Children

7 pages, 184 KiB

Open AccessArticle

Efficacy of Teduglutide in Pediatric Short Bowel Syndrome: Association with Citrulline Levels and Anatomical Location of Remnant Small Intestine

by Yudai Goto, Kouji Masumoto, Takato Sasaki, Kazuki Shirane, Tomohiro Aoyama, Naoya Sakamoto and Takahiro Jimbo

Children 2025, 12(8), 977; https://doi.org/10.3390/children12080977 (registering DOI) - 24 Jul 2025

Abstract

Background/Objectives: Short bowel syndrome (SBS) is the leading cause of pediatric intestinal failure. Plasma citrulline is considered a marker indicating an enterocyte volume and may help evaluate the response to teduglutide; however, this interpretation may vary depending on the remnant bowel anatomy. Methods: [...] Read more.

Background/Objectives: Short bowel syndrome (SBS) is the leading cause of pediatric intestinal failure. Plasma citrulline is considered a marker indicating an enterocyte volume and may help evaluate the response to teduglutide; however, this interpretation may vary depending on the remnant bowel anatomy. Methods: We conducted a retrospective case series of four pediatric patients with SBS (aged < 15 years) who received teduglutide for 12 months at our hospital between 2018 and 2023. Changes in plasma citrulline levels and parenteral nutrition requirements were assessed in addition to bowel anatomy classification. Results: This study included two males and two females. All patients showed an increase in plasma citrulline levels and a reduction in the requirement for parenteral nutrition (PN) after 12 months of teduglutide treatment. In SBS type 2 (jejunocolic anastomosis), citrulline levels increased by 114% and 52%, with PN reduction rates of 100% and 30%, respectively. In SBS type 3 (jejunoileal anastomosis), citrulline levels increased by 13.6% and 34%, with PN reductions of 33% and 73%, respectively. Conclusions: Teduglutide treatment increased plasma citrulline levels and reduced PN levels in all cases. However, the magnitude of the citrulline change varied across bowel anatomy types, suggesting that the anatomical difference in the remnant bowel may influence the biomarker response. Further detailed pediatric cases are required to clarify the role of citrulline in evaluating GLP-2 analogue treatment outcomes. Full article

(This article belongs to the Section Pediatric Gastroenterology and Nutrition)

13 pages, 248 KiB

Open AccessArticle

An Assessment of Motor Skills in Infants at Risk of Atypical Psychomotor Development Using the Vojta Method

by Robert Podstawski, Katarzyna Balewska-Juras, Krzysztof Borysławski, Attila Szabo and Jadwiga Snarska

Children 2025, 12(8), 976; https://doi.org/10.3390/children12080976 - 24 Jul 2025

Abstract

Background: Some neonates are assessed for the risk of atypical psychomotor development at birth and are referred for reflex locomotion therapy using the Vojta method. Aim: The aim of this study was to analyze the relationships between spontaneous motor activity (SMA), [...] Read more.

Background: Some neonates are assessed for the risk of atypical psychomotor development at birth and are referred for reflex locomotion therapy using the Vojta method. Aim: The aim of this study was to analyze the relationships between spontaneous motor activity (SMA), ideal movement patterns (IMPs), central coordination disorders (CCDs), vital signs at birth, involuntary reflexes, and postural asymmetry in infants. Methods: This study involved 90 female and 107 male subjects in the age interval of 1–16 months (4.15 ± 2.18). Their psychomotor development was assessed using the Vojta method. Age-appropriate involuntary reflexes were evaluated, and both parameters were correlated with perinatal risk factors. Results: Males scored significantly higher than females (difference of −0.7, p = 0.022) in the SMA test. In both genders, SMA (p < 0.001 in both genders) and IMP scores improved significantly with age. In male infants, higher CCD scores were associated with significantly lower SMA and IMP scores (p = 0.017 and p < 0.001, respectively). Significantly higher CCD scores were noted in female subjects with the Moro reflex and postural asymmetry (p = 0.003 and p = 0.002, respectively). In males, the Moro reflex was significantly correlated with the Vojta reaction (p = 0.012) and the Collis vertical suspension reflex (p < 0.001). Conclusions: Vital signs at birth, including birth weight, Apgar score, and type of delivery, can predict motor development disorders but do not clearly differentiate infants that require neurodevelopmental therapy. Full article

(This article belongs to the Special Issue Recent Advances in Children’s Motor Development: From Birth to Adolescence)

13 pages, 2736 KiB

Open AccessArticle

Early Predictors of Outcome in Pediatric Acquired Demyelinating Syndromes: A Retrospective Study Stratified by Final Diagnosis

by Emanuela Claudia Turco, Martina Gnazzo, Sara Giordani, Giulia Pisanò, Valentina Baldini, Elena Giroldini, Benedetta Piccolo, Cosimo Neglia, Susanna Esposito and Maria Carmela Pera

Children 2025, 12(8), 975; https://doi.org/10.3390/children12080975 - 24 Jul 2025

Abstract

Background/Objectives: Pediatric acquired demyelinating syndromes (ADSs) encompass a heterogeneous group of disorders, including multiple sclerosis (MS), MOG antibody-associated disease (MOGAD), and neuromyelitis optica spectrum disorder (NMOSD), with distinct clinical trajectories and prognoses. While analyzed collectively at baseline to reflect real-world diagnostic uncertainty, [...] Read more.

Background/Objectives: Pediatric acquired demyelinating syndromes (ADSs) encompass a heterogeneous group of disorders, including multiple sclerosis (MS), MOG antibody-associated disease (MOGAD), and neuromyelitis optica spectrum disorder (NMOSD), with distinct clinical trajectories and prognoses. While analyzed collectively at baseline to reflect real-world diagnostic uncertainty, outcome predictors were also examined according to final diagnosis. Identifying early predictors is crucial for optimizing long-term outcomes. Methods: We retrospectively analyzed 30 pediatric patients (mean onset age: 11.3 years) with ADSs. Clinical, radiological, CSF, antibody, and neurophysiological data were collected and analyzed alongside treatment strategies. Outcomes—EDSS scores, neuroradiological changes, and clinical status—were evaluated over a 3-year period. Results: Final diagnoses included MOGAD (36.6%), MS (33.3%), NMOSD (6.6%), ADEM (10%), and other ADSs (13.3%). At onset, ≥3 brain lesions were present in 76.7% of patients. Disease-modifying therapies (DMTs) were used in 37% and acute immunotherapy in 90%. EDSS progression was significantly associated with DMT use at multiple timepoints, with additional predictors including MRI lesion type, CSF findings, antibody status, and evoked potentials. At 3 years, neurocognitive function predicted clinical outcome. Conclusions: Early immunotherapy and baseline instrumental findings are key predictors of outcome in pediatric ADSs. MOGAD showed a more favorable course, while MS and NMOSD were associated with greater long-term disability. A comprehensive, early diagnostic approach is essential for improving prognosis. Full article

(This article belongs to the Special Issue Recent Advances in Pediatric-Onset Multiple Sclerosis)

7 pages, 1733 KiB

Open AccessCase Report

Bilateral Symmetrical Brain MRI Findings in Acute Necrotising Encephalopathy Type 1

by Alexander T. Hoppe, Twinkle Ghia, Richard Warne, Peter Shipman and Rahul Lakshmanan

Children 2025, 12(8), 974; https://doi.org/10.3390/children12080974 - 24 Jul 2025

Abstract

Background: Acute necrotising encephalopathy (ANE) is a rare and severe type of encephalopathy with bilateral symmetrical brain lesions, often following a viral prodrome. ANE type 1 (ANE1) is a disease subtype with a predisposing mutation in the gene encoding RAN binding protein 2 [...] Read more.

Background: Acute necrotising encephalopathy (ANE) is a rare and severe type of encephalopathy with bilateral symmetrical brain lesions, often following a viral prodrome. ANE type 1 (ANE1) is a disease subtype with a predisposing mutation in the gene encoding RAN binding protein 2 (RANBP2). Methods: We report a case of a 3-year-old girl with clinical symptoms of ANE and brain MRI findings suggesting ANE1, which was subsequently confirmed by genetic analysis. Results: MRI of the brain demonstrated symmetrical high T2/FLAIR signal changes in the lateral geniculate bodies, claustrum, ventromedial thalami, subthalamic nuclei, mamillary bodies, and brainstem, with partly corresponding diffusion restriction, as well as additional haemorrhagic changes in the lateral geniculate bodies on susceptibility weighted imaging. Genetic analysis revealed a heterozygous pathogenic variant of the RANBP2 gene. With immunosuppressive and supportive treatment, the patient fully recovered and was discharged after 10 days in the hospital with no residual symptoms. Conclusions: Recognition of the characteristic MRI findings in ANE1 can facilitate a timely diagnosis and enhance the clinical management of the patient and their relatives, especially given the high risk of disease recurrence. Full article

(This article belongs to the Special Issue Genetic Rare Diseases in Children)

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15 pages, 236 KiB

Open AccessArticle

Insights into Fanconi Anemia Based on Molecular and Clinical Characteristics: A Multicentre Study of 13 Patients

by Simoni Saranti, Nikoletta Selenti, Christalena Sofocleous, Joanne Traeger-Synodinos, Antonis Kattamis, Vassilios Papadakis, Evgenios Goussetis, Charikleia Kelaidi, Anna Paisiou, Sophia Polychronopoulou and Lydia Kossiva

Children 2025, 12(8), 973; https://doi.org/10.3390/children12080973 - 24 Jul 2025

Abstract

Background: Fanconi Anemia (FA) is a rare disorder, characterized by chromosomal instability, congenital abnormalities, progressive bone marrow failure, and predisposition to cancer. FA is caused by pathogenic variants in any of the 23 (FANCA-FANCY) linked genes. Procedure: Retrospective analysis [...] Read more.

Background: Fanconi Anemia (FA) is a rare disorder, characterized by chromosomal instability, congenital abnormalities, progressive bone marrow failure, and predisposition to cancer. FA is caused by pathogenic variants in any of the 23 (FANCA-FANCY) linked genes. Procedure: Retrospective analysis of 13 FA patients with a causative variant was performed. Patients (6 boys and 7 girls) aged from 9 to 26 years old, (mean age of 7.3 years), at diagnosis. Results: Phenotype evaluation demonstrated in 11/13 patients’ congenital anomalies, with pigmentary changes and short stature, present in 90% of cases. Hematological abnormalities were present in 10/11 patients, with thrombocytopenia being the prominent finding. Genetic analysis for the most common complementation group FA-A revealed that 12/13 patients belonged to this group and only one patient was found to be FA-E. Exon deletions, single nucleotide variations, and duplications were identified. Familial patterns, due to consanguinity, were evident in one case. Twelve patients underwent hematopoietic stem cell transplantation (HSCT), with variable pre-HSCT supportive treatments. Post-HSCT data showed that 9 out of 10 patients for whom follow up data was available, survived for a median time of 5.4 years. Complications like acute graft-versus-host disease were noted. Conclusions: Our study highlights the importance of genotype towards tailored monitoring for children and families with FA. Full article

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

16 pages, 566 KiB

Open AccessArticle

Assessing the Impact of Serum Ferritin on Life Skills in Children with ADHD

by Merve Okuyucu, Mariam Kavakci, Merve Terzioğlu, Mehmet Enes Gökler and Mahmut Cem Tarakçıoğlu

Children 2025, 12(8), 972; https://doi.org/10.3390/children12080972 - 24 Jul 2025

Abstract

Background/Objectives: This study aimed to investigate the association between serum ferritin levels and functional impairment in children with Attention Deficit Hyperactivity Disorder (ADHD). In addition, we investigated whether this relationship remained significant after controlling for core symptom severity and examined the correlations between [...] Read more.

Background/Objectives: This study aimed to investigate the association between serum ferritin levels and functional impairment in children with Attention Deficit Hyperactivity Disorder (ADHD). In addition, we investigated whether this relationship remained significant after controlling for core symptom severity and examined the correlations between ferritin levels and ADHD symptom levels. Methods: The sample included 88 children aged 6–13 years: 44 diagnosed with ADHD and 44 healthy controls (HCs) matched for age and sex. ADHD symptom severity was assessed using Turgay’s DSM-IV-Based ADHD and Disruptive Behavior Disorders Screening Scale (T-DSM-IV-S; parent-report) and the Clinical Global Impression—Severity (CGI-S) scale (clinician-rated). Functional impairment was measured using the Weiss Functional Impairment Rating Scale—Parent Report (WFIRS-P). Serum ferritin levels were determined through venous blood samples. Statistical analyses included group comparisons, Spearman correlations, and partial correlations controlling for symptom severity. Results: Children with ADHD had significantly lower serum ferritin levels and higher levels of both symptom severity and functional impairment compared to HCs. Ferritin levels were negatively correlated with ADHD symptom severity and with functional impairment in the Life Skills domain. However, after controlling for ADHD symptom severity, the association with Life Skills was no longer statistically significant. Conclusions: Ferritin levels were found to be associated with both ADHD symptom severity and functional impairment in the Life Skills domain. However, this relationship was not independent of symptom severity, suggesting that core ADHD symptoms may mediate the impact of iron status on daily functioning. Due to the study’s limitations (e.g., cross-sectional design, small sample size, gender imbalance, and lack of inflammatory and dietary data), our findings should be interpreted with caution, as they do not establish causality or resolve the ongoing inconsistencies in the literature. These results underscore the relevance of iron metabolism in the clinical presentation of ADHD and highlight the need for future research to determine whether improving iron status could serve as an adjunctive strategy in the management of functional impairments in this population. Full article

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14 pages, 731 KiB

Open AccessArticle

Readhesion of Tongue-Tie Following Neonatal Frenotomy: Incidence and Impact of Postoperative Exercises in a Prospective Observational Study

by Beatriz Valle-Del Barrio, Silvia Maya-Enero, Jordi Prat-Ortells, María Ángeles López-Vílchez and Júlia Candel-Pau

Children 2025, 12(8), 971; https://doi.org/10.3390/children12080971 - 24 Jul 2025

Abstract

Background/Objectives: Frenotomy is the procedure of choice for treating ankyloglossia. The literature reports that readhesion of the frenulum occurs in 2.6–13% of cases. There is no published evidence to support performing tongue exercises to prevent it. We aimed to determine the readhesion rate [...] Read more.

Background/Objectives: Frenotomy is the procedure of choice for treating ankyloglossia. The literature reports that readhesion of the frenulum occurs in 2.6–13% of cases. There is no published evidence to support performing tongue exercises to prevent it. We aimed to determine the readhesion rate of ankyloglossia, the benefits of tongue exercises to prevent it, and the characteristics of patients who experienced readhesion. Methods: This is a prospective, observational study of neonates who underwent a frenotomy between January and August 2024. Following the frenotomy, we recommended that all parents perform a series of exercises 6–8 times daily over 15 days. Patients were re-evaluated 10–15 days post-procedure for signs of ankyloglossia using the Hazelbaker tool and clinical variables such as nipple pain or cracks. Results: We enrolled 212 patients; thirty patients underwent a refrenotomy (14.1%). The raw risk of readhesion in our study was 0.335 (95%CI 0.275–0.401), and for symptomatic readhesion, 0.156 (95%CI 0.113–0.211). Adjusted by sex, the risk of readhesion for female patients was 0.236 (95%CI 0.155–0.344), and for males, 0.390 (95%CI 0.312–0.474). The appearance and function Hazelbaker scores were significantly lower before the frenotomy than post-procedure in all cases. In females, not following the exercise protocol multiplied the risk of readhesion by 1.61 (95%CI 1.03–2.56), whereas in males the risk was multiplied by 1.47 (95%CI 1.03–2.08). Symptomatic readhesion was significantly correlated with age at frenotomy and Hazelbaker score. Conclusions: Readhesion of tongue-tie was higher than previously published (33.5%); however, symptomatic readhesion was less frequent (15.6%). Proper adherence to post-frenotomy exercises significantly reduces the risk of readhesion, although it has less impact on symptomatic readhesion. Full article

(This article belongs to the Section Pediatric Neonatology)

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21 pages, 850 KiB

Open AccessArticle

Beyond the Overlap: Understanding the Empirical Association Between ADHD Symptoms and Executive Function Impairments in Questionnaire-Based Assessments

by Claudia Ceruti and Gian Marco Marzocchi

Children 2025, 12(8), 970; https://doi.org/10.3390/children12080970 - 24 Jul 2025

Abstract

Background/Objectives: Executive function (EF) difficulties are increasingly recognized as closely linked to ADHD, particularly when assessed via rating scales. Methods: The present study investigated the nature of these associations, using the Conners 3 Rating Scales to assess ADHD symptoms and the [...] Read more.

Background/Objectives: Executive function (EF) difficulties are increasingly recognized as closely linked to ADHD, particularly when assessed via rating scales. Methods: The present study investigated the nature of these associations, using the Conners 3 Rating Scales to assess ADHD symptoms and the Executive Function Questionnaire (EFQU) to assess EF impairments, in a sample of 1068 children (40.8% males, 38.8% females) aged 7–14 years (M = 10.7, SD = 1.74). Results: Both parent and teacher ratings revealed strong correlations, particularly between inattentive symptoms and EF difficulties, across multiple executive domains. To examine whether these associations stemmed from construct or phrasing overlap, exploratory and confirmatory factor analyses were conducted. The results demonstrate that the Conners 3 and the EFQU capture distinct latent dimensions of functioning, with virtually no overlap in item content. Conclusions: The strength and consistency of the associations between these latent factors support the interpretation that, although conceptually distinct, ADHD symptoms and EF impairments are empirically intertwined in everyday functioning, as consistently reported by both parents and teachers. Interestingly, teachers provided more integrated views of behavior, while parents tended to distinguish ADHD and EF traits more clearly. These findings underscore the importance of multi-informant assessment and contextual variability in understanding children’s functioning. Full article

(This article belongs to the Special Issue Early Detection and Intervention of ADHD in Children and Adolescents)

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13 pages, 231 KiB

Open AccessArticle

Enhancing Preschoolers’ Motor Creativity Through Playfulness and Social Engagement

by Despoina Ourda, Eleni Polyzoudi, Athanasios Gregoriadis and Vassilis Barkoukis

Children 2025, 12(8), 969; https://doi.org/10.3390/children12080969 (registering DOI) - 23 Jul 2025

Abstract

Background/Objectives: Motor creativity is a vital component of preschoolers’ growth and development. However, its underlying determinants remain largely underexplored. This study investigates the interrelationship among playful behavior, social profile, and motor creativity in preschool children, emphasizing its implications for holistic health and [...] Read more.

Background/Objectives: Motor creativity is a vital component of preschoolers’ growth and development. However, its underlying determinants remain largely underexplored. This study investigates the interrelationship among playful behavior, social profile, and motor creativity in preschool children, emphasizing its implications for holistic health and development. Methods: A total of 200 children and their kindergarten teachers from Greece participated in the study. The Children’s Playfulness Scale (CPS) was employed to assess the children’s playfulness, while a sociometric test was used to evaluate their social standing within peer groups. Motor creativity was measured through TCAM, a performance-based test focusing on fluency, imagination, and originality. Results: The findings revealed that the dimensions of playful behavior, particularly motor and social playfulness, significantly and positively influenced motor creativity, a core component of physical and mental health in early childhood. Conversely, certain aspects of social behavior had a negative association with imaginative capacities. Conclusions: The study underscores the critical role of movement-based playful activities in fostering children’s physical, emotional, cognitive, and social health. It highlights the need for educators to design developmentally appropriate motor play activities that cultivate creativity and social integration, promoting a balanced and health-oriented early education framework. The results contribute to educational policy and practice by reinforcing the importance of structured motor play in supporting preschoolers’ well-being and comprehensive development. Full article

(This article belongs to the Section Global Pediatric Health)

15 pages, 1251 KiB

Open AccessArticle

Training, Awareness, and Clinical Perspectives of Pediatric Dentists on Headache and Migraine Management: A National Survey Study

by Samantha Glover, Linda Sangalli and Caroline M. Sawicki

Children 2025, 12(8), 968; https://doi.org/10.3390/children12080968 - 23 Jul 2025

Abstract

Background/Objectives: Migraine affects approximately 3–10% of school-aged children and up to 28% of adolescents, with prevalence increasing during adolescence. For pediatric specialty providers, increased awareness of this condition may influence patient care. This study examined pediatric dentists’ education, clinical exposure, and perceived knowledge [...] Read more.

Background/Objectives: Migraine affects approximately 3–10% of school-aged children and up to 28% of adolescents, with prevalence increasing during adolescence. For pediatric specialty providers, increased awareness of this condition may influence patient care. This study examined pediatric dentists’ education, clinical exposure, and perceived knowledge gaps related to pediatric migraine, with the goal of identifying barriers to recognition and referral, as well as informing future training to support accurate diagnosis and interdisciplinary care. Methods: A 28-item electronic questionnaire was distributed to all members of the American Academy of Pediatric Dentistry, including pediatric dentists and postgraduate pediatric dental residents, assessing knowledge, beliefs, clinical experience, and interest in further training regarding pediatric headache/migraine management. Respondents with and without previous training were compared in terms of general understanding using t-tests; a linear regression model analyzed predictors of provider awareness regarding links between oral conditions and headache/migraine. Results: Among 315 respondents, the mean self-perceived awareness score was 2.7 ± 1.3 (on a 0–5 scale). The most frequently identified contributing factors were clenching (73.7%), bruxism (72.4%), and temporomandibular disorders (65.7%). Nearly all respondents (95.2%) reported no formal education on headache/migraine prevention, yet 78.1% agreed on the importance of understanding the relationship between oral health and headache/migraine. Respondents with prior training were significantly more aware (p < 0.001) than those without prior training. Educating families (p < 0.001), frequency of patient encounters with headache (p = 0.032), coordination with healthcare providers (p = 0.002), and access to appropriate management resources (p < 0.001) were significant predictors of providers’ awareness. Conclusions: Pediatric dental providers expressed strong interest in enhancing their knowledge of headache/migraine management, highlighting the value of integrating headache/migraine-related education into training programs and promoting greater interdisciplinary collaboration. Full article

(This article belongs to the Special Issue Pediatric Headaches: Diagnostic and Therapeutic Issues)

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13 pages, 583 KiB

Open AccessReview

Chronic Disease in Pediatric Population—A Narrative Review of Psychosocial Dimensions and Strategies for Management

by Francesca Mastorci, Maria Francesca Lodovica Lazzeri, Lamia Ait-Ali, Pierluigi Festa and Alessandro Pingitore

Children 2025, 12(8), 967; https://doi.org/10.3390/children12080967 - 23 Jul 2025

Abstract

Children living with chronic diseases represent a great challenge for the health care system, their families, and communities. These young patients face continuous medical needs that affect not only their health but also their daily routines, emotional well-being, and family dynamics. In response, [...] Read more.

Children living with chronic diseases represent a great challenge for the health care system, their families, and communities. These young patients face continuous medical needs that affect not only their health but also their daily routines, emotional well-being, and family dynamics. In response, clinical practice is increasingly integrating psychosocial indicators alongside traditional medical parameters. Consequently, there is a growing consensus that the evaluation of pediatric chronic diseases should address not only clinical dimensions but also the disease’s impact on socialization, emotional health, and daily functioning. This narrative review explores the role of psychosocial variables in the management of pediatric chronic illnesses, including the experiences of parents and siblings, with a focus on effective strategies to improve everyday life. The integration of quality of life and well-being within a multidimensional care model could be instrumental in both symptom management and psychosocial support. Recognizing that children with chronic conditions are at increased risk for long-term adverse outcomes, it is critical to develop interventions that go beyond clinical care, encompassing education, coping reinforcement, and family-centered approaches. Full article

(This article belongs to the Section Pediatric Mental Health)

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13 pages, 896 KiB

Open AccessArticle

Impact of Delivery Method on Initiation and Continuation of Breastfeeding: A Prospective Cohort Study

by İlke Özer Aslan, Mustafa Törehan Aslan, Nebibe Can, Özlem Sevinç Ergül and Nihal Çallıoğlu

Children 2025, 12(8), 966; https://doi.org/10.3390/children12080966 - 23 Jul 2025

Abstract

Background/Objectives: Cesarean delivery often leads to delayed breastfeeding initiation, potentially affecting infant health compared with vaginal delivery. This prospective observational study (conducted between August 2022 and January 2024) comparatively evaluates the impact of delivery method—vaginal, planned cesarean, and emergency cesarean—on breastfeeding initiation [...] Read more.

Background/Objectives: Cesarean delivery often leads to delayed breastfeeding initiation, potentially affecting infant health compared with vaginal delivery. This prospective observational study (conducted between August 2022 and January 2024) comparatively evaluates the impact of delivery method—vaginal, planned cesarean, and emergency cesarean—on breastfeeding initiation and continuation and examines the maternal factors influencing these outcomes. Materials and Methods: We enrolled 338 mother–infant pairs at a tertiary university hospital. Breastfeeding effectiveness was assessed using the Bristol Breastfeeding Assessment Tool (BBAT) at birth and at one, three, and six months postpartum. Rates of breastfeeding continuation and formula supplementation were documented through structured interviews. Results: The mothers who delivered vaginally had a significantly higher rate of breastfeeding within one hour after birth (85.5%) compared with planned (57.9%) and emergency cesarean sections (64.9%) (p < 0.001). Baseline BBAT scores were higher for vaginal births but converged across the groups by one month postpartum (p > 0.05). At six months, breastfeeding continuation rates remained high (94.4–95.2%) irrespective of delivery method. Conclusions: Delivery method exerts a transient effect on breastfeeding initiation. With lactation support, the mothers delivering by cesarean section achieved comparable breastfeeding outcomes within the first month postpartum. These findings reinforce the importance of Baby-Friendly Hospital Initiative (BFHI) practices, including immediate skin-to-skin contact, effective pain management, and lactation counseling, in ensuring equitable breastfeeding outcomes. Full article

(This article belongs to the Section Pediatric Neonatology)

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14 pages, 1030 KiB

Open AccessArticle

Lumen-Apposing Metal Stents for Endoscopic Transgastric Drainage of Pancreatic Fluid Collections in Children—A Case Report and Review of Safety and Efficacy

by Irene Wen Hui Tu, Zong Jie Koh, Khek-Yu Ho, Sivaramakrishnan Venkatesh Karthik and Vidyadhar Padmakar Mali

Children 2025, 12(8), 965; https://doi.org/10.3390/children12080965 - 23 Jul 2025

Abstract

Background/Objectives: Pancreatic fluid collections (PFCs) in acute pancreatitis require drainage when symptomatic or infected. Walled-off necrosis (WON) is difficult to drain with plastic stents alone. A lumen-apposing metal stent (LAMS) offers larger calibre drainage, lower migration risk than conventional methods, and the option [...] Read more.

Background/Objectives: Pancreatic fluid collections (PFCs) in acute pancreatitis require drainage when symptomatic or infected. Walled-off necrosis (WON) is difficult to drain with plastic stents alone. A lumen-apposing metal stent (LAMS) offers larger calibre drainage, lower migration risk than conventional methods, and the option of direct endoscopic necrosectomy through the stent. However, the paediatric literature on LAMSs is sparse. We report our institutional experience, and summarise current evidence on the feasibility, efficacy and safety of LAMSs for PFC drainage in children. Methods: We performed a retrospective study at the National University Hospital (NUH) and a full review of the literature on LAMS use in children for endoscopic trans-gastric drainage of PFCs from April 2012 to September 2024. Results: There were, respectively, 2 (males, 10 and 17 years) and 18 children who underwent endoscopic trans-gastric LAMS insertion for drainage of PFCs in acute pancreatitis in the NUH and across the nine included studies, which were published between 2015 and 2024. The technical and clinical success was 100%. There were no complications during insertion or indwell time (28 and 50 days in the NUH and 40 days, range of 7–100 days in the systematic review, respectively). Endoscopic removal of LAMSs was uneventful. There were no recurrent PFCs over a 4-month (1,7 months) and 12-month (range, 2–44 months) follow-up, respectively. Migration of LAMSs to colon following the collapse of the WON was reported in one case. Conclusions: An transgastric LAMS (with trans-stent necrosectomy) is a technically feasible method of drainage of WON following acute pancreatitis in children with minimal complications. Full article

(This article belongs to the Section Pediatric Surgery)

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13 pages, 694 KiB

Open AccessArticle

Lifestyle and SSRI Interventions in Pediatric Cyclic Vomiting Syndrome: Rethinking First-Line Management

by Cansu Altuntaş, Doğa Sevinçok, Merve Hilal Dolu and Ece Gültekin

Children 2025, 12(8), 964; https://doi.org/10.3390/children12080964 - 23 Jul 2025

Abstract

Background: Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder characterized by recurrent episodes of intense nausea and vomiting. Despite increasing awareness, a standardized treatment approach remains lacking in pediatric populations. Lifestyle factors and anxiety are common triggers, yet their systematic management [...] Read more.

Background: Cyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder characterized by recurrent episodes of intense nausea and vomiting. Despite increasing awareness, a standardized treatment approach remains lacking in pediatric populations. Lifestyle factors and anxiety are common triggers, yet their systematic management has not been fully incorporated into therapeutic strategies. Objective: To evaluate the effectiveness of lifestyle modifications and selective serotonin reuptake inhibitors (SSRIs) in the management of pediatric CVS and to compare their outcomes with standard cyproheptadine prophylaxis. Methods: This retrospective study included 119 patients aged 1.2–17.5 years who were diagnosed with CVS according to Rome IV criteria between September 2021 and January 2025. Clinical, psychiatric, and lifestyle data were retrieved from the university’s digital medical records. Patients were grouped according to treatment modality: cyproheptadine, SSRI, or acute attack management alone. Treatment success at 12 weeks was defined as complete cessation of vomiting episodes or absence of hospitalization, prolonged attacks, and school/work absenteeism. Results: Anxiety symptoms were present in 78.2% of patients. SSRIs were prescribed to 34 patients with moderate to severe anxiety, all of whom achieved treatment success. Lifestyle adherence was observed in 73.9% and was found to be a predictor of treatment success. Cyproheptadine was administered to 66 patients but did not provide additional benefit over effective lifestyle modification. Six patients discontinued cyproheptadine due to drowsiness or weight gain. Conclusions: Lifestyle interventions significantly improve outcomes in pediatric CVS. SSRIs represent a safe and effective prophylactic option for patients with comorbid anxiety or poor adherence to behavioral recommendations. These findings support the integration of psychosocial and lifestyle-based strategies into standard CVS treatment protocols. Full article

(This article belongs to the Section Pediatric Mental Health)

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12 pages, 603 KiB

Open AccessArticle

Pediatric-Onset Multiple Sclerosis and Primary Headache: Is There a Link?

by Giuseppe Tiralongo, Gabriele Monte, Michela A. N. Ferilli, Fabiana Ursitti, Giorgia Sforza, Claudia Ruscitto, Giuseppe Mazzeo, Alessandro Borrelli, Massimiliano Valeriani and Laura Papetti

Children 2025, 12(8), 963; https://doi.org/10.3390/children12080963 - 22 Jul 2025

Abstract

Background: Pediatric-onset multiple sclerosis (POMS) is a rare but often more aggressive form of multiple sclerosis, associated with early cognitive impairment and significant impact on quality of life. Multiple sclerosis and primary headaches, particularly migraine, are well established in adults, but data on [...] Read more.

Background: Pediatric-onset multiple sclerosis (POMS) is a rare but often more aggressive form of multiple sclerosis, associated with early cognitive impairment and significant impact on quality of life. Multiple sclerosis and primary headaches, particularly migraine, are well established in adults, but data on pediatric populations remain limited. Methods: The purpose of this retrospective study was to examine 64 POMS patients, divided into groups with and without headaches, to determine potential correlations between headache presence, age at POMS onset, and MRI lesion burden. Results: Headaches were reported by 78% of patients, predominantly migraines (68%), with a significantly higher prevalence in females (74%). No significant differences were found in age at MS onset or lesion load on brain MRI between patients with and without headaches. Among those with headaches, migraines represented a higher frequency of attacks and a greater need for prophylactic treatment compared to other headache types. Headache characteristics, including pain location and associated symptoms, showed no correlation with age at MS onset or lesion burden. Conclusions: These findings indicate that while headaches are common in POMS and more frequent in females, their presence and features do not appear to directly influence the clinical or neuroradiological course of the disease. Further research with larger cohorts and longitudinal follow-up is warranted to better understand the underlying mechanisms and long-term impact of headaches in pediatric MS. Full article

(This article belongs to the Special Issue Management of Chronic Pain in Adolescents and Children: 2nd Edition)

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17 pages, 477 KiB

Open AccessArticle

COVID-19 Stress and Family Well-Being: The Role of Sleep in Mental Health Outcomes for Parents and Children

by Alzena Ilie, Andy J. Kim, Danika DesRoches, Elizabeth Keys, Simon B. Sherry, Sherry H. Stewart, S. Hélène Deacon and Penny V. Corkum

Children 2025, 12(8), 962; https://doi.org/10.3390/children12080962 - 22 Jul 2025

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Abstract

Background/Objectives: The COVID-19 pandemic introduced various stressors for families, including changes to daily routines, work, and schooling. Studies have linked these stressors to increased mental health challenges for parents and children. Sleep difficulties were also common during the pandemic, with some children and [...] Read more.

Background/Objectives: The COVID-19 pandemic introduced various stressors for families, including changes to daily routines, work, and schooling. Studies have linked these stressors to increased mental health challenges for parents and children. Sleep difficulties were also common during the pandemic, with some children and parents experiencing poorer sleep quality and shorter sleep duration. However, it remains unclear whether the effects of COVID-19 stress on mental health challenges are explained, at least in part, by effects of COVID-19 stress on child and/or parent sleep challenges. This study examined the impacts of COVID-19 stress on sleep and, in turn, mental health difficulties in school-aged children and their parents in Canada and the United States. Methods: Parents (N = 961) completed validated measures of COVID-19 stress, and of their own and their child’s sleep and mental health. Path analyses tested direct and indirect effects of COVID-19 stress on mental health outcomes with sleep problems as the potential mediator. Results: Child sleep problems partially mediated COVID-19 stress effects on both parent (β = 0.33) and child (β = 0.20) mental health difficulties, while parent sleep problems contributed significantly but to a lesser degree (parent mental health: β = 0.07; child mental health: β = 0.03). There also remained significant direct effects of COVID-19 stress on both child and parent mental health difficulties that were not mediated through sleep difficulties. Conclusions: Our findings underscore the interconnected nature of sleep and mental health, demonstrating that stress-related disruptions in sleep (particularly children’s sleep) can exacerbate mental health difficulties for both parents and children during crises like the COVID-19 pandemic. Full article

(This article belongs to the Special Issue Parental Mental Health and Child Development)

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11 pages, 810 KiB

Open AccessArticle

Pediatric Hematology–Oncology Provider Attitudes and Beliefs About the Use of Acupuncture for Their Patients

by Holly L. Spraker-Perlman, Kenneth M. Busby, Amy Ly, Maggi Meyer, Justin N. Baker and Deena R. Levine

Children 2025, 12(8), 961; https://doi.org/10.3390/children12080961 - 22 Jul 2025

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Abstract

Background/Objectives: Children with cancer suffer due to the underlying disease and prescribed cancer-directed therapies, and non-pharmacologic modalities may offer improved symptom control without additional medications. We sought to elicit knowledge, attitudes, and beliefs of Pediatric Hematology Oncology (PHO) providers surrounding the incorporation [...] Read more.

Background/Objectives: Children with cancer suffer due to the underlying disease and prescribed cancer-directed therapies, and non-pharmacologic modalities may offer improved symptom control without additional medications. We sought to elicit knowledge, attitudes, and beliefs of Pediatric Hematology Oncology (PHO) providers surrounding the incorporation of acupuncture for symptom management for their patients. Methods: A cross-sectional survey instrument was created, formatted, and delivered to physicians and advanced practice providers (APPs) at a single US pediatric cancer center. Survey responses were summarized by descriptive statistics. Results: A total of 78 PHO clinicians participated (response rate 29%). Most participants were interested in learning more about acupuncture (n = 42, 56.0%), yet rarely (n = 17, 22.7%) or never (n = 46, 61.3%) recommend acupuncture to patients. Most (n = 51, 73.9%) noted that they would support institutional development of an acupuncture program. Over half (n = 37, 52.2%) indicated their threshold for minimum hematologic indices for acupuncture includes a platelet count greater than 20,000 and absolute neutrophil count (ANC) greater than 500 (n = 37, 54.4%). Approximately two-thirds (n = 52, 66.7%) of participants noted that acupuncture could improve their patient’s quality of life, and most (n = 46, 67.6%) were not worried about harm. Conclusions: Acupuncture for symptom management is an evidenced-based, guideline-concordant recommendation for adults with cancer, but robust data in the pediatric oncology population are lacking. PHO providers do not routinely recommend acupuncture for patients but note that it may improve quality of life. Given their high symptom burden, rigorous studies of non-pharmacologic strategies for pediatric symptom management are vital. Acupuncture should be examined as a potential beneficial adjunct. Full article

(This article belongs to the Special Issue Integrative Medicine Approaches in Children and Adolescents with Cancer)

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11 pages, 219 KiB

Open AccessArticle

Evaluation of the Dental Caries Status of New Pediatric Patients in Tertiary Dental Institutions in 2013, 2018, and 2023

by Eimi Tabata, Ami Kaneki, Masashi Ogawa, Taku Nishimura, Yuya Ito, Shunya Ikeda, Yasuko Tsuge, Shuma Hamaguchi, Tatsuya Akitomo and Ryota Nomura

Children 2025, 12(8), 960; https://doi.org/10.3390/children12080960 - 22 Jul 2025

Viewed by 79

Abstract

Background: Although the prevalence of dental caries in children has been decreasing in recent years, many patients still visit tertiary dental institutions with dental caries as their chief complaint. In addition, the COVID-19 pandemic that occurred around the world in 2020 may have [...] Read more.

Background: Although the prevalence of dental caries in children has been decreasing in recent years, many patients still visit tertiary dental institutions with dental caries as their chief complaint. In addition, the COVID-19 pandemic that occurred around the world in 2020 may have affected the lifestyle and oral condition of children. Methods: We investigated the oral condition of new patients whose chief complaint was dental caries, and compared the results for 3 fiscal years: 2013, 2018, and 2023. The caries status was evaluated using the dmft/DMFT index. Results: The number of subjects was 129 in 2013, 163 in 2018, and 127 in 2023. The number of preschoolers in 2023 was lower than in the other years, whereas the number of elementary school students was higher, showing a statistically significant difference (p < 0.05). For the 3 years investigated, there was no change in the incidence of dental caries in primary teeth in elementary school children; however, the incidence in permanent teeth increased over time. Additionally, in the age group, the df and DMF scores were higher in 2023 than in the other years. Conclusions: At this tertiary dental institution, the number of elementary school patients, especially females, increased over the 10-year period, and the amount of dental caries in their permanent teeth also increased. It is important for dental professionals to understand this trend and focus on providing oral hygiene education to this age group. Full article

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

13 pages, 1220 KiB

Open AccessArticle

Investigating Different Clinical Manifestations of Staphylococcus aureus Infections in Childhood—Can D-Dimer and Fibrinogen Predict Deep Tissue Invasion?

by Pınar Önal, Gözde Apaydın Sever, Beste Akdeniz Eren, Gülşen Kes, Ayşe Ayzıt Kılınç Sakallı, Fatih Aygün, Gökhan Aygün, Haluk Çokuğraş and Fatma Deniz Aygün

Children 2025, 12(8), 959; https://doi.org/10.3390/children12080959 - 22 Jul 2025

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Abstract

Background: Staphylococcus aureus is a significant pathogen causing both local and systemic infections in children, with deep tissue involvement leading to severe complications. This study aimed to assess clinical manifestations and identify risk factors for deep tissue involvement in pediatric S. aureus [...] Read more.

Background: Staphylococcus aureus is a significant pathogen causing both local and systemic infections in children, with deep tissue involvement leading to severe complications. This study aimed to assess clinical manifestations and identify risk factors for deep tissue involvement in pediatric S. aureus infections. Methods: All children between 1 month and 18 years who had S. aureus growth in blood, pus, or joint fluid culture were included. Results: A total of 61 patients (median age 55 months) were included, with 22.9% having deep tissue infections. Osteoarticular infections, pyomyositis, and pulmonary involvement were common. Deep-seated infections were significantly associated with community-acquired infections and positive hemocultures after 72 hours (p < 0.01). Laboratory results showed significantly higher levels of C-reactive protein, sedimentation rate, D-dimer, and fibrinogen in the group with deep-seated infections (p = 0.02, p = 0.018, p = 0.01, and p = 0.015, respectively). The decision tree model showed that the first indicator of deep-seated infection was a D-dimer level above 1.15 mg/L, followed by a fibrinogen level above 334 mg/dL. Conclusions: Deep-seated S. aureus infections are more frequently associated with community-acquired cases, persistent hemoculture positivity, and methicillin-susceptible Staphylococcus aureus (MSSA) strains. Additionally, elevated D-dimer and fibrinogen levels may serve as valuable markers for identifying deep-seated infections in pediatric patients. Full article

(This article belongs to the Section Pediatric Infectious Diseases)

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Children, Volume 12, Issue 8 (August 2025) – 19 articles

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