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Children
Volume 13
Issue 1
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Children, Volume 13, Issue 1 (January 2026) – 160 articles

Cover Story (view full-size image): Neurodevelopmental morbidity accounts for much of the lifelong burden of extreme prematurity (22–24 weeks’ gestation), reflecting the immature brain’s heightened vulnerability to hypoxic-ischemic injury, inflammation, and hemodynamic instability during early extrauterine adaptation. Artificial womb technologies (AWTs) are designed to sustain fetal physiology ex utero by providing low-resistance extracorporeal gas exchange within a sterile, fluid-filled environment to support continued organ maturation during the periviable period. In this narrative review, we summarize the spectrum of neurologic sequelae among extremely preterm infants and review current state-of-the-art preclinical AWT models, emphasizing structural, developmental, and functional neurodevelopmental endpoints relevant to near-term clinical translation. View this paper
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9 pages, 209 KB  
Article
Optimal Timing of Inguinal Hernia Repair in Premature Infants: A Retrospective Study
by Joshua Z. E. Yau, Paul C. Y. Chang, Nien-Lu Wang, Jin-Cherng Sheu, Hsuan Huang and Yi-Ting Yeh
Children 2026, 13(1), 160; https://doi.org/10.3390/children13010160 - 22 Jan 2026
Viewed by 108
Abstract
Background/Objectives: The optimal timing for inguinal hernia repair in premature infants remains controversial. Most premature patients in our institution undergo repair just before discharge. This study evaluates postoperative complications in premature patients and proposes the optimal timing for hernia repair. Methods: [...] Read more.
Background/Objectives: The optimal timing for inguinal hernia repair in premature infants remains controversial. Most premature patients in our institution undergo repair just before discharge. This study evaluates postoperative complications in premature patients and proposes the optimal timing for hernia repair. Methods: A retrospective single-center review was conducted between January 2020 and November 2023. All infants undergoing hernia repair as inpatients under 50 weeks postmenstrual age (PMA) were included. Data collected included demographic details, perioperative characteristics, and postoperative outcomes. Results: A total of 202 patients were analyzed. Forty-five patients underwent surgery before 38 weeks PMA (early group), and 157 after 38 weeks PMA (late group). The early group had significantly lower gestational age, lower body weight, and more comorbidities. Postoperative respiratory complications were more frequent in the early group. Conclusions: Repair after 38 weeks PMA is associated with fewer respiratory complications while earlier repair increases transient airway support requirements. Full article
(This article belongs to the Section Pediatric Surgery)
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18 pages, 318 KB  
Systematic Review
Integrating Digital Health into School Nursing for Food Allergy Management: A Systematic Review
by Rita Nocerino, Flavia Lotito, Emma Montella and Roberto Berni Canani
Children 2026, 13(1), 159; https://doi.org/10.3390/children13010159 - 22 Jan 2026
Viewed by 94
Abstract
Background: Food allergy [FA] is a growing public health concern among school-age children, with schools and childcare/daycare settings representing high-risk environments for accidental exposure and anaphylaxis. Objective: To systematically review evidence on digital health interventions supporting FA education, prevention, and management in school [...] Read more.
Background: Food allergy [FA] is a growing public health concern among school-age children, with schools and childcare/daycare settings representing high-risk environments for accidental exposure and anaphylaxis. Objective: To systematically review evidence on digital health interventions supporting FA education, prevention, and management in school settings. Methods: A systematic search of PubMed, Scopus, Web of Science, and CINAHL was conducted to identify studies published between January 2015 and December 2025 [PROSPERO CRD420251185553]. Eligible studies evaluated e-learning, mHealth, or web-based programs targeting school staff, parents, or students. Results: Sixteen studies met inclusion criteria. Digital health emerged as a catalyst for professional development, interprofessional communication, and health equity within school communities. Interventions consistently improved knowledge, preparedness, and self-efficacy in anaphylaxis management among school staff, strengthened parental empowerment and communication with schools, and supported coping and inclusion among allergic children. Evidence on clinical outcomes; however, remains limited. Conclusions: Digital health can meaningfully enhance school preparedness and reduce inequalities in allergy management. Integrating digital tools into national school health frameworks—particularly where school nursing is not yet institutionalized—may represent a pivotal step toward safer, more equitable inclusion of children with food allergy. Full article
(This article belongs to the Special Issue Allergic Diseases in Children: From Pathophysiological Mechanisms to Management)
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12 pages, 671 KB  
Article
How Do Gait Outcomes Evolve in Adults with Spastic Cerebral Palsy Who Received Orthopedic Treatment in Childhood?
by Anne Tabard-Fougère, Alice Bonnefoy-Mazure, Geraldo de Coulon, Oscar Vazquez and Stéphane Armand
Children 2026, 13(1), 158; https://doi.org/10.3390/children13010158 - 22 Jan 2026
Viewed by 70
Abstract
Background/Objectives: Cerebral palsy (CP) is the most common cause of physical disability in childhood. While gait improvements are often observed during childhood, it remains unclear whether these gains are sustained into adulthood. This study aimed to evaluate the long-term evolution of gait [...] Read more.
Background/Objectives: Cerebral palsy (CP) is the most common cause of physical disability in childhood. While gait improvements are often observed during childhood, it remains unclear whether these gains are sustained into adulthood. This study aimed to evaluate the long-term evolution of gait outcomes from childhood to adulthood in individuals with CP who received orthopedic care early in life. Methods: This retrospective study included 83 adults with cerebral palsy (44 unilateral/uCP, 39 bilateral/bCP; GMFCS I–III) who underwent clinical gait analysis in childhood and again as adults (minimum 4 years between visits, n = 249 CGA). Gait was assessed using the modified Gait Profile Score (mGPS) and normalized walking speed (NWS). The effects of life stage (childhood, adolescence, early adulthood, and adulthood) were analyzed using Kruskal–Wallis tests with post hoc comparisons. Individual clinical transitions were quantified from early adulthood to adulthood, with a minimal clinically important difference (MCID) change in mGPS (1.6°) and NWS (0.20 s−1) for improvement or decline. Results: Longitudinal analysis revealed that while group-average mGPS improved from childhood to adulthood, NWS declined significantly for all patients (p < 0.01). However, individual trajectories from early adulthood to adulthood diverged by CP type. Those with bCP GMFCS II and III had a more frequent clinical decline in mGPS (4/14, 29%), with minimal potential for improvement (1/14, 17%). In contrast, individuals with uCP had less frequent decline (1/17, 6%) and a greater improvement (3/17, 18%). Conclusions: While significant improvements in gait quality are achieved by early adulthood, substantial clinical decline occurs during adulthood in bCP (GMFCS II–III) patients. These findings highlight the need for lifelong monitoring, with re-evaluation regarding the need for surgical interventions from early adulthood to adulthood in bCP patients with greater motor impairments. Full article
(This article belongs to the Collection Advancements in the Management of Children with Cerebral Palsy)
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25 pages, 495 KB  
Article
Screen Time, Digital Content Quality, and Parental Mediation as Predictors of Linguistic and Pragmatic Development: Implications for Pediatric and Preventive Health
by Csongor Toth, Brigitte Osser, Gyongyi Osser, Laura Ioana Bondar, Roland Fazakas, Nicoleta Anamaria Pascalau, Ramona Nicoleta Suciu, Corina Dalia Toderescu and Bombonica Gabriela Dogaru
Children 2026, 13(1), 157; https://doi.org/10.3390/children13010157 - 22 Jan 2026
Viewed by 268
Abstract
Background/Objectives: Although numerous studies have examined associations between screen time and early language development, less is known about how screen exposure interacts with developmental stage, digital content quality, and parental mediation across childhood and adolescence, particularly with respect to pragmatic communication. This study [...] Read more.
Background/Objectives: Although numerous studies have examined associations between screen time and early language development, less is known about how screen exposure interacts with developmental stage, digital content quality, and parental mediation across childhood and adolescence, particularly with respect to pragmatic communication. This study aimed to address these gaps by examining the joint associations of screen time, content composition, and parental mediation with multiple linguistic and pragmatic domains across a broad age range. Methods: A cross-sectional study was conducted with 286 Romanian participants aged 5–19 years, grouped into four developmental stages. Measures included daily screen time, proportion of educational versus recreational content, parental mediation practices, and standardized assessments of vocabulary, verbal fluency, grammatical competence, and pragmatic communication. Analyses included descriptive statistics, Pearson correlations, 4 × 3 factorial ANOVAs (age group × screen-time category), and multiple linear regression. Results: Higher levels of screen exposure were consistently associated with lower performance across all linguistic and pragmatic domains (r = −0.19 to −0.28, all p < 0.01). Participants viewing >2 h/day showed significantly weaker outcomes than those with ≤1 h/day, particularly in semantic and phonemic fluency and pragmatic communication (p < 0.001). Educational content correlated positively with linguistic scores, whereas recreational content showed negative associations. Parental mediation emerged as a significant positive predictor. In the regression model (R2 = 0.42), age (β = 0.47), parental mediation (β = 0.21), and educational content (β = 0.18) predicted better linguistic performance, while screen time (β = −0.29) predicted lower performance. Conclusions: The findings indicate that associations between digital media use and linguistic and pragmatic performance vary across developmental stages and contextual factors. Rather than screen time alone, digital content quality and parental mediation are associated with differences in communicative performance. These results highlight the value of a nuanced, developmentally informed perspective when considering children’s digital media environments. Full article
(This article belongs to the Section Global Pediatric Health)
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15 pages, 250 KB  
Article
Exploring Patient, Parent and Clinician Views of Outcomes for Family-Centered Care in Neonatal Settings: A Qualitative Study
by Cansel Kocakabak, Agnes van den Hoogen, Jos M. Latour and on behalf of the COUSIN Study Group
Children 2026, 13(1), 156; https://doi.org/10.3390/children13010156 - 22 Jan 2026
Viewed by 157
Abstract
Background/Objectives: A neonatal intensive care units (NICU) admission of a premature infant is lifesaving; however, it can also be emotionally devastating experiences for parents. Family-centered care (FCC) interventions are designed to support parents and infants in the NICUs by integrating families into care [...] Read more.
Background/Objectives: A neonatal intensive care units (NICU) admission of a premature infant is lifesaving; however, it can also be emotionally devastating experiences for parents. Family-centered care (FCC) interventions are designed to support parents and infants in the NICUs by integrating families into care delivery through partnerships with healthcare professionals. Heterogeneity in outcome reporting across FCC studies limits comparability. Developing a core outcome set (COS) for FCC is essential to address this gap. Aim: The aim of this study was to explore the views of former neonatal patients, parents, and healthcare professionals who have experiences with FCC in neonatal settings and elucidate outcomes that are important to them. Methods: This study followed the Core Outcome Measures Effectiveness Trial Handbook, which suggests involving stakeholders in identifying outcomes to reflect what is important to them rather than to researchers. Nine focus group discussions were conducted with 27 international key stakeholders from multiple countries (former neonatal patient n = 1; parents n = 8; healthcare professionals n = 18), reflecting FCC experiences across different neonatal settings. Data were analyzed using a modified framework analysis. Findings: Five outcome domains were identified including 42 distinct outcomes: (1) Emotional functioning/wellbeing of parents, infants, and healthcare professionals, reflecting emotional responses to a NICU admission of an infant; (2) Role functioning of parents, healthcare professionals, and others, highlighting that FCC strengthens their roles; (3) Delivery of care, highlighting the role of staff attitudes and organizational factors in supporting FCC; (4) Physiological health, reflecting infant physical health; (5) Hospital environment and resource use, reflecting healthcare utilization outcomes. Conclusions: Participants’ experiences provide meaningful insights into outcomes that should be evaluated in neonatal research and practice. These findings will inform the development of a COS for FCC in neonatal settings. Full article
(This article belongs to the Section Pediatric Neonatology)
17 pages, 453 KB  
Article
“Why Are You Happy if Your Dad Died?”: The Social Experiences of Parentally Bereaved Children in Elementary and Middle Schools
by Yael Boutton-Laor, Yulia Muchnik-Rozanov and Rivi Frei-Landau
Children 2026, 13(1), 155; https://doi.org/10.3390/children13010155 - 22 Jan 2026
Viewed by 113
Abstract
Background: Parental loss in childhood is a significant developmental risk factor, underscoring the need for evidence-based knowledge to guide support. Although social responses play a central role in children’s adjustment to loss, little is known about how parentally bereaved children in Israel [...] Read more.
Background: Parental loss in childhood is a significant developmental risk factor, underscoring the need for evidence-based knowledge to guide support. Although social responses play a central role in children’s adjustment to loss, little is known about how parentally bereaved children in Israel experience social support in school. Methods: This qualitative study examined how parentally bereaved children in elementary and middle school experience social responses in the school context. Thirty-six participants were interviewed: 20 children who participated in dyadic interviews with their 16 surviving parents. Linguistic analysis, combined with Grounded Theory, was used to analyze the data. Results: Peer support was found to lie on a continuum ranging from support, through an unintentional lack of support, to deliberate nonsupport (teasing). These patterns shaped children’s experiences of returning to school, their sense of belonging, and their ability to share their grief. Conclusions: The findings, discussed in light of the Dual Process Model of Coping with Bereavement, highlight the crucial role of peers in children’s adaptation to parental loss. Developing evidence-based knowledge in this area may inform policy change and tailored school-based training to promote optimal support for parentally bereaved children. Full article
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21 pages, 337 KB  
Article
Implementing PROMEHS to Foster Social and Emotional Learning, Resilience, and Mental Health: Evidence from Croatian Schools
by Sanja Tatalović Vorkapić, Lidija Vujičić, Akvilina Čamber Tambolaš, Ilaria Grazzani, Valeria Cavioni, Carmel Cefai and Liberato Camilleri
Children 2026, 13(1), 154; https://doi.org/10.3390/children13010154 - 22 Jan 2026
Viewed by 179
Abstract
Background/Objectives: In light of the concerning research data on students’ mental health, it is essential to provide high-quality programs that support children and young people in strengthening their psychological well-being. To address this need, the three-year Erasmus+ KA3 international project PROMEHS: Promoting [...] Read more.
Background/Objectives: In light of the concerning research data on students’ mental health, it is essential to provide high-quality programs that support children and young people in strengthening their psychological well-being. To address this need, the three-year Erasmus+ KA3 international project PROMEHS: Promoting Mental Health at Schools was developed. The project involved universities and education policy representatives from seven European countries, Italy (project leader), Greece, Croatia, Latvia, Malta, Portugal, and Romania. Its core activities included the development of the PROMEHS curriculum, grounded in three key components: social and emotional learning, resilience, and the prevention of behavioral problems, alongside a rigorous evaluation of its implementation. The main research aim was to test the effect of PROMEHS on students’ and teachers’ mental health. Methods: In Croatia, the curriculum was introduced following the training of teachers (N = 76). It was implemented in kindergartens, and primary and secondary schools (N = 32), involving a total of 790 children. Using a quasi-experimental design, data were collected at two measurement points in both experimental and control groups by teachers, parents, and students. Results: The findings revealed significant improvements in children’s social and emotional competencies and resilience, accompanied by reductions in behavioural difficulties. These effects were most evident in teachers’ assessments, compared to parents’ ratings and student self-reports. Furthermore, teachers reported a significantly higher level of psychological well-being following implementation. Conclusions: Bearing in mind some study limitations, it can be concluded that this study provides evidence of the positive effects of PROMEHS in Croatian educational settings. Building on these outcomes and PROMEHS as an evidence-based program, a micro-qualification education was created to ensure the sustainability and systematic integration of the PROMEHS curriculum into Croatian kindergartens and schools. Full article
(This article belongs to the Special Issue Advances in Adolescent Mental Health: Early Prevention and Intervention)
12 pages, 963 KB  
Article
Training Healthcare Assistants for School-Based Care of Children Receiving Paediatric Palliative Care: A Post-Training Evaluation
by Anna Santini, Anna Marinetto, Enrica Grigolon, Alessandra Fasson, Mirella Schiavon, Igor D’angelo, Nicoletta Moro, Barbara Roverato, Pierina Lazzarin and Franca Benini
Children 2026, 13(1), 153; https://doi.org/10.3390/children13010153 - 22 Jan 2026
Viewed by 103
Abstract
Background/Objectives: Children in paediatric palliative care often face school attendance barriers due to complex health needs. This study describes post-training perceptions of a training program by a pediatric hospice team to prepare school care assistants to safely include children with complex conditions, [...] Read more.
Background/Objectives: Children in paediatric palliative care often face school attendance barriers due to complex health needs. This study describes post-training perceptions of a training program by a pediatric hospice team to prepare school care assistants to safely include children with complex conditions, focusing on procedural skills, knowledge of the child, and family partnership. Methods: Care assistants who completed a structured course at the Paediatric Palliative Care Centre, University Hospital of Padua (2023–2024), were surveyed immediately after training. The program combined classroom instruction with hands-on simulation using high-fidelity mannequins and standard devices, including suction, pulse oximetry, ventilation, enteral feeding, and tracheostomy care. It also covered modules on urgent and emergency management, as well as family communication. An anonymous online questionnaire gathered socio-demographic data, prior training, clinical tasks performed, self-efficacy levels, and open-ended feedback. Quantitative results were analyzed descriptively, while qualitative comments were subjected to thematic analysis. Results: Of 130 invited assistants, 105 participated (81%). Participants reported strong perceived confidence: 85% selected the upper end of the 5-point scale (“very” or “extremely”) for routine-management ability, and 60% selected these same response options for emergency-management ability. In the most severe events recalled, 60.5% of incidents were resolved autonomously, 7.6% involved contacting emergency services, and 3.8% involved community or hospice nurses. Seventy-five percent judged the course comprehensive; thematic analysis of 102 comments identified satisfaction, requests for regular refreshers, stronger practical components, and requests for targeted topics. Conclusions: Immediately after the session, participants tended to select the upper end of the self-assurance item for both routine and emergency tasks. Combining core emergency procedures with personalized, child-specific modules and family-partnership training may support safety, trust, and inclusion. Regular refreshers and skills checks are advised. Full article
(This article belongs to the Special Issue Specialized Pediatric Palliative Care: In-Hospital, Homecare and Intersectoral Demands)
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15 pages, 801 KB  
Systematic Review
Artificial Intelligence in Pediatric Dentistry: A Systematic Review and Meta-Analysis
by Nevra Karamüftüoğlu, Büşra Yavuz Üçpunar, İrem Birben, Asya Eda Altundağ, Kübra Örnek Mullaoğlu and Cenkhan Bal
Children 2026, 13(1), 152; https://doi.org/10.3390/children13010152 - 21 Jan 2026
Viewed by 297
Abstract
Background/Objectives: Artificial intelligence (AI) has gained substantial prominence in pediatric dentistry, offering new opportunities to enhance diagnostic precision and clinical decision-making. AI-based systems are increasingly applied in caries detection, early childhood caries (ECC) risk prediction, tooth development assessment, mesiodens identification, and other key [...] Read more.
Background/Objectives: Artificial intelligence (AI) has gained substantial prominence in pediatric dentistry, offering new opportunities to enhance diagnostic precision and clinical decision-making. AI-based systems are increasingly applied in caries detection, early childhood caries (ECC) risk prediction, tooth development assessment, mesiodens identification, and other key diagnostic tasks. This systematic review and meta-analysis aimed to synthesize evidence on the diagnostic performance of AI models developed specifically for pediatric dental applications. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, and Embase following PRISMA-DTA guidelines. Studies evaluating AI-based diagnostic or predictive models in pediatric populations (≤18 years) were included. Reference screening, data extraction, and quality assessment were performed independently by two reviewers. Pooled sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were calculated using random-effects models. Sources of heterogeneity related to imaging modality, annotation strategy, and dataset characteristics were examined. Results: Thirty-two studies met the inclusion criteria for qualitative synthesis, and fifteen were eligible for quantitative analysis. For radiographic caries detection, pooled sensitivity, specificity, and AUC were 0.91, 0.97, and 0.98, respectively. Prediction models demonstrated good diagnostic performance, with pooled sensitivity of 0.86, specificity of 0.82, and AUC of 0.89. Deep learning architectures, particularly convolutional neural networks, consistently outperformed traditional machine learning approaches. Considerable heterogeneity was identified across studies, primarily driven by differences in imaging protocols, dataset balance, and annotation procedures. Beyond quantitative accuracy estimates, this review critically evaluates whether current evidence supports meaningful clinical translation and identifies pediatric domains that remain underrepresented in AI-driven diagnostic innovation. Conclusions: AI technologies exhibit strong potential to improve diagnostic accuracy in pediatric dentistry. However, limited external validation, methodological variability, and the scarcity of prospective real-world studies restrict immediate clinical implementation. Future research should prioritize the development of multicenter pediatric datasets, harmonized annotation workflows, and transparent, explainable AI (XAI) models to support safe and effective clinical translation. Full article
(This article belongs to the Section Pediatric Dentistry & Oral Medicine)
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11 pages, 430 KB  
Article
Association Between Point-of-Care Viral Testing for Influenza and Adenovirus and Antibiotic Management in a Pediatric Emergency Department in Italy
by Tommaso Bellini, Andrea Lacovara, Daniele Franzone, Marcello Mariani, Giorgia Iovinella, Martina Virgilio, Julia Lasagna, Simona Matarese, Carlotta Pepino, Francesca Canzoneri, Milena Guazzi, Emanuela Piccotti and Andrea Moscatelli
Children 2026, 13(1), 151; https://doi.org/10.3390/children13010151 - 21 Jan 2026
Viewed by 179
Abstract
Background: Respiratory tract infections (RTIs) represent one of the most prevalent reasons for visits to Pediatric Emergency Departments (PEDs). Because viral and bacterial presentations frequently overlap, a substantial proportion of antibiotic prescriptions in pediatric acute care are potentially unnecessary, contributing to antimicrobial resistance. [...] Read more.
Background: Respiratory tract infections (RTIs) represent one of the most prevalent reasons for visits to Pediatric Emergency Departments (PEDs). Because viral and bacterial presentations frequently overlap, a substantial proportion of antibiotic prescriptions in pediatric acute care are potentially unnecessary, contributing to antimicrobial resistance. Rapid Diagnostic Tests (RDTs) for respiratory viruses have been suggested as tools to enhance diagnostic precision and support antimicrobial stewardship. However, evidence regarding their real-world impact in pediatric emergency settings is limited. Objectives: This study aimed to assess the association between point-of-care RDT results and antibiotic management in a tertiary PED, focusing on both the discontinuation of antibiotics in children already receiving treatment and the avoidance of new antibiotic prescriptions in untreated children. The secondary objective was to evaluate the short-term safety through 72-h return visits. Methods: A retrospective cohort study was conducted at a tertiary PED during two epidemic seasons (December–February 2023–2024 and 2024–2025). Children aged <18 years who underwent RDTs for febrile respiratory illnesses were included. Patients were stratified based on whether they were already receiving antibiotic therapy at presentation. The primary outcomes were antibiotic discontinuation among treated patients and initiation among untreated patients. Unplanned return visits to the PED within 72-h post-discharge were used as a pragmatic short-term safety outcome to capture early clinical deterioration. RDTs (SD Biosensor Standard F Antigen) were performed at the bedside with a turnaround time of 10–15 min. Results: A total of 1238 children were included, of whom 330 (26.6%) tested positive for influenza and/or adenovirus. Among the 234 children already receiving antibiotics, discontinuation was significantly more frequent in the RDT-positive group (p < 0.001; OR 0.044). Among the 1004 untreated children, antibiotic prescription was significantly lower in the positive group than in the negative group (p < 0.001; OR 0.097). Return visits within 72-h did not differ between the groups in either cohort. No invalid tests occurred. Conclusions: Influenza/adenovirus RDT positivity was associated with lower antibiotic initiation among untreated children and higher discontinuation among those already receiving antibiotics, with no differences in 72-h return visits. These findings suggest a potential role for bedside viral testing as a decision-support tool for antibiotic management in the PED. Full article
(This article belongs to the Special Issue Viral Respiratory Infections and Bacterial Superinfections in Children—2nd Edition)
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11 pages, 277 KB  
Review
Non-Invasive Surfactant Administration in Preterm Infants
by Faten Budajaja, Nadine Lahage and Ivan L. Hand
Children 2026, 13(1), 150; https://doi.org/10.3390/children13010150 - 21 Jan 2026
Viewed by 403
Abstract
Background: Although surfactant replacement therapy has been a cornerstone of respiratory distress syndrome (RDS) management for decades, traditional delivery via endotracheal intubation and mechanical ventilation is associated with procedure-related complications and increased risk of bronchopulmonary dysplasia (BPD). These concerns have driven the development [...] Read more.
Background: Although surfactant replacement therapy has been a cornerstone of respiratory distress syndrome (RDS) management for decades, traditional delivery via endotracheal intubation and mechanical ventilation is associated with procedure-related complications and increased risk of bronchopulmonary dysplasia (BPD). These concerns have driven the development of less invasive surfactant administration strategies. Objective: This review aims to summarize and evaluate the current literature on less invasive surfactant delivery techniques used in preterm infants with RDS, with a focus on their feasibility, efficacy, and short- and long-term neonatal outcomes. Methods: We reviewed the available literature evaluating less invasive surfactant administration methods, including InSurE, Less Invasive Surfactant Therapy/Minimally Invasive Surfactant Therapy (LISA/MIST), surfactant administration via laryngeal mask airway (SALSA/LMA), pharyngeal administration, and nebulized surfactant. We compared major outcomes, namely the need for mechanical ventilation, incidence of BPD, procedural complications and long-term neurodevelopmental outcomes. Results: Non-invasive surfactant administration techniques have been associated with reduced exposure to mechanical ventilation and lower rates of BPD compared with conventional approaches. Studies on LISA/MIST demonstrate the most consistent evidence in reducing the need for mechanical ventilation and BPD, while other techniques such as LMA-assisted delivery and nebulization show promise but remain limited by device constraints, gestational age applicability, and heterogeneous study designs. Long-term neurodevelopmental outcome data remain sparse across all techniques. Conclusions: Non-invasive surfactant administration represents an important advancement in the management of RDS. While several techniques offer potential advantages over traditional intubation-based delivery, further high-quality studies are required to optimize patient selection, standardize techniques, develop safe and effective delivery devices, and evaluate long-term neurodevelopmental outcomes. Full article
(This article belongs to the Special Issue Diagnosis and Management of Newborn Respiratory Distress Syndrome)
16 pages, 437 KB  
Article
Do They Already Feel Like Frauds? Exploring the Impostor Phenomenon in Children and Adolescents
by Mona Leonhardt, Jane De Vries, Sonja Etzler, Sarah Peetz and Sonja Rohrmann
Children 2026, 13(1), 149; https://doi.org/10.3390/children13010149 - 21 Jan 2026
Viewed by 153
Abstract
Objectives: The Impostor Phenomenon (IP), defined as persistent self-doubt despite objective success, has been extensively researched in adults. In contrast, empirical research on children and adolescents remains limited. Methods: The present study examines the prevalence, correlates, and potential risk as well as protective [...] Read more.
Objectives: The Impostor Phenomenon (IP), defined as persistent self-doubt despite objective success, has been extensively researched in adults. In contrast, empirical research on children and adolescents remains limited. Methods: The present study examines the prevalence, correlates, and potential risk as well as protective factors of the IP in a sample of 286 participants (56.6% female, 42.7% male, and 0.7% diverse) aged 8–18 years (M = 11.75, SD = 2.50). Participants were recruited from four distinct German subsamples between 2022 and 2024, including a clinically vulnerable group. The study employed a cross-sectional survey design administered to children and adolescents. Results: The results of the study indicate the presence of the IP as early as primary school age, with increasing intensity during adolescence. The study identified robust correlations between the IP and neuroticism, extraversion, conscientiousness, and self-esteem. In the present study, children and adolescents exhibiting depressive–anxious symptomatology demonstrated significantly elevated impostor scores in comparison to those manifesting other disorders. Furthermore, the study yielded negative associations between impostorism and various personal resources (e.g., optimism, self-efficacy) and family resources (e.g., parental support, authoritative parenting style). Conclusions: The present findings underline the importance of early intervention in addressing impostor feelings among younger age groups. In conclusion, the present findings contribute to our understanding of the IP etiology and underscore the importance of understanding the IP during formative years to inform prevention and intervention strategies. Full article
(This article belongs to the Section Global Pediatric Health)
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23 pages, 643 KB  
Article
Integrating Growth Mindset with Functional-Cognitive Approaches: A Mixed-Methods Feasibility and Acceptability Study in Youth Residential Care
by Miri Tal Saban and Sharon Zlotnik
Children 2026, 13(1), 148; https://doi.org/10.3390/children13010148 - 20 Jan 2026
Viewed by 351
Abstract
Background: Adolescents in residential care frequently face functional challenges, yet few interventions integrate functional-cognitive models with motivational theories to support their daily function. Methods: This mixed-methods feasibility study is an innovative conceptual integration that links motivational and metacognitive approaches with growth-mindset principles to [...] Read more.
Background: Adolescents in residential care frequently face functional challenges, yet few interventions integrate functional-cognitive models with motivational theories to support their daily function. Methods: This mixed-methods feasibility study is an innovative conceptual integration that links motivational and metacognitive approaches with growth-mindset principles to address both beliefs about the ability to change and functional performance. Quantitative data were collected from staff (n = 44), alumnae (n = 5), and current residents (n = 3), assessing mindset and functional-skill confidence among three focus groups (n = 16). The qualitative insights highlighted the motivational processes, strategy use, and barriers each group faced. Results: The findings informed the development of structured intervention psychoeducation protocol to facilitate goal-setting and reflective questioning. The feasibility and acceptability were tested by a pilot study among five staff members. Before implementation, staff demonstrated lower confidence in promoting daily autonomy and providing strategy-focused feedback. Alumnae and residents reported high emotional support, yet persistent gaps in functional independence. Conclusions: The pilot findings may inform the development of structured staff practices for delivering functional guidance, pending further evaluation. This study offers a novel conceptual contribution by positioning growth mindset as an active mechanism that supports functional-cognitive processes to enhance autonomy among adolescents in residential care settings. Full article
(This article belongs to the Section Pediatric Mental Health)
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13 pages, 262 KB  
Article
Suicidal Behaviour, Self-Harm and Related Factors: A Retrospective Study from the Adolescent Psychiatric Unit
by Sigita Lesinskienė, Miglė Zabarauskaitė, Tadas Valiulis, Giedrius Dailidė and Arūnas Germanavičius
Children 2026, 13(1), 147; https://doi.org/10.3390/children13010147 - 20 Jan 2026
Viewed by 233
Abstract
Background and objectives: Suicide attempts and self-harm are critical issues in adolescence, often leading to serious and irreversible consequences. These behaviours frequently co-occur and share common biopsychosocial risk factors. Identifying these factors enables a more comprehensive assessment of suicide and self-harm risk, [...] Read more.
Background and objectives: Suicide attempts and self-harm are critical issues in adolescence, often leading to serious and irreversible consequences. These behaviours frequently co-occur and share common biopsychosocial risk factors. Identifying these factors enables a more comprehensive assessment of suicide and self-harm risk, helping specialists recognize high-risk individuals and implement effective preventive measures. This study aimed to examine the association between suicide attempts, self-harm and psychosocial factors among hospitalized adolescents. Materials and methods: A retrospective data analysis was performed using the database of the University Department of Children and Adolescents of the Republican Vilnius Psychiatric Hospital. The study covered patients’ records from December 2022 to February 2025. Information on gender, age, suicide attempts, self-harm, adverse events (bullying, psychological abuse, physical violence within the family, and sexual abuse) and unhealthy habits (smoking, harmful alcohol consumption, and psychoactive substance use), was selected and analyzed in this study. A Chi-square test was used to assess the difference between groups. Results were considered statistically significant when p < 0.05. Results: The study included 599 hospitalized adolescents (26.9% boys; mean age 15.1 ± 1.4 years), of whom 70.8% reported at least one episode of self-harm and 37.8% at least one suicide attempt. Rates of self-harm and suicide attempts were significantly higher in girls than in boys (self-harm: 81.3% vs. 42.2%, ϕ=0.381, p<0.001; suicide attempts: 45.5% vs. 16.5%, ϕ=0.304, p<0.001), and adolescents with self-harm had a significantly higher prevalence of suicide attempts than those without self-harm (46.7% vs. 15.8%, ϕ=0.308, p<0.001). Adverse childhood experiences and unhealthy behaviours were significantly more frequent in adolescents with self-harm and suicide attempts, although effect sizes were small to moderate (ϕ range 0.086–0.230, all p<0.05). In multivariable models, female gender (β=0.355, p<0.001) and smoking (β=0.330, p<0.001) were the strongest predictors of self-harm, whereas alcohol use (β=0.337, p<0.001) and self-harm (β=0.232, p<0.001). Conclusions: Exposure to adverse childhood experiences and engagement in unhealthy habits were associated with higher rates of both self-harm and suicide attempts. A comprehensive assessment and early detection of self-harm behaviours and adverse psychosocial circumstances are crucial elements of effective suicide prevention strategies and prompt intervention among high-risk adolescents. Full article
(This article belongs to the Special Issue Factors Associated with Adolescent and Young Risk Behaviors and Intervention Measures)
13 pages, 310 KB  
Article
Outcome Predictors of Oral Food Challenge in Children
by Vojko Berce, Anja Pintarič Lonzarić, Elena Pelivanova and Sara Jagodic
Children 2026, 13(1), 146; https://doi.org/10.3390/children13010146 - 20 Jan 2026
Viewed by 186
Abstract
Background: Food allergy is a leading cause of severe allergic reactions in children and often results in restrictive elimination diets. The oral food challenge (OFC) remains the diagnostic gold standard but is resource-intensive and carries a risk of adverse reactions. This study [...] Read more.
Background: Food allergy is a leading cause of severe allergic reactions in children and often results in restrictive elimination diets. The oral food challenge (OFC) remains the diagnostic gold standard but is resource-intensive and carries a risk of adverse reactions. This study aimed to identify epidemiological, clinical, and laboratory predictors of OFC outcomes and reaction severity in children with suspected immediate-type food allergies. Methods: We conducted a retrospective review of 148 children who underwent hospital-based, open OFCs due to suspected immediate-type food reactions. Data on demographics, comorbidities, characteristics of the initial reaction, sensitisation profiles (specific IgE [sIgE], skin prick test [SPT]), and OFC outcomes were analysed. Reactions were graded using the Ring and Messmer scale. Results: OFC was positive in 44 of 148 children (29.7%). However, no clinical or laboratory parameters—including prior reaction severity and the magnitude of allergy test results—were associated with the severity of reactions during OFC. Comorbidities—specifically asthma, atopic dermatitis, and allergic rhinitis—were significantly associated with a positive OFC (p < 0.01), as were elevated sIgE levels and larger SPT wheal diameters (p < 0.01 for both). The optimal thresholds for predicting a positive OFC were 0.73 IU/mL for sIgE and 3.5 mm for SPT. Conclusions: Oral food challenge (OFC) remains essential for confirming food allergies in children. Given that the severity of reactions during OFCs cannot be reliably predicted and that low cut-off values of allergy tests were identified for predicting a positive OFC outcome, OFCs should be performed in a controlled and fully equipped medical setting, particularly in children with atopic comorbidities. Full article
(This article belongs to the Section Pediatric Allergy and Immunology)
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11 pages, 230 KB  
Case Report
Pediatric Mixed Plasmodium vivax–P. falciparum Infection with Disparate Parasitemias: Diagnostic and Surveillance Challenges
by Jose Luis Estela-Zape
Children 2026, 13(1), 145; https://doi.org/10.3390/children13010145 - 20 Jan 2026
Viewed by 143
Abstract
Background and Clinical Significance: Malaria remains a significant public health issue in Latin America, where Plasmodium vivax predominates but P. falciparum continues to circulate. Mixed-species infections are uncommon and can pose diagnostic challenges, particularly when parasite densities differ markedly, increasing the risk of [...] Read more.
Background and Clinical Significance: Malaria remains a significant public health issue in Latin America, where Plasmodium vivax predominates but P. falciparum continues to circulate. Mixed-species infections are uncommon and can pose diagnostic challenges, particularly when parasite densities differ markedly, increasing the risk of underdetecting P. falciparum with conventional methods. Case report: We report a 9-year-old boy from an endemic area with a six-day febrile syndrome. Thick smear and peripheral blood film microscopy, complemented by rapid diagnostic tests for pan-Plasmodium and HRP2 antigens, confirmed a mixed infection with P. vivax (5500 parasites/µL) and P. falciparum (562 parasites/µL). The patient was hemodynamically stable, without severe malaria criteria, and laboratory values were within normal limits. Following confirmation of normal glucose-6-phosphate dehydrogenase activity, treatment with artemether–lumefantrine was initiated, followed by primaquine for hypnozoite eradication. Clinical evolution was favorable, with progressive defervescence, treatment tolerance, and documented parasite clearance. Conclusions: This case illustrates the risk of underestimating P. falciparum in mixed infections with disparate parasitemias and highlights the value of integrated diagnostic approaches in resource-limited endemic settings. It also underscores surveillance limitations that can misclassify mixed infections, potentially affecting epidemiological estimates and treatment strategies. Timely recognition and comprehensive diagnostic evaluation are essential to ensure appropriate antimalarial therapy, prevent complications, and inform public health interventions in regions where both species coexist. Full article
18 pages, 1235 KB  
Article
Parental Attitudes and Hesitancy Towards Childhood Influenza Vaccination in Slovakia: A Cross-Sectional Survey of 301 Parents
by Peter Kunč, Jaroslav Fábry, Martina Neuschlová, Matúš Dohál, Renata Péčová, Jana Mazuchová and Miloš Jeseňák
Children 2026, 13(1), 144; https://doi.org/10.3390/children13010144 - 20 Jan 2026
Viewed by 207
Abstract
Background/Objectives: Seasonal influenza imposes a significant burden on pediatric public health. Despite official recommendations and full insurance coverage, vaccination rates among children in Slovakia remain critically low. This study aims to analyze the attitudes, beliefs, and determinants of parental hesitancy regarding childhood [...] Read more.
Background/Objectives: Seasonal influenza imposes a significant burden on pediatric public health. Despite official recommendations and full insurance coverage, vaccination rates among children in Slovakia remain critically low. This study aims to analyze the attitudes, beliefs, and determinants of parental hesitancy regarding childhood influenza vaccination in the post-pandemic context. Methods: A single-center cross-sectional survey was conducted between February and March 2025 using convenience sampling among parents of children attending a pediatric immunoallergology center. An anonymous questionnaire collected data on demographics, risk perception, and attitudes. Data from 301 parents were analyzed using descriptive statistics, chi-squared tests, and odds ratios (OR) to identify key predictors of hesitancy. Results: Only 27.6% of parents expressed willingness to vaccinate their children, while 42.5% were opposed and 29.9% hesitant. Statistical analysis revealed no significant association between parental university education and vaccination intent (p > 0.05), indicating that vaccine hesitancy in this specific setting was present across all educational backgrounds. However, the source of information proved to be a critical determinant: consulting a pediatrician significantly increased the odds of acceptance (OR = 6.32; 95% CI: 3.54–11.28), whereas reliance on the internet and social media was a significant predictor of refusal (OR = 0.29; 95% CI: 0.17–0.50). The primary reported barrier was fear of adverse effects (70.4%), which significantly outweighed doubts about efficacy (30.2%). Conclusions: Parental hesitancy in Slovakia is a widespread phenomenon pervasive across all educational backgrounds, driven primarily by safety concerns and digital misinformation. The contrast between the protective influence of pediatricians and the negative impact of digital media underscores that clinical encounters are currently the most effective firewall against hesitancy. Public health strategies must therefore pivot from general education to empowering pediatricians with active, presumptive communication strategies. Full article
(This article belongs to the Special Issue Pediatric Infectious Disease Epidemiology)
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22 pages, 554 KB  
Article
Time-Processing, Daily Time Management, and Autonomy in School-Age Children with ADHD Compared to Typically Developing Children and Children with Intellectual Disabilities—Different Patterns
by Birgitta Wennberg, Anette Kjellberg, Per A. Gustafsson, Lena Almqvist and Gunnel Janeslätt
Children 2026, 13(1), 143; https://doi.org/10.3390/children13010143 - 20 Jan 2026
Viewed by 233
Abstract
Background: Children with ADHD and children with intellectual disability (ID) often have problems with daily time management (DTM). It is, however, less well-known how the underlying time-processing ability (TPA) may impact children’s DTM and autonomy. The purpose of this study was to investigate [...] Read more.
Background: Children with ADHD and children with intellectual disability (ID) often have problems with daily time management (DTM). It is, however, less well-known how the underlying time-processing ability (TPA) may impact children’s DTM and autonomy. The purpose of this study was to investigate DTM, TPA, and self-rated autonomy in the activities of everyday life among children aged 9–15 years with and without disabilities. Methods: The participants were matched samples of children with ADHD (n = 47), with ID (n = 47), and typically developing (TD) children (n = 47). A descriptive, comparative, and cross-sectional design was used. Group comparisons with one-way analysis of variance (ANOVA), Tukey post-hoc tests, bootstrapping, and a cluster analysis were used to analyze the data. Results: Children with ADHD and children with ID had significantly lower TPA and DTM than TD children. Children with ADHD had even lower DTM than those with ID. Children with ADHD and ID have the same overall pattern of TPA, but it may be delayed, affecting their DTM and autonomy. However, there was considerable heterogeneity among the children with ADHD and ID, ranging from skilled to having significant problems in TPA. For all children, the levels of self-rated autonomy seemed to follow the level of TPA. Conclusions: Children with ADHD and children with ID have an increased risk of delayed TPA, affecting their DTM and autonomy, which may also influence their participation in daily activities. The results indicate a need to measure TPA and DTM to tailor interventions for each child. Full article
(This article belongs to the Special Issue Children with Specific Neurodevelopmental Disorders: Assessment and Intervention (2nd Edition))
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16 pages, 819 KB  
Article
Differences in Management of Neonates with Hypoxic–Ischemic Encephalopathy (HIE) by Level of Neonatal Care Provided at Birth: Insights from a Referral-Based Cohort in the Canton of Zurich, Switzerland
by Ladina Erni, Ariane Pfister, Christian Haslinger, Michael Kleber, Barbara Brotschi, Dirk Bassler, Vinzenz Boos and Beate Grass
Children 2026, 13(1), 142; https://doi.org/10.3390/children13010142 - 19 Jan 2026
Viewed by 170
Abstract
Background/Objectives: Neonates with hypoxic–ischemic encephalopathy (HIE) are born in delivery facilities with different levels of neonatal care. The objective of this study was to investigate differences in the incidence of HIE and postnatal management between different levels of neonatal care in delivery [...] Read more.
Background/Objectives: Neonates with hypoxic–ischemic encephalopathy (HIE) are born in delivery facilities with different levels of neonatal care. The objective of this study was to investigate differences in the incidence of HIE and postnatal management between different levels of neonatal care in delivery facilities. Methods: This is a retrospective, multi-center cohort study of neonates with moderate-to-severe HIE receiving therapeutic hypothermia (TH) in the Canton of Zurich, Switzerland, registered in the Swiss National Asphyxia and Cooling Register between 2015 and 2023. Incidences of HIE receiving TH were calculated for all delivery facilities according to the national levels of neonatal care on site (Level I—basic; Level IIB—intermediate (no Level IIA facility in the Canton of Zurich); Level III—intensive neonatal care). Perinatal characteristics and variables on transport and outcomes were compared between neonates born in Level I and Level IIB facilities (the majority of the HIE population) and reported for neonates born in all other facilities (for completeness). Results: A total of 173 neonates (79 (45.7%) born in Level I; 80 (46.2%) in Level IIB; 9 (5.2%) in Level III; 5 (2.9%) in birthing centers) were admitted to a neonatal cooling center to receive TH. The average number of annual cases of HIE receiving TH per facility was 0.67 (0.11–1.50) in Level I and 2.22 (0.22–3.11) in Level IIB facilities (p = 0.088), respectively. There was no difference in Apgar score, worst pH (within 60 min after birth) and the severity of encephalopathy between neonates born in Level I and Level IIB facilities. Neonatal transport team requests were initiated earlier in Level I facilities (median 12 vs. 34 min of life, p < 0.001). There was no difference in age at initiation of TH (median 3 vs. 3 h, p = 0.431) and the time when target temperature was reached (median 4 vs. 4 h, p = 0.431) between neonates born in Level I and Level IIB facilities. Conclusions: The level of neonatal care available in delivery facilities influenced the management of neonates with HIE receiving TH. Full article
(This article belongs to the Special Issue Hypoxic–Ischemic Brain Injury in Newborn: The Present Status and Challenges in the Future)
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11 pages, 204 KB  
Article
Comparative Analysis of Pediatric and Adult Mastocytosis: Clinical Presentation, Triggers, and Treatment Patterns from a Tertiary Care Registry
by Sundus M. NoorSaeed, Roy Khalaf, Athari Alenezi, Eviatar Fields, Connor Prosty, Abdulaziz S. Alrafiaah, Barbara Miedzybrodzki, Elena Netchiporouk, John Sampalis, Michael Fein and Moshe Ben-Shoshan
Children 2026, 13(1), 141; https://doi.org/10.3390/children13010141 - 19 Jan 2026
Viewed by 230
Abstract
Background: Mastocytosis is a rare hematologic disorder, classified into cutaneous mastocytosis (CM) and systemic mastocytosis (SM). Understanding age-related differences in presentation and management is essential for individualized care. Methods: Data from patients recruited from the Montreal Children’s and Montreal General Hospitals between 2015 [...] Read more.
Background: Mastocytosis is a rare hematologic disorder, classified into cutaneous mastocytosis (CM) and systemic mastocytosis (SM). Understanding age-related differences in presentation and management is essential for individualized care. Methods: Data from patients recruited from the Montreal Children’s and Montreal General Hospitals between 2015 and 2024 were analyzed. Descriptive statistics were employed to present patient demographics, clinical characteristics, and medication usage. Statistical analyses included Fisher’s exact test for categorical variables and t-tests or non-parametric equivalents for continuous variables. Results: A total of 63 patients were included, comprising 39 children and 24 adults. Children had a median age of 1.9 years, while adults had a median age of 49.3 years. CM was exclusively prevalent in children (100.0%), while SM was more common in adults (45.8%). Adults with SM had a significantly higher median age than CM (49.4 versus 44.7 years, respectively, p = 0.03). Epinephrine use was more frequent in adult SM patients (36.4% versus 0%, respectively, p = 0.03). No pediatric patients required epinephrine for symptom control. Conclusions: This study highlights important clinical differences between pediatric and adult mastocytosis. CM was more common in children while SM predominated in adults and was associated with greater flare severity and higher tryptase levels. Full article
(This article belongs to the Section Pediatric Allergy and Immunology)
17 pages, 959 KB  
Review
Obesity Hypoventilation Syndrome in Children and Adolescents
by Duilio Petrongari, Paola Di Filippo, Francesca Cacciatore, Armando Di Ludovico, Giuseppe Francesco Sferrazza Papa, Sabrina Di Pillo, Francesco Chiarelli and Marina Attanasi
Children 2026, 13(1), 140; https://doi.org/10.3390/children13010140 - 18 Jan 2026
Viewed by 212
Abstract
Obesity hypoventilation syndrome (OHS) is a severe and underrecognized respiratory disorder characterized by the coexistence of obesity, daytime hypercapnia, and sleep-disordered breathing. Although well described in adults, pediatric OHS remains poorly defined despite the rising prevalence of childhood obesity. Its pathophysiology is multifactorial, [...] Read more.
Obesity hypoventilation syndrome (OHS) is a severe and underrecognized respiratory disorder characterized by the coexistence of obesity, daytime hypercapnia, and sleep-disordered breathing. Although well described in adults, pediatric OHS remains poorly defined despite the rising prevalence of childhood obesity. Its pathophysiology is multifactorial, involving obesity-related mechanical constraints, impaired ventilatory control, altered chemosensitivity, and frequent overlap with obstructive sleep apnea. Clinical manifestations in children are often subtle and nonspecific, including snoring, sleep fragmentation, daytime sleepiness, and neurocognitive impairment, frequently leading to delayed diagnosis and, in some cases, acute cardiopulmonary decompensation. Management of pediatric OHS is challenging and largely extrapolated from adult data. Positive airway pressure therapy remains the cornerstone of treatment, while weight reduction is essential but difficult to achieve in pediatric populations. Pharmacological approaches such as medroxyprogesterone or acetazolamide remain experimental, with limited pediatric evidence. This review synthesizes current knowledge on pediatric OHS, focusing on epidemiology, pathophysiology, clinical presentation, diagnostic challenges, and therapeutic strategies. Increased awareness and earlier recognition are essential to prevent progression to chronic respiratory failure and long-term cardiovascular complications. Full article
(This article belongs to the Special Issue Clinical Presentation, Evaluation, and Treatment of Sleep-Disorders in Children and Adolescents)
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16 pages, 382 KB  
Article
Are Maternal Adverse Childhood Experiences Associated with Their Preschool Children’s Sleep Disruptions? Longitudinal Mediation Through Mothers’ Depressive Symptoms and Children’s Screen Time
by Stefan Kurbatfinski, Lalith Nandakumar, Janelle Boram Lee, Gerald F. Giesbrecht and Nicole Letourneau
Children 2026, 13(1), 139; https://doi.org/10.3390/children13010139 - 18 Jan 2026
Viewed by 258
Abstract
Background: Children of mothers exposed to adverse childhood experiences (ACEs) may be at increased risk of sleep disruptions, such as night waking, due to potential suboptimal caregiving or living conditions. Mothers’ ACEs are also associated with maternal depressive symptoms, which in turn are [...] Read more.
Background: Children of mothers exposed to adverse childhood experiences (ACEs) may be at increased risk of sleep disruptions, such as night waking, due to potential suboptimal caregiving or living conditions. Mothers’ ACEs are also associated with maternal depressive symptoms, which in turn are associated with children’s screen time and sleep disruptions, revealing relevant, but unexplored, mediation pathways. This Canadian study investigated if mothers’ ACEs were associated with their 5-year-old children’s sleep disruptions (1) directly and (2) indirectly through independent or serial mediation via maternal depressive symptoms and/or children’s screen time. Methods: Data (n = 622; maternal mean age 32.3 years, 88.4% white) came from the longitudinal APrON Study. ACEs were measured 1 year postpartum. Mother’s depressive symptoms were measured across prenatal and postnatal timepoints. Children’s evening screen time (i.e., number of days in a week children engaged in one hour of screen time before bedtime) and sleep disruptions (number of days in a week their child wakes up multiple times) were measured at 5 years postpartum using adapted scales (52.9% male). PROCESS was used to assess for mediation. Results: Mothers’ ACEs had an indirect effect on their children’s sleep disruptions through mothers’ mean depressive symptoms (effect = 0.018, 95% CI [0.006, 0.034]), but not through children’s screen time. No other effects (i.e., direct, total) were observed. Conclusions: Although replication studies are warranted, this novel study reveals that the effects of maternal ACEs on children’s sleep disruptions may operate indirectly with effects potentiated through maternal depressive symptoms, thus serving as a target for intervention. Full article
(This article belongs to the Section Pediatric Mental Health)
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15 pages, 246 KB  
Article
Laying the Foundation for an Elementary School Sleep Education Program
by Alzena Ilie, Peyton Williams, Gabrielle Rigney, Shelly K. Weiss, Sarah Bluden and Penny V. Corkum
Children 2026, 13(1), 138; https://doi.org/10.3390/children13010138 - 18 Jan 2026
Viewed by 195
Abstract
Background/Objectives: Many elementary school-aged children (i.e., 5 to 12 years old) experience sleep difficulties that negatively impact their daytime functioning. Despite this high prevalence, sleep education is rarely included in school curricula and evidence-based interventions are limited. To better understand this gap, a [...] Read more.
Background/Objectives: Many elementary school-aged children (i.e., 5 to 12 years old) experience sleep difficulties that negatively impact their daytime functioning. Despite this high prevalence, sleep education is rarely included in school curricula and evidence-based interventions are limited. To better understand this gap, a needs assessment was conducted to inform the development of a sleep education program. Method: Semi-structured virtual interviews were conducted with 14 elementary school teachers in Nova Scotia, Canada. Participants were asked 20 questions about their students’ sleep and its impact, teachers’ needs and practices in sleep education, what a sleep education program would look like, and how it could be delivered. During the interview, participants watched the online ABCs of SLEEPING storybook as a potential foundation for developing a sleep education program, and interview themes were analyzed using deductive thematic analysis. Results: All teachers identified poor sleep as an issue impacting students’ behavior and learning, and reported that they had a lack of resources to teach sleep education. Teachers believed the storybook could be used with their students and integrated into the curriculum. Recommended modifications include making the storybook available for families, adding interactive activities and student discussions, providing teacher resources, and tailoring the content to be suitable for both lower and upper elementary school-aged students. Most teachers indicated that the storybook could be adapted for upper elementary students with more age-appropriate vocabulary and visuals. Conclusions: The findings from this needs assessment will inform the development of an elementary school sleep education program using the ABCs of SLEEPING storybook as the foundation of the program, while noting limitations such as sample diversity. Full article
(This article belongs to the Special Issue Children’s Well-Being and Mental Health in an Educational Context)
20 pages, 1178 KB  
Article
Performance of the Bebé VieScope Versus Direct Laryngoscopy During Pediatric Cardiopulmonary Resuscitation: A Prospective Randomized Simulation Study
by Pawel Wieczorek, Halla Kaminska, Michal Pruc, Wojciech Wieczorek, Katarzyna Karczewska, Jacek Smereka, Şahin Çolak and Lukasz Szarpak
Children 2026, 13(1), 137; https://doi.org/10.3390/children13010137 - 17 Jan 2026
Viewed by 187
Abstract
Background/Objectives: Effective airway management during pediatric cardiopulmonary resuscitation (CPR) is crucial but technically challenging, especially during continuous chest compressions. While direct laryngoscopy with Macintosh (MAC) or Miller (MIL) blades remains the standard, optical devices such as the VieScope (VSL) may enhance performance [...] Read more.
Background/Objectives: Effective airway management during pediatric cardiopulmonary resuscitation (CPR) is crucial but technically challenging, especially during continuous chest compressions. While direct laryngoscopy with Macintosh (MAC) or Miller (MIL) blades remains the standard, optical devices such as the VieScope (VSL) may enhance performance under dynamic resuscitation conditions. This study compared first-pass success and intubation time, as well as procedural difficulty and glottic visualization, of MAC, MIL, and VSL during simulated pediatric cardiopulmonary resuscitation. Methods: This prospective, randomized crossover simulation study involved 53 medical students. Participants performed endotracheal intubation on a high-fidelity manikin simulating a 5-year-old pediatric patient using MAC, MIL, and the Bebé VieScope laryngoscope. Each technique was evaluated in two scenarios: with and without continuous chest compressions. Results: Without chest compressions, first-pass success (FPS) and intubation time varied significantly between techniques. VSL achieved the highest FPS (100%; p = 0.032) and the shortest intubation time (27.9 ± 9.2 s; p = 0.040), performing faster than MIL and achieving higher FPS than MAC. Visualization quality, ease of intubation, and optimization maneuvers were similar across techniques. During continuous chest compressions, all outcomes differed significantly. FPS increased from MAC to MIL and VSL (p = 0.001), with MAC showing the lowest success rate. VSL showed the shortest intubation time (35.9 ± 13.0 s; p < 0.001), better glottic visualization, easier intubation, and fewer optimization maneuvers, followed by MIL. Conclusions: In this simulated pediatric cardiac arrest model, the VieScope laryngoscope demonstrated superior overall performance, especially during uninterrupted chest compressions. Optical tubular laryngoscopy may therefore provide clinically relevant benefits in pediatric resuscitation where maintaining high-quality chest compressions is crucial. Given the manikin-based design of this study, confirmation of these findings in clinical pediatric cardiac arrest settings will require further prospective clinical investigation. Full article
(This article belongs to the Special Issue Emergency Management and Treatment Strategies in Children Cardiac Arrest)
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12 pages, 518 KB  
Article
Animal-Assisted Psychoeducational Intervention in Paediatric Oncohaematology: Evidence from a Single-Centre Observational Study
by Chiara Battaglini, Valentina Isaja, Gaia Riscossa, Mario Giordano, Paola Quarello, Giulia Zucchetti and Franca Fagioli
Children 2026, 13(1), 136; https://doi.org/10.3390/children13010136 - 16 Jan 2026
Viewed by 180
Abstract
Background: Hospitalisation for paediatric oncohaematological diseases entails significant physical and psychological stress, often compromising children’s emotional regulation and daily functioning. In this context, complementary interventions can provide additional support to the clinical work conducted with children and adolescents undergoing treatment, fostering emotional [...] Read more.
Background: Hospitalisation for paediatric oncohaematological diseases entails significant physical and psychological stress, often compromising children’s emotional regulation and daily functioning. In this context, complementary interventions can provide additional support to the clinical work conducted with children and adolescents undergoing treatment, fostering emotional awareness and well-being. This study evaluates the feasibility and perceived benefits of an animal-assisted psychoeducational intervention to enhance emotional coping during hospitalisation. Methods: A single-centre observational study was conducted at Regina Margherita Children’s Hospital in Italy in collaboration with the ZOOM Foundation (Turin, Italy), between September 2023 and May 2025. Sixty patients aged 6–15 years participated in an intervention combining observation of an in-ward aquarium, virtual animal encounters, and completion of a psychoeducational booklet promoting emotional reflection through symbolic identification with animal behaviours. Results: The intervention showed high feasibility and acceptability: 90% of participants (54/60) reported positive emotions and enjoyment, 80% (48/60) found the booklet engaging, and all participants (100%) perceived care and attention from facilitators. The activities fostered engagement, curiosity, and well-being, though their impact on deeper emotional processing appeared limited. Conclusions: Animal-assisted psychoeducational interventions are feasible and well-received in paediatric oncohaematology, offering complementary support to clinical care by promoting emotional resilience and enriching the hospital experience. Full article
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21 pages, 1509 KB  
Article
Cross-Sectional Associations of Sport Participation, Academic Performance, and Psychological Well-Being Among Rural Romanian Adolescent Boys in the Context of Family Background
by Filoména Dávid, Krisztina Rácz and Pál Salamon
Children 2026, 13(1), 135; https://doi.org/10.3390/children13010135 - 16 Jan 2026
Viewed by 332
Abstract
Background: Adolescence is a sensitive period for psychological, academic, and social development, and sports participation has been described as a potential protective factor for academic performance and psychological well-being. However, limited research has examined the combined influence of sports involvement, sport type, and [...] Read more.
Background: Adolescence is a sensitive period for psychological, academic, and social development, and sports participation has been described as a potential protective factor for academic performance and psychological well-being. However, limited research has examined the combined influence of sports involvement, sport type, and family background on adolescents’ academic and psychological outcomes. This study aimed to investigate the associations between organized sport participation, sport type (football vs. judo), psychological well-being, psychosomatic symptoms, academic performance, and family socioeconomic background among adolescent boys. Methods: The sample consisted of 52 boys aged 11–14 years from a rural school, divided into football players (n = 13), judo athletes (n = 13), non-athletes (n = 13), and a contextual subgroup of students with special educational needs (SEN; n = 13), with the latter included for exploratory purposes only. Data included school-record-based academic performance and validated self-report measures of life satisfaction, depressive symptoms, psychosomatic complaints, perceived physical fitness, and socioeconomic background. Results: Athletes demonstrated significantly higher academic achievement than non-athletes in overall grade point average (p < 0.001), mathematics (p < 0.001), Romanian (p < 0.001), English (p = 0.03), and Hungarian (p < 0.001). They also reported higher life satisfaction (p < 0.001) but simultaneously showed slightly elevated depressive symptom scores (p < 0.001), indicating a paradoxical pattern of concurrent psychosocial benefits and psychological strain. Parental education (p < 0.001), parental occupational status (p = 0.01), and fathers’ occupational position (p = 0.02) were significantly higher among athletes’ families. Perceived physical fitness was also rated higher by athletes (p < 0.001). No significant differences were found in body mass index, family structure, or most psychosomatic symptoms. Conclusions: Sport participation was associated with more favorable academic and psychological indicators, yet also with elevated depressive symptoms, highlighting the dual nature of organized sport during adolescence. Future research should apply longitudinal designs, include female participants, and incorporate objective indicators of training load. Full article
(This article belongs to the Special Issue Physical Fitness and Health in Adolescents)
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20 pages, 1086 KB  
Article
Psychometric Properties of the CEVEO Bullying Subscales for Aggressors in School and Leisure Contexts Among Chilean Adolescents: Profiles Based on Moral Disengagement, Aggression Frequency, and Context
by Karina Oñate-Hormazábal, Beatriz Pérez and Andrés Concha-Salgado
Children 2026, 13(1), 134; https://doi.org/10.3390/children13010134 - 16 Jan 2026
Viewed by 271
Abstract
Background: Adolescent violence occurs both within and beyond the school setting. Furthermore, risk factors for aggression, such as Moral Disengagement (MD), do not operate uniformly and may be triggered in one context but not another. This highlights the need for instruments that assess [...] Read more.
Background: Adolescent violence occurs both within and beyond the school setting. Furthermore, risk factors for aggression, such as Moral Disengagement (MD), do not operate uniformly and may be triggered in one context but not another. This highlights the need for instruments that assess aggression’s manifestation across contexts to enable a more comprehensive understanding of the phenomenon. Objective: To assess the psychometric properties of the Bullying at School and Bullying during Leisure subscales from the Questionnaire for Assessing Peer Violence in School and Leisure Settings (CEVEO) in Chilean adolescents, and to examine differences in MD among perpetrator profiles based on both frequency and context of aggression. Method: Instrumental, multivariate, cross-sectional, quantitative, and correlational design. The sample comprised 864 Chilean students (M age = 15.4; SD age = 1.3). Girls represented 58% of the sample. Results: A 13-item unifactorial model was supported for both subscales, with good internal consistency. Scores correlated positively with MD, and boys scored higher than girls on both subscales. Three profiles were identified: (1) no high aggression; (2) high aggression in one context; and (3) high aggression in two contexts. MD increased with the number of contexts, regardless of aggression frequency. Conclusions: Findings provide validity evidence for the CEVEO bullying subscales in Chilean adolescents, based on their internal structure, associations with external variables, and reliability. The instrument is useful for detecting violence across settings and identifying profiles based on the contextual extent of aggression. Full article
(This article belongs to the Special Issue Youth Vulnerability and Maladjustment: A Look at Its Effects)
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14 pages, 1179 KB  
Review
Gonadotropins in Mini-Puberty: Pathophysiological and Therapeutic Implications for Male Congenital Hypogonadism
by Ignazio Cammisa, Donato Rigante and Clelia Cipolla
Children 2026, 13(1), 133; https://doi.org/10.3390/children13010133 - 15 Jan 2026
Viewed by 257
Abstract
Background: Mini-puberty is a transient but critical postnatal activation of the hypothalamic–pituitary–gonadal axis, essential for male gonadal maturation, penile and testicular growth, and future reproductive potential: this physiological hormonal surge is absent or blunted in congenital hypogonadotropic hypogonadism (CHH), often manifesting as micropenis, [...] Read more.
Background: Mini-puberty is a transient but critical postnatal activation of the hypothalamic–pituitary–gonadal axis, essential for male gonadal maturation, penile and testicular growth, and future reproductive potential: this physiological hormonal surge is absent or blunted in congenital hypogonadotropic hypogonadism (CHH), often manifesting as micropenis, cryptorchidism, and impaired Sertoli cell proliferation. Objective: The aim of this review is to summarize current evidence on the impact of early gonadotropin therapy in male infants with CHH. Methods: We conducted a comprehensive literature review using PubMed, including studies reporting on male infants with confirmed or suspected CHH receiving gonadotropin therapy. Keywords included “mini-puberty and hypogonadism”, “gonadotropins and infancy,” and “gonadotropin therapy in CHH.” Eligible studies reported biochemical outcomes (luteinizing hormone, follicle-stimulating hormone, testosterone, inhibin B, anti-Müllerian hormone) and clinical measures (penile length, testicular volume, testicular descent). Data extraction focused on endocrine responses, genital growth, and safety. Results: Twelve studies including 95 infants were analyzed. Early gonadotropin therapy effectively restored postnatal hormonal levels, with consistent increases in testosterone, inhibin B, and anti-Müllerian hormone. Clinically, treatment induced significant penile growth, increased testicular volume and partial or complete testicular descent in the majority of cases. Both continuous infusion and intermittent injection regimens were effective, though hormone kinetics and growth responses varied. No serious adverse events were reported, and therapy was generally well tolerated. Conclusions: Early gonadotropin therapy during mini-puberty represents a safe and effective intervention to replicate the physiological postnatal hormonal surge in male infants with CHH. Prospective longitudinal studies are warranted to evaluate sustained effects on puberty, fertility, and adult reproductive function. Full article
(This article belongs to the Section Pediatric Endocrinology & Diabetes)
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14 pages, 226 KB  
Article
Arabic Mothers’ Experiences Using Complementary and Alternative Medicine for Children with Autism Spectrum Disorder: A Qualitative Study
by Mais Hatahet and Attila Sárváry
Children 2026, 13(1), 132; https://doi.org/10.3390/children13010132 - 15 Jan 2026
Viewed by 290
Abstract
Background/Objectives: Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental disorder characterized by social, communication, and behavioral challenges. complementary and alternative medicine (CAM) is widely used by parents worldwide, yet research exploring parents’ experiences, particularly in Arab countries, is limited. This study explored mothers’ [...] Read more.
Background/Objectives: Autism Spectrum Disorder (ASD) is a lifelong neurodevelopmental disorder characterized by social, communication, and behavioral challenges. complementary and alternative medicine (CAM) is widely used by parents worldwide, yet research exploring parents’ experiences, particularly in Arab countries, is limited. This study explored mothers’ perceptions and experiences of CAM use for children with ASD, information-seeking behaviors and challenges encountered. Methods: A qualitative study using semi-structured interviews was conducted among twenty mothers at Autism Academy of Jordan in 2024. Inclusion criteria were mothers with children diagnosed with ASD for at least six months and those who had used at least one CAM therapy. Interviews were conducted via Skype, transcribed verbatim, and analyzed using NVivo 12 with inductive thematic analysis. Results: Three major themes emerged in this qualitative study: (1) mothers’ experiences with CAM and perceptions of benefit; (2) sources of information and decision-making processes; and (3) main challenges in selecting and implementing CAM. Mothers reported using therapies such as honey, black seed, camel milk, Hujama, olive oil, supplements, and region-specific programs like Andalosiah. Faith, cultural beliefs, and the desire for natural, safe interventions strongly influenced CAM selection. Internet searches and social media groups were primary information sources. Challenges included financial, logistical, emotional burdens, and lack of trustworthy, Arabic-language information sources. Conclusions: Mothers in Arab countries navigate CAM use for their children with ASD through culturally and religiously informed practices. Interventions should focus on developing evidence-based guidance, culturally sensitive counseling, and accessible information to support families in safe, informed CAM use. Full article
(This article belongs to the Special Issue Health Behaviour, Health Literacy and Mental Health in Children: 3rd Edition)
16 pages, 3840 KB  
Article
Resin Infiltration for Anterior Teeth Affected by Molar Incisor Hypomineralization in Children and Adolescents: A Clinical Study of Color Masking, Sensitivity, and Aesthetic Perception: A Prospective Single-Arm Interventional Clinical Study
by María Dolores Casaña-Ruiz, Mª Ángeles Vello-Ribes and Montserrat Catalá-Pizarro
Children 2026, 13(1), 131; https://doi.org/10.3390/children13010131 - 15 Jan 2026
Viewed by 229
Abstract
Background/objective: To evaluate the effectiveness of resin infiltration in managing anterior molar incisor hypomineralization (MIH) defects, focusing on color improvement, lesion size reduction, sensitivity outcomes and patient aesthetic perception. Enamel defects in MIH result from a combination of environmental, systemic, and genetic factors, [...] Read more.
Background/objective: To evaluate the effectiveness of resin infiltration in managing anterior molar incisor hypomineralization (MIH) defects, focusing on color improvement, lesion size reduction, sensitivity outcomes and patient aesthetic perception. Enamel defects in MIH result from a combination of environmental, systemic, and genetic factors, indicating a multifactorial etiology. These defects, particularly in anterior teeth, pose significant aesthetic and emotional challenges due to their high visibility. This study provides one of the few prospective clinical evaluations of resin infiltration for anterior MIH lesions, assessing not only objective clinical outcomes but also patients’ aesthetic perception. It further introduces a patient-centered approach by comparing aesthetic evaluations made by children and dental professionals over time. Methods: A total of 109 MIH-affected anterior teeth were treated using Icon® resin infiltration (DMG, Hamburg, Germany) in this registered prospective clinical study (ClinicalTrials.gov: NCT05597956). Participants were classified as children (6–12 years) and adolescents (13–17 years) according to standard pediatric age definitions. Of these, 101 teeth were available for evaluation at the 6-month follow-up due to patient loss to follow-up. The evaluation included photographic follow-up, measurement of lesion size and color, and assessment of sensitivity. During follow-up visits, patients rated the appearance of their lesions using the FDI scale. Results: Before treatment, spectrophotometric analysis showed that lesions exhibited a reddish hue (mean a* = 2.12), were distinctly yellowish (mean b* = 23.20), and clearly differed from surrounding enamel (ΔE = 8.62). The brightness level (L* = 69.81) indicated medium-high luminosity. Lesion size was reduced by an average of 4.5 percentage points. Significant increases in L values and reductions in a* and b* components were observed, with clinically perceptible ΔE changes. Sensitivity improved in 36.6% of patients, who reported a 1–2 point decrease on the SCASS. Moreover, patients’ aesthetic perception significantly improved after Icon® infiltration resin. Conclusions: Resin infiltration produced noticeable improvements in color, reduced lesion size and sensitivity, and enhanced aesthetic perception, making it a valuable treatment option for managing MIH-affected anterior teeth in children. Full article
(This article belongs to the Section Pediatric Dentistry & Oral Medicine)
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