Children

19 pages, 259 KB

Open AccessArticle

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

by Michelle L. Nighswander

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

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

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

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

14 pages, 726 KB

Open AccessArticle

by Semine Ozdemir Dilek and Fatma Özgüç Comlek

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

Abstract

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

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

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

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13 pages, 988 KB

Open AccessArticle

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

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

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

Abstract

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

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

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

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22 pages, 329 KB

Open AccessStudy Protocol

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

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

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

Abstract

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

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

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

14 pages, 1338 KB

Open AccessArticle

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

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

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

Abstract

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

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

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

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13 pages, 656 KB

Open AccessReview

Cherubism: An African-Focused Review

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

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

Abstract

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

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

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

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12 pages, 455 KB

Open AccessArticle

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

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

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

Abstract

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

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

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

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20 pages, 519 KB

Open AccessReview

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

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

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

Abstract

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

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

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

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28 pages, 1352 KB

Open AccessReview

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

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

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

Abstract

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

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

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

7 pages, 494 KB

Open AccessCase Report

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

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

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

Abstract

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

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

(This article belongs to the Section Pediatric Surgery)

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8 pages, 194 KB

Open AccessArticle

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

by Marcin Losin, Andrzej Golebiewski and Piotr Czauderna

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

Abstract

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

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

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

20 pages, 737 KB

Open AccessArticle

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

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

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

Abstract

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

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

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

14 pages, 265 KB

Open AccessArticle

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

by Fatma Durak and Özlem Tezol

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

Abstract

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

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

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

16 pages, 593 KB

Open AccessSystematic Review

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

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

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

Abstract

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

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

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

22 pages, 594 KB

Open AccessReview

Breastfeeding in Infancy and Adult Health: A Narrative Review

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

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

Abstract

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

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

18 pages, 696 KB

Open AccessArticle

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

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

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

Abstract

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

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

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

10 pages, 1248 KB

Open AccessArticle

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

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

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

Abstract

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

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

(This article belongs to the Section Pediatric Ophthalmology)

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9 pages, 1014 KB

Open AccessCase Report

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

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

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

Abstract

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

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

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

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13 pages, 621 KB

Open AccessSystematic Review

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

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

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

Abstract

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

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

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

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