Children

9 pages, 479 KiB

Open AccessArticle

Impact of Change in Neonatal Resuscitation Program Guidelines for Infants Born Through Meconium-Stained Amniotic Fluid

by Hamza Abbasi, James Shelton, Praveen Chandrasekharan and Munmun Rawat

Children 2025, 12(8), 1072; https://doi.org/10.3390/children12081072 (registering DOI) - 15 Aug 2025

Background: In 2016, the neonatal resuscitation program (NRP) changed its recommendation to perform endotracheal suctioning in non-vigorous neonates born through meconium-stained amniotic fluid (MSAF). The objective of this study is to compare outcomes in non-vigorous neonates born through MSAF before and after [...] Read more.

Background: In 2016, the neonatal resuscitation program (NRP) changed its recommendation to perform endotracheal suctioning in non-vigorous neonates born through meconium-stained amniotic fluid (MSAF). The objective of this study is to compare outcomes in non-vigorous neonates born through MSAF before and after the change in the NRP’s recommendations. Methods: This is a retrospective cohort study in a single center assessing all neonates ≥34 weeks of gestation with MSAF in 2010–2015 (pre-implementation of new guidelines) and 2017–2022 (post-implementation of new guidelines). Results: Neonates receiving tracheal suctioning were more likely to be diagnosed with MAS (29.3% vs. 19.7%; p = 0.03) and PPHN (8.9% vs. 2.5%; p = 0.003) and more likely to receive surfactant (7.6% vs. 3.2%; p = 0.03). Conclusions: In our institution, non-vigorous neonates born via MSAF after the change in NRP guidelines were less likely to be diagnosed with MAS and PPHN and were less likely to receive surfactant. Our study supports current NRP guidelines. Full article

(This article belongs to the Special Issue New Insights in Neonatal Resuscitation)

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9 pages, 275 KiB

Open AccessArticle

Sex Differences in Wheezing During the First Three Years of Life After Delivery via Caesarean Section

by Evangelia Papathoma, Theodore Dassios, Maria Triga, Sotirios Fouzas and Gabriel Dimitriou

Children 2025, 12(8), 1071; https://doi.org/10.3390/children12081071 (registering DOI) - 14 Aug 2025

Abstract

Background: Emerging evidence suggests that delivery by caesarean section predisposes to wheezing in early childhood, but the effect may differ between boys and girls. Such sex-specific differences remain insufficiently explored to date, particularly considering the wide range of perinatal and antenatal confounding factors. [...] Read more.

Background: Emerging evidence suggests that delivery by caesarean section predisposes to wheezing in early childhood, but the effect may differ between boys and girls. Such sex-specific differences remain insufficiently explored to date, particularly considering the wide range of perinatal and antenatal confounding factors. In this study, we aimed to investigate sex-specific differences in the association between delivery by caesarean section and preschool wheezing. Methods: This is a secondary analysis of a population of 470 children (53% boys), born and cared for between August 2009 and March 2011 at the maternity services of the University Hospital of Patras, Greece. Participants were followed up regularly until the age of 36 months. Wheezing was defined as at least one episode of doctor-diagnosed wheezing per year during the surveillance period of three years. Multivariable regression models were used to explore possible associations and adjust for confounders. Results: The rate of caesarean section was 51% (N = 240). Wheezing was reported in 144 (31%) of the children. Following delivery by caesarean section, 52 of 137 (38%) of the boys and 33 of 103 (32%) of the girls developed wheezing. In the whole cohort, development of wheezing was significantly associated with male sex [odds ratio: 1.83 (95% CI: 1.22–2.75), adjusted p = 0.004], but not with caesarean section or gestational age. In girls, the development of wheezing was significantly associated with caesarean section [odds ratio: 2.48 (95% CI: 1.28–4.83), adjusted p = 0.007]. In boys, the development of wheezing was not significantly associated with delivery by caesarean section. Conclusions: Girls born by caesarean section developed wheezing more frequently than their vaginally born counterparts during the first three years of life. Although male sex proved an overall predisposing factor to preschool wheezing, boys born by caesarean section were not diagnosed with wheezing more frequently than those delivered vaginally. Full article

(This article belongs to the Section Pediatric Neonatology)

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11 pages, 249 KiB

Open AccessArticle

The Psychological Impact of Experiencing Sexual Abuse Revictimization by a Different Perpetrator in Childhood

by Elizabeth L. Jeglic, Georgia M. Winters, Benjamin N. Johnson and Emma Fisher

Children 2025, 12(8), 1070; https://doi.org/10.3390/children12081070 - 14 Aug 2025

Abstract

Background/Objectives: Research has shown that those who experience childhood sexual abuse (CSA) are at increased risk of subsequent sexual revictimization. Multiple sexual victimizations can lead to higher rates of depression, anxiety, trauma, and suicidality. Prior research has yielded varying definitions of revictimization, including [...] Read more.

Background/Objectives: Research has shown that those who experience childhood sexual abuse (CSA) are at increased risk of subsequent sexual revictimization. Multiple sexual victimizations can lead to higher rates of depression, anxiety, trauma, and suicidality. Prior research has yielded varying definitions of revictimization, including only accounting for revictimization that occurred in adulthood or multiple CSA episodes by the same perpetrator, or it has broadly assessed maltreatment without a specific focus on CSA. This study examined mental health outcomes in survivors of CSA who experienced sexual revictimization in childhood from a different perpetrator, comparing their mental health outcomes (i.e., depression, suicidal ideation, post-traumatic stress disorder (PSTD), hopelessness, guilt, and shame) to those who reported CSA by one perpetrator. Methods: Adult survivors of CSA (n = 627) completed an online survey describing their CSA experience, whether they experienced CSA by one or multiple perpetrators in childhood, and a series of mental health questionnaires. Results: Almost half of the sample reported CSA by more than one perpetrator in childhood (n = 267; 42.58%). Survivors who reported multiple CSA perpetrators reported significantly higher levels of depression, suicidal thoughts, PTSD, hopelessness, shame, and some facets of guilt in adulthood compared to those who reported CSA by a single perpetrator. Conclusions: Experiencing CSA by multiple perpetrators in childhood may lead to more negative mental health outcomes in adulthood. The findings emphasize the importance of early identification and intervention for individuals who experienced CSA. Full article

(This article belongs to the Section Pediatric Mental Health)

13 pages, 1166 KiB

Open AccessArticle

Psychometric Properties of the Experience of Cognitive Intrusion of Pain (ECIP) Scale in Pediatric Chronic Pain

by Cherish Heard, Keri R. Hainsworth and Kristen E. Jastrowski Mano

Children 2025, 12(8), 1069; https://doi.org/10.3390/children12081069 - 14 Aug 2025

Abstract

Background/Objectives: Chronic pain symptoms can disrupt cognitive processes. Such interruptions may negatively impact one’s overall functioning, causing frustration and distress when engaging in important tasks. This experience has been referred to as cognitive intrusion of pain. To date, only one adult [...] Read more.

Background/Objectives: Chronic pain symptoms can disrupt cognitive processes. Such interruptions may negatively impact one’s overall functioning, causing frustration and distress when engaging in important tasks. This experience has been referred to as cognitive intrusion of pain. To date, only one adult self-report measure of cognitive intrusion of pain exists: the Experience of Cognitive Intrusion of Pain (ECIP). The purpose of the current study was to examine the psychometric properties of the ECIP in a sample of pediatric patients with chronic pain. Methods: The internal consistency reliability, factor structure, and validity of the ECIP were evaluated in a sample (N = 182) of youth ages 11 to 18 who presented to a multidisciplinary chronic pain clinic at a large Midwestern children’s hospital in the United States. Results: Results suggest excellent reliability (α = 0.94). Confirmatory factor analysis results supported a one-factor model, with excellent model fit. The ECIP demonstrated evidence of convergent validity, with moderate and positive correlations with measures of pain-related limitations in functioning, pain symptoms, anxiety, and depression. Regarding discriminant validity evidence, the ECIP was minimally and inversely related to measures of readiness to transition to self-managed care and global health. Conclusions: Overall, the ECIP demonstrated strong initial reliability and validity evidence for use in pediatric chronic pain. Further research is recommended in more diverse samples and to evaluate the clinical utility of the ECIP. Full article

(This article belongs to the Section Pediatric Anesthesiology, Perioperative and Pain Medicine)

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24 pages, 2467 KiB

Open AccessArticle

The Voice of Families: Perceptions of Family-Centred Practices and Natural Environments in Early Intervention in Spain

by Mónica Montaño-Merchán, Roberto Sanz-Ponce, Laura Padilla-Bautista and Joana Calero-Plaza

Children 2025, 12(8), 1068; https://doi.org/10.3390/children12081068 - 14 Aug 2025

Abstract

The family-centred Early Intervention model based on routines and natural environments has been widely supported by international evidence in recent decades. Within this framework, Family-Centred Practices (FCP) and their development in natural environments have emerged as an evidence-based intervention model of reference, promoting [...] Read more.

The family-centred Early Intervention model based on routines and natural environments has been widely supported by international evidence in recent decades. Within this framework, Family-Centred Practices (FCP) and their development in natural environments have emerged as an evidence-based intervention model of reference, promoting parental empowerment, shared decision-making, and functional intervention through daily routines. However, its effective implementation in real contexts presents multiple challenges, especially from the perspective of families receiving the service. Background/Objectives: This study explores the experiences, meanings, and assessments of Spanish families with children who have disabilities or developmental difficulties in relation to the application of these professional practices. This study is carried out in the Spanish context, since Campus Capacitas (Campus Capacitas—Catholic University of Valencia, Spain) has been implementing, in recent years, the family-centred model as a model of early intervention. Methods: A qualitative, descriptive, and interpretative methodology was used. Data collection was carried out through semi-structured interviews and discussion groups with 30 families from the 17 Spanish autonomous communities. Data analysis was carried out through thematic coding following criteria of qualitative rigour such as triangulation and theoretical saturation. Results: The findings show a significant gap between the theoretical model of family-centred practices and their practical application. Families who have experienced a clinical model criticise the absence of personalised intervention, unidirectional communication, as well as lack of participation in decision-making. In that sense, it is the different specialists of the early intervention team who are responsible for making intervention decisions. Therefore, these families demand more emotional and educational support. On the other hand, other families report positive experiences associated with collaborative, transdisciplinary, and home-based models based on a family-centred model. Conclusions: The results highlight the urgent need to move towards early intervention that strengthens the active role of families, promotes professional co-responsibility, and adapts to real child development environments, in line with international recommendations. Regarding future lines of research, we are committed to the development of longitudinal studies on the sustainable effects of interventions centred on families and on the global development of children and families. To carry out comparative studies between autonomous communities, to assess the influence of regulatory factors and regional resources on the practices implemented, as well as to carry out triangulation studies of the professional practices implemented, incorporating the perspectives of professionals and other intervention agents to enrich the analysis. Full article

(This article belongs to the Section Global Pediatric Health)

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14 pages, 410 KiB

Open AccessArticle

Validation of the Brief Autism Mealtime Behavior Inventory in Parents of Children in Cyprus

by Andri Papaleontiou, Vassiliki Siafaka, Louiza Voniati, Alexandros Gryparis, Rafaella Georgiou and Dionysios Tafiadis

Children 2025, 12(8), 1067; https://doi.org/10.3390/children12081067 - 14 Aug 2025

Abstract

Background/Objectives: Autism Spectrum Disorder (ASD) includes significant feeding difficulties, behavioral issues, and communication deficits that are linked to serious medical complications and developmental challenges. The Brief Autism Mealtime Behavior Inventory (BAMBI) is a commonly used tool to screen for mealtime behavior problems in [...] Read more.

Background/Objectives: Autism Spectrum Disorder (ASD) includes significant feeding difficulties, behavioral issues, and communication deficits that are linked to serious medical complications and developmental challenges. The Brief Autism Mealtime Behavior Inventory (BAMBI) is a commonly used tool to screen for mealtime behavior problems in children with ASD; however, it lacks validation for use within the Greek-Cypriot population. The current study sought to present the translation, cultural adaptation, and validation of the BAMBI for Greek-Cypriot parents of children with ASD. Methods: Three bilingual experts translated the inventory into Greek, following the translation guidelines by the World Health Organization. The inventory was then administered to 117 parents: 42 children with ASD and 75 typically developing children. Principal Component Analysis was used to obtain the tool’s statistical reliability and validity. Results: BAMBI-Gr demonstrated strong internal consistency, as indicated by a Cronbach’s alpha of 0.755, and showed excellent test–retest reliability, with an intraclass correlation coefficient of 0.999. PCA identified three key factors: General Refusals, Refusing Food, and Autism-Related Features. Significant differences in BAMBI-Gr scores of the comparative group of parents of children with ASD and parents of typically developing children highlighted the tool’s sensitivity in detecting mealtime behavior problems. Receiver Operating Characteristics analysis set the cut-off points for optimum distinguishing of feeding problems at 46.00 (sensitivity 0.738, 1-specificity 0.000). Conclusions: The Greek-translated version of the BAMBI demonstrates validity and effectiveness as a parent-reported assessment tool for identifying feeding and mealtime difficulties in children with ASD. Full article

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

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32 pages, 3096 KiB

Open AccessReview

Orthodontic Perspectives in the Interdisciplinary Management of Pediatric Obstructive Sleep Apnea

by Silvia Müller-Hagedorn, Véronique Abadie and Theodosia Bartzela

Children 2025, 12(8), 1066; https://doi.org/10.3390/children12081066 - 14 Aug 2025

Abstract

Pediatric obstructive sleep apnea (OSA) is a highly prevalent, multifactorial, and often underdiagnosed condition with significant consequences for cognitive and behavioral development. Early detection and timely multidisciplinary interventions are essential, particularly in children with craniofacial anomalies or syndromes associated with increased OSA risks, [...] Read more.

Pediatric obstructive sleep apnea (OSA) is a highly prevalent, multifactorial, and often underdiagnosed condition with significant consequences for cognitive and behavioral development. Early detection and timely multidisciplinary interventions are essential, particularly in children with craniofacial anomalies or syndromes associated with increased OSA risks, to prevent long-term complications. This narrative review explores the orthodontists’ role in the interdisciplinary management of pediatric OSA, focusing on early screening for craniofacial risk factors and implementing interceptive orthodontic interventions that support favorable airway development and growth modulation. Through early and frequent interaction with pediatric patients, orthodontists are well-positioned to identify clinical signs of airway-related abnormalities and craniofacial risk factors such as mandibular and maxillary retrognathism, maxillary constriction, and high-arched palatal vaults. Orthodontic interventions such as rapid maxillary expansion (RME), mandibular advancement, and myofunctional therapy may improve airway patency in selected cases. These approaches should be coordinated and integrated within the multidisciplinary team, including orthodontists, pediatricians, sleep specialists, ENT specialists, and speech-language pathologists. Furthermore, caregivers’ involvement and patients’ compliance are keys to success. Despite encouraging clinical observations, current evidence is limited by heterogeneity and a lack of long-term outcome data. Future research should prioritize well-designed prospective trials, explore the effectiveness of combined therapeutic strategies, and support the development of standard diagnostic protocols. Equally important is a stronger focus on early diagnosis and preventive measures to enhance patient outcomes and long-term treatment strategies. Integrating orthodontists into early OSA care is essential for optimizing outcomes and reducing long-term morbidity. Full article

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

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20 pages, 1893 KiB

Open AccessSystematic Review

Association Between Endotype of Prematurity and Cystic Periventricular Leukomalacia: A Bayesian Model-Averaged Meta-Analysis

by Neirude P. A. Lissone, Tamara M. Hundscheid, Gloria M. Galán-Henríquez, Gema E. González-Luis, František Bartoš and Eduardo Villamor

Children 2025, 12(8), 1065; https://doi.org/10.3390/children12081065 - 13 Aug 2025

Abstract

Introduction: Pathophysiological pathways—or endotypes—leading to prematurity can be clustered into two groups: infection/inflammation and dysfunctional placentation. We aimed to perform a systematic review and meta-analysis of studies exploring the association between these endotypes and cystic periventricular leukomalacia (cPVL). Methods: PubMed and Embase were [...] Read more.

Introduction: Pathophysiological pathways—or endotypes—leading to prematurity can be clustered into two groups: infection/inflammation and dysfunctional placentation. We aimed to perform a systematic review and meta-analysis of studies exploring the association between these endotypes and cystic periventricular leukomalacia (cPVL). Methods: PubMed and Embase were searched for observational studies examining preterm infants and reporting data on the association between endotype of prematurity and cPVL. Chorioamnionitis represented the infectious–inflammatory endotype, while dysfunctional placentation proxies were hypertensive disorders of pregnancy (HDPs) and small for gestational age (SGA)/intrauterine growth restriction (IUGR). Bayesian model-averaged (BMA) meta-analysis was used to calculate Bayes factors (BFs). The BF₁₀ is the ratio of the probability of the data under the alternative hypothesis (H_1; presence of association) over the probability of the data under the null hypothesis (H_0; absence of association). Results: Of 1141 potentially relevant studies; 67 (108,571 infants) were included. The BMA analysis showed strong evidence in favor of a positive association between chorioamnionitis and cPVL (OR 1.58; 95% CrI 1.12 to 2.20; BF₁₀ = 20.5) and extreme evidence in favor of a negative association between HDPs and cPVL (OR 0.63; 95% CrI 0.54 to 0.75; BF₁₀ = 2937). The evidence for the SGA/IUGR group was inconclusive (OR 0.87; 95% CrI 0.75 to 1.01; BF₁₀ = 1.41). Conclusions: This Bayesian meta-analysis provides evidence indicative of an association between antenatal infection–inflammation and an increased risk of developing cPVL in preterm infants. Conversely, infants exposed to HDPs are less likely to develop cPVL. Full article

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

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26 pages, 2865 KiB

Open AccessSystematic Review

Effectiveness of Intravenous and Nebulized MgSO₄ in Children with Asthma Exacerbation: A Systematic Review and Meta-Analysis of Clinical Trials

by Víctor Hugo Estupiñán Pérez, Freiser Eceomo Cruz Mosquera, Mayerli de la Rosa Caldas, Olmer Alexander Pantoja Rodríguez and Yamil Liscano

Children 2025, 12(8), 1064; https://doi.org/10.3390/children12081064 - 13 Aug 2025

Abstract

Background/Objectives: Moderate or severe asthma exacerbations may require pharmacological interventions in addition to standard treatment. In this context, magnesium sulfate has been proposed as a second-line therapeutic option, owing to its physiological effects on bronchial smooth muscle. Therefore, the objective of this meta-analysis [...] Read more.

Background/Objectives: Moderate or severe asthma exacerbations may require pharmacological interventions in addition to standard treatment. In this context, magnesium sulfate has been proposed as a second-line therapeutic option, owing to its physiological effects on bronchial smooth muscle. Therefore, the objective of this meta-analysis is to determine the effectiveness of intravenous or nebulized magnesium sulfate in patients with a moderate-to-severe asthmatic crisis. Methods: This systematic review and meta-analysis included randomized controlled trials published between 1990 and 2024, using the PubMed, Scopus, Science Direct, Web of Science, LILACS, Cochrane Library, Springer, and Scielo databases. The risk of bias was assessed using the RoB 2 tool, the quality of evidence with the Jadad scale, and the certainty of the evidence per outcome was evaluated following the GRADE guidelines. The meta-analysis was developed using the statistical software Jamovi 2.3.28^® and RevMan 5.4^®. Results: Fourteen studies with a total of 2242 patients with a moderate-to-severe asthmatic crisis were included. Of these, ten studies evaluated the severity score, eight evaluated hospitalization, five evaluated the length of the hospital stay, and three evaluated intensive care unit admission. The meta-analysis demonstrates that the use of magnesium sulfate is associated with a statistically significant reduction in the risk of hospitalization (RR: 0.79, 95% CI: from 0.67 to 0.94, p = 0.02). However, no effects were observed on the severity score (SMD: −0.37, 95% CI: from −0.92 to 0.17, p = 0.16), the length of the hospital stay (SMD: −0.75, 95% CI: from −1.90 to 0.40, p = 0.14), or admission to intensive care units (RR: 0.62, 95% CI: from 0.28 to 1.36, p = 0.23). Subgroup and sensitivity analyses did not yield significant findings or produce any modification of the effect. Conclusions: Magnesium sulfate reduces hospitalizations in moderate-to-severe pediatric asthma, although it does not improve other relevant clinical outcomes. Full article

(This article belongs to the Section Pediatric Emergency Medicine & Intensive Care Medicine)

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47 pages, 1390 KiB

Open AccessReview

Biological, Psychosocial, and Microbial Determinants of Childhood-Onset Obsessive–Compulsive Disorder: A Narrative Review

by Alejandro Borrego-Ruiz and Juan J. Borrego

Children 2025, 12(8), 1063; https://doi.org/10.3390/children12081063 - 13 Aug 2025

Abstract

The etiology of obsessive–compulsive disorder (OCD) remains incompletely understood, but it is widely recognized as the result of a complex interplay among multiple contributing mechanisms, often emerging during childhood. This narrative review synthesizes current evidence on the etiology of childhood-onset OCD, with particular [...] Read more.

The etiology of obsessive–compulsive disorder (OCD) remains incompletely understood, but it is widely recognized as the result of a complex interplay among multiple contributing mechanisms, often emerging during childhood. This narrative review synthesizes current evidence on the etiology of childhood-onset OCD, with particular focus on whether GM alterations are involved in the pathophysiological mechanisms underlying the disorder. Specifically, the review first examines both biological and psychosocial determinants of OCD, and then explores the role of the gut microbiome (GM), including the potential of psychobiotics as a novel therapeutic approach. OCD has a strong hereditary component, involving both common polygenic variants and rare mutations. Epigenetic mechanisms such as DNA methylation and microRNA play a role in mediating gene–environment interactions and influencing OCD risk. Dysfunction and hyperactivity within cortico-striato-thalamo-cortical circuits underlie one of the neurobiological bases of OCD. Infections and autoimmune reactions can trigger or exacerbate OCD, particularly in pediatric populations. A range of psychosocial factors have been implicated in the onset of OCD, often in interaction with underlying neurobiological vulnerabilities. Current evidence indicates that GM alterations may also contribute to OCD pathophysiology through immune-mediated neuroinflammation, disrupted gut–brain signaling, and neurotransmitter imbalance. Individuals with OCD present reduced microbial diversity and lower abundance of butyrate-producing taxa, as well as altered IgA levels and increased infection susceptibility. These shifts may affect dopaminergic, glutamatergic, and serotonergic pathways, particularly via tryptophan metabolism and compromised gut integrity. Thus, the GM plays a pivotal role in OCD, constituting a promising approach for understanding its etiology and highlighting the significant clinical potential of microbial-based treatments such as psychobiotics. Nevertheless, despite progress, gaps remain in understanding childhood-onset OCD determinants, including limited longitudinal studies, incomplete characterization of the GM, scarce psychobiotic trials, and a need for integrated multidisciplinary approaches. Moreover, epidemiological evidence is compromised by reliance on lay diagnoses, questionable assessment validity, and insufficient distinction from related disorders. Full article

(This article belongs to the Section Pediatric Mental Health)

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8 pages, 544 KiB

Open AccessArticle

Resilience in Pediatric-Onset Inflammatory Bowel Disease: Associations with Age, Therapy Change, and Health-Related Quality of Life

by Elizabeth Hilow, Jessica Barry, Nila Mistry Ambani, Kate Eshleman, Sarah Worley, Wei Liu and Jacob A. Kurowski

Children 2025, 12(8), 1062; https://doi.org/10.3390/children12081062 - 13 Aug 2025

Abstract

Background: Resilience is associated with improved outcomes in adult inflammatory bowel disease (IBD), yet little is known about its relationship to health-related quality of life and disease characteristics in pediatric-onset IBD. Methods: This prospective, cross-sectional study enrolled pediatric-onset IBD patients (≥12 years) at [...] Read more.

Background: Resilience is associated with improved outcomes in adult inflammatory bowel disease (IBD), yet little is known about its relationship to health-related quality of life and disease characteristics in pediatric-onset IBD. Methods: This prospective, cross-sectional study enrolled pediatric-onset IBD patients (≥12 years) at Cleveland Clinic Children’s. Participants completed the Connor–Davidson Resilience Scale (CD-RISC-10) and an age-appropriate health-related quality of life (HRQOL) survey. Measure: IMPACT-III (ages 12–17) or SF-36 (≥18). Demographic and clinical data were collected via chart review. Associations between resilience, HRQOL, and clinical variables were analyzed. Results: Seventy participants completed the study (35 adolescents and 35 young adults). Young adults had significantly higher resilience scores than adolescents (31 ± 4.6 vs. 27 ± 5.3; p = 0.007). Resilience scores were significantly lower among patients who had experienced a change in IBD therapy within the prior year (27 vs. 30; p = 0.045). No significant associations were found between resilience and age at diagnosis, disease duration, HRQOL, or prior surgery. Use of pharmacologic treatment for mental health conditions was higher in young adults compared to adolescents (22.9% vs. 14.3%; p = 0.015), despite similar rates of diagnosed mental health comorbidities. Conclusions: Resilience in pediatric-onset IBD patients varies by age and is lower in the context of recent therapy changes, suggesting a potential vulnerability during periods of disease instability. Routine assessment of resilience may help identify patients who could benefit from early psychosocial intervention to support coping and improve long-term outcomes. Full article

(This article belongs to the Special Issue Pediatric Inflammatory Bowel Disease: Update on Treatment and Therapeutic Endpoints)

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Graphical abstract

23 pages, 1455 KiB

Open AccessArticle

COVID-19 and Its Aftermath on Pediatric Oral Health: A Study of Dental Caries and Hygiene in Romanian Children

by Maximilian Ilea, Alina-Ioana Forray, Nausica Bianca Petrescu, Ioana-Codruta Mirica, Alina Ormenişan, Mine Betül Üçtaşli, Adriana Melnic and Ondine Patricia Lucaciu

Children 2025, 12(8), 1061; https://doi.org/10.3390/children12081061 - 12 Aug 2025

Abstract

Background/Objectives: Official data on the oral health of young children in Romania are limited, especially concerning the societal shifts following the COVID-19 pandemic. This study aimed to compare the oral health status, hygiene habits, diet, and dental care patterns of 6-year-old children [...] Read more.

Background/Objectives: Official data on the oral health of young children in Romania are limited, especially concerning the societal shifts following the COVID-19 pandemic. This study aimed to compare the oral health status, hygiene habits, diet, and dental care patterns of 6-year-old children in a rural Romanian region before and after the pandemic. Methods: A cross-sectional survey studied two groups of 6-year-olds from rural Transylvania: Group 1 (n = 77), assessed 2018–2020 pre-pandemic, and Group 2 (n = 136), assessed in 2024 post-pandemic. Clinical data used the Decayed, Missing, and Filled Teeth (DMFT) index. Parents completed questionnaires on oral hygiene, diet, dental visits, and pandemic-related topics for Group 2. Chi-square, Student’s t-tests, and a multiple linear regression were used to analyze the data. Results: Post-pandemic, 70% of children brushed twice daily, up from 26%. Despite this, negative outcomes increased: the number of affected teeth rose from 6.8% to 29.6% (p < 0.001), sugar intake increased, and dental visits became more reactive, with pain being the main reason for 61% of post-pandemic visits, compared to 17% pre-pandemic. Conclusions: This study reveals a significant oral health paradox: despite a three-fold increase in recommended toothbrushing, caries experience in permanent teeth increased four-fold. This outcome was driven by a high-risk environment of more cariogenic diets and reduced preventive care, with lower maternal education also identified as a key independent risk factor. These findings show that promoting hygiene alone is insufficient, underscoring the urgent need for public health programs that integrate nutritional counseling, improve access to preventive care, and address underlying socioeconomic disparities. Full article

(This article belongs to the Section Pediatric Dentistry & Oral Medicine)

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14 pages, 257 KiB

Open AccessArticle

Parents’ Perspectives on Participation Among Gifted and Typically Developing Children: A Pilot Study

by Yael Fogel and Miri Ben Amram

Children 2025, 12(8), 1060; https://doi.org/10.3390/children12081060 - 12 Aug 2025

Abstract

Background/Objectives: Despite growing interest in giftedness, the differences in daily participation between gifted and typically developing children remain understudied and insufficiently understood. Exploring these differences may provide valuable insights into the unique needs and support required for gifted children compared to their [...] Read more.

Background/Objectives: Despite growing interest in giftedness, the differences in daily participation between gifted and typically developing children remain understudied and insufficiently understood. Exploring these differences may provide valuable insights into the unique needs and support required for gifted children compared to their typically developing peers. This comparative exploratory study aims to examine the differences between gifted and typically developing children’s daily participation patterns in home, school, and community environments and their parents’ perspectives and explore underlying developmental characteristics that may predict their participation. Methods: Parents of 215 children (8–18 years; 53% boys) in a gifted group (n = 136) and a matched typically developing children group (n = 79) completed the Five-to-Fifteen-revised questionnaire and the Child and Adolescent Scale of Participation. Results: We found no significant between-group differences in daily participation. However, we noted significant correlations in each group between the questionnaires’ participation domains (r = −0.243 to −0.460 in the gifted group, and r = −0.57 to −0.78 in the typically developing children group). Social and memory skills predicted 24% of the gifted children’s participation, and social and mental skills predicted 65% of the typically developing children’s participation. Conclusions: The results indicate similar participation patterns of gifted children and typically developing children. Social skills are a key element enabling daily participation among children in both groups. Full article

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

15 pages, 234 KiB

Open AccessArticle

A Closer Look at Parental Narratives: A Qualitative Analysis of Parental Entries in Neonatal Research Diaries of Preterm Infants Participating in the REPORT-BPD Feasibility Study

by Wisam Muhsen, Ana Guillot Lozano and Jos M. Latour

Children 2025, 12(8), 1059; https://doi.org/10.3390/children12081059 - 12 Aug 2025

Abstract

Background/Objectives: Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting preterm infants, often resulting in prolonged neonatal intensive care unit (NICU) stays and significant parental stress. The experiences of parents navigating their preterm infant’s early NICU journey are important to support clinical trials [...] Read more.

Background/Objectives: Bronchopulmonary dysplasia (BPD) is a chronic lung disease affecting preterm infants, often resulting in prolonged neonatal intensive care unit (NICU) stays and significant parental stress. The experiences of parents navigating their preterm infant’s early NICU journey are important to support clinical trials to improve infant outcomes. Aim: The aim of this study was to explore parental perceptions of their infant’s health progression during the first 10 days of life through personal diary entries and their correlation with the echo scans assessments, as part of the Exploring Right vEntricular function applicability in a Prediction mOdel to identify pReterm infanTs with early BronchoPulmonary Dysplasia (REPORT-BPD) feasibility study. Methods: An embedded qualitative design was employed, utilising thematic analysis of 17 parent diaries. Parents of preterm infants (<32 weeks of gestation) admitted to a NICU documented their daily experiences. Thematic analysis was applied to ensure a rigorous, inductive examination of emerging themes. Findings: Four main themes were identified: (1) developing parent–infant relationships, highlighting the emotional impact of separation and the significance of bonding; (2) health and well-being of premature infants and family, reflecting parental vigilance, cautious optimism, and emotional distress; (3) parents navigating support and the NICU environment, describing challenges related to medical procedures, communication with staff, and adapting to a highly technical setting; and (4) emotions and protective gestures, illustrating parental resilience, coping mechanisms, and the innate drive to protect their child. Conclusions: Parental experiences in the NICU were shaped by emotional turmoil, uncertainty, and the need for support in navigating their infant’s care. Diaries provided an effective means for parents to express their experiences; they could serve as a communication tool in clinical trials to provide a deeper understanding of the development of the recruited preterm infants. Full article

(This article belongs to the Section Pediatric Neonatology)

9 pages, 227 KiB

Open AccessArticle

Sleep Disorders in Infants and Toddlers with Hypoxic Ischemic Encephalopathy Treated with Therapeutic Hypothermia: A Case–Control Study Using the SDSC

by Domenico M. Romeo, Chiara Arpaia, Maria Rosaria Lala, Giorga Cordaro, Claudia Brogna, Marianna Moro, Francesca Gallini, Giovanni Vento and Eugenio Mercuri

Children 2025, 12(8), 1058; https://doi.org/10.3390/children12081058 - 12 Aug 2025

Abstract

Background and Objectives: Sleep complaints are particularly relevant in the development of children, affecting cognitive development, neuropsychological functioning, and learning abilities. The aims of this study were as follows: (i) to determine the incidence of sleep disorders in low-risk infants and toddlers with [...] Read more.

Background and Objectives: Sleep complaints are particularly relevant in the development of children, affecting cognitive development, neuropsychological functioning, and learning abilities. The aims of this study were as follows: (i) to determine the incidence of sleep disorders in low-risk infants and toddlers with hypoxic ischemic encephalopathy (HIE) treated with therapeutic hypothermia (TH), using the Italian version of the Sleep Disturbance Scale for Children (SDSC); and (ii) to compare the data with those of a healthy control group. Materials and Methods: This is a cross-sectional case–control study involving a total of 167 infants and toddlers (aged 6–36 months) with HIE treated with TH and 160 typically developing infants assessed using the SDSC filled out by the mother. A neurocognitive assessment was also performed. Exclusion criteria were mild perinatal asphyxia, major brain lesions, congenital malformations, severe postnatal infectious diseases, metabolic complications, cerebral palsy, neurodevelopmental impairment, and epilepsy. Results: In the study group, an abnormal total SDSC score was found in 1.8% of infants; 10% of infants had an abnormal score on at least one of the SDSC factors. No specific differences in the SDSC total and the factor scores were observed between the study and control group, with the exception of difficulties in maintaining sleep and sleep hyperhidrosis, with higher scores in HIE infants. Conclusions: Low-risk infants and toddlers with HIE showed a low incidence of sleep disorders, similar to those observed in control group, with some exceptions. As these incidences may increase significantly with age, further clinical assessments will be needed to confirm these data at older ages. Full article

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

14 pages, 9863 KiB

Open AccessArticle

Examination of Behavioral and Neuropsychological Characteristics of Hungarian Patients with Juvenile Idiopathic Arthritis: A Cross-Sectional Analysis

by Diána Garan, Lilla Lengvári, Andrea Ponyi, Márton Szabados, Gyurgyinka Gergev, Imre Bozi, Wouter Wijker and Tamás Constantin

Children 2025, 12(8), 1057; https://doi.org/10.3390/children12081057 - 12 Aug 2025

Abstract

Background: Children with juvenile idiopathic arthritis (JIA) may experience chronic pain, contributing to psychological distress. Objective: The objective was to assess neuropsychological functions and behavioral skills in patients with JIA and identify demographic and disease-related factors influencing these outcomes. Methods: This cross-sectional study [...] Read more.

Background: Children with juvenile idiopathic arthritis (JIA) may experience chronic pain, contributing to psychological distress. Objective: The objective was to assess neuropsychological functions and behavioral skills in patients with JIA and identify demographic and disease-related factors influencing these outcomes. Methods: This cross-sectional study evaluated 112 patients at the Division of Pediatric Rheumatology, Semmelweis University (2015–2016). Participants completed psychological assessments using the Child Behavior Checklist and Woodcock–Johnson III Tests. Examined variables included demographic (age and sex), clinical (age at diagnosis and disease activity), and treatment-related factors (therapy type and duration). Treatment groups comprised (a) combination therapy with TNF inhibitor and methotrexate (MTX) (n = 60), (b) MTX monotherapy (n = 34), and (c) TNF inhibitor monotherapy (n = 18). Results: Neuropsychological variables showed no clinically significant differences between treatment groups. These skills were unaffected by age, sex, therapy duration, or disease activity. Pathological behavioral scores were significantly higher (p < 0.05) in younger patients (<7 years), with females showing greater susceptibility to anxiety and depression (p < 0.05). Conclusions: No clinically significant psychological impairments were observed in our cohort. Further research is warranted to clarify the significance of abnormal behavioral scores. Psychological care provision remains vital for improving the quality of life in JIA patients. Full article

(This article belongs to the Special Issue Advances in Pediatric Rheumatology: Focus on Juvenile Idiopathic Arthritis)

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12 pages, 1134 KiB

Open AccessArticle

Relationship Between Personality of Parents and Pediatric Post-Intensive Care Syndrome for a Family in the PICU: A Prospective, Observational Cohort Pilot Study

by Misaki Kotani, Mitsuki Ikeda, Gen Aikawa, Hideaki Sakuramoto, Akira Ouchi, Haruhiko Hoshino, Keishun Boku, Yuki Enomoto, Nobutake Shimojo and Yoshiaki Inoue

Children 2025, 12(8), 1056; https://doi.org/10.3390/children12081056 - 12 Aug 2025

Abstract

Introduction: Post-Intensive Care Syndrome in Pediatrics (PICS-P) for families is a growing concern as receiving care in the Pediatric Intensive Care Unit (PICU) improves child survival. PICU parental stress may cause post-discharge psychiatric symptoms. Understanding personality-related distress is key for early intervention. This [...] Read more.

Introduction: Post-Intensive Care Syndrome in Pediatrics (PICS-P) for families is a growing concern as receiving care in the Pediatric Intensive Care Unit (PICU) improves child survival. PICU parental stress may cause post-discharge psychiatric symptoms. Understanding personality-related distress is key for early intervention. This study examined whether parental personality traits correlate with such symptoms for PICS-P prevention. Methods: A cohort pilot study was conducted at a Japanese university hospital PICU (eight beds, 200–300 annual admissions, mandatory critical care consultation) between January and September 2022. Participants were parents of children admitted for longer than 1 week. Personality traits were investigated using the Big-Five-based test, and psychiatric symptoms were investigated using the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the PTSD Checklist-5 (PCL-5). The correlation between personality traits and psychiatric symptoms was investigated. Results: Among the 53 subjects who met the inclusion criteria, 25 gave consent to participate in this study. The correlation analysis revealed distinct patterns. Agreeableness demonstrated negative correlations: a moderately significant negative correlation with PTSD symptoms (ρ = −0.612, p < 0.05) and non-significant negative correlations with anxiety (ρ = −0.238) and depression (ρ = −0.060). Conversely, neuroticism exhibited positive correlations: a moderately significant positive correlation with anxiety symptoms (ρ = 0.539, p < 0.05), alongside non-significant positive correlations with depression (ρ = 0.318) and PTSD symptoms (ρ = 0.327). Regarding other personality traits, extraversion showed negative correlations with anxiety (ρ = −0.282), depression (ρ = −0.399), and PTSD (ρ = −0.438), conscientiousness displayed positive correlations with anxiety (ρ = 0.318), depression (ρ = 0.127), and PTSD (ρ = 0.467), while openness exhibited negative correlations with anxiety (ρ = −0.333), depression (ρ = −0.312), and PTSD (ρ = −0.309), although none of these associations were statistically significant. Conclusions: Lower levels of agreeableness and higher levels of neuroticism in parents are significantly associated with increased PTSD and anxiety symptoms, respectively, in the PICU setting. These personality traits may serve as predictors of parental psychological distress, suggesting their utility in informing targeted PICS-P interventions and preventative strategies. Full article

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

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18 pages, 303 KiB

Open AccessArticle

Feeling the Same Strain? A Cross-Sectional Comparison Study of Fathers’ Versus Mothers’ Parenting Stress During the COVID-19 Pandemic

by Anna Friedmann, Anne Sophie Wenzel, Katharina Richter, Ina Nehring and Volker Mall

Children 2025, 12(8), 1055; https://doi.org/10.3390/children12081055 - 11 Aug 2025

Abstract

Background/Objectives: Parenting stress is associated with parent and child mental health problems and has increased since the beginning of COVID-19. Research on paternal parenting stress is sparse—even if family models are changing increasingly with fathers being more strongly involved in caregiving for [...] Read more.

Background/Objectives: Parenting stress is associated with parent and child mental health problems and has increased since the beginning of COVID-19. Research on paternal parenting stress is sparse—even if family models are changing increasingly with fathers being more strongly involved in caregiving for their children. This study investigated (1) overall parenting stress levels and specific parenting stress subscales in fathers with young children in comparison to mothers and (2) potential influencing factors on fathers’ and mothers’ parenting stress during the pandemic. Methods: In a cross-sectional online study, N = 368 parents (50.00% fathers) of children (0–3 years) filled out the German version of the Parenting Stress Index (EBI) and answered questions on sociodemographic and pandemic-related factors. Results: Fathers were 36.17 years (SD = 5.21) and mothers 33.65 years (SD = 4.39) old and 67.50% had a high educational background. Children (45.38% female) were 16.34 months (SD = 11.66) old. There was no significant group difference between fathers’ and mothers’ overall parenting stress (p = 0.39). Parenting stress scores in the attachment subscale were significantly higher in fathers (p < 0.001, r = 0.19). An increase in family conflicts during the pandemic had the highest impact on both paternal (ß = 0.45) and maternal (ß = 0.35) parenting stress. Conclusions: Parenting stress was equally high for fathers and mothers during the COVID-19 crisis, indicating a levelling of pre-pandemic differences due to pandemic-related factors. Future support measures should focus on reducing family conflicts and on strengthening fathers’ attachment to their child. Full article

(This article belongs to the Special Issue Stress and Stress Resilience in Children and Adolescents: 2nd Edition)

12 pages, 886 KiB

Open AccessReview

Exploring the Association Between Glucose-6-Phosphate Dehydrogenase Deficiency and Autism Spectrum Disorder: A Narrative Review

by Maitha Abdulla Alshamsi, Maitha Tareq Al Teneiji, Subhranshu Sekhar Kar and Rajani Dube

Children 2025, 12(8), 1054; https://doi.org/10.3390/children12081054 - 11 Aug 2025

Abstract

Autism spectrum disorder (ASD) is a complex neurodevelopmental disease of multifactorial etiologies, manifesting as persistent challenges in social interactions, restrictive interests, and repetitive behaviors. Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common human enzymopathy affecting red blood cell function. Although G6PD enzyme deficiency [...] Read more.

Autism spectrum disorder (ASD) is a complex neurodevelopmental disease of multifactorial etiologies, manifesting as persistent challenges in social interactions, restrictive interests, and repetitive behaviors. Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common human enzymopathy affecting red blood cell function. Although G6PD enzyme deficiency is known for its role in hemolytic anemia, emerging studies have suggested a potential association between G6PD deficiency and neurodegenerative and neurodevelopmental disorders, including autism. This narrative review explores the possible connection between G6PD deficiency and autism by analyzing relevant literature from the PubMed and Scopus databases. Current evidence points to plausible biological links, particularly oxidative stress and folate metabolism, warranting further investigation into G6PD deficiency as a potential risk modifier in ASD. Moreover, further research is necessary to elucidate the nature of this relationship and its implications for clinical practice. Full article

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

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