 200–300 annual admissions, mandatory critical care consultation) between January and September 2022. Participants were parents of children admitted for longer than 1 week. Personality traits were investigated using the Big-Five-based test, and psychiatric symptoms were investigated using the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the PTSD Checklist-5 (PCL-5). The correlation between personality traits and psychiatric symptoms was investigated. Results: Among the 53 subjects who met the inclusion criteria, 25 gave consent to participate in this study. The correlation analysis revealed distinct patterns. Agreeableness demonstrated negative correlations: a moderately significant negative correlation with PTSD symptoms (ρ = −0.612, p < 0.05) and non-significant negative correlations with anxiety (ρ = −0.238) and depression (ρ = −0.060). Conversely, neuroticism exhibited positive correlations: a moderately significant positive correlation with anxiety symptoms (ρ = 0.539, p < 0.05), alongside non-significant positive correlations with depression (ρ = 0.318) and PTSD symptoms (ρ = 0.327). Regarding other personality traits, extraversion showed negative correlations with anxiety (ρ = −0.282), depression (ρ = −0.399), and PTSD (ρ = −0.438), conscientiousness displayed positive correlations with anxiety (ρ = 0.318), depression (ρ = 0.127), and PTSD (ρ = 0.467), while openness exhibited negative correlations with anxiety (ρ = −0.333), depression (ρ = −0.312), and PTSD (ρ = −0.309), although none of these associations were statistically significant. Conclusions: Lower levels of agreeableness and higher levels of neuroticism in parents are significantly associated with increased PTSD and anxiety symptoms, respectively, in the PICU setting. These personality traits may serve as predictors of parental psychological distress, suggesting their utility in informing targeted PICS-P interventions and preventative strategies. Full article
(This article belongs to the Special Issue Nursing Management in Pediatric Intensive Care)
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18 pages, 303 KiB  
Article
Feeling the Same Strain? A Cross-Sectional Comparison Study of Fathers’ Versus Mothers’ Parenting Stress During the COVID-19 Pandemic
by Anna Friedmann, Anne Sophie Wenzel, Katharina Richter, Ina Nehring and Volker Mall
Children 2025, 12(8), 1055; https://doi.org/10.3390/children12081055 - 11 Aug 2025
Viewed by 109
Abstract
Background/Objectives: Parenting stress is associated with parent and child mental health problems and has increased since the beginning of COVID-19. Research on paternal parenting stress is sparse—even if family models are changing increasingly with fathers being more strongly involved in caregiving for [...] Read more.
Background/Objectives: Parenting stress is associated with parent and child mental health problems and has increased since the beginning of COVID-19. Research on paternal parenting stress is sparse—even if family models are changing increasingly with fathers being more strongly involved in caregiving for their children. This study investigated (1) overall parenting stress levels and specific parenting stress subscales in fathers with young children in comparison to mothers and (2) potential influencing factors on fathers’ and mothers’ parenting stress during the pandemic. Methods: In a cross-sectional online study, N = 368 parents (50.00% fathers) of children (0–3 years) filled out the German version of the Parenting Stress Index (EBI) and answered questions on sociodemographic and pandemic-related factors. Results: Fathers were 36.17 years (SD = 5.21) and mothers 33.65 years (SD = 4.39) old and 67.50% had a high educational background. Children (45.38% female) were 16.34 months (SD = 11.66) old. There was no significant group difference between fathers’ and mothers’ overall parenting stress (p = 0.39). Parenting stress scores in the attachment subscale were significantly higher in fathers (p < 0.001, r = 0.19). An increase in family conflicts during the pandemic had the highest impact on both paternal (ß = 0.45) and maternal (ß = 0.35) parenting stress. Conclusions: Parenting stress was equally high for fathers and mothers during the COVID-19 crisis, indicating a levelling of pre-pandemic differences due to pandemic-related factors. Future support measures should focus on reducing family conflicts and on strengthening fathers’ attachment to their child. Full article
(This article belongs to the Special Issue Stress and Stress Resilience in Children and Adolescents: 2nd Edition)
12 pages, 886 KiB  
Review
Exploring the Association Between Glucose-6-Phosphate Dehydrogenase Deficiency and Autism Spectrum Disorder: A Narrative Review
by Maitha Abdulla Alshamsi, Maitha Tareq Al Teneiji, Subhranshu Sekhar Kar and Rajani Dube
Children 2025, 12(8), 1054; https://doi.org/10.3390/children12081054 - 11 Aug 2025
Viewed by 169
Abstract
Autism spectrum disorder (ASD) is a complex neurodevelopmental disease of multifactorial etiologies, manifesting as persistent challenges in social interactions, restrictive interests, and repetitive behaviors. Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common human enzymopathy affecting red blood cell function. Although G6PD enzyme deficiency [...] Read more.
Autism spectrum disorder (ASD) is a complex neurodevelopmental disease of multifactorial etiologies, manifesting as persistent challenges in social interactions, restrictive interests, and repetitive behaviors. Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common human enzymopathy affecting red blood cell function. Although G6PD enzyme deficiency is known for its role in hemolytic anemia, emerging studies have suggested a potential association between G6PD deficiency and neurodegenerative and neurodevelopmental disorders, including autism. This narrative review explores the possible connection between G6PD deficiency and autism by analyzing relevant literature from the PubMed and Scopus databases. Current evidence points to plausible biological links, particularly oxidative stress and folate metabolism, warranting further investigation into G6PD deficiency as a potential risk modifier in ASD. Moreover, further research is necessary to elucidate the nature of this relationship and its implications for clinical practice. Full article
(This article belongs to the Section Pediatric Neurology & Neurodevelopmental Disorders)
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22 pages, 431 KiB  
Review
Lived Experiences of School-Age Children with Food Allergies: A Qualitative Systematic Review and Meta-Synthesis
by Noriko Nishida, Yuki Maeda, Ikuo Okafuji and Shingo Ueki
Children 2025, 12(8), 1053; https://doi.org/10.3390/children12081053 - 11 Aug 2025
Viewed by 154
Abstract
Background/Objectives: School-age children with food allergies (FAs) face substantial psychosocial challenges. Herein, we aimed to synthesize the experiences of such children. Methods: A systematic review of qualitative studies was conducted using the Joanna Briggs Institute methodology. The protocol was registered in [...] Read more.
Background/Objectives: School-age children with food allergies (FAs) face substantial psychosocial challenges. Herein, we aimed to synthesize the experiences of such children. Methods: A systematic review of qualitative studies was conducted using the Joanna Briggs Institute methodology. The protocol was registered in PROSPERO (CRD42022359854). A systematic search was conducted of eight databases. Thirteen studies met the inclusion criteria. The data were synthesized through meta-aggregation, and the confidence in the findings was assessed using the ConQual approach. Results: Seventy-three unequivocal findings were extracted and synthesized into three integrated findings. (1) Children with FAs live with daily fear, social restrictions, and emotional stress. To ensure their safety and foster self-management skills, the trusted adults in their lives must be well-informed about allergy management. (2) Children with FAs experience isolation, teasing, and exclusion from peers, whereas peer communication can foster understanding and acceptance. To address this, schools must promote peer empathy, provide allergy education, and build inclusive environments that empower children to express their needs safely. (3) Motivated by curiosity and personal goals, some children engage in oral immunotherapy or allergen reintroduction, leading to meaningful outcomes, such as increased food choices, social inclusion, and reduced anxiety. At the same time, they face emotional and physical burdens, highlighting the need for safety-focused, informed, supported care that considers both the benefits and burdens. Conclusions: This review highlights the need for child-centered, emotionally supportive, and inclusive care involving families, schools, and healthcare providers. However, the moderate ConQual score of the synthesized findings indicates that the recommendations should be considered with caution. Full article
(This article belongs to the Section Global Pediatric Health)
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13 pages, 417 KiB  
Article
Cholecystectomy in Children: Indications and Timing
by Radu Balanescu, Andreea Moga, Laura Balanescu, Mara Untaru, Ruxandra Caragata and Patricia Cimpeanu
Children 2025, 12(8), 1052; https://doi.org/10.3390/children12081052 - 11 Aug 2025
Viewed by 126
Abstract
Background: Pediatric cholelithiasis has become increasingly diagnosed, partly due to enhanced imaging accessibility and rising obesity rates. Despite laparoscopic cholecystectomy being the standard treatment, the optimal timing for surgery remains debated, especially in complicated cases. The aim of our study is to analyze [...] Read more.
Background: Pediatric cholelithiasis has become increasingly diagnosed, partly due to enhanced imaging accessibility and rising obesity rates. Despite laparoscopic cholecystectomy being the standard treatment, the optimal timing for surgery remains debated, especially in complicated cases. The aim of our study is to analyze the demographic, clinical, and surgical characteristics of pediatric patients undergoing cholecystectomy and to identify the most favorable timing for surgery in terms of outcomes and complications. Material and methods: A retrospective study was conducted on 101 pediatric patients who underwent cholecystectomy between 2015 and 2024 at a tertiary children’s hospital. Patients were categorized based on surgical timing: elective, early (day 1–4), intermediate (day 5–14), and delayed (after day 14). Demographic data, clinical presentation, laboratory values, imaging, operative time, intraoperative findings, and postoperative complications were analyzed. Results: The median age was 15 years, with 64.35% female. Obesity was highly prevalent and significantly associated with choledocholithiasis and pancreatitis. Elective and delayed surgeries (after 14 days) had the shortest operative times (median: 2 h) and the lowest complication rates. Early surgeries (within 4 days) showed longer operative times and a higher incidence of intraoperative difficulties and complications. Histopathological findings did not influence clinical management, suggesting potential for selective examination. Conclusions: Elective or delayed cholecystectomy after a “cool-down” period of 5–14 days provides the most favorable outcomes in pediatric patients with complicated cholelithiasis. Conservative management remains appropriate for asymptomatic cases. A standardized approach to surgical timing may reduce complications and hospital costs Full article
(This article belongs to the Section Pediatric Surgery)
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22 pages, 685 KiB  
Systematic Review
Understanding Parental Representations Across the Perinatal Period: A Systematic Review of Empirical Findings and Clinical Implications
by Renata Tambelli, Ludovica Del Proposto and Francesca Favieri
Children 2025, 12(8), 1051; https://doi.org/10.3390/children12081051 - 11 Aug 2025
Viewed by 160
Abstract
Background/Objectives: Parental mental representations play a crucial role in shaping early parent–child relationships, particularly during the perinatal period. These internal models influence caregiving behaviors, emotional attunement, and the intergenerational transmission of attachment. The present systematic review aims to address this gap by [...] Read more.
Background/Objectives: Parental mental representations play a crucial role in shaping early parent–child relationships, particularly during the perinatal period. These internal models influence caregiving behaviors, emotional attunement, and the intergenerational transmission of attachment. The present systematic review aims to address this gap by examining the nature of both maternal and paternal mental representations in the perinatal period (involving pregnancy and the first postnatal time), with a particular emphasis on reflective functioning, and by outlining the variables that are influenced by these representations. Methods: Following PRISMA guidelines, eligible peer-reviewed studies were identified through a comprehensive literature search of major scientific databases (Scopus, Web of Science, PsychArticle/PsycInfo). Qualitative assessment and detailed description were carried out. Results: In total, 28 studies were selected and analyzed. Findings reveal that while representations tend to organize around shared psychological domains—such as expectations regarding the child, parental identity, and the anticipated relationship—there is significant heterogeneity in how these are conceptualized and measured across studies. Risk factors such as maternal depression, low social support, and adverse life experiences were consistently linked to disengaged or distorted representations, whereas balanced representations were associated with greater RF, emotional availability, and protective relational contexts. Conclusions: Overall, the review highlights the clinical relevance of assessing parental mental representations and RF during the perinatal period, suggesting that early, targeted interventions may enhance parental sensitivity and promote secure parent–infant bonds. Future research should adopt integrated theoretical models, include diverse family configurations, and evaluate the efficacy of preventive programs that support reflective and adaptive representations. Full article
(This article belongs to the Section Pediatric Mental Health)
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2 pages, 139 KiB  
Correction
Correction: de Almeida et al. The Challenges of Diagnosing, Managing, and Preventing Pediatric Delirium. Children 2025, 12, 918
by Juliana Patrícia Chaves de Almeida, Yu Kawai, Arnaldo Prata-Barbosa and Roberta Esteves Vieira de Castro
Children 2025, 12(8), 1050; https://doi.org/10.3390/children12081050 - 11 Aug 2025
Viewed by 73
Abstract
In the published publication [...] Full article
16 pages, 2425 KiB  
Article
The Translation and Validation of the Children’s Health Internet Research Parental Inventory (CHIRPI) in Greek: A Crucial Tool for Evaluating Parent Internet Use for Children’s Health Information
by Danai Maria Psoma, Stavroula Ilia, George Briassoulis, Antonia Barke, Bettina K. Doering, Aggeliki Xirorafa and George Notas
Children 2025, 12(8), 1049; https://doi.org/10.3390/children12081049 - 10 Aug 2025
Viewed by 198
Abstract
The internet is now the primary mode of information exchange worldwide. Online health information-seeking behavior (e-HISB) has become a prevalent practice, especially among parents concerned with their children’s health, creating both opportunities and risks. Objective: The present study aims to translate and culturally [...] Read more.
The internet is now the primary mode of information exchange worldwide. Online health information-seeking behavior (e-HISB) has become a prevalent practice, especially among parents concerned with their children’s health, creating both opportunities and risks. Objective: The present study aims to translate and culturally adapt the CHIRPI questionnaire into Greek and conduct a comprehensive psychometric validation, including analyses of internal consistency, test–retest reliability (temporal stability), and inter-rater reliability. The adapted tool is further pilot-tested for its utility in measuring parental internet use concerning child health information. Methods: The translation, validation, and pilot study of the questionnaire were conducted in accordance with internationally recommended procedures. CHIRPI was translated into Greek using forward–backward translation and was culturally adapted. A pilot sample of 105 parents (children aged 0–10) participated. The majority of participants were mothers (66.7%), aged 31–40 years, residing in urban areas, and they held tertiary or postgraduate degrees. Internal consistency was measured with Cronbach’s alpha, test–retest reliability with the ICC, and inter-rater reliability with the kappa coefficient. Item responses were also analyzed in relation to demographic factors. Results: The CHIRPI Greek version demonstrated excellent internal consistency (Cronbach’s α = 0.91; all subscales had α values greater than 0.70). Test–retest reliability (ICC = 0.632–1.000) and inter-rater reliability (kappa = 0.615–1.000) indicated moderate to excellent agreement. The scale showed satisfactory psychometric properties, supporting its use in Greek populations. Higher education was linked to more frequent health-related internet searches and increased distress (p < 0.001). Conclusions: The CHIRPI Greek version is a valid and reliable tool for assessing parental online health information-seeking behavior related to children’s health among Greek-speaking populations. As the first standardized tool in Greek, it fills a critical methodological gap in eHealth research. Full article
32 pages, 3916 KiB  
Review
Advances in Fluorescent Adjuncts in Pediatric Surgery: A Comprehensive Review of Applications of Indocyanine Green Across Surgical Specialties
by Nicholas Jose Iglesias, Andres Mauricio Corona, Akshat Sanan, Eduardo Alfonso Perez and Carlos Theodore Huerta
Children 2025, 12(8), 1048; https://doi.org/10.3390/children12081048 - 9 Aug 2025
Viewed by 347
Abstract
Introduction: Indocyanine green (ICG) dye is used in a myriad of medical and surgical applications and complications related to its use are exceedingly rare. ICG fluorescence can be detected in unique locations depending on route, dosage, and timing. Although ICG fluorescence is used [...] Read more.
Introduction: Indocyanine green (ICG) dye is used in a myriad of medical and surgical applications and complications related to its use are exceedingly rare. ICG fluorescence can be detected in unique locations depending on route, dosage, and timing. Although ICG fluorescence is used more commonly in the adult population, its adoption in pediatric surgery has been increasing more frequently. This comprehensive review aims to elucidate the myriad of ICG surgical applications within the pediatric population and important clinical considerations for administration. Methods: PubMed was queried for pediatric surgical applications of indocyanine green. Surgical application, route of administration, dosage, ICG-related complications, and surgical impact of ICG fluorescence were analyzed. Results: In the pediatric population, ICG is used in a multitude of hepatobiliary, gastrointestinal, cardiothoracic, lymphatic, urologic, gynecologic, plastic, ENT, ophthalmologic, and neurosurgical procedures. Applications range from oncologic resections to benign and congenital reconstructions. Administration can be intravenous, intralesional, subcutaneous, inhaled, or enteric. Timing, dosage, and route of administration are dependent on the pathology of interest. Conclusions: ICG is a safe and useful adjunct for a wide variety of pediatric surgical applications. This comprehensive review aims to highlight administration considerations and the efficacy of ICG fluorescence in various surgical subspecialty pathologies. Future studies should continue to focus on how to integrate pathology-specific ICG fluorescence into intraoperative decision-making. Full article
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12 pages, 630 KiB  
Article
Ten-Year Clinical and Functional Outcomes of Anterograde Calcaneo-Stop Arthroereisis for Idiopathic Flexible Flatfoot in Children: A Single-Center Cohort Study
by Giovanni Trisolino, Marco Ramella, Valeria Pizzuti, Marco Todisco, Stefania Claudia Parisi, Tosca Cerasoli and Gino Rocca
Children 2025, 12(8), 1047; https://doi.org/10.3390/children12081047 - 9 Aug 2025
Viewed by 230
Abstract
Background: Idiopathic painful flexible flatfoot (FFF) in childhood can persist into adulthood, yet long-term data on subtalar arthroereisis via the calcaneo-stop (C-Stop) procedure are scarce. We aimed to evaluate clinical and functional outcomes at ≥10 years post-surgery and compare them with age-matched normative [...] Read more.
Background: Idiopathic painful flexible flatfoot (FFF) in childhood can persist into adulthood, yet long-term data on subtalar arthroereisis via the calcaneo-stop (C-Stop) procedure are scarce. We aimed to evaluate clinical and functional outcomes at ≥10 years post-surgery and compare them with age-matched normative values in healthy populations. Methods: We conducted a single-time-point long-term follow-up on a subset of 232 children (age 10–14 years) selected from a retrospective cohort of 494 patients who underwent bilateral anterograde C-Stop between 2010 and 2014. Inclusion required idiopathic symptomatic FFF refractory to conservative care and a minimum 10-year follow-up. At a mean follow-up of 12.1 ± 2.5 years, patients completed the Foot and Ankle Ability Measure (FAAM) and Tegner Activity Scale (TAS). Secondary data included anthropometrics, implant details, accessory procedures, screw removal, and complications. Results: Respondents demonstrated excellent function: FAAM total 98.8 ± 3.7 (range 75–100) with 87.5% achieving the ceiling score; FAAM–ADL 99.3 ± 3.2; FAAM–Sport 98.0 ± 6.4. The mean TAS was 3.7 ± 2.0, with 53% active in sports—72% low-impact, 12% high-impact non-competitive, and 4% competitive. Sex and history of complications produced statistically significant but clinically small differences (<3% on FAAM total; <6 points on subscales). No outcome differences were observed by age or BMI, accessory procedures, or screw removal status. Conclusions: Ten years after C-Stop arthroereisis in childhood, patients exhibit functional scores comparable to normative values, high rates of ceiling effect on FAAM, and a modest level of physical activity predominantly in low-impact sports. Full article
(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)
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20 pages, 543 KiB  
Article
More than a Feeling: Self-Esteem as a Predictor of Life Satisfaction in Adolescents: A Cross-Sectional Analysis in Saudi Arabia
by Hawa Alabdulaziz
Children 2025, 12(8), 1046; https://doi.org/10.3390/children12081046 - 9 Aug 2025
Viewed by 217
Abstract
Introduction: Prior research underscores self-esteem as a core determinant of life satisfaction and overall well-being. However, few studies have examined this relationship within the unique sociocultural context of Saudi Arabia. This study assesses the relationship between self-esteem and life satisfaction in adolescents, as [...] Read more.
Introduction: Prior research underscores self-esteem as a core determinant of life satisfaction and overall well-being. However, few studies have examined this relationship within the unique sociocultural context of Saudi Arabia. This study assesses the relationship between self-esteem and life satisfaction in adolescents, as well as the potential moderating effects of demographic factors. Methods: A cross-sectional study was conducted involving 502 adolescents aged 13–18, selected from urban and rural regions of Saudi Arabia. Participants completed the Rosenberg Self-Esteem Scale and the Satisfaction with Life Scale. Data were collected via online survey platforms. Descriptive statistics, correlation analyses, chi-square tests, and multivariate logistic regressions were performed using SPSS version 26. Ethical approval was obtained, and informed consent was secured from all participants. Results: A significant positive correlation was found between life satisfaction and self-esteem scores (r = 0.37, p < 0.001). Adolescents reporting dissatisfaction with life had over seven times greater odds of low self-esteem (OR = 7.2; 95% CI: 3.75–13.83). Higher life satisfaction was associated with being in secondary education, having a family income of 10,000 Saudi Riyal (SR) or more, and living with both parents. Additionally, prior contact with a psychologist was linked to lower self-esteem and reduced life satisfaction. Conclusions: Findings confirm self-esteem as a strong predictor of life satisfaction among Saudi adolescents. Socioeconomic status, family structure, and previous psychological consultation also influenced outcomes. These results emphasize the critical need for culturally sensitive mental health interventions tailored to the Saudi context. Furthermore, they highlight the importance of implementing early mental health screening and support programs within schools to provide accessible and preventive care for youth. Full article
(This article belongs to the Section Pediatric Mental Health)
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14 pages, 1720 KiB  
Article
Impact of Preoperative Halo Traction on Cobb Angle Reduction in Adolescent Idiopathic Scoliosis: A Retrospective Analysis
by Mihai Bogdan Popescu, Harun Marie, Alexandru Ulici, Sebastian Nicolae Ionescu, Adelina Ionescu, Ioana Alexandra Popescu and Alexandru Herdea
Children 2025, 12(8), 1045; https://doi.org/10.3390/children12081045 - 9 Aug 2025
Viewed by 263
Abstract
Background/Objectives: Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity often requiring surgical correction in severe cases. Halo-gravity traction (HGT) is commonly employed preoperatively to enhance spinal flexibility and reduce curve severity. This study aimed to evaluate the effectiveness of HGT in reducing [...] Read more.
Background/Objectives: Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity often requiring surgical correction in severe cases. Halo-gravity traction (HGT) is commonly employed preoperatively to enhance spinal flexibility and reduce curve severity. This study aimed to evaluate the effectiveness of HGT in reducing Cobb angles in AIS and to assess how patient age, skeletal maturity (Risser score), and curve type (Lenke classification) influence treatment response. Methods: We conducted a retrospective cohort study of 28 AIS patients with Cobb angles > 65° who underwent preoperative HGT followed by posterior spinal fusion. Traction was applied for a mean of 24.64 days, reaching 40–50% of each patient’s body weight. Radiographic measurements were collected pre-traction, post-traction, and postoperatively. Statistical analyses included paired t-tests, Pearson correlations, Kruskal–Wallis tests, and linear regression. Results: Mean primary Cobb angle was reduced from 82.46° pre-traction to 61.00° post-traction (26.09% reduction) and further to 29.54° postoperatively (64.58% total reduction). Similar reductions were observed in secondary curves. No statistically significant correlations were found between age or Risser score and the magnitude of correction. Lenke type 3 showed the highest traction response, while type 5 had the greatest surgical gain. Curve type and skeletal maturity did not significantly affect final outcomes. Conclusions: Halo-gravity traction is a safe and effective adjunct in the surgical treatment of severe AIS, achieving substantial Cobb angle reduction. The degree of correction was not significantly influenced by age, Risser score, or curve type, supporting the broad applicability of HGT across adolescent patients. Full article
(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)
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23 pages, 474 KiB  
Article
Fostering Infant/Toddler Mental Health and Language in Underserved Family Child Care Settings
by Chin R. Reyes, Brooke Rumper and Reem Khamis
Children 2025, 12(8), 1044; https://doi.org/10.3390/children12081044 - 8 Aug 2025
Viewed by 256
Abstract
Background: Early language development, a key predictor of later academic achievement, arises out of social interactions and communication. High-quality social and emotional interactions in early child care and education (ECCE) programs may therefore promote language-rich environments for young children. While culturally and linguistically [...] Read more.
Background: Early language development, a key predictor of later academic achievement, arises out of social interactions and communication. High-quality social and emotional interactions in early child care and education (ECCE) programs may therefore promote language-rich environments for young children. While culturally and linguistically minoritized communities face systemic barriers that limit equitable access to high-quality ECCE including social and emotional learning (SEL) programs, access to evidence-based SEL programs remains inequitable, disproportionately benefiting White, English-speaking, and higher-income ECCE providers. The current study aims to examine how I-T CHILD, a program designed to foster a climate that supports mental health and SEL in ECCE, improves the quality of the language environment using LENA technology. Methods: Implemented at the height of the COVID-19 pandemic, 38 family child care providers located in an urban setting (63.2% Hispanic/Latine; 40% living in poverty) were randomly assigned to the 12-week I-T CHILD program or to the waitlist-control group. Data were analyzed using hierarchical linear modeling procedures. Results: Infants and toddlers cared for by I-T CHILD providers produced significantly more vocalizations (p = 0.002; ES = 1.50) and were exposed to significantly less media and electronic sounds (p = 0.032; ES = −0.97) than infants and toddlers in the waitlist-control condition. Conclusions: Our findings reinforce the importance of the mental health climate in ECCE and its circular effect on early language development. We offer key insights into how mental health climate interventions in ECCE settings can enhance language interactions, center the child, and foster foundational skills linked to long-term academic success for historically underserved populations. Full article
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14 pages, 531 KiB  
Article
Building Bridges: Developing and Implementing a New Transition to Adult Care Program for Youth with Complex Healthcare Needs at a Canadian Children’s Hospital
by Sara Santos, Julia Orkin, Dara Abells, Brooke Allemang, Bianca Arenas Rodriguez, Kimberly Colapinto, Nora Constas, Mackenzie Heath, Megan Henze, Tomisin John, Robyn Lippett, Susan Miranda, Joanna Soscia, Jessica Teicher, Donna Thomson, Jennifer Tyrrell, Eryn Vandepoele, Karla Wentzel, Darryl Yates, Eyal Cohen and Alène Toulanyadd Show full author list remove Hide full author list
Children 2025, 12(8), 1043; https://doi.org/10.3390/children12081043 - 8 Aug 2025
Viewed by 149
Abstract
Background/Objectives: Transitioning from pediatric to adult services can be challenging for youth with complex chronic health conditions, especially those with multi-morbidity. These youth often require extra coordination and support during this phase of their healthcare journey. Building upon existing provincial and national [...] Read more.
Background/Objectives: Transitioning from pediatric to adult services can be challenging for youth with complex chronic health conditions, especially those with multi-morbidity. These youth often require extra coordination and support during this phase of their healthcare journey. Building upon existing provincial and national initiatives for transitions from pediatric to adult healthcare services, we have developed a hospital-wide program within one of Canada’s largest children’s hospitals that incorporates an integrated care model aimed at better serving these patients and improving outcomes. Methods: Guided by provincial quality standards, an environmental scan and knowledge user engagement were conducted to develop the program, followed by an implementation phase, where the model was piloted. Ongoing learnings from the pilot continue to inform program implementation and evaluation. Results: The Transition to Adult Care (TAC) program offers disease-agnostic care to youth with complex needs for 1–3 years, including 1-year post-transfer, addressing the fragmentation of care across multiple services, organizations and providers. Our interdisciplinary team works in partnership with youth and caregivers to deliver transition navigation, easing the burden on patients and families by tailoring transition supports to each individual youth and caregiver. Preliminary data from the pilot revealed a lack of awareness about transition resources and timelines; however, with early engagement and flexible support beyond age 18, youth were able to complete their transition successfully. Conclusions: The TAC program demonstrates a systems-level approach to improving transition to adult care for youth with complex health needs by integrating individualized support, cross-sectoral collaboration, and continuous quality improvement. Early engagement, flexible post-transfer support, and close partnership with youth, caregivers, and providers are key to facilitating transition. These learnings can inform broader implementation efforts and help address persistent gaps in transitional care across healthcare systems. Full article
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Article
Long-Term Bowel and Urinary Function Outcomes and Quality of Life in Patients with Anorectal Malformations: 20 Years of Experience
by Fabio Baldanza, Francesco Grasso, Marco Pensabene, Maria Sergio and Maria Rita Di Pace
Children 2025, 12(8), 1042; https://doi.org/10.3390/children12081042 - 8 Aug 2025
Viewed by 138
Abstract
Background: Anorectal malformations (ARMs) are rare congenital anomalies requiring surgical correction and long-term multidisciplinary care. Despite advances in surgical techniques like posterior sagittal anorectoplasty (PSARP), patients often experience ongoing issues with bowel and urinary function and psychosocial well-being. Aim: To evaluate the long-term [...] Read more.
Background: Anorectal malformations (ARMs) are rare congenital anomalies requiring surgical correction and long-term multidisciplinary care. Despite advances in surgical techniques like posterior sagittal anorectoplasty (PSARP), patients often experience ongoing issues with bowel and urinary function and psychosocial well-being. Aim: To evaluate the long-term outcomes of bowel function, urinary function, and quality of life in patients born with anorectal malformation and treated at our center. Methods: A cross-sectional study evaluated 55 ARM patients treated at the University Hospital of Palermo between 2002 and 2020. Data on clinical characteristics, surgical management, bowel and urinary function, and quality of life were collected using the following validated tools: Rintala Bowel Function Score, PedsQL Family Impact Module, Fecal Incontinence Quality of Life Score, and Lower Urinary Tract Symptoms Questionnaire. Statistical analysis was performed using Fisher’s exact test and ANOVA. Results: Excellent bowel function was observed in 44% of patients, particularly those with low-type ARMs. A bowel management program (BMP) was required in 62% of cases, though 44% of these patients, especially adolescents, showed poor adherence. BMP non-adherence significantly correlated with lower quality of life and worse bowel function (p < 0.01). Bladder dysfunction was noted in 24% of patients, mainly younger ones. Conclusions: Tailored BMPs and transition care are important for long-term success in ARM patients. Adherence to BMPs improves continence and quality of life, highlighting the need for continuous, multidisciplinary follow-up from childhood into adulthood. Full article
(This article belongs to the Special Issue Bowel Management in Paediatric Colorectal Disease)
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