Children

21 pages, 522 KB

Open AccessReview

Scoping Review of the Psychological Effects of Gender-Based Violence on Children

by Maria Rodriguez Rodriguez and Diego Gomez-Baya

Children 2025, 12(9), 1277; https://doi.org/10.3390/children12091277 - 22 Sep 2025

Cited by 1 | Viewed by 4308

The lack of acknowledgment of children as victims of gender-based violence hinders the support they receive. This study aimed to identify the psychological consequences of children’s exposure to gender-based violence and gaps in knowledge. This work used a scoping review approach, based on [...] Read more.

The lack of acknowledgment of children as victims of gender-based violence hinders the support they receive. This study aimed to identify the psychological consequences of children’s exposure to gender-based violence and gaps in knowledge. This work used a scoping review approach, based on the PRISMA quality criteria. The search was conducted in the 14 databases included in the Web of Science platform. A total of 13 open-access articles published in English between 2015 and 2025 that focus on gender-based violence psychological consequences in children met the inclusion criteria. The results of the review indicate that gender violence has significant negative psychological, emotional, and social effects on children exposed to it. Thus, symptoms of internalizing, externalizing, and post-traumatic stress disorder may appear. Additionally, there is a high probability of experiencing difficulties in school, interpersonal relationships, and identity development. These effects may have long-term consequences affecting well-being and development later in life. It is crucial to recognize children as direct and significant victims of gender-based violence and promote their protection through psychological, educational, and social support. Full article

(This article belongs to the Special Issue Child Trauma and Psychology)

► Show Figures

Figure 1

10 pages, 432 KB

Open AccessArticle

Outcome of Infantile Malignant Solid Tumors: A Single-Center Experience

by Burcu Tufan Taş and Nurşah Eker

Children 2025, 12(9), 1276; https://doi.org/10.3390/children12091276 - 22 Sep 2025

Viewed by 1415

Abstract

Background: Malignant solid tumors diagnosed during the first year of life represent a rare but clinically significant subgroup of pediatric cancers. Their biological behavior, treatment responses, and prognosis differ substantially from tumors diagnosed in older children due to developmental immaturity and age-related therapeutic [...] Read more.

Background: Malignant solid tumors diagnosed during the first year of life represent a rare but clinically significant subgroup of pediatric cancers. Their biological behavior, treatment responses, and prognosis differ substantially from tumors diagnosed in older children due to developmental immaturity and age-related therapeutic limitations. Methods: We retrospectively analyzed 88 infants diagnosed with malignant solid tumors before 12 months of age at a single tertiary center between March 2011 and March 2023. Demographic, clinical, pathological, and treatment data were collected. Overall survival (OS) was estimated by Kaplan–Meier analysis, and prognostic factors were evaluated using univariate and multivariate Cox regression models. Results: Of the 98 initially screened patients, 88 were eligible for analysis. The median age at diagnosis was 7 months, with a median follow-up of 42 months. The most common tumor locations were intra-abdominal (64.7%), brain (20.5%), and bone/soft tissue (12.5%). Neuroblastoma was the leading diagnosis (30.7%), with spontaneous regression observed in 29.6% of cases. Atypical teratoid rhabdoid tumor (ATRT) was the most frequent brain tumor (9.1%). The 5-year OS for the entire cohort was 78.3%. Brain tumors were associated with significantly higher mortality (HR 4.32, p = 0.01), while intra-abdominal tumors predicted improved survival (HR 0.31, p = 0.02). Conclusions: Infantile malignant solid tumors display heterogeneous clinical behavior and outcomes. While favorable results can be achieved in neuroblastoma and soft tissue sarcomas, brain tumors, particularly ATRT, remain a therapeutic challenge. Age-specific, risk-adapted treatment strategies and earlier detection are critical to improving survival and reducing long-term sequelae in this vulnerable population. Full article

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

► Show Figures

Figure 1

16 pages, 237 KB

Open AccessArticle

Adapting Pediatric Emergency Services for Children with Autism Spectrum Disorder: A Phenomenological Approach

by Saray Betancort-Avero, María-Ángeles Ferrera-Fernández, Héctor González-de la Torre, Javier Auyanet-Franchy and Claudio-Alberto Rodríguez-Suárez

Children 2025, 12(9), 1275; https://doi.org/10.3390/children12091275 - 22 Sep 2025

Cited by 1 | Viewed by 2969

Abstract

Background/Objectives: Children with Autism Spectrum Disorder (ASD) who attend pediatric emergency services face challenges related to their sensory, cognitive, and behavioral characteristics. This study explored the perceptions of healthcare professionals and parents regarding the need to implement adaptations, particularly a sensory-adapted room, [...] Read more.

Background/Objectives: Children with Autism Spectrum Disorder (ASD) who attend pediatric emergency services face challenges related to their sensory, cognitive, and behavioral characteristics. This study explored the perceptions of healthcare professionals and parents regarding the need to implement adaptations, particularly a sensory-adapted room, for children with ASD in pediatric emergency departments. Methods: A phenomenological qualitative study was conducted through semi-structured interviews (October–December 2024) until data saturation. Participants included healthcare professionals and parents of children diagnosed with ASD. Intentional coding and co-occurrence analysis were performed using Atlas.ti (version 25.0.1). The study was approved by the Research Ethics Committee (code: 204-458-1). Results: Eighteen informants participated (10 professionals and 8 parents). Professionals’ interviews revealed three themes and eight subthemes: Professional Training (approach strategies; training received; perceived needs), Hospital Environment (resource allocation; infrastructure; perceived needs during the emergency visit), and Emotional Aspects (emotional experience related to patient care; professionals’ personal perceptions). Parents’ interviews yielded four themes and ten subthemes: Professional Training (perceptions of staff training; demonstrated emotional competencies; socioemotional relationships during care), Hospital Environment (infrastructure; perceived needs during emergency visits), Emotional Aspects (families’ experiences; emotions during care), and ASD (diagnostic characteristics; children’s needs; sensory regulation). Conclusions: Pediatric emergency services should be adapted to better meet the needs of children with ASD. Both healthcare professionals and parents recognize the importance of such adaptations, particularly sensory-adapted spaces. The main barriers identified were a lack of professional training, inadequate hospital environments, and stress affecting both patients and provider. Priority measures include continuous ASD-specific training programs, improvements in sensory infrastructure, and more flexible clinical protocols, advancing toward a more inclusive and comprehensive model of care. Full article

(This article belongs to the Section Pediatric Neurology & Neurodevelopmental Disorders)

14 pages, 238 KB

Open AccessArticle

Investigating Pediatricians’ Practice, Knowledge, and Barriers in Diagnosing Cerebral Palsy

by Vivian Wong, Stacey D. Miller, Olivia Scoten, Mor Cohen-Eilig, Stephanie Glegg, Angie Ip, Chetna Jetha, Kishore Mulpuri, Maureen O’Donnell and Ram Mishaal

Children 2025, 12(9), 1274; https://doi.org/10.3390/children12091274 - 22 Sep 2025

Cited by 2 | Viewed by 1140

Abstract

Background/Objectives: Data from the Canadian Cerebral Palsy (CP) Registry suggests that children in British Columbia (BC) are diagnosed, on average, at 25 months of age. This is much later than currently recommended. This study aimed to examine current practices and beliefs of pediatricians [...] Read more.

Background/Objectives: Data from the Canadian Cerebral Palsy (CP) Registry suggests that children in British Columbia (BC) are diagnosed, on average, at 25 months of age. This is much later than currently recommended. This study aimed to examine current practices and beliefs of pediatricians in the province related to CP and CP diagnosis. Methods: All pediatricians and subspecialty pediatricians in the province were invited to participate in two consecutive online surveys. The initial survey aimed to assess current practice, knowledge of CP, and beliefs about diagnosis. The second survey, which was distributed to the same group of pediatricians, as well as pediatric neurologists and geneticists, aimed to re-assess current practice and identify specific barriers and facilitators to CP diagnosis. Results: The two surveys were completed by 76 and 59 respondents, respectively. Less than 60% of general pediatricians, in both surveys, reported diagnosing children with CP. In survey 2, only 50% of respondents felt that pediatricians should provide a diagnosis of CP. Most general pediatricians (93%) identified that pediatricians, with support from a developmental pediatrician or neurologist, should provide a diagnosis. Common barriers to an early CP diagnosis included uncertainty about other potential diagnoses and uncertainty over diagnosing at a young age. Lack of access to education and therapists to help inform the diagnosis were also frequently identified barriers. Conclusions: While general pediatricians are knowledgeable about CP, a significant proportion in those surveyed were not diagnosing CP, despite believing that early diagnosis is important. Findings from these surveys have identified that general pediatricians have gaps in knowledge, skills, and confidence in diagnosing CP. Support from a developmental pediatrician or neurology colleague was identified as a potential strategy to support earlier diagnosis. Full article

(This article belongs to the Section Pediatric Neurology & Neurodevelopmental Disorders)

16 pages, 1008 KB

Open AccessArticle

Mother–Preterm Infant Contingent Interactions During Supported Infant-Directed Singing in the NICU—A Feasibility Study

by Shulamit Epstein, Shmuel Arnon, Gabriela Markova, Trinh Nguyen, Stefanie Hoehl, Liat Eitan, Sofia Bauer-Rusek, Dana Yakobson and Christian Gold

Children 2025, 12(9), 1273; https://doi.org/10.3390/children12091273 - 22 Sep 2025

Cited by 1 | Viewed by 1465

Abstract

Background: Supported infant-directed singing (IDS) for parents and their preterm infants has proven beneficial for parents and preterm infants’ health and relationship building. Studying parent–infant contingent interactions through behavioral observations is an established method for assessing the quality of interactions. Very few studies [...] Read more.

Background: Supported infant-directed singing (IDS) for parents and their preterm infants has proven beneficial for parents and preterm infants’ health and relationship building. Studying parent–infant contingent interactions through behavioral observations is an established method for assessing the quality of interactions. Very few studies have measured contingency between parent and preterm infants in the neonatal period during supported IDS. Methods: We conducted a feasibility study to assess the possibility of analyzing parent–very preterm infant dyads’ contingency during supported IDS in the NICU. We recruited four mother–infant dyads and video-recorded a single music therapy (MT) session before their discharge from the hospital. Two independent researchers coded three selected segments (beginning, middle, and end) from each video, according to adapted behavioral scales with inter-rater agreement analysis. Contingency between infant and maternal behaviors was analyzed. Results: Twelve video segments were coded. High inter-rater agreements (Cohen’s kappa) were found for infant eye-opening (0.93), hand positions (0.79), and head orientation (0.94), as well as maternal head orientation (0.95) and vocalizations (0.95). During supported IDS, increased infant head orientation toward the mother, eyes closed, as well as maternal head orientation toward the infant (all p < 0.001), were recorded compared to no IDS. Direction of the maternal head toward her infant was contingent on the infant’s closed eyes, extended hands, and head not toward mother. Conclusions: This feasibility study demonstrates contingency between mothers and their preterm infants’ specific behaviors during IDS. These interactions can be analyzed through video segments with high inter-rater agreement. The method described might help in evaluating other modalities that might be related to contingency. Recent advances in AI can make this tool easier to accomplish, with further studies to evaluate the importance of contingency for child development. The findings suggest that supported IDS influences infant attention and regulation. Full article

(This article belongs to the Section Pediatric Neonatology)

► Show Figures

Figure 1

18 pages, 563 KB

Open AccessArticle

A Longitudinal Transdisciplinary Approach for Autism Spectrum Disorder

by Aline Kabarite, Glória Maria Marques Ferreira, José Carlos Pitangueira, Rayana de Souza Arimatéa, Renata da Costa Rebello de Mendonça, Roberta Sousa Marcello, Thais Giudice Schulz, Rudimar dos Santos Riesgo and Kamila Castro

Children 2025, 12(9), 1272; https://doi.org/10.3390/children12091272 - 22 Sep 2025

Cited by 4 | Viewed by 4263

Abstract

Background/Objectives: Autism Spectrum Disorder (ASD) presents complex developmental challenges that require coordinated, individualized interventions. This study aimed to evaluate the effectiveness of a transdisciplinary, family-centered approach in improving clinical and functional outcomes in children and adolescents with ASD. Methods: A longitudinal [...] Read more.

Background/Objectives: Autism Spectrum Disorder (ASD) presents complex developmental challenges that require coordinated, individualized interventions. This study aimed to evaluate the effectiveness of a transdisciplinary, family-centered approach in improving clinical and functional outcomes in children and adolescents with ASD. Methods: A longitudinal study was conducted with 53 participants aged 2 to 16 years, all with confirmed ASD diagnoses. Assessments were performed at baseline, 6 months, and 12 months. Participants received personalized, evidence-based interventions provided by a multidisciplinary team working within a transdisciplinary model. Therapies were delivered individually and in groups, with flexible intervention phases tailored to each participant’s evolving needs. Outcomes were measured using the Clinical Global Impression (CGI), Global Assessment of Functioning (GAF), and the Aberrant Behavior Checklist (ABC). Results: Clinical and functional improvements were observed over the 12-month period. Most participants reached high functional levels by the end of the study. Caregivers reported notable reductions in support needs, while therapist ratings confirmed more moderate improvements. Decreases in behavioral challenges, sensory difficulties, and sleep disturbances were observed, alongside gains in adaptability and functional play. Greater family involvement was associated with more favorable outcomes. Conclusions: A transdisciplinary, family-centered intervention model was beneficial in supporting developmental progress in children and adolescents with ASD. The findings highlight the importance of flexible, team-based care and emphasize the critical role of family engagement in achieving positive long-term outcomes. Full article

(This article belongs to the Special Issue Children with Autism Spectrum Disorder: Diagnosis and Treatment)

► Show Figures

Figure 1

9 pages, 1486 KB

Open AccessArticle

Disabilities and Handicaps of Patients with Laron Syndrome

by Zvi Laron

Children 2025, 12(9), 1271; https://doi.org/10.3390/children12091271 - 22 Sep 2025

Cited by 1 | Viewed by 2476

Abstract

Background: Laron Syndrome (LS) is a rare hereditary form of dwarfism occurring, with few exceptions, in Jewish, Muslim, and Asian populations or their descendants spread over all continents. It is caused by deletions or mutations in the GH-Receptor gene, resulting in high [...] Read more.

Background: Laron Syndrome (LS) is a rare hereditary form of dwarfism occurring, with few exceptions, in Jewish, Muslim, and Asian populations or their descendants spread over all continents. It is caused by deletions or mutations in the GH-Receptor gene, resulting in high serum levels of a structurally and biologically normal, but inactive GH and low-to-undetectable IGF-I. Aim: To summarize the disabilities and handicaps observed in patients with LS, from infancy through adult age. Results: Diagnosing, treating and following a cohort of 76 patients with LS (in many cases from infancy into adult age) enabled our department to study not only their growth and social achievements, but also the difficulties these patients encounter in life. The longstanding IGF-I deficiency caused somatic and biochemical changes which led to disabilities starting in infancy and becoming more severe with advancing age. The most serious symptoms LS patients have are dwarfism, progressive obesity, diabetes, fatty liver, cardiovascular disease, and neurological and orthopedic problems, leading to difficulties in vocational training, occupation, and social life, all lowering the Quality of Life (QoL) of these patients. Conclusions: Early initiation of IGF-I replacement treatment in patients with Laron Syndrome prevents and reverses some of the symptoms associated with longstanding IGF-I deficiency. Full article

(This article belongs to the Section Pediatric Endocrinology & Diabetes)

► Show Figures

Figure 1

31 pages, 665 KB

Open AccessReview

The Epidemiology of Nontuberculous Mycobacteria in Cystic Fibrosis

by Aikaterini Sotiropoulou, Ioanna Loukou, Christiana Vliora, Konstantinos Douros and Maria Moustaki

Children 2025, 12(9), 1270; https://doi.org/10.3390/children12091270 - 22 Sep 2025

Cited by 2 | Viewed by 2147

Abstract

Background: Nontuberculous mycobacteria (NTM) are opportunistic pathogens responsible for chronic pulmonary infections, primarily affecting individuals with underlying conditions such as cystic fibrosis (CF). The aim of this review is to present the epidemiological profile of NTM in CF patients, with a focus on [...] Read more.

Background: Nontuberculous mycobacteria (NTM) are opportunistic pathogens responsible for chronic pulmonary infections, primarily affecting individuals with underlying conditions such as cystic fibrosis (CF). The aim of this review is to present the epidemiological profile of NTM in CF patients, with a focus on incidence, prevalence, predominant species, and geographic distribution. Methods: The search included cross-sectional, retrospective, and prospective observational studies published in English that reported epidemiological data concerning the isolation and/or infection of individuals with CF by NTM. NTM infection was defined as the isolation of any NTM species at least once per patient. Out of an initial 1120 references identified in PubMed, and following the application of exclusion criteria based on PRISMA guidelines, a total of 78 studies were included. Results: The reported prevalence of NTM in CF patients ranges globally from 0% to 40.9%. This wide variability is attributed to population heterogeneity, study period, and geographical region. Of the studies included, 30 were conducted in Europe and 25 in the U.S.A. Mycobacterium abscessus and the Mycobacterium avium complex (MAC) were the most commonly isolated species, with MAC being more prevalent in older individuals. The incidence of NTM pulmonary disease was high, with the majority of cases being associated with M. abscessus. Although emerging evidence suggests that CFTR modulator therapy may reduce the risk of NTM isolation and/or disease, current data remain limited. Conclusions: Nontuberculous mycobacteria are significant pathogens in patients with cystic fibrosis, with a negative impact on respiratory health. Full article

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

► Show Figures

Figure 1

9 pages, 3600 KB

Open AccessCase Report

Surgical Technique for Revision of the Distally Migrated Fassier–Duval Femoral Rod in Osteogenesis Imperfecta: A Case Report

by Peter Staunton, Pasin Tangadulrat and Reggie Charles Hamdy

Children 2025, 12(9), 1269; https://doi.org/10.3390/children12091269 - 21 Sep 2025

Viewed by 1853

Abstract

Background/Objectives: Managing long bone fractures and deformities in osteogenesis imperfecta (OI) with telescoping rods is a common but challenging procedure. A rare complication is the distal migration of the rod’s proximal female component, which complicates standard revision surgery. This article aims to [...] Read more.

Background/Objectives: Managing long bone fractures and deformities in osteogenesis imperfecta (OI) with telescoping rods is a common but challenging procedure. A rare complication is the distal migration of the rod’s proximal female component, which complicates standard revision surgery. This article aims to describe a surgical technique for the revision of a distally migrated Fassier–Duval (FD) femoral rod. Methods: We present the case of an 8-year-old girl with OI type IV who experienced distal migration of her right femoral FD rod—the surgical technique involved extracting the rod retrogradely through the fracture/osteotomy site. We used a trephine to remove surrounding bone within the canal, thereby preserving the critical bone stock in the greater trochanter needed for secure fixation of the revision implant. Results: The distally migrated female component was successfully removed through the trephined canal with a combination of axial traction and rotational force. The proximal bone stock was preserved, allowing for the stable placement of a revision FD rod. Conclusions: The retrograde trephine technique is a viable and effective strategy for revising a distally migrated telescoping rod in patients with OI. This approach prioritizes the preservation of proximal bone stock, which is crucial for the stability and longevity of the revision implant. Full article

(This article belongs to the Special Issue Diagnosis and Management of Injuries, Fractures, and Complications in Children)

► Show Figures

Figure 1

9 pages, 2008 KB

Open AccessCase Report

Efficacy of Modified Upadacitinib Dosing in Pediatric Refractory IBD: A Case-Based Analysis

by Frank Risto Rommel, Christa Bergheim, Inga Jerrentrup, Stefanie Weber and Andreas Jenke

Children 2025, 12(9), 1268; https://doi.org/10.3390/children12091268 - 21 Sep 2025

Viewed by 2077

Abstract

This case report describes four pediatric patients with severe, therapy-refractory ulcerative colitis (UC) and one pediatric patient with severe, therapy-refractory Crohn’s disease (CD), all of whom failed widely used biologic therapies, including the approved treatments infliximab and adalimumab, as well as off-label use [...] Read more.

This case report describes four pediatric patients with severe, therapy-refractory ulcerative colitis (UC) and one pediatric patient with severe, therapy-refractory Crohn’s disease (CD), all of whom failed widely used biologic therapies, including the approved treatments infliximab and adalimumab, as well as off-label use of vedolizumab and ustekinumab. Despite these first- and second-line interventions, patients’ diseases remained active. Following the initiation of upadacitinib, an off-label Janus kinase (JAK) inhibitor with positive results in adult UC and CD patients, four children experienced rapid symptom improvement and achieved clinical remission. The rising incidence of pediatric inflammatory bowel disease (IBD) and the limited number of approved therapies underscore the need for additional treatment options in pediatric gastroenterology. Infliximab remains one of the only biologic therapies approved for pediatric UC and CD, forcing clinicians to rely on off-label medications, such as vedolizumab, ustekinumab, and upadacitinib, when standard treatments fail. To address this gap, it is crucial to include pediatric patients in clinical trials of new therapies, expanding the range of approved medications and improving outcomes for children with IBD. Full article

(This article belongs to the Special Issue Advances in Pediatric Gastroenterology (2nd Edition))

► Show Figures

Figure 1

20 pages, 477 KB

Open AccessArticle

Parents’ Perceptions of What Health Means for Adolescents with Depression—A Qualitative Study

by Stina Persson, Emma Haglund, Rebecca Mortazavi, Håkan Jarbin and Ingrid Larsson

Children 2025, 12(9), 1267; https://doi.org/10.3390/children12091267 - 21 Sep 2025

Viewed by 1923

Abstract

Background: Adolescent depression is a growing public health concern. Health promotion for this group requires an understanding of what health means in the context of depression. Given that parents play a central role in adolescents’ everyday lives, their perspectives on health for adolescents [...] Read more.

Background: Adolescent depression is a growing public health concern. Health promotion for this group requires an understanding of what health means in the context of depression. Given that parents play a central role in adolescents’ everyday lives, their perspectives on health for adolescents are important. The aim of this study was to describe parents’ perceptions of what health means for adolescents with depression. Methods: This qualitative study employed a phenomenographic approach. In-depth interviews were conducted with 28 parents of adolescents with depression. The analysis resulted in four categories, each comprising two sub-categories, reflecting variations in how health was perceived. Results: Parents described health for adolescents with depression in terms of taking initiative in everyday life and creating a daily structure through routines (navigating daily life with depression); experiencing belonging in supportive relationships and understanding one’s own value (building trust in self and others); having a positive outlook while facing struggles and finding pleasure in daily activities (experiencing joy despite depression); and balancing body and mind and maintaining healthy habits (supporting well-being despite depression). Conclusions: The findings provide new insights into how parents understand health for adolescents with depression. These perceptions may inform the development of supportive and health-promoting strategies tailored to adolescents’ and their families’ everyday challenges. Full article

(This article belongs to the Section Pediatric Mental Health)

► Show Figures

Figure 1

14 pages, 552 KB

Open AccessArticle

Oro-Dental Characteristics Associated with Pediatric Dental Neglect: A Retrospective Study

by Anamaria Violeta Țuțuianu, Abel Emanuel Moca, Teodora Ștefănescu, Dan Alexandru Slăvescu, Lucian Roman Șipoș, Horia Câlniceanu and Anca Ionel

Children 2025, 12(9), 1266; https://doi.org/10.3390/children12091266 - 21 Sep 2025

Cited by 1 | Viewed by 1666

Abstract

Background/Objectives: Dental neglect represents a preventable form of child maltreatment that may lead to significant oral and systemic health complications. This study primarily aimed to investigate the main oral manifestations and determinants of dental neglect in a pediatric population from Bihor County, Romania. [...] Read more.

Background/Objectives: Dental neglect represents a preventable form of child maltreatment that may lead to significant oral and systemic health complications. This study primarily aimed to investigate the main oral manifestations and determinants of dental neglect in a pediatric population from Bihor County, Romania. Additionally, it assessed the association between systemic factors, such as nutritional status and psychological conditions, and the severity of oro-dental lesions, with the goal of informing future preventive strategies and public health interventions. Methods: A retrospective analysis was conducted on 333 pediatric patients diagnosed with dental neglect. Clinical data were collected from two centers between 2020 and 2024. Oral health status, socio-demographic characteristics, and psychological conditions were evaluated. Statistical analyses included Fisher’s Exact Test, Mann–Whitney U Test, and Bonferroni-adjusted Z-tests, with significance set at p ≤ 0.05. Results: Among the 333 participants, 52.9% were male, with a mean age of 8.75 ± 3.29 years. Most children (81.7%) resided in rural areas, and 55.6% were first-born. Carious lesions were identified in 100% of cases, with 54.7% showing complications such as endodontic pathology. Poor oral hygiene was reported in 99.1% of children, while 58.6% presented signs of periodontal disease and 37.2% reported spontaneous gingival bleeding. Acute pain was experienced by 40.2% of participants. Nutritional issues were prevalent, with 24.3% classified as obese and 21.6% as malnourished. Significant associations were found between lesion severity and both psychological disorders (p < 0.001) and malnutrition (p < 0.001). Conclusions: This study identifies untreated carious lesions, poor oral hygiene, acute dental pain, and oro-dental trauma as key clinical indicators of pediatric dental neglect, with rural residency and limited education as significant socio-demographic risk factors. The findings highlight the urgent need for integrated, community-based strategies, including school-based screenings, parental education, and referral pathways, to improve early detection and prevention in Romania. Full article

(This article belongs to the Special Issue Dental Status and Oral Health in Children and Adolescents)

► Show Figures

Figure 1

15 pages, 569 KB

Open AccessArticle

Early Predictors of School Absenteeism in First-Grade Children: A Multidimensional Longitudinal Study in Japan

by Yuki Soma, Yu Ogasawara and Hiromi Kobayashi

Children 2025, 12(9), 1265; https://doi.org/10.3390/children12091265 - 20 Sep 2025

Cited by 1 | Viewed by 2853

Abstract

Background: Continuous schooling and healthy learning are essential during childhood. Therefore, we investigated the risk factors of absenteeism in supporting at-risk students. The aim of this study examined the longitudinal relationships between absenteeism and body mass index (BMI), lifestyle, physical fitness, academic [...] Read more.

Background: Continuous schooling and healthy learning are essential during childhood. Therefore, we investigated the risk factors of absenteeism in supporting at-risk students. The aim of this study examined the longitudinal relationships between absenteeism and body mass index (BMI), lifestyle, physical fitness, academic performance, and frequency of school health room use during the first grade of elementary school. Methods: A total of 453 first-grade students in elementary school were included in the analysis. These students were enrolled in the target elementary schools between 2014 and 2021. The analysis used data obtained from the students’ schoolwork. We performed a Cox regression analysis to assess the characteristics associated with absenteeism for 10 days or more, excluding absences due to relatives’ funerals and suspension of attendance. The independent variables were BMI, sleep duration, sleep quality, frequency of physical activity, screen time, physical fitness, grade points, and frequency of health room use during the first grade of elementary school. Results: The grade point average (girls: hazard ratio [HR] = 0.013; boys: HR = 0.115) and frequency of use of school health rooms due to illness (girls: HR = 1.252; boys: HR = 1.261) were common among girls and boys in the adjusted model. Additionally, three or more days of physical activity per week and six or more days of sound sleep were additional predictors for girls. Conclusions: Our results suggest that careful monitoring of children with minimal physical activity, poor sleep quality, low grade point average, and frequent school health room usage in the first grade of elementary school and providing them with support in dealing with school difficulties may reduce absenteeism. Full article

(This article belongs to the Section Global Pediatric Health)

► Show Figures

Figure 1

15 pages, 251 KB

Open AccessArticle

Associations of Hair Biomarkers with Height, Weight, and Body Mass Index in Preschool Children

by Anjali Gupta, Cynthia R. Rovnaghi and Kanwaljeet J. S. Anand

Children 2025, 12(9), 1264; https://doi.org/10.3390/children12091264 - 20 Sep 2025

Viewed by 1992

Abstract

Background: Adverse childhood experiences (ACEs) can lead to hypothalamic–pituitary–adrenal axis dysregulation, negatively impacting child growth and development. Methods: The Hair Biomarkers Study (HBS-I) evaluated healthy preschool children using parent-reported surveys, anthropometrics, and painlessly obtained scalp hair to measure hair cortisol (HCC; ng/mg) and [...] Read more.

Background: Adverse childhood experiences (ACEs) can lead to hypothalamic–pituitary–adrenal axis dysregulation, negatively impacting child growth and development. Methods: The Hair Biomarkers Study (HBS-I) evaluated healthy preschool children using parent-reported surveys, anthropometrics, and painlessly obtained scalp hair to measure hair cortisol (HCC; ng/mg) and oxytocin concentrations (HOC; ng/mg) via ELISA; log-transformed data were used in analyses. Height, weight, and BMI percentiles were based on CDC growth curves. Linear regressions examined associations of child and maternal hair biomarkers with percentiles, adjusting for sociodemographic factors. Results: The median age was 39.1 months (IQR 23.5–53.0, N = 1189). Higher child Ln-HCC was associated with an increased BMI percentile (0.027; 95%Cl: 0.013, 0.040), while higher child Ln-HOC was associated with a decreased BMI (−0.016; 95%Cl: −0.028, −0.005). Similar significant associations were observed between maternal biomarkers and child growth. In models mutually adjusted for mother and child hair biomarkers, maternal Ln-HCC was associated with an increased BMI percentile (0.036; 95%Cl: 0.003, 0.069), while maternal Ln-HOC was associated with a decreased BMI percentile (−0.034; 95%Cl: −0.052, −0.016). Maternal ACEs of 2–3 vs. 0–1 were associated with increased child weight (0.057; 95%Cl: 0.003, 0.112) and BMI percentiles (0.076; 95%Cl: 0.017, 0.135). Conclusions: We show that higher maternal and child HCC was associated with increased child BMI percentiles, while higher HOC was linked with decreased BMI percentiles. Hair biomarkers may reflect the effects of nurturing vs. adverse experiences during critical windows of growth and development in early childhood. Full article

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

24 pages, 777 KB

Open AccessReview

Gestational Diabetes and Obesity: Immediate and Late Sequelae for Offspring

by Maria Kaza, George Paltoglou, Kalliopi Rodolaki, Konstantinos Kakleas, Spyridon Karanasios and Kyriaki Karavanaki

Children 2025, 12(9), 1263; https://doi.org/10.3390/children12091263 - 19 Sep 2025

Cited by 4 | Viewed by 4691

Abstract

Background/Objectives: Gestational diabetes mellitus (GDM) and maternal obesity are major global health gestation-related conditions associated with several adverse maternal and neonatal outcomes. GDM is a common gestational metabolic disorder, presented usually during the second or third trimester of pregnancy with maternal hyperglycemia [...] Read more.

Background/Objectives: Gestational diabetes mellitus (GDM) and maternal obesity are major global health gestation-related conditions associated with several adverse maternal and neonatal outcomes. GDM is a common gestational metabolic disorder, presented usually during the second or third trimester of pregnancy with maternal hyperglycemia due to insulin intolerance. Maternal obesity, defined as a BMI of a woman during gestation ≥ 30 kg/m², has been associated with maternal complications such as GDM, fetal macrosomia and others. Methods: The presented article is a narrative review. The aim of this study was to review scientific evidence and conduct a comprehensive analysis of GDM and maternal obesity (“diabesity”) and its immediate and late complications for both maternal and fetal/offspring wellbeing. Results: This review highlighted that gestational hyperglycemia results in oxidative and nitrogen stress development and that maternal obesity may have an impact similar to maternal diabetes, as it may cause fetal macrosomia and cardiometabolic complications later in life. Conclusions: Optimal diabetic control is responsible for the prevention of oxidative stress in diabetic pregnancies. Similarly, pregnant women should exercise regularly, receive folic acid supplementation and avoid excess weight gain during pregnancy. Breastfeeding during the first months of life has a positive impact on weight monitoring in infants born to mothers with diabesity and may be crucial in the prevention of obesity and metabolic syndrome later in life. Full article

(This article belongs to the Section Pediatric Endocrinology & Diabetes)

► Show Figures

Figure 1

16 pages, 1197 KB

Open AccessArticle

Adapted Basketball Training Improves Fitness and Motivation in Adolescents with Moderate Obesity: A Randomized Controlled Trial

by Oumayma Slimi, Mohamed Abdelkader Souissi, Santo Marsigliante, Georgian Badicu, Jolita Vveinhardt and Antonella Muscella

Children 2025, 12(9), 1262; https://doi.org/10.3390/children12091262 - 19 Sep 2025

Cited by 2 | Viewed by 3546

Abstract

Background: Adolescent obesity represents a global public health issue, with an urgent need for tailored intervention strategies, particularly in school settings. Objectives: This study investigated the impact of adapted basketball training—with and without video summaries—on BMI, fitness, motivation, and technical skills in adolescents [...] Read more.

Background: Adolescent obesity represents a global public health issue, with an urgent need for tailored intervention strategies, particularly in school settings. Objectives: This study investigated the impact of adapted basketball training—with and without video summaries—on BMI, fitness, motivation, and technical skills in adolescents with moderate obesity. Methods: Fifty-five participants were randomly assigned to one of three instructional modalities—a modified basketball program enriched with video summaries (ADAPT + VID), a modified program without videos (ADAPT), and a traditional program (CONT)—and completed an eight-week intervention. Before (T0) and after (T1) the intervention, participants in all three groups underwent testing to assess: (i) anthropometric measurements (BMI), (ii) technical accuracy (passing, dribbling, and shooting), (iii) physical fitness using the Intermittent Fitness Test 15-15 (Spartacus Test), and (iv) motivation using the Situational Motivation Scale. Results: Assessments revealed significant improvements in the ADAPT + VID group, with notable reductions in BMI (d = 0.25, p < 0.05), enhanced physical fitness (d = 0.19, p = 0.002), and improved performance in passing (d = 1.42, p < 0.001), dribbling (d = 1.30, p < 0.001), and free-throw shooting (d = 0.80, p < 0.001). Moreover, a significant increase in intrinsic motivation (d = 1.18, p < 0.001) and a reduction in amotivation (d = 1.12, p < 0.001) were observed. Conclusions: These findings suggest that incorporating pedagogical video summaries into an adapted basketball program may effectively improve physical health, motor skills, and motivation among adolescents with moderate obesity. Full article

(This article belongs to the Section Global Pediatric Health)

► Show Figures

Figure 1

12 pages, 313 KB

Open AccessArticle

Spatiotemporal Gait Variables and Step-to-Step Variability in Preschool-Aged Children Born Very Preterm at Risk for Developmental Coordination Disorder: A Cohort Study

by Reem A. Albesher, Jennifer L. McGinley, Fiona L. Dobson, Benjamin F. Mentiplay, Tara L. FitzGerald, Kate L. Cameron, Jeanie L. Y. Cheong and Alicia J. Spittle

Children 2025, 12(9), 1261; https://doi.org/10.3390/children12091261 - 19 Sep 2025

Cited by 2 | Viewed by 1633

Abstract

Background/Objective: The gait pattern of children born very preterm shows gait decrements compared to their full-term peers in dual-task walking. It is essential to identify children at a higher risk for these gait deficits. The aim of this study was to compare spatiotemporal [...] Read more.

Background/Objective: The gait pattern of children born very preterm shows gait decrements compared to their full-term peers in dual-task walking. It is essential to identify children at a higher risk for these gait deficits. The aim of this study was to compare spatiotemporal gait variables in preschool-age children born very preterm at risk for developmental coordination disorder (DCD) with those not at risk. Methods: Preschool-age children born < 30 weeks’ gestation. Risk for DCD was defined as (i) ≤16th percentile on the Movement Assessment Battery for Children—Second Edition, (ii) ≥80 on the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition, and (iii) without cerebral palsy. Spatiotemporal gait variables and variability were assessed using GAITRite^® during preferred speed, cognitive and motor dual-task, and tandem conditions. Variables included speed (cm/s), step time (s), cadence (steps/min), step length (cm), base of support (BOS; cm), and single and double support time (%gait cycle). Results: Of 111 children who were assessed, 26 children were classified as at risk for DCD. Most gait variables were similar between groups at preferred speed walking. Children at risk for DCD had wider BOS and shorter single support time in motor dual-tasking (mean difference [MD] = 0.86 cm, 95% confidence interval [CI] 0.10, 1.61; MD = −1.77%, 95% CI −3.36, −0.19) compared to those not at risk. Similarly, wider BOS and higher cadence were found when tandem walking (MD = 0.63 cm, 95% CI 0.07, 1.20; MD = 0.63 steps/min, 95% CI 0.07, 1.20). Conclusions: Children born very preterm at risk for DCD had poorer walking performance than those not at risk for DCD at preschool age, especially during dual-task situations. Clinicians may incorporate complex gait assessments into early evaluations to detect subtle impairments in children. Future research is needed to investigate the impact of gait variability on children’s daily lives and participation in sports activities. Full article

(This article belongs to the Special Issue Physical Therapy in Pediatric Developmental Disorders)

► Show Figures

Figure 1

23 pages, 1808 KB

Open AccessArticle

Bridging the Gap: The Role of Parent–Teacher Perception in Child Developmental Outcomes

by McKayla Jensen, Mikaela J. Dufur, Jonathan A. Jarvis and Shana L. Pribesh

Children 2025, 12(9), 1260; https://doi.org/10.3390/children12091260 - 19 Sep 2025

Cited by 2 | Viewed by 3178

Abstract

Background/Objectives: Time spent with parents and educators encompasses a large portion of a child’s waking hours, with the home and early childhood education and care serving as two of the first settings in which children develop social and cognitive abilities. While previous studies [...] Read more.

Background/Objectives: Time spent with parents and educators encompasses a large portion of a child’s waking hours, with the home and early childhood education and care serving as two of the first settings in which children develop social and cognitive abilities. While previous studies have used social and cognitive tests to examine antecedents of child behavior, we extend such studies to take into account the congruence and incongruence of parents’ and teachers’ views on those antecedents. We examine the importance of parent-teacher alignment on the perceptions of a child’s personality and abilities in early development. Methods: Parents and teachers of 2968 German Kindergarten-aged (4–5 years old) children were surveyed using the National Educational Panel Study (NEPS). Parents and teachers independently rated 10 child behavioral traits, with higher scores indicating more prosocial behavior. Educators also rated children on five developmental abilities (social abilities, ability to concentrate, language abilities, general knowledgeability, and mathematical reasoning) compared to the student’s peers. While previous work has often examined how parental investments in children or teachers’ views of children might be related to development, we provide a new take by examining parents and teachers in conjunction with each other. Research that has looked at both parents and teachers has tended to examine alignment, or lack thereof, on child behaviors and personality traits. We analyzed child developmental abilities using OLS regression models, measures of parent–teacher divergences in ratings of child behavior, and demographic controls. Results: Greater differences in parent and teacher perceptions of desire for knowledge were negatively associated with all five developmental abilities. Differences in parent and teacher perceptions on talkativeness, confidence, good-naturedness, and understanding were negatively associated with at least one developmental outcome. By contrast, differences in perceptions of children’s neatness were positively associated with all five developmental abilities. Conclusions: Using both parent and teacher perceptions of child behaviors and abilities is a unique approach to understanding the relevance of parent and educator perceptions to a child’s development. Our findings indicate the need for collaboration across young children’s home and school or care settings. Establishing congruence in perceptions and the kinds of relationships that can lead to such congruence can help children with behavioral issues receive support in both home and educational settings and encourage mutual respect and partnership between parents and educators. Full article

(This article belongs to the Section Pediatric Mental Health)

► Show Figures

Figure 1

15 pages, 627 KB

Open AccessArticle

Enhancing the Prediction of Inborn Errors of Immunity: Integrating Jeffrey Modell Foundation Criteria with Clinical Variables Using Machine Learning

by Alaaddin Yorulmaz, Ali Şahin, Gamze Sonmez, Fadime Ceyda Eldeniz, Yahya Gül, Mehmet Ali Karaselek, Şükrü Nail Güler, Sevgi Keleş and İsmail Reisli

Children 2025, 12(9), 1259; https://doi.org/10.3390/children12091259 - 19 Sep 2025

Cited by 4 | Viewed by 2078

Abstract

Background: Inborn errors of immunity (IEIs) are a heterogeneous group of rare disorders caused by genetic defects in one or more components of the immune system. The Jeffrey Modell Foundation’s (JMF) Ten Warning Signs are widely used for early detection; however, their [...] Read more.

Background: Inborn errors of immunity (IEIs) are a heterogeneous group of rare disorders caused by genetic defects in one or more components of the immune system. The Jeffrey Modell Foundation’s (JMF) Ten Warning Signs are widely used for early detection; however, their diagnostic sensitivity is limited. Machine learning (ML) approaches may improve prediction accuracy by integrating additional clinical variables into decision-making frameworks. Methods: This retrospective study included 298 participants (98 IEI, 200 non-IEI) evaluated at a university-affiliated clinical immunology clinic between January and December 2020. IEI diagnoses were confirmed using European Society for Immunodeficiencies (ESID) criteria. Two datasets were constructed: one containing only JMF criteria and another combining JMF criteria with additional clinical variables. Four ML algorithms—random forest (RF), k-nearest neighbors (k-NN), support vector machine (SVM), and naive Bayes (NB)—were trained and optimized using nested 5-fold stratified cross-validation repeated three times. Performance metrics included accuracy, sensitivity, specificity, F1 score, Youden Index, and the area under the receiver operating characteristic curve (AUROC). SHapley Additive exPlanations (SHAP) were applied to evaluate feature importance. Results: Using only JMF criteria, the best-performing model was SVM (accuracy: 0.90 ± 0.04, sensitivity: 0.93 ± 0.05, AUROC: 0.91 ± 0.02). With the addition of clinical variables, the SVM achieved superior performance (accuracy: 0.94 ± 0.03, sensitivity: 0.97 ± 0.03, AUROC: 0.99 ± 0.00), outperforming both the classical JMF criteria (accuracy: 0.91, sensitivity: 0.87, AUROC: 0.90) and the JMF-only SVM model. SHAP analysis identified family history of early death, pneumonia history, and ICU admission as the most influential predictors. Conclusions: ML models, particularly SVM integrating JMF criteria with additional clinical variables, substantially improve IEI prediction compared with classical JMF criteria. Implementation of such models in clinical settings may facilitate earlier diagnosis and timely intervention, potentially reducing morbidity and healthcare burden in IEI patients. Full article

(This article belongs to the Section Pediatric Allergy and Immunology)

► Show Figures

Figure 1

18 pages, 615 KB

Open AccessArticle

Temporal Shifts in Pathogen Profiles Due to the COVID-19 Pandemic in a Romanian Pediatric Tertiary Hospital

by Dan Dumitru Vulcanescu, Iulia Cristina Bagiu, Monica Susan, Virgiliu Bogdan Sorop, Octavia Harich, Andrada Oprisoni, Radu Galis and Florin George Horhat

Children 2025, 12(9), 1258; https://doi.org/10.3390/children12091258 - 18 Sep 2025

Cited by 1 | Viewed by 1622

Abstract

Background: The COVID-19 pandemic disrupted pediatric healthcare systems globally, altering infection dynamics, hospital admissions, and antimicrobial practices. This study aimed to evaluate temporal shifts in patient demographics, clinical aspects, and microbial pathogen profiles in a tertiary pediatric hospital in Western Romania, spanning [...] Read more.

Background: The COVID-19 pandemic disrupted pediatric healthcare systems globally, altering infection dynamics, hospital admissions, and antimicrobial practices. This study aimed to evaluate temporal shifts in patient demographics, clinical aspects, and microbial pathogen profiles in a tertiary pediatric hospital in Western Romania, spanning pre-pandemic (2019), pandemic (2021), and post-pandemic (2023) periods. Methods: A retrospective observational study was conducted at the “Louis Țurcanu” Emergency Children’s Hospital, Timișoara. Pediatric patients (<18 years) with laboratory-confirmed bacterial infections were included. Data on demographics, hospital wards, sample types, and pathogen distribution were analyzed using Χ² tests, incidence rate ratios (IRR), and non-parametric statistical methods. Results: A total of 3530 patients and 6885 samples were analyzed. Pediatric admissions declined by nearly 50% during the pandemic. The Outpatient and Emergency department observed a decrease in cases, while the ICU and surgical ward cases increased proportionally. Nasal and pharyngeal samples declined during the pandemic, while catheter, blood, and conjunctival samples rose. The study identified a significant shift in pathogen prevalence, with Escherichia coli and Staphylococcus aureus as the most frequent isolates. ICU patients showed increased rates of Pseudomonas aeruginosa, Candida albicans, and Klebsiella pneumoniae. Group A Streptococcus resurged post-pandemic after a decline in 2021. Conclusions: The pandemic significantly impacted pediatric infection profiles, hospital service utilization, and sample collection patterns. Strengthening infection surveillance, ensuring consistent reporting standards, and adapting pediatric care to future crises are critical for improving child health outcomes. Full article

(This article belongs to the Special Issue Pediatric Infectious Disease Epidemiology)

► Show Figures

Figure 1

10 pages, 3915 KB

Open AccessCommunication

Pacifier Sizing as a Prescription for Better Oral Health Outcomes for Infants: A Call to Action

by David A. Tesini, Clive Friedman, Adithya Kethu and Kristin W. Hendricks

Children 2025, 12(9), 1257; https://doi.org/10.3390/children12091257 - 18 Sep 2025

Cited by 1 | Viewed by 4815

Abstract

Sucking is essential for feeding and impacts the development of the cranio-facial-respiratory complex (CFRC). Non-nutritive sucking on a pacifier causes palatal narrowing and modifies the natural balanced relationship between intraoral pressure, peristaltic action of the tongue and the palate. Advanced engineering models have [...] Read more.

Sucking is essential for feeding and impacts the development of the cranio-facial-respiratory complex (CFRC). Non-nutritive sucking on a pacifier causes palatal narrowing and modifies the natural balanced relationship between intraoral pressure, peristaltic action of the tongue and the palate. Advanced engineering models have shown that malocclusions caused by pacifier use, are often a result of improper sizing. The sizing of pacifiers has historically been based on chronological age. Chronological age is not a size metric. Undersized pacifiers in a baby’s mouth can cause growth complications, palatal collapse airway incompetence and other orthodontic problems that can last a lifetime. Technical advances in facial anthropometrics and predictability of the rapid growth of the infant palate, can guide recommendations for pacifier size and design. This encourages change to a model of biometric sizing. Smartphone applications are being developed that use Ai and machine learning can predict conformity between palatal width and pacifier width. Full article

(This article belongs to the Section Pediatric Neonatology)

► Show Figures

Figure 1

16 pages, 558 KB

Open AccessArticle

Developing and Validating a Childhood Trauma-Informed Curriculum for Primary School Teachers in Limpopo Province, South Africa

by Muimeleli Munyadziwa and Lufuno Makhado

Children 2025, 12(9), 1256; https://doi.org/10.3390/children12091256 - 18 Sep 2025

Cited by 1 | Viewed by 2023

Abstract

Background/Objectives: Childhood trauma significantly hinders the developmental and academic outcomes of learners, particularly in under-resourced schools such as those in Limpopo province, South Africa. Teachers in these settings often face challenges in supporting trauma-exposed learners due to a lack of knowledge, training, [...] Read more.

Background/Objectives: Childhood trauma significantly hinders the developmental and academic outcomes of learners, particularly in under-resourced schools such as those in Limpopo province, South Africa. Teachers in these settings often face challenges in supporting trauma-exposed learners due to a lack of knowledge, training, and appropriate resources. Addressing this gap requires the development of structured, trauma-informed educational support systems. Methods: This study forms the final phase of a multi-phase research project aimed at developing a trauma-informed curriculum for primary school teachers. A multi-phase mixed method design was adopted across four phases: (1) a global scoping review to identify effective trauma-informed interventions; (2) empirical interviews with primary school teachers, trauma center managers, clinical psychologists, and social workers to understand local needs and experiences; (3) development of a conceptual framework grounded in theoretical and empirical findings; and (4) curriculum development guided by El Sawi’s curriculum design model. The curriculum was validated using structured questionnaires with a panel of stakeholders including educators, mental health professionals, and curriculum experts. Results: The study identified critical issues, including teachers’ limited understanding of childhood trauma, lack of standardized training, and inadequate classroom strategies. Key curriculum components were developed to address these gaps, including modules on the nature of trauma, early identification of symptoms, trauma-informed teaching practices, and collaboration with mental health professionals. Validation results indicated strong agreement on the curriculum’s clarity, relevance, and potential impact. Conclusions: The developed trauma-informed curriculum provides primary school teachers in Limpopo with the knowledge, tools, and confidence to support trauma-exposed learners. It emphasizes early identification, responsive classroom strategies, and inter-professional collaboration. This curriculum has the potential to enhance learning environments and promote better educational and psychosocial outcomes for trauma-affected learners. Full article

(This article belongs to the Section Global Pediatric Health)

► Show Figures

Figure 1

13 pages, 406 KB

Open AccessArticle

Reduction in Perioperative Risk in Patients with Spinal Muscular Atrophy Following the Release of Disease-Modifying Therapies: An Analysis of the National Surgical Quality Improvement Program Database

by Erin Toaz, Nisha Pinto, Keith Kilner and Eric Cheon

Children 2025, 12(9), 1255; https://doi.org/10.3390/children12091255 - 18 Sep 2025

Cited by 1 | Viewed by 1733

Abstract

Background/Objectives: Spinal muscular atrophy (SMA) is a progressive neurodegenerative disease resulting in proximal muscle weakness and paralysis. SMA treatment has radically changed in the past 10 years thanks to the development of novel therapies such as nusinersen and onasemnogene abeparvovec. Since the advent [...] Read more.

Background/Objectives: Spinal muscular atrophy (SMA) is a progressive neurodegenerative disease resulting in proximal muscle weakness and paralysis. SMA treatment has radically changed in the past 10 years thanks to the development of novel therapies such as nusinersen and onasemnogene abeparvovec. Since the advent of new treatments, the incidence and perioperative risk factors of patients with SMA undergoing longer, higher-risk surgeries are unknown. We hypothesized that patients with SMA would be at an overall elevated risk for postoperative pulmonary complications (PPC) and prolonged length of stay compared to the general population, but that this would be reduced in patients undergoing surgery in the years after the release of new therapies. Methods: Patients who underwent surgery at a continuously enrolled American College of Surgeons National Surgery Quality Improvement Program-Pediatric hospital from 1 January 2012, to 31 December 2021, were included in this study. Cases with missing covariate or primary outcome data were excluded from the analysis. Patients with ages greater than 17 years, preoperative tracheostomy, preoperative mechanical ventilation, missing covariate or primary outcome data were excluded. Patients with SMA were identified by their ICD-9 and 10 codes. A cutoff year of 2018 was chosen for analysis of the primary outcomes as this was a full year after nusinersen received FDA approval. Results: On univariable analysis, the risk for PPC in patients with SMA was reduced in patients undergoing surgery in 2018 or later compared to pre-2018 (pre-2018 OR 4.44, 95% CI 1.56–9.6, p = 0.008; post-2018 OR 3.48, 95% CI 0.84–9.12, p = 0.08). On multivariable analysis, the association between SMA and PPC substantially decreased in 2018 and after but was no longer statistically significant (pre-2018 OR 1.96, 95% CI 0.80–4.80, p = 0.14; post-2018 OR 1.03, 95% CI 0.33–3.26, p = 0.96). SMA was positively associated with LOS in the pre-2018 cohort, with a coefficient from a log linear model of 0.67 (95% CI 0.32–1.01; p < 0.001), and SMA adding an additional 1.93 days in LOS. For data post-2018, the effect of SMA on LOS was no longer statistically significant. Conclusions: Utilizing a large dataset, we found a reduced association between SMA and PPC a year following widespread implementation of SMN antisense oligonucleotide therapy, and a statistically significant reduction in LOS in patients with SMA after 2018. This may reflect improved motor outcomes and respiratory mechanics in the new treatment era. Full article

(This article belongs to the Special Issue New Insights into Pain Management and Sedation in Children)

► Show Figures

Figure 1

13 pages, 951 KB

Open AccessArticle

Evaluation of Acetabular Defects in Children with Cerebral Palsy: A Comparative Analysis of CT Measurements and Radiographic Parameters

by Domenic Grisch, Olivier Weber, Britta K. Krautwurst, Franziska L. Hatt, Michael Zellner, Christian von Deimling, Tobias Götschi, Bastian Sigrist and Thomas Dreher

Children 2025, 12(9), 1254; https://doi.org/10.3390/children12091254 - 17 Sep 2025

Viewed by 1701

Abstract

Objectives: This retrospective study examines acetabular morphology and defects in children with cerebral palsy (CP). The study discovers the usefulness and reliability of a reconstructed 3D CT measurement technique and compares it to conventional radiographic measurements. Methods: 33 subjects with CP [...] Read more.

Objectives: This retrospective study examines acetabular morphology and defects in children with cerebral palsy (CP). The study discovers the usefulness and reliability of a reconstructed 3D CT measurement technique and compares it to conventional radiographic measurements. Methods: 33 subjects with CP who underwent hip reconstruction, including Dega osteotomy and varus derotation femoral osteotomy, were included and compared to an age-matched group of 42 typically developing children. We reproduced a three directional acetabular index (3DAI), including anterosuperior, superolateral and posterosuperior indices in CT analysis, and compared them with established radiographic measurements for the migration percentage (MP) and the acetabular index (AI). Results: The results showed significantly higher 3DAI in every direction of wall deficiency, accentuating the methods sensitivity for acetabular dysplasia. The interrater and test–retest reliability were robust with ICC = 0.939–0.988 for the CP group. Conventional radiographic measurements demonstrated better discriminative power for identifying hip dislocation and correlated strongly with the 3DAI (p < 0.001). Conclusions: The 3DAI method showcases an important addition to the conventional radiographic measurements by enabling a quantification of the defect amount and direction for operative planning. The study supports the potential of a 3D analysis in the improvement of diagnostic precision and suggests a continuous refinement of the CT measurement technique. Full article

(This article belongs to the Special Issue Cerebral Palsy in Children: Improving Quality of Life and Preventing Painful Musculoskeletal Disorders)

► Show Figures

Figure 1

19 pages, 2185 KB

Open AccessArticle

Postural Fitness Protocol in Children and Adolescents: Descriptive Values from the ISQUIOS Program

by María Teresa Martínez-Romero, Mark De Ste Croix and Pilar Sainz de Baranda

Children 2025, 12(9), 1253; https://doi.org/10.3390/children12091253 - 17 Sep 2025

Cited by 6 | Viewed by 3234

Abstract

Background/Objectives: Back pain is increasingly prevalent during childhood and adolescence, often predicting adult spinal disorders. This study aimed to describe sex-specific anthropometric and “Postural Fitness” characteristics in school-aged children and adolescents and to introduce a standardized, field-based assessment protocol for early screening of [...] Read more.

Background/Objectives: Back pain is increasingly prevalent during childhood and adolescence, often predicting adult spinal disorders. This study aimed to describe sex-specific anthropometric and “Postural Fitness” characteristics in school-aged children and adolescents and to introduce a standardized, field-based assessment protocol for early screening of postural and functional deficits. Methods: This cross-sectional study included a total of 494 students (8–17 years; 50% girls) from 14 schools in Murcia (Spain). Exclusion criteria included diagnosed spinal pathology or major physical injury, lack of signed informed consent, absence on the testing day, and incomplete Postural Fitness assessment. The “Postural Fitness” protocol included assessments of sagittal spinal alignment (inclinometer), hip range of motion (ROM) (inclinometer with an extendable telescopic arm), pelvic tilt (goniometer with a spirit level system), and trunk muscle endurance (chronometer). Tests were conducted in physical education sessions by trained sports scientists. Results: Significant sex-based differences were observed. Boys exhibited greater thoracic kyphosis (40.3 ± 9.6° vs. 36.7 ± 9.2°), reduced hip ROM (passive hip extension (PHE): 16.8 ± 8.1°, passive hip flexion with knee extension (PHFKE): 68.9 ± 8.6°), and more posterior pelvic tilt (104.9 ± 8.4° vs. 99.7 ± 8.1°), whereas girls demonstrated increased lumbar lordosis (35.7 ± 8.6° vs. 31.5 ± 8.5°), greater hip ROM (PHE: 18.5 ± 9°, PHFKE: 77.9 ± 13°), and superior trunk extensor endurance (123.2 ± 74.7 s vs. 106.2 ± 69.8 s). Lateral trunk muscle endurance was higher in boys (48.7 ± 31 s vs. 41.4 ± 24.9 s). Conclusions: The “Postural Fitness” protocol proved feasible in school settings and revealed key sex-based disparities in spinal and neuromuscular profiles. These findings highlight the need for individualized, sex-specific screening and preventive programs to enhance back health during growth. Implementing this protocol may support early identification of modifiable risk factors linked to spinal dysfunction and pain in youth. Full article

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

► Show Figures

Figure 1

13 pages, 296 KB

Open AccessArticle

Outcomes of Pediatric Orthopedic Management of Ambulatory Cerebral Palsy Utilizing a Closely Monitored, Lifespan-Guided Approach

by Zhe Yuan, Nancy Lennon, Chris Church, Michael Wade Shrader and Freeman Miller

Children 2025, 12(9), 1252; https://doi.org/10.3390/children12091252 - 17 Sep 2025

Cited by 2 | Viewed by 2347

Abstract

Background: Cerebral palsy (CP) is a static, non-progressive brain pathology that affects mobility and musculoskeletal health. Objective: This review aims to describe the pediatric orthopedic management strategy at one specialty center with focus on optimal lifelong mobility function for ambulatory CP. Methods: Beginning [...] Read more.

Background: Cerebral palsy (CP) is a static, non-progressive brain pathology that affects mobility and musculoskeletal health. Objective: This review aims to describe the pediatric orthopedic management strategy at one specialty center with focus on optimal lifelong mobility function for ambulatory CP. Methods: Beginning in the 1990s, a protocol was developed to proactively monitor children with surgical or conservative interventions. After three decades, we undertook a prospective institutional review, board-approved 25–45-year-old adults callback study. Inclusion criteria were all children treated through childhood who could be located and were willing to return for a full evaluation. Results: Pediatric orthopedic interventions focused on regular surveillance with proactive treatment of progressive deformities. When function was impacted, we utilized multi-level orthopedic surgery guided by instrumented gait analysis. Childhood outcomes of this approach were evaluated through retrospective studies. Results show high correction rates were achieved for planovalgus foot deformity, knee flexion contracture, torsional malalignments, and stiff-knee gait. Our prospective adult callback study evaluated 136 adults with CP, gross motor function classification system levels I (21%), II (51%), III (22%), and IV (7%), with average ages of 16 ± 3 years (adolescent visit) compared with 29 ± 3 years (adult visit). Adults in the study had an average of 2.5 multi-level orthopedic surgery events and 10.4 surgical procedures. Compared with adults without disability, daily walking ability was lower in adults with CP. Adults with CP had limitations in physical function but no increased depression. A higher frequency of chronic pain compared with normal adults was present, but pain interference in daily life was not different. Adults demonstrated similar levels of education but higher rates of unemployment, caregiver needs, and utilization of Social Security disability insurance. Conclusions: The experience from our center suggests that consistent, proactive musculoskeletal management at regular intervals during childhood and adolescence may help maintain in gait and mobility function from adolescence to young adulthood in individuals with CP. Full article

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

18 pages, 807 KB

Open AccessArticle

Let’s Learn About Emotions Program: Acceptability, Fidelity, and Students’ Mental Well-Being Outcomes for Finnish Primary School Children

by Yuko Mori, Tiia Ståhlberg, Xiao Zhang, Kaisa Mishina, Sanna Herkama, Tarja Korpilahti-Leino, Terja Ristkari, Meeri Kanasuo, Saara Siirtola, Vesa Närhi, Hannu Savolainen, Susanna Hinkka-Yli-Salomäki, Shiho Torii, Kohei Matsubara, Kohei Kishida, Noriko Hida, Shin-ichi Ishikawa and Andre Sourander

Children 2025, 12(9), 1251; https://doi.org/10.3390/children12091251 - 17 Sep 2025

Viewed by 2691

Abstract

Background/Objectives: School-based universal mental health interventions offer an inclusive and scalable approach to promote mental health and well-being among children. This study evaluates the Let’s Learn About Emotions (Opitaan tunteista in Finnish) program, an evidence-based, teacher-led universal school-based intervention originally developed in [...] Read more.

Background/Objectives: School-based universal mental health interventions offer an inclusive and scalable approach to promote mental health and well-being among children. This study evaluates the Let’s Learn About Emotions (Opitaan tunteista in Finnish) program, an evidence-based, teacher-led universal school-based intervention originally developed in Japan and culturally adapted for Finnish primary schools. Methods: A total of 512 fourth-grade students from 14 schools participated in the 12-week program during spring 2023. Using a mixed-methods design, we assessed (1) the program’s acceptability among students, parents, teachers, and school principals, (2) fidelity of implementation, and (3) changes in students’ mental well-being pre- to post-intervention. Quantitative data included standardized questionnaires with valid responses collected from 233 students at baseline and 209 students at post-intervention, as well as parents and teachers. Qualitative data were collected through focus group discussions involving parents, teachers, and school principals during spring 2024. Results: Acceptability was high across all respondent groups. Teachers adhered closely to the teaching manual, as confirmed by self-reports and direct classroom observations. Statistically significant improvements were observed in parent-reported conduct problems, hyperactivity, and peer problems, though student self-reports did not show similar benefits. Conclusions: The program was found to be both acceptable and culturally appropriate in the Finnish context. Findings from this study provide valuable insights for refining and improving the program for future implementation. To more rigorously examine its effectiveness, future studies should employ a randomized controlled trial design. Full article

(This article belongs to the Special Issue Advances in Mental Health and Well-Being in Children (2nd Edition))

► Show Figures

Figure 1

14 pages, 351 KB

Open AccessArticle

Comorbid Insomnia and Sleep Apnea Across the Pediatric Age: A Polysomnographic Study

by Lisa Brunel, Marion Comajuan, Sabine Plancoulaine, Benjamin Putois, Julien Lioret, Marine Thieux, Laurianne Coutier, Patricia Franco and Aurore Guyon

Children 2025, 12(9), 1250; https://doi.org/10.3390/children12091250 - 17 Sep 2025

Cited by 3 | Viewed by 1906

Abstract

Background/Objectives: Comorbid insomnia and sleep apnea (COMISA) in children is poorly documented. This study aimed to evaluate the frequency of COMISA and to explore its clinical and polysomnographic characteristics in children referred for polysomnography (PSG) for any sleep complaint. Methods: All patients with [...] Read more.

Background/Objectives: Comorbid insomnia and sleep apnea (COMISA) in children is poorly documented. This study aimed to evaluate the frequency of COMISA and to explore its clinical and polysomnographic characteristics in children referred for polysomnography (PSG) for any sleep complaint. Methods: All patients with a complete insomnia sub-score on the Sleep Disturbance Scale for Children (SDSC; for children from 6 months to 16 years old) who underwent a night PSG in a pediatric sleep unit (2018–2024) were included in this retrospective study. Pathological SDSC insomnia sub-score defined insomnia and obstructive apnea-hypopnea index ≥ 2/h on PSG defined OSA. Questionnaires regarding sleepiness, depression, anxiety, and hyperactivity were also collected. Results: Children had isolated insomnia in 11.5% of cases, isolated OSA in 37.5%, and COMISA in 13.5%. Insomnia frequency was not different between patients with and those without OSA (26.5% vs. 23.5%). COMISA was more frequent in patients under 4 years old than in older ones (39.1% vs. 5.8%). No polysomnographic or clinical characteristic of COMISA was identified, except that OAHI was higher in children with isolated OSA. Patients with COMISA or isolated insomnia were more anxious than those with isolated OSA. Conclusions: Unlike in adults, the present findings do not support a mutual association between OSA and insomnia in children. OSA severity was lower in children with COMISA. Anxiety levels were higher in children with insomnia, regardless of the presence of OSA, suggesting that anxiety should be assessed in all children with OSA. Full article

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

► Show Figures

Figure 1

27 pages, 948 KB

Open AccessReview

Tumor–Immune Interactions in Pediatric Oral Rhabdomyosarcoma: A Narrative Review on Immuno-Oncology and Emerging Therapies

by Omar A. El Meligy, Noha M. Elemam, Wael A. Hassan and Iman M. Talaat

Children 2025, 12(9), 1249; https://doi.org/10.3390/children12091249 - 17 Sep 2025

Cited by 2 | Viewed by 3240

Abstract

Pediatric oral rhabdomyosarcoma (RMS) is a rare and aggressive cancer of the head and neck, characterized by a complex and mostly immunosuppressive tumor–immune microenvironment. Unlike adult cancers, pediatric RMS typically exhibits a “cold” immune profile, characterized by minimal T-cell infiltration, a low mutational [...] Read more.

Pediatric oral rhabdomyosarcoma (RMS) is a rare and aggressive cancer of the head and neck, characterized by a complex and mostly immunosuppressive tumor–immune microenvironment. Unlike adult cancers, pediatric RMS typically exhibits a “cold” immune profile, characterized by minimal T-cell infiltration, a low mutational burden, and resistance to immune checkpoint blockade. The tumor’s location in the oral cavity adds difficulty to treatment because of anatomical and functional limitations. Additionally, the presence of fusion oncogenes, such as PAX3:FOXO1, hampers immunogenicity and treatment response by disrupting antigen presentation and reducing immune cell infiltration. Advances in immuno-oncology have introduced new strategies, including immune checkpoint inhibitors, chimeric antigen receptor (CAR) therapies, cancer vaccines, and oncolytic viruses. However, these approaches face specific challenges in the pediatric population due to developmental immune factors. This narrative review highlights recent findings on the immunobiology of pediatric oral RMS, focusing on tumor–immune interactions and their impact on disease progression and treatment resistance. We reviewed the cellular components of the TIME, the mechanisms of immune evasion, and the expression of immune checkpoints, including PD-L1 and B7-H3. Emerging immunotherapies, including CAR-T, CAR-NK, and CAR-CIK cell therapies; checkpoint inhibitors; oncolytic viruses; and cancer vaccines, are discussed, with an emphasis on their current limitations and potential to transform the pediatric RMS immune landscape. Full article

(This article belongs to the Special Issue Comprehensive Approaches in Pediatric Dentistry: Managing Health and Disabilities Across All Specialties)

► Show Figures

Figure 1

21 pages, 3560 KB

Open AccessEditor’s ChoiceReview

A Comprehensive Review of Pediatric Necrotizing Pneumonia

by Manette Ness-Cochinwala and Balagangadhar R. Totapally

Children 2025, 12(9), 1248; https://doi.org/10.3390/children12091248 - 17 Sep 2025

Cited by 10 | Viewed by 11204

Abstract

Necrotizing pneumonia is a serious complication of pediatric pneumonia, characterized by liquefaction and cavitation of the lung parenchyma. Streptococcus pneumoniae and Staphylococcus aureus are the most implicated organisms. Mycoplasma pneumoniae has been an increasingly recognized pathogen, especially is Asian and Pseudomonas aeruginosa is [...] Read more.

Necrotizing pneumonia is a serious complication of pediatric pneumonia, characterized by liquefaction and cavitation of the lung parenchyma. Streptococcus pneumoniae and Staphylococcus aureus are the most implicated organisms. Mycoplasma pneumoniae has been an increasingly recognized pathogen, especially is Asian and Pseudomonas aeruginosa is mainly noted in a higher percentage of patients with complex chronic conditions. Clinical presentation typically includes fever, respiratory distress, and failure to respond to standard antibiotic therapy. These patients are more likely to have pleural involvement in the form of effusion or empyema and a higher need for respiratory support. Diagnosis is typically through a combination of chest radiographs, lung ultrasound, and chest computed tomography. Management is primarily via prolonged intravenous antibiotics that cover the above organisms, though pleural drainage with fibrinolytics is often required. Surgical intervention is often reserved for refractory cases that fail initial fibrinolytic therapy. Prognosis is usually favorable in the short and long term, though early recognition and appropriate management are imperative to reduce the duration of illness and morbidity. Full article

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

► Show Figures

Figure 1

Journal Menu

Journal Browser

Children, Volume 12, Issue 9 (September 2025) – 174 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI