Children

10 pages, 810 KB

Open AccessArticle

Kangaroo Care on High-Frequency Jet Ventilation: Overcoming Perceived Barriers in Micro Preemies with Birth Weights Less than 750 Grams

by Aparna Patra, Pratibha Thakkar, Lisa D. McGee, Prasad Bhandary, Peter J. Giannone and Elie G. Abu Jawdeh

Children 2026, 13(2), 310; https://doi.org/10.3390/children13020310 - 23 Feb 2026

Viewed by 1946

Abstract

Objective: Kangaroo care (KC) is underutilized in preterm infants on ventilator support due to perceived physiologic instability. The objective of our study is to demonstrate the feasibility of safe KC provision on high-frequency jet ventilation (HFJV) in micro preemies weighing less than 750 [...] Read more.

Objective: Kangaroo care (KC) is underutilized in preterm infants on ventilator support due to perceived physiologic instability. The objective of our study is to demonstrate the feasibility of safe KC provision on high-frequency jet ventilation (HFJV) in micro preemies weighing less than 750 g. Study Design: Our neonatal intensive care unit has a multidisciplinary clinical standard for KC while preterm infants are on HFJV (HFJV-KC). Bedside staff documented cardiorespiratory and physiologic parameters pre, during, and post HFJV-KC. We performed a retrospective assessment of the feasibility of HFJV-KC in the micro preemie population. Results: A total of 96 HFJV-KC occurrences from 13 neonates with median gestational age 24 1/7 weeks and birth weight of 670 g were included. There were no significant differences in heart rate and temperature pre, during, and post-HFJV-KC. There were statistically significant improvements in oxygen saturation and fraction of inspired oxygen post HFJV-KC. Secondary analyses of prolonged HFJV-KC beyond 1 h (mean 2.3 h) compared to the standard 1 h duration also showed no differences in outcome measures. Conclusions: This study demonstrates that KC may be performed in the smallest micro preemie infants (<750 g) on HFJV. Our study also presents processes to overcome perceived barriers of HFJV-KC implementation in a vulnerable population. Full article

(This article belongs to the Section Pediatric Neonatology)

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17 pages, 562 KB

Open AccessEditor’s ChoiceArticle

Enhancing Parent–Child Interaction and Self-Efficacy in Motor Skills Development for Young Children with Developmental Delays

by Yu-Lin Lai, Szu-Yin Chu, I-Huei Lee and Hsiu-Wen Yang

Children 2026, 13(2), 309; https://doi.org/10.3390/children13020309 - 23 Feb 2026

Cited by 1 | Viewed by 3015

Abstract

Background/Objectives: The present study investigated the effects of parental participation in home program intervention on parent–child interactions, parental self-efficacy, and the goal attainment of children with developmental delays in motor skills. Methods: While the interviews consisted of qualitative data, quantitative analyses [...] Read more.

Background/Objectives: The present study investigated the effects of parental participation in home program intervention on parent–child interactions, parental self-efficacy, and the goal attainment of children with developmental delays in motor skills. Methods: While the interviews consisted of qualitative data, quantitative analyses were applied to the results, making this a mixed-methods study. Participants were 2–6-year-old young children and their families. Twenty-three parent–child dyads were randomly assigned to an intervention group (n = 13) or a comparison group (n = 10). Outcomes were evaluated using the Parent–Child Interaction Questionnaire and Parental Self-Efficacy Questionnaire. Results: Improvements in parental self-efficacy and in the Goal Attainment Scale scores of the children were evident in the posttest, whereas no evidence of differences in improvement was found in parent–child interactions between the intervention and comparison groups on the pretest and posttest. Conclusions: Parent collaboration with therapists has a significant impact on achieving functional goals for young children, and parental involvement in intervention programs effectively enhances parental self-efficacy. Full article

(This article belongs to the Special Issue Health Care in Children with Disabilities)

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18 pages, 262 KB

Open AccessArticle

Self-Reported Well-Being and Health Among Deaf and Hard-of-Hearing Adolescents in Mainstream Schools: A Swedish School Survey Study

by Sylvia Olsson and Carina Loeb

Children 2026, 13(2), 308; https://doi.org/10.3390/children13020308 - 23 Feb 2026

Cited by 1 | Viewed by 2396

Abstract

Background: Deaf and hard-of-hearing (DHH) adolescents in mainstream schools may face communication barriers and social challenges that can affect their well-being and health. However, population-based knowledge based on adolescents’ own reports—particularly including those with additional disabilities—remains limited. The aim of this study was [...] Read more.

Background: Deaf and hard-of-hearing (DHH) adolescents in mainstream schools may face communication barriers and social challenges that can affect their well-being and health. However, population-based knowledge based on adolescents’ own reports—particularly including those with additional disabilities—remains limited. The aim of this study was to assess self-reported well-being, mental health complaints, somatic complaints, and perceived teacher support among DHH adolescents in Swedish mainstream schools and to compare these outcomes with those of hearing adolescents and DHH adolescents with additional disabilities. Methods: This cross-sectional study was based on data from the Swedish school survey Liv och Hälsa Ung (Life and Health of Young People). The sample comprised 5923 adolescents aged 13–18 years attending grades 7 and 9 in compulsory school and year 2 in upper-secondary school. Outcomes included well-being (WHO-5 or a single-item measure for grade 7), mental health complaints, somatic complaints, and perceived teacher support. Group differences by hearing status, additional disability, gender, and school level were examined using analysis of variance (ANOVA). Results: Hearing adolescents reported higher well-being, fewer somatic complaints, fewer mental health complaints, and higher perceived teacher support compared with DHH adolescents. DHH adolescents with additional disabilities consistently reported the poorest outcomes across all domains. For example, perceived teacher support was significantly lower among DHH adolescents with additional disabilities (M = 3.66, 95% CI [3.54–3.78]) compared with hearing adolescents (M = 4.01, 95% CI [3.99–4.03]). Across all groups, girls, particularly those with disabilities, reported poorer well-being and higher levels of somatic and mental health complaints than boys. Conclusions: The findings highlight substantial health disparities among adolescents with hearing loss in mainstream schools, especially among those with additional disabilities. Perceived teacher support emerged as an important contextual factor and may represent a key target for school-based interventions aimed at promoting well-being and mental health among DHH adolescents. Full article

(This article belongs to the Special Issue Health Care in Children with Disabilities)

13 pages, 228 KB

Open AccessProtocol

Prevalence, Incidence, and Risk of Different Comorbidity Categories in Pediatric Multiple Sclerosis: A Systematic Review and Meta-Analysis Protocol

by Sara Samadzadeh, Moein Mirzai, Aysan Valinejad Qanati, Andrea Icks and Charalabos-Markos Dintsios

Children 2026, 13(2), 307; https://doi.org/10.3390/children13020307 - 23 Feb 2026

Viewed by 1208

Abstract

Background/Objectives: Pediatric-onset multiple sclerosis (POMS), defined as onset before age 18, is increasingly recognized as a distinct entity, often associated with a more burdensome disease course and earlier disability milestones than adult-onset MS. Although comorbidities may significantly affect disease progression and outcomes, their [...] Read more.

Background/Objectives: Pediatric-onset multiple sclerosis (POMS), defined as onset before age 18, is increasingly recognized as a distinct entity, often associated with a more burdensome disease course and earlier disability milestones than adult-onset MS. Although comorbidities may significantly affect disease progression and outcomes, their prevalence, incidence, risk, and characteristics in POMS remain poorly understood. To date, no systematic review has comprehensively evaluated comorbidities in POMS. The primary aim is to systematically identify and synthesize available evidence on the prevalence, incidence, risk, and characteristics of these comorbidities in POMS populations, as well as any reported effects on disease course, treatment outcomes, and overall clinical management. Methods: We will conduct a systematic review and meta-analysis following a hierarchical and pragmatic analytical strategy tailored to the expected heterogeneity and limited evidence base in POMS. MEDLINE (via PubMed) and Embase (produced by Elsevier) will be searched without date restrictions, combining controlled vocabulary terms (MeSH/Emtree) and relevant keywords for POMS and 15 predefined comorbidity categories. Study selection, abstract and full-text screening, and data extraction will be performed independently by two reviewers using predefined criteria and standardized forms. The primary quantitative outcome will be the pooled prevalence of comorbidities. Where study design and reporting permit, incidence rates will be assessed as secondary outcomes, and risk estimates (e.g., odds ratios) will be evaluated only in studies with appropriate comparator groups. Meta-analyses will be conducted using random-effects models when pooling is feasible. Heterogeneity will be assessed using the I² statistic and Cochran’s Q test, with sensitivity and subgroup analyses performed only when sufficient data are available. When quantitative synthesis is not appropriate due to limited data or substantial heterogeneity, findings will be summarized descriptively. Publication bias will be evaluated using funnel plots and, where applicable, Egger’s and Begg’s tests. This protocol adheres to PRISMA and PRISMA-P guidelines. Discussion: A systematic quantification of comorbidity prevalence, incidence (where available), and risk, together with POMS-specific characteristics and any reported impact on clinical outcomes, is anticipated to provide a crucial evidence base for guiding screening, refining management strategies, and informing future research directions. Ultimately, these findings may improve clinical outcomes and quality of life for children and adolescents with MS. Full article

19 pages, 348 KB

Open AccessEditor’s ChoiceArticle

Associations Between Body Mass Index, Movement Behaviors, Motor Skills, Inhibition and Visuospatial Working Memory in Preschool Children: A Cross-Sectional Study Based on WHO References

by Mohamed Amine Ltifi, Kacem Nejah, Fadhel Hammami, Monica Delia Bîcă, Anna Zwierzchowska, Michal Wilk, Dan Iulian Alexe and Mohamed-Souhaiel Chelly

Children 2026, 13(2), 306; https://doi.org/10.3390/children13020306 - 23 Feb 2026

Cited by 3 | Viewed by 1868

Abstract

Background: Early childhood represents a key stage for the development of movement behaviors (MB), motor skills (MS), and executive functions (EF). Body Mass Index (BMI), defined according to World Health Organization (WHO) references, may influence these domains early in life. In this context, [...] Read more.

Background: Early childhood represents a key stage for the development of movement behaviors (MB), motor skills (MS), and executive functions (EF). Body Mass Index (BMI), defined according to World Health Organization (WHO) references, may influence these domains early in life. In this context, this cross-sectional observational study aimed to examine the associations between BMI and 24-h MB, MS, and EF in Tunisian preschool children aged 4 to 5 years. Methods: This cross-sectional observational study included 112 Tunisian children aged 4 to 5 years (50 boys, 62 girls), recruited from kindergartens in urban and rural areas. Anthropometric measurements were used to calculate age-specific BMI z-scores and classify children into three BMI categories: below normal, normal, and above normal. Twenty-four-hour MB physical activity (PA), sedentary behavior (SB), and sleep were objectively assessed using accelerometry over five consecutive days. EF (inhibition and working memory) were assessed using standardized cognitive tests, gross MS were evaluated using the Supine Timed Up and Go test (functional mobility), One-Leg Standing Balance test (postural steadiness), Hand Grip Dynamometer (upper body strength), and Standing Long Jump (lower body strength), and fine MS were assessed using the 9-Hole Pegboard Test (dexterity). All tools are validated and standardized for children. Results: Significant differences between BMI categories were observed for anthropometric variables (p < 0.05). In contrast, no significant differences were found for 24-h MB, adherence to recommendations, EF, and MS (p > 0.05). Only Sleep duration showed a difference significantly between BMI < normal and BMI > normal (p = 0.022). Conclusions: In Tunisian preschool children, weight status is primarily associated with differences in physical growth, with no marked relationship to MB, EF, or MS. These findings highlight the importance of universal preventive interventions, particularly focusing on growth monitoring, starting in early childhood. These results should be interpreted with caution and highlight the need for further studies on larger populations to better understand the relationships between BMI, PA, and development in young children. Full article

(This article belongs to the Special Issue Fundamental Movement/Motor Skills—the Bridging Element Between Motor Development Milestones and Physical Activity)

17 pages, 535 KB

Open AccessSystematic Review

Dual-Level Ureteral Obstruction in Children: A Systematic Review Highlighting Diagnostic Challenges and Optimal Surgical Strategy

by Olivia-Oana Stanciu, Andreea Moga, Radu Balanescu and Mircea Andriescu

Children 2026, 13(2), 305; https://doi.org/10.3390/children13020305 - 22 Feb 2026

Cited by 3 | Viewed by 1330

Abstract

Background: Ipsilateral concomitant ureteropelvic junction (UPJ) and ureterovesical junction (UVJ) obstruction is an uncommon but clinically important pediatric condition. Because standard imaging often detects only one level of obstruction, the coexistence of both lesions is frequently overlooked. Delayed diagnosis may result in persistent [...] Read more.

Background: Ipsilateral concomitant ureteropelvic junction (UPJ) and ureterovesical junction (UVJ) obstruction is an uncommon but clinically important pediatric condition. Because standard imaging often detects only one level of obstruction, the coexistence of both lesions is frequently overlooked. Delayed diagnosis may result in persistent hydronephrosis, recurrent urinary tract infections, and progressive renal injury. This systematic review synthesizes current evidence regarding diagnostic challenges, management strategies, and outcomes in children with dual UPJ–UVJ obstruction. Methods: A systematic review following PRISMA 2020 guidelines was conducted and prospectively registered in PROSPERO. Major databases were searched for studies describing pediatric patients with confirmed ipsilateral UPJ + UVJ obstruction. Extracted data included clinical presentation, diagnostic pathways, imaging modalities, timing of diagnosis, surgical sequencing, and postoperative outcomes. Results: Across the 8 included studies, preoperative recognition of dual obstruction was uncommon. Most cases were diagnosed intraoperatively when retrograde stent passage failed or postoperatively when hydronephrosis persisted after an apparently adequate first procedure. Retrograde or antegrade pyelography consistently outperformed ultrasonography and diuretic renography in identifying distal pathology. Staged repair—typically beginning with pyeloplasty—emerged as the most reliable approach, as correction of the proximal obstruction alone frequently improved distal drainage. UVJ-first strategies were less effective and often required secondary pyeloplasty. Endoscopic and minimally invasive techniques showed promise in selected patients but were reported in limited numbers with short follow-up. Functional renal outcomes generally stabilized or improved following complete correction, particularly when intervention occurred early in life. Conclusions: Dual UPJ–UVJ obstruction remains a diagnostic challenge in pediatric urology. Complementing standard imaging with contrast pyelography and maintaining vigilance during intraoperative stent placement can improve detection. Available reports suggest that a staged proximal-first surgical strategy can optimize drainage and reduce the risk of unnecessary distal reconstruction. Early intervention appears beneficial for renal recovery, though long-term outcomes remain insufficiently studied. Ongoing follow-up is essential, particularly in children with recurrent urinary tract infections or persistent hydronephrosis. Full article

(This article belongs to the Section Pediatric Surgery)

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21 pages, 326 KB

Open AccessArticle

Practices and Challenges in Portuguese Early Childhood Intervention: A Descriptive Study

by Cristina Costeira, Inês Lopes, Saudade Lopes, Vanda Varela Pedrosa, Susana Custódio, Elisabete Cioga and Cândida G. Silva

Children 2026, 13(2), 304; https://doi.org/10.3390/children13020304 - 22 Feb 2026

Viewed by 1649

Abstract

Background/Objectives: Early Childhood Intervention (ECI) services are critical for supporting children with developmental needs and their families. Despite an established legislative framework, challenges related to accessibility, equity, resources, and standardization of practices persist. This study aimed to describe the perspectives of early intervention [...] Read more.

Background/Objectives: Early Childhood Intervention (ECI) services are critical for supporting children with developmental needs and their families. Despite an established legislative framework, challenges related to accessibility, equity, resources, and standardization of practices persist. This study aimed to describe the perspectives of early intervention professionals in Portugal regarding current barriers, facilitators, and priority areas for improvement within the system. Methods: A descriptive study was conducted involving 82 professionals working in early intervention in Portugal. Data were collected using a survey specifically developed by the research team, grounded in a comprehensive literature review and professional expertise. The instrument was validated through a Delphi Panel with two rounds involving six experts in ECI. Data from open-ended questions were analyzed using content analysis, identifying categories and sub-categories to describe the responses, and descriptive statistics for the closed-ended questions. Results: Professionals highlighted the need to update the National ECI System (SNIPI), improve accessibility, and ensure equitable access to early intervention services. Participants reported limited resources, a lack of standardization in practices, and emphasized the importance of professional training and continuous professional development. The findings also pointed to the urgent need for investment and functional and structural restructuring of early intervention services. Various barriers and facilitators were identified. Conclusions: The study provides valuable insights into the perspectives of early intervention professionals, identifying critical areas for policy improvement, resource allocation, and practice standardization. Full article

(This article belongs to the Special Issue Optimizing Evidence-Based Interventions for Enhancing Development in Early Childhood)

24 pages, 365 KB

Open AccessReview

Callous–Unemotional Traits and Their Association with Neurodevelopmental Disorders: Insights from Gaze Behaviour During Emotion Recognition

by Astrid Priscilla Martinez-Cedillo, Christian A. Delaflor Wagner, Lilia Albores-Gallo and Tom Foulsham

Children 2026, 13(2), 303; https://doi.org/10.3390/children13020303 - 22 Feb 2026

Cited by 2 | Viewed by 3744

Abstract

Callous–unemotional (CU) traits are characterised by reduced empathy, guilt, and emotional responsiveness, and are strongly linked to atypical socioemotional processing. Eye-tracking research provides a valuable window into these processes by capturing early developing patterns of attention to emotionally salient social cues, particularly facial [...] Read more.

Callous–unemotional (CU) traits are characterised by reduced empathy, guilt, and emotional responsiveness, and are strongly linked to atypical socioemotional processing. Eye-tracking research provides a valuable window into these processes by capturing early developing patterns of attention to emotionally salient social cues, particularly facial expressions. This narrative review examines how alterations in gaze behaviour contribute to the emergence of CU traits across neurodevelopmental disorders (NDs), with a focus on autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and conduct disorder (CD). Across studies, elevated CU traits are associated with reduced fixations on the eye region, most consistently in response to fearful faces. ASD is associated with robust eye avoidance, ADHD with inhibitory and attentional control difficulties during face processing, and CD with atypical gaze allocation to negative emotional expressions such as fear and anger. These patterns appear amplified when CU traits co-occur with NDs. Competing explanatory accounts, including aberrant amygdala functioning, oculomotor disinhibition, and hostile attribution biases, each capture aspects of these patterns but fail to provide a unified explanation. Integrating developmental, neurobiological, and environmental perspectives, we propose that CU traits reflect a transdiagnostic developmental construct shaped by early attentional–emotional mechanisms, rather than a disorder-specific identity. Full article

(This article belongs to the Section Pediatric Mental Health)

11 pages, 607 KB

Open AccessArticle

Peak Flow Meter and Spacer Use in Adolescents with Asthma: More than Just Ownership

by Hyekyun Rhee and Nattasit Katchamat

Children 2026, 13(2), 302; https://doi.org/10.3390/children13020302 - 22 Feb 2026

Viewed by 1049

Abstract

Background: Effective self-management is essential for optimizing asthma control. Although peak flow meters (PFMs) and spacers are recommended to support self-management, the associations between device use patterns and asthma outcomes remain unclear. This study aims to examine the ownership and use of devices [...] Read more.

Background: Effective self-management is essential for optimizing asthma control. Although peak flow meters (PFMs) and spacers are recommended to support self-management, the associations between device use patterns and asthma outcomes remain unclear. This study aims to examine the ownership and use of devices among adolescents with asthma and their associations with asthma exacerbations in the past 12 months and asthma control. Methods: Cross-sectional data from 373 inner-city adolescents with asthma were analyzed. Participants reported PFM or spacer ownership and their frequency of use. Exacerbation history was determined based on oral corticosteroid use, hospitalizations, and emergency department visits in the past 12 months. Asthma control was assessed using the Asthma Control Questionnaire. Chi-square tests and independent t-tests were used to examine associations among device ownership, use frequency, asthma control, and exacerbations. Results: Ownership rates were 36% for PFMs and 61.6% for spacers. Ownership of both devices was negatively associated with asthma exacerbations in the past year (all p < 0.001). Regular use was reported by only 15.2% of PFM owners and 40.2% of spacer owners. Regular users did not differ from infrequent users in exacerbation history but reported significantly poorer asthma control (PFM: p = 0.007; spacer: p < 0.001). Conclusions: Adolescents’ ownership of peak flow meters and spacers remains suboptimal, and the routine adoption of these devices is limited. Adolescents with exacerbations in the past year were more likely to own devices but use them infrequently. Regular use was associated with poorer asthma control, suggesting reactive rather than preventive use. Findings highlight the need for improved education on preventive device use, enhanced training in proper use, and proactive integration of devices into adolescent asthma self-management. Full article

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18 pages, 428 KB

Open AccessArticle

Prognostic Factors of Dysphagia and Recovery Following Pediatric Acquired Brain Injury

by Suhad Bishara, Oshrat Sella Weiss, Saja Hejla-Assi, Tmira Nachum and Sharon Shaklai

Children 2026, 13(2), 301; https://doi.org/10.3390/children13020301 - 21 Feb 2026

Cited by 1 | Viewed by 1485

Abstract

Objectives: Dysphagia is a major complication of acquired brain injury (ABI) in children; however, its trajectory and prognostic indicators remain insufficiently characterized. This study aimed to identify predictors of dysphagia and its recovery following pediatric ABI. Methods: This retrospective study included all children [...] Read more.

Objectives: Dysphagia is a major complication of acquired brain injury (ABI) in children; however, its trajectory and prognostic indicators remain insufficiently characterized. This study aimed to identify predictors of dysphagia and its recovery following pediatric ABI. Methods: This retrospective study included all children admitted with ABI to tertiary pediatric rehabilitation center between 2014 and 2017. Data were collected from electronic medical records. Results: One hundred children aged 2:00–17:11 years were included; 61% had dysphagia at admission. Participants with dysphagia received speech–language pathology (SLP) treatment, with a recovery rate of 78.68%. Treatment duration was significantly shorter among children who recovered (36 days) compared with those who did not (136 days; p < 0.001). Dysphagia at admission was associated with mechanical ventilation, duration of unconsciousness, duration of acute hospitalization, CNS tumor etiology, cranial nerve impairment (V, IX, X, XII), voice and speech impairments, and cognitive and behavioral impairments. Logistic regression showed that reduced consciousness, cranial nerve impairment, voice disorders, and CNS tumors explained 70.6% of dysphagia likelihood. Non-recovery was associated with unconsciousness, enteral feeding, hypoglossal injury, and dysphagia severity at admission. Level of consciousness at admission explained 33.7% of recovery likelihood. Conclusions: Dysphagia was highly prevalent among children with ABI. Recovery rates following SLP treatment were high and were associated with level of consciousness at admission to rehabilitation. Full article

(This article belongs to the Special Issue Advancing Physical Rehabilitation for Children and Adolescents)

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19 pages, 259 KB

Open AccessArticle

Adapting Instead of Reacting: A Qualitative Study Exploring Parenting Strategies for Childhood Emotional Disturbance

by Michelle L. Nighswander

Children 2026, 13(2), 300; https://doi.org/10.3390/children13020300 - 21 Feb 2026

Viewed by 1128

Abstract

Background: Children with emotional disturbance (ED) frequently display highly unpredictable behaviors compared to other children. The magnitude and unpredictability of childhood ED make finding effective management strategies difficult for parents. Prior research has examined parents’ stress and the children’s behaviors in schools, but [...] Read more.

Background: Children with emotional disturbance (ED) frequently display highly unpredictable behaviors compared to other children. The magnitude and unpredictability of childhood ED make finding effective management strategies difficult for parents. Prior research has examined parents’ stress and the children’s behaviors in schools, but we know very little about how parents manage at home. Methods: This qualitative study used Naturalistic Inquiry to explore how parents respond to the challenges which arise at home due to childhood ED. Eight mothers raising 10 children with ED were recruited nationally. Data were gathered through semi-structured, individual interviews. Results: Consequences-based parenting strategies were unsuccessful, but mothers achieved greater success with pre-planned, intentional responses and adapting the child’s environment. Mothers learned their child’s world view was very different than their own. This realization caused mothers’ perspective toward their child to change. Mothers saw their child as struggling with a problem, instead of simply being defiant. The perception shift allowed mothers to approach situations with greater compassion and inner peace. Conclusions: The findings provide suggestions for pediatric healthcare providers who work with such parents seeking assistance and advice. Full article

(This article belongs to the Special Issue Health Care in Children with Disabilities)

14 pages, 726 KB

Open AccessArticle

by Semine Ozdemir Dilek and Fatma Özgüç Comlek

Children 2026, 13(2), 299; https://doi.org/10.3390/children13020299 - 21 Feb 2026

Cited by 1 | Viewed by 1620

Abstract

Background/Objectives: The objective of this study is to determine the extent to which obesity alters the diagnostic reliability of the clonidine stimulation test (CST) for growth hormone deficiency (GHD) and whether incorporating insulin-like growth factor 1 (IGF-1) and the annual growth velocity standard [...] Read more.

Background/Objectives: The objective of this study is to determine the extent to which obesity alters the diagnostic reliability of the clonidine stimulation test (CST) for growth hormone deficiency (GHD) and whether incorporating insulin-like growth factor 1 (IGF-1) and the annual growth velocity standard deviation score (GV SDS) improves diagnostic precision. Methods: This retrospective study included 101 children evaluated for short stature using the clonidine stimulation test, with serum GH concentrations determined by a two-site, solid-phase, enzyme-labeled chemiluminescent immunometric assay (Immulite 2000 XPi, Siemens Healthcare Diagnostics, USA). Diagnostic performance was compared between overweight/obese (n = 47) and normal-weight (n = 54) groups. A two-step algorithm was evaluated: Step 1 applied a GH peak threshold of <5 ng/mL; Step 2 integrated IGF-1 SDS < −1.5 and annual GV SDS < −2.0 among children with subthreshold GH responses. Results: The median GH peak was significantly lower in overweight/obese children (4.5 [IQR 2.0–7.4] vs. 8.2 [5.1–11.5] ng/mL; p = 0.043). Although sensitivity remained comparable (82.6% vs. 90.5%; p = 0.666), elevated BMI markedly reduced specificity (50.0% vs. 84.8%; p = 0.008) and overall accuracy (66.0% vs. 87.0%; p = 0.017). Overweight/obese children demonstrated a higher proportion of false-positive CST results than non-obese children (25.5% vs. 9.3%). Among obese children with a GH peak of <5 ng/mL (n = 31), Step 2, which integrates IGF-1 and GV, improved specificity from 50% to 75% and the positive predictive value from 61.3% to 84.2%, correctly reclassifying 9 of 12 children without GHD who would otherwise have been misdiagnosed based on CST alone. Conclusions: Fixed GH cutoffs may lead to the misclassification of GHD in children with elevated BMI. Obesity significantly reduces the specificity and diagnostic accuracy of CST, increasing false-positive results. A two-step approach integrating IGF-1 and GV improves diagnostic precision and helps to differentiate true GHD from obesity-related GH suppression. Full article

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

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13 pages, 988 KB

Open AccessArticle

Occlusal Relationships and Dental Changes in Mixed Dentition Patients Treated with Clear Aligners: A 2-Year Follow Up

by Francesca Gazzani, Chiara Pavoni, Francesca Chiara De Razza, Letizia Lugli, Saveria Loberto, Alessio Lachi, Paola Cozza and Roberta Lione

Children 2026, 13(2), 298; https://doi.org/10.3390/children13020298 - 21 Feb 2026

Viewed by 1119

Abstract

Background: This study assessed the long-term stability of dental arch changes achieved through clear aligner treatment in growing patients during the early mixed dentition stage. Methods: This retrospective study included 20 patients (mean age 8.3 ± 0.4 years) treated with clear aligners according [...] Read more.

Background: This study assessed the long-term stability of dental arch changes achieved through clear aligner treatment in growing patients during the early mixed dentition stage. Methods: This retrospective study included 20 patients (mean age 8.3 ± 0.4 years) treated with clear aligners according to a standardized sequential expansion protocol. No additional auxiliaries, interproximal reductions, or retentions were used. Dental casts were collected at baseline (T0), end of treatment (T1), and two years post-treatment without retention (T2). Linear and angular measurements (arch width, molar and incisor torque, Henry’s angle, overjet, overbite, and Little’s index) were assessed on digital models. Friedman ANOVA and Wilcoxon signed-rank tests were applied (α = 0.05). Results: At T1-T0, significant transversal expansion was achieved in both arches (U6–6 mesial +2.1 mm; L6–6 mesial +2.4 mm; p < 0.05), with favorable torque changes and a reduction in overjet (−1.5 mm). From T1 to T2, only minimal, non-significant relapse was detected, except for a slight reduction in lower left molar torque (−1.1°). The T2-T0 comparison confirmed stable improvements in mesial intermolar widths (upper +2.0 mm; lower +1.6 mm), molar derotations, and overjets (−1.9 mm), with no significant loss of expansion or sagittal correction. Conclusions: Clear aligners in early mixed dentition achieved significant and stable dental arch modifications over a 2-year follow-up without the use of retention appliances. This therapeutic approach may represent a reliable interceptive option in growing patients. Full article

(This article belongs to the Special Issue Early Dental Treatment in Children: A Focus on Behavior Intervention and Management)

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22 pages, 329 KB

Open AccessStudy Protocol

PURSUIT Protocol: Development of a Novel Approach to Managing Youth Physical and Mental Health in Schools

by Thea Senger-Carpenter, Jocelyn Zuckerman, Audrey Searles, Cara Poland, Crystal L. Cederna, Sarah Nelson, Mallet R. Reid, Kelly Theaker, Steven J. Pierce, Angela Chia-Chen Chen and Natoshia R. Cunningham

Children 2026, 13(2), 297; https://doi.org/10.3390/children13020297 - 21 Feb 2026

Viewed by 1122

Abstract

Background/Objectives: Physical and mental health symptoms commonly affecting children are often under-addressed given the limited availability of pediatric behavioral healthcare. Training school providers (e.g., nurses, mental health professionals) to address these concerns is a promising strategy to explore, considering the unique level of [...] Read more.

Background/Objectives: Physical and mental health symptoms commonly affecting children are often under-addressed given the limited availability of pediatric behavioral healthcare. Training school providers (e.g., nurses, mental health professionals) to address these concerns is a promising strategy to explore, considering the unique level of accessibility afforded by school settings. While our earlier work augmented school providers’ pain management skills, providers desired more comprehensive training and youth support tools. Our team of interdisciplinary academic researchers and community partners will bridge this gap by developing the PURSUIT (Preventing Use of Substances for the Underserved with Innovative Technology) provider training program and companion online self-management platform for youth and caregivers. This protocol paper describes our planned approach to developing, implementing, and evaluating the PURSUIT program. Methods: We will draw from evidence-based cognitive–behavioral, trauma-focused, and mindfulness protocols to develop a comprehensive provider training program and interactive online self-management platform for youth and caregivers. Content areas will include core cognitive–behavioral strategies and specific skills for pediatric pain management, trauma-focused care, and substance use prevention. Innovative technological approaches, such as live and animated videos, will be used to promote user engagement. Academic and community partners will have roles in material co-development. Outcomes of this project will include the PURSUIT training program and self-management platform feasibility and acceptability (e.g., completion/engagement rates, quantitative/qualitative reports), as well as the impact of the training program on provider knowledge and the impact of the self-management platform on youth/caregiver outcomes. Conclusions: Interdisciplinary collaboration and community engagement will be critical to developing and evaluating a provider training program and youth/caregiver self-management platform. Full article

(This article belongs to the Special Issue Health Behaviour, Health Literacy and Mental Health in Children: 3rd Edition)

14 pages, 1338 KB

Open AccessArticle

Prevalence and Recovery of Euthyroid Sick Syndrome in Pediatric Diabetic Ketoacidosis: A Retrospective Cohort Study

by Youssef A. Alqahtani, Ayed A. Shati, Ayoub A. Alshaikh, Abdullah Saeed Mohammed Raffaa, Abdulaziz Saeed Alqahtani, Fahad Abdullah Saeed Alshahrani, Mohammed Fahad Nasser Alshahrani, Mohammed Abdulrahman Al-Sultan, Abdulaziz Saud Alotaibi, Yazeed Sultan Alshahrani and Ramy Mohamed Ghazy

Children 2026, 13(2), 296; https://doi.org/10.3390/children13020296 - 20 Feb 2026

Cited by 1 | Viewed by 1306

Abstract

Background: Euthyroid sick syndrome (ESS) is a common finding in critically ill patients, including children with diabetic ketoacidosis (DKA). However, its prevalence, specific hormonal patterns, and recovery in the pediatric population remain inadequately characterized. This study aimed to determine the prevalence of ESS [...] Read more.

Background: Euthyroid sick syndrome (ESS) is a common finding in critically ill patients, including children with diabetic ketoacidosis (DKA). However, its prevalence, specific hormonal patterns, and recovery in the pediatric population remain inadequately characterized. This study aimed to determine the prevalence of ESS in pediatric DKA, characterize its hormonal subtypes, and identify factors associated with short-term thyroid function recovery. Methods: A retrospective cohort study was conducted involving 182 pediatric patients (0–18 years) with type 1 diabetes mellitus admitted for DKA between January 2023 and June 2025. Thyroid function tests (TSH, FT4, FT3) were measured at presentations and two weeks after DKA resolution. ESS was defined using age-specific reference ranges. Results: The prevalence of ESS at DKA presentation was 61.5% (112/182). Two distinct hormonal phenotypes were identified: isolated low FT3 (n = 40, 35.7%) and combined low FT4 and FT3 (n = 72, 64.3%). Patients with the isolated low FT3 pattern were significantly younger (median 9.5 [3.50, 11.00] vs. 12.0 [8.50, 14.00] years, p = 0.004) and had milder hormonal derangement than the combined group. Normalization of FT4 was significantly lower in children with severe DKA compared with those with mild/moderate disease (50.0% vs. 84.8%, p = 0.002). FT3 normalization was also reduced in the severe group (20.0% vs. 42.4%), although this difference did not reach statistical significance (p = 0.078). After 2 weeks, all ESS patients (100%) had achieved normal levels of at least one thyroid hormone, with 38.4% reaching normalization of FT3 and 36.6% achieving normalization of all measured thyroid parameters. Age (adjusted odds ratio [aOR] = 2.08, 95% confidence interval (CI): 1.57–3.06, p < 0.001) and baseline FT4 level (aOR = 2.14, 95% CI: 1.51–3.32, p < 0.001) were positive predictors for complete recovery. Conclusion: ESS is highly prevalent in pediatric DKA, with distinct phenotypic patterns associated with age and the severity of acute illness, particularly the degree of acidosis. While transient in nature, complete biochemical recovery within two weeks is not universal. These findings underscore that thyroid function tests during acute DKA should be interpreted with caution to avoid misdiagnosis of primary thyroid disease, and they support the critical practice of follow-up testing after metabolic stabilization instead of immediate hormone replacement. Full article

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

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13 pages, 656 KB

Open AccessReview

Cherubism: An African-Focused Review

by Salma Kabbashi, Imaan A. Roomaney, Martin Douglas-Jones, Karen Fieggen, Nakita Laing, Suvarna Indermun and Manogari Chetty

Children 2026, 13(2), 295; https://doi.org/10.3390/children13020295 - 20 Feb 2026

Viewed by 1366

Abstract

Cherubism is a rare fibro-osseous disorder of the jaws that typically presents in early childhood and is recognised as genetically heterogeneous. While the condition is well described in non-African populations, African data and molecular confirmation remain limited. Background/Objectives: This structured narrative review aimed [...] Read more.

Cherubism is a rare fibro-osseous disorder of the jaws that typically presents in early childhood and is recognised as genetically heterogeneous. While the condition is well described in non-African populations, African data and molecular confirmation remain limited. Background/Objectives: This structured narrative review aimed to synthesize published African cases of cherubism by describing patterns of presentation, diagnosis, management, and genetic investigation. Methods: A structured narrative literature review was conducted using PubMed, Scopus, Google Scholar, and African Journals Online. Peer-reviewed case reports and case series describing cherubism in African patients were included. Data extraction followed predefined criteria, capturing demographic features, age at onset and presentation, clinical, radiological and histological findings, management strategies, and the use of molecular genetic testing. Findings were synthesised descriptively. Results: Fourteen studies reporting 20 individual cases from eight African countries were identified, with the majority originating from North Africa. Although symptom onset most commonly occurred in early childhood, the median age at presentation for management was 13.75 years, suggesting delayed access to care. Molecular genetic testing was reported in only two cases, while most diagnoses relied on clinical, radiological, and histopathological features. Surgical intervention was commonly described, with fewer cases managed conservatively. Conclusions: Within the limitations of a structured narrative review based predominantly on published case reports and case series, and constrained by the scarcity of molecularly confirmed cases, the available African literature on cherubism remains limited in scope, geographically skewed, and characterised by incomplete genetic reporting. Recurring features include delayed presentation, reliance on clinical diagnosis, and limited use of molecular testing. These observations reflect gaps in reporting and genetic characterisation rather than population-level patterns, underscoring the need for improved molecular diagnostics, multidisciplinary care, and African registries. Full article

(This article belongs to the Special Issue Advances in Pediatric Genetic Disorders)

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12 pages, 455 KB

Open AccessArticle

Abnormalities on Spinal Magnetic Resonance Imaging in Children and Adolescents: A Two-Center Retrospective Cohort Study

by Heshen Delwar, Nina M. C. Mathijssen and Joost H. van Linge

Children 2026, 13(2), 294; https://doi.org/10.3390/children13020294 - 20 Feb 2026

Viewed by 1474

Abstract

Background/Objectives: Magnetic Resonance Imaging (MRI) is frequently used to evaluate back pain and other spinal indications in the pediatric population. However, the diagnostic value in the pediatric population remains unclear. This study aimed to determine the prevalence of spinal abnormalities detected by MRI [...] Read more.

Background/Objectives: Magnetic Resonance Imaging (MRI) is frequently used to evaluate back pain and other spinal indications in the pediatric population. However, the diagnostic value in the pediatric population remains unclear. This study aimed to determine the prevalence of spinal abnormalities detected by MRI in children and adolescents and to identify factors associated with MRI findings of added diagnostic value. Methods: A retrospective two-centre cohort study was conducted among 229 patients aged 0–16 years who underwent spinal MRI at two hospitals. MRI findings were classified into five categories: (1) no finding; (2) spinal incidental finding; (3) confirmed diagnosis with no additional information; (4) confirmed diagnosis/severity with additional information; and (5) new diagnosis. In categories 4 and 5, there was an added value of the MRI scan. Patients with and without added MRI findings were compared regarding age, gender, presence of night pain, exercise-dependent pain, sharp pain localization, trauma, neurological abnormalities, and symptom duration. Results: The prevalence of MRI abnormalities related to the patient’s complaints was 19.2%. When the ‘added value of MRI’ group is compared to the ‘no added value of MRI group’, neurological abnormalities (p = 0.009) and shorter symptom duration (p = 0.002) were statistically associated with abnormal MRI findings. Stratified analysis showed that MRIs provided added diagnostic value more frequently in patients with clinical indications other than chronic back pain. Most abnormalities were located in the lumbar spine, with spondylolysis/spondylolisthesis and discopathy as the most common findings. Conclusions: Although spinal MRIs frequently detected abnormalities, only a small proportion of MRIs revealed findings that provided added diagnostic or therapeutic value. This highlights the importance of developing clear criteria for spinal MRI use in children and adolescents to minimize unnecessary imaging, limit patient burden, and optimize healthcare resources. Full article

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

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20 pages, 519 KB

Open AccessReview

Personalizing Nutritional Therapy in Pediatric Oncology: The Role of Gut Microbiome Profiling and Metabolomics in Mitigating Mucositis and Enhancing Immune Response to Chemotherapy

by Piotr Pawłowski, Natalia Zaj, Kamil Iwaniszczuk, Izabela Grzelka, Wojciech Makuch, Emilia Samardakiewicz-Kirol, Aneta Kościołek and Marzena Samardakiewicz

Children 2026, 13(2), 293; https://doi.org/10.3390/children13020293 - 20 Feb 2026

Cited by 2 | Viewed by 1717

Abstract

Introduction: Intensive chemotherapy protocols and hematopoietic stem cell transplantation (HSCT) in children with cancer frequently lead to severe complications, such as mucositis and immune dysfunction. A growing body of evidence indicates that these complications are closely associated with the patient’s nutritional status and [...] Read more.

Introduction: Intensive chemotherapy protocols and hematopoietic stem cell transplantation (HSCT) in children with cancer frequently lead to severe complications, such as mucositis and immune dysfunction. A growing body of evidence indicates that these complications are closely associated with the patient’s nutritional status and the composition of the gut microbiome, which becomes profoundly destabilized as a result of cytotoxic therapy and antibiotic use. Background: The aim of this review is to critically evaluate the current state of knowledge on the interplay between gut dysbiosis, metabolomic profiles—with particular emphasis on short-chain fatty acids (SCFAs)—and treatment-related toxicity in pediatric patients, as well as to delineate pathways toward personalized nutritional therapy. Methods: A narrative review was conducted, including clinical and preclinical studies published between January 2015 and October 2025. PubMed/MEDLINE, Embase, Cochrane Library, and other databases were searched, focusing on changes in microbiome composition, correlations between gut-derived metabolites and the severity of complications (sepsis, graft-versus-host disease [GvHD], mucositis), and the effects of targeted nutritional interventions (probiotics, prebiotics, postbiotics, and fecal microbiota transplantation [FMT]) on microbiome modulation during anticancer therapy. Results: The analysis demonstrates that pediatric oncologic treatment leads to a marked reduction in microbial diversity, including the loss of protective Clostridiales taxa (e.g., Faecalibacterium), accompanied by an overgrowth of Proteobacteria pathobionts. Metabolomic profiling indicates that low SCFA levels (e.g., butyrate < 20–50 µmol/g) are a strong predictor of severe mucositis, prolonged neutropenia, and an increased risk of sepsis. Interventions aimed at restoring eubiosis and enhancing SCFA production show potential in strengthening the intestinal barrier, modulating immune responses, and enabling maintenance of the planned relative dose intensity (RDI) of chemotherapy by reducing treatment-related toxicity. Conclusions: Gut microbiome profiling and fecal metabolomics represent promising prognostic tools in pediatric oncology. There is an urgent need for further research employing “omics”-based approaches to develop precise, individually tailored nutritional protocols. Such strategies, including postbiotics and FMT, may minimize treatment-related adverse effects and improve long-term clinical outcomes in pediatric patients. Full article

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

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26 pages, 2300 KB

Open AccessReview

Promoting Functional Mobility in Individuals with Non-Ambulatory Cerebral Palsy: A Scoping Review of the MOVE Programme

by Riclef Schomerus, Ginny S. Paleg, Roslyn W. Livingstone, Britta Dawal and Liane Bächler

Children 2026, 13(2), 292; https://doi.org/10.3390/children13020292 - 20 Feb 2026

Viewed by 2796

Abstract

Background/Objective: Mobility Opportunities Via Education (MOVE) is a structured intervention to enhance independent mobility skills in individuals who are non-ambulatory. This study aims at identifying and mapping the literature related to the MOVE programme and to describe its content according to preselected categories, [...] Read more.

Background/Objective: Mobility Opportunities Via Education (MOVE) is a structured intervention to enhance independent mobility skills in individuals who are non-ambulatory. This study aims at identifying and mapping the literature related to the MOVE programme and to describe its content according to preselected categories, focusing on individuals with non-ambulatory cerebral palsy. Methods: A scoping review was conducted, with thirteen databases searched in May 2024, complemented by reference search and private databases; the search was updated in August 2025. Publications after 1985 were included without restrictions on language, population, or context. Two reviewers independently screened records and extracted data using qualitative content analysis. Results: From 6794 records, 228 publications in 15 languages were included, mainly from the United States and Europe. MOVE was developed in the 1980s during a shift towards age-appropriate, functional interventions for individuals with severe disabilities. It is an early task-specific, activity-based and family-centred approach with retrospectively proposed foundations in dynamic systems theory and motor learning. Implementation follows a structured six-step process, embedding mobility training into daily routines. MOVE has been implemented across populations, settings, and countries, particularly for non-ambulatory individuals with cerebral palsy. Full article

(This article belongs to the Special Issue Advances in Children with Cerebral Palsy and Motor Impairment)

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7 pages, 494 KB

Open AccessCase Report

A Portal-Rex Shunt Using Patent Proximal Main Portal Vein as Venous Inflow and Internal Jugular Vein as Conduit

by Irene Wen Hui Tu, Yang Yang Lee and Vidyadhar Padmakar Mali

Children 2026, 13(2), 291; https://doi.org/10.3390/children13020291 - 19 Feb 2026

Viewed by 1076

Abstract

Background: Extrahepatic portal vein obstruction (EHPVO) accounts for more than two thirds of pediatric portal hypertension. Rex shunt is the preferred surgical management, as it restores hepatopetal flow and minimizes or reverses liver dysfunction. Case Summary: We report surgical treatment of [...] Read more.

Background: Extrahepatic portal vein obstruction (EHPVO) accounts for more than two thirds of pediatric portal hypertension. Rex shunt is the preferred surgical management, as it restores hepatopetal flow and minimizes or reverses liver dysfunction. Case Summary: We report surgical treatment of EHPVO in a 9-year-old girl using portal-Rex shunt with internal jugular vein (IJV) as a conduit and the intact proximal main portal vein instead of the superior mesenteric vein as a venous inlet. Improvement in thrombocytopenia and reduction in splenic size were achieved post-operatively. The portal-Rex shunt remains patent with good hepatopetal flow at one year post-operation. Conclusions: The success of a portal-Rex shunt to selectively bypass EHPVO rests upon careful selection of inlet and outlet veins, as well as a conduit with good patency, such as the IJV. Full article

(This article belongs to the Section Pediatric Surgery)

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8 pages, 194 KB

Open AccessArticle

Is There a Place for Versius (CMR) Robotic Platform in Children?

by Marcin Losin, Andrzej Golebiewski and Piotr Czauderna

Children 2026, 13(2), 290; https://doi.org/10.3390/children13020290 - 19 Feb 2026

Viewed by 1112

Abstract

Introduction: Since its introduction in 1994, robot-assisted surgery has advanced significantly and has become a widely accepted tool in minimally invasive surgery. Over the past two decades, robotic technology has also been increasingly adopted in pediatric surgery. Currently, only two robotic systems are [...] Read more.

Introduction: Since its introduction in 1994, robot-assisted surgery has advanced significantly and has become a widely accepted tool in minimally invasive surgery. Over the past two decades, robotic technology has also been increasingly adopted in pediatric surgery. Currently, only two robotic systems are officially approved for pediatric use: the da Vinci surgical system and the Senhance system, both of which have certain limitations. To address these challenges, new robotic platforms such as the Versius system are being developed. Materials and Methods: Following approval from the institutional bioethics committee, a total of 14 pediatric patients underwent robotic-assisted surgery using the Versius robotic system between 10 June and 21 October 2024. Procedures included pyeloplasty, vascular hitch, and cholecystectomy. Results: Procedures with the Versius system were performed including children as young as six years of age and with body weight as low as 15 kg. All procedures were completed successfully without conversion to conventional laparoscopy or open surgery. No intraoperative complications were recorded. The overall postoperative complication rate was 21.4% (3/14 cases), including one anastomotic leak, one case of postoperative hematuria, and one case of postoperative ascites. Discussion: The Versius system represents a promising robotic platform for pediatric surgery, offering a different approach to robotic surgery through modularity, mobility, and compatibility with 5 mm instruments. However, several challenges remain, including prolonged setup and docking times, cable management issues, arm conflicts, and limited access to advanced instrumentation. Nevertheless, with ongoing technological development, robotic surgery is likely to play an increasingly important role in pediatric surgical care. Full article

(This article belongs to the Special Issue Innovation in Pediatric Surgery: From Robotic Procedures to Emerging Technologies)

19 pages, 526 KB

Open AccessArticle

Work–Family Conflict, Parental Mental Health, and Children’s Emotional and Behavioral Difficulties

by Vitória Dias, Sara Albuquerque, Ana Beato and Stephanie Alves

Children 2026, 13(2), 289; https://doi.org/10.3390/children13020289 - 19 Feb 2026

Viewed by 1952

Abstract

Background/Objectives: Work–family conflict (WFC) is a common stressor for working parents and has been associated with poorer child adjustment. However, the mechanisms linking WFC to young children’s emotional and behavioral difficulties remain insufficiently understood. This study examined whether parental mental health mediates the [...] Read more.

Background/Objectives: Work–family conflict (WFC) is a common stressor for working parents and has been associated with poorer child adjustment. However, the mechanisms linking WFC to young children’s emotional and behavioral difficulties remain insufficiently understood. This study examined whether parental mental health mediates the association between WFC and children’s emotional and behavioral difficulties in early childhood. Methods: This quantitative cross-sectional study was conducted in Portugal with 313 parents of children aged 18–72 months. Parents completed validated self-report measures of WFC, parental stress, depressive symptoms, parental self-efficacy, and children’s emotional and behavioral difficulties. Mediation and moderated mediation analyses were performed, testing children’s age (toddlers vs. preschool-aged) as a moderator. Results: Higher WFC was associated with greater emotional and behavioral difficulties in children (parents reported). This association was fully mediated by parental stress and depressive symptoms, whereas parental self-efficacy did not show a significant mediating effect. The indirect pathways were consistent across children’s age groups. Conclusions: The findings indicate that WFC may affect young children’s adjustment, primarily through its impact on parental psychological distress. Supporting parental mental health and reducing WFC may be key targets for early prevention and intervention. Full article

(This article belongs to the Special Issue Precision Treatment and Medication Strategies for Childhood Mental Illness)

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14 pages, 265 KB

Open AccessArticle

The Association Between Sleep and Home Accidents Among Preschool Children in Türkiye: A Case–Control Study

by Fatma Durak and Özlem Tezol

Children 2026, 13(2), 288; https://doi.org/10.3390/children13020288 - 19 Feb 2026

Viewed by 854

Abstract

Background: Both home accidents and sleep problems are prevalent health issues among young children. This study aimed to investigate the association between the sleep characteristics of both preschool children and their mothers and the occurrence of home accidents among children. Methods: In this [...] Read more.

Background: Both home accidents and sleep problems are prevalent health issues among young children. This study aimed to investigate the association between the sleep characteristics of both preschool children and their mothers and the occurrence of home accidents among children. Methods: In this analytical cross-sectional study, the home accident group consisted of 90 children who presented to the Mersin University Hospital Pediatric Emergency Department due to home accidents. The control group comprised 90 healthy children, matched for age and sex with the home accident group. Sleep patterns of both children aged 12–72 months and their mothers, as primary caregivers, were evaluated through face-to-face interviews with the mothers. Results: Each one-hour increase in the child’s total nocturnal sleep duration increased the risk of being in the home accident group by 1.63 times (95% CI: 1.19–2.21, p = 0.002). Conversely, each one-hour increase in the mother’s total nocturnal sleep duration reduced the risk of child home accidents by a factor of 0.72 (95% CI: 0.58–0.91, p = 0.006). Maternal excessive daytime sleepiness increased the risk of home accidents in children by 11.35 times (95% CI: 2.38–54.26, p = 0.002). Conclusions: Preschool children who have had home accidents and their mothers should be evaluated for sleep problems. To reduce the frequency and severity of injuries associated with home accidents, greater focus must be placed on improving the sleep hygiene of both children and their mothers. Full article

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

15 pages, 762 KB

Open AccessSystematic Review

Sodium Values During the First 10 Postnatal Days in Extremely-Low-Birth-Weight Infants and Long-Term Neurocognitive Outcomes: A Systematic Review

by Sara Beyen, Karel Allegaert, Thomas Salaets and Anke Raaijmakers

Children 2026, 13(2), 287; https://doi.org/10.3390/children13020287 - 19 Feb 2026

Viewed by 640

Abstract

Purpose: To synthesize all existing literature on the association between sodium disturbances during the first 10 days of life in Extremely-Low-Birth-Weight (ELBW) infants and the risk of developing severe intraventricular hemorrhage (IVH > grade 1) or long-term neurodevelopmental impairment. Methods: Applying systematic review [...] Read more.

Purpose: To synthesize all existing literature on the association between sodium disturbances during the first 10 days of life in Extremely-Low-Birth-Weight (ELBW) infants and the risk of developing severe intraventricular hemorrhage (IVH > grade 1) or long-term neurodevelopmental impairment. Methods: Applying systematic review (ID CDR42024622933) principles, five major databases were explored. Any study was included if it reported on ELBW infants, on serum sodium values within the first 10 postnatal days, or was related these to neurocognitive or neurodevelopmental outcomes. Results: Ten studies (13,276 infants) met inclusion criteria. Six studies evaluated the association between hypernatremia (>145 or >150 mmol/L) and severe IVH, and two reported a significant association. Among two studies studying hyponatremia (ranging <130 or <120 mmol/L), one found a significant association with severe IVH. Evidence regarding sodium fluctuations (difference between the maximum and minimum serum sodium values) identified fluctuations >13 mmol/L as a strong risk factor for severe IVH, while another study showed that glucose-corrected sodium fluctuations were independently associated with severe IVH. Long-term neurodevelopmental outcomes were reported in four studies; hyponatremia was significantly associated with hearing loss in one study (OR 5.6 (95% CI 1.1–27.8)), while another study reported that glucose-corrected sodium fluctuations were associated with neurodevelopmental impairment at 18–21 months, although significance disappeared after adjustment for confounding factors. Conclusion: Considering the limitations related to heterogeneity in study design, threshold sodium values and cohort size, this systematic review suggests a possible association between early sodium disturbances and adverse neurodevelopmental outcomes in ELBW infants, emphasizing the need for further high-quality, prospective studies, especially since sodium management can be modulated. Full article

(This article belongs to the Special Issue Follow-Up of High-Risk Infants After NICU Admission)

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21 pages, 339 KB

Open AccessReview

Breastfeeding in Infancy and Adult Health: A Narrative Review

by Eleftherios Panteris, Ioanna Kakatsaki, Ourania Galani, Zoi Koukou and Eleftheria Hatzidaki

Children 2026, 13(2), 286; https://doi.org/10.3390/children13020286 - 19 Feb 2026

Cited by 2 | Viewed by 1729

Abstract

Within the Developmental Origins of Health and Disease (DOHaD) framework, breast-feeding is a modifiable early postnatal exposure, but its long-term associations are difficult to separate from socioeconomic and family context. We conducted a structured literature search (PubMed/MEDLINE and Scopus; January 2015–December 2025) and [...] Read more.

Within the Developmental Origins of Health and Disease (DOHaD) framework, breast-feeding is a modifiable early postnatal exposure, but its long-term associations are difficult to separate from socioeconomic and family context. We conducted a structured literature search (PubMed/MEDLINE and Scopus; January 2015–December 2025) and prioritised large prospective/birth cohorts and genetic epidemiology studies reporting quantitative associations between breastfeeding in infancy (ever versus never, duration and, where available, exclusivity) and adult outcomes. Eighteen key primary studies were included in evidence tables across cardiometabolic, cancer, and neurocognitive domains. Overall, breastfeeding was associated with modestly lower all-cause and cardiovascular mortality, small reductions in cardiovascular disease and type 2 diabetes, and slightly more favour-able cardiometabolic profiles, including lower adiposity and higher HDL cholesterol. Where reported, effect sizes were generally small (e.g., hazard ratios typically close to 1.00), indicating limited clinical impact at the individual level but potential population relevance. Genetic analyses provide cautious support for a protective association with coronary outcomes, although lipid-mediated pathways appear to explain only a small proportion of the observed associations. Evidence for adult cancer outcomes remains mixed and largely inconclusive, while longer breastfeeding is associated with small ad-vantages in cognitive performance, educational attainment and selected psychological outcomes. Taken together, current evidence suggests that breastfeeding is associated with modestly more favourable adult cardiometabolic and neurobehavioural profiles, but its contribution to long-term health is small relative to the influence of later-life lifestyle and clinical risk factors and should therefore be interpreted cautiously. Full article

17 pages, 784 KB

Open AccessArticle

Problem-Solving Skills and Career Aspirations: The Role of Identity Acquisition and Self-Understanding in Italian Students

by Emanuela Calandri, Enrico Vitolo, Jessica Verdiglione, Martina Bollo, Angelica Arace, Paola Ricchiardi, Teodora Lattanzi, Marianna Campione and Silvia Gattino

Children 2026, 13(2), 285; https://doi.org/10.3390/children13020285 - 19 Feb 2026

Viewed by 1177

Abstract

Background/Objectives: Adolescence is a critical developmental period in which individuals are required to orient themselves toward the future and construct a coherent life plan, including educational and career aspirations. Future orientation is closely linked to identity development and self-understanding, which allow adolescents to [...] Read more.

Background/Objectives: Adolescence is a critical developmental period in which individuals are required to orient themselves toward the future and construct a coherent life plan, including educational and career aspirations. Future orientation is closely linked to identity development and self-understanding, which allow adolescents to integrate past, present, and anticipated future selves. Among the personal resources supporting this process, problem-solving skills play a key role by enabling effective coping with challenges and informed, goal-directed decision-making. This study examined the association between problem-solving skills and adolescents’ aspirations for an ideal occupation, and tested whether this relationship was mediated by identity acquisition and self-understanding, with attention to gender differences. Methods: A quantitative study design was adopted. Participants were 2443 Italian adolescents (aged 15–19 years) attending upper secondary schools. They completed self-report measures assessing perceived problem-solving skills, identity acquisition, self-understanding, and aspiration for an ideal occupation. Two multigroup mediation models were tested using structural equation modeling, examining identity acquisition and self-understanding as mediators and comparing pathways across genders. Results: Problem-solving skills were indirectly associated with stronger aspirations toward an ideal occupation through identity-related processes. Identity acquisition mediated this association only among females, whereas self-understanding emerged as a significant mediator for both females and males, with partial mediation among females and full mediation among males. Conclusions: Overall, although constrained by the cross-sectional design, the findings are consistent with the notion that problem-solving skills contribute to future-oriented career aspirations chiefly by promoting identity coherence and self-clarity. These findings highlight the importance of integrating problem-solving training with identity-focused interventions in educational and career guidance programs, while considering gender-specific developmental pathways. Full article

(This article belongs to the Special Issue Advances in Adolescent Mental Health: Early Prevention and Intervention)

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10 pages, 1248 KB

Open AccessArticle

Normative Database and Determinants of Retinal and Choroidal Vessel Density in Tibetan Children

by Zhaojun Meng, Yao Yao, Lei Li, Weiwei Chen and Jing Fu

Children 2026, 13(2), 284; https://doi.org/10.3390/children13020284 - 19 Feb 2026

Viewed by 524

Abstract

Background/Objectives: This study investigates the normative data and determinants of retinal and choroidal vessel density (VD) in Tibetan children using optical coherence tomography angiography (OCTA). Methods: This study recruited students from primary schools in Lhasa who underwent OCTA encompassing VD in the superficial [...] Read more.

Background/Objectives: This study investigates the normative data and determinants of retinal and choroidal vessel density (VD) in Tibetan children using optical coherence tomography angiography (OCTA). Methods: This study recruited students from primary schools in Lhasa who underwent OCTA encompassing VD in the superficial capillary plexus (SCP) and the deep capillary plexus (DCP) and choriocapillaris (CC) in the macular region, as well as refractive status, axial length, and systemic examinations. Results: This study included a total of 645 children who met the criteria. The results showed that VD in the fovea was significantly higher in the SCP than in the DCP, while CC had the highest VD in the fovea. Correlation analysis revealed strong correlations in VD among all quadrants of the SCP, DCP, and CC, as well as significant correlations between corresponding regions of the SCP and DCP. VD showed no significant association with age, sex, axial length, or spherical equivalent. Foveal VD in both the SCP and DCP was positively correlated with oxygen saturation. No consistent correlation was found between choroidal or retinal thickness and VD in any layer. Conclusions: The identified link between systemic oxygen saturation and foveal vascular density offers a novel perspective on human adaptation to chronic hypoxia, positioning the retinal microcirculation as a sensitive indicator of systemic oxygen homeostasis. Full article

(This article belongs to the Section Pediatric Ophthalmology)

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9 pages, 1014 KB

Open AccessCase Report

Neuroblastoma Presenting as a Congenital Renal Mass in a Neonate: A Diagnostic Pitfall

by Agnieszka Sokół, Alicja Romaniak, Iwona Dachowska-Kałwak, Anna Wojtyłko, Marzena Kozakiewicz, Jan Godziński and Marek Ussowicz

Children 2026, 13(2), 283; https://doi.org/10.3390/children13020283 - 19 Feb 2026

Viewed by 1314

Abstract

Background: Congenital renal masses in neonates are most commonly congenital mesoblastic nephroma or, less frequently, or Wilms tumor. We describe a neonate with an apparent primary renal tumor that proved to be adrenal neuroblastoma infiltrating the kidney, highlighting diagnostic pitfalls in this subgroup [...] Read more.

Background: Congenital renal masses in neonates are most commonly congenital mesoblastic nephroma or, less frequently, or Wilms tumor. We describe a neonate with an apparent primary renal tumor that proved to be adrenal neuroblastoma infiltrating the kidney, highlighting diagnostic pitfalls in this subgroup of patients. Methods: We retrospectively reviewed the diagnostic work-up, histopathology, genomic profiling, treatment, and outcome of a term neonate in whom a renal mass was detected incidentally on ultrasound. Results: Ultrasound and MRI showed a 2 cm solid lesion centered in the upper pole of the left kidney, interpreted as nephroblastomatosis/early Wilms tumor. Left nephrectomy with adrenalectomy revealed stroma-poor, undifferentiated neuroblastoma with regional node involvement and multiple segmental chromosomal aberrations, including 1p and 3p loss, but no MYCN or ALK alterations. Initial management consisted of surgery alone with close surveillance. Within weeks, early disseminated relapse with bone and soft-tissue metastases occurred, necessitating escalation to high-risk, COJEC-based chemotherapy; resection of residual mass; and modified consolidation without high-dose chemotherapy or radiotherapy. The child remains in complete remission with preserved renal function. Conclusions: Neuroblastoma should be considered in the differential diagnosis of congenital “renal” masses. Imaging-driven provisional diagnoses may be misleading, and genomic risk profiling may help lower the threshold for systemic therapy in selected cases. Full article

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

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13 pages, 621 KB

Open AccessSystematic Review

Effects of Martial Arts Intervention in Children and Young People with Developmental Coordination Disorder (DCD): A Systematic Review

by Beatriz Olhos, Marco Branco, Beatriz Rosa, David Catela and Cristiana Mercê

Children 2026, 13(2), 282; https://doi.org/10.3390/children13020282 - 19 Feb 2026

Cited by 2 | Viewed by 1985

Abstract

Background: Developmental Coordination Disorder (DCD) is a neurodevelopmental motor disorder characterised by marked difficulties in the acquisition and execution of motor skills, substantially affecting daily activities and quality of life. Martial arts (MAs), due to their multi-skilled nature, have been studied as possible [...] Read more.

Background: Developmental Coordination Disorder (DCD) is a neurodevelopmental motor disorder characterised by marked difficulties in the acquisition and execution of motor skills, substantially affecting daily activities and quality of life. Martial arts (MAs), due to their multi-skilled nature, have been studied as possible intervention strategies to improve motor competence and functionality in children with DCD. Objectives: The present systematic review aimed to explore the effects of MA practice in children and adolescents with DCD, identifying the benefits, methodological characteristics and practical implications of existing interventions. Methods: The search was conducted in the PubMed, Web of Science, and EBSCO databases, following the PRISMA 2021 guidelines, using the keywords (developmental coordination disorder OR DCD OR dyspraxia) AND (karate OR judo OR taekwondo OR aikido OR martial art) AND (child OR preschool). Experimental and quasi-experimental studies that applied MA programmes to children and adolescents (≤18 years) with a confirmed diagnosis of DCD were included. Results: Of the 1834 identified records, five studies met the inclusion criteria. The MA modalities examined were karate, tai chi, and taekwondo. Across studies (n per study = 16–145), MA-based programmes consistently yielded significant pre- to post-intervention improvements in overall motor competence (MC), balance, muscle strength, and coordination; one study reported maintenance of coordination gains at 3-month follow-up. Methodological quality assessed with the Downs and Black checklist ranged from fair to good (scores = 18–22). No adverse events were reported. Conclusions: Based on the included studies, MA interventions demonstrate potential as an effective motor intervention approach for children and adolescents with DCD. Findings consistently indicated significant improvements in motor competence, balance, muscle strength, and coordination, with additional benefits observed in cognitive and psychosocial domains and no reported adverse effects. Full article

(This article belongs to the Special Issue Advances in Dyspraxia and Developmental Coordination Disorder in Children)

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Sonographic Brain Volume Growth Trajectories in VLBW and Clinical Determinants—Data from the NeoNEVS Project

by Christian Brickmann, Renée Lampe, Irina Sidorenko, Nils Gauger, Julia Hauer, Marcus Krüger and Simon Loth

Children 2026, 13(2), 281; https://doi.org/10.3390/children13020281 - 18 Feb 2026

Cited by 3 | Viewed by 722

Abstract

Background: Very Low Birth Weight preterm infants are at elevated risk for disrupted brain growth and later neurodevelopmental impairment. Bedside-accessible tools for monitoring cerebral development remain limited. Methods: In this retrospective pilot cohort study, 153 Very Low Birth Weight infants (<32 weeks gestational [...] Read more.

Background: Very Low Birth Weight preterm infants are at elevated risk for disrupted brain growth and later neurodevelopmental impairment. Bedside-accessible tools for monitoring cerebral development remain limited. Methods: In this retrospective pilot cohort study, 153 Very Low Birth Weight infants (<32 weeks gestational age and/or <1500 g) from two Level III Neonatal Intensive Care Units underwent serial cranial ultrasound assessments. Total brain volume was estimated using an ellipsoid formula derived from standardized imaging planes. Growth trajectories were analysed via linear mixed-effects modelling. Associations with clinical predictors—including invasive ventilation, sepsis, and somatic growth—were evaluated. Results: A total of 976 brain volume measurements were collected. Median cerebral volume increased from 164 cm³ to 275 cm³ across the hospital stay, corresponding to a median growth rate of 2.3 cm³/day (95% CI: 1.5–3.1). Duration of invasive mechanical ventilation was associated with reduced cerebral growth (p < 0.01, R² = 0.26). Cerebral volume growth showed a weak but statistically significant correlation with head circumference percentile progression (p < 0.05, ρ = 0.16). Conclusions: Sonographic brain volumetry is a feasible and non-invasive method for tracking cerebral development in Very Low Birth Weight infants. These findings confirm significant associations between cerebral growth and head growth and identify prolonged invasive ventilation as a risk factor for impaired cerebral development. Full article

(This article belongs to the Special Issue Advances in Neurodevelopmental Outcomes for Preterm Infants)

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Children, Volume 13, Issue 2 (February 2026) – 150 articles

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