Children

16 pages, 763 KiB

Open AccessArticle

Internalizing/Externalizing Problems and Sensory Processing Alteration in Children Referred to Child Mental Health Centers

by Macarena Valencia, Ana D’Ocon, Raquel Plata, Sandra Simó and María José Cantero

Children 2025, 12(6), 664; https://doi.org/10.3390/children12060664 - 22 May 2025

Abstract

Background/Objectives: Internalizing and externalizing problems have been associated with sensory processing (SP) alteration, where severe alterations are equivalent to sensory processing disorder (SPD). This study aims to examine the relationship between childhood problems and the degree of SP alteration in children referred to [...] Read more.

Background/Objectives: Internalizing and externalizing problems have been associated with sensory processing (SP) alteration, where severe alterations are equivalent to sensory processing disorder (SPD). This study aims to examine the relationship between childhood problems and the degree of SP alteration in children referred to a child mental health center (CMHC). Methods: The study included sixty-four children (44 boys and 20 girls), aged 6 to 8 years, referred to a CMHC in Gipuzkoa, Spain. Parents completed the Child Behavior Checklist (CBCL/6–18) and the Child Sensory Profile (CSP-2). Analyses of variance and qualitative analyses were conducted to compare T-scores of childhood problems across SP alteration groups (no alteration, mild, moderate, and severe). Results: Of the participants, 31.3% (n = 20) exhibited a severe SP alteration and obtained significantly higher scores than those without SP alteration on the Withdrawn/Depressed and Attention, Social, and Thought Problems syndrome scales, as well as on the Internalizing Problems and Total Problems scales. Furthermore, children with severe SP alteration scored within the clinical range on the Anxious/Depressed and Attention Problems scales. Mean scores for Internalizing, Externalizing and Total Problems reached the clinical threshold when the SP alteration was classified as moderate or severe. These findings indicate that SP alteration is associated with increased internalizing and externalizing problems in children referred to the CMHC, with clinical levels observed particularly in cases of moderate to severe SP alteration. Conclusions: This study highlights the importance of including SP assessment in the diagnostic evaluation of childhood mental health problems. Full article

(This article belongs to the Section Pediatric Mental Health)

16 pages, 903 KiB

Open AccessArticle

A New Genre of Digital Texts That Explore Children’s Frame of Mind, Health Literacy Skills, and Behavioral Intentions for Obesity Prevention

by Valerie A. Ubbes

Children 2025, 12(6), 663; https://doi.org/10.3390/children12060663 - 22 May 2025

Abstract

Background: This project focuses on the relevance of using a health literacy approach to educating children about obesity prevention. The Habits of Health and Habits of Mind© model was used to write Electronic Texts for Health Literacy© to encourage actions that support obesity [...] Read more.

Background: This project focuses on the relevance of using a health literacy approach to educating children about obesity prevention. The Habits of Health and Habits of Mind© model was used to write Electronic Texts for Health Literacy© to encourage actions that support obesity prevention. Guided by the Integrative Theory of Behavioral Prediction, the design template for a new genre of digital texts called Electronic Texts for Health Literacy© emerges for exploring children’s frame of mind, health literacy skills, and behavioral intentions toward obesity prevention. Methods: Online materials from selected websites were strategically reviewed for improving obesity prevention and child health literacy. The digital resources were juxtaposed with the Electronic Texts for Health Literacy©, with the latter written by and for children. Discussion: Health educators who use a constructivist pedagogy can help students to write health literacy narratives about obesity prevention, then read and talk about their multimodal compositions to further the practice and development of their health literacy skills. Children with obesogenic body frames can also gain from cowriting visual–textual–gestural health narratives with their peers or health professionals. Co-constructed narratives can help children make deeper connections about their identity, frame of mind, and social agency. Summary: Although this untested resource is available as a new genre of digital text, health educators could nudge children toward developing a stronger frame of mind and behavioral intentions toward obesity prevention when they write health literacy narratives that focus on decision-making, goal setting, and communication in the context of eating nutritious foods and participating in physical activities. Full article

(This article belongs to the Section Global Pediatric Health)

12 pages, 1220 KiB

Open AccessArticle

A Single-Center Retrospective Analysis of a Standardized Sedation Protocol for MRI in Children with Achondroplasia: Minimal Complications and Excellent Imaging Quality

by Barbora Nedomová, Lucia Babulicová, Ľubica Tichá, Salome Jakešová, Ladislava Wsólová and Rudolf Riedel

Children 2025, 12(6), 662; https://doi.org/10.3390/children12060662 - 22 May 2025

Abstract

Background/Objectives: Achondroplasia, the most common form of skeletal dysplasia, poses significant challenges for procedural sedation due to distinct anatomical and physiological features. This study evaluated the safety, effectiveness, and imaging quality of a standardized sedation protocol for magnetic resonance imaging (MRI) in children [...] Read more.

Background/Objectives: Achondroplasia, the most common form of skeletal dysplasia, poses significant challenges for procedural sedation due to distinct anatomical and physiological features. This study evaluated the safety, effectiveness, and imaging quality of a standardized sedation protocol for magnetic resonance imaging (MRI) in children with achondroplasia. Methods: We conducted a single-center, retrospective analysis of 22 MRI procedures in 12 pediatric patients. Intravenous midazolam and propofol were used as primary sedatives, with continuous monitoring and standardized dosing. Sedation parameters were compared between children aged <1 year and children aged ≥1 year. Results: The median sedation duration was 35 (25–65) min, and the median recovery time was 9 (5–14) min. No significant differences were found between age groups in midazolam dose (<1 year: 0.15 ± 0.05 mg/kg vs. ≥1 year: 0.13 ± 0.04 mg/kg; p = 0.238), propofol induction (2.26 ± 1.14 vs. 1.80 ± 0.52 mg/kg; p = 0.375), or infusion rate (3.18 ± 2.74 vs. 5.13 ± 2.65 mg/kg/h; p = 0.203), indicating protocol consistency. High-quality images were obtained in all cases. In one case (4.5%), self-limited desaturation to 92% occurred, with no intervention required. No airway instrumentation or other complications were reported. Conclusions: This protocol provides safe, effective, and reproducible sedation in children with achondroplasia, ensuring high-quality MRI with minimal adverse events. Full article

(This article belongs to the Special Issue Advances in Pediatric Anesthesia, Pain Medicine and Intensive Care (2nd Edition))

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11 pages, 1104 KiB

Open AccessArticle

Cryopreserved Aortic Homograft Replacement in Pediatric Patients: A Single-Center Experience with Midterm Follow-Up

by Mustafa Kemal Avşar, Yasin Güzel, Barış Kırat, İbrahim Özgür Önsel, Deniz Yorgancılar, İlker Kemal Yücel, Cenap Zeybek and İbrahim Savaş Yıldırım

Children 2025, 12(6), 661; https://doi.org/10.3390/children12060661 - 22 May 2025

Abstract

Objective: To evaluate early and midterm outcomes of cryopreserved aortic homograft implantation in pediatric patients undergoing aortic valve and root replacement. Methods: A retrospective analysis was conducted on 36 pediatric patients aged 2 to 7 years who underwent cryopreserved aortic homograft implantation between [...] Read more.

Objective: To evaluate early and midterm outcomes of cryopreserved aortic homograft implantation in pediatric patients undergoing aortic valve and root replacement. Methods: A retrospective analysis was conducted on 36 pediatric patients aged 2 to 7 years who underwent cryopreserved aortic homograft implantation between January 2016 and December 2024. Indications included complex congenital aortic valve disease, annular hypoplasia, failed Ross procedure, and infective endocarditis. The standard root replacement technique was used under moderate hypothermic cardiopulmonary bypass. Postoperative outcomes were analyzed, including early complications, mortality, echocardiographic parameters, and long-term graft performance. Statistical analyses included the use of chi-square test, the Mann–Whitney U test, and Spearman correlation. Results: There was no 30-day mortality. One patient (2.8%) experienced late mortality at year 3, and two patients (5.6%) underwent reoperation at years 4 and 7 due to root aneurysm and severe regurgitation, respectively. Early postoperative echocardiography showed satisfactory hemodynamic performance with a mean gradient of 8.4 ± 3.2 mmHg. At 5-year follow-up, 92.9% of grafts maintained normal function. Conclusions: Cryopreserved homografts provide a safe and effective option for pediatric aortic valve replacement in the early and midterm period. However, potential late complications such as structural degeneration or root dilation necessitate long-term surveillance. Advances in decellularized grafts may improve future durability and integration. Full article

(This article belongs to the Section Pediatric Cardiology)

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14 pages, 717 KiB

Open AccessArticle

Maternal Stress Responses and Coping Following a NICU Experience

by Kim K. Doheny, Fumiyuki C. Gardner, Saher Ali, Brittany J. Fronheiser, Claire J. Miller and Gina M. Brelsford

Children 2025, 12(6), 660; https://doi.org/10.3390/children12060660 - 22 May 2025

Abstract

Background/Objectives: Mothers of infants admitted to the neonatal intensive care unit (NICU) experience significant stress, which can have lasting effects on mental health and parent–infant bonding. This mixed-methods study aimed to explore maternal stress response, coping, and resilience by examining physiological stress [...] Read more.

Background/Objectives: Mothers of infants admitted to the neonatal intensive care unit (NICU) experience significant stress, which can have lasting effects on mental health and parent–infant bonding. This mixed-methods study aimed to explore maternal stress response, coping, and resilience by examining physiological stress markers and maternal narratives. Methods: A total of 28 mothers who had an infant hospitalized in the NICU within the past three years participated in a two-hour laboratory session, which included stress induction using the Trier Social Stress Test (TSST). Salivary cortisol (sCort) and heart rate variability (HRV) were measured to assess physiological responses. Results: Qualitative analysis of maternal narratives identified two distinct response patterns: an anger/trauma (AT) group (n = 7) and a gratitude/optimism (GO) group (n = 6), with the remaining 15 mothers classified as a mixed (M) group. GO mothers exhibited significantly higher cortisol reactivity during recovery compared to AT mothers (p < 0.01). While GO mothers had higher baseline HF-HRV, no significant between-group differences were found in HRV responses. Conclusions: Findings suggest that maternal perception of NICU experiences is associated with distinct physiological stress response patterns, highlighting the importance of stress appraisal and coping in maternal well-being. Full article

(This article belongs to the Special Issue Nursing Management in Pediatric Intensive Care)

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10 pages, 538 KiB

Open AccessArticle

Sagittal Spinal Alignment in Children and Adolescents: Associations with Age, Weight Status, and Sports Participation

by Giada Annarumma, Fiore Mazza, Alessandro Ambrosi, Erica Keeling, Fredrick Fernando, Felice Sirico, Rossana Gnasso, Andrea Demeco, Marco Vecchiato, Maria Letizia Motti, Alessandro Biffi and Stefano Palermi

Children 2025, 12(5), 659; https://doi.org/10.3390/children12050659 - 21 May 2025

Abstract

Background. Poor posture is a common musculoskeletal concern in children and adolescents and may lead to spinal discomfort and long-term structural issues. While excess weight has been linked to altered sagittal alignment, the impact of sports participation on spinal posture remains unclear. [...] Read more.

Background. Poor posture is a common musculoskeletal concern in children and adolescents and may lead to spinal discomfort and long-term structural issues. While excess weight has been linked to altered sagittal alignment, the impact of sports participation on spinal posture remains unclear. This study aimed to investigate the associations between weight status, sports participation, and sagittal spinal alignment in a pediatric population. Methods. This cross-sectional study was conducted within the “Ferrari Formula Benessere” corporate wellness program and included 698 children aged 5 to 16 years. Sagittal Index (SI) was measured using a standardized plumb line technique. Body mass index (BMI) was calculated and classified according to the WHO growth standards. Sports participation was self-reported and grouped into five categories: sedentary, skill-based, power-based, mixed, and endurance sports. Results. Age was the only significant independent predictor of the SI (β = 2.45, p < 0.001), with older children exhibiting higher SI values. Although a weak correlation was observed between BMI and SI (Spearman’s r = 0.24, p < 0.001), BMI was not a significant predictor when controlling for age. No significant differences in the SI were found between active and non-active children. Among sport disciplines, the SI was lowest in power-based sports (56.7 ± 22.3 mm) and higher in endurance (62.7 ± 24.4 mm), mixed (64.5 ± 23.2 mm), skill-based (61.1 ± 22.0 mm), and non-sport (64.2 ± 24.0 mm) groups, although these differences did not reach statistical significance (ANOVA p = 0.224). Conclusions. Age appears to be the primary factor associated with sagittal spinal alignment in children, while BMI and general sports participation showed no independent effect. Although some differences emerged between sport types, these findings were not statistically significant and should be interpreted with caution. These findings underscore the need for sport-specific, longitudinal research using objective posture assessment methods. Full article

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

15 pages, 363 KiB

Open AccessArticle

Promoting Mental Health in Adolescents Through Physical Education: Measuring Life Satisfaction for Comprehensive Development

by Santiago Gómez-Paniagua, Antonio Castillo-Paredes, Pedro R. Olivares and Jorge Rojo-Ramos

Children 2025, 12(5), 658; https://doi.org/10.3390/children12050658 - 21 May 2025

Abstract

Background: Life satisfaction serves as a preventive agent against various emotional, cognitive, and behavioral challenges, making it a crucial cognitive indicator of subjective well-being, particularly during adolescence. Accurately assessing life satisfaction is essential for understanding and promoting adolescent mental health, especially in applied [...] Read more.

Background: Life satisfaction serves as a preventive agent against various emotional, cognitive, and behavioral challenges, making it a crucial cognitive indicator of subjective well-being, particularly during adolescence. Accurately assessing life satisfaction is essential for understanding and promoting adolescent mental health, especially in applied settings such as physical education, which plays a key role in fostering psychological well-being and positive youth development. However, additional investigation is needed to confirm the tools used for this purpose. This study aimed to analyze the psychometric properties, metric invariance, and temporal stability of the Satisfaction with Life Scale (SWLS) in adolescents from a region in southeastern Spain. Thus, the present study sought to answer the following research questions: (1) Does the SWLS demonstrate adequate psychometric properties in an adolescent population? (2) Is the SWLS invariant across gender and residential environments? (3) Does the SWLS show adequate stability over time? Methods: A sample of 400 students was assessed using exploratory and confirmatory factor analyses, multigroup comparisons, and test–retest techniques. Results: The results showed significant differences in scale scores in the sex and demographic location variables. Also, a robust unifactorial model with five items demonstrated good performance in terms of goodness of fit and internal consistency. Furthermore, full metric invariance was observed across genders, while configural invariance was supported for residential environment. Concurrent validity analyses revealed significant associations with another unidimensional well-being measure, and temporal stability was confirmed through the intraclass correlation coefficient. Conclusions: The findings support the SWLS as a potentially valid, reliable, and time-effective tool for assessing adolescent life satisfaction. Its strong psychometric properties make it highly suitable for use in mental health research, longitudinal monitoring, and large-scale studies. Moreover, its ease of administration allows its integration into educational, clinical, community-based, and physical education contexts, offering insightful information for the creation of long-lasting mental health regulations and preventive measures meant to improve the well-being of adolescents. Notwithstanding these encouraging results, some restrictions must be noted. The sample was restricted to a single geographic area, and contextual or cultural factors may have an impact on how satisfied people are with their lives. Furthermore, response biases could have been introduced by using self-report measures. Full article

(This article belongs to the Special Issue Addressing Challenges in Child Mental Health: Research and Strategies for Comprehensive Development)

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17 pages, 594 KiB

Open AccessArticle

Psychological Well-Being and Life Satisfaction in Children and Adolescents with Chronic Illness: The Role of Depression, Nonproductive Thoughts, and Problematic Internet Use

by Karolina Eszter Kovács, Péter Boris and Beáta Erika Nagy

Children 2025, 12(5), 657; https://doi.org/10.3390/children12050657 - 21 May 2025

Abstract

Theoretical background: The study of psychological well-being in children and adolescents living with chronic illness is of particular relevance, as the physical and psychosocial aspects of the illness can have a significant impact on their quality of life. Previous research has highlighted that [...] Read more.

Theoretical background: The study of psychological well-being in children and adolescents living with chronic illness is of particular relevance, as the physical and psychosocial aspects of the illness can have a significant impact on their quality of life. Previous research has highlighted that depression, nonproductive thoughts and various aspects of problematic internet use may be related to life satisfaction and ways of coping with illness. This study aims to examine how depression, nonproductive thoughts, and problematic internet use interact with illness perception and burden to affect psychological well-being and life satisfaction. Methods: A cross-sectional study was conducted with 207 chronically ill children aged 10–18 years. The children, aged between 10 and 18 years old, attended regular check-ups in different specialities (gastroenterology, pulmonology, onco-haematology, and paediatric rehabilitation). A cross-sectional study was carried out using psychological instruments to measure life satisfaction (SWLS), nonproductive thoughts (NPG-K), problematic internet use (PIU-Q), illness perception (PRISM) and illness burden (PRISM-D, IIRS), and depression (BDI-R). Spearman rank correlation analysis was used to explore the associations between variables. Results: Life satisfaction was negatively related to nonproductive thoughts (r = −0.28, p < 0.001), internet obsession (r = −0.20, p < 0.01), and internet neglect (r = −0.20, p = 0.004). Conversely, a positive correlation was found with the PRISM (r = 0.14, p = 0.042), suggesting that less dominance of illness detection is associated with higher life satisfaction. Depression and nonproductive thoughts showed a strong positive relationship (r = 0.49, p < 0.001), and depression and problematic internet use also showed significant correlations for the obsession, neglect and control subscales (r = 0.23–0.29, all p < 0.001). Cluster analysis identified three psychological profiles: ‘positive fighters’, ‘avoidant sufferers’, and ‘negative observers’, distinguished by differences in depression, nonproductive thoughts, illness burden, and well-being. Conclusions: The results suggest that the quality of life of children and adolescents with chronic illness is significantly affected by mental health factors, particularly depression, nonproductive thoughts and problematic internet use. Illness perception and illness-related distress also play a key role in shaping life satisfaction and overall psychosocial well-being. These findings underscore the need for targeted psychological interventions in pediatric chronic care to enhance well-being and promote adaptive coping and suggest that psychological interventions and targeted psychosocial support can significantly improve these children’s quality of life. Further research is needed to explore intervention options and to develop optimal support strategies. Full article

(This article belongs to the Special Issue Mental Health of Children with Special Needs)

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10 pages, 1201 KiB

Open AccessArticle

Infliximab Biosimilar Utilization in a Large Pediatric Learning Health System

by Ross M. Maltz, Shehzad A. Saeed and Jeremy Adler

Children 2025, 12(5), 656; https://doi.org/10.3390/children12050656 - 20 May 2025

Abstract

Background/Objectives: Infliximab biosimilars entered the United States (US) market in November 2016. Uptake of infliximab biosimilars has been slow in adult studies. We aimed to assess variation in the initiation of infliximab biosimilars in a large pediatric cohort. Methods: We performed [...] Read more.

Background/Objectives: Infliximab biosimilars entered the United States (US) market in November 2016. Uptake of infliximab biosimilars has been slow in adult studies. We aimed to assess variation in the initiation of infliximab biosimilars in a large pediatric cohort. Methods: We performed a retrospective cohort study using data from 2016 to 2023 prospectively collected by the ImproveCareNow (ICN) Network, a multicenter pediatric inflammatory bowel disease (IBD) quality improvement collaborative. Pediatric patients with IBD who started any infliximab therapy were included. Descriptive statistics were used to summarize patient characteristics and changes in the use of infliximab agents. Chi-square or Fisher’s exact tests were used to evaluate differences in infliximab biosimilar initiation over time by race, age, ethnicity, and region. Results: In total, 4602 patients from 73 ICN centers started an infliximab agent. Infliximab biosimilar initiation rose steadily from 1% in 2018 to nearly 42% in 2023, with 88% of centers using biosimilars in 2023. Overall, from 2016 to 2023, the total percentage of patients who were started on an infliximab biosimilar was 17.3%. There were no differences in infliximab biosimilar initiation by age, race, or ethnicity, except in 2020 for age and race. The Midwest, West, and Southwest regions had higher initiation rates of infliximab biosimilars than the rest of the US. Conclusions: The percentage of patients with IBD initiating an infliximab biosimilar rose slowly to nearly 42% by 2023, and eight (12%) centers never recorded prescribing an infliximab biosimilar in the ICN Network. There were no differences in biosimilar initiation based on race or ethnicity. Full article

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

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15 pages, 456 KiB

Open AccessReview

Parental Perspectives on Oral Health and Access to Care in Children with Down Syndrome: A Narrative Review

by Petra Saitos, Raluca Iurcov, Abel Emanuel Moca, Teofana Bota, Rebeca Daniela Marton and Mihai Juncar

Children 2025, 12(5), 655; https://doi.org/10.3390/children12050655 - 20 May 2025

Abstract

Background/Objectives: Children with Down syndrome are predisposed to various oro-dental conditions, which can impact their oral-health-related quality of life (OHRQoL) and overall well-being. Given their critical role, parents’ and caregivers’ perceptions are essential for understanding the challenges in oral care access and [...] Read more.

Background/Objectives: Children with Down syndrome are predisposed to various oro-dental conditions, which can impact their oral-health-related quality of life (OHRQoL) and overall well-being. Given their critical role, parents’ and caregivers’ perceptions are essential for understanding the challenges in oral care access and quality. This narrative review aimed to synthesise the available evidence on parental and caregiver perceptions regarding oral health, OHRQoL, and dental care access for children with Down syndrome. Methods: A literature search was conducted in PubMed, Web of Science, and Scopus, covering studies published between January 2015 and January 2025. The search included the keywords “Down syndrome”, “oral health”, “oral health-related quality of life”, “caregivers”, “parents”, “dental care access”, and “special needs children”. Thirteen studies were included after applying eligibility criteria, which selected original research focusing on the target population and themes. Results: The findings highlighted that oral health significantly affects the quality of life of children with Down syndrome, influencing their functional, emotional, and social well-being. Caregivers often reported a gap between perceived and clinically observed oral health. Barriers to dental care access included insufficient training of dental professionals, financial constraints, systemic limitations, and perceived biases. Variations across different countries also revealed the influence of cultural and healthcare system factors. Conclusions: Oral health plays a critical role in the lives of children with Down syndrome and their families. Strengthening caregiver education, improving communication, validating adapted OHRQoL instruments, and enhancing dental professionals’ training in special needs care are crucial steps to ensure equitable and family-centred oral healthcare. Full article

(This article belongs to the Special Issue Dental Status and Oral Health in Children and Adolescents)

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16 pages, 629 KiB

Open AccessArticle

Family Support, Communication with Parents, and Adolescent Health Risk Behaviour: A Case of HBSC Study from Bulgaria and Lithuania

by Elitsa Dimitrova and Apolinaras Zaborskis

Children 2025, 12(5), 654; https://doi.org/10.3390/children12050654 - 19 May 2025

Abstract

Objective: This study aimed to explore the association between adolescents’ health risk behaviours (excessive use of alcohol, (e)cigarette smoking, cannabis use) and familial factors. A special objective of this study was to compare findings between Bulgarian and Lithuanian adolescents aged 15 years. Material [...] Read more.

Objective: This study aimed to explore the association between adolescents’ health risk behaviours (excessive use of alcohol, (e)cigarette smoking, cannabis use) and familial factors. A special objective of this study was to compare findings between Bulgarian and Lithuanian adolescents aged 15 years. Material and Methods: National samples from the WHO Health Behaviour in School-aged Children (HBSC) survey in 2021/2022 were analysed. The focus was on adolescents aged 15 (n = 64,349), including those from Bulgaria (n = 793) and Lithuania (n = 1137). The set of outcome variables included drunkenness, smoked cigarettes, e-cigarettes, and used cannabis (all variables were measured during the last 30 days); their indicators were child’s talking separately to their father and separately to their mother, as well as the four-item family support scale. All variables were dichotomised and their associations were analysed using Structural Equation Modelling with a WLSMV estimator. Results: In the total sample, the prevalence of drunkenness was 14.9%, cigarette smoking at 12.6%, e-cigarette smoking at 18.4%, and cannabis use at 5.9%; while in Bulgaria, in contrast to Lithuania, these behaviours were much more prevalent, at 27.0%, 29.9%, 29.8%, and 11.1%, respectively. The use of substances was significantly associated with selected familial factors, which were more pronounced among girls than boys in most subsamples. Low family support showed the strongest association with increased substance use (in the total sample, regression weight B varied from 0.231 to 0.382). Adolescents’ difficulty in talking to mother was more pronounced (B = 0.123 to 0.204) than difficulty in talking to their father (B = 0.058 to 0.140). Comparison of data samples from Bulgaria and Lithuania showed stronger relationships in Bulgarian adolescents compared to other countries, which are more pronounced among boys. In addition, among Bulgarian adolescents, easy communication with their father had an inverse association (increasing prevalence) with cannabis use. Conclusions: Adolescent health risk behaviours, such as use of substances, are associated with familial factors, including parent–teen communication and family support. Generally, these associations are more pronounced among girls than boys, and more evident among Bulgarian adolescents than their Lithuanian counterparts. Identifying environmental factors in families helps to plan interventions to prevent development of multiple health risk behaviours in adolescents. Full article

(This article belongs to the Special Issue Parenting and Child/Adolescent Development: Current Updates and Global Perspectives (2nd Edition))

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13 pages, 580 KiB

Open AccessArticle

Short-Term Impact of Slow Maxillary Expansion on Labial Ectopic Canine Eruption Pathway in Children: A Retrospective Study

by Qian Tong, Xue Yang, Yue Fei and Jun Wang

Children 2025, 12(5), 653; https://doi.org/10.3390/children12050653 - 19 May 2025

Abstract

Objectives: This retrospective study evaluated the short-term effects of removable slow maxillary expansion (SME) on eruption patterns of labially ectopic canines in a Chinese pediatric population, comparing treated patients with untreated controls. Methods: Seventy-six patients (mean age 8.38 ± 0.88 years) underwent SME [...] Read more.

Objectives: This retrospective study evaluated the short-term effects of removable slow maxillary expansion (SME) on eruption patterns of labially ectopic canines in a Chinese pediatric population, comparing treated patients with untreated controls. Methods: Seventy-six patients (mean age 8.38 ± 0.88 years) underwent SME treatment for 11.04 ± 4.44 months. Canine positions were categorized as labial ectopic (TE: n = 40) or normally positioned (TN: n = 112). The TE group was stratified vertically: superior (TES; n = 15, canines above lateral incisors’ roots or adjacent to unerupted incisors) and inferior (TEI; n = 25, canines adjacent to erupted lateral incisors’ roots). Untreated controls (n = 58; mean age 8.46 ± 0.78 years) included labial ectopic (CE group; n = 32) and normal canines (CN group; n = 84), with CE further divided vertically into CES (n = 24) and CEI (n = 8). Panoramic radiographs at baseline (T0) and follow-up (T1) evaluated sector distribution, midline proximity (3c-ML: canine cusp to midline distance), vertical position (3c-OP: cusp to occlusal plane distance), and angular (3^ML: canine-midline angle). Results: SME significantly improved midline proximity (3c-ML increased) while reducing vertical height (3c-OP decreased) and angulation (3^ML reduced) in the TE group. Notably, TE patients revealed a significantly greater increase in 3c-ML compared to CE. Subgroup analysis showed that TEI canines exhibited significant improvements in all three parameters (3c-OP, 3c-ML, and 3^ML), whereas TES canines displayed minimal changes. The shifts in sector distribution were similar between the treatment and control groups. Conclusions: SME demonstrated short-term efficacy in guiding labially ectopic canines toward more favorable eruption trajectories, particularly when erupted beyond the roots of the lateral incisor. The observed positional improvements underscore SME’s potential to optimize eruption outcomes during early orthodontic intervention. Full article

(This article belongs to the Special Issue Behavior Intervention and Early Orthodontic Treatment in Pediatric Dentistry)

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10 pages, 216 KiB

Open AccessArticle

Gender Differences in a Cohort of Children with Eating Disorders: A Retrospective Study

by Isabella Tarissi de Jacobis, Elena Inzaghi, Elena Bozzola, Valeria Zanna, Cristina Mascolo, Sara Caterina Kupiec and Maria Rosaria Marchili

Children 2025, 12(5), 652; https://doi.org/10.3390/children12050652 - 19 May 2025

Abstract

Introduction: Eating disorders (EDs) are severe psychiatric disorders that significantly impact the psychological and physiological well-being of affected individuals. Despite increasing prevalence in males over the past few decades, EDs are mainly considered a female disease. This retrospective study aims to evaluate [...] Read more.

Introduction: Eating disorders (EDs) are severe psychiatric disorders that significantly impact the psychological and physiological well-being of affected individuals. Despite increasing prevalence in males over the past few decades, EDs are mainly considered a female disease. This retrospective study aims to evaluate the influence of gender on the clinical, laboratory, and developmental characteristics of EDs in pediatric patients. Material and methods: A retrospective study was conducted on patients referred to the EDs between 2019 and 2024 at Bambino Gesù Children’s Hospital, Rome, Italy. Gender differences were evaluated in the whole cohort and in a sub-cohort of males and females well matched for age. Results: In the whole cohort of 501 patients (age range 8–17 years), 45 were males and 456 were females. In male patients, EDs occurred at a younger age (12.65 vs. 14.65 years, p < 0.05). When considering the matched cohort, male patients showed more severe clinical conditions, as evidenced by a tendency to a lower BMI SDS at the onset, higher inflammatory parameters (ferritin and transaminase levels), and poorer nutritional status (vitamin D levels: 23.15 vs. 26.9 ng/mL, p < 0.05). However, male patients had a shorter hospital stay (14.8 vs. 19.9 days, p < 0.05) and showed a tendency to a greater clinical improvement. Differences in therapy were also observed, with fewer males receiving pharmacological treatment or nasogastric feeding. Conclusions: The results of the current study confirm the higher prevalence of EDs in females, even though they suggest EDs are not exclusively a female disease. Male gender may represent a risk factor for a worse clinical course and a younger onset. Further studies with a longer follow-up are required to understand the significant differences between females and males in this complex disorder. Full article

(This article belongs to the Special Issue Pediatric Anorexia Nervosa and Eating Disorders: Challenges in Identification, Intervention, and Recovery)

11 pages, 823 KiB

Open AccessBrief Report

by Lucía Fernanda Flores-Santy, Barbara Martina Trujillo Gutiérrez, Cristina Mileny Campaña Iza and Juan Pablo Hervás Pérez

Children 2025, 12(5), 651; https://doi.org/10.3390/children12050651 - 19 May 2025

Abstract

The General Movements Assessment provides early insight into motor development’s range of motion; however, its relationship with joint kinematics, such as hip abduction range of motion, remains underexplored. This study analyzed hip abduction kinematics during General Movements, evaluating potential sex differences and variations [...] Read more.

The General Movements Assessment provides early insight into motor development’s range of motion; however, its relationship with joint kinematics, such as hip abduction range of motion, remains underexplored. This study analyzed hip abduction kinematics during General Movements, evaluating potential sex differences and variations in movement patterns (Fidgety vs. Writhing), and aimed to provide quantitative data that complement qualitative pediatric assessments. This cross-sectional observational study analyzed video recordings of spontaneous motor activity in 32 infants under three months of corrected age. Hip abduction range of motion was extracted using biomechanical analysis during General Movements. Interrater reliability was evaluated using Fleiss’s Kappa. Correlations were assessed using Pearson’s test, and a two-way ANOVA examined the effects of sex and the type of movements on range of motion. Interrater reliability for movement classification was excellent (Kappa = 0.909, p < 0.001). No significant correlations were found between sex or General Movements type and hip abduction range of motion (p > 0.68). Two-way ANOVA showed no significant effects of sex, movement pattern, or their interaction on range of motion in either hip (right: p = 0.726, left: p = 0.823), with small effect sizes (η² < 0.013). A minor asymmetry favoring the right hip was observed but was not clinically significant. Sex and General Movements type did not significantly influence hip abduction range of motion in infants under three months. Early joint mobility appears consistent across sexes and movement patterns, supporting its reliability as a biomechanical marker of typical development. Full article

(This article belongs to the Special Issue Motor Development in Children and Adolescence)

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23 pages, 10910 KiB

Open AccessArticle

The Impact of Antenatal and Postnatal Factors on the Development of the Pulmonary Microvasculature in Preterm Infants

by Raluca Chirculescu, Ruxandra Viorica Stănculescu, Paul Cristian Bălănescu and Gheorghe Peltecu

Children 2025, 12(5), 650; https://doi.org/10.3390/children12050650 - 18 May 2025

Abstract

This research aimed to assess the influence of prenatal and postnatal factors on the remodeling of the pulmonary microvasculature. Methods: The investigation analyzed 67 cases of preterm infants, whose lifespans ranged from 1 day to 149 days. After selecting the cases from [...] Read more.

This research aimed to assess the influence of prenatal and postnatal factors on the remodeling of the pulmonary microvasculature. Methods: The investigation analyzed 67 cases of preterm infants, whose lifespans ranged from 1 day to 149 days. After selecting the cases from the autopsy database, two lung tissue microarrays were created. Histological slides were stained using the hematoxylin and eosin technique to precisely capture the microscopic details. For the assessment of pulmonary microvascularization and the media layer of the vascular walls, an immunohistochemical analysis was performed utilizing CD34 and SMA markers. Results: Following the assessment of the quantity of capillaries positive for CD34, a negative correlation was identified between the average capillary count per alveolus and the duration of oxygen therapy. Preterm infants who developed pulmonary fibrosis exhibited an average reduction of 5.43 capillaries in comparison to other newborns. Preterm neonates born to mothers with preeclampsia exhibited an average reduction of 2.82 capillaries compared to those born to mothers unaffected by this pregnancy complication. A positive correlation was evident between increased thickness of the arteriolar media, lifespan, and the duration of oxygen therapy, as well as in those preterm infants who developed pulmonary fibrosis. Conclusions: Antenatal risk factors did not exert a significant impact on pulmonary vascular remodeling, whereas postnatal influences, particularly oxygen therapy, demonstrated a detrimental effect on the density of capillary structures within the alveolocapillary membrane. Premature neonates with increased thickness of the arteriolar media had a greater susceptibility to pulmonary hypertension. Full article

(This article belongs to the Special Issue Recent Advances in Maternal and Fetal Health (2nd Edition))

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9 pages, 1339 KiB

Open AccessCase Report

Presumed Bartonella-Associated Spondylodiscitis in a 3-Year-Old Child: A Case Report and Review of the Literature

by Hadi El Assaad, Eckehard Schumann, Christian Klemann, Nadine Dietze-Jergus, Christoph-Eckhard Heyde and Philipp Pieroh

Children 2025, 12(5), 649; https://doi.org/10.3390/children12050649 - 16 May 2025

Abstract

With an incidence of 0.3 per 100,000, spondylodiscitis is a rare condition in children. It is typically bacterial in origin and most commonly caused by Staphylococcus aureus. Bone involvement in cat-scratch disease (CSD) due to Bartonella henselae is exceedingly rare, occurring in [...] Read more.

With an incidence of 0.3 per 100,000, spondylodiscitis is a rare condition in children. It is typically bacterial in origin and most commonly caused by Staphylococcus aureus. Bone involvement in cat-scratch disease (CSD) due to Bartonella henselae is exceedingly rare, occurring in only 0.17–0.27% of cases. We present the case of a 3-year-old boy with a two-week history of intermittent back pain and a recent onset fever. Initial laboratory findings were unremarkable, and MRI revealed spondylodiscitis at L3/4 without abscess formation. Empirical antibiotic treatment with ampicillin/sulbactam showed no clinical response. Serologic testing revealed a positive Bartonella henselae IgM (IgG negative), leading to a change in antibiotic treatment to azithromycin and rifampicin for three weeks, resulting in rapid clinical improvement. Follow-up at nine weeks showed marked clinical and radiologic improvement. Although IgM subsequently turned negative without IgG seroconversion—a pattern previously described in Bartonella infections—this does not exclude the diagnosis. Biopsy or tissue PCR was not performed due to the mild clinical course. A review of the literature identified 28 pediatric cases of Bartonella henselae spondylodiscitis, with significant variation in diagnostic and treatment approaches. This case underscores the importance of considering Bartonella in the differential diagnosis of pediatric vertebral osteomyelitis. Full article

(This article belongs to the Section Pediatric Infectious Diseases)

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25 pages, 2516 KiB

Open AccessSystematic Review

The Pharmacokinetics, Dosage, Preparation Forms, and Efficacy of Orally Administered Melatonin for Non-Organic Sleep Disorders in Autism Spectrum Disorder During Childhood and Adolescence: A Systematic Review

by Ekkehart Paditz, Bertold Renner, Rainer Koch, Barbara M. Schneider, Angelika A. Schlarb and Osman S. Ipsiroglu

Children 2025, 12(5), 648; https://doi.org/10.3390/children12050648 - 16 May 2025

Abstract

Background: To date, it remains unclear which oral doses and preparation forms of melatonin should be recommended for children and adolescents with non-organic sleep disorders and autism spectrum disorder (ASD). We reviewed the current state of knowledge on this topic based on randomised [...] Read more.

Background: To date, it remains unclear which oral doses and preparation forms of melatonin should be recommended for children and adolescents with non-organic sleep disorders and autism spectrum disorder (ASD). We reviewed the current state of knowledge on this topic based on randomised placebo-controlled trials (RCTs) and diagnosis-related blood melatonin concentrations available in this age group. Method: Two investigators independently searched PubMed, PsycINFO, MEDLINE, and Cochrane CENTRAL on 1 March 2025 for the keywords “melatonin”, “autism”, and “randomised” in titles and abstracts in all languages, including an evaluation of the references of the reviews, systematic reviews, and meta-analyses published up to that date, some of which were based on searches in numerous databases. Based on this, additional in-depth searches were carried out in PubMed for pharmacokinetic, physiological, and pathophysiological data on melatonin in children and adolescents, with a special focus on ASD. Results: To date, five RCTs on non-organic sleep disorders in children and adolescents with the sole diagnosis of ASD or with subgroup analyses in the presence of several initial diagnoses such as ADHD, epilepsy, Smith–Magenis, or Fragile X syndrome are available. In these studies, rapid-release, non-delayed preparations were administered orally. In one of these studies, the clinical efficacy of a combination preparation with a sustained-release and a non-released active substance component was tested. Pharmacokinetic data with multiple determinations of melatonin concentrations in the blood are only available for children with ASD in the form of a case series (N = 9). Discussion: RCTs comparing the efficacy of delayed melatonin preparations with non-delayed rapid-release oral preparations are not yet available. Physiological data and clinical effects documented in five RCTs indicate that non-delayed melatonin preparations with an initial rapid onset of action are effective for non-organic sleep disorders in children and adolescents with ASD. Conclusions: From a clinical, pharmacokinetic, and physiological point of view, the RCTs available to date and the data on melatonin concentrations in the blood of children with ASD, measured several times over 24 h, suggest that a low oral melatonin dose and a non-delayed preparation with rapid onset should be started in children and adolescents with non-organic sleep disorders in ASD, if sleep hygiene advice and psychotherapeutic interventions have not demonstrated sufficient effects. Full article

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

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14 pages, 244 KiB

Open AccessReview

Fertility Preservation in Female Children and Adolescent Cancer Patients

by Min Wang and Chao Yang

Children 2025, 12(5), 647; https://doi.org/10.3390/children12050647 - 16 May 2025

Abstract

The five-year survival rate for childhood cancer now exceeds 80%, leading to an increasing number of young women who may confront infertility in the future due to the gonadotoxic effects of surgery, chemotherapy, and radiation. Despite current guidelines advocating for fertility preservation counseling [...] Read more.

The five-year survival rate for childhood cancer now exceeds 80%, leading to an increasing number of young women who may confront infertility in the future due to the gonadotoxic effects of surgery, chemotherapy, and radiation. Despite current guidelines advocating for fertility preservation counseling and necessary reproductive protection measures for all patients, significant barriers and ethical considerations persist, particularly within the pediatric and adolescent female population. In this review, we provide an overview of the impact and mechanisms of anti-tumor therapies on ovarian function, fertility preservation strategies for pediatric and adolescent patients, and the associated costs and ethical considerations that need to be addressed. Full article

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

11 pages, 2912 KiB

Open AccessCase Report

Pediatric Medial Discoid Meniscus: Case Series and Postoperative Outcomes

by Franck Accadbled, Oliwer Sygacz, Joe Rassi and Alexandru Herdea

Children 2025, 12(5), 646; https://doi.org/10.3390/children12050646 - 16 May 2025

Abstract

Discoid medial meniscus (DMM) is a rare congenital anomaly, with bilateral cases being even more uncommon. Due to its rarity, comprehensive data on its prevalence, clinical presentation, and optimal management strategies are limited. This study aimed to evaluate the prevalence, clinical characteristics, and [...] Read more.

Discoid medial meniscus (DMM) is a rare congenital anomaly, with bilateral cases being even more uncommon. Due to its rarity, comprehensive data on its prevalence, clinical presentation, and optimal management strategies are limited. This study aimed to evaluate the prevalence, clinical characteristics, and treatment outcomes of symptomatic DMM in a pediatric population. A retrospective review was conducted on patients under 18 years of age diagnosed with symptomatic DMM. Data were extracted using ICD-10 codes Q68.6 and M23.16 and were supplemented by free-text searches. The inclusion criteria encompassed a confirmed DMM diagnosis, availability of MRI and radiographic imaging, complete clinical documentation, and a minimum of six months of postoperative follow-up. Demographic data, clinical presentations, imaging findings, surgical interventions, and outcomes were analyzed. Three patients (five knees) met the inclusion criteria. All presented with symptomatic DMM requiring surgical intervention. Arthroscopic saucerization combined with meniscal repair was performed in all cases. Postoperative follow-up revealed that two of the patients achieved excellent outcomes, while one required three reoperations due to retearing but remained symptom-free at one year post-revision. Radiographic assessments did not reveal characteristic changes typically associated with DMM. Symptomatic DMM, though rare, may be encountered more frequently than previously reported, especially when focusing on symptomatic cases. Arthroscopic saucerization with concurrent meniscal repair appears to be an effective treatment modality, yielding favorable mid-term outcomes. Given the limited number of cases and the variability in their presentations, further research with larger cohorts is essential to establish standardized management protocols and to better understand the long-term prognosis of patients with this rare condition. Full article

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

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