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Updates on Anti-Obesity Medications in Children and Adolescents
Effects of the SmartACT Intervention on Motor and Psychological Variables in Adolescent Athletes: A Controlled Trial Using BlazePod and Microgate
Interventions to Minimize Unnecessary Antibiotic Use for Acute Otitis Media: A Meta-Analysis

Journal Description

Children

Children is an international, peer-reviewed, open access journal on children’s health, published monthly online by MDPI.

Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
High Visibility: indexed within Scopus, SCIE (Web of Science), PubMed, PMC, Embase, and other databases.
Journal Rank: JCR - Q2 (Pediatrics) / CiteScore - Q2 (Pediatrics, Perinatology and Child Health)
Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 17.5 days after submission; acceptance to publication is undertaken in 2.7 days (median values for papers published in this journal in the second half of 2025).
Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.

Impact Factor: 2.1 (2024); 5-Year Impact Factor: 2.3 (2024)

Imprint Information Journal Flyer Open Access ISSN: 2227-9067

Latest Articles

13 pages, 1275 KB

Open AccessReview

Psychological Intervention Strategies in Adolescents with Asthma: A Review of the Literature

by Esther Rodríguez-Jiménez, Javier Martín-Ávila, Selene Valero-Moreno and Marián Pérez-Marín

Children 2026, 13(2), 181; https://doi.org/10.3390/children13020181 (registering DOI) - 28 Jan 2026

Background/Objectives: Asthma is one of the most prevalent chronic diseases in adolescence, a stage in which its management may be affected by developmental changes. The aim of the present study was to examine the core areas of psychological interventions in adolescents with [...] Read more.

Background/Objectives: Asthma is one of the most prevalent chronic diseases in adolescence, a stage in which its management may be affected by developmental changes. The aim of the present study was to examine the core areas of psychological interventions in adolescents with asthma. Methods: A scientific search of the literature was conducted, identifying 26 articles that described intervention programs targeting this population. Results: The findings show heterogeneity both in the characteristics of these interventions and in the variables assessed. Moreover, numerous studies do not clearly specify the theoretical framework employed, nor do they consider relevant factors such as comorbidity or the differing levels of disease severity. These limitations hinder the replicability and generalization of the results, as well as the understanding of psychological and behavioral impact. Conclusions: Therefore, the need to advance research that develops personalized programs integrating relevant aspects and improving quality of life and clinical outcomes is highlighted. Nevertheless, the interpretation of these findings is limited by the heterogeneity of the available evidence, including variability in intervention formats, theoretical frameworks, and outcome measures. Full article

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

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20 pages, 449 KB

Open AccessReview

IronDeficiency Across Neurodevelopmental Disorders: Comparative Insights from ADHD and Autism Spectrum Disorder

by Lourdes M. DelRosso, Lilliana Estrada Chaverri and Fernando Alberto Ceballos Fuentes

Children 2026, 13(2), 180; https://doi.org/10.3390/children13020180 (registering DOI) - 28 Jan 2026

Background: Iron plays a crucial role in neurotransmitter synthesis, myelination, and neuronal metabolism. Iron deficiency has been associated with a variety of neurodevelopmental disorders, particularly attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). However, the prevalence, clinical impact, and treatment implications differ between [...] Read more.

Background: Iron plays a crucial role in neurotransmitter synthesis, myelination, and neuronal metabolism. Iron deficiency has been associated with a variety of neurodevelopmental disorders, particularly attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). However, the prevalence, clinical impact, and treatment implications differ between these conditions. Objective: To synthesize current evidence on the prevalence, neurobehavioral consequences, and therapeutic implications of iron deficiency in ADHD and ASD, highlighting convergences and disorder-specific findings. Results: In ADHD, studies using serum ferritin and related peripheral markers show inconsistent associations with core symptom severity, with reported ferritin thresholds for deficiency ranging widely. While some studies suggest links between low ferritin and hyperactivity, inattention, or stimulant response, others report null findings. In contrast, emerging neuroimaging evidence consistently demonstrates reduced brain iron in dopaminergic regions in children. In ASD, the strongest link is between low ferritin and sleep-related motor disturbances, and iron supplementation may improve sleep and motor symptoms. Conclusions: Screening for iron status and targeted supplementation may improve sleep and behavioral outcomes in ADHD and ASD, meriting integration into clinical practice and further randomized controlled trials. Full article

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

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12 pages, 630 KB

Open AccessCase Report

A Clinical Practice Example of Smith–Magenis Syndrome in the Neuropediatric Clinic: Etiology, Clinical Presentation, Diagnostics and Therapeutic Approaches—A Case Report

by Oleksandr Shevchenko

Children 2026, 13(2), 179; https://doi.org/10.3390/children13020179 (registering DOI) - 28 Jan 2026

Background/Objectives: Smith–Magenis syndrome (SMS) is a rare neurogenetic disorder caused by a microdeletion in chromosome region 17p11.2 or by pathogenic variants in the RAI1 gene. The syndrome is characterized by a distinctive neurobehavioral profile, including cognitive deficits, sleep disturbances, self-injurious behavior, and typical [...] Read more.

Background/Objectives: Smith–Magenis syndrome (SMS) is a rare neurogenetic disorder caused by a microdeletion in chromosome region 17p11.2 or by pathogenic variants in the RAI1 gene. The syndrome is characterized by a distinctive neurobehavioral profile, including cognitive deficits, sleep disturbances, self-injurious behavior, and typical dysmorphic features. A characteristic diagnostic hallmark is paradoxical melatonin secretion, with increased daytime levels instead of the normal nocturnal peak. This article aims to summarize current knowledge on the etiology, diagnostics, EEG findings, therapy, and prognosis of SMS from a neuropediatric perspective. Methods: A narrative review of the literature on Smith–Magenis syndrome was conducted, focusing on genetic background, clinical features, diagnostic approaches, EEG characteristics, therapeutic strategies, and prognosis. In addition, a detailed clinical case of a 16-year-old female patient with SMS is presented. Results: The reviewed data confirm that SMS is associated with characteristic neurobehavioral abnormalities and sleep–wake rhythm disturbances. EEG findings may include epileptiform activity without overt epilepsy. In the presented case, “Rolandic-type” spike–sharp wave complexes were observed on EEG and are interpreted as an expression of congenital disturbances in brain maturation processes. Therapeutic recommendations addressing behavioral symptoms and sleep regulation are discussed. Conclusions: Smith–Magenis syndrome represents a complex neurodevelopmental disorder with distinctive clinical, neurophysiological, and genetic features. Early recognition of characteristic signs, including sleep disturbances and EEG abnormalities, is essential for appropriate management. A multidisciplinary, individualized therapeutic approach may improve quality of life and long-term outcomes. Full article

(This article belongs to the Special Issue Current Advances in Paediatric Sleep Medicine (2nd Edition))

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21 pages, 792 KB

Open AccessSystematic Review

ADHD and Moral Development in Childhood and Adolescence: A Systematic Review of Attachment, Temperament, and Socio-Emotional Mechanisms

by Ilaria Notaristefano, Federica Gigliotti, Benedetta Altomonte, Ilaria Graziani, Beatrice Piunti and Maria Romani

Children 2026, 13(2), 178; https://doi.org/10.3390/children13020178 - 28 Jan 2026

Background: Moral development (MD) arises from the interaction of attachment, temperament, emotion regulation, and decision-making. Children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) frequently show impairments across these domains, suggesting increased vulnerability to disruptions in MD. However, the mechanisms linking ADHD to MD remain [...] Read more.

Background: Moral development (MD) arises from the interaction of attachment, temperament, emotion regulation, and decision-making. Children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) frequently show impairments across these domains, suggesting increased vulnerability to disruptions in MD. However, the mechanisms linking ADHD to MD remain poorly understood. Methods: A systematic review was conducted according to PRISMA 2020 guidelines. PubMed was searched for studies published between January 2014 and November 2024 examining MD-related constructs, including moral reasoning, fairness, aggression, bullying, callous–unemotional (CU) traits, decision-making, and reward sensitivity, in individuals aged 0–18 years with diagnosed or subclinical ADHD. Due to substantial heterogeneity in study design, measures, and outcomes, a qualitative synthesis was performed. Results: Of the 2104 records identified, 23 studies met inclusion criteria. Insecure or disorganized attachment, difficult temperament, and emotional dysregulation consistently emerged as developmental risk factors for impaired MD. Hyperactivity–impulsivity and deficient inhibitory control were strongly associated with aggressive and antisocial behaviors. Children with ADHD demonstrated a pronounced preference for immediate over delayed rewards, altered decision-making in social contexts, and reduced sensitivity to positive feedback. CU traits and aggression were frequently identified as behavioral correlates of MD impairments, particularly in interaction with family adversity and comorbid externalizing conditions. Social dysfunction, including bullying involvement, peer rejection, and interpersonal difficulties, was common and contributed to elevated long-term psychosocial risk. Conclusions: ADHD is associated with multidimensional vulnerabilities in MD through intertwined cognitive, emotional, and relational pathways. Interventions targeting attachment security, emotion regulation, reward processing, and social skills may foster MD and reduce later social difficulties. Longitudinal and cross-cultural research is needed to clarify causal mechanisms and inform developmentally sensitive prevention and treatment strategies. Full article

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

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10 pages, 1327 KB

Open AccessCase Report

Possibilities and Limitations of Prenatal Diagnosis of Rare Imprinting Syndromes: Prader–Willi Syndrome

by Simona Anzhel, Nikolinka Yordanova, Emil Kovachev, Darina Krumova and Elis Ismail

Children 2026, 13(2), 177; https://doi.org/10.3390/children13020177 - 28 Jan 2026

Background: Prader–Willi syndrome (PWS) is a multisystemic complex imprinting disorder. Prenatal diagnosis of PWS is still a challenge with non-specific ultrasound markers and limitations for diagnosis with non-invasive screening methods. Prenatal suspicion and early postnatal diagnosis are essential for promoting healthy growth and [...] Read more.

Background: Prader–Willi syndrome (PWS) is a multisystemic complex imprinting disorder. Prenatal diagnosis of PWS is still a challenge with non-specific ultrasound markers and limitations for diagnosis with non-invasive screening methods. Prenatal suspicion and early postnatal diagnosis are essential for promoting healthy growth and development, preventing complications, and providing healthcare professionals and families with the necessary support and resources for effective management. Presentation: We report two PWS cases caused by maternal uniparental disomy, who presented with IUGR, characterized by reduced fetal abdominal circumference (AC) in the second and early third trimesters, reduced fetal movements, normal Doppler indices and oligohydramnios. They were diagnosed in the early neonatal period with no prenatal suspicion but with similar ultrasound markers of the developing pregnancies, analyzed retrospectively. Aim: This study aims to emphasize the need to raise awareness among specialists about genetic syndromes such as Prader–Willi syndrome, to improve the information provided to couples regarding the limitations of current prenatal screening methods, as well as to ensure that, in cases of prenatal suspicion, appropriate genetic testing can be initiated. A confirmed diagnosis would allow timely and adequate measures to be taken, given the complications of the postnatal period in these patients and their need for specialized care and management. Conclusions: The presence of the aforementioned prenatal characteristics may raise suspicion for PWS. In such cases, invasive diagnostic procedures and methylation testing may be indicated, enabling earlier diagnosis and timely management, which can ultimately improve the quality of life of affected individuals and their families. Full article

(This article belongs to the Special Issue Prenatal Screening and Diagnosis: Fetal Medicine Perspectives)

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18 pages, 633 KB

Open AccessArticle

Parental Burnout and Early-Childhood Behavioral Problems: Longitudinal Associations Beyond Maternal Depression

by Anna Suarez and Vera Yakupova

Children 2026, 13(2), 176; https://doi.org/10.3390/children13020176 - 27 Jan 2026

Background: Parenting is increasingly recognized as a highly demanding and stressful role that, in the absence of sufficient resources, may lead to parental burnout (PB). This risk may be particularly pronounced in the Russian context, where limited access to childcare for children under [...] Read more.

Background: Parenting is increasingly recognized as a highly demanding and stressful role that, in the absence of sufficient resources, may lead to parental burnout (PB). This risk may be particularly pronounced in the Russian context, where limited access to childcare for children under three and reduced extended family support coincide with strong social expectations of intensive parenting. Although PB and maternal depression frequently co-occur, it remains unclear whether PB exerts a unique influence on child development, especially during toddlerhood. The present study examined the association between PB and behavioral problems in children aged 1.5 to 4 years while controlling for maternal depression assessed both during the first year postpartum and concurrently with PB. Methods: Using a longitudinal design, maternal mental health was assessed within the first 12 months postpartum (Stage 1) and again at follow-up (Stage 2), on average 2.24 years later, in 419 Russian mother–child dyads. Mothers completed measures of postpartum depression (PPD) (Edinburgh Postnatal Depression Scale), current depressive symptoms (Beck Depression Inventory-II), and PB (Parental Burnout Inventory). Child emotional and behavioral problems were assessed at Stage 2 using the Russian version of the Child Behavior Checklist (CBCL/1½–5). Results: Mothers of children with borderline/clinically significant internalizing, externalizing, and total problems had significantly higher PB, PPD, and present maternal depressive symptoms, although the effect sizes were small. PB was strongly associated with all domains of child behavioral problems, also after correction for both postpartum and present depressive symptoms, as well as for other important covariates. Higher maternal PB symptoms further increased the odds of children having borderline/clinically significant internalizing and externalizing problems, although those effects were not independent of maternal depression. In turn, neither postpartum nor present maternal depressive symptoms were associated with any of the child behavioral problems domains. Conclusions: PB represents a distinct and clinically relevant risk factor for emotional and behavioral problems in toddlers, beyond the effects of maternal postpartum or present depression, in a context characterized by high caregiving demands and limited institutional support. These findings highlight an urgent need for programs aimed at identifying and supporting families in which parents experience high levels of exhaustion, regardless of whether they meet the criteria for other diagnosable mental health disorders. Addressing PB during toddlerhood may be critical for protecting both parental well-being and early child development. Full article

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

24 pages, 921 KB

Open AccessReview

Neonatal and Pediatric Transport: A Contemporary Review

by Keith Meyer and Balagangadhar R. Totapally

Children 2026, 13(2), 175; https://doi.org/10.3390/children13020175 - 27 Jan 2026

Safe transport of critically ill infants and children is an essential component of high-quality, pediatric regionalized care. The modern transport environment blends principles of critical care medicine, aviation physiology, provider training, and coordinated systems of care. This review provides an updated examination of [...] Read more.

Safe transport of critically ill infants and children is an essential component of high-quality, pediatric regionalized care. The modern transport environment blends principles of critical care medicine, aviation physiology, provider training, and coordinated systems of care. This review provides an updated examination of current practices in neonatal and pediatric transport, including team structure, clinical bundles, operational considerations, and emerging technologies. Special attention is given to rapidly evolving areas, including data-informed dispatch, real-time clinical decision support, and next-generation devices. The review closes with a discussion of future priorities for research, workforce development, and system design. Full article

(This article belongs to the Special Issue Addressing Challenges in Pediatric Critical Care Medicine)

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12 pages, 240 KB

Open AccessArticle

Can a Peripheral Blood Marker for Airway Neutrophilia Be Identified in Children with Bronchiectasis?

by Hendrik Willem Wiltingh, Julie Marchant, Anne Chang and Vikas Goyal

Children 2026, 13(2), 174; https://doi.org/10.3390/children13020174 - 27 Jan 2026

Background: Airway bacterial infection and inflammation are often present in children with bronchiectasis. Systemic inflammation has also been reported. Currently, there are no data on the association between systemic inflammatory markers with airway pathogens or neutrophilia in children with bronchiectasis. We aimed to [...] Read more.

Background: Airway bacterial infection and inflammation are often present in children with bronchiectasis. Systemic inflammation has also been reported. Currently, there are no data on the association between systemic inflammatory markers with airway pathogens or neutrophilia in children with bronchiectasis. We aimed to define the bronchoalveolar lavage (BAL) pathogens (bacteria and viruses), and cytology in children with bronchiectasis and to explore any association between peripheral inflammatory markers and airway neutrophilia. Methods: Participants numbering 402, aged <18 years, with peripheral blood and BAL results within 3 months of diagnosis of bronchiectasis were included. Blood and BAL results were reviewed and analysed for possible associations. Results: Of 355 children (88.31%), cultured bacteria from BAL and Haemophilus influenzae (n = 185) were the most frequent. A virus was identified in 131 (32.59%). Adenovirus (n = 69) was most common. Children numbering 279 (69.40%) had airway neutrophilia (neutrophils > 15%) which was associated with the presence of H. influenzae (OR 2.03 95% CI 1.31–3.15, p = 0.002), S. pneumonia 2.41 (95% CI 1.36–4.29, p = 0.003), and Adenovirus (OR 2.06 95% CI 1.06–4.04, p = 0.033). Airway neutrophilia was associated with raised CRP (OR 2.26 95% CI 1.14–4.49, p = 0.019), but there were no other systemic inflammatory markers including monocyte/lymphocyte ratio, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and platelet/mean platelet volume ratio. Conclusions: In children, there is an association between airway neutrophilia and raised CRP in bronchiectasis, but not with other peripheral inflammatory markers. There is a need to identify non-invasive inflammatory markers in children with bronchiectasis. Full article

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

18 pages, 990 KB

Open AccessArticle

Burden of RSV-Associated Inpatient Care and Emergency Service Utilization in Two German Pediatric Centers Across Six Seasons Including the First Nirsevimab Year

by Lisa Gürke, Gregor Hanslik, Linda-Marie Mulzer, Stefan Zimmermann, Heiko Reutter, Patrick Morhart, Joachim Wölfle, Michael K. Baumgartner, Anna-Lena Behr, Anne Christina Garbe, Hans-Christoph von Andrian, Melanie L. Conrad, Fabian B. Fahlbusch and Steven Hébert

Children 2026, 13(2), 173; https://doi.org/10.3390/children13020173 - 26 Jan 2026

Background/Objectives: Respiratory syncytial virus (RSV) is a major cause of infant respiratory morbidity, yet real-world data on healthcare utilization following universal immunoprophylaxis remain limited. Methods: We retrospectively analyzed RSV-positive inpatient and emergency department (ED) encounters from two German tertiary pediatric centers across six [...] Read more.

Background/Objectives: Respiratory syncytial virus (RSV) is a major cause of infant respiratory morbidity, yet real-world data on healthcare utilization following universal immunoprophylaxis remain limited. Methods: We retrospectively analyzed RSV-positive inpatient and emergency department (ED) encounters from two German tertiary pediatric centers across six seasons (2019/20–2024/25). Augsburg contributed inpatient data for 2022/23–2024/25, including immunization status and severity metrics, while Erlangen provided inpatient and ED data across all seasons. Results: In Augsburg, RSV hospitalizations were higher in pre-immunization seasons than in 2024/25, accompanied by a reduced proportion of infants < 1 year. RSV season onset occurred later in 2024/25, while severity metrics remained stable. Among infants < 1 year hospitalized in 2024/25, all severe cases occurred in unimmunized infants; no severe outcomes were observed among the small number of immunized cases. Conclusions: Integrated multicenter data descriptively coincide with reduced RSV hospitalization burden following immunoprophylaxis introduction, without evidence of increased disease severity. Full article

(This article belongs to the Section Pediatric Neonatology)

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22 pages, 720 KB

Open AccessArticle

DBT-K for Adolescents: Feasibility and Preliminary Outcomes of a Creative Eight-Week, DBT-Based Transdiagnostic Skills Group

by Elias Legat, Lucas Rainer, Florian Huber, Belinda Plattner, Andreas Kaiser, Pauline Schaffer, Helena Gampe and Kornelius Winds

Children 2026, 13(2), 172; https://doi.org/10.3390/children13020172 - 26 Jan 2026

Background: Mental disorders and emotion dysregulation are highly prevalent in adolescence, yet access to intensive, age-appropriate treatments remains limited. This pilot study examined the feasibility and preliminary effects of a creative, 8-week, DBT-based transdiagnostic skills group for adolescents (DBT-K). Methods: 53 [...] Read more.

Background: Mental disorders and emotion dysregulation are highly prevalent in adolescence, yet access to intensive, age-appropriate treatments remains limited. This pilot study examined the feasibility and preliminary effects of a creative, 8-week, DBT-based transdiagnostic skills group for adolescents (DBT-K). Methods: 53 outpatients (aged 13–18, 50 female) with heterogeneous psychiatric diagnoses completed baseline self-report measures of internet use, emotion regulation, self-esteem, temperament, and psychopathology. During eight weekly group sessions, positive and negative emotions were assessed before and after each session; self-esteem and emotion regulation strategies were reassessed at the final session. Linear mixed models were used to analyze trajectories of affect and self-esteem. Results: Adolescents showed high baseline internalizing symptoms, low adaptive emotion regulation, and low self-esteem, with a substantial proportion meeting criteria for problematic internet use. Across sessions, negative affect exhibited a significant reduction, with a significant main effect of time and pre- vs. post-session condition. Positive emotions showed no systematic pre-post change and a small decline over time. Self-esteem height remained stable across sessions. No significant changes emerged for total adaptive or maladaptive strategies, but expression of emotions increased significantly. Conclusions: These findings suggest that a brief, creative DBT-based group is feasible in a highly burdened, transdiagnostic outpatient sample and was associated with a reduction in negative affect and an increase in emotional expression. However, the lack of control group, high attrition, short duration, and absence of follow-up emphasize that conclusions are preliminary. Full article

(This article belongs to the Section Pediatric Mental Health)

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Graphical abstract

15 pages, 552 KB

Open AccessReview

Sleep, Emotion, and Sex-Specific Developmental Trajectories in Childhood and Adolescence

by Giuseppe Marano and Marianna Mazza

Children 2026, 13(2), 171; https://doi.org/10.3390/children13020171 - 26 Jan 2026

Sleep plays a central role in shaping emotional development during childhood and adolescence, yet increasing evidence indicates that these processes unfold differently in boys and girls. This narrative review synthesizes current findings on sex-specific associations between sleep patterns, neurodevelopmental trajectories, and emotional regulation [...] Read more.

Sleep plays a central role in shaping emotional development during childhood and adolescence, yet increasing evidence indicates that these processes unfold differently in boys and girls. This narrative review synthesizes current findings on sex-specific associations between sleep patterns, neurodevelopmental trajectories, and emotional regulation across pediatric populations. It examines how biological factors, including pubertal timing, sex hormones, circadian physiology, and maturation of fronto-limbic circuits, interact with environmental influences to generate distinct vulnerabilities to anxiety, depression, and behavioral dysregulation. Growing data suggest that girls exhibit greater sensitivity to sleep disturbances, particularly during the pubertal transition, with stronger links to internalizing symptoms such as anxiety and mood disorders. In contrast, boys appear more prone to externalizing behaviors and show differential responses to circadian misalignment and short sleep duration. Emerging evidence on sex-specific sleep architecture, REM-related emotional processing, and the bidirectional pathways through which sleep quality affects affective functioning are explored. Finally, clinical implications for early detection, personalized prevention, and targeted interventions tailored by sex and developmental stage are discussed. Understanding sex-based differences in sleep–emotion interactions offers a critical opportunity to refine pediatric mental health strategies and improve outcomes across developmental trajectories. Full article

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

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13 pages, 486 KB

Open AccessArticle

A National Forecast and Clinical Analysis of Pediatric Acute Mastoiditis in Kazakhstan

by Nazik Sabitova, Timur Shamshudinov, Assiya Kussainova, Dinara Toguzbayeva, Bolat Sadykov, Yevgeniya Rahanskaya and Laura Kassym

Children 2026, 13(2), 170; https://doi.org/10.3390/children13020170 - 26 Jan 2026

Background: Ongoing healthcare and medical education reforms in Kazakhstan have been accompanied by persistent workforce shortages and reduced inpatient capacity in pediatric care. Therefore, this study aimed to assess and forecast selected healthcare system indicators using acute mastoiditis (AM) as a sentinel condition [...] Read more.

Background: Ongoing healthcare and medical education reforms in Kazakhstan have been accompanied by persistent workforce shortages and reduced inpatient capacity in pediatric care. Therefore, this study aimed to assess and forecast selected healthcare system indicators using acute mastoiditis (AM) as a sentinel condition while also describing its clinical and epidemiological characteristics. Materials and Methods: This study combined an analysis of national healthcare and demographic statistics in Kazakhstan from 1998 to 2024 with a retrospective review of pediatric AM patients treated at a tertiary referral center. Long-term trends in healthcare resources were assessed, and future needs were projected via average annual percentage change (AAPC) and time series forecasting methods. Clinical, laboratory, and radiological data were extracted from medical records. Statistical analyses were performed via SPSS version 24.0 (IBM Corp., Armonk, NY, USA). Results: From 1998 to 2024, the number of pediatricians and ENT hospital beds declined, whereas the density of ENT physicians remained relatively stable, and the proportion of ENT surgical procedures increased. Projections to 2030 suggest continued constraints in pediatric and ENT workforce capacity and further reductions in inpatient beds despite sustained growth in surgical demand. Among 95 pediatric AM cases, complications, most commonly subperiosteal abscess and zygomatic abscess, were identified in 40% of patients. Conclusions: AM may be considered a contextual indicator of pressures within specialized pediatric ENT services rather than a direct measure of healthcare system performance. These findings highlight the need for further studies to validate these observations and better inform healthcare planning. Full article

(This article belongs to the Special Issue Diagnosis and Management of Pediatric Ear and Vestibular Disorders)

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18 pages, 1102 KB

Open AccessReview

The Cross-Knit Between Immune Cells and Thyroid Function in Autoimmune Thyroid Disorders: What We Can Learn from Inborn Errors of Immunity

by Laura Grilli, Francesca Cillo, Roberta Romano, Giuliana Giardino, Francesca Romana Rotondo, Sara Vasaturo, Mariacarolina Salerno and Donatella Capalbo

Children 2026, 13(2), 169; https://doi.org/10.3390/children13020169 - 25 Jan 2026

Autoimmune thyroid diseases (AITDs), including Hashimoto thyroiditis and Graves’ disease, are the most common autoimmune endocrinopathies, affecting up to 5% of the population. Pathogenetic pathways have not yet been fully elucidated, even though different immune-genetic alterations have been proposed. Specific immune defects presenting [...] Read more.

Autoimmune thyroid diseases (AITDs), including Hashimoto thyroiditis and Graves’ disease, are the most common autoimmune endocrinopathies, affecting up to 5% of the population. Pathogenetic pathways have not yet been fully elucidated, even though different immune-genetic alterations have been proposed. Specific immune defects presenting with AITDs may serve as an experimentum naturae to study the involvement of a specific pathway in the pathogenesis of the disease. In fact, since immune dysregulation with autoimmunity frequently characterize inborn errors of immunity (IEIs), understanding the mechanisms of immune tolerance breakdown leading to autoimmunity in these conditions may provide useful insight to understand the pathogenesis of AITDs. In this review, we will highlight the main immunological aspects of AITDs and their pathogenesis in IEIs. Full article

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

12 pages, 745 KB

Open AccessArticle

Is Perioperative Antibiotic Prophylaxis Necessary for Pediatric and Adolescent ESIN Osteosyntheses?—A Retrospective Analysis of 939 Surgical Procedures

by Lino Hundhausen, Christian Wulbrand, Eva Scheerer-Harbauer, Patrik Sperling, Clemens Memmel and Alexander Hanke

Children 2026, 13(2), 168; https://doi.org/10.3390/children13020168 - 25 Jan 2026

Background: Elastic stable intramedullary nailing (ESIN) is widely used in pediatric trauma surgery for benefits such as early limb loading, short hospital stays, and easy implant removal. Perioperative antibiotic prophylaxis (PAP) is used to reduce surgical site infections (SSIs). However, the necessity of [...] Read more.

Background: Elastic stable intramedullary nailing (ESIN) is widely used in pediatric trauma surgery for benefits such as early limb loading, short hospital stays, and easy implant removal. Perioperative antibiotic prophylaxis (PAP) is used to reduce surgical site infections (SSIs). However, the necessity of PAP in minimally invasive pediatric procedures like ESIN remains unclear. Methods: This retrospective analysis reviewed all pediatric fractures treated with ESIN osteosynthesis at a pediatric trauma center over a time span of 10 years. Focus was set on the use of PAP during implantation and complications in the period between osteosynthesis and implant removal, which was used as follow-up. Results: Between January 2013 and December 2023, a total of 979 ESIN osteosyntheses were performed. In total, 4.1% were lost to follow-up resulting in 939 eligible cases. Complications occurred in 14.7% of all cases. However, complications such as wound healing disorders, wound infections, and osteomyelitis were rare, at 1.7%. Between the different subgroups regarding the application of PAP, type of reduction, openness of the fractures, or localization, no significant differences were found. Conclusions: Besides the most minor complications, ESIN osteosynthesis in children and adolescents is safe treatment. No increased risk for complications was observed when closed reduction was performed without the administration of PAP. Full article

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

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11 pages, 517 KB

Open AccessArticle

Pulse Oximetry Histogram Profiles Before and After Red Blood Cell Transfusion in Very Preterm Infants: A Prospective Observational Cohort

by Nevra Çolak, Murat Konak and Saime Sündüs Uygun

Children 2026, 13(2), 167; https://doi.org/10.3390/children13020167 - 25 Jan 2026

Background/Objectives: Red blood cell (RBC) transfusion is frequently used to treat anemia of prematurity, yet bedside metrics that capture its short-term impact on oxygenation stability are limited. We assessed whether pulse oximetry histogram-derived oxygen saturation (SpO₂) exposure changes after transfusion and [...] Read more.

Background/Objectives: Red blood cell (RBC) transfusion is frequently used to treat anemia of prematurity, yet bedside metrics that capture its short-term impact on oxygenation stability are limited. We assessed whether pulse oximetry histogram-derived oxygen saturation (SpO₂) exposure changes after transfusion and whether responses differ across clinical subgroups. Methods: This prospective observational cohort included preterm infants born <32 weeks’ gestation who received a standardized RBC transfusion (15 mL/kg). Continuous SpO₂ histograms quantified the percentage of monitored time spent in hypoxemia (<85%), normoxemia (86–95%), and hyperoxemia (≥96%) during four intervals: 24 h pre-transfusion and 24, 48, and 72 h post-transfusion. Repeated-measures and subgroup analyses (BPD, sex, birth weight < 1000 g) were performed. Results: Thirty-three infants were analyzed (gestational age 29.4 ± 2.1 weeks; birth weight 1220.6 ± 316.9 g). Hemoglobin increased from 8.6 ± 1.1 to 11.7 ± 1.0 g/dL (p < 0.001). Cohort-level histogram shifts were modest: normoxemia increased from 68.4 ± 12.1% to 72.6 ± 11.4% at 24 h (p = 0.18), hypoxemia decreased from 10.3 ± 6.5% to 6.6 ± 4.8% (p = 0.09), and hyperoxemia remained stable (21.3 ± 9.2% to 20.8 ± 8.5%; p = 0.44). Infants with BPD and those <1000 g showed persistently higher hypoxemia and/or hyperoxemia at 72 h compared with counterparts. Exploratory ROC analyses showed modest discrimination of 24 h hypoxemia for ROP (AUC 0.71) and 72 h hyperoxemia for BPD (AUC 0.74). Conclusions: RBC transfusion corrected anemia but did not produce a consistent cohort-level improvement in SpO₂ histogram stability. Histogram metrics may help characterize heterogeneous oxygenation responses and support hypothesis generation for individualized monitoring strategies. Full article

(This article belongs to the Special Issue Advances in Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment (Second Edition))

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18 pages, 8205 KB

Open AccessSystematic Review

Modified Stoppa Approach for ORIF of a Paediatric Transverse Acetabular Fracture: Case Report and Systematic Review of Internal Fixation in Children

by Massimo Berdini, Roberto Procaccini, Donato Carola, Mario Marinelli and Antonio Gigante

Children 2026, 13(2), 166; https://doi.org/10.3390/children13020166 - 24 Jan 2026

Background: Paediatric pelvic and acetabular fractures are rare and usually the consequence of high-energy trauma, often associated with life-threatening injuries. The majority are managed non-operatively; however, open reduction and internal fixation (ORIF) is indicated in selected, complex, or displaced, acetabular fractures. The modified [...] Read more.

Background: Paediatric pelvic and acetabular fractures are rare and usually the consequence of high-energy trauma, often associated with life-threatening injuries. The majority are managed non-operatively; however, open reduction and internal fixation (ORIF) is indicated in selected, complex, or displaced, acetabular fractures. The modified Stoppa approach is well established in adults, but has been rarely reported in skeletally immature patients, and evidence guiding surgical approach and fixation in children remains limited. Methods: We report the case of an 11-year-old girl who sustained a transverse acetabular fracture following a high-energy trauma. The fracture was treated with ORIF through a modified Stoppa approach. We also performed a systematic review of the literature, focusing on ORIF of acetabular fractures in children. Results: In our patient, ORIF of the acetabular fracture was performed, achieving an anatomical reduction, 10 days after initial damage-control fixation of a concomitant open tibial plateau fracture. Postoperative management consisted of four weeks of non-weight bearing, followed by progressive weight bearing. At six months, she had returned to full daily activities and sports. The review of the literature identified 16 studies (retrospective series and case reports) describing paediatric acetabular fractures treated with ORIF using plates, screws, or flexible nails. In the literature, good to excellent clinical and radiographic outcomes were reported when anatomical reduction and stable fixation were achieved, although growth disturbance and avascular necrosis were described, particularly in cases with delayed reduction or severe triradiate cartilage injury. Conclusions: Our case illustrates the technical feasibility of the modified Stoppa approach in a skeletally immature patient with a complex acetabular fracture, with excellent mid-term outcome. Although it is not contraindicated in paediatric patients, it should be reserved for treating this type of complex fracture. The available literature supports that satisfactory results are reported after ORIF in children, but the heterogeneity and low level of evidence preclude firm recommendations on the optimal approach. Full article

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

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17 pages, 343 KB

Open AccessReview

Diencephalic Syndrome: Clinical Features, Pathophysiology, and Long-Term Outcomes

by Antonio Ruggiero, Palma Maurizi, Alberto Romano, Fernando Fuccillo, Dario Talloa, Stefano Mastrangelo and Giorgio Attinà

Children 2026, 13(2), 165; https://doi.org/10.3390/children13020165 - 24 Jan 2026

Background/Objectives: Diencephalic syndrome (DS) is an uncommon pediatric disorder presenting with severe failure to thrive despite adequate caloric intake and preserved linear growth. First characterized by Russell, this condition predominantly affects infants under 12 months and remains diagnostically challenging. Methods: We [...] Read more.

Background/Objectives: Diencephalic syndrome (DS) is an uncommon pediatric disorder presenting with severe failure to thrive despite adequate caloric intake and preserved linear growth. First characterized by Russell, this condition predominantly affects infants under 12 months and remains diagnostically challenging. Methods: We performed a comprehensive literature review examining clinical presentation, underlying pathophysiology, associated pathology, diagnostic approaches, and long-term outcomes of DS. Results: DS typically manifests in the first year of life with profound cachexia, normal or increased appetite, preserved height velocity, and characteristic features including hyperactivity, euphorism, and visual pathway involvement. Low-grade gliomas of the hypothalamic–chiasmatic region, particularly pilocytic astrocytomas, represent the predominant underlying pathology. The pathophysiological mechanisms remain incompletely understood but likely involve complex dysregulation of hypothalamic energy homeostasis. While overall survival exceeds 90% at five years, most patients experience significant long-term morbidity including visual impairment, multiple endocrine deficiencies, and hypothalamic obesity. Diagnostic delays averaging 11 months contribute to irreversible complications. Conclusions: Early recognition of DS is essential to prevent permanent visual loss and optimize outcomes. Multidisciplinary management incorporating chemotherapy as first-line treatment for underlying gliomas has improved survival while reducing radiation-associated toxicities. However, survivors face substantial lifelong sequelae requiring comprehensive monitoring and intervention. Future research should focus on elucidating precise pathophysiological mechanisms, developing targeted molecular therapies, and improving management of hypothalamic obesity and other late effects. Full article

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

11 pages, 432 KB

Open AccessArticle

Making Symptoms Visible: The Impact of Real-Time PROM Integration in Pediatric Oncology

by Natalie Bradford, Ethan Whalan, Paula Condon, Remziye Semerci, Alison Bowers and Xiomara Skrabal Ross

Children 2026, 13(2), 164; https://doi.org/10.3390/children13020164 - 23 Jan 2026

Background/Objectives: Children undergoing cancer treatment experience multiple distressing symptoms that often go undetected in routine care. This study evaluated the potential impact of integrating the Symptom Screening in Pediatrics Tool (SSPedi) into clinical workflows, focusing on symptom detection and implications for service delivery. [...] Read more.

Background/Objectives: Children undergoing cancer treatment experience multiple distressing symptoms that often go undetected in routine care. This study evaluated the potential impact of integrating the Symptom Screening in Pediatrics Tool (SSPedi) into clinical workflows, focusing on symptom detection and implications for service delivery. Methods: Seventy children (aged 4–18 years) receiving active treatment, and/or their caregivers completed SSPedi weekly for eight weeks (n = 479 completions). Medical records were audited for documentation of symptom assessments and symptom prevalence. SSPedi completions were categorized using a clinical algorithm (low, moderate, immediate concerns) and compared with score-only threshold. Results: The most bothersome symptoms were appetite changes (12%), fatigue (11%), nausea/vomiting (9%) and pain (9%). Severe bother detected by SSPedi was more frequent while hospitalized than at home (e.g., appetite changes 17% versus 9%). Documentation rates of severe symptoms in medical records were substantially lower than SSPedi reports—12% when SSPedi was completed at home and 49% when completed in hospital. Applying the clinical algorithm flagged 58% of SSPedi completions as an immediate concern in home and 63% in hospital, compared with score-only thresholds (31% at home and 17% in hospital). Algorithm-based alerts for immediate concerns would have triggered almost twice as many phone calls as score-based thresholds (168 vs. 91). Conclusions: Routine PROM integration could improve symptom detection and timely intervention. Clinical algorithms enhance sensitivity but increase alert burden, highlighting the need to review thresholds and redesign workflows. Full article

(This article belongs to the Section Global Pediatric Health)

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16 pages, 1551 KB

Open AccessArticle

Enhancing Youth Mental Health Through Virtual Lifestyle Behavior Change Support: A Pilot Feasibility Trial

by Meaghan Halle Smith, Patricia E. Longmuir, Marjorie Robb, Mark L. Norris, Miranda DiGasparro, Kaitlin Laurie, Natasha Baechler, Natasha McBrearty, Kimberly Courtney, Fiona Cooligan, Paula Cloutier and Clare Gray

Children 2026, 13(2), 163; https://doi.org/10.3390/children13020163 - 23 Jan 2026

Background: Among many deleterious effects on the well-being of children and youth, the COVID-19 pandemic contributed to a surge in youth mental health distress. This, coupled with pre-existing prolonged wait times for mental health care, highlighted the need for accessible community-based mental [...] Read more.

Background: Among many deleterious effects on the well-being of children and youth, the COVID-19 pandemic contributed to a surge in youth mental health distress. This, coupled with pre-existing prolonged wait times for mental health care, highlighted the need for accessible community-based mental health supports. The Healthy Living Project (HELP) is a virtual lifestyle change support program aimed at promoting positive lifestyle changes and improved mental well-being among youth with mental distress. A pilot feasibility study explored youth engagement with HELP e-resources, and preliminary mental health and lifestyle measures over a 3-month period. Methods: Youth were enrolled in a 3-month pilot of the HELP e-resource. Feasibility metrics (recruitment, retention, and platform engagement) were documented, while exploratory self-reported data on emotional and behavioral difficulties, youth quality of life, sedentary behavior (screen time), sleep hygiene, and physical activity were assessed at baseline and 3 months. Results: Twenty-three youth (mean age 15.7 years, SD 1.7) completed baseline assessments and started the intervention, with ten participants retained by the end of the study. Compared with non-completers (n = 13), study completers (n = 10) tended to report higher quality of life and healthier habits (lower screen time, improved sleep hygiene, and higher activity). Ongoing access to HELP over 3 months was associated with suggestive trends toward improvement in emotional and behavioral difficulties and sleep hygiene. Engaged participants who received screen time education tended to report lower screen times as compared to unengaged counterparts. Conclusions: This study provides early insights into the implementation and acceptability of HELP e-resources among youth experiencing mental distress, with suggestive trends toward potential benefit. Low recruitment and high attrition preclude definitive conclusions, and the findings should be interpreted as exploratory. Lessons from this pilot will inform the design of a subsequent trial to more rigorously evaluate feasibility and the potential impact of HELP on youth with mental distress. Full article

(This article belongs to the Section Pediatric Mental Health)

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12 pages, 436 KB

Open AccessReview

The Science of Growth Monitoring: Beyond the Basics

by Melodee Liegl and Amy Y. Pan

Children 2026, 13(2), 162; https://doi.org/10.3390/children13020162 - 23 Jan 2026

Growth charts are widely used as a clinical and research tool to assess physical growth performance of infants, children, and adolescents. They have been widely accepted as indicators of health and wellness. CDC and WHO growth charts are well known and used for [...] Read more.

Growth charts are widely used as a clinical and research tool to assess physical growth performance of infants, children, and adolescents. They have been widely accepted as indicators of health and wellness. CDC and WHO growth charts are well known and used for tracking childhood growth. The differences between WHO and CDC growth curves are largely attributable to distinct reference population and curve construction methodologies. The aim of this review is to focus on the construction, utilization, as well as clinical significance of the CDC and WHO growth charts. Full article

(This article belongs to the Special Issue Pediatric Nutrition: From General Guidelines to Precision-Based Strategies)

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