Children

23 pages, 1070 KB

Open AccessArticle

Breastfeeding, Mother–Child Dyads of Interaction, and Neurodevelopment of Preterm Children: A Longitudinal Study of Feeding Methods During the First Two Years

by Júlia Vicente Hass, Carolina Panceri, Rita C. Silveira and Nadia Cristina Valentini

Children 2025, 12(11), 1480; https://doi.org/10.3390/children12111480 (registering DOI) - 2 Nov 2025

Abstract

Objective: Our objectives were as follows: (1) to compare cognitive, motor, language, and social performance, parenting skills, and mother–child interactions among preterm children exposed to different feeding practices (exclusive breastfeeding, mixed feeding, and formula feeding) during the first two years of life; and [...] Read more.

Objective: Our objectives were as follows: (1) to compare cognitive, motor, language, and social performance, parenting skills, and mother–child interactions among preterm children exposed to different feeding practices (exclusive breastfeeding, mixed feeding, and formula feeding) during the first two years of life; and (2) to examine the associations between the feeding type, risks and protective factors, and neurodevelopmental outcomes (cognitive, motor, language, and social domains) in these population in the first two years of life. Method: A total of 116 preterm children (<32 weeks gestational age—GA) and their mothers were recruited from a public hospital in southern Brazil and followed at a neonatal clinic. Children were organized into three groups based on feeding at NICU discharge (exclusive breastfeeding, formula, or mixed feeding). Assessments were conducted at 4, 8, 12, 18, and 24 months of corrected age using the BSITD-III and additional validated instruments measuring environment stimulation, daily activities, maternal knowledge, breastfeeding experience, and mother–child interactions. Results: Clinical and sociodemographic factors were similar across feeding groups. Group comparisons showed that exclusive breastfeeding was associated with higher motor scores at 12 (p = 0.015) and 24 (p = 0.026) months, higher cognitive scores at 12 (p = 0.049) and 18 (p = 0.013) months, and higher language scores at 12 (p < 0.001) and 18 (p = 0.014) months compared to formula feeding. In the social domain, the exclusive breastfeeding group consistently outperformed the formula group across most time points, although a temporary dip was observed at 18 months. Mixed feeding showed intermediate patterns. Children in the exclusive breastfeeding group also demonstrated higher maternal parenting skills and stronger mother–child interactions across time. Longitudinal analyses revealed that the quality of mother–child interactions predicted better motor, cognitive, language, and social outcomes, while clinical vulnerabilities (e.g., prolonged NICU stay, BPD, leukomalacia) negatively influenced trajectories. Conclusions: Exclusive breastfeeding and responsive mother–child interactions emerged as consistent protective factors across developmental domains, buffering the adverse effects of clinical risks. Breastfeeding not only enhances maternal engagement but also contributes to more favorable motor, cognitive, language, and social outcomes in preterm children. Supporting breastfeeding and promoting sensitive caregiving practices are essential strategies for optimizing developmental trajectories and improving the quality of life in this vulnerable population. Full article

(This article belongs to the Section Pediatric Neonatology)

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14 pages, 598 KB

Open AccessArticle

Effects of Modified Crohn’s Disease Exclusion Diet as Adjunctive Therapy on Clinical Remission and Nutrition in Pediatric Crohn’s Disease: A Real-World Study from China

by Dongdan Li, Yan Kong, Xiaolin Ye, Tianzhuo Zhang, Feihong Yu and Jie Wu

Children 2025, 12(11), 1479; https://doi.org/10.3390/children12111479 (registering DOI) - 2 Nov 2025

Abstract

Background/Objective: Crohn’s disease exclusion diet (CDED) is used to induce remission and maintenance treatment of Crohn’s disease (CD), but its efficacy as adjuvant treatment of biological agents is not clear, especially for children with CD in China. The aim is to compare [...] Read more.

Background/Objective: Crohn’s disease exclusion diet (CDED) is used to induce remission and maintenance treatment of Crohn’s disease (CD), but its efficacy as adjuvant treatment of biological agents is not clear, especially for children with CD in China. The aim is to compare the synergistic induction of remission, as well as the effects on physical growth and nutritional indicators, of the CDED and Exclusive Enteral Nutrition (EEN), when used alongside infliximab as adjunctive therapies for children with CD. Methods: A retrospective analysis was conducted on newly diagnosed children with CD who were receiving infliximab treatment in combination with either CDED or EEN at the Department of Gastroenterology at Beijing Children’s Hospital between April 2022 and June 2025. The patients were divided into two groups: CDED and EEN. Changes in disease activity, physical growth indicators, nutritional status, and inflammatory markers were then compared between the two groups at six and twelve weeks post-treatment. Results: A total of 45 children with CD who met the inclusion and exclusion criteria were included in the study. Of these, 27 were boys (60%) and 18 were girls (40%), with an average age of (11.6 ± 2.9) years. Based on nutritional intervention, 19 patients were assigned to the CDED group and 26 to the EEN group. The clinical remission rates were 89.5% and 94.7% at 6 and 12 weeks post-treatment, respectively, in the CDED group and 88.5% and 84.6%, respectively, in the EEN group. At 12 weeks, the endoscopic remission rates were 47.1% (8/17) and 24.0% (5/26), respectively, in the CDED and EEN groups. There were no statistically significant differences between the two groups in terms of clinical remission or endoscopic remission (p > 0.05). Comparisons of physical growth indicators showed that, after 6 and 12 weeks of treatment, children in the CDED group had a significantly higher body mass index (BMI) for age Z-score than those in the EEN group (p < 0.05). Comparisons of serum nutritional and inflammatory markers revealed that, after 12 weeks of treatment, fecal calprotectin levels were significantly lower in the CDED group than in the EEN group (p < 0.05), with no significant differences observed in other markers. Conclusions: For children with moderate-to-severe or high-risk factors, CDED and EEN therapy as adjunctive treatment to infliximab demonstrate comparable efficacy in inducing disease remission. However, CDED was more effective than EEN at improving physical growth and reducing intestinal inflammation. Full article

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

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26 pages, 992 KB

Open AccessReview

Emotion and Feeling in Parent–Child Dyads: Neurocognitive and Psychophysiological Pathways of Development

by Antonios I. Christou and Flora Bacopoulou

Children 2025, 12(11), 1478; https://doi.org/10.3390/children12111478 (registering DOI) - 2 Nov 2025

Abstract

Although widely used across disciplines, the terms emotion and feeling remain conceptually ambiguous, particularly within developmental science. Emotion is defined as an evolutionarily conserved, biologically embedded system of action readiness and intersubjective communication, shaped by attentional, neural, and physiological reactivity to environmental salience. [...] Read more.

Although widely used across disciplines, the terms emotion and feeling remain conceptually ambiguous, particularly within developmental science. Emotion is defined as an evolutionarily conserved, biologically embedded system of action readiness and intersubjective communication, shaped by attentional, neural, and physiological reactivity to environmental salience. In contrast, feeling is conceptualized as the consciously experienced, representational outcome of emotional activation, emerging through cognitive appraisal and symbolic processing. Building upon this distinction, the review explores how emotion develops within parent–child dyads through coregulated neurocognitive and psychophysiological mechanisms. Drawing on empirical evidence from eye-tracking studies of visual attention to emotional faces, functional near-infrared spectroscopy (fNIRS) research on social-emotional activation in prefrontal brain regions, and cortisol-based assessments of hormonal synchrony, the paper highlights how emotional attunement and transmission are embedded in early caregiving interactions. The review also emphasizes the moderating role of environmental sensitivity—both in children and parents—in shaping these developmental pathways. By positioning emotion as a dynamic, intersubjective process and feeling as its emergent experiential correlate, this review offers a novel developmental framework for understanding affect and proposes directions for future research on resilience, dysregulation, and intervention. Full article

(This article belongs to the Special Issue Parental Mental Health and Child Development)

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11 pages, 413 KB

Open AccessArticle

Patient-Oriented Priorities for Pediatric Erythromelalgia: A Priority-Setting Process

by Don Daniel Ocay, Meghan Halpin, Ella Ford, Karen Keighley, Neva Keighley, Nikki Ramsay, Tayla Ramsay, Camelia M. Sheridan, Sarah M. Sheridan, Kirsten R. Tice, Deirdre De Ranieri, See Wan Tham, Catherine A. Brownstein, Jacqui Clinch, Dawn Marie Davis, Carolina Donado, Genevieve D’Souza, Deepa Kattail, Kimberly Lobo, Danielle Ravetti, Paola Sandroni, Jennifer N. Stinson, Gary A. Walco, Suellen M. Walker, Timothy W. Yu and Charles B. Berde Show full author list Hide full author list

Children 2025, 12(11), 1477; https://doi.org/10.3390/children12111477 (registering DOI) - 2 Nov 2025

Abstract

Background/Objectives: Erythromelalgia is a rare condition characterized by burning pain, redness, and warmth primarily in the extremities, usually worsened by heat and alleviated by cold. The objective of this study was to identify the top 10 priorities in pediatric erythromelalgia from multiple [...] Read more.

Background/Objectives: Erythromelalgia is a rare condition characterized by burning pain, redness, and warmth primarily in the extremities, usually worsened by heat and alleviated by cold. The objective of this study was to identify the top 10 priorities in pediatric erythromelalgia from multiple perspectives, including clinicians, people with lived experience of childhood-onset erythromelalgia, and their family members. Methods: A modified James Lind Alliance Priority-Setting Process was conducted. The top priorities were identified through four phases: (1) an international online survey to gather priorities, (2) data processing, (3) an interim prioritization online survey, and (4) a virtual workshop to set the final priorities. Results: In phase 1, 185 potential priorities were submitted by 74 respondents (53% patients, 24% family members, and 23% clinicians) that were developed into 68 unique research questions (phase 2). In phase 3, of the 68 questions, 50 were rated for importance by 58 participants (38% patients, 36% family members, and 26% clinicians), reducing the list to 25 questions. In phase 4, the top 10 was reached through consensus by 12 participants (33% patients, 25% family members, and 42% clinicians) across Canada, South Africa, the United States of America, and the United Kingdom. Conclusions: The final priorities focused on the treatment of erythromelalgia, understanding underlying mechanisms, the association of erythromelalgia with various body systems, and generating awareness. This list is the first international patient-centered research agenda for childhood-onset erythromelalgia and a call to action from key partners to improve future research and care. Full article

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

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12 pages, 277 KB

Open AccessArticle

Associations Between Electronic Vapor Product Use and Prescription Opioid Misuse Among High School Students in the United States; A Retrospective Cross-Sectional Analysis

by Killian M. Pache, Lionel Kameni and Cornelius B. Groenewald

Children 2025, 12(11), 1476; https://doi.org/10.3390/children12111476 (registering DOI) - 1 Nov 2025

Abstract

Study objective: Electronic vapor product (EVP) use remains prevalent among adolescents in the United States. EVP use may be associated with high-risk substance use behaviors. This study investigates the association between current EVP use and current opioid misuse in high school students. Methods: [...] Read more.

Study objective: Electronic vapor product (EVP) use remains prevalent among adolescents in the United States. EVP use may be associated with high-risk substance use behaviors. This study investigates the association between current EVP use and current opioid misuse in high school students. Methods: We conducted a secondary analysis of the 2021 Youth Risk Behavior Survey (YRBS) (n = 7471). We first examined the prevalence rates of current prescription opioid misuse between participants ages 14 to 19 who reported any EVP use compared to those who did not report any EVP use. We conducted an adjusted Poisson regression analysis to determine whether EVP use was associated with prescription opioid misuse after controlling for multiple variables, including age, biological sex, race, ethnicity, alcohol use, other tobacco use, marijuana use, and depressive symptoms. Results: Among participants, 17.2% (95% confidence interval (CI): 15.4–19.1%) reported current EVP use. The prevalence of current opioid misuse was higher in the group of students who use EVPs (13.3%) as compared to students who do not use EVPs (3.2%) (p < 0.0001). Compared to participants who did not use EVPs, those with EVP use had an 80% greater prevalence of opioid misuse, after adjusting in regression analyses (adjusted prevalence rate ratio: 1.8, 95% CI: 1.4–2.3, p < 0.0001). Conclusions: Our findings highlight the significantly increased prevalence of opioid misuse among this population and the need to educate adolescents about the additional risks associated with nicotine and EVP use. Longitudinal studies are needed to test causal relationships and better understand the biobehavioral mechanisms that connect EVP use and opioid misuse. Full article

(This article belongs to the Section Global Pediatric Health)

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18 pages, 2872 KB

Open AccessSystematic Review

Pathogen Profiles and Antimicrobial Resistance Patterns of Neonatal Sepsis in the Gulf Cooperation Council: A Systematic Review

by Razique Anwer, Hassan Al-shehri, Musab Alsulami, Ziyad Alsulami, Faisal Alzkari, Nawaf Alshaalan, Nawaf Almutairi, Abdullah Saleh Albalawi, Khalid Alshammari, Abdulelah F. Alshehri, Nawaf Alzahrani, Ibrahim A. Alamer, Albaraa Alotaibi and Meshal Alzakari

Children 2025, 12(11), 1475; https://doi.org/10.3390/children12111475 (registering DOI) - 1 Nov 2025

Abstract

Background: Neonatal sepsis (NS) is a life-threatening condition in newborns, which is an infectious process with a systemic inflammatory reaction to bacterial, viral, or fungal infection acquired in the first 28 days of life. Methods: This study examines the major pathogens causing neonatal [...] Read more.

Background: Neonatal sepsis (NS) is a life-threatening condition in newborns, which is an infectious process with a systemic inflammatory reaction to bacterial, viral, or fungal infection acquired in the first 28 days of life. Methods: This study examines the major pathogens causing neonatal sepsis in the Gulf Cooperation Council (GCC) and their resistance patterns to antimicrobial agents. We utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to develop this systematic review to follow a systematic and transparent process. The comprehensive literature review was done in several national and global databases, which include PubMed, Scopus, Google Scholar, Embase, and Cochrane Library. The key words inserted in the search strategy were “neonatal sepsis,” “late-onset sepsis,” “early-onset sepsis,” and “Gulf Cooperation Council (GCC),” and the keywords of antimicrobial resistance and pathogens were used: “antimicrobial drug resistance” and “pathogens.” Only articles published from January 1983 to January 2025 were included for screening. Results: The final count of the articles that fit the inclusion criteria is 54, and 5177 neonatal sepsis cases’ data have been identified. The most common pathogens were coagulase-negative staphylococci (CoNS) and Klebsiella spp., which caused 17.4 percent (901 cases) and 15.9 percent (825 cases) of neonatal sepsis, respectively. Coagulase-negative staphylococci (CoNS) were the most resistant, especially to oxacillin and erythromycin. The most isolated pathogens among Gram-negative spp. were Klebsiella spp., which showed a resistance to ampicillin, amoxicillin, and ceftriaxone. Conclusions: The bacterial isolates had a diversity of antimicrobial resistance, stressing the necessity of continuous hospital surveillance. Sophisticated diagnostic methods and well-designed research are necessary, especially in areas characterized by high rates of neonatal mortality, to determine the prevalence of neonatal sepsis, risk factors, and clinical outcomes. Full article

(This article belongs to the Special Issue Sepsis in Pediatrics: Present Status and Challenges for the Future)

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14 pages, 318 KB

Open AccessSystematic Review

XR Technologies in Inclusive Education for Neurodivergent Children: A Systematic Review 2020–2024

by Bárbara Valverde Olivares, Loretto Muñoz Araya, José Luis Valín, Marcela Jarpa Azagra, Rocío Hidalgo Escobar, Isabel Cuevas Quezada and Cristóbal Galleguillos Ketterer

Children 2025, 12(11), 1474; https://doi.org/10.3390/children12111474 (registering DOI) - 1 Nov 2025

Abstract

Background/Objectives: Extended reality (XR) technologies have been increasingly applied in inclusive education settings to assist neurodivergent children. However, the existing evidence remains fragmented across diverse contexts and disciplines. This systematic review synthesizes current research to identify the educational purposes, implementation characteristics, and [...] Read more.

Background/Objectives: Extended reality (XR) technologies have been increasingly applied in inclusive education settings to assist neurodivergent children. However, the existing evidence remains fragmented across diverse contexts and disciplines. This systematic review synthesizes current research to identify the educational purposes, implementation characteristics, and reported outcomes associated with the use of XR in inclusive educational environments. Methods: A comprehensive literature search was conducted in major academic databases using predefined keyword combinations related to XR, inclusive education, and neurodivergence. Peer-reviewed articles that applied XR tools in educational settings for neurodivergent children were screened against predefined inclusion and exclusion criteria. Data were extracted regarding study design, participant characteristics, XR modality, educational objectives, and outcome indicators. Results: The reviewed studies report heterogeneous applications of XR technologies, including virtual and augmented reality, to support cognitive, social, and behavioral skill development in neurodivergent learners. Most studies employed small sample sizes and quasi-experimental or exploratory designs. Although several studies reported improvements in engagement, communication skills, and task performance, outcome measures varied substantially and methodological rigor was limited in many cases. Conclusions: Current evidence suggests that XR technologies hold potential as complementary tools in inclusive education for neurodivergent children. Nonetheless, the heterogeneity of study designs and the lack of standardized assessment metrics limit the generalizability of the results. More robust empirical investigations are required to establish evidence-based guidelines for the implementation of XR in inclusive educational contexts. Full article

(This article belongs to the Special Issue Children and Adolescents with Neurodevelopmental Disabilities: Ecological Assessment Tools and Cognitive Analysis)

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12 pages, 492 KB

Open AccessArticle

Prevalence and Predictive Factors of Angle’s Class Malocclusion Asymmetries Without Crossbite in Primary School Children: A Cross-Sectional Study

by Marolita Orazi, Maria Grazia Cagetti, Lucia Giannini, Niccolò Cenzato and Cinzia Maria Norma Maspero

Children 2025, 12(11), 1473; https://doi.org/10.3390/children12111473 (registering DOI) - 1 Nov 2025

Abstract

Background: Angle’s dental class asymmetries not associated with crossbite are malocclusions that are often underestimated in pediatric patients. However, they may be associated with alterations in the development of the stomatognathic system. Objective: The objective of this study was to evaluate the prevalence [...] Read more.

Background: Angle’s dental class asymmetries not associated with crossbite are malocclusions that are often underestimated in pediatric patients. However, they may be associated with alterations in the development of the stomatognathic system. Objective: The objective of this study was to evaluate the prevalence of Angle’s class asymmetries without crossbite in primary-school-aged children and to investigate possible associations with perinatal, clinical, and functional variables. Materials and Methods: This cross-sectional observational study analyzed a sample of 391 children aged 6 to 11 years, attending a primary school in the metropolitan area of Milan, Italy. Data were systematically collected through both clinical examination and patient history, with the aim of identifying significant correlations with the occurrence of dental asymmetries in the absence of crossbite. Results. The results revealed a higher prevalence of occlusal asymmetries associated with factors such as oral breathing, low tongue posture, type of delivery, formula feeding, and systemic diseases during the first three years of life. Advanced carious lesions and inclination of the occlusal plane were significantly associated with asymmetry. Conclusions: The study highlights the importance of early diagnosis and a multidisciplinary approach to prevent malocclusions and complex craniofacial dysfunctions later in life. Full article

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

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10 pages, 782 KB

Open AccessArticle

Umbilical and Peripheral Venous Catheter-Related Outcomes in Premature Neonates

by Nilüfer Okur, Turan Derme, Mehmet Büyüktiryaki, Ufuk Ateş, Suzan Şahin and Şerife Suna Oğuz

Children 2025, 12(11), 1472; https://doi.org/10.3390/children12111472 (registering DOI) - 1 Nov 2025

Abstract

Background: Central venous catheters are essential but associated with complications in premature infants. We compared the short-term outcomes of umbilical venous catheter (UVC) versus peripherally inserted central catheter (PICC) as the initial postnatal primary venous access in preterm infants. Methods: Preterm infants with [...] Read more.

Background: Central venous catheters are essential but associated with complications in premature infants. We compared the short-term outcomes of umbilical venous catheter (UVC) versus peripherally inserted central catheter (PICC) as the initial postnatal primary venous access in preterm infants. Methods: Preterm infants with a birth weight ≤ 1500 g within the first postnatal hours were included. Patients were randomly assigned to the UVC or PICC groups. Catheter insertion time, number of attempts, number of operators, duration of catheter use, reason for removal, and overall duration were recorded. Results: A total of 107 premature infants were included, with 63 receiving UVC and 44 receiving PICC. Nineteen infants who initially had UVC placement on day 1 required PICC placement on day 5. The number of attempts, number of operators, and insertion time were significantly higher in the PICC group compared with the UVC group (p < 0.001, p = 0.002, and p = 0.002, respectively). Catheter removal due to thrombosis or leakage occurred in 14.2% of UVC cases versus 40.1% of PICC cases (p = 0.002). Conclusion: UVC placement appears to be superior to PICC as the first venous access in preterm infants during the early postnatal period. PICC placement may be less advantageous in the first days of life due to a smaller catheter diameter, technical difficulty, and longer insertion time. Full article

(This article belongs to the Section Pediatric Neonatology)

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Graphical abstract

22 pages, 1348 KB

Open AccessArticle

Clinical, Sleep, and Chronobiological Characteristics of Children with Smith–Magenis Syndrome Under Treatment for Sleep Disorders

by Marion Comajuan, Aurore Guyon, Véronique Raverot, Marie-Noelle Babinet, Julien Lioret, Lisa Brunel, Bruno Claustrat, Caroline Demily and Patricia Franco

Children 2025, 12(11), 1471; https://doi.org/10.3390/children12111471 (registering DOI) - 31 Oct 2025

Abstract

Background/Objectives: Smith–Magenis Syndrome (SMS) is a rare neurodevelopmental disorder characterized by severe sleep disturbances and an advanced melatonin rhythm. Current treatments, mainly exogenous melatonin and β-blockers, have not been evaluated in children. This study aimed to characterize the clinical, sleep, and chronobiological profiles [...] Read more.

Background/Objectives: Smith–Magenis Syndrome (SMS) is a rare neurodevelopmental disorder characterized by severe sleep disturbances and an advanced melatonin rhythm. Current treatments, mainly exogenous melatonin and β-blockers, have not been evaluated in children. This study aimed to characterize the clinical, sleep, and chronobiological profiles of children with SMS under treatment and to assess the effects of melatonin and β-blockers. Methods: In this prospective, single-center study, 20 children with genetically confirmed SMS (aged 5–13 years; 55% female) underwent 15-day home actimetry and 48 h hospitalization, during which questionnaires, polysomnography (PSG), and salivary melatonin/cortisol profiling were performed. Melatonin and psychostimulants were discontinued 36 h before hospitalization. Results: Overall, 95% of children received melatonin and 20% β-blockers. Despite treatment, insomnia was reported in 90%, excessive daytime sleepiness in 65%, and learning problems in 90%. On actimetry, melatonin improved the mean nocturnal awakening duration (1.4 vs. 2.3 min, p = 0.040), wake-up time (06:50 vs. 06:11, p = 0.004), and longest continuous sleep episode (398 vs. 317 min, p = 0.040), but had little effect on the total sleep time, efficiency, and midpoint of sleep. Very high daytime salivary melatonin persisted (median peak 169.50 pg/mL) despite the last exogenous melatonin intake being more than 48 h prior to sampling, suggesting possible iatrogenic accumulation. The median peak in melatonin occurred at 11:57 and that in cortisol at 08:22. In children with β-blockers, there was a tendency toward an earlier melatonin peak but also toward delayed sleep onset, increased nocturnal awakenings, and reduced total sleep. Conclusions: Children with SMS showed persistent sleep difficulties and an advanced circadian phase despite sleep treatments. Exogenous melatonin provides partial benefit but may lead to daytime accumulation, while β-blockers may have adverse sleep effects despite beneficial effects on melatonin peak secretion, warranting further study. Full article

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

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12 pages, 251 KB

Open AccessArticle

Evaluation of Sleep Disturbances and Depression in Children with Juvenile Idiopathic Arthritis Using the Beck Depression Inventory and Child Sleep Disorder Scale: Relationship with Leukocyte and Neutrophil Counts

by Seyda Dogantan, Evin İlter Bahadur, Burcu Bozkaya Yücel, Adem Keskin and Esma Bekece

Children 2025, 12(11), 1470; https://doi.org/10.3390/children12111470 (registering DOI) - 31 Oct 2025

Abstract

Background/Objectives: The pathophysiology of juvenile idiopathic arthritis (JIA), the most widespread rheumatologically illness in juvenile period, is shaped by complex interactions between leukocytes and the cytokines they secrete. The aim of this research was to evaluate the severity of sleep disturbances and [...] Read more.

Background/Objectives: The pathophysiology of juvenile idiopathic arthritis (JIA), the most widespread rheumatologically illness in juvenile period, is shaped by complex interactions between leukocytes and the cytokines they secrete. The aim of this research was to evaluate the severity of sleep disturbances and depression, which are closely associated with many diseases and can negatively impact the course of the illness, in patients with JIA using Beck Depression Inventory (BDI) and Sleep Disturbance Scale for Children (SDSC) scores and to investigate the relationship between these scores and laboratory findings in patients with JIA. Methods: The research involved 58 children with JIA and 71 healthy children as controls. BDI and SDSC scores of these groups were compared with laboratory findings and correlation analysis were performed. Results: In the JIA group, BDI and SDSC scores, C-reactive protein (CRP), red blood cell distribution width (RDW), erythrocyte sedimentation rate, neutrophil, and leukocyte counts, were higher than in the control group, while vitamin D values were lower. A positive relation was determined between BDI and SDSC scores in the JIA group, but no correlation was found in the control group. In the JIA group, both BDI and SDSC scores were found to be negatively related with leukocyte and neutrophil counts. In the control group, the BDI score was determined to be negatively correlated with CRP, vitamin D and RDW levels. Conclusions: Depression and sleep disorders may interact in patients with JIA, and their causal relationship with leukocyte and neutrophil levels should be investigated. Full article

(This article belongs to the Section Pediatric Allergy and Immunology)

7 pages, 191 KB

Open AccessCase Report

Delayed Diagnosis of X-Linked Adrenal Hypoplasia Congenita in a Boy with a Novel NR0B1 Variant: A Case Report

by Shin-Hee Kim and Kyoung Soon Cho

Children 2025, 12(11), 1469; https://doi.org/10.3390/children12111469 - 31 Oct 2025

Abstract

NR0B1 (DAX-1) is an orphan nuclear receptor essential for the development and regulation of the adrenal glands and gonads. Pathogenic variants in NR0B1 cause X-linked adrenal hypoplasia congenita (AHC), which typically presents with adrenal insufficiency and hypogonadotropic hypogonadism (HH) in boys. Delayed diagnosis [...] Read more.

NR0B1 (DAX-1) is an orphan nuclear receptor essential for the development and regulation of the adrenal glands and gonads. Pathogenic variants in NR0B1 cause X-linked adrenal hypoplasia congenita (AHC), which typically presents with adrenal insufficiency and hypogonadotropic hypogonadism (HH) in boys. Delayed diagnosis during adolescence is uncommon but, when it occurs, can lead to preventable adrenal crisis, underscoring the need for early recognition of atypical presentations. We describe a 14-year-old boy who presented with adrenal insufficiency and delayed puberty. Genetic testing revealed a novel hemizygous in-frame duplication variant of NR0B1 (NM_000475.4:c.833_835dup p.(Leu278dup)). This variant has not been previously reported in association with X-linked AHC. The patient received hydrocortisone (10–12 mg/m²/day) and fludrocortisone (0.1 mg/day) as replacement therapy for adrenal insufficiency, along with testosterone supplementation (100–240 mg/day) to induce pubertal progression. Plasma ACTH levels gradually decreased from 10,175 pg/mL at diagnosis to 215 pg/mL during follow-up, accompanied by clinical improvement in skin pigmentation and pubertal development. This case underscores the importance of NR0B1 genetic testing in children with adrenal insufficiency and HH. Early recognition and genetic confirmation are critical for appropriate management and genetic counseling. Identification of novel variants expands the NR0B1 mutational spectrum and enhances our understanding of genotype–phenotype correlations in X-linked AHC. Full article

(This article belongs to the Special Issue Clinical Insights into Pediatric Endocrine Disease)

20 pages, 2478 KB

Open AccessReview

Towards a Multidisciplinary Approach of ECG Screening in Children and Adolescents: A Scoping Review (2005–2025)

by Giovanna Zimatore, Maria Chiara Gallotta, Matteo Campanella, Stavros Hatzopoulos, Piotr Henryk Skarzynski, Marta Ricci and Leonarda Galiuto

Children 2025, 12(11), 1468; https://doi.org/10.3390/children12111468 (registering DOI) - 30 Oct 2025

Abstract

Background: The reported data on ECG screening are focused on the last two decades. The objectives of this review were bifold: (i) to identify, within a timespan of twenty years, the most recent literature data on cardiac screening in children and adolescents and [...] Read more.

Background: The reported data on ECG screening are focused on the last two decades. The objectives of this review were bifold: (i) to identify, within a timespan of twenty years, the most recent literature data on cardiac screening in children and adolescents and (ii) to provide data on the procedures used. Methods: Queries were conducted using PubMed, Scopus, and Google Scholar databases for the time window of 2005–2025. The mesh terms used were “ECG”, “Universal Screening”, “Cardiac Pathologies”, “Heart Rate”, and “Sports Pre-participation Evaluation”. Only research articles and review papers were included. The standard English language filter was used. Successively, only research articles were selected. Results: Data from 14 papers were considered, reflecting the lack of information about subjects <16 years of age. Conclusions: The information on objective ECG screening measures is quite scarce, and it is an urgent need to introduce a multidisciplinary approach to differentiate between ECG physiological changes due to growth and ECG pathological changes due to early pathology. Full article

(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology: 3rd Edition)

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16 pages, 272 KB

Open AccessArticle

Sleep Duration and Screen Time in Young Children with Mild Language Delays

by Subul Malik, Melissa Gonzalez, Paris Rayneri, Ruixuan Ma, Ruby Natale and Elana Mansoor

Children 2025, 12(11), 1467; https://doi.org/10.3390/children12111467 - 30 Oct 2025

Abstract

Background/Objectives: Excessive screen time and inadequate sleep are well-established developmental risk factors, yet limited research has examined the relationship between adherence to national sleep and screen time guidelines and language outcomes in children with mild language delays. This study examined sleep, screen [...] Read more.

Background/Objectives: Excessive screen time and inadequate sleep are well-established developmental risk factors, yet limited research has examined the relationship between adherence to national sleep and screen time guidelines and language outcomes in children with mild language delays. This study examined sleep, screen time, and language outcomes in 765 children aged 1–5 with mild language delays enrolled in the Early Discovery Program. Methods: Sleep and screen time were categorized according to American Academy of Pediatrics and Caring for Our Children guidelines. Language outcomes were measured using standardized scores from the Preschool Language Scales–Fifth Edition. Results: Sociodemographic factors, including race, insurance status, and caregiver education, were significantly associated with sleep and screen behaviors. Excessive screen time was negatively associated with expressive language scores, while sleep duration showed no significant relationship. Conclusions: Findings highlight the need for early interventions that promote adherence to national health guidelines and address sociodemographic factors influencing language development in young children. Full article

(This article belongs to the Special Issue Effects of Screen Time on Children’s Mental, Social, and Cognitive Health)

26 pages, 960 KB

Open AccessArticle

Validity Study of the Spanish Version of the Parental Stress Index (PSI-4) in Its Two Forms (Long Form and Short Form)

by Mercedes Ríos-Requeni, Yurena Alonso-Esteban, Esperanza Navarro-Pardo and Francisco Alcantud-Marín

Children 2025, 12(11), 1466; https://doi.org/10.3390/children12111466 - 29 Oct 2025

Abstract

Background/Objectives: Parental stress is caused by the accumulation of difficulties related to raising children and is directly related to the educational functioning of a family and family dysfunction. The PSI (Parental Stress Index) is an assessment instrument and is considered the gold standard [...] Read more.

Background/Objectives: Parental stress is caused by the accumulation of difficulties related to raising children and is directly related to the educational functioning of a family and family dysfunction. The PSI (Parental Stress Index) is an assessment instrument and is considered the gold standard for measuring parental stress; however, there is no official Spanish version of this tool. Methods: Both the PSI-4 long form and short form were administered to a sample of 828 parents of children between 0 and 12 years of age. Results: The discrepancy between the scores of the original typification sample and the Spanish sample necessitates the establishment of specific normative values. Regarding internal consistency, test–retest stability, and construct validity, the results demonstrate consistency with the original study and other adaptation studies. The validity of the theoretical structure of the instrument was studied using confirmatory factor analysis (CFA). The CFA fit indices in the overall PSI-4 LF model (101 items distributed across 13 first-order factors and two second-order factors) are not satisfactory. Therefore, the methodology used by the author in constructing the PSI-4 was employed, which involved performing two exploratory factor analyses (EFA). The domains of both parents and children exhibit partial replication of the theoretical subscales of the PSI-4. The analysis of the short form of the PSI-4 SF (comprising 36 items distributed across three subscales and a total score) yielded results similar to those of the long form. Conclusions: These results suggest the potential for developing specific standards for the Spanish population and conducting criterion validity studies for the clinical use of all dimensions of the PSI-4 in its two forms (LF and SF). Full article

(This article belongs to the Special Issue The Power of Early Intervention: Promoting Mental Health and Well-Being in Very Young Children and Their Families)

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26 pages, 889 KB

Open AccessReview

The Body as a Battlefield: Identity Development and Psychosomatic Expression in Eating Disorders Across Childhood and Adolescence

by Giuseppe Marano, Daniele Napolitano, Esmeralda Capristo, Gianandrea Traversi, Osvaldo Mazza, Eleonora Gaetani and Marianna Mazza

Children 2025, 12(11), 1465; https://doi.org/10.3390/children12111465 - 29 Oct 2025

Abstract

Background/Objectives: Eating disorders (EDs) frequently emerge during critical stages of childhood and adolescence, when identity development and emotional regulation are still maturing. Disturbances in self-concept clarity and identity integration may transform the body into a symbolic battlefield for autonomy, belonging, and self-worth. This [...] Read more.

Background/Objectives: Eating disorders (EDs) frequently emerge during critical stages of childhood and adolescence, when identity development and emotional regulation are still maturing. Disturbances in self-concept clarity and identity integration may transform the body into a symbolic battlefield for autonomy, belonging, and self-worth. This review synthesizes developmental, psychosocial, neurocognitive, and therapeutic perspectives on the role of identity disturbance in EDs. Methods: A narrative review was conducted (2010–2025) using combinations of terms related to identity, self-concept clarity, self-discrepancy, objectification, interoception, and eating disorders (anorexia nervosa, bulimia nervosa, and binge-eating disorder). Results: Findings indicate that identity vulnerability (expressed as low self-concept clarity, heightened self-discrepancies, and self-objectification) mediates the association between early adversity, sociocultural pressures, and ED symptoms. Neurocognitive studies reveal altered self-referential processing, default mode network connectivity, and interoceptive signaling. Clinically, comorbid borderline personality features further exacerbate identity disturbance and complicate recovery. Evidence-based treatments such as enhanced cognitive-behavioral therapy (CBT-E) effectively target core maintaining mechanisms, while adjunctive interventions (mentalization-based therapy, schema therapy, narrative approaches, and compassion- or acceptance-based methods) show promise in addressing identity-related processes and improving outcomes. Conclusions: Identity disturbance provides a unifying framework for understanding why ED symptoms become entrenched despite adverse consequences. Integrating identity-focused approaches with nutritional and medical care may enhance recovery and reduce chronicity in youth. Future research should adopt longitudinal and mechanistic designs to clarify pathways linking identity change to clinical improvement and test identity-specific augmentations to standard ED treatments. Full article

(This article belongs to the Special Issue Addressing Challenges in Child Mental Health Research and Strategies for Comprehensive Development (2nd Edition))

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13 pages, 886 KB

Open AccessReview

Healthcare Information Avoidance in the Context of Caring for a Child with a Serious Illness

by Tiina Jaaniste, Shujauddin Mohammed and Sue Cowan

Children 2025, 12(11), 1464; https://doi.org/10.3390/children12111464 - 29 Oct 2025

Abstract

Caregivers of a child with a serious medical condition are often confronted with difficult and stressful medical information. While they commonly seek out health-related information to better care for their child and help with their decision-making, sometimes caregivers engage in healthcare information avoidance. [...] Read more.

Caregivers of a child with a serious medical condition are often confronted with difficult and stressful medical information. While they commonly seek out health-related information to better care for their child and help with their decision-making, sometimes caregivers engage in healthcare information avoidance. Healthcare information avoidance is the decision to prevent or delay the acquisition of available, but potentially unwanted, health-related information. We begin by defining the construct of healthcare information avoidance and exploring key theoretical frameworks that illuminate its underlying mechanisms including emotion regulation theory, attentional and cognitive models, approach-avoidance coping strategies, and dispositional theories. A lack of validated measures to assess caregiver healthcare information avoidance was noted as contributing to the dearth of empirical work in this area. Common areas of caregiver healthcare information avoidance were identified at various points throughout the pediatric palliative care illness trajectory. The review concludes with directions for future research and practical recommendations for clinical care, highlighting the importance of identifying the occurrence and reasons for caregiver information avoidance as well as optimizing approaches to information provision. Full article

(This article belongs to the Special Issue Pediatric Palliative Care and Pain Management)

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17 pages, 263 KB

Open AccessArticle

Socio-Emotional Outcomes of Child Care Participation: Results of a Four-Year Longitudinal Cohort Study

by Mila Kingsbury and Leanne Findlay

Children 2025, 12(11), 1463; https://doi.org/10.3390/children12111463 - 28 Oct 2025

Abstract

Background/Objectives: Despite a wealth of research on potential socio-emotional outcomes of child care participation, results have been mixed, likely reflecting between-study differences in confounding variables assessed. Moreover, there is a need for updated studies using Canadian population data. The purpose of this study [...] Read more.

Background/Objectives: Despite a wealth of research on potential socio-emotional outcomes of child care participation, results have been mixed, likely reflecting between-study differences in confounding variables assessed. Moreover, there is a need for updated studies using Canadian population data. The purpose of this study was to assess associations between child care participation between the ages of 1 and 5 years and socio-emotional outcomes four years later, accounting for a wide range of potential confounding variables. Methods: This study uses data from 8929 children ages 1–5 who participated in the 2019 Canadian Health Survey on Children and Youth, for whom follow-up data were available from the 2023 collection cycle. Parents reported on their use of child care for the target child in 2019; children’s socio-emotional functioning was assessed via a parent report in 2023. Associations between child care participation and outcomes were assessed using logistic and linear regression, adjusting for confounding factors including child age and gender, low family income, parental education, parental marital status, positive parenting, and education disruptions due to the COVID-19 pandemic. Results: Child care participation among 1–5 year olds was associated with higher scores for symptoms of attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and internalizing problems but a lower likelihood of having functional difficulty making friends four years later. Differences in these associations were noted based on the type of child care attended and family income, with centre-based care showing the most robust associations with ODD and internalizing symptoms, particularly among those living above the low-income threshold. Conclusions: These results highlight important contextual differences in associations between child care participation in early childhood and socio-emotional outcomes four years later. Associations with socio-emotional outcomes persisted after adjusting for important contextual factors, including positive parenting and COVID-related school disruptions. Full article

(This article belongs to the Special Issue Early Childhood Education and Care Lays the Foundations for Learning and Wellbeing)

14 pages, 2580 KB

Open AccessArticle

Optimal Duration of Umbilical Cord Clamping with Ventilation in a Preterm Asphyxiated Ovine Model

by Mausma Bawa, Sylvia Gugino, Justin Helman, Nicole Bradley, Lori Nielsen, Arun Prasath, Clariss Blanco, Mary Divya Kasu, Hamza Abbasi, Munmun Rawat and Praveen Chandrasekharan

Children 2025, 12(11), 1462; https://doi.org/10.3390/children12111462 - 28 Oct 2025

Abstract

Background: There is inadequate evidence to support recommendations for the delayed clamping of umbilical cords in preterm neonates who are born non-vigorous. Objective: In a preterm bradycardic ovine model, our objective was to compare the effects of early cord clamping with [...] Read more.

Background: There is inadequate evidence to support recommendations for the delayed clamping of umbilical cords in preterm neonates who are born non-vigorous. Objective: In a preterm bradycardic ovine model, our objective was to compare the effects of early cord clamping with ventilation (ECCV) and various time periods of delayed cord clamping with ventilation (DCCV) at 1 min (DCCV1), 2 min (DCCV2), 3 min (DCCV3), 4 min (DCCV4), and 5 min (DCCV5). The primary composite outcome was (i) incidence of achieving a combined heart rate (HR) ≥ 100 bpm and preductal saturation (SpO₂) ≥80% by 5 min, and (ii) time to attain this outcome. Secondary outcomes were to evaluate gas exchange/hemodynamics. Methods: 32 preterm lambs of 126–128-day gestational age were randomized to one of six groups: ECCV (n = 5), DCCV1 (n = 6), DCCV2 (n = 5), DCCV3 (n = 6), DCCV4 (n = 6), and DCCV5 (n = 4). Asphyxia was induced by umbilical cord occlusion to attain a HR ≤ 90 beats per minute (bpm). Results: All lambs in DCCV5 achieved a primary composite outcome by 5 min. The time taken to achieve the primary composite outcome in DCCV5 was significantly lower (p = 0.02). Partial pressure of arterial carbon dioxide (PaCO₂) was significantly lower (p = 0.0001) in DCCV5. Peak pulmonary blood flow (PBF) was significantly higher (p = 0.0001) in DCCV5 while peak carotid blood flow (CBF) was highest in the ECCV (p < 0.0001) compared to other groups. Conclusions: In a preterm ovine model of asphyxia, resuscitation with an intact umbilical cord for 5 min increased the incidence and reduced the time to achieve the primary composite outcome, while also improving gas exchange by enhancing pulmonary blood flow, compared to shorter durations of DCCV and ECCV. These findings suggest that DCCV for 5 min may offer physiological advantages in the resuscitation of non-vigorous preterm neonates, warranting further investigation in clinical settings. Full article

(This article belongs to the Special Issue Advances in Neonatal Resuscitation and Intensive Care)

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