Journal Description
Children
Children
is an international, peer-reviewed, open access journal on children’s health, published monthly online by MDPI.
- Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
- High Visibility: indexed within Scopus, SCIE (Web of Science), PubMed, PMC, Embase, and other databases.
- Journal Rank: JCR - Q2 (Pediatrics) / CiteScore - Q2 (Pediatrics, Perinatology and Child Health)
- Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 17.5 days after submission; acceptance to publication is undertaken in 2.7 days (median values for papers published in this journal in the second half of 2025).
- Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.
Impact Factor:
2.1 (2024);
5-Year Impact Factor:
2.3 (2024)
Latest Articles
Fundamental Motor Skills and Motor Competence in Children and Adolescents with Autism Spectrum Disorder (ASD): A Narrative Review
Children 2026, 13(4), 520; https://doi.org/10.3390/children13040520 - 8 Apr 2026
Abstract
Background/Objectives: Children and adolescents on the autism spectrum often experience delays in both gross and fine motor skills, which can limit their participation in physical activity and everyday tasks. Methods: This narrative review synthesizes evidence from 88 peer-reviewed studies examining fundamental motor skills,
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Background/Objectives: Children and adolescents on the autism spectrum often experience delays in both gross and fine motor skills, which can limit their participation in physical activity and everyday tasks. Methods: This narrative review synthesizes evidence from 88 peer-reviewed studies examining fundamental motor skills, broader motor competence, and perceived motor competence in individuals aged 3–18 years with a formal diagnosis of autism. Results: Across the literature, children with autism consistently demonstrate lower proficiency in locomotor and object control skills compared with their typically developing peers, while perceived competence emerges as an important factor influencing motivation and engagement. Intervention studies—most commonly school-based or structured physical activity programs—generally report short-term improvements in motor performance, although outcomes vary depending on study design, dosage, and assessment tools. The review also highlights substantial methodological heterogeneity and a notable lack of evidence concerning adolescents, underscoring the need for longitudinal and developmentally sensitive research. Conclusions: Practical implications are discussed for creating supportive movement environments in educational and adapted physical activity settings. This review follows a narrative synthesis approach informed by a structured search strategy.
Full article
(This article belongs to the Special Issue Physical and Motor Development in Children)
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Open AccessArticle
Adolescents Admitted for Suicide Attempts to a Tertiary Pediatric Hospital in Romania: An Eleven-Year Retrospective Study
by
Andreea Lescaie, Gabriela Viorela Nitescu, Andreea Catalina Stratula, Dora Andreea Boghițoiu, Cristina Iolanda Vivisenco, Andreea Manolache, Diana Georgiana Cotuna, Alina Mitrea and Florina Rad
Children 2026, 13(4), 519; https://doi.org/10.3390/children13040519 - 8 Apr 2026
Abstract
Introduction: Adolescent suicide behavior is a global concern and a leading cause of morbidity and mortality in this age group. Pharmaceutical ingestion is a frequent method of suicide attempts, requiring toxicology and psychiatric interventions. This study analyzed data from a pediatric tertiary hospital
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Introduction: Adolescent suicide behavior is a global concern and a leading cause of morbidity and mortality in this age group. Pharmaceutical ingestion is a frequent method of suicide attempts, requiring toxicology and psychiatric interventions. This study analyzed data from a pediatric tertiary hospital to elucidate the trends, demographics, and methods used. Methods: This retrospective study was conducted at a single tertiary pediatric hospital in Romania and included adolescents aged 10–18 years admitted for suicide attempts between 2014 and 2024. Data extracted from electronic medical records included age, sex, residence, suicide method, psychiatric history, and clinical outcomes. Temporal trends were analyzed using regression-based methods, and group comparisons were performed using chi-square tests, with statistical significance set at p < 0.05. Results: The study included 1840 adolescents, with a significant increasing trend over time (p < 0.0001), but with a transient decline in 2020. The female-to-male ratio was 5.4:1 (p < 0.0001). The median age of the patients was 15.2 years. The suicide attempt methods were pharmaceutical poisoning (95%), chemical ingestion (4%), and violent methods (1%). Females were more prone to pharmaceutical poisoning, while males were associated with chemical ingestion and violent methods (p < 0.0001). Previously documented psychiatric disorders were present in 32.8% of patients, while 9.6% had a history of prior suicide attempts. Two fatalities (0.1%) were recorded, both involving defenestration. Conclusions: Hospital-treated suicide attempts among Romanian adolescents increased over time, mainly affecting females through pharmaceutical poisoning. Adolescents without prior psychiatric diagnoses reveal gaps in early identification and prevention. These findings highlight important patterns among hospital-treated adolescents and may inform targeted prevention efforts.
Full article
(This article belongs to the Section Pediatric Mental Health)
Open AccessCase Report
Intraoperative Hemodynamic Collapse During Patent Ductus Arteriosus Ligation in an Extremely Low-Birth-Weight Infant: A Case Report
by
Jeongsoo Choi, Ho Soon Jung, Da Hyung Kim, Yong Han Seo, Hea Rim Chun, Hyung Yoon Gong, Jae Young Ji, Jin Soo Park and Sangwoo Im
Children 2026, 13(4), 518; https://doi.org/10.3390/children13040518 - 8 Apr 2026
Abstract
Background and Clinical Significant: Patent ductus arteriosus (PDA) is a common cardiovascular disorder in extremely low-birth-weight (ELBW) infants, for which surgical ligation is indicated when pharmacologic closure fails. Sudden increases in afterload combined with immature myocardial contractility can lead to post-ligation cardiac syndrome
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Background and Clinical Significant: Patent ductus arteriosus (PDA) is a common cardiovascular disorder in extremely low-birth-weight (ELBW) infants, for which surgical ligation is indicated when pharmacologic closure fails. Sudden increases in afterload combined with immature myocardial contractility can lead to post-ligation cardiac syndrome (PLCS), which usually occurs within hours after surgery. However, acute intraoperative hemodynamic collapse during PDA ligation has rarely been described. Case Presentation: A preterm infant born at 24 weeks and 3 days of gestation with a birth weight of 890 g underwent emergency PDA ligation for a hemodynamically significant PDA (hs-PDA) refractory to pharmacological treatment. Fifteen minutes after skin incision, the infant developed desaturation, bradycardia, and non-measurable noninvasive blood pressure, which required immediate hemodynamic resuscitation with manual ventilation, fluid administration, and dopamine and dobutamine infusions. Hemodynamics gradually recovered after completion of ductal ligation, whereas oxygen saturation did not fully recover. Postoperative chest radiography revealed a left-sided pneumothorax, and oxygen saturation stabilized after pleural air aspiration. The subsequent clinical course was uneventful, and typical PLCS did not develop. Conclusions: This case suggests that intraoperative hemodynamic collapse during PDA ligation may share pathophysiologic features with PLCS, and that concomitant pneumothorax can further aggravate hemodynamic instability by worsening hypoxemia and reducing venous return.
Full article
(This article belongs to the Section Pediatric Cardiology)
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Open AccessReview
Perioperative Management of Pediatric Epilepsy Neuromodulation Devices
by
Young May Cha, Ashley Smith, Hubert A. Benzon and Becky J. Wong
Children 2026, 13(4), 517; https://doi.org/10.3390/children13040517 - 8 Apr 2026
Abstract
Drug-resistant epilepsy (DRE) has a significant burden on children and their families that extends beyond seizure management. Surgery can be a curative treatment but is sometimes not an option for certain generalized epilepsies or epilepsy in an eloquent region. Neuromodulation therapies (vagus nerve
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Drug-resistant epilepsy (DRE) has a significant burden on children and their families that extends beyond seizure management. Surgery can be a curative treatment but is sometimes not an option for certain generalized epilepsies or epilepsy in an eloquent region. Neuromodulation therapies (vagus nerve stimulation–VNS, deep brain stimulation–DBS, and responsive neurostimulation–RNS) have emerged as effective palliative treatments to mitigate seizure burden. Only VNS is FDA-approved for use in certain pediatric populations for epilepsy, but all are used off-label to treat pediatric drug-resistant epilepsy. This review provides an overview of these therapies, the perioperative considerations related to their implantation, and the perioperative considerations related to managing a device in situ. Care must be taken to avoid unintentional harm to the device, the leads, and the generator. Procedures must be cognizant of possible physiological changes that can occur intraoperatively and anatomic restrictions due to lead/generator placement. Although there is still a need for more long-term safety data regarding the use of neuromodulation devices in children, the current data demonstrate good efficacy and safety thus far. More children are likely to receive these devices for treatment, and so continued training and education will be needed for health care providers to maintain device longevity and safety.
Full article
(This article belongs to the Special Issue Transforming Care in Childhood Epilepsy: Advances in Diagnosis and Treatment)
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Open AccessArticle
Behavioral Determinants in Pediatric Dentistry: A Comparative Analysis of Cooperative Versus Uncooperative Patients
by
Narmin Helal, Nisma Merdad and Heba Jafar Sabbagh
Children 2026, 13(4), 516; https://doi.org/10.3390/children13040516 - 8 Apr 2026
Abstract
Background/Objectives: Uncooperative behavior in pediatric dental settings remains a significant barrier to effective treatment. Factors such as demographics, psychological variables, and family influences may impact children’s behavior, but their relative importance is not fully understood. This study explores the emotional, familial, and
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Background/Objectives: Uncooperative behavior in pediatric dental settings remains a significant barrier to effective treatment. Factors such as demographics, psychological variables, and family influences may impact children’s behavior, but their relative importance is not fully understood. This study explores the emotional, familial, and demographic factors influencing cooperation among children in dental clinics in Jeddah, Saudi Arabia. Methods: A cross-sectional study was conducted among children aged 6–11 years attending dental clinics in Jeddah, Saudi Arabia. Participants undergoing non-invasive dental procedures were recruited. Behavioral cooperation was assessed using the Frankl Behavior Rating Scale, and dental anxiety was measured using the validated Abeer Children Dental Anxiety Scale (ACDAS). Data on demographic characteristics, child cognitive factors, and parental dental anxiety were collected through structured interviews. Multivariable logistic regression analysis was performed to identify independent determinants of cooperative behavior. Results: A total of 906 children were included in the analysis. Demographic variables, including gender, age, and income, were not significantly associated with child behavior (all p > 0.05). Fear of losing control emerged as the strongest predictor in the model. Children reporting fear of losing control had significantly lower odds of cooperative behavior (AOR = 0.14, 95% CI [0.10–0.22], p < 0.001). Shyness in the clinic was not statistically significant (p = 0.216). Maternal dental anxiety was significantly associated with child behavior, with higher maternal anxiety scores linked to lower odds of cooperative behavior (AOR = 0.96, 95% CI [0.93–0.997], p = 0.032). Paternal dental anxiety was not significantly associated with child behavior (p = 0.701). Conclusions: Fear of losing control and maternal dental anxiety were independently associated with children’s behavioral responses during dental visits. These findings highlight the relevance of children’s perceived control and maternal anxiety in understanding behavioral outcomes in pediatric dental settings.
Full article
(This article belongs to the Special Issue Early Dental Treatment in Children: A Focus on Behavior Intervention and Management)
Open AccessCase Report
Management of Severe Congenital Protein C Deficiency with Continuous Subcutaneous Infusion via Insulin Pump: A Pediatric Case Report
by
Angelo Gentile, Giordano Spacco, Nicola Minuto, Vera Morsellino, Sandro Dallorso, Angelo Claudio Molinari, Mohamad Maghnie, Marta Bassi and Laura Banov
Children 2026, 13(4), 515; https://doi.org/10.3390/children13040515 - 7 Apr 2026
Abstract
Severe congenital Protein C deficiency (SCPCD) is a rare autosomal recessive thrombophilia that typically presents in the neonatal period with early-onset life-threatening thrombotic complications. We report the case of a female infant who presented at birth with digital ischemic necrosis and laboratory evidence
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Severe congenital Protein C deficiency (SCPCD) is a rare autosomal recessive thrombophilia that typically presents in the neonatal period with early-onset life-threatening thrombotic complications. We report the case of a female infant who presented at birth with digital ischemic necrosis and laboratory evidence of consumptive coagulopathy consistent with neonatal purpura fulminans. Severe Protein C deficiency was confirmed by markedly reduced Protein C activity (<0.03 IU/mL) and compound heterozygous variants in the PROC gene. After initial stabilization and intermittent intravenous Protein C replacement, pharmacokinetic assessment showed marked peak–trough variability. Continuous subcutaneous infusion of Protein C concentrate was therefore initiated using a programmable insulin pump in combination with oral anticoagulation. This strategy achieved stable Protein C activity levels, allowed progressive reduction of the weight-adjusted replacement dose, and enabled removal of the central venous catheter. Continuous subcutaneous infusion of Protein C concentrate via an insulin pump, combined with oral anticoagulation, may represent a feasible long-term therapeutic option in selected patients with SCPCD.
Full article
(This article belongs to the Special Issue Advances in Neonatal Hematology and Hemostasis)
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Open AccessArticle
An Observational Study of the Role of Adiponectin and Vita-min D in Pediatric Asthma and Obesity
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Jelena Knežević, Olga Malev, Marcel Lipej, Ivana Banić and Mirjana Turkalj
Children 2026, 13(4), 514; https://doi.org/10.3390/children13040514 - 7 Apr 2026
Abstract
Background/Objectives: The co-occurrence of asthma and obesity presents a significant clinical challenge, but the underlying mechanisms remain unclear. Reduced adiponectin and vitamin D levels have been associated with both conditions, suggesting that their potential modulatory roles warrant further investigation. This study aimed to
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Background/Objectives: The co-occurrence of asthma and obesity presents a significant clinical challenge, but the underlying mechanisms remain unclear. Reduced adiponectin and vitamin D levels have been associated with both conditions, suggesting that their potential modulatory roles warrant further investigation. This study aimed to evaluate whether vitamin D and adiponectin levels differ among pediatric groups defined by their asthma and obesity status, to better characterize the metabolic and inflammatory profile of the obesityasthma phenotype. Methods: A total of 120 participants aged 6–18 were enrolled and categorized into four groups: Asthma (n = 30), Obesity (n = 30), Asthma + Obesity (n = 30), and Control group (n = 30). All participants underwent lung function testing, anthropometric assessment and measurement of fraction of exhaled nitric oxide (FeNO). Participants were further categorized according to BMI percentiles. Adiponectin levels were measured using ELISA, while vitamin D levels were detected using HPLC. Results: Vitamin D levels and lung function parameters did not differ across groups, although deficiency was most prevalent in the obesity group. FeNO was elevated in asthmatics relative to obese children (p = 0.038) and in obese asthmatics compared with both controls (p = 0.040) and obese children (p = 0.021). Adiponectin levels were lower in obese asthmatic children compared to the controls (p = 0.024). A similar difference was observed between the controls and obese asthmatics among children with low vitamin D levels (p = 0.014). Conclusions: The dominant mechanisms underlying the obesity–asthma phenotype remain unclear; however, our findings indicate a link between adiponectin dysregulation and heightened airway inflammation, as evidenced by increased FeNO levels, though the precise pathways involved are still not well-understood. The role of vitamin D appears less consistent. These results highlight the need for further research to clarify the interplay between metabolic and inflammatory pathways and to support more personalized management strategies in children with obesity-related asthma.
Full article
(This article belongs to the Special Issue Allergic Diseases in Children: From Pathophysiological Mechanisms to Management)
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Open AccessArticle
Clinical Patterns and Outcomes of Eosinophilic Esophagitis in Children and Adolescents at a Tertiary Care Center in Lebanon
by
Amal Rahi, Rima Hanna-Wakim, Abir Barhoumi and Nadine Yazbeck
Children 2026, 13(4), 513; https://doi.org/10.3390/children13040513 - 7 Apr 2026
Abstract
Background: Studies on the clinical presentation of eosinophilic esophagitis and its outcome in children in the Middle East and North African region are scarce. The aim of this 10-year retrospective study was to describe the common clinical manifestations, endoscopic and histological findings, and
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Background: Studies on the clinical presentation of eosinophilic esophagitis and its outcome in children in the Middle East and North African region are scarce. The aim of this 10-year retrospective study was to describe the common clinical manifestations, endoscopic and histological findings, and the response to medication and dietary intervention in children and adolescents with eosinophilic esophagitis. Methods: This study was a retrospective chart review of patients aged 6 months to 18 years who attended the Pediatric Gastroenterology clinic at the American University of Beirut Medical Center between 1 January 2013 and 30 June 2023 and who were diagnosed with eosinophilic esophagitis. Results: A total of 15 patients met the inclusion criteria. The median age at diagnosis was 9 years. Male patients accounted for 73% of our cohort. The most frequent presenting symptoms were dysphagia (80%) and choking (47%). The esophagus appeared normal in 33% of subjects despite histologic confirmation of disease, highlighting the importance of routine biopsies. Adherence to therapy was variable, with 73% of subjects reporting symptom improvement following initial therapy, even in cases where histology remained active. This pattern suggests that symptomatic improvement alone may not reliably reflect disease control and underscores the importance of objective monitoring through follow-up biopsy. Conclusions: The recognition of manifestations of eosinophilic esophagitis in children, early diagnosis, and strict adherence to the diet and medication are essential to prevent long-term complications. In a resource-constrained country like Lebanon, the management remains challenging in view of the burden of dietary restrictions and high cost of procedures and biologics. Socioeconomic feasibility and long-term adherence to diet and medication is as critical as pharmacologic efficacy in determining outcomes in pediatric patients.
Full article
(This article belongs to the Special Issue Non-IgE Pediatric Food Allergy: Clinical and Research Issues)
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Open AccessReview
Functional Motor Assessment and Rehabilitation in Joubert Syndrome: A Narrative Review and Conceptual Framework for Pediatric Neurorehabilitation
by
Łukasz Mański, Aleksandra Moluszys and Jolanta Wierzba
Children 2026, 13(4), 512; https://doi.org/10.3390/children13040512 - 7 Apr 2026
Abstract
Background/Objectives: Joubert syndrome (JS) is a rare neurodevelopmental disorder characterized by cerebellar and brainstem malformations, resulting in a complex and heterogeneous motor phenotype. Despite increasing clinical recognition, functional assessment and physiotherapy strategies in this population remain insufficiently characterized. This study aimed to
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Background/Objectives: Joubert syndrome (JS) is a rare neurodevelopmental disorder characterized by cerebellar and brainstem malformations, resulting in a complex and heterogeneous motor phenotype. Despite increasing clinical recognition, functional assessment and physiotherapy strategies in this population remain insufficiently characterized. This study aimed to synthesize current rehabilitation evidence and to propose a conceptual framework for functional motor assessment in children with JS. Methods: A structured narrative review was conducted across PubMed, Scopus, Web of Science, EBSCOhost, the Cochrane Library, and PEDro databases, including studies published between 2000 and 2026. Eligible studies involved pediatric patients (0–18 years) with JS and reported physiotherapy or motor-related outcomes. Data were synthesized descriptively, and recurring functional domains were identified to inform the development of a conceptual framework. Results: Ten studies (eight case reports and two case series) were included. Rehabilitation approaches were heterogeneous and predominantly multidisciplinary, focusing on postural control, trunk stability, and motor milestone acquisition. Functional improvements were reported across studies; however, outcome measures were primarily based on generic pediatric tools such as GMFM-88 and WeeFIM. These tools did not fully capture the multidimensional nature of motor impairment, particularly in relation to regulatory and sensorimotor domains. Evidence also suggested that postural control and gross motor performance may not fully correspond, highlighting additional functional components such as axial control and thoracoabdominal organization. Given the absence of formal risk-of-bias assessment and the low methodological quality of included studies, all findings should be interpreted as exploratory. Conclusions: Current functional assessment in JS may not adequately reflect the interaction between regulatory processes, sensorimotor integration, and motor control. The proposed conceptual framework provides a multidimensional, hypothesis-generating perspective that may support clinical reasoning and physiotherapy planning. Further research is required to validate this framework and to develop more sensitive, syndrome-specific assessment tools.
Full article
(This article belongs to the Section Pediatric Neurology & Neurodevelopmental Disorders)
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Open AccessArticle
Operative Vaginal Delivery Compared to Cesarean After Failed Labor: A Population-Based Analysis of Neonatal and Maternal Outcomes
by
Yvalis Cortes-Rojas and Braxton Forde
Children 2026, 13(4), 511; https://doi.org/10.3390/children13040511 - 7 Apr 2026
Abstract
Objective: We sought to compare common neonatal and maternal morbidity outcomes amongst operative vaginal delivery (OVD) versus cesarean delivery performed in the setting of failed attempt at labor. We planned to stratify outcomes by type of OVD (vacuum-assisted vaginal delivery (VAVD) and forceps-assisted
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Objective: We sought to compare common neonatal and maternal morbidity outcomes amongst operative vaginal delivery (OVD) versus cesarean delivery performed in the setting of failed attempt at labor. We planned to stratify outcomes by type of OVD (vacuum-assisted vaginal delivery (VAVD) and forceps-assisted vaginal delivery (FAVD)). Methods: This was a retrospective cohort study of singleton live births in the United States, using the 2023 National Vital Statistics birth certificate dataset. The primary outcome of interest was the risk of neonatal morbidity, as listed on the birth certificate. The secondary outcome of interest was the risk of maternal morbidity. Neonatal morbidities were planned to be analyzed independently (i.e., risk of NICU admission, need for antibiotics) as well as in aggregate (i.e., the risk of any morbidity occurring). Three groups were planned: FAVD, VAVD, and cesarean in the setting of attempted labor or attempted induction of labor (referent group). Differences in demographic and clinical characteristics were compared and subsequently adjusted for, and odds ratios (aOR) were calculated using multivariable logistic regression. Results: Of the 3,605,081 births from 2023, there were 15,384 FAVDs; 83,134 VAVDs; and 325,310 cesareans after failed labor. Neonatal morbidity was lower in FAVD (aOR 0.71, 95% CI 0.66–0.76) and VAVD (aOR 0.57, 95% CI 0.55–0.59) compared to cesarean delivery, with VAVD showing the lowest rates, in particular, the need for assisted ventilation (aOR 0.52 95% CI 0.48–0.57 with VAVD and aOR 0.74 95% CI 0.68–0.81 with FAVD) and NICU admissions aOR 0.66, 95% CI 0.60–0.71 with FAVD and aOR 0.48, 95% CI 0.46–0.51 with VAVD) were reduced with operative vaginal delivery. Antibiotic usage was only reduced in VAVD, not FAVD. Maternal morbidity was highest FAVD; however, this was driven by perineal lacerations. ICU admission, hysterectomy, and ruptured uterus were all higher in cesarean delivery than FAVD or VAVD. Conclusions: Operative vaginal delivery, particularly VAVD, is associated with reduced neonatal morbidity compared to cesarean delivery in the setting of labor.
Full article
(This article belongs to the Section Pediatric Neonatology)
Open AccessReview
Pediatric Pes Planovalgus and Femoral Antetorsion: Understanding a Biomechanical Unit: A Narrative Review of the Proximal-to-Distal Kinetic Chain in Childhood Flatfoot
by
Carlo Camathias, Victor Valderrabano, Erich Rutz and Bernhard M. Speth
Children 2026, 13(4), 510; https://doi.org/10.3390/children13040510 - 6 Apr 2026
Abstract
Background: Pes planovalgus affects 44–54% of preschool children and represents one of the most common concerns in pediatric orthopedic practice. Aim: This narrative review synthesizes the evidence linking increased femoral antetorsion to pediatric flatfoot deformity. Methods: A comprehensive literature search was conducted in
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Background: Pes planovalgus affects 44–54% of preschool children and represents one of the most common concerns in pediatric orthopedic practice. Aim: This narrative review synthesizes the evidence linking increased femoral antetorsion to pediatric flatfoot deformity. Methods: A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science through January 2026. The initial search yielded 847 records; after screening, 52 studies were included, 29 of which are directly cited. Search terms included combinations of: “femoral antetorsion” OR “femoral anteversion” AND “flatfoot” OR “pes planovalgus” AND “children” OR “pediatric”. Results: Strong correlations exist between flatfoot and increased internal hip rotation (as a proxy for femoral antetorsion) in preschool children (r = 0.53–0.77), suggesting an association, though direct causation remains unproven. Both deformities share similar developmental trajectories with spontaneous resolution by school age. The biomechanical model proposes that elevated antetorsion reduces gluteus medius moment arms by 40–50%, necessitating compensatory hip internal rotation; however, this derives from computational models and cerebral palsy populations, with limited direct validation in typically developing children. Femoral derotation osteotomy improves the foot progression angle, though transfer efficiency is incomplete (~54% of surgical correction manifests distally). Conclusions: Femoral antetorsion and pes planovalgus are strongly associated in preschool children, though whether this represents a direct mechanistic cascade or parallel manifestations of common developmental factors remains uncertain. This understanding supports watchful waiting in preschool children and, in persistent cases, prioritizes the assessment of the entire rotational profile before intervention.
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(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)
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Open AccessArticle
Virtual Reality Technology Reduces Pain and Anxiety in Hospitalized Pediatric Patients Undergoing Peripheral Venous Catheterization: A Randomized Controlled Trial
by
Jiao Yu, Qiqi Cheng, Min Luo, Huidan Yu and Suqing Wang
Children 2026, 13(4), 509; https://doi.org/10.3390/children13040509 - 5 Apr 2026
Abstract
Objective: To investigate the effects of virtual reality (VR) technology on pain and anxiety in hospitalized pediatric patients undergoing Peripheral Venous Catheterization. Methods: This study is a randomized controlled trial (RCT). Between July and December 2024, eligible pediatric inpatients aged 5–14 years from
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Objective: To investigate the effects of virtual reality (VR) technology on pain and anxiety in hospitalized pediatric patients undergoing Peripheral Venous Catheterization. Methods: This study is a randomized controlled trial (RCT). Between July and December 2024, eligible pediatric inpatients aged 5–14 years from the Chegu Branch of Wuhan Union Hospital were randomly assigned to either the experimental group or the control group. The control group received routine care during peripheral venous catheterization, including health education and psychological comfort. The intervention group, in addition to routine care, used VR headsets to watch age-appropriate game videos, with each VR session lasting 10–15 min. The primary outcome measure was patient-reported pain levels, with anxiety as a key secondary outcome. Secondary outcome measures included catheterization time, heart rate, patient satisfaction with nursing procedures, and usability evaluation of the VR equipment. Results: A total of 80 pediatric patients were enrolled, with 40 in the VR group (mean age 8.05 ± 2.60 years) and 40 in the control group (mean age 8.63 ± 2.50 years). Generalized estimating equation (GEE) analysis showed a significant interaction effect between group and time for pain (Wald χ2 = 7.091, p = 0.029), while no significant interaction was found for anxiety (Wald χ2 = 0.971, p = 0.615). Before peripheral venous catheterization, there was no significant difference in pain and anxiety scores between the two groups of pediatric patients (p > 0.05). Patients in the VR group reported significantly reduced pain (β = −0.78; 95% CI, −1.40 to −0.15; p = 0.015) during catheterization, and overall anxiety scores were also lower in the VR group (β = −0.43; 95% CI, −0.77 to −0.08; p = 0.016), although the group by time interaction for anxiety was not significant. The intervention group also demonstrated a lower peak heart rate (107.67 ± 16.25 beats/min vs. 115.25 ± 29.53 beats/min; p = 0.047) and a shorter procedure duration [110 (100, 120) seconds vs. 120 (110, 123.5) seconds; p < 0.001]. Operator satisfaction with the nursing procedure was also significantly higher in the intervention group (95.0% vs. 72.5%, p < 0.001). Conclusions: VR significantly reduces pain and anxiety in hospitalized pediatric patients during peripheral venous catheterization.
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(This article belongs to the Section Pediatric Nursing)
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Open AccessArticle
Caregivers’ Baseline Mental Health Problems and Early Childhood Social Skills at One-Year Follow-Up in an Urban Area of Indonesia
by
Hilda Meriyandah, Yuri Nurdiantami, Smarika Shresta, Maiko Shigeeda and Tokie Anme
Children 2026, 13(4), 508; https://doi.org/10.3390/children13040508 - 4 Apr 2026
Abstract
Background/Objectives: Social development in children is a significant aspect that supports appropriate behavior in the community, and parents, as the main caregivers, play a central role in developing social skills in children. However, caregivers experiencing mental health problems—such as depression, anxiety, and stress—may
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Background/Objectives: Social development in children is a significant aspect that supports appropriate behavior in the community, and parents, as the main caregivers, play a central role in developing social skills in children. However, caregivers experiencing mental health problems—such as depression, anxiety, and stress—may find it challenging to provide a nurturing rearing environment. This one-year follow-up study examined whether the baseline mental health of caregivers was associated with social skills in children 1 year later in an urban Indonesian context. Methods: A one-year follow-up study was conducted in an urban area of Indonesia in 2023–2024, inviting all nine kindergartens in the area to participate. Caregivers completed the demographic questionnaire and the Depression, Anxiety, Stress Scale (DASS-21), while teachers assessed social skills in children using the Social Skills Scale (SSS). Linear mixed-effects models with random intercepts for kindergarten were estimated to account for clustering. Results: Finally, a total of 270 parent–child dyads were included. After adjusting for baseline social skills and covariates, higher levels of baseline caregiver depression (B = −0.15, p < 0.001), anxiety (B = −0.22, p < 0.001), and stress (B = −0.27, p < 0.001) were associated with lower social skills in children in the follow-up. Conclusions: Even subclinical variations in caregiver mental health problems may be meaningfully associated with social development in children over time. The findings highlight mental health in caregivers as a potentially important factor associated with early social development in an urban setting of Indonesia.
Full article
Open AccessArticle
Artificial Intelligence-Assisted Detection of Canine Impaction, Localization, and Classification from Panoramic Images: A Diagnostic Accuracy Comparative Study with CBCT
by
Narmin M. Helal, Abdulrahman F. Aljehani, Sawsan A. Alomari, Reem A. Mahmoud and Hanadi M. Khalifa
Children 2026, 13(4), 507; https://doi.org/10.3390/children13040507 - 4 Apr 2026
Abstract
Background/Objectives: This study aimed to develop and evaluate deep learning models for the detection, localization, and classification of impacted maxillary canines, and to compare their performance with cone-beam computed tomography (CBCT) as the reference standard. Methods: This cross-sectional diagnostic accuracy study was conducted
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Background/Objectives: This study aimed to develop and evaluate deep learning models for the detection, localization, and classification of impacted maxillary canines, and to compare their performance with cone-beam computed tomography (CBCT) as the reference standard. Methods: This cross-sectional diagnostic accuracy study was conducted at King Abdulaziz University Dental Hospital to develop and validate artificial intelligence (AI) models for detecting and localizing maxillary canine impactions using panoramic and cone-beam computed tomography (CBCT) imaging data. A total of 641 panoramic ra and 158 CBCT scans were collected, of which 158 cases had matched panoramic–CBCT pairs for localization analysis. Images were annotated and validated by expert radiologists and orthodontists, with consensus review ensuring labeling reliability. Data augmentation expanded each panoramic and CBCT category to 500 samples for panoramic and 1000 samples for CBCT, resulting in 1935 panoramic and 5703 CBCT images after preprocessing and normalization. The datasets were divided into (training + validation) (80%) and testing (20%) subsets. MobileNetV2 architectures were used for classification, and whdiographsile, a ResNet-50–based Few-Shot Learning framework, enabled spatial localization of impacted canines. Models were trained using the Adam optimizer with a learning rate of 1 × 10−4 and evaluated using accuracy, precision, recall, F1 score, and area under the receiver operating characteristic curve (AUC). Cohen’s kappa and 95% confidence intervals were used to assess agreement between AI predictions and expert annotations. Results: Panoramic classification achieved 94% accuracy, demonstrating the highest performance in normal cases and reduced recall for bilateral impactions. The CBCT classifier achieved 98% accuracy across positional categories. Cross-modality prediction reached 93.5% accuracy, with strong agreement compared to CBCT (Cohen’s kappa = 0.91). Expert review confirmed reliable localization of impacted canines on both imaging modalities. Conclusions: Artificial intelligence applied to panoramic radiographs supports the detection, localization, and characterization of impacted maxillary canines with performance comparable to CBCT. This approach may enable lower-radiation decision support for clinical triage.
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(This article belongs to the Section Pediatric Dentistry & Oral Medicine)
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Open AccessArticle
Psychometric Validation of a Spanish–Chilean Instrument for Assessing Public Attitudes Toward Childhood Stuttering: Construct Validity and Internal Consistency
by
Yasna Sandoval, Carlos Rojas, Francisco Novoa-Muñoz, Gabriel Lagos, Carla Figueroa, Álvaro Silva, Jaime Crisosto-Alarcón and Mauricio Alfaro-Calfullán
Children 2026, 13(4), 506; https://doi.org/10.3390/children13040506 - 3 Apr 2026
Abstract
Background/Objectives: Stuttering is a neurodevelopmental disorder of speech fluency. It emerges most commonly between 2 and 5 years old, often causing social exclusion and stigma. In Latin America, cultural misconceptions regarding its causes exacerbate these psychosocial challenges. This study validated a culturally adapted
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Background/Objectives: Stuttering is a neurodevelopmental disorder of speech fluency. It emerges most commonly between 2 and 5 years old, often causing social exclusion and stigma. In Latin America, cultural misconceptions regarding its causes exacerbate these psychosocial challenges. This study validated a culturally adapted instrument for Chile to measure public attitudes toward stuttering. The instrument provides a psychometrically sound method to assess and address stigma within educational and community settings. Methods: A total of 756 Chilean adults (mean age = 36.7 years, SD = 15.8; 64% women, 36% men) were recruited using stratified probability sampling to reflect the national demographics. Ethical approval and informed consent were obtained. The subsection underwent rigorous cross-cultural adaptation (translation, expert review, cognitive debriefing n = 30, pre-testing n = 50). Analysis employed polychoric matrices, EFA, CFA with WLSMV, and multiple reliability/validity indices. Results: Joint analysis showed poor fit (CFI = 0.72, RMSEA = 0.12), confirming independence. Beliefs (14 items): three-factor CFA fit excellent (CFI = 0.993, RMSEA = 0.034); factors: competence/normality (α = 0.85), psychological causes (α = 0.78), and help/support (α = 0.72). Reactions (11 items): four-factor fit adequate (CFI = 0.97, RMSEA = 0.043); factors: distant concern (α = 0.82), personal concern (α = 0.79), media sources (α = 0.75), and formal sources (α = 0.77). Validity was supported; bifactor models favored multidimensionality. Conclusions: The adapted subsection is psychometrically robust and effectively captures Chilean-specific attitudes toward childhood stuttering. It provides a reliable tool for quantifying public stigma and misconceptions, particularly in educational and school contexts, thereby supporting the design of targeted school-based policies and interventions to reduce bullying, promote inclusion, and safeguard the psychosocial well-being of children and adolescents who stutter.
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(This article belongs to the Section Pediatric Mental Health)
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Open AccessArticle
Chest Radiography Use in Hospitalized Children with Acute Respiratory Tract Infections: A Baseline Analysis for Imaging Optimization
by
Roxana Axinte, Sorin Axinte, Elena Tătăranu, Laura Ion, Adina Mihaela Frenți, Florin Filip, Gabriela Burțilă, Liliana Anchidin-Norocel and Smaranda Diaconescu
Children 2026, 13(4), 505; https://doi.org/10.3390/children13040505 - 3 Apr 2026
Abstract
Background: Pediatric respiratory infections represent a leading cause of emergency department (ED) visits and hospitalizations. Chest X-rays are frequently used in their diagnostic evaluation, despite guideline recommendations advocating restrictive imaging strategies, particularly in young children with uncomplicated disease. Excessive imaging raises concerns regarding
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Background: Pediatric respiratory infections represent a leading cause of emergency department (ED) visits and hospitalizations. Chest X-rays are frequently used in their diagnostic evaluation, despite guideline recommendations advocating restrictive imaging strategies, particularly in young children with uncomplicated disease. Excessive imaging raises concerns regarding cumulative radiation exposure and inefficient resource utilization. Objectives: To quantify potentially unnecessary chest radiography use in hospitalized pediatric patients with respiratory infections and to identify age-related and diagnostic patterns suitable for targeted imaging optimization interventions. Methods: We conducted a retrospective observational study analyzing pediatric patients presented to the ED of a tertiary county hospital in Romania over a period of 12 months. Data regarding respiratory diagnoses, hospitalization status, patient age, and chest radiography utilization were extracted from electronic medical records. Results: Among more than 26,000 pediatric emergency presentations, 4139 children required hospitalization, of whom 1212 were diagnosed with respiratory infections. A total of 3414 chest radiographs were performed, with the highest imaging burden observed in children aged 0–4 years. Repeated imaging was common in interstitial pneumonia, bronchiolitis, and bronchial hyperreactivity. A strong negative correlation was identified between patient age and imaging frequency (r = −0.70, p < 0.001). Conclusions: Thoracic radiographs are disproportionately used in young children with respiratory infections, particularly in conditions with limited imaging indications. These findings provide an essential baseline for the development of targeted quality improvement interventions aimed at reducing unnecessary pediatric imaging.
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(This article belongs to the Special Issue Improving Respiratory Care for Children)
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Open AccessArticle
Phenotypic Associations of Early Cardiovascular Surgery in Pediatric Marfan Syndrome
by
Veronika C. Stark, Thomas S. Mir, Caja Langkat, Daniel Biermann, Johanna J. Kanitz, Gerhard Schoen, Yskert von Kodolitsch, Nora Lang, Rainer Kozlik-Feldmann, Michael Huebler and Jakob Olfe
Children 2026, 13(4), 504; https://doi.org/10.3390/children13040504 - 3 Apr 2026
Abstract
Background/Objectives: Cardiovascular manifestations in pediatric Marfan syndrome (MFS) exhibit substantial heterogeneity. Early identification of patients at elevated risk of requiring cardiac surgery is essential to optimizing outcomes. This study aimed to determine phenotypic features associated with cardiovascular surgery in genetically confirmed pediatric
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Background/Objectives: Cardiovascular manifestations in pediatric Marfan syndrome (MFS) exhibit substantial heterogeneity. Early identification of patients at elevated risk of requiring cardiac surgery is essential to optimizing outcomes. This study aimed to determine phenotypic features associated with cardiovascular surgery in genetically confirmed pediatric MFS. Methods: Among the 1006 children evaluated, 214 with genetically verified MFS were included in the analysis. We categorized patients by the presence or absence of cardiac surgery during childhood. Systemic and cardiovascular features were assessed. We applied binary logistic regression to identify independent associated manifestations with surgical intervention. Results: 20/214 patients (9.3%, 11.5 ± 5.5 years) underwent cardiac surgery (50% aortic root replacement, 20% mitral valve surgery, 30% combined interventions). Extracardiac features—Marfan-type facial features, pectus carinatum, pes planus, hindfoot deformity, and myopia of ≥3 diopters—were significantly associated with an increased probability of surgery (OR 3.0–4.6). Tricuspid valve prolapse and pulmonary artery dilatation were more prevalent in surgical patients. Surgical patients exhibited higher systemic manifestation scores (9.2 vs. 5.2; p ≤ 0.05) per revised Ghent criteria (RGC). Conclusions: A higher systemic score (RGC) correlates with increased risk for surgery. Marfan-type facial features, pectus carinatum, pes planus, hindfoot deformity, and myopia ≥ 3 diopters were strongly associated with the need for early cardiac surgery. Comprehensive phenotypic assessment, including systemic manifestation scoring, enables risk stratification and supports timely surgical planning in pediatric MFS.
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(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology: 4th Edition)
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Open AccessArticle
Rapid Shallow Breathing Index as a Predictor of Extubation Outcomes After Pediatric Cardiac Surgeries
by
Mustafa Saad El Masri, Wajih Nasr, Marianne N. Majdalani and Jihane Moukhaiber
Children 2026, 13(4), 503; https://doi.org/10.3390/children13040503 - 2 Apr 2026
Abstract
Background/Objectives: Determining the optimal timing for the discontinuation of mechanical ventilation (MV) in pediatric patients following cardiac surgery remains challenging. Both delayed and premature extubation increase the risk of complications. The rapid shallow breathing index (RSBI) is widely used, but its role and
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Background/Objectives: Determining the optimal timing for the discontinuation of mechanical ventilation (MV) in pediatric patients following cardiac surgery remains challenging. Both delayed and premature extubation increase the risk of complications. The rapid shallow breathing index (RSBI) is widely used, but its role and optimal cutoff in pediatric cardiac populations remain uncertain. This study aimed to determine a clinically useful RSBI cutoff for predicting extubation readiness in children after cardiac surgery. Methods: We conducted a prospective single-center observational cohort study including children younger than 18 years who required postoperative MV after cardiac surgery and were admitted to the Pediatric Intensive Care Unit (PICU) between July 2020 and June 2024. The RSBI was measured one minute prior to extubation during a spontaneous breathing trial (SBT). Extubation failure was defined as the need for reintubation within 48 h. Results: A total of 247 patients were enrolled, with 13 (5.3%) experiencing extubation failure. Patients who failed extubation had significantly higher RSBI values compared with those successfully extubated (median 4.97 vs. 3.76; p < 0.001). An RSBI cutoff ≥ 4.62 breaths/min/mL/kg provided a sensitivity of 84.6%, specificity of 94.0%, positive predictive value (PPV) of 44%, and negative predictive value (NPV) of 99.1%. The RSBI was the only independent predictor of extubation failure in multivariable analysis (p = 0.014). Conclusions: The RSBI is a simple and reliable physiological marker for assessing extubation readiness in pediatric patients after cardiac surgery. An RSBI threshold of ≥4.62 breaths/min/mL/kg identifies patients at increased risk of extubation failure. Larger, multicenter studies will be important to validate our results.
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(This article belongs to the Section Pediatric Cardiology)
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Open AccessOpinion
Moving from Challenge to Change: Redesigning Inpatient Care for Children with Complex Care Needs
by
Emma Popejoy, Jane Coad, Eyal Cohen, Aysha Sheikhi and Joseph C. Manning
Children 2026, 13(4), 502; https://doi.org/10.3390/children13040502 - 2 Apr 2026
Abstract
Children with complex care needs represent a growing and highly vulnerable population within inpatient hospital settings. They experience disproportionately long lengths of stay, higher rates of safety incidents, and poorer care experiences than other children. Their increasing prevalence in hospitals reflects broader advances
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Children with complex care needs represent a growing and highly vulnerable population within inpatient hospital settings. They experience disproportionately long lengths of stay, higher rates of safety incidents, and poorer care experiences than other children. Their increasing prevalence in hospitals reflects broader advances in medical care that have improved survival, yet current inpatient systems remain largely designed around episodic, single-condition models of care. As a result, children with complex care needs and their families frequently encounter inpatient services which are fragmented and stretched and environments which are not adequately suited to their needs. The challenges are well recognised, and current drivers exist to move toward meaningful system change. Recent policy drivers, workforce development agendas, and new funding streams provide an opportunity to reimagine how inpatient services are organised and delivered for this population. This opinion piece, situated within the UK healthcare context, offers a structured analysis of the systemic challenges facing inpatient services for children with complex care needs and identifies priority domains of safe care, workforce development, and knowledge generation, where targeted redesign is both feasible and urgently required.
Full article
(This article belongs to the Special Issue Healthcare and Transition in Children with Special Needs, Complex Chronic Illness, and Medical Technology Dependence)
Open AccessArticle
Educational Needs and Priorities for Pediatric Emergency Nursing: A Cross-Sectional Study of Clinical Nurses
by
Jung Hwa Lee, So Yeon Park and Hyeon Ok Ju
Children 2026, 13(4), 501; https://doi.org/10.3390/children13040501 - 2 Apr 2026
Abstract
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Background/Objectives: Pediatric emergency nursing requires timely, accurate interventions, yet educational content is not always aligned with clinical priorities. Identifying and prioritizing educational gaps based on clinical relevance and nurses’ current performance is essential to improve pediatric emergency care. Methods: This descriptive cross-sectional study
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Background/Objectives: Pediatric emergency nursing requires timely, accurate interventions, yet educational content is not always aligned with clinical priorities. Identifying and prioritizing educational gaps based on clinical relevance and nurses’ current performance is essential to improve pediatric emergency care. Methods: This descriptive cross-sectional study assessed clinical performance and educational needs among nurses working in emergency departments, general wards, and intensive care units. Data were collected using a structured questionnaire on 20 pediatric emergency conditions and related procedures. Priorities were identified using the Borich Needs Assessment and the Locus for Focus model, based on differences between required and present competence and the level of perceived importance. Results: Educational needs were consistently high across participant characteristics. In both the Borich needs assessment and the Locus for Focus model, the highest priorities were identified in pediatric emergency nursing competencies related to time-critical emergencies and core procedures, particularly resuscitation and high-risk medication administration. Conclusions: Educational priorities in pediatric emergency nursing span urgent conditions and skill-intensive procedures. Although performance varied by age and experience, educational needs were consistently high, supporting continuous, standardized training. Simulation-based and mobile-enabled, scenario-focused education should be considered to enhance preparedness and response capacity among nursing students and early-career nurses.
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