Children

10 pages, 3501 KB

Open AccessCommunication

Pacifier Sizing as a Prescription for Better Oral Health Outcomes for Infants: A Call to Action

by David A. Tesini, Clive Friedman, Adithya Kethu and Kristin W. Hendricks

Children 2025, 12(9), 1257; https://doi.org/10.3390/children12091257 - 18 Sep 2025

Sucking is essential for feeding and impacts the development of the cranio-facial-respiratory complex (CFRC). Non-nutritive sucking on a pacifier causes palatal narrowing and modifies the natural balanced relationship between intraoral pressure, peristaltic action of the tongue and the palate. Advanced engineering models have [...] Read more.

Sucking is essential for feeding and impacts the development of the cranio-facial-respiratory complex (CFRC). Non-nutritive sucking on a pacifier causes palatal narrowing and modifies the natural balanced relationship between intraoral pressure, peristaltic action of the tongue and the palate. Advanced engineering models have shown that malocclusions caused by pacifier use, are often a result of improper sizing. The sizing of pacifiers has historically been based on chronological age. Chronological age is not a size metric. Undersized pacifiers in a baby's mouth can cause growth complications, palatal collapse airway incompetence and other orthodontic problems that can last a lifetime. Technical advances in facial anthropometrics and predictability of the rapid growth of the infant palate, can guide recommendations for pacifier size and design. This encourages change to a model of biometric sizing. Smartphone applications are being developed that use Ai and machine learning can predict conformity between palatal width and pacifier width. Full article

(This article belongs to the Section Pediatric Neonatology)

16 pages, 566 KB

Open AccessArticle

Developing and Validating a Childhood Trauma-Informed Curriculum for Primary School Teachers in Limpopo Province, South Africa

by Muimeleli Munyadziwa and Lufuno Makhado

Children 2025, 12(9), 1256; https://doi.org/10.3390/children12091256 - 18 Sep 2025

Abstract

Background/Objectives: Childhood trauma significantly hinders the developmental and academic outcomes of learners, particularly in under-resourced schools such as those in Limpopo province, South Africa. Teachers in these settings often face challenges in supporting trauma-exposed learners due to a lack of knowledge, training, [...] Read more.

Background/Objectives: Childhood trauma significantly hinders the developmental and academic outcomes of learners, particularly in under-resourced schools such as those in Limpopo province, South Africa. Teachers in these settings often face challenges in supporting trauma-exposed learners due to a lack of knowledge, training, and appropriate resources. Addressing this gap requires the development of structured, trauma-informed educational support systems. Methods: This study forms the final phase of a multi-phase research project aimed at developing a trauma-informed curriculum for primary school teachers. A multi-phase mixed method design was adopted across four phases: (1) a global scoping review to identify effective trauma-informed interventions; (2) empirical interviews with primary school teachers, trauma center managers, clinical psychologists, and social workers to understand local needs and experiences; (3) development of a conceptual framework grounded in theoretical and empirical findings; and (4) curriculum development guided by El Sawi’s curriculum design model. The curriculum was validated using structured questionnaires with a panel of stakeholders including educators, mental health professionals, and curriculum experts. Results: The study identified critical issues, including teachers’ limited understanding of childhood trauma, lack of standardized training, and inadequate classroom strategies. Key curriculum components were developed to address these gaps, including modules on the nature of trauma, early identification of symptoms, trauma-informed teaching practices, and collaboration with mental health professionals. Validation results indicated strong agreement on the curriculum’s clarity, relevance, and potential impact. Conclusions: The developed trauma-informed curriculum provides primary school teachers in Limpopo with the knowledge, tools, and confidence to support trauma-exposed learners. It emphasizes early identification, responsive classroom strategies, and inter-professional collaboration. This curriculum has the potential to enhance learning environments and promote better educational and psychosocial outcomes for trauma-affected learners. Full article

(This article belongs to the Section Global Pediatric Health)

13 pages, 406 KB

Open AccessArticle

Reduction in Perioperative Risk in Patients with Spinal Muscular Atrophy Following the Release of Disease-Modifying Therapies: An Analysis of the National Surgical Quality Improvement Program Database

by Erin Toaz, Nisha Pinto, Keith Kilner and Eric Cheon

Children 2025, 12(9), 1255; https://doi.org/10.3390/children12091255 - 18 Sep 2025

Abstract

Background/Objectives: Spinal muscular atrophy (SMA) is a progressive neurodegenerative disease resulting in proximal muscle weakness and paralysis. SMA treatment has radically changed in the past 10 years thanks to the development of novel therapies such as nusinersen and onasemnogene abeparvovec. Since the advent [...] Read more.

Background/Objectives: Spinal muscular atrophy (SMA) is a progressive neurodegenerative disease resulting in proximal muscle weakness and paralysis. SMA treatment has radically changed in the past 10 years thanks to the development of novel therapies such as nusinersen and onasemnogene abeparvovec. Since the advent of new treatments, the incidence and perioperative risk factors of patients with SMA undergoing longer, higher-risk surgeries are unknown. We hypothesized that patients with SMA would be at an overall elevated risk for postoperative pulmonary complications (PPC) and prolonged length of stay compared to the general population, but that this would be reduced in patients undergoing surgery in the years after the release of new therapies. Methods: Patients who underwent surgery at a continuously enrolled American College of Surgeons National Surgery Quality Improvement Program-Pediatric hospital from 1 January 2012, to 31 December 2021, were included in this study. Cases with missing covariate or primary outcome data were excluded from the analysis. Patients with ages greater than 17 years, preoperative tracheostomy, preoperative mechanical ventilation, missing covariate or primary outcome data were excluded. Patients with SMA were identified by their ICD-9 and 10 codes. A cutoff year of 2018 was chosen for analysis of the primary outcomes as this was a full year after nusinersen received FDA approval. Results: On univariable analysis, the risk for PPC in patients with SMA was reduced in patients undergoing surgery in 2018 or later compared to pre-2018 (pre-2018 OR 4.44, 95% CI 1.56–9.6, p = 0.008; post-2018 OR 3.48, 95% CI 0.84–9.12, p = 0.08). On multivariable analysis, the association between SMA and PPC substantially decreased in 2018 and after but was no longer statistically significant (pre-2018 OR 1.96, 95% CI 0.80–4.80, p = 0.14; post-2018 OR 1.03, 95% CI 0.33–3.26, p = 0.96). SMA was positively associated with LOS in the pre-2018 cohort, with a coefficient from a log linear model of 0.67 (95% CI 0.32–1.01; p < 0.001), and SMA adding an additional 1.93 days in LOS. For data post-2018, the effect of SMA on LOS was no longer statistically significant. Conclusions: Utilizing a large dataset, we found a reduced association between SMA and PPC a year following widespread implementation of SMN antisense oligonucleotide therapy, and a statistically significant reduction in LOS in patients with SMA after 2018. This may reflect improved motor outcomes and respiratory mechanics in the new treatment era. Full article

(This article belongs to the Special Issue New Insights into Pain Management and Sedation in Children)

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13 pages, 951 KB

Open AccessArticle

Evaluation of Acetabular Defects in Children with Cerebral Palsy: A Comparative Analysis of CT Measurements and Radiographic Parameters

by Domenic Grisch, Olivier Weber, Britta K. Krautwurst, Franziska L. Hatt, Michael Zellner, Christian von Deimling, Tobias Götschi, Bastian Sigrist and Thomas Dreher

Children 2025, 12(9), 1254; https://doi.org/10.3390/children12091254 - 17 Sep 2025

Abstract

Objectives: This retrospective study examines acetabular morphology and defects in children with cerebral palsy (CP). The study discovers the usefulness and reliability of a reconstructed 3D CT measurement technique and compares it to conventional radiographic measurements. Methods: 33 subjects with CP [...] Read more.

Objectives: This retrospective study examines acetabular morphology and defects in children with cerebral palsy (CP). The study discovers the usefulness and reliability of a reconstructed 3D CT measurement technique and compares it to conventional radiographic measurements. Methods: 33 subjects with CP who underwent hip reconstruction, including Dega osteotomy and varus derotation femoral osteotomy, were included and compared to an age-matched group of 42 typically developing children. We reproduced a three directional acetabular index (3DAI), including anterosuperior, superolateral and posterosuperior indices in CT analysis, and compared them with established radiographic measurements for the migration percentage (MP) and the acetabular index (AI). Results: The results showed significantly higher 3DAI in every direction of wall deficiency, accentuating the methods sensitivity for acetabular dysplasia. The interrater and test–retest reliability were robust with ICC = 0.939–0.988 for the CP group. Conventional radiographic measurements demonstrated better discriminative power for identifying hip dislocation and correlated strongly with the 3DAI (p < 0.001). Conclusions: The 3DAI method showcases an important addition to the conventional radiographic measurements by enabling a quantification of the defect amount and direction for operative planning. The study supports the potential of a 3D analysis in the improvement of diagnostic precision and suggests a continuous refinement of the CT measurement technique. Full article

(This article belongs to the Special Issue Cerebral Palsy in Children: Improving Quality of Life and Preventing Painful Musculoskeletal Disorders)

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19 pages, 2185 KB

Open AccessArticle

Postural Fitness Protocol in Children and Adolescents: Descriptive Values from the ISQUIOS Program

by María Teresa Martínez-Romero, Mark De Ste Croix and Pilar Sainz de Baranda

Children 2025, 12(9), 1253; https://doi.org/10.3390/children12091253 - 17 Sep 2025

Abstract

Background/Objectives: Back pain is increasingly prevalent during childhood and adolescence, often predicting adult spinal disorders. This study aimed to describe sex-specific anthropometric and “Postural Fitness” characteristics in school-aged children and adolescents and to introduce a standardized, field-based assessment protocol for early screening of [...] Read more.

Background/Objectives: Back pain is increasingly prevalent during childhood and adolescence, often predicting adult spinal disorders. This study aimed to describe sex-specific anthropometric and “Postural Fitness” characteristics in school-aged children and adolescents and to introduce a standardized, field-based assessment protocol for early screening of postural and functional deficits. Methods: This cross-sectional study included a total of 494 students (8–17 years; 50% girls) from 14 schools in Murcia (Spain). Exclusion criteria included diagnosed spinal pathology or major physical injury, lack of signed informed consent, absence on the testing day, and incomplete Postural Fitness assessment. The “Postural Fitness” protocol included assessments of sagittal spinal alignment (inclinometer), hip range of motion (ROM) (inclinometer with an extendable telescopic arm), pelvic tilt (goniometer with a spirit level system), and trunk muscle endurance (chronometer). Tests were conducted in physical education sessions by trained sports scientists. Results: Significant sex-based differences were observed. Boys exhibited greater thoracic kyphosis (40.3 ± 9.6° vs. 36.7 ± 9.2°), reduced hip ROM (passive hip extension (PHE): 16.8 ± 8.1°, passive hip flexion with knee extension (PHFKE): 68.9 ± 8.6°), and more posterior pelvic tilt (104.9 ± 8.4° vs. 99.7 ± 8.1°), whereas girls demonstrated increased lumbar lordosis (35.7 ± 8.6° vs. 31.5 ± 8.5°), greater hip ROM (PHE: 18.5 ± 9°, PHFKE: 77.9 ± 13°), and superior trunk extensor endurance (123.2 ± 74.7 s vs. 106.2 ± 69.8 s). Lateral trunk muscle endurance was higher in boys (48.7 ± 31 s vs. 41.4 ± 24.9 s). Conclusions: The “Postural Fitness” protocol proved feasible in school settings and revealed key sex-based disparities in spinal and neuromuscular profiles. These findings highlight the need for individualized, sex-specific screening and preventive programs to enhance back health during growth. Implementing this protocol may support early identification of modifiable risk factors linked to spinal dysfunction and pain in youth. Full article

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

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13 pages, 296 KB

Open AccessArticle

Outcomes of Pediatric Orthopedic Management of Ambulatory Cerebral Palsy Utilizing a Closely Monitored, Lifespan-Guided Approach

by Zhe Yuan, Nancy Lennon, Chris Church, Michael Wade Shrader and Freeman Miller

Children 2025, 12(9), 1252; https://doi.org/10.3390/children12091252 - 17 Sep 2025

Abstract

Background: Cerebral palsy (CP) is a static, non-progressive brain pathology that affects mobility and musculoskeletal health. Objective: This review aims to describe the pediatric orthopedic management strategy at one specialty center with focus on optimal lifelong mobility function for ambulatory CP. Methods: Beginning [...] Read more.

Background: Cerebral palsy (CP) is a static, non-progressive brain pathology that affects mobility and musculoskeletal health. Objective: This review aims to describe the pediatric orthopedic management strategy at one specialty center with focus on optimal lifelong mobility function for ambulatory CP. Methods: Beginning in the 1990s, a protocol was developed to proactively monitor children with surgical or conservative interventions. After three decades, we undertook a prospective institutional review, board-approved 25–45-year-old adults callback study. Inclusion criteria were all children treated through childhood who could be located and were willing to return for a full evaluation. Results: Pediatric orthopedic interventions focused on regular surveillance with proactive treatment of progressive deformities. When function was impacted, we utilized multi-level orthopedic surgery guided by instrumented gait analysis. Childhood outcomes of this approach were evaluated through retrospective studies. Results show high correction rates were achieved for planovalgus foot deformity, knee flexion contracture, torsional malalignments, and stiff-knee gait. Our prospective adult callback study evaluated 136 adults with CP, gross motor function classification system levels I (21%), II (51%), III (22%), and IV (7%), with average ages of 16 ± 3 years (adolescent visit) compared with 29 ± 3 years (adult visit). Adults in the study had an average of 2.5 multi-level orthopedic surgery events and 10.4 surgical procedures. Compared with adults without disability, daily walking ability was lower in adults with CP. Adults with CP had limitations in physical function but no increased depression. A higher frequency of chronic pain compared with normal adults was present, but pain interference in daily life was not different. Adults demonstrated similar levels of education but higher rates of unemployment, caregiver needs, and utilization of Social Security disability insurance. Conclusions: The experience from our center suggests that consistent, proactive musculoskeletal management at regular intervals during childhood and adolescence may help maintain in gait and mobility function from adolescence to young adulthood in individuals with CP. Full article

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

18 pages, 807 KB

Open AccessArticle

Let’s Learn About Emotions Program: Acceptability, Fidelity, and Students’ Mental Well-Being Outcomes for Finnish Primary School Children

by Yuko Mori, Tiia Ståhlberg, Xiao Zhang, Kaisa Mishina, Sanna Herkama, Tarja Korpilahti-Leino, Terja Ristkari, Meeri Kanasuo, Saara Siirtola, Vesa Närhi, Hannu Savolainen, Susanna Hinkka-Yli-Salomäki, Shiho Torii, Kohei Matsubara, Kohei Kishida, Noriko Hida, Shin-ichi Ishikawa and Andre Sourander

Children 2025, 12(9), 1251; https://doi.org/10.3390/children12091251 - 17 Sep 2025

Abstract

Background/Objectives: School-based universal mental health interventions offer an inclusive and scalable approach to promote mental health and well-being among children. This study evaluates the Let’s Learn About Emotions (Opitaan tunteista in Finnish) program, an evidence-based, teacher-led universal school-based intervention originally developed in [...] Read more.

Background/Objectives: School-based universal mental health interventions offer an inclusive and scalable approach to promote mental health and well-being among children. This study evaluates the Let’s Learn About Emotions (Opitaan tunteista in Finnish) program, an evidence-based, teacher-led universal school-based intervention originally developed in Japan and culturally adapted for Finnish primary schools. Methods: A total of 512 fourth-grade students from 14 schools participated in the 12-week program during spring 2023. Using a mixed-methods design, we assessed (1) the program’s acceptability among students, parents, teachers, and school principals, (2) fidelity of implementation, and (3) changes in students’ mental well-being pre- to post-intervention. Quantitative data included standardized questionnaires with valid responses collected from 233 students at baseline and 209 students at post-intervention, as well as parents and teachers. Qualitative data were collected through focus group discussions involving parents, teachers, and school principals during spring 2024. Results: Acceptability was high across all respondent groups. Teachers adhered closely to the teaching manual, as confirmed by self-reports and direct classroom observations. Statistically significant improvements were observed in parent-reported conduct problems, hyperactivity, and peer problems, though student self-reports did not show similar benefits. Conclusions: The program was found to be both acceptable and culturally appropriate in the Finnish context. Findings from this study provide valuable insights for refining and improving the program for future implementation. To more rigorously examine its effectiveness, future studies should employ a randomized controlled trial design. Full article

(This article belongs to the Special Issue Advances in Mental Health and Well-Being in Children (2nd Edition))

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14 pages, 351 KB

Open AccessArticle

Comorbid Insomnia and Sleep Apnea Across the Pediatric Age: A Polysomnographic Study

by Lisa Brunel, Marion Comajuan, Sabine Plancoulaine, Benjamin Putois, Julien Lioret, Marine Thieux, Laurianne Coutier, Patricia Franco and Aurore Guyon

Children 2025, 12(9), 1250; https://doi.org/10.3390/children12091250 - 17 Sep 2025

Abstract

Background/Objectives: Comorbid insomnia and sleep apnea (COMISA) in children is poorly documented. This study aimed to evaluate the frequency of COMISA and to explore its clinical and polysomnographic characteristics in children referred for polysomnography (PSG) for any sleep complaint. Methods: All patients with [...] Read more.

Background/Objectives: Comorbid insomnia and sleep apnea (COMISA) in children is poorly documented. This study aimed to evaluate the frequency of COMISA and to explore its clinical and polysomnographic characteristics in children referred for polysomnography (PSG) for any sleep complaint. Methods: All patients with a complete insomnia sub-score on the Sleep Disturbance Scale for Children (SDSC; for children from 6 months to 16 years old) who underwent a night PSG in a pediatric sleep unit (2018–2024) were included in this retrospective study. Pathological SDSC insomnia sub-score defined insomnia and obstructive apnea-hypopnea index ≥ 2/h on PSG defined OSA. Questionnaires regarding sleepiness, depression, anxiety, and hyperactivity were also collected. Results: Children had isolated insomnia in 11.5% of cases, isolated OSA in 37.5%, and COMISA in 13.5%. Insomnia frequency was not different between patients with and those without OSA (26.5% vs. 23.5%). COMISA was more frequent in patients under 4 years old than in older ones (39.1% vs. 5.8%). No polysomnographic or clinical characteristic of COMISA was identified, except that OAHI was higher in children with isolated OSA. Patients with COMISA or isolated insomnia were more anxious than those with isolated OSA. Conclusions: Unlike in adults, the present findings do not support a mutual association between OSA and insomnia in children. OSA severity was lower in children with COMISA. Anxiety levels were higher in children with insomnia, regardless of the presence of OSA, suggesting that anxiety should be assessed in all children with OSA. Full article

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

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27 pages, 948 KB

Open AccessReview

Tumor–Immune Interactions in Pediatric Oral Rhabdomyosarcoma: A Narrative Review on Immuno-Oncology and Emerging Therapies

by Omar A. El Meligy, Noha M. Elemam, Wael A. Hassan and Iman M. Talaat

Children 2025, 12(9), 1249; https://doi.org/10.3390/children12091249 - 17 Sep 2025

Abstract

Pediatric oral rhabdomyosarcoma (RMS) is a rare and aggressive cancer of the head and neck, characterized by a complex and mostly immunosuppressive tumor–immune microenvironment. Unlike adult cancers, pediatric RMS typically exhibits a “cold” immune profile, characterized by minimal T-cell infiltration, a low mutational [...] Read more.

Pediatric oral rhabdomyosarcoma (RMS) is a rare and aggressive cancer of the head and neck, characterized by a complex and mostly immunosuppressive tumor–immune microenvironment. Unlike adult cancers, pediatric RMS typically exhibits a “cold” immune profile, characterized by minimal T-cell infiltration, a low mutational burden, and resistance to immune checkpoint blockade. The tumor’s location in the oral cavity adds difficulty to treatment because of anatomical and functional limitations. Additionally, the presence of fusion oncogenes, such as PAX3:FOXO1, hampers immunogenicity and treatment response by disrupting antigen presentation and reducing immune cell infiltration. Advances in immuno-oncology have introduced new strategies, including immune checkpoint inhibitors, chimeric antigen receptor (CAR) therapies, cancer vaccines, and oncolytic viruses. However, these approaches face specific challenges in the pediatric population due to developmental immune factors. This narrative review highlights recent findings on the immunobiology of pediatric oral RMS, focusing on tumor–immune interactions and their impact on disease progression and treatment resistance. We reviewed the cellular components of the TIME, the mechanisms of immune evasion, and the expression of immune checkpoints, including PD-L1 and B7-H3. Emerging immunotherapies, including CAR-T, CAR-NK, and CAR-CIK cell therapies; checkpoint inhibitors; oncolytic viruses; and cancer vaccines, are discussed, with an emphasis on their current limitations and potential to transform the pediatric RMS immune landscape. Full article

(This article belongs to the Special Issue Comprehensive Approaches in Pediatric Dentistry: Managing Health and Disabilities Across All Specialties)

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21 pages, 3560 KB

Open AccessReview

A Comprehensive Review of Pediatric Necrotizing Pneumonia

by Manette Ness-Cochinwala and Balagangadhar R. Totapally

Children 2025, 12(9), 1248; https://doi.org/10.3390/children12091248 - 17 Sep 2025

Abstract

Necrotizing pneumonia is a serious complication of pediatric pneumonia, characterized by liquefaction and cavitation of the lung parenchyma. Streptococcus pneumoniae and Staphylococcus aureus are the most implicated organisms. Mycoplasma pneumoniae has been an increasingly recognized pathogen, especially is Asian and Pseudomonas aeruginosa is [...] Read more.

Necrotizing pneumonia is a serious complication of pediatric pneumonia, characterized by liquefaction and cavitation of the lung parenchyma. Streptococcus pneumoniae and Staphylococcus aureus are the most implicated organisms. Mycoplasma pneumoniae has been an increasingly recognized pathogen, especially is Asian and Pseudomonas aeruginosa is mainly noted in a higher percentage of patients with complex chronic conditions. Clinical presentation typically includes fever, respiratory distress, and failure to respond to standard antibiotic therapy. These patients are more likely to have pleural involvement in the form of effusion or empyema and a higher need for respiratory support. Diagnosis is typically through a combination of chest radiographs, lung ultrasound, and chest computed tomography. Management is primarily via prolonged intravenous antibiotics that cover the above organisms, though pleural drainage with fibrinolytics is often required. Surgical intervention is often reserved for refractory cases that fail initial fibrinolytic therapy. Prognosis is usually favorable in the short and long term, though early recognition and appropriate management are imperative to reduce the duration of illness and morbidity. Full article

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

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20 pages, 728 KB

Open AccessReview

Effects of Bilingualism on Executive Function of Children with Neurodevelopmental Disorders: A Scoping Review

by Hoi Kwan Yuen, Haoyan Ge, Caicai Zhang, Yuen Ting Wong, Eva Y. W. Chan, William W. N. Tsang and Catherine M. Capio

Children 2025, 12(9), 1247; https://doi.org/10.3390/children12091247 - 17 Sep 2025

Abstract

Background: Children with neurodevelopmental disorders (NDDs) commonly experience executive function (EF) impairments that impact daily life and academics. While bilingualism has generally been associated with cognitive advantages in typically developing (TD) children, its relationship with EF in children with NDDs remains unclear and [...] Read more.

Background: Children with neurodevelopmental disorders (NDDs) commonly experience executive function (EF) impairments that impact daily life and academics. While bilingualism has generally been associated with cognitive advantages in typically developing (TD) children, its relationship with EF in children with NDDs remains unclear and represents a critical knowledge gap for families and clinicians considering bilingual exposure in these populations. Methods: For this scoping review, we searched PubMed, ProQuest, CogNet, PsycINFO, Scopus, ERIC, Embase, CINAHL, Linguistics Abstracts Online, and Google Scholar for studies published between database inception and December 2024, without language restrictions. We included quantitative, qualitative, and mixed-methods studies that (i) involved participants aged 4–12 years with diagnosed NDDs; (ii) examined children with bilingual language exposure; (iii) employed validated instruments for measuring cognitive or executive function; (iv) presented original empirical findings; and (v) were published in English. We excluded studies lacking comparisons between groups and longitudinal studies. Data on study characteristics, participants, EF assessments, and main findings were extracted. This study is registered with OSF Registries. Findings: Fifteen cross-sectional studies met the inclusion criteria, all of which focused exclusively on children with autism spectrum disorder (ASD), with no studies examining other NDDs. The studies involved 982 children with ASD (463 monolingual; 404 bilingual) and 644 TD children. Most studies (n = 11) revealed that, compared with monolingual children with ASD, bilingual children with ASD demonstrated advantages in working memory, cognitive flexibility, and inhibitory control on performance-based tasks. However, findings were inconsistent for spatial inhibition tasks, and parent-reported measures sometimes failed to detect bilingual-related differences. Interpretation: Bilingualism is associated with specific EF benefits for children with ASD, adding to evidence that questions longstanding concerns about the negative impacts of bilingual exposure in NDD populations. The evidence suggests that bilingual exposure could potentially serve as a complementary approach to traditional interventions for addressing EF impairments in children with ASD, although this evidence is limited to cross-sectional designs and requires further studies. However, the exclusive focus on ASD limits generalisability across the broader spectrum of NDDs. Further research is needed across diverse NDD populations employing comprehensive, multi-method EF assessments that combine performance-based tasks with parent-reported measures to better inform parenting, clinical, and educational practices. Full article

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

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13 pages, 582 KB

Open AccessFeature PaperReview

Exploring Manual Interventions for Infantile Colic: A Scoping Review of the Evidence

by Roberto Tedeschi and Federica Giorgi

Children 2025, 12(9), 1246; https://doi.org/10.3390/children12091246 - 17 Sep 2025

Abstract

Background: Infantile colic affects up to 40% of otherwise healthy infants and can severely distress caregivers. Manual therapies are increasingly employed as non-pharmacological options, yet their effectiveness and safety remain uncertain. Methods: A scoping review was conducted in accordance with Joanna Briggs Institute [...] Read more.

Background: Infantile colic affects up to 40% of otherwise healthy infants and can severely distress caregivers. Manual therapies are increasingly employed as non-pharmacological options, yet their effectiveness and safety remain uncertain. Methods: A scoping review was conducted in accordance with Joanna Briggs Institute methodology and reported following PRISMA-ScR. Five databases (MEDLINE, CENTRAL, Scopus, PEDro, Web of Science) were searched from December 2024 to May 2025 without restrictions at the search stage; however, only English-language randomised controlled trials published from 2012 onwards were included at the eligibility stage to ensure consistency and focus on the most recent body of evidence. Randomised controlled trials (RCTs) evaluating hands-on interventions for infants ≤ 6 months with colic were eligible. Two reviewers independently screened records, charted data, and grouped outcomes narratively. Results: Seven RCTs investigated abdominal massage, paediatric Tuina, craniosacral therapy, chiropractic manipulation, osteopathic light touch, reflexology, and acupressure. Five trials reported statistically or clinically significant reductions in daily crying (0.6–6.6 h) compared with usual care or sham. Three studies also documented meaningful gains in sleep duration (1.1–2.8 h). Parent-reported satisfaction improved in most interventions. No serious adverse events were recorded, although safety monitoring was inconsistently reported. Substantial heterogeneity in diagnostic criteria, outcome measures, and intervention dose precluded meta-analysis. Conclusions: Low-force manual therapies may offer modest short-term relief for colicky infants and improve parental experience, with an apparently favourable safety profile. However, methodological variability and small sample sizes limit certainty. Standardised protocols, objective outcome measures, and robust adverse-event surveillance are priorities for future research. Full article

(This article belongs to the Section Pediatric Nursing)

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14 pages, 396 KB

Open AccessArticle

Revealing Microvascular Involvement in Pediatric Localized Scleroderma Through Nailfold Capillaroscopy

by Sema Nur Taşkın, Şeyda Doğantan, Esra Esen, Sümeyra Özdemir Çiçek, Ayşenur Paç Kısaarslan and Muammer Hakan Poyrazoğlu

Children 2025, 12(9), 1245; https://doi.org/10.3390/children12091245 - 17 Sep 2025

Abstract

Background/Objectives: Juvenile localized scleroderma (jLoS) is a chronic inflammatory disorder with skin and subcutaneous tissue involvement. Microvascular alterations are thought to contribute to its pathogenesis. This study aimed to investigate microvascular alterations in children with jLoS using nailfold capillaroscopy (NFC) and to [...] Read more.

Background/Objectives: Juvenile localized scleroderma (jLoS) is a chronic inflammatory disorder with skin and subcutaneous tissue involvement. Microvascular alterations are thought to contribute to its pathogenesis. This study aimed to investigate microvascular alterations in children with jLoS using nailfold capillaroscopy (NFC) and to compare the capillaroscopic findings between patients and healthy controls. Methods: A total of 13 children diagnosed with jLoS and 16 age- and sex-matched healthy controls were enrolled. Capillaroscopic assessment included capillary density, tortuosity, dilatation, disorganization, branching, and neoangiogenesis. Dilated and giant capillaries, hemorrhages, avascular areas, and capillary loss were evaluated. The Microangiopathy Evaluation Score (MES) was used to semi-quantitatively assess capillary loss, disorganization, and ramifications. Disease activity and damage were evaluated using the modified Localized Scleroderma Skin Severity Index (mLoSSI) and the Localized Scleroderma Damage Index (LoSDI), respectively. Functional status was measured via the 6 min walk test (6MWT). Results: Plaque morphea was the most common subtype (61.5%), and antinuclear antibody (ANA) positivity was present in 53.8% of patients. Compared to controls, jLoS patients exhibited significantly more frequent capillaroscopic abnormalities, including increased tortuosity, crossing, dilatation, and neoangiogenesis (p < 0.05). Capillary density, length, arterial limb width, apical loop width, and disorganization scores were significantly higher, while intercapillary distance was lower in jLoS patients (p < 0.05). No avascular areas or giant capillaries were observed. MESs were similar between groups. Conclusions: NFC revealed significant microvascular alterations in jLoS patients, supporting its utility as a non-invasive tool for early vascular assessment in localized scleroderma. Full article

(This article belongs to the Special Issue Rheumatic Diseases in Children and Adolescents: Present and Future Challenges)

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9 pages, 677 KB

Open AccessCase Report

Esophageal Atresia and Intrathoracic Stomach in a Complex Case of Congenital Anomalies

by Philipp Christoph Köhler, Raphael Staubach, Helen Glosse, Loredana Chiaie, Ventsislav Sheytanov and Steffan Loff

Children 2025, 12(9), 1244; https://doi.org/10.3390/children12091244 - 16 Sep 2025

Abstract

Background/Objectives: Complex cases in pediatric surgery involving multiple congenital anomalies pose significant diagnostic and therapeutic challenges. These conditions require coordinated interdisciplinary care tailored to the individual patient. We present a case of syndromic congenital anomalies in a neonate, later diagnosed with CHARGE syndrome, [...] Read more.

Background/Objectives: Complex cases in pediatric surgery involving multiple congenital anomalies pose significant diagnostic and therapeutic challenges. These conditions require coordinated interdisciplinary care tailored to the individual patient. We present a case of syndromic congenital anomalies in a neonate, later diagnosed with CHARGE syndrome, to illustrate the importance of staged, multidisciplinary management. Methods: A 34-year-old woman in her third pregnancy developed significant polyhydramnios at 31 weeks of gestation, followed by preterm labor. The neonate presented with esophageal atresia with tracheoesophageal fistula (EA/TEF), intrathoracic stomach, aortic coarctation, patent ductus arteriosus, atrial septal defect, and bilateral choanal atresia. A structured treatment protocol was developed and implemented at Klinikum Stuttgart by an interdisciplinary team comprising gynecology, pediatric surgery, cardiology, ENT, neonatology, and genetics. Results: Initial pediatric surgical procedures included ligation of the tracheoesophageal fistula, repositioning of the intrathoracic stomach, and primary esophageal anastomosis. Cardiovascular anomalies were managed through staged interventions. Bilateral choanal atresia was surgically corrected. Genetic testing confirmed CHARGE syndrome. Postoperative care included respiratory support, enteral nutrition, and regular esophageal dilations. Due to persistent reflux esophagitis, antireflux surgery is planned. Conclusions: This case underscores the importance of a highly individualized and interdisciplinary approach in the management of syndromic congenital anomalies. The presence of CHARGE syndrome with multiple system involvement required careful staging of surgical interventions and long-term coordination of follow-up care. Early genetic diagnosis and integrated team planning were critical in optimizing outcomes in this complex neonatal case. Full article

(This article belongs to the Section Pediatric Surgery)

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15 pages, 837 KB

Open AccessArticle

Optimal Timing for Auditory Brainstem Response After Tympanostomy Tube Placement in Children with Cleft Lip and Palate: A Retrospective Study

by Koichiro Oyake, Sei Kobayashi, Tomotaka Shimura, Yasunobu Amari, Ayaka Kise, Naoto Miyoshi, Naomi Imaizumi, Yukiko Inoue and Toshikazu Shimane

Children 2025, 12(9), 1243; https://doi.org/10.3390/children12091243 - 16 Sep 2025

Abstract

Objective: Children with cleft lip and/or palate (CLP) commonly present with otitis media with effusion (OME), with increased referrals for newborn hearing screening (NHS). Auditory brainstem response (ABR) testing with OME may mimic sensorineural hearing loss. This study evaluated NHS and ABR [...] Read more.

Objective: Children with cleft lip and/or palate (CLP) commonly present with otitis media with effusion (OME), with increased referrals for newborn hearing screening (NHS). Auditory brainstem response (ABR) testing with OME may mimic sensorineural hearing loss. This study evaluated NHS and ABR findings on and optimal timing for ABR reassessment after tympanostomy in patients with CLP. Methods: We conducted a retrospective study reviewing 271 CLP cases at our institution. The data included the cleft type, NHS results, ABR findings, OME incidence, and tympanostomy rate. Subgroup analyses compared ABR results before and after tympanostomy and via postoperative timing. Statistical comparisons were performed using the Mann–Whitney U test and Fisher’s exact test. Results: The NHS referral rate was 14.0%, and the OME incidence was 48.7%. These cases occurred in patients with cleft palate involvement, with an OME prevalence of 73.4%. Tympanostomy was performed in 72.6% of cases. Among 36 ears tested pre- and post-tympanostomy, wave V thresholds improved from 61.67 ± 16.08 to 34.72 ± 6.54 dBnHL (p < 0.0001), and wave I latency decreased from 2.27 ± 0.36 to 1.76 ± 0.12 ms (p < 0.0001). Postoperative wave V thresholds were significantly better in the ≥15-day group (p = 0.037), with 65% (17/26) of ears showing thresholds <40 dBnHL compared to 25% (3/12) in the <15-day group (p = 0.035). No timing-related differences were found regarding wave I latency. Conclusions: Tympanostomy significantly improved the ABR results in children with CLP and OME. Reassessment on or after postoperative day 15 may yield more accurate results and may help to reduce parental anxiety. Full article

(This article belongs to the Section Pediatric Otolaryngology)

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16 pages, 238 KB

Open AccessArticle

Factors Associated with Acute Respiratory Infections in Children Under Five Years Old: Analysis of the Demographic and Family Health Survey

by Diego A. Polo-Pucho, Javier J. Gonzales-Carrillo and Miguel A. Arce-Huamani

Children 2025, 12(9), 1242; https://doi.org/10.3390/children12091242 - 16 Sep 2025

Abstract

Background/Objectives: Acute respiratory infections (ARIs) remain a leading cause of morbidity and mortality in children under five in low- and middle-income countries. This study aimed to estimate the prevalence of caregiver-reported ARI symptoms and identify independent risk factors among Peruvian children under five [...] Read more.

Background/Objectives: Acute respiratory infections (ARIs) remain a leading cause of morbidity and mortality in children under five in low- and middle-income countries. This study aimed to estimate the prevalence of caregiver-reported ARI symptoms and identify independent risk factors among Peruvian children under five using a nationally representative survey. Methods: We conducted an analytical cross-sectional study using the 2022 Demographic and Family Health Survey (ENDES) of Peru. Children under five with complete data were included. ARI symptoms were defined from the standardized DHS/ENDES question asking whether the child had a cough in the preceding two weeks. Analyses accounted for the complex survey design (weights, strata, primary sampling units). Associations were evaluated using modified Poisson regression with robust standard errors to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Results: Among 6299 children under five, the prevalence of caregiver-reported ARI symptoms was 38.5%. After multivariable adjustment, male sex (adjusted PR: 1.07; 95% CI: 1.00–1.14; p = 0.04) and age 1 to <3 years (adjusted PR: 1.18; 95% CI: 1.09–1.27; p < 0.001) and 3 to <5 years (adjusted PR: 1.14; 95% CI: 1.05–1.24; p = 0.001) were associated with higher prevalence compared with infants <1 year. Wealth quintile, maternal education, and low birth weight were not independently associated with ARI symptoms. Conclusions: Caregiver-reported ARI symptoms remain highly prevalent among Peruvian children under five. Sex- and age-specific differences highlight the need for context-sensitive prevention, caregiver education, and efficient resource allocation within nationally representative, survey-informed child-health strategies. Full article

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

27 pages, 504 KB

Open AccessArticle

Do Playful Parenting Programs Implemented at Scale Improve Caregiver Practices and Child Development?

by Carina Omoeva, Rafael Contreras Gomez, Rachel Hatch, Frances Aboud, Ania Chaluda, Given Hapunda, Karma Choden, Francis Sichimba, Ksenija Krstić and Jill Popp

Children 2025, 12(9), 1241; https://doi.org/10.3390/children12091241 - 16 Sep 2025

Abstract

Background/Objectives: As an independent research group, we examined parent and child outcomes of three different parenting programs delivered at scale. The programs were implemented in Bhutan, Serbia and Zambia by different organizations. Methods: Mixed methods included a caregiver interview using the [...] Read more.

Background/Objectives: As an independent research group, we examined parent and child outcomes of three different parenting programs delivered at scale. The programs were implemented in Bhutan, Serbia and Zambia by different organizations. Methods: Mixed methods included a caregiver interview using the HOME Inventory, a direct child assessment using the Global Scales of Early Development (GSED) and focus group discussions with caregivers (FGD). Sampled mothers and children were randomly selected for the HOME/GSED: Bhutan n = 432, Serbia n = 636, Zambia n = 1024. Over 40 mothers and fathers of children under 3 years were purposively selected for FGD. Intention-to-treat and secondary regression analyses of attendees and non-attendees were conducted on the HOME and GSED; FGDs were subject to content analysis. Results: Parenting practices were found to be minimally (Bhutan) or modestly (Zambia) higher for caregivers who attended group sessions. Caregivers in Serbia who recalled receiving play messages had higher HOME scores. Child outcomes showed small (Bhutan) or no differences (Serbia, Zambia) associated with participation. Conclusions: Explanations focused on limits to program participation in scaled programs, the need for pilot evaluations to ensure that the program design is effective, and the need to monitor delivery quality and other implementation processes. Full article

(This article belongs to the Special Issue The Impact of Family Education on Children and Adolescents)

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14 pages, 780 KB

Open AccessArticle

Gut Microbiota Composition and Sleep in Preschoolers: The ELFE Birth Cohort Study

by Zeinab Houshialsadat, Cécile Zaros, Marie-José Butel, Marie-Aline Charles, Gaël Toubon and Sabine Plancoulaine

Children 2025, 12(9), 1240; https://doi.org/10.3390/children12091240 - 16 Sep 2025

Abstract

Background/Objectives: Sleep is essential for children’s well-being, yet insufficient sleep duration and quality are common among preschoolers. The brain–gut microbiota axis, a bidirectional communication network connecting the brain, the gastrointestinal tract, and the microorganisms living there, known as the gut microbiota, influences sleep [...] Read more.

Background/Objectives: Sleep is essential for children’s well-being, yet insufficient sleep duration and quality are common among preschoolers. The brain–gut microbiota axis, a bidirectional communication network connecting the brain, the gastrointestinal tract, and the microorganisms living there, known as the gut microbiota, influences sleep regulation, but its role in children remains largely unexplored. Here, we examined the association between gut microbiota and sleep in preschoolers from Étude Longitudinale Française depuis l’Enfance (ELFE) birth cohort study. Methods: This study included 597 children (51.2% boys) with available stool samples and sleep data at 3.5 years. The gut microbiota data was analyzed using bacterial 16S rRNA sequencing. Data on day and night sleep durations and frequencies of sleep onset difficulties and night waking were collected through telephone questionnaires and grouped into ‘optimal’ and ‘suboptimal’ clusters using Latent Class Analysis. Statistical analyses involved multivariate logistic regressions or multivariate permutation analysis of variance, controlling for confounders. Results: In total, 25% of the included children were in the suboptimal sleep cluster. No significant associations were found between gut microbiota diversity and composition and sleep clusters at age 3.5 years. Similarly, no differences were found in the abundance of specific microbiota genera between the two sleep clusters. Conclusions: While emerging evidence suggests correlations between gut microbiota and sleep in preschool children, our results do not confirm such correlations. The data used in this study were obtained from a homogeneous, high socioeconomic population, which must be considered when interpreting the findings. Further research is needed to validate the results of this study. Full article

(This article belongs to the Special Issue Insufficient Sleep Syndrome in Children and Adolescents)

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11 pages, 752 KB

Open AccessArticle

Idiopathic Flatfoot in Children and Adolescents Treated with Arthroereisis—Muscle Recession May Not Be Necessary in Feet with Mild Gastrocnemius Shortening

by Rebecca Alexandra Jakobs, Harald Böhm, Albert Fujak and Chakravarthy Ugandhar Dussa

Children 2025, 12(9), 1239; https://doi.org/10.3390/children12091239 - 16 Sep 2025

Abstract

Background: Arthroereisis is a well-accepted and relatively easy procedure to treat the flexible flatfeet in children and adolescents. A mild calf-muscle shortening is not seldom an accompanying feature. The need for a gastrocnemius recession in addition to arthroereisis is controversial. Therefore, the objective [...] Read more.

Background: Arthroereisis is a well-accepted and relatively easy procedure to treat the flexible flatfeet in children and adolescents. A mild calf-muscle shortening is not seldom an accompanying feature. The need for a gastrocnemius recession in addition to arthroereisis is controversial. Therefore, the objective of this study is to investigate the need for a gastrocnemius recession in mild cases of gastrocnemius shortening to improve ankle dorsiflexion in addition to arthroereisis. Methods: Twenty-seven patients (ages 9–15 years) who underwent arthroereisis for painful idiopathic flatfeet were included in this non-randomised retrospective study, approved by Friedrich-Alexander University, Erlangen-Nürnberg (22-86-Br). The gait data of 18 typically developed children in same age group was used as reference. Based on the intraoperative Silfverskjöld test, two groups could be identified in the collective, one with shortened of gastrocnemius who underwent gastrocnemius recession (FFGR) and one without (FF). A control group included 18 feet of 18 typically developing children. Outcomes were evaluated by comparing pre- and postoperative clinical assessments including pain scores, gait analysis using a multi-segmental foot model, and radiological imaging. The mean follow-up was 22.1 months, and statistical analysis included a two-factor ANOVA. Results: No statistically significant differences in anthropometric, clinical, and gait parameters were observed between the groups preoperatively. Improvements in ankle dorsiflexion and pain were seen in both groups without statistical significance. There was no loss of calf-muscle strength or ankle power. Conclusions: Arthroereisis effectively corrects an idiopathic flexible flatfoot and reduces pain in children and adolescents. The gastrocnemius muscle stretches following arthroereisis and therefore, no lengthening is necessary when mildly shortened. The major limitations of this study are its retrospective nature, non-randomisation, and small size of the study collective. Full article

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

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