Children

Background: Pediatric fractures are common, but the relative contributions of BMI-related body size and vitamin D–calcium metabolism remain uncertain. This study examined anthropometric and biochemical factors associated with fracture status in otherwise healthy children after low-energy trauma. Methods: This prospective case–control study included 100 children aged 3–15 years: 50 with radiographically confirmed fractures and 50 trauma controls without fracture. BMI and age- and sex-standardized BMI measures were recorded. Serum 25OHD, PTH, ALP, calcium, and phosphate were measured within seven days of injury, and dietary calcium intake was estimated. Associations were evaluated using correlation analyses, logistic regression, and BMI-adjusted analysis of covariance. Results: Fracture cases had higher BMI z-scores than controls (median 0.53 [IQR −0.53 to 1.44] versus −0.16 [IQR −0.89 to 0.38]; p = 0.006) and lower 25OHD concentrations. After adjustment for BMI z-score, the estimated geometric mean 25OHD concentration was 58.0 nmol/L (95% CI 53.0–64.1) in cases and 66.7 nmol/L (95% CI 60.3–73.7) in controls (p = 0.046). The Group × BMI z-score interaction was not significant (p = 0.327). Vitamin D deficiency (<30 nmol/L) affected only 3% of participants, and consistent biochemical abnormalities of mineralization were uncommon. Conclusions: Fracture status was associated with higher standardized BMI measures and lower 25OHD concentrations, but there was no evidence that the BMI–25OHD relationship differed by fracture status. These observational findings do not establish a predominant causal mechanism and support cautious, clinically targeted metabolic evaluation. Full article

Background/Objectives: Complicated appendicitis carries greater morbidity than uncomplicated disease, yet its prevalence and determinants in southwestern Saudi Arabia are largely undocumented. This study estimated the prevalence of complicated appendicitis among children undergoing appendectomy and identified the preoperative characteristics independently associated with it. Methods: A hospital-based cross-sectional study included 275 children aged 14 years or younger who underwent appendectomy at King Fahd Central Hospital, Jazan, between January 2020 and December 2024. Complicated appendicitis was defined by appendiceal perforation, purulent intra-abdominal collection, or generalized peritonitis documented in the structured intraoperative record. Prevalence is reported with Wilson 95% confidence intervals. Adjusted prevalence ratios (aPR) with 95% confidence intervals were estimated by modified Poisson regression with robust variance, using preoperative variables selected for clinical plausibility. Two sensitivity analyses used broader outcome definitions. Results: Complicated appendicitis was present in 57 of 275 children, a prevalence of 20.7% (16.4–25.9). Prevalence did not differ by age group, sex, referral status, or symptom duration, but was higher among urban than rural residents (26.3% vs. 15.2%, p = 0.035). Two preoperative characteristics were independently associated with complicated disease: generalized abdominal tenderness (aPR 3.01, 1.75–5.20) and reported fever (aPR 1.87, 1.11–3.17). Symptom duration, clinical dehydration, leukocyte count, and admission haemoglobin were not independently associated with severity. Among children with imaging, appendiceal diameter contributed independently in an exploratory model (aPR 1.06 per mm, 1.02–1.11). Under broader outcome definitions, symptom duration and dehydration became significant while generalized abdominal tenderness remained associated throughout, indicating that several associations depend on how severity is defined. Conclusions: One in five children came to the operation with complicated appendicitis. Tenderness extending beyond the right iliac fossa, together with reported fever, was the most consistent bedside signal of advanced disease, whereas associations with delayed presentation, dehydration, and haemoglobin were sensitive to the outcome definition and require prospective confirmation. Full article

Background: Iron deficiency (ID) is the most prevalent nutritional deficiency worldwide and remains a major public health concern, particularly during pregnancy, infancy, and early childhood. Because iron is essential for brain development, both insufficient and excessive iron exposure during critical developmental periods may have lasting effects on neurodevelopment. Objective: This study aims to review the available evidence on the effects of iron status and iron supplementation (IS) during early life on neurodevelopmental outcomes. Methods: A review was conducted in accordance with the PRISMA 2020 guidelines. Six electronic databases were searched independently by two reviewers. Studies investigating the association between iron status or IS and neurodevelopmental outcomes in infants and children were selected according to predefined eligibility. Results: The search identified 884 records, of which 15 studies met the inclusion criteria. The available evidence indicates that ID during pregnancy and early childhood is associated with poorer cognitive, motor, language, and behavioral outcomes, with some studies reporting effects that persist into later childhood and adulthood. IS reduced the risk of ID and iron deficiency anemia (IDA) in vulnerable populations. However, in children with adequate iron stores, excessive iron exposure was associated with less favorable neurodevelopmental outcomes in several studies. Conclusions: Maintaining adequate iron status during early life is essential for optimal neurodevelopment. The findings support targeted supplementation strategies in populations at risk of deficiency and highlight the importance of appropriate screening using biomarkers such as ferritin, hemoglobin, and inflammatory markers, including C-reactive protein. Additional longitudinal studies are needed to define the long-term neurodevelopmental effects of different supplementation strategies. Full article

Background: Pectus excavatum is the most common congenital chest wall deformity and it may impair cardiovascular function, pulmonary mechanics, exercise capacity, and quality of life. Although minimally invasive repair of pectus excavatum (MIRPE) is the current standard surgical treatment, the perioperative dynamics of myocardial injury, inflammation, and their relationship with functional and echocardiographic changes remain incompletely understood, particularly in pediatric patients. Objective: The objective is to prospectively evaluate the perioperative dynamics of cardiac troponin and the change in right ventricular free-wall longitudinal strain as co-primary endpoints, and—as secondary outcomes—additional biochemical markers, echocardiographic parameters, pulmonary function, exercise capacity, and quality of life in children and adolescents undergoing MIRPE. Methods: This is a single-center, prospective, observational cohort study to be conducted at the Department of Pediatric Surgery and Urology, University Children’s Clinical Hospital, Medical University of Bialystok, Poland. Sixty pediatric patients (approximately 14–18 years of age) undergoing primary minimally invasive repair of pectus excavatum will be enrolled. Biochemical markers, including troponins, natriuretic peptides and inflammatory markers will be assessed before surgery and during the first 72 h postoperatively. Echocardiography, pulmonary function tests (spirometry and body plethysmography), the 20 m shuttle run test (Léger), and quality-of-life assessments will be performed preoperatively and during postoperative follow-up. Longitudinal changes will be analyzed using appropriate statistical methods for repeated measurements. Discussion: This study is expected to provide a comprehensive evaluation of the cardiovascular, pulmonary, biochemical, and functional consequences of minimally invasive repair of pectus excavatum in pediatric patients. The findings may improve the understanding of the perioperative myocardial response, cardiac remodeling, and functional recovery following the MIRPE and contribute to optimizing perioperative assessment and long-term follow-up in this patient population. Full article

Background/Objectives: Multimodal large language models (LLMs) can interpret clinical text and images, but their performance in pediatric rash assessment remains uncertain. This study compared the clinical utility, safety, information quality, diagnostic correctness, and readability of ChatGPT, Gemini and Grok. Methods: Fifteen content-validated pediatric rash vignettes with brief histories and anonymized photographs were submitted once to each platform using a standardized zero-shot prompt. Three pediatricians blinded to platform identity independently rated the 45 responses using a five-point Clinical Utility and Safety (CUS) scale and a five-item modified DISCERN instrument. Diagnostic correctness was assessed descriptively; platform comparisons used Friedman tests with Bonferroni-adjusted Wilcoxon tests when appropriate. Results: Overall, 82.2% of CUS ratings were in categories 4–5 and 83.0% of modified DISCERN scores were ≥20/25; no rating was assigned to CUS category 1. Gemini and Grok had descriptively higher expert ratings than ChatGPT, but CUS did not differ significantly across platforms (p = 0.157), and although modified DISCERN differed globally (p = 0.038), no pairwise comparison remained significant after adjustment. In the single-query diagnostic assessment, at least one platform missed the reference diagnosis in 9/15 vignettes, and all three missed porphyria. Gemini generated the longest responses, whereas Grok produced the most linguistically complex text; neither response length nor readability was associated with expert ratings. Conclusions: The three multimodal LLMs produced predominantly clinically acceptable responses, but performance varied by vignette and platform. Because each vignette–platform combination was sampled once, diagnostic findings represent single-response observations rather than stable platform accuracy estimates. Clinical verification remains necessary. Full article

Background/Objectives: Online health information (OHI) is used by adolescents and caregivers to manage pediatric rheumatic diseases (PRDs). Little is known about the lived experiences of this group as they navigate complex, evolving online healthcare information and services. This study aimed to explore the lived experiences and indicators of digital health literacy (DHL) among adolescents with PRD and caregivers of children and adolescents with PRD through their use of OHI to learn about and manage their disease. Methods: Qualitative interviews using Interpretive Description methodology was utilized. Adolescent and caregiver participants were recruited using purposeful sampling from one rheumatology clinic in Saskatchewan, Canada. After completing a pre-interview questionnaire, one-on-one semi-structured telephone interviews were completed, audio-recorded, transcribed verbatim, and analyzed using constant comparative analysis. Results: A total of 10 caregivers and 7 adolescents completed the interviews. Three key themes emerged: (1) OHI offers knowledge without imposing on PRD practitioners. Participants were motivated to use OHI for symptom management, reassurance, and medication administration. (2) Participants had difficulty finding OHI, resulting from their search strategies, desire for answers to complex problems, lack of information for novel biologic medications, the absence of adolescent-focused OHI, and confusion around pediatric to adult disease names. (3) Although aware of misinformation, participants discussed and demonstrated inadequate appraisal of OHI. Conclusions: Participants relied on inappropriate indicators of medical accuracy and misplaced trust in OHI sources, leading to exposure to misinformation. Proactively addressing these concerns, including OHI prescriptions, fostering independent OHI appraisal, and development of age-appropriate OHI, may improve DHL and aid PRD management. Full article

Background/Objectives: The transition from paediatric to adult care in inflammatory bowel disease (IBD) is a period of genuine clinical vulnerability. Despite international guidelines, real-world implementation of transition programmes remains inconsistent and the field lacks consensus on clinically meaningful outcome measures. We introduce the concept of “transition failure” as a provisional composite outcome framework to reorient research toward patient-centred endpoints. Methods: A narrative search of PubMed, MEDLINE, and Embase was conducted using terms including “inflammatory bowel disease”, “transition”, “transfer to adult care”, and “adherence”; no formal quality appraisal was applied. The search covered the databases from inception to 30 June 2026. Results: We synthesise current evidence on transition readiness and its limitations, delineate patient- and system-level barriers—including the underappreciated role of parental involvement—and characterise high-risk subgroups. Five evidence-informed, provisional domains of transition failure are proposed. Where published data permit, illustrative quantitative benchmarks are described; however, these are not assumed to be universally applicable across therapies or disease phenotypes. A composite of ≥2 domains within 24 months is proposed as a candidate research classification rule pending prospective validation, rather than as a clinical diagnostic threshold. Conclusions: The transition failure framework provides a hypothesis-generating construct for evaluating transition quality. Prospective multicentre validation, standardised and therapy-specific outcome definitions, adjustment for baseline disease severity, and risk-stratified multidisciplinary programmes are identified as research priorities. Full article

Background/Objectives: Juvenile systemic sclerosis (jSSc) is a rare, chronic autoimmune disease with limited pediatric data. We aimed to characterize the demographic, clinical, immunological, and microvascular features of a Russian cohort of children with jSSc, and to evaluate treatment outcomes and predictors of escalation to biologic therapy. Methods: A retrospective single-center study of 40 children with jSSc (36 girls, 4 boys) followed over a 20-year period (2004–2024) was conducted. Clinical assessment included the modified Rodnan Skin Score (mRSS) and the Juvenile Systemic Sclerosis Severity Score (J4S). Nailfold capillaroscopy (NFC) was performed in 12 patients. Autoantibody profiling was available for 30 patients. Two first-line regimens were compared: glucocorticosteroids with penicillamine (PA, n = 19) versus glucocorticosteroids with DMARDs (methotrexate, mycophenolate mofetil, or cyclophosphamide; n = 21). Predictors of switching to biologic therapy were identified using binary logistic regression. Results: Median age at onset was 9.0 years (IQR 6.0–10.0), and diagnostic delay was 12.0 months (IQR 4.0–24.0). Diffuse cutaneous jSSc predominated (82.5%). Gastrointestinal involvement was detected in 82.5%, Raynaud’s phenomenon in 87.5%, and ILD in 37.5%. NFC revealed reduced capillary density (5.26 ± 1.33/mm). Giant capillaries were observed exclusively in males (4/4 vs. 0/8, p = 0.002). DMARD-based regimens were associated with better outcomes than PA, particularly for joint involvement. Eleven patients (27.5%) were switched to biologic therapy, primarily rituximab. ILD and J4S > 15 were the strongest predictors of switching (probability 60–61% vs. 8–15%, p < 0.001). The 5-year survival was 100%; the estimated 10-year survival was 71.4%, although the latter estimate should be interpreted cautiously because of the small number of events and loss to follow-up. Conclusions: In our cohort, children with jSSc present predominantly with diffuse cutaneous involvement. Male patients may be at risk for more severe microvascular changes, possibly related to diagnostic delay. ILD and J4S > 15 were associated with escalation to biologic therapy, and earlier switching to rituximab may be beneficial in refractory patients. Future prospective multicenter studies are needed to validate these findings. Full article

The neonatal cardiovascular system is dynamic and influenced by multiple factors, which makes neonatal shock a challenging early clinical diagnosis. Real-time monitoring has been limited to indirect measurements of hemodynamic well-being, such as heart rate, blood pressure, capillary refill time, and biochemical markers of adequate oxygen delivery and oxygen consumption. Bedside diagnostic ultrasound to guide decision-making has become increasingly integrated into modern neonatal care. It allows clinicians to enhance physiologic monitoring, differentiate among diverse cardiovascular phenotypes, including time-critical conditions such as tamponade, that may present with similar clinical signs, and interpret complex, evolving physiology in real time. By providing this additional layer of physiologic insight, it may enable more precise, individualized management, with potential implications for fluid administration, vasoactive support, and ventilatory strategies. Among neonatologists who incorporate bedside imaging into clinical practice, some rely on focused point-of-care ultrasound (POCUS) skills, while others have formal training in targeted neonatal echocardiography (TNE). This review outlines the distinct but complementary roles of POCUS and TNE, highlighting the specific diagnostic questions each can address, as well as their respective limitations in the evaluation of neonatal shock. Broadly, POCUS is designed to rapidly identify causes of clinical deterioration through focused lung, cardiac, abdominal, and cranial assessments. In contrast, TNE provides a more comprehensive and longitudinal evaluation of cardiovascular function guiding management over time. Differences in training pathways may create a perceived dichotomy between POCUS and TNE; however, these modalities are inherently complementary and should be integrated in the care of critically ill infants. Ultimately, the neonate must be assessed holistically, with ultrasound serving to augment—rather than replace—clinical judgment within the broader clinical context. A clear understanding of the interdependent roles of POCUS and TNE is essential to enable timely, meaningful, and integrated use of bedside ultrasound in the neonatal intensive care unit. Full article

Background: Insufficient physical activity has become a significant public health problem. Currently, physical education classes alone are insufficient to meet the physical activity levels recommended by the World Health Organization. Physically Active Learning (PAL), as a novel curriculum, promotes physical activity by teaching new knowledge in various school subjects. Objective: To systematically evaluate the effects of PAL interventions on primary school students’ physical fitness, physical activity, and sedentary behavior, characterize the key features of PAL interventions, identify research gaps, and provide evidence-based recommendations for practice. Methods: Following the PRISMA guidelines, four electronic databases—Web of Science, ProQuest, Ebsco, and Embase—were searched, and English-language controlled intervention studies that met the PICOS eligibility criteria were included. Two researchers independently screened the literature and extracted and cross-checked the data. Results: This study included 17 studies from 8 countries published between 2009 and 2025. These studies involved primary school students aged 6 to 12. PAL most consistently increased MVPA (moderate-to-vigorous physical activity) or number of steps during the targeted academic lesson, whereas effects on whole-school-day, daily, or weekly physical activity were inconsistent. Lesson-level sedentary behaviour generally decreased or was replaced by walking, standing, or sit-to-stand transitions, but effects on whole-day sedentary time were mixed. Physical fitness interventions yielded varied outcomes, demonstrating significant improvements in upper body strength and explosive muscle strength and endurance, while showing inconsistent effects on aerobic capacity, and no significant changes in BMI or agility indicators. Conclusions: Our findings indicate that PAL has the potential to improve students’ physical activity levels in the classroom. However, its effects on physical fitness indicators remained equivocal across evaluated outcomes. PAL should be considered part of a broader school strategy to promote physical activity rather than as a standalone approach. To maximize health benefits, stronger integration of PAL with active recess, active commuting, and structured physical education is recommended. Full article

Background: Type I neurofibromatosis (NF1) represents an autosomal dominant inherited genodermatosis predisposing to tumor occurrence, caused by mutations in the NF1 gene, clinically characterized by the impairment of skin pigmentation, dermal neurofibromas, neuro-psychiatric involvement, and Lisch nodules. The initially defined diagnostic criteria were revised in 2021 to facilitate the diagnosis in young children who present only with skin pigmentation anomalies or a positive family history of NF1. Hemochromatosis (HC) is a genetic disorder consisting of systemic iron overload due to a defect in hepcidin. The mutations are commonly located in the HFE gene. The clinical picture is associated with joint pain, hyperpigmentation, hepatomegaly, etc. Genetic testing is mandatory for the diagnosis of HC. Case Presentation: The aim of this case report is to underline the importance of a multidisciplinary approach for a precise diagnosis. A 17-year-old male teenager with a past medical history of multiple abdominal surgical interventions presented to the emergency department for diarrhea and abdominal pain. The physical examination revealed weight deficit, café-au-lait macules, axillary and inguinal freckling, and mild abdominal tenderness. Laboratory evaluation revealed high CRP, mild leucocytosis and lymphopenia. The surgical consult ruled out an acute surgical cause. The abdominal X-ray, stool culture, fecal cytology, urinalysis and urine culture were negative, but ferritin level and serum iron level were very high. Ophthalmological consult described a Lisch nodule. Multiplex Ligation-dependent Probe Amplification (MLPA) genetic testing found no deletions or duplications within the NF1 gene. The clinical evolution was favorable under third-generation cephalosporin, but the ferritin and serum iron levels remain elevated. The Whole-Exome Sequencing (WES) identified a heterozygous pathogenic variant in the NF1 gene, i.e., chr17:29560075CA>C, NF1(NM_001042492.3):c.3556del; p.(Ile1186SerfsTer29); rs2151435407, but also revealed a homozygous pathogenic variant in the HFE gene, i.e., chr6:26090951C>G, HFE(NM_000410.4):c.187C>G; p.(His63Asp), rs1799945, which is associated with hereditary HC. Conclusions: The overlapping dermatological findings of both NF1 and HC might lead to diagnostic delays. The holistic approach to all pediatric patients presenting with particular hyperpigmentation involves thorough laboratory investigations, neurological, ophthalmological, cardiological and genetic examinations. In the absence of DNA Copy Number Variations (CNVs) that can be identified rapidly and cost-effectively by MLPA, sequencing is indicated to analyze small DNA variations, especially when two conditions with similar clinical pictures coexist. Full article

Congenital chest wall deformities encompass a broad spectrum of anomalies, from the common pectus excavatum and pectus carinatum to rare, life-threatening conditions such as sternal clefts, ectopia cordis, pentalogy of Cantrell, and asphyxiating thoracic dystrophy (Jeune syndrome). This narrative review synthesizes current evidence on their epidemiology and pathogenesis, genetics and syndromic associations, diagnostic assessment, and the full range of conservative and surgical management, with particular attention to developments of the past decade. Pectus deformities affect roughly 1% of children, and although familial clustering supports a genetic contribution, no single causative gene has been established; syndromic associations, especially connective-tissue disorders, remain clinically actionable and warrant cardiovascular surveillance. Conservative treatment has become first-line for suitable patients: the vacuum bell for pectus excavatum and dynamic compression bracing for pectus carinatum both achieve good results when compliance is maintained. Minimally invasive repair remains the surgical standard for pectus excavatum, complemented by the modified Ravitch and hybrid procedures for complex morphology, while emerging innovations and enhanced-recovery protocols continue to improve safety and recovery. The rarer midline and chondrodysplastic deformities demand individualized, often emergency, multidisciplinary care. Across the spectrum, the most reproducible benefit of treatment lies in body image, self-esteem and quality of life, whereas a generalizable cardiopulmonary benefit remains unproven. Management should be individualized to the deformity, the child’s physiology, and the psychosocial burden of disease. Full article

Background: Traumatic brain injury is a major cause of morbidity in children. This study evaluates pediatric patients with skull fractures in the emergency department to determine independent factors associated with neurosurgical intervention. Methods: This single-center retrospective study included 133 patients under 18 years old with CT-confirmed skull fractures following head trauma. Demographics, trauma mechanisms, neurological status, fracture characteristics, and intracranial injuries were recorded. Firth penalized logistic regression examined factors associated with surgery. Results: The mean age was 4.47 years, and falls were the most common trauma mechanism (63.9%). Pneumocephalus and intracranial hemorrhage were each present in 24.8% of patients. In total, 12 patients (9.0%) required neurosurgical intervention. In univariate analyses, depressed fractures, comminuted fractures, pneumocephalus, and intracranial hemorrhage were strongly associated with intervention. In the multivariable model, age, intracranial hemorrhage and depressed fracture were the factors retaining statistical significance (p = 0.017, p = 0.022, p = 0.013). Conclusions: Intracranial hemorrhage showed the strongest independent statistical association with neurosurgical intervention. Although depressed, comminuted fractures and pneumocephalus were associated with surgery in univariate analyses, their independent contributions could not be reliably established due to limited surgical events. Clinical decisions must integrate neurological status and fracture characteristics. Full article

Background/Objectives: The retina is a highly metabolically active tissue that depends on precise vascular regulation. Childhood represents a critical period of ocular growth, and retinal vascular characteristics may provide insights into the relationship between microvascular development, ocular biometry, and refractive development. However, retinal vascular parameters in children living at high altitude remain poorly characterized. Our goal was to characterize retinal vascular caliber and evaluate its associations with ocular biometric parameters, refractive status, and peripheral oxygen saturation among children living at high altitude. Methods: This cross-sectional baseline analysis included 1410 children from the Lhasa Childhood Eye Study. Retinal vascular parameters, including central retinal arteriolar equivalent (CRAE), central retinal venular equivalent (CRVE), and arteriolar-to-venular ratio (AVR), were measured from fundus photographs using computer-assisted IVAN software. Ocular biometric parameters, cycloplegic refraction, and SpO₂ were assessed. Multivariable linear regression and sensitivity analyses accounting for school clustering and ocular magnification were performed. Results: The mean age was 7.90 ± 0.49 years, and 47.6% were female. Girls had shorter axial length (AL) and larger CRAE and CRVE than boys. Longer AL was associated with smaller CRAE (B = −5.64, p < 0.001) and CRVE (B = −11.24, p < 0.001), while AVR was positively associated with AL (p = 0.03). Lower SpO₂ was independently associated with larger CRAE (B = −0.35, p = 0.042), but not CRVE. After AL-based relative ocular magnification correction, the associations between AL and CRAE or CRVE were no longer significant. Myopic children had smaller CRAE and CRVE and higher AVR than non-myopic children. Conclusions: Retinal vascular caliber was associated with ocular biometric characteristics, SpO₂, and refractive status in children living at high altitude. The attenuation of AL-related associations after magnification correction highlights the importance of accounting for ocular magnification in retinal vascular measurements. Full article

Background: Children and adolescents with type 1 diabetes mellitus (T1DM) are at increased risk of comorbid anxiety and depressive symptoms, which can adversely affect glycemic control. Eye Movement Desensitization and Reprocessing (EMDR) therapy has demonstrated efficacy for trauma-related and anxiety symptoms, but its use in pediatric T1DM populations has been rarely studied. Methods: In this retrospective comparative study, 52 children and adolescents with T1DM and comorbid anxiety/depressive symptoms were classified into two equally sized groups according to whether they had received EMDR, based on real-world clinical decision-making rather than randomization: an EMDR group (n = 26) and a comparison group receiving standard psychiatric follow-up without EMDR (n = 26). Anxiety and depressive symptoms were assessed with the Revised Child Anxiety and Depression Scale (RCADS; standardized T-scores) before and after the intervention period. Three-month average blood glucose and mean daily insulin injection frequency were recorded before and after the same period. Group differences were analyzed using two-way repeated-measures analysis of variance (time × group) with Fisher’s LSD post hoc comparisons; baseline continuous and categorical variables were compared using the independent-samples t-test and chi-square test, respectively. Results: The EMDR and comparison groups did not differ significantly in age, sex, or other sociodemographic/clinical characteristics (all p > 0.05); baseline RCADS scores were comparable between groups except for obsessive–compulsive symptoms, which were higher in the comparison group (62.92 ± 11.24 vs. 55.38 ± 12.76; p = 0.020). There was a significant main effect of time (i.e., an overall improvement averaged across both groups) for all eight RCADS subscales (all p ≤ 0.02); within-group comparisons showed significant improvement in the EMDR group on every subscale, whereas the comparison group did not improve significantly on depression (p = 0.130) or total anxiety-plus-depression (p = 0.247). A significant time × group interaction, indicating significantly greater improvement in the EMDR group, was found for separation anxiety (p = 0.033), depression (p < 0.001), total anxiety (p = 0.011), and total anxiety-plus-depression (p = 0.015); interactions for generalized anxiety, panic, social phobia, and obsessive–compulsive symptoms did not reach significance (p = 0.07–0.86). There was also a significant main effect of time for mean blood glucose and for insulin injection frequency; however, within-group comparisons showed a significant reduction in the EMDR group only, with no significant change in the comparison group for either measure (p = 0.719 and p = 0.163, respectively). A significant time × group interaction confirmed a substantially greater reduction in the EMDR group for both mean blood glucose (F = 40.45, p < 0.001) and insulin injection frequency (F = 19.45, p < 0.001). Conclusions: EMDR therapy was associated with greater improvement than standard psychiatric follow-up in separation anxiety, depressive symptoms, and overall anxiety burden, and, notably, with a significantly greater reduction in mean blood glucose; a parallel pattern was observed for insulin injection frequency, a secondary, treatment-related measure that should be interpreted with caution. Given the retrospective, non-randomized design and the post hoc identification of these outcome patterns, these findings should be interpreted as exploratory and hypothesis-generating, warranting confirmation in prospective controlled trials. Full article

Background: The Adverse Childhood Experiences (ACE) Pyramid has been widely used for more than two decades to illustrate pathways linking childhood adversity to health outcomes across the lifespan. Since its development, substantial advances in the science of toxic stress have expanded understanding of the biological mechanisms through which adversity influences lifelong health. Objective: To describe the development and scientific rationale for a revised ACE Pyramid that reflects contemporary evidence on toxic stress, the biological pathways linking childhood adversity to health, and opportunities for prevention and healing. Methods: A multidisciplinary revision process was conducted in collaboration with subject matter experts from government, academia, healthcare, professional associations, and community-based organizations. Iterative review and refinement were used to align the framework with current scientific evidence and practice. Results: A revised ACE Pyramid was developed that preserves the familiar structure of the existing framework while incorporating advances in the science of toxic stress, prevention, and healing. Compared with the ACE Pyramid featured on the CDC website during development of the revised framework, the revised framework more explicitly emphasizes prolonged or excessive activation of the stress response as a central mechanistic pathway linking childhood adversity to lifelong health, expands the biological layer to encompass multiple interacting biological systems beyond neurodevelopment alone, and integrates prevention and healing opportunities throughout the framework. Conclusions: The revised ACE Pyramid synthesizes more than two decades of advances in the science of toxic stress into an accessible conceptual framework. It explains how childhood adversity becomes biologically embedded to shape lifelong health while emphasizing that prevention is possible and healing can occur throughout the life course. By providing a shared framework for understanding toxic stress biology, it may help inform trauma-informed clinical care, public health action, research, and policy aimed at advancing health equity and improve outcomes for children and families. Full article

Background/Objectives: The primary objective of the present study was to assess motor competence and identify motor difficulties among Greek adolescents using the Movement Assessment Battery for Children—2nd Edition (MABC-2). The secondary aim was to evaluate associations and differences across gender, school grade (age), BMI, hand dominance, extracurricular organized PA participation, and school type in relation to motor competence. Methods: The MABC-2 was utilized primarily as an exploratory screening instrument to identify potential motor difficulties within the sampled adolescent cohort (N = 742; M_age = 13.98 yrs.), rather than as a definitive clinical diagnostic tool for Developmental Coordination Disorder. Results: This study identified a low prevalence of motor difficulties among the sampled adolescents (1.5% definite, 3.6% at risk). Preliminary trends suggested a 1.5:1 boy-to-girl motor difficulty ratio. Within exploratory analyses, “at-risk” boys scored lower in balance and manual dexterity, while girls showed potential challenges in ball skills. Tentative subgroup analyses indicated that physical activity participants within these cohorts scored higher in balance and ball skills, though small sample sizes warrant caution. Other demographic or school environmental factors—specifically academic grades, body mass index, handedness, and school types—showed no clear associations with motor competence. Conclusions: This study identified a low prevalence of motor difficulties among Greek adolescents, with preliminary trends suggesting that structured extracurricular activity may support motor development. The findings indicate potential gender variations in specific motor domains and highlight the need for longitudinal research to confirm these observations. Full article

Background/Objectives: Fidgety movements are established markers of early neurological function in preterm infants. However, associated biological and neonatal factors remain insufficiently understood, particularly in infants without major structural brain abnormalities. This study aimed to compare biological maturity and neonatal morbidity in infants with normal, abnormal, and absent fidgety movements. Methods: Prospectively collected data from 57 preterm infants assessed at 12–16 weeks corrected age using Prechtl’s General Movements Assessment were analysed. Infants with moderate or severe abnormalities on term-equivalent magnetic resonance imaging were excluded. Gestational age, birth weight, clinically significant morbidities, a cumulative morbidity count, and durations of non-invasive respiratory support and mechanical ventilation were compared by fidgety movement classification. Results: Significant overall differences were found for gestational age (p = 0.018), birth weight (p = 0.027), non-invasive respiratory support (p = 0.014), and mechanical ventilation (p = 0.016). Infants with absent fidgety movements had lower gestational age (mean difference, 2.6 weeks; adjusted p = 0.021), lower birth weight (mean difference, 386 g; adjusted p = 0.021), longer non-invasive respiratory support (adjusted p = 0.014), and longer mechanical ventilation (adjusted p = 0.019) than infants with abnormal fidgety movements. Comparisons involving infants with normal fidgety movements were not significant. Individual morbidities and the cumulative morbidity count also did not differ by classification. Conclusions: Biological maturity and respiratory-treatment duration differed according to fidgety movement classification. However, the observed pattern did not indicate a simple ordinal relationship between the examined clinical characteristics and normal, abnormal, and absent fidgety movements. Full article

Background/Objectives: BioFlx crowns have recently been introduced as an aesthetic full-coverage option for restoring primary molars; however, clinical evidence remains limited. This prospective, single-arm, non-randomized interventional study evaluated the short-term clinical performance of BioFlx crowns in primary molars over six months and assessed immediate satisfaction of children and their parents after crown placement. Methods: Healthy children aged 6–9 years or children with mild, stable systemic medical conditions who were cooperative and required at least one full-coverage restoration in a primary molar were recruited from the pediatric dentistry clinics at King Abdulaziz University Faculty of Dentistry. BioFlx crowns were placed by trained pediatric dentistry residents under a consultant’s supervision. Immediately after crown cementation, proximal contact and occlusion were recorded. At three- and six-month follow-up visits, clinical outcomes evaluated were the proximal contacts, occlusion, crown retention, staining, wear of the opposing tooth, marginal integrity, and any changes in the crown material surface. In addition, plaque accumulation and gingival health around each crowned tooth were assessed at the tooth level. Immediate post-treatment satisfaction of children and their parents was assessed following crown cementation. Results: Twenty-eight children received 71 BioFlx crowns. The gingival health was favorable, with most teeth showing no bleeding throughout the follow-up visits. At six months, all evaluated crowns maintained ideal occlusion and showed no opposing-tooth wear; 98.4% remained retentive, 91.8% showed no staining, 93.4% maintained ideal marginal integrity, and minor surface indentations were common at 59%, while perforations were limited to 4.9% at six-month assessment. Children and parents reported high overall satisfaction with appearance (9.8 ± 0.4 and 9.5 ± 0.8, respectively). Conclusions: Within the selected cohort, BioFlx crowns demonstrated favorable short-term clinical performance over six months and high immediate post-treatment satisfaction among children and parents; however, surface indentations were frequently observed, and occasional clinically unacceptable perforations were noted. Full article