Children, Volume 13, Issue 8 (August 2026) – 149 articles

Background/Objectives: Kidney transplantation is the most effective treatment for pediatric patients with end-stage renal disease (ESRD), offering superior survival rates and quality of life compared to dialysis. However, long-term graft survival remains a complex clinical and surgical challenge. This systematic review aims to evaluate short- and long-term graft outcomes and comprehensively analyze the primary clinical, immunological, and procedural risk factors driving pediatric graft failure. Methods: A comprehensive search was conducted across the PubMed database, yielding 289 initial records. Following duplicate removal and systematic title and abstract screening, 108 full-text articles were evaluated for eligibility. Ultimately, 35 high-quality studies met the full inclusion criteria and were selected for final data synthesis and analysis. Results: Synthesized data revealed high short-term outcomes, with a 1-year graft survival rate of 94.60%. However, survival experienced a steady decline over time, dropping to 59.50% at the 10-year mark. Acute rejection episodes and delayed graft function (DGF) were identified as the primary immunological primary risk factors. Furthermore, specific donor characteristics, early surgical complications (such as vascular thrombosis), post-transplant infections affecting nearly 45% of patients, and adolescent non-adherence to immunosuppressive regimens were heavily associated with accelerated graft failure. Conclusions: While short-term success in pediatric kidney transplantation is highly encouraging, long-term graft longevity requires targeted clinical interventions. Optimizing outcomes necessitates precise, lifelong management strategies specifically focused on mitigating chronic rejection, preventing post-operative infections, and implementing multidisciplinary support systems to enhance patient adherence to immunosuppressive therapy. Full article

Background/Objectives: Achondroplasia is the most common genetic skeletal dysplasia associated with disproportionate short stature and is primarily caused by gain-of-function variants in the fibroblast growth factor receptor 3 (FGFR3) gene. Constitutive FGFR3 activation disrupts growth plate homeostasis and endochondral ossification through complex alterations in chondrocyte proliferation, differentiation, hypertrophy, extracellular matrix organization, and intracellular signaling. The increasing understanding of these mechanisms has enabled the transition from exclusively supportive management toward disease-modifying and precision-based therapeutic strategies. This narrative review aimed to critically synthesize current evidence on the genetic basis, molecular pathogenesis, growth plate abnormalities, and current and emerging targeted therapies in achondroplasia. Methods: A narrative literature review was conducted using PubMed/MEDLINE, Scopus, and Web of Science Core Collection, with Google Scholar used as a supplementary source, together with manual screening of the reference lists of relevant original studies, clinical trials, reviews, consensus documents, and clinical guidelines. The principal literature search covered publications from January 2010 to March 2026, while selected seminal primary studies published before 2010 were included when necessary to document the original identification of pathogenic FGFR3 variants and foundational mechanisms of FGFR3-mediated growth plate regulation. Particular emphasis was placed on FGFR3 variants, receptor activation mechanisms, growth plate dysfunction, intracellular signaling pathways, vosoritide, C-type natriuretic peptide-based therapies, FGFR3 inhibitors, ligand–receptor blockade, drug repurposing, Wnt/β-catenin modulation, and gene-based therapeutic approaches. Results: Achondroplasia is characterized by marked molecular homogeneity, with the recurrent p.Gly380Arg substitution accounting for most cases. Mutant FGFR3 displays sustained activity through partial ligand independence, enhanced receptor dimerization and kinase activation, increased receptor stability, and reduced degradation. Excessive signaling through MAPK/ERK, STAT, PI3K/AKT, IHH/PTHrP, and related pathways impairs chondrocyte proliferation and hypertrophic differentiation, alters extracellular matrix turnover, disrupts primary cilium function, and reduces longitudinal bone growth. Vosoritide provides clinical proof that pharmacological modulation of FGFR3-related signaling can improve growth velocity. Additional therapeutic strategies under clinical or preclinical investigation include long-acting CNP analogues, selective FGFR inhibitors, decoy receptors, RNA aptamers, repurposed drugs, Wnt/DKK1 pathway modulation, and gene- or enhancer-targeted interventions. Conclusions: Achondroplasia is increasingly understood as a disorder of dysregulated growth plate signaling rather than solely a condition of reduced stature. Although vosoritide has established the feasibility of disease-modifying treatment, substantial uncertainty remains regarding final adult height, skeletal proportionality, cranio-spinal development, orthopedic outcomes, and long-term safety. Future progress will depend on mechanistically informed therapeutic combinations, improved biomarkers, advanced cellular and animal models, and long-term clinical and real-world evidence. Full article

Background/Objectives: Acute lower respiratory infections (ALRIs) are an important cause of morbidity among children under five years of age. This study aimed to identify factors associated with ALRI among children under five treated at a Peruvian emergency hospital. Methods: We conducted an observational, analytical, retrospective cross-sectional study using medical records of children treated in the pediatric emergency department of Hospital de Emergencias José Casimiro Ulloa, Lima, Peru, between January and December 2024. ALRI was defined as a physician-recorded diagnosis of pneumonia or bronchiolitis; the comparison group comprised children with acute bronchitis or upper respiratory tract infection. Crude and adjusted prevalence ratios (PRs) with 95% confidence intervals (CIs) were estimated using Poisson regression with robust variance. Results: The final sample included 322 children, of whom 154 (47.8%) had ALRI. In the adjusted model, age 0 to <2 years (aPR = 1.27; 95% CI: 1.03–1.56), absence of exclusive breastfeeding (aPR = 1.24; 95% CI: 1.02–1.51), birth weight < 1000 g (aPR = 1.43; 95% CI: 1.09–1.87), incomplete immunizations (aPR = 1.28; 95% CI: 1.07–1.53), and passive smoking exposure (aPR = 1.38; 95% CI: 1.15–1.65) were independently associated with higher ALRI prevalence. Conclusions: ALRI accounted for nearly half of the ARI diagnoses in this pediatric emergency analytical sample. Younger age, absence of exclusive breastfeeding, extremely low birth weight, incomplete immunizations, and passive smoking exposure were independently associated with ALRI and may help identify children requiring closer clinical assessment and preventive interventions. Full article

Background/Objectives: Inflammatory bowel disease (IBD) may require topical rectal treatment for distal colonic inflammation. Rectal foams or rectal enemas can reach deeper bowel sections but are complex to administer, especially for pediatric patients with IBD. Furthermore, it is a challenge to visualize this administration process in a structured manner. We aimed to design a rectal demonstration model to enable the visualization of rectal foam administration and to assess the clinical risk potentially associated with detectable errors. Methods: A rectal demonstration model was developed, handling errors were defined, and their clinical risk was rated. The model was tested for rectal foam administration by 19 adolescent patients (aged 12–18 years). Results: A total of 12 observable administration steps, including their clinical risk, were defined by an expert panel of physicians and pharmacists. Seven handling errors were rated with a high clinical risk, such as “Not shaking the spray can at all before administration”. In demonstrations by adolescent patients, a median of three (Q25/Q75; 2/4.5; min/max 1/7) handling errors were identified. The most frequent error was releasing the pump dome too quickly after pushing down (11/19, 58%). At least one error with high clinical risk (score: 5–6) was identified in 15/19 (79%) of patients’ administrations. Conclusions: The developed demonstration model facilitates the visualization of handling errors in rectal foam administration that would otherwise not be accessible in routine care. A high rate of clinically relevant handling errors was identified in adolescents. Prospectively, the model can be used to practice rectal foam administration and address patient handling errors to increase patient safety. Full article

Background: Ovarian torsion is a pediatric surgical emergency in which timely diagnosis and preservation of ovarian tissue are important considerations for future reproductive and endocrine function. This study aimed to describe the clinical characteristics, diagnostic evaluation, surgical management, and outcomes of pediatric ovarian torsion and explore factors associated with ovarian preservation and oophorectomy. Methods: A retrospective, single-center cohort study was conducted including 56 girls with surgically confirmed ovarian torsion treated at a tertiary pediatric center between January 2010 and December 2025. Secondary analyses of factors associated with oophorectomy were considered exploratory. Demographic, clinical, imaging, operative, and outcome data were extracted from medical records. Variables included symptom duration, degree of torsion, laterality, diagnostic assessment, gynecologist consultation, associated pathology, intraoperative macroscopic color change following detorsion, oophoropexy, oophorectomy, postoperative complications, and recurrence. Univariable comparisons were performed using the Mann–Whitney U test, chi-square test, Fisher’s exact test, or Monte Carlo exact test, as appropriate. Exploratory multivariable logistic regression, supplemented by Firth penalized logistic regression, was performed in the postnatal cohort to assess factors associated with oophorectomy. Results: The median age at diagnosis was 10 years (range 0–17) and the median duration of symptoms before admission was 18 h (IQR 8–72). Ovarian preservation was achieved in 35 patients (62.5%), whereas complete oophorectomy or adnexectomy was performed in 21 (37.5%). Complete macroscopic color change following detorsion was observed in 19 patients (33.9%), partial color change in 13 (23.2%), and no macroscopic color change in 24 (42.9%). Prenatal ovarian torsion represented a clinically distinct subgroup and was associated with a high oophorectomy rate (8/8, 100%), compared with 13/48 (27.1%) among patients with postnatal torsion (p < 0.001). In the postnatal cohort, complete oophorectomy or adnexectomy occurred in 19.4% of patients with preoperative gynecologist consultation and 41.2% of those without consultation (unadjusted OR 0.34, 95% CI 0.09–1.28; p = 0.173). In exploratory multivariable analysis adjusting for age and calendar period, preoperative gynecologist consultation was not independently associated with oophorectomy (adjusted OR 0.41, 95% CI 0.09–1.78; p = 0.234); Firth penalized regression yielded similar results. Associated pathology was identified in 66.1% of patients. Documented recurrence occurred in three patients (5.4%), and postoperative complications were uncommon (3.6%). Conclusions: Ovarian preservation was achieved in more than half of pediatric patients with ovarian torsion, whereas prenatal torsion was associated with a high oophorectomy rate. Preoperative gynecologist consultation was associated with a numerically lower unadjusted oophorectomy rate; however, this association was not statistically significant in either unadjusted or adjusted analyses, and residual confounding and changes in clinical practice over the 15-year study period cannot be excluded. Full article

Context: Previous studies and reviews in adult patients have shown that hope is an important coping mechanism in patients with serious health problems. Although there are individual studies in pediatric patients, there is a lack of a systematic review of how hope manifests and how it can be supported in children with life-threatening illnesses and their families. Objectives: This systematic review aims to identify the key factors that are associated with the experience of hope in pediatric palliative care. It examines how hope is fostered or diminished in children with life-limiting illnesses, their parents, and other family members. Methods: A systematic search was conducted across major medical databases for studies published between 1990 and 2024. Thematic analysis was used to identify factors associated with hope. The quality of the included studies was critically appraised. Results: Out of 1373 identified records, 105 studies met the inclusion criteria. Most studies were qualitative in design and met a high proportion of the applicable criteria in their respective design-specific appraisal tools. Factors associated with increased hope included open and empathetic communication, trusting relationships with healthcare providers, strong social and family support, spiritual and religious faith, effective symptom management, involvement in care decisions, and access to practical resources. Conversely, reduced hope was associated with poor communication, social isolation, uncontrolled symptoms, uncertainty, caregiver distress, financial strain, and negative healthcare experiences. These factors were consistent across cultural and diagnostic contexts, with some variation in emphasis. Conclusions: Hope in pediatric palliative care is associated with relational, psychological, spiritual, and systemic factors. Many of these are modifiable. A family-centered and multidisciplinary approach is essential to sustaining hope in pediatric palliative contexts. Full article

Background/Objectives: Fetal Alcohol Spectrum Disorder (FASD) is a preventable neurodevelopmental condition associated with dysfunction of fronto-subcortical networks affecting attention, executive function, and behavioral regulation. Central auditory processing difficulties frequently persist despite preserved peripheral hearing, complicating clinical evaluation when behavioral testing is limited or unreliable, and objective markers that do not depend on behavioral cooperation are therefore needed. This exploratory observational case study investigated whether Frequency-Following Responses (FFRs) can capture measurable within-subject change in speech-evoked neural encoding in a pediatric patient with FASD. Methods: FFRs were recorded at two time points bracketing an eight-session period of non-invasive superficial neuromodulation (NESA^®) in an 8-year-old girl with FASD, using speech syllables (/da/, /ba/, /ga/) presented monaurally at 80 dB SPL. Two-tailed block-level Mann–Whitney U tests with rank-biserial correlations compared peak latencies, sustained pitch-tracking metrics (pitch strength, pitch error), onset stimulus–response correlation, and signal-to-noise ratio. Results: Sustained pitch-tracking metrics differed between time points, with increased pitch strength and reduced pitch error, whereas onset peak latencies, onset cross-correlation, and signal-to-noise ratio remained stable. Peak C, marking the transition to the sustained portion of the response, occurred earlier at the post-assessment in all six stimulus–ear combinations. The differences were therefore selective to sustained encoding rather than to onset timing or recording quality. Conclusions: FFR-derived pitch-encoding metrics detected measurable within-subject change, providing proof of concept for the feasibility of FFRs as a candidate objective tool for longitudinal monitoring of speech-evoked neural encoding in pediatric FASD. This single-case observation does not evaluate diagnostic accuracy, sensitivity, specificity, or discrimination from typically developing children, and therefore does not establish FFR as a validated diagnostic technique. The findings are hypothesis-generating and motivate controlled longitudinal studies. Full article

Background/Objectives: Recent pediatric sleep research has increasingly adopted an integrated lifestyle perspective, examining sleep together with diet, physical activity, sedentary behavior, and family environments. However, bowel habits remain comparatively underrepresented despite their potential importance for child health. This conceptual narrative review revisits the Four Kai framework, which brings together sleep, eating, bowel habits, and physical activity as four fundamental daily physiological behaviors and explores their potential relationships with adaptive pleasure, self-regulation, and daytime functioning. Methods: This conceptual narrative review incorporated a descriptive PubMed literature-mapping exercise conducted on 16 July 2026. The search covered publications from January through June of each year from 2022 to 2026 and focused on studies in which sleep was a principal research topic together with terms related to diet, bowel function, physical activity, and lifestyle. Publications clearly outside pediatric or adolescent populations were excluded. Titles and abstracts were reviewed, with full texts consulted when necessary, and eligible studies were classified thematically according to their principal research objective. This exercise was intended to provide descriptive context for the conceptual review and was not conducted as a systematic or scoping review. Results: The descriptive mapping and narrative synthesis indicate that pediatric sleep research frequently examines sleep in relation to diet, physical activity, sedentary behavior, family environments, and other lifestyle factors, whereas everyday bowel habits remain comparatively underrepresented. The reviewed literature supports multiple individual and pairwise associations among sleep, eating, physical activity, bowel function, and daytime functioning but does not establish that these four behaviors operate as a single integrated physiological system. Direct empirical evidence for a pathway linking the Four Kai through adaptive pleasure and positive self-regulation to daytime functioning is currently lacking. Conclusions: The Four Kai framework is best regarded as a hypothesis-generating conceptual framework rather than an established biological or causal model. Its potential value lies in bringing sleep, eating, bowel habits, and physical activity into a common perspective and generating testable questions about their possible functional integration. Future longitudinal and intervention studies should evaluate these behaviors together with adaptive pleasure, self-regulation, and daytime functioning to determine which proposed relationships can be empirically supported. Full article

Background/Objectives: Most children and adolescents do not meet recommended physical activity (PA) levels. Artificial intelligence (AI) may enable personalized and adaptive interventions, but evidence across delivery formats remains unclear. This scoping review mapped AI-enabled PA interventions for children and adolescents aged 6–18 years. Methods: Following PRISMA-ScR and Joanna Briggs Institute guidance, six databases were searched on 24 May 2026 for English-language studies published since 2018. Eligible studies used AI in intervention delivery and empirically evaluated at least one participant-level PA-related outcome following exposure to the intervention. The review protocol was registered during data analysis. Results: Seven studies published between 2022 and 2026 were included. Primary AI techniques were computer vision (n = 3), generative AI or large language models (n = 2), reinforcement learning (n = 1), and evolutionary computation (n = 1). Interventions included immersive systems (n = 2), conversational agents (n = 2), exergames or serious games (n = 2), and a robot (n = 1). Three studies used controlled designs and four were single-arm pilot or feasibility studies. Conclusions: AI supported movement recognition, content generation, personalization, and adaptive feedback. However, the small, heterogeneous, and predominantly early-stage evidence base precludes conclusions about effectiveness. Rigorous controlled studies and transparent AI-specific reporting are needed. Full article

Background/Objectives: This study used structural equation modeling (SEM) to examine the sequential mediating roles of school belonging and prosocial behavior in the effects of parent–adolescent and teacher–student relationships on adolescents’ academic achievement. Methods: Using a cross-sectional design, the study included 523 adolescents (61.6% female, 38.4% male) aged 13 to 19. Data were collected with the Mother–Adolescent Relationship Quality Scale, the Teacher–Student Relationship Quality Index, the School Belongingness Scale, and the Student Prosocial Behavior Scale, together with subjective (perceived achievement) and objective (school grades) indicators of academic achievement. Results: Both parent–adolescent (β = 0.25) and teacher–student (β = 0.44) relationships significantly predicted school belonging; school belonging significantly predicted prosocial behavior (β = 0.22); and prosocial behavior, in turn, significantly predicted academic achievement (β = 0.22). The direct effect of parent–adolescent relationships on academic achievement was significant (β = 0.26), whereas neither the direct effect of teacher–student relationships (β = 0.13) nor the direct effect of school belonging on academic achievement was significant. The indirect effects of both relational contexts on prosocial behavior via school belonging were significant, and school belonging predicted academic achievement indirectly through prosocial behavior; however, neither the total indirect effect of parent–adolescent relationships on academic achievement, nor its specific serial indirect effect through school belonging and prosocial behavior, reached statistical significance. The corresponding specific serial indirect effect for teacher–student relationships was statistically significant, although small in magnitude and not accompanied by a significant total indirect effect. Conclusions: These findings indicate that school belonging is more closely tied to socio-emotional processes than to academic achievement directly, and that the associations between relational contexts and academic achievement followed a differentiated rather than a uniform pattern: parent–adolescent relationships were linked to achievement primarily through a direct association, and their hypothesized distal indirect pathway to achievement via school belonging and prosocial behavior was not statistically supported. Teacher–student relationships, by contrast, showed no significant direct association with achievement, but the corresponding distal indirect pathway was statistically supported, although the effect was small and imprecisely estimated, underscoring the need for cautious interpretation of these relational mechanisms. Full article

Objectives: To describe BMI-for-age and transverse dental arch measurements in growing children with Marfan syndrome (MFS) and a non-Marfan pediatric comparison group. Materials and Methods: A retrospective case–control observational study included 41 children aged 6–11 years: 15 patients with MFS (7 males, 8 females; mean age 8.8 ± 1.5 years) and 26 non-Marfan controls (10 males, 16 females; mean age 8.9 ± 1.6 years). Anthropometric parameters and BMI-for-age z-scores were assessed using the WHO 2007 Growth Reference. Digital dental models were used to measure intermolar width (IMW), intercanine width (ICW), and the IMW/ICW ratio. Descriptive statistics, exploratory between-group comparisons, and Pearson correlation analyses were performed. Results: Children with MFS showed significantly lower BMI and BMI-for-age z-scores than controls, although BMI-for-age values generally remained within the normal range. Height values were consistently elevated, reflecting the characteristic growth pattern of MFS. The MFS group showed a significantly smaller mean ICW than controls, whereas the difference in IMW was not statistically significant. The IMW/ICW ratio was also evaluated to characterize transverse dental arch proportions. Pearson correlation analyses showed no significant associations between BMI-for-age z-score and IMW or ICW in either group. In controls, age was positively correlated with BMI-for-age z-score and IMW was positively correlated with ICW; these associations were not observed between BMI-for-age z-score and dental measurements in the MFS group. Conclusions: Children with MFS showed a leaner anthropometric profile and a significantly smaller mean ICW, whereas the difference in IMW was not statistically significant. These preliminary findings should be interpreted cautiously given the small sample size and exploratory nature of the study. Further longitudinal studies with larger cohorts are warranted. Full article

Legal definitions of human viability vary worldwide. Background/Objectives: The treatment of periviable newborns remains controversial and raises ethical concerns. However, currently, the World Health Organization (WHO) sets the lower limit of viability at 22 weeks of gestation or 500 g birth weight. The aim of our research was to determine the knowledge of healthcare practitioners in our country regarding this topic, as well as including a course after which we sought to evaluate whether their perceptions regarding the management of these cases changed. Methods: The recruitment of participants encompassed those who voluntarily took part in the survey, and 30 clinicians were included; they participated in a 30 h online course and completed a survey questionnaire before and after the course. Results: After Holm adjustment, we observed an improvement in participants’ perceptions regarding recommendations concerning a multidisciplinary approach, perinatal counseling (20.0% vs. 100.0%), ethical issues (16.7% vs. 93.3%), and awareness of national guidelines (36.7% vs. 100.0%). Moreover, they recognized the importance of including parental wishes in decision-making (Holm-adjusted p = 0.0469), but with clinicians having the final word in the decision. Other factors did not change, with practitioners having knowledge about the serious outcomes of newborns in such challenging situations. Conclusions: Ethically grounded strategies to guide the management of newborns at the limit of viability is of great importance, whereby gestational age is an insufficient parameter. A collaborative, multidisciplinary process is mandatory in order to ensure the best outcomes for the newborn. The value of continuing medical education should be acknowledged. Full article

Background/Objectives: Problematic internet use (PIU) is a growing behavioral health concern among school-aged children. Whether health literacy and health-promoting lifestyle beliefs are associated with PIU among gifted children—a developmentally distinct population—has, to the best of our knowledge, not been investigated. Methods: A cross-sectional correlational design was used with 118 gifted students (M = 13.80, SD = 2.06) attending a Science and Art Center (BİLSEM) in İzmir, Türkiye. Data were collected using the Problematic Internet Use Scale–Adolescent Form (PIUS-A; α = 0.92), the Health Literacy for School-Aged Children Scale (HLSAC; α = 0.87), and the Adolescent Health-Promoting Lifestyle Beliefs Scale (AHPLBS; α = 0.91) in a classroom setting under researcher supervision. A three-step hierarchical multiple linear regression was performed, with age, sex, daily sleep duration, daily screen time, and weekly physical activity entered as covariates in the first step. Results: Covariates explained 24.8% of the variance in PIU (p < 0.001), with daily screen time as the strongest predictor (β = 0.36). Health-promoting lifestyle beliefs added significant incremental variance (ΔR² = 0.063, p = 0.023); health beliefs were the only statistically significant belief predictor (β = −0.24, p = 0.036), with lower health belief scores associated with higher PIU. Health literacy domains did not add statistically significant incremental variance (ΔR² = 0.028, p = 0.495), and no individual domain was a statistically significant predictor. Conclusions: Within the constraints of a cross-sectional design, health beliefs appear to play a more prominent role than health literacy in the covariate-adjusted explanation of PIU among gifted school-aged children. School health nurses may prioritize interventions that strengthen internalized health beliefs alongside information-based education, contributing to more equitable, tailored school health services for this population. Full article

Background: Executive functions (EFs) are cognitive and emotional abilities that underpin goal-directed behavior, decision-making, and problem-solving. EFs can be categorized into two broad types, Hot EFs and Cool EFs, distinguished by their relation to emotional processing. Cool EFs are associated with cognitive control, while Hot EFs involve emotional regulation and decision-making in emotionally charged contexts. EFs contribute to self-regulation, including the ability to adjust behavior in response to feedback. Methods: The aim of this study is to investigate the relationship between Hot (decision-making under uncertainty) and Cool (cognitive flexibility) EFs in middle childhood. To assess these dimensions of EFs, we used two tasks, the Iowa Gambling Task (IGT) and the Wisconsin Card Sorting Test (WCST), completed by children (N = 90) aged 6–12 years. Results: Traditional WCST indices of cognitive flexibility were not associated with IGT performance. Using hierarchical linear regression models, the most significant overlap concerns the negative relationship between post-loss adjustment in the WCST (post-loss reaction time—plRT) and learning across the IGT (learning index—LI). Children who responded faster after negative feedback (plRT ↓) showed greater improvement in advantageous choice over the course of the task (LI ↑). Conclusions: The findings suggest that decision-making in the IGT is more closely linked to dynamic, process-based aspects of self-regulation than to static measures of cognitive flexibility. It can be concluded that the relationship between WCST and IGT during middle childhood is best described as weak, process-specific, and developmentally modulated, indicating that Cool and Hot EFs are partially distinct yet interconnected systems. Full article

Background/Objectives: Existing mental health help-seeking measures may not adequately reflect adolescents’ developmental and sociocultural contexts. This study developed and evaluated a mental health help-seeking scale for Korean adolescents. Methods: Following DeVellis’ guidelines, items were generated through concept analysis and in-depth interviews. Expert review reduced 50 initial items to 33 preliminary items. Data were collected from 500 adolescents in Gyeongsangbuk-do, Republic of Korea. EFA and CFA were conducted using separate samples of 250 participants. Results: The final scale comprised 16 items across three factors: Mental Health Help-Seeking Willingness, Overcoming Stigma in Mental Health Help-Seeking, and Knowledge of Mental Health Help-Seeking Resources. The factors explained 46.4% of the variance, and CFA provided preliminary support for the three-factor structure. Cronbach’s α was 0.85 overall and ranged from 0.73 to 0.85 across subscales. Conclusions: The scale provides preliminary evidence of reliability and validity for assessing mental health help-seeking among Korean adolescents and may be useful in research and early-prevention settings. Full article

Objective: To evaluate the response of various oxygenation indices to the oxygen challenge test (OCT), prior to decannulation, in neonates supported with VA ECMO for respiratory indications, and to compare these responses between survivors and non-survivors. Design: Single-center retrospective observational study. Setting: Single, tertiary care, 40-bed Pediatric Intensive Care Unit in Miami, Florida. Patients: Neonates cannulated to VA ECMO for respiratory failure from 2012 to 2022 who had an OCT. Patients with congenital heart disease were excluded. Measurements and Main Results: A total of 63 neonates were included, of whom 13 patients died (20.6%). Oxygenation indices compared before and during OCT include PaO2, Delta PaO2, P/F ratios, Alveolar-arterial gradient, arterial/alveolar ratios, and shunt fraction. The Wilcoxon signed-rank test demonstrated increases in all oxygenation indices during OCT compared to pre-OCT, except for P/F ratios. There were no differences in oxygenation indices between survivors and non-survivors during OCT. However, after decannulation, all oxygenation indices were worse in non-survivors (p < 0.05). Linear regression analysis demonstrated that delta FiO2 on the ventilator, P/F before OCT, and ECMO flow during OCT significantly affected PaO2 response during OCT. Shunt fraction above 28.8% after decannulation demonstrated the highest discriminatory ability for mortality (AUC 0.853). Conclusions: The OCT response during ECMO is not a reliable predictor of survival in neonates on VA ECMO, and its value in assessing readiness for ECMO trial-off warrants further evaluation. Further studies investigating the role of oxygenation indices at the time of trial-off for predicting outcomes may be helpful. Full article

Background/Objectives: Illness uncertainty is inherent in irritable bowel syndrome (IBS); however, the factors that contribute to it and outcomes impacted by it have yet to be assessed in pediatric IBS. As such, the current longitudinal pilot study assessed the relationship between disease characteristics, illness appraisals, mood, and health-related outcomes. Methods: 50 youth (ages 10–18) diagnosed with IBS completed self-report measures across three timepoints. Path analysis models specifying illness uncertainty as the mediator were constructed and assessed with Mplus using Bayesian Estimation. Results: Time-2 illness uncertainty significantly predicted time-3 depressive and anxiety symptoms, higher functional disability, and lower levels of problem- and emotion-focused coping. Exploratory indirect effects demonstrating clinical signals were also identified. Conclusions: Future observational studies with larger samples are needed to further investigate illness appraisals’ relationships with adjustment and health-related outcomes in pediatric IBS. This is a fruitful avenue to identify modifiable areas of targeted intervention. Full article

Background/Objectives: Breastfeeding confers important health benefits for mothers and children. The coronavirus disease 2019 (COVID-19) pandemic disrupted childcare practices and maternal behaviors, with some effects persisting beyond the acute phase. This study aimed to evaluate the impact of the COVID-19 pandemic on breastfeeding. Methods: This retrospective single-center study included full-term infants born at Tokyo Metropolitan Toshima Hospital between January 2019 and January 2024. Data was routinely collected. The participants were categorized into those born before, during, and after the pandemic. The rates of exclusive breastfeeding and volume of formula milk at 1-month health checkups were compared across the groups using the chi-square test and regression analysis. Results: A total of 812 (30.1%), 1602 (61.0%), and 214 (8.1%) infants born before, during, and after the pandemic, respectively, were analyzed. The rates of exclusive breastfeeding differed significantly among the groups, (42.2%, 28.1%, and 22.9%, respectively). Concurrently, formula milk consumption increased during the study period, with significant differences observed between those born before and during the pandemic and between those born before and after the pandemic. Conclusions: Breastfeeding rate declined during the COVID-19 pandemic and the effect persisted after the pandemic. We speculate this trend may be attributed to the loss of educational opportunities and reduced interactions among mothers. Another contributing factor was the shift in the sources of information for maternal decision-making. After the pandemic, reliance on social media as a primary source of guidance increased; however, much of this information was less evidence-based and potentially inaccurate. Healthcare providers should recognize these challenges and prepare for future pandemics. Full article

Background/Objectives: Diaphragm ultrasonography enables noninvasive bedside assessment of diaphragmatic structure and function. However, longitudinal changes in diaphragm ultrasound parameters across different respiratory support modalities remain insufficiently characterized in critically ill children. This exploratory study aimed to evaluate serial changes in diaphragm ultrasound parameters and to explore whether these changes differed according to the initial respiratory support modality or showed a relationship with respiratory outcomes. Methods: This prospective, single-center observational cohort study included children aged 1 month to 18 years who required respiratory support for acute respiratory failure between March 2025 and March 2026. Diaphragm excursion (DE), end-expiratory diaphragm thickness (DTee), end-inspiratory diaphragm thickness (DTei), and diaphragm thickening fraction (TFdi) were measured at baseline, 48 h, and immediately before discontinuation of respiratory support. Patients were grouped according to the initial respiratory support modality: high-flow nasal cannula, nasal noninvasive ventilation, mask noninvasive ventilation, or invasive mechanical ventilation. Results: A total of 100 children were included; the median age was 4 months, and 66% were male. No statistically significant longitudinal changes were observed in DE (p = 0.210), TFdi (p = 0.850), DTee (p = 0.492), or DTei (p = 0.467). Baseline values and longitudinal percentage changes did not differ significantly among the four respiratory support groups. No statistically significant relationship was observed between serial changes in DE, TFdi, or DTee and total respiratory support duration. Conclusions: No statistically significant longitudinal changes in diaphragm ultrasound parameters were detected during short-term respiratory support, and no statistically significant differences were identified among the initial respiratory support groups. These findings should not be interpreted as demonstrating physiological equivalence between respiratory support modalities. Serial diaphragm ultrasonography should be interpreted within the broader clinical context rather than as an isolated prognostic tool. Full article

Bronchopulmonary dysplasia (BPD) remains one of the leading chronic respiratory complications of extreme prematurity despite major advances in neonatal intensive care. Current diagnostic definitions are primarily based on respiratory support requirements and provide limited information on the biological heterogeneity and longitudinal evolution of lung injury. Lung ultrasound (LUS) is progressively reshaping the clinical approach to BPD by enabling radiation-free, bedside, and repeatable assessment of peripheral lung abnormalities throughout the neonatal course. This narrative review examines the current role of LUS in BPD, integrating its pathophysiological basis with the available evidence and distinguishing explicitly between its diagnostic, prognostic, monitoring, and treatment-guiding applications, which are supported by markedly different levels of evidence. We discuss how LUS findings reflect the major components of BPD pathophysiology, compare LUS with conventional imaging modalities, and summarize the scanning protocols, semiquantitative scoring systems, examination schedules, and patient populations that have been evaluated to date. We also review the emerging contribution of artificial intelligence to automated image analysis, standardized image acquisition, and personalized risk prediction. Most of the available evidence is prognostic rather than diagnostic: early LUS scores predict BPD subsequently defined at 36 weeks’ postmenstrual age, whereas LUS has not been validated as a diagnostic test for established BPD, and reported cutoffs remain study- and protocol-specific rather than universally applicable. Randomized evidence is confined to LUS-guided surfactant administration, where the demonstrated benefits concern the timing of treatment and the need for invasive ventilation; no trial has yet shown that LUS-guided management reduces the incidence of BPD. Current evidence supports LUS as a complementary imaging modality that extends beyond the assessment of acute neonatal respiratory disease and enables longitudinal bedside monitoring of peripheral lung aeration. Although further multicenter prospective studies are required to harmonize protocols and validate LUS-guided management strategies, the integration of standardized LUS assessment with emerging artificial intelligence technologies has the potential to establish LUS as a key component of precision respiratory care for infants at risk of BPD. Full article

Background: Dental anxiety is a prevalent condition in pediatric oral healthcare and linked with multiple etiologic factors. Although sociodemographic factors are frequently examined, the influence of internal psychological constructs such as self-esteem remains underexplored in children. This cross-sectional study aims to evaluate the association between dental anxiety and self-esteem among school-age Turkish children. Methods: The study was conducted with 204 participants aged 7–12 years. Dental anxiety and self-esteem were assessed using Corah’s Dental Anxiety Scale and the Rosenberg Self-Esteem Scale, respectively. Group comparisons were performed with the Mann–Whitney U and Kruskal–Wallis tests, and their association was examined with Spearman’s rank correlation. Independent predictors of dental anxiety were further identified through a stepwise multiple linear regression. Results: Dental anxiety was prevalent in 24.5% of participants. No significant differences in anxiety or self-esteem were found by gender, age, or socioeconomic status (p > 0.05). A moderate negative correlation (r = −0.301, p < 0.001) was observed between self-esteem and dental anxiety. Regression analysis confirmed self-esteem as the only significant independent predictor of dental anxiety (Adjusted R² = 0.080, p < 0.001) in this model. Conclusions: Findings indicate that self-esteem is independently associated with pediatric dental anxiety, although the explained variance was modest. Whether incorporating children’s psychological profile into behavioral management improves clinical outcomes remains to be investigated. Full article

Background/Objectives: Adolescence is a dynamic neurodevelopmental period during which structured language performance may reflect ongoing biological reorganization processes. This study examined whether inflammatory, nutritional, and hormonal biomarkers were modestly associated with structured language task performance and cognitive performance in healthy pubertal children. Methods: A total of 156 healthy pubertal children (78 female, 78 male; mean age of 11.84 ± 2.98 years) meeting Tanner Stage ≥ 2 were included in this retrospective cross-sectional study. Language was assessed with the Test of Language Development-Primary: Fourth Edition (TOLD-P:4; Turkish adaptation) and cognition with the Wechsler Intelligence Scale for Children-Revised (WISC-R). Pan-Immune-Inflammation Value (PIV), Prognostic Nutritional Index (PNI), Neutrophil-to-Lymphocyte Ratio (NLR), vitamin B12, 25-OH vitamin D, ferritin, and TSH were included as biomarkers. Two-block hierarchical OLS regression and Spearman correlations with Benjamini–Hochberg FDR correction were used. Results: The biomarker block provided a statistically significant incremental contribution to the spoken language model (ΔR² = 0.066, p = 0.041; full model R² = 0.287). The primary test statistic was ΔR². In exploratory coefficient-level analyses that were not corrected for multiple comparisons, the PIV (β = +0.17, p = 0.033) and TSH (β = −0.17, p = 0.031) coefficients reached nominal significance. After FDR correction, PIV was positively associated with WISC-R Verbal score (ρ = +0.24, p_FDR = 0.019) and TSH negatively with TOLD-P:4 Speaking (ρ = −0.22, p_FDR = 0.029). Biomarker contribution to WISC-R Full-Scale IQ was non-significant (ΔR² = 0.049, p = 0.223). Conclusions: At the block level, the biomarker set contributed significantly to the structured spoken-language model but not to the Full-Scale IQ model; however, one of the two FDR-significant bivariate associations involved a verbal cognitive measure (PIV with WISC-R Verbal). Any language-versus-cognition contrast should therefore be interpreted cautiously. The modest effect sizes suggest these relationships are best interpreted within a developmental and neuroimmune framework. Longitudinal and multimodal studies are needed to replicate these findings. Because the TOLD-P:4/TODİL was applied beyond its validated age range (4; 0–8; 11) and its cross-age scoring could not be verified from the retrospective records, all language-based findings are exploratory and require confirmation with an age-validated instrument; the study’s confirmatory finding is the FDR-significant association of PIV with age-appropriate WISC-R Verbal performance. Because the TOLD-P:4/TODİL composite scores could not be verified as comparable across the sample’s age range, all TOLD-P:4-based results reported here are exploratory and hypothesis-generating; the confirmatory analyses rely on the age-appropriate WISC-R outcomes. Full article

Background: Advances in neonatal intensive care have improved survival in congenital diaphragmatic hernia (CDH), shifting the clinical focus toward long-term complications such as feeding difficulties. Initiation of enteral feeding varies across centers, with evidence suggesting that intra-abdominal pressure (IAP) may influence time to feeding and clinical decision-making. We explored associations of early postoperative heart rate (HR), recorded Apgar score, and intra-abdominal pressure (IAP) with time to enteral trophic feeding. Methods: We retrospectively evaluated 28 consecutive neonates undergoing CDH repair at a national referral center between January 2022 and June 2025. Trophic enteral feeding (≥10 mL/kg/day for ≥24 h) was the primary endpoint. Aalen–Johansen estimates and two parsimonious Fine–Gray models (HR plus Apgar; IAP plus Apgar) were primary analyses and cause-specific Cox models were sensitivity analyses. Results: Within 30 postoperative days, trophic enteral feeding was achieved in 21 cases, six patients died before feeding, and one did not achieve feeding before censoring. Each 10 bpm higher HR was associated with lower feeding incidence (subdistribution HR 0.62, 0.46–0.85; p = 0.003); the cause-specific point estimate was also below 1 (HR 0.65, 0.47–0.89; p = 0.007). Mean IAP was not clearly associated with feeding incidence (subdistribution HR 1.01 per mmHg, 0.82–1.25; p = 0.925). Both Cox models failed global proportional-hazards tests. Conclusions: Each 10 bpm increase in HR was associated with a longer time to trophic enteral feeding, and the cause-specific sensitivity analysis pointed in the same direction. Because both estimates derive from the same 28 infants, their agreement is expected rather than corroborative. These findings are exploratory and do not establish causality, individual predictive value, or superiority of HR over IAP. Prospective multicenter studies with adequate sample sizes are needed to confirm these findings. Full article

Background/Objectives: Insulin resistance (IR) plays a central role in metabolic dysfunction and elevates the risk of chronic diseases such as type 2 diabetes mellitus in later life. Early identification of IR in adolescents is therefore important. This study aimed to determine the triglyceride-to-high-density lipoprotein cholesterol (TG:HDL-C) ratio cutoff for IR and assess its association with IR predictors among adolescents with obesity. Methods: A total of 215 blood samples from adolescents aged 13–16 years with obesity were analyzed for fasting blood glucose, lipids, insulin, leptin, and adiponectin. Obesity was defined using BMI z-scores, while IR was classified using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR ≥ 4.0). Receiver operating characteristic (ROC) analysis was performed to compare the discriminatory performance between the TG:HDL-C ratio and Leptin:Adiponectin ratio (LAR). Multiple logistic regression was performed to assess associations between the TG:HDL-C ratio and IR-related markers. Results: The area under the ROC curve for the TG:HDL-C ratio was comparable to LAR (0.73 vs. 0.68, p = 0.3). The optimal TG:HDL-C ratio cutoff identified using the maximum Youden index was 0.89, with 62% sensitivity and 75% specificity. A TG:HDL-C ratio ≥ 0.89 was associated with higher odds of elevated insulin (AOR 1.1, 95% CI 1.0–1.13), elevated HbA1c (AOR 2.7, 95% CI 1.1–6.6), abdominal obesity (AOR 3.6, 95% CI 1.9–6.7), and raised LAR (AOR 1.2, 95% CI 1.0–1.5). Conclusions: These findings suggest that a TG:HDL-C ratio cutoff of 0.89 may be a useful marker for identifying IR in adolescents with obesity. Full article

Background/Objectives: Digital technologies have created new pathways through which perpetrators can initiate contact with children, yet evidence directly comparing child sexual abuse (CSA) cases according to the mode of first contact between the victim and the perpetrator remains limited. This study compared CSA cases in which the victim first met the perpetrator online with cases in which first contact occurred face-to-face and examined whether online-initiated contact was associated with a higher prevalence of penetrative abuse. Methods: We retrospectively reviewed 1511 CSA cases evaluated at a tertiary-care Child Monitoring Center in Turkey (2017–2018). Cases were classified by mode of first contact as online-initiated (n = 91, 6.0%) or face-to-face (n = 1420, 94.0%); the face-to-face group served as a comparison group defined by mode of contact rather than a non-exposed control group. Groups were compared using chi-square tests with Bonferroni-adjusted post hoc analyses; effect sizes were expressed as Cramér’s V and risk ratios (RRs). Results: Victims in the online-initiated group were predominantly female (89.0% vs. 79.4%; p = 0.027) and aged 12–18 years (79.2%). The perpetrator was most often described by the child as a friend or boyfriend (81.3% vs. 34.2%; p < 0.001), a pattern consistent with grooming dynamics. Penetrative abuse occurred in 54.9% of online-initiated versus 26.9% of face-to-face cases, an approximately twofold difference (RR = 2.04; p < 0.001). Conclusions: In this forensic sample, online-initiated contact was associated with a distinct case profile and more frequent penetrative abuse. Because the data derive from cases referred by judicial authorities for forensic evaluation rather than from adjudicated cases, the findings are associative and cannot be generalized to all CSA; nevertheless, they support the systematic documentation of online contact histories in forensic evaluation and child protection practice. Full article

Background and objectives: Children born prematurely are more likely to have altered sensory profiles, which can affect family and school functioning. This scoping review aimed to analyze the relationship between prematurity and the development of atypical sensory profiles. Methods: A scoping review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), including studies evaluating children aged 1 to 12 years who were born at a gestational age of ≤32 weeks. The data sources were PubMed, Scopus, and Web of Science. The search was limited to English-language studies published in the previous 10 years. The keywords “Sensory Processing”, “Child Development”, “Perception”, “Sensory Profile”, “Sensory Integration”, “Preterm”, “Infant Premature”, “Infant Extremely Low Birth Weight”, and “Infant Low Birth Weight” were used to search the databases. Articles with outcomes related to cerebral palsy, blindness, low vision, hearing impairment, behavioral disorders, and autism were excluded. After article selection, the atypical sensory profiles identified were organized into thematic categories and evaluated according to frequency of occurrence. Results: Seven articles were included and showed frequent atypical sensory profiles in very preterm children, especially in sensory processing, particularly hyporesponsiveness, and visual perception. Conclusions: These findings indicate altered sensory performance among very preterm children, which may negatively affect motor, cognitive, and behavioral development. Early sensory screening may improve detection and guide interventions to minimize adverse developmental outcomes. Full article

Background/Objectives: This retrospective study aimed to evaluate the association between decayed, missing, and filled teeth (DMFT) scores and sinonasal anatomical variations, including Haller cells, concha bullosa, and the direction and severity of nasal septal deviation in children. Methods: Cone-beam computed tomography (CBCT) images of 167 patients aged 6–17 years were retrospectively analyzed. The direction and severity of nasal septal deviation, presence of Haller cells, presence and subtypes of concha bullosa, and DMFT index were evaluated. Nasal septal deviation was categorized as mild (<9°), moderate (9–15°), or severe (≥15°). Concha bullosa was classified as lamellar, bulbous, or extensive. DMFT scores were assessed radiologically using reconstructed panoramic images, without intraoral clinical examination data. The DMFT index was calculated only for permanent teeth. Results: Among the 167 patients, 87 were male and 80 were female. Mild nasal septal deviation was the most common type, observed in 63.5% of cases. Lamellar concha bullosa was the most frequently detected subtype on both sides. No statistically significant association was found between concha bullosa or Haller cells and DMFT scores (p > 0.05). However, a significant positive ordered trend was observed between increasing nasal septal deviation severity and DMFT scores (p = 0.004). Conclusions: Increased nasal septal deviation severity was associated with higher DMFT scores in children. However, because of the retrospective design and radiological assessment of DMFT, this association should be interpreted as a potential relationship rather than a causal effect. Full article

Background/Objectives: Childhood cancer outcomes are influenced by clinical, socioeconomic, and territorial factors, particularly in resource-limited settings. This study characterized pediatric cancer patients from Córdoba and Sucre, Colombia, and evaluated factors associated with clinical outcomes in a regional referral center. Methods: A retrospective hospital-based study included 434 patients aged 0–18 years diagnosed between 2018 and 2024. Sociodemographic, clinical, and territorial socioeconomic variables were analyzed using the Multidimensional Poverty Index (MPI). Clinical outcomes were classified as favorable, non-favorable, or death. Firth-penalized logistic regression models were used to assess adjusted associations. Results: Hematologic malignancies predominated (65.9%), with acute lymphoblastic leukemia as the most frequent diagnosis. Most patients came from municipalities with moderate or high multidimensional poverty (85.2%), and the rural territories of origin showed greater deprivation in education, employment, housing, water access, and sanitation. Favorable outcomes occurred in 82.9% of patients, while 8.5% had non-favorable outcomes and 8.5% died. Older age and non-hematologic malignancies were associated with non-favorable outcomes. Mortality was associated with older age, subsidized health insurance, and non-hematologic malignancies. MPI and rural residence were not independently associated with outcomes after adjustment. Conclusions: Although MPI was not independently associated with clinical outcomes, it identified substantial territorial deprivation. Integrating clinical and territorial indicators may support equity-oriented surveillance and pediatric oncology interventions. Full article

Background/Objectives: The minimally invasive repair of pectus excavatum (MIRPE) and its modifications represent the gold standard for surgical repair of chest wall deformities. Severe complications during or after MIRPE are rare but likely underreported in the literature. Methods/Results: We report the case of a 14-year-old adolescent who underwent an uneventful repair of an asymmetric pectus excavatum. Six weeks postoperatively, the patient presented with shortness of breath and dizziness. Clinical examination and imaging revealed a spontaneous massive right-sided hemothorax. Following chest tube placement, an initial 600 mL of bloody pleural fluid was drained. CT angiography demonstrated no active bleeding but raised suspicion of an injury to the right-sided internal mammary artery. After a total drainage of 1600 mL, the patient remained hemodynamically stable, and the chest tube was removed within 24 h. During 32 months of follow-up, the further clinical course was uneventful, and imaging demonstrated no secondary displacement of the implants. Discussion/Conclusions: Accidental injury to the internal mammary or intercostal vessels during pectus surgery is a rare but potentially life-threatening complication. Only a few cases of delayed hemorrhage following MIRPE have been reported, and in many a clear source of bleeding could not be identified. Pectus surgeons should be aware of this rare complication and should report such cases to improve understanding of its incidence and management. Full article