Children

12 pages, 372 KB

Open AccessArticle

Early Leukocyte Profiles in Preterm Infants Born to Mothers with Systemic Lupus Erythematosus: An Exploratory Matched Cohort Study

by Hikaru Takahashi, Shutaro Suga, Toshihiko Manabe, Yusuke Saito and Reiji Fukano

Children 2026, 13(9), 1237; https://doi.org/10.3390/children13091237 (registering DOI) - 12 Sep 2026

Abstract

Background/Objectives: Maternal systemic lupus erythematosus (SLE) is associated with preterm birth, but whether maternal disease activity influences early neonatal hematologic profiles beyond developmental immaturity remains unclear. We compared hematologic parameters between SLE-exposed preterm infants and maturity-matched controls and explored findings according to [...] Read more.

Background/Objectives: Maternal systemic lupus erythematosus (SLE) is associated with preterm birth, but whether maternal disease activity influences early neonatal hematologic profiles beyond developmental immaturity remains unclear. We compared hematologic parameters between SLE-exposed preterm infants and maturity-matched controls and explored findings according to maternal SLE flare during pregnancy. Methods: This single-center retrospective matched-cohort study included 13 SLE-exposed preterm infants and 39 controls matched 1:3 by gestational age, birth weight, and sex. White blood cell (WBC) count, absolute neutrophil count (ANC), hemoglobin concentration, and platelet count were assessed at birth, around postnatal day 5, and at their nadir during hospitalization. Group differences were estimated using linear regression models including matched-set identifiers as fixed effects. Flare-stratified and hepatic analyses were exploratory, without adjustment for multiple comparisons. Results: Overall matched-set analyses showed no clear differences in WBC count, ANC, hemoglobin, or platelet values between SLE-exposed infants and controls. The estimated difference in nadir ANC was −405/μL (95% confidence interval [CI], −985 to 174/μL; p = 0.164). In the maternal-flare subgroup, nadir WBC count was lower than in its matched controls (difference, −2.31 × 10³/μL; 95% CI, −3.96 to −0.65 × 10³/μL; p = 0.009), as was nadir ANC (difference, −672/μL; 95% CI, −1260 to −85/μL; p = 0.028). Corresponding matched-set differences were not evident at birth or around postnatal day 5. The non-flare subgroup did not show a consistent pattern of leukocyte suppression. Conclusions: Maternal SLE exposure was not clearly associated with an overall difference in neonatal hematologic profiles within matched sets. Maternal SLE flare may identify a subgroup with lower WBC and neutrophil nadirs, but this exploratory finding requires confirmation in larger studies. Full article

(This article belongs to the Special Issue Advances in Neonatal Hematology and Hemostasis)

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31 pages, 640 KB

Open AccessSystematic Review

Parental Cognition Regarding Children’s Sugar Consumption and Its Implications for Dental Caries Prevention: A Systematic Review

by Areena Tahir, Esther García-Miralles, Juan Ignacio Aura-Tormos, Clara Guinot-Barona and Laura Marqués-Martínez

Children 2026, 13(9), 1236; https://doi.org/10.3390/children13091236 (registering DOI) - 12 Sep 2026

Abstract

Background/Objectives: Parental perceptions, beliefs, attitudes, and knowledge may influence children’s sugar exposure, but these cognitive constructs are distinct from children’s actual intake. This review synthesised parental cognition regarding children’s sugar consumption and secondarily examined its relationship with reported or measured intake and implications [...] Read more.

Background/Objectives: Parental perceptions, beliefs, attitudes, and knowledge may influence children’s sugar exposure, but these cognitive constructs are distinct from children’s actual intake. This review synthesised parental cognition regarding children’s sugar consumption and secondarily examined its relationship with reported or measured intake and implications for caries prevention. Methods: PubMed, Scopus, PsycINFO, CINAHL, and Web of Science were searched for primary studies published from January 2016 to April 2026. Study selection and narrative synthesis followed PRISMA 2020. Results: We included 35 studies from ten countries: 19 cross-sectional, 6 qualitative, 4 experimental/randomised, 2 pre-post, 1 longitudinal, and 3 other survey-based or mixed-design studies. Misperceptions of product healthfulness and limited knowledge of sugar content were common. Associations between cognition and children’s intake were inconsistent; parental modelling, household availability, cultural norms, and commercial influences were also associated with sugar exposure. Most evidence was observational, measures were heterogeneous, and no study measured dental caries directly. Conclusions: Parental cognition is relevant but insufficient on its own to explain children’s sugar exposure. Caries-preventive counselling should combine factual education with attention to caregiver behaviour and the home food environment. Full article

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

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37 pages, 3035 KB

Open AccessSystematic Review

by Massimo Pisano, Giuseppe Sangiovanni, Eugenio Frucci, Michela Scorziello, María del Carmen Villanueva-Vilchis and Giuseppina De Benedetto

Children 2026, 13(9), 1235; https://doi.org/10.3390/children13091235 (registering DOI) - 12 Sep 2026

Abstract

Background/Objectives: Molar incisor hypomineralization (MIH) is a qualitative enamel defect affecting pediatric populations, predisposing to hypersensitivity, caries, and post-eruptive breakdown, and potentially impacting oral health-related quality of life (OHRQoL). Therefore, the primary aim of the present umbrella review was to evaluate the overall [...] Read more.

Background/Objectives: Molar incisor hypomineralization (MIH) is a qualitative enamel defect affecting pediatric populations, predisposing to hypersensitivity, caries, and post-eruptive breakdown, and potentially impacting oral health-related quality of life (OHRQoL). Therefore, the primary aim of the present umbrella review was to evaluate the overall OHRQoL among pediatric subjects with MIH, as well as individual domains from both children and parents. Secondary aims were to evaluate the influence of MIH severity, extent/distribution pattern, age, and dentition status on overall- and domain-specific OHRQoL outcomes, and to assess the impact of different dental treatments on OHRQoL. Methods: Following PRISMA guidelines and PROSPERO registration, six systematic reviews were included. To address metric heterogeneity, mean scores were normalized into a 0–100% descriptive percentage impact index. Treatment-related changes were calculated as percentage improvements. Results: A total of 4028 respondents (3193 children and 835 parents/caregivers) were evaluated for OHRQoL. The overall impact on children and parents was highest in the oral domain (26.43%), followed by the psychological (20.25%), functional (19.50%), and social (11.75%) domains. Parental underestimation of MIH was consistently observed across all domains. Children in early mixed dentition reported a higher perceived impact than those in late mixed/permanent dentition (26.77% vs. 14.43%). In an exploratory subsample (n = 494), MIH severity appeared to impact OHRQoL, particularly in oral and functional domains. Overall, post-treatment OHRQoL improved across all domains, although evaluated in a limited sample (n = 491). Conclusions: MIH showed a relevant impact on pediatric OHRQoL. Notably, children consistently report a greater perceived impact than parents, suggesting potential parental underestimation. However, findings regarding dentition stage, MIH severity, and post-treatment improvements should be interpreted with caution, as heterogeneity in assessment tools, limited subsamples, and variable follow-up intervals precludes definitive conclusions. Full article

(This article belongs to the Special Issue Digital Health Implementation in Pediatric Dental Care)

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14 pages, 244 KB

Open AccessArticle

Combining Neuromuscular Electrical Stimulation with Activity Based Training in Children with Chronic Cervical Spinal Cord Injury: A Retrospective Case Series

by Kathryn Noonan-Eaton, Beatrice Ugiliweneza, Andrea L. Behrman and Goutam Singh

Children 2026, 13(9), 1234; https://doi.org/10.3390/children13091234 (registering DOI) - 12 Sep 2026

Abstract

Background/Objectives: Neuromuscular electrical stimulation (NMES) is a promising adjunct to activity-based training for individuals with spinal cord injury (SCI). While lower extremity NMES applications are well documented, upper extremity (UE) outcomes remain underexplored in pediatric SCI. The objective of this case series was [...] Read more.

Background/Objectives: Neuromuscular electrical stimulation (NMES) is a promising adjunct to activity-based training for individuals with spinal cord injury (SCI). While lower extremity NMES applications are well documented, upper extremity (UE) outcomes remain underexplored in pediatric SCI. The objective of this case series was to evaluate outcomes following a combined NMES and activity-based therapy program targeting the UE in children with chronic SCI. Methods: In this retrospective case series, we analyzed outcomes from five children, ages 4 to 15 years old, with chronic cervical level SCI who completed an individualized activity-based training program with concurrent wide pulse neuromuscular electrical stimulation (WPS-NMES). Participants were children with chronic SCI (≥6 months post-injury). Functional assessments were conducted by pre- and post-intervention. Pre- and post-intervention outcomes were summarized descriptively at the individual case level. Results: Five children with chronic cervical SCI (ages 4–15 years) completed a mean of 54 intervention sessions. All patients demonstrated improved trunk control, with Segmental Assessment of Trunk Control (SATCo) increases of 1–6 points. UE gains on the Peds-NRS were observed in 4/5 patients, primarily in overhead reach and object-to-mouth items. Box and Blocks Test scores improved in 4/5 patients in at least one UE, while one patient remained at 0 bilaterally, and one patient experienced a unilateral decline. One patient demonstrated proximal and trunk improvements without changes in manual dexterity. No unanticipated adverse events were reported. Conclusions: Observed improvements in selected trunk and UE outcomes occurred during participation in a multimodal rehabilitation program incorporating WPS-NMES. These preliminary findings describe functional changes observed during the rehabilitation program and may help inform the design of future controlled studies evaluating multimodal rehabilitation approaches for children with chronic SCI. Full article

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

16 pages, 362 KB

Open AccessArticle

Evaluation of Grazing Behavior and Its Associations with Obesity, Emotion Regulation Difficulties, and Problematic Smartphone Use in Adolescents with Essential Hypertension

by Gunes Isik, Cansu Mercan Isik and Masum Ozturk

Children 2026, 13(9), 1233; https://doi.org/10.3390/children13091233 - 11 Sep 2026

Abstract

Background: This study aimed to compare grazing behavior scores between adolescents with essential hypertension (HTN) and controls. It also investigated the associations of grazing behavior with obesity, emotion regulation difficulties (ERD), problematic smartphone use, and screen time. Methods: This cross-sectional case–control study enrolled [...] Read more.

Background: This study aimed to compare grazing behavior scores between adolescents with essential hypertension (HTN) and controls. It also investigated the associations of grazing behavior with obesity, emotion regulation difficulties (ERD), problematic smartphone use, and screen time. Methods: This cross-sectional case–control study enrolled 60 adolescents with essential HTN and 60 controls selected via frequency matching based on age and sex, all aged 12–18 years. The diagnosis of essential HTN was confirmed using 24-h ambulatory blood pressure monitoring (ABPM). Grazing behavior, ERD, problematic smartphone use, screen time and body mass index (BMI) were assessed in all participants. Group comparisons and associations between grazing behavior and the study variables were analyzed. Results: The essential HTN and control groups were comparable with respect to age and sex distribution (p > 0.05). The mean BMI in the essential HTN group was 31.18 ± 6.81 kg/m², which was significantly higher than that in the control group (23.35 ± 4.47 kg/m²) (p < 0.001). A significant positive correlation was found between total Grazing Questionnaire (GQ) scores and BMI (r = 0.252; p = 0.006), ERD (r = 0.187; p = 0.041), and problematic smartphone use (r = 0.315; p < 0.001). A statistically significant difference was observed between the essential HTN and control groups in total GQ scores [F(1, 117) = 4.85, p = 0.030, η²p = 0.040]. After adjustment for BMI, participants with hepatic steatosis had significantly higher total GQ scores (p = 0.019, η²p = 0.138), Grazing Behaviors subscale scores (p = 0.046, η²p = 0.107), and Uncontrollability subscale scores (p = 0.025, η²p = 0.123) than those without hepatic steatosis. Conclusions: Adolescents with essential HTN had higher grazing behavior scores than controls after adjustment for BMI. Grazing behavior was also associated with ERD and problematic smartphone use across the study sample. The findings regarding grazing behavior and hepatic steatosis warrant cautious interpretation, as the subgroup analysis was exploratory and included a relatively small number of participants. Full article

(This article belongs to the Section Pediatric Nephrology & Urology)

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50 pages, 1872 KB

Open AccessReview

Mapping Randomized Controlled Trials of Family- and Community-Centered Healthcare Interventions for Pediatric Asthma, Type 1 Diabetes, or Juvenile Idiopathic Arthritis—A Scoping Review

by Svetlana Solgaard Nielsen, Alessio Bricca, Stavros Orologas, Ann-Marie Malby Schoos, Anna-Helene Bohr, Kija Lin Østergaard, Julie Mondahl, Sofie Ahlgreen Gram, Dan Grabowski, Fatma Demircioglu Bilgin, Marie Sofie Oxlund Hoppe, Tine Petz Rasmussen, Charlotte Simonÿ, Alexander Luijk, Line Nørgaard Remmen, Henrik Hallas, Louisa Mittet, Mette Tækker Jensen and Jeanette Reffstrup Christensen

Children 2026, 13(9), 1232; https://doi.org/10.3390/children13091232 - 11 Sep 2026

Abstract

Background: Family and community are key support sources for children and adolescents with chronic illnesses. This study aimed to map the characteristics of family- and community-centered interventions for pediatric chronic somatic disease. Methods: This scoping review followed the Arksey and O’Malley guidance. Through [...] Read more.

Background: Family and community are key support sources for children and adolescents with chronic illnesses. This study aimed to map the characteristics of family- and community-centered interventions for pediatric chronic somatic disease. Methods: This scoping review followed the Arksey and O’Malley guidance. Through a systematic search in Medline (PubMed), EMBASE, PsycINFO, Cochrane, and CINAHL, free web sources, the gray literature, and citations, we identified publications of randomized controlled trials evaluating family- and community-centered interventions for children aged 0–17 years with asthma, type 1 diabetes, or juvenile idiopathic arthritis. Two or more reviewers independently conducted screening, verification of machine-assisted data extraction, risk-of-bias assessment, and narrative synthesis. Results: Of 7285 items identified, we included 76 publications on 71 interventions comprising 16,342 participants (median n = 157; IQR 81–303; range 12–1316) with a median age of 9 (range 0–19) years. Interventions incorporating educational, psychosocial, and care-coordination elements targeted asthma (68%), type 1 diabetes (29%), and juvenile idiopathic arthritis (3%) that had lasted ≤6 months (63%) and were delivered in person (83%) by healthcare professionals (62%). Primary outcomes included symptom burden (44%), coping with the disease (24%), disease control (20%), activity participation, child psychosocial functioning, medication or healthcare use (18% each), or child quality of life (17%). Usual care (59%) and other treatment (31%) were frequent comparators. Conclusions: Most interventions were short-term, healthcare professional-led multicomponent programs compared with usual care. Primary outcomes targeted symptom management and disease control. Mixed diagnoses, peer support, family activities, and non-professional delivery were uncommon. This study identified gaps in diagnosis coverage and the need for additional high-quality studies. Full article

(This article belongs to the Special Issue Promoting Child Health and Wellness: The Crucial Role of Family, Community, and Schools in Early and Lifespan Development)

17 pages, 493 KB

Open AccessReview

Glutamine and Pediatric Intestinal Barrier Function: A Scoping Review of Clinical Evidence and Research Gaps

by Dejan Dobrijević, Nataša Nastić and Kristian Pastor

Children 2026, 13(9), 1231; https://doi.org/10.3390/children13091231 - 11 Sep 2026

Abstract

Background/Objectives: Glutamine has been proposed as a nutritional modulator of intestinal epithelial integrity, but its effects on intestinal barrier function in children remain uncertain. This scoping review mapped the available human evidence on glutamine in relation to pediatric intestinal permeability, mucosal injury, microbial [...] Read more.

Background/Objectives: Glutamine has been proposed as a nutritional modulator of intestinal epithelial integrity, but its effects on intestinal barrier function in children remain uncertain. This scoping review mapped the available human evidence on glutamine in relation to pediatric intestinal permeability, mucosal injury, microbial translocation, and intestinal adaptation. Methods: The review followed Joanna Briggs Institute methodology and PRISMA-ScR guidance. PubMed, Scopus, and Web of Science Core Collection were searched. Eligible studies included participants aged <18 years and assessed glutamine supplementation or endogenous glutamine status in relation to predefined barrier-related outcomes. Data were charted using a standardized form and synthesized descriptively according to clinical population, study design, glutamine exposure, and barrier domain. Results: Of 598 records identified, 434 unique records were screened. Eighteen publications representing 15 distinct or partially overlapping studies/cohorts were included. Functional intestinal permeability was the most frequently investigated domain. Findings were heterogeneous, with favorable, partial, transient, and null effects reported across different pediatric populations. Evidence for microbial translocation was limited and showed no clear benefit. Positive findings related to intestinal adaptation were mainly derived from uncontrolled or combined interventions, limiting attribution to glutamine. Direct mechanistic evidence in children was sparse, and no consistent major safety signal emerged, although the available safety evidence was limited. Conclusions: Current evidence does not support a uniform beneficial effect of glutamine on pediatric intestinal barrier function. Observed effects vary across populations, intervention characteristics, and outcome assessment methods. Full article

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

11 pages, 370 KB

Open AccessArticle

Primary Headache Disorders in Pediatric Irritable Bowel Syndrome: Characterizing IBS-Associated Migraine Highlights

by Özben Akıncı Göktaş and Suna Selbuz

Children 2026, 13(9), 1230; https://doi.org/10.3390/children13091230 - 11 Sep 2026

Abstract

Background/Objectives: This study aimed to determine the prevalence of primary headache disorders in children and adolescents with irritable bowel syndrome (IBS), compare the clinical characteristics of IBS-associated and non-IBS headache populations, and identify factors associated with migraine and tension-type headache (TTH) in pediatric [...] Read more.

Background/Objectives: This study aimed to determine the prevalence of primary headache disorders in children and adolescents with irritable bowel syndrome (IBS), compare the clinical characteristics of IBS-associated and non-IBS headache populations, and identify factors associated with migraine and tension-type headache (TTH) in pediatric IBS. Methods: This retrospective observational study included 100 patients aged 6–18 years diagnosed with IBS according to the Rome IV criteria. All patients underwent systematic headache screening and neurological evaluation using the International Classification of Headache Disorders, 3rd edition. Age- and sex-frequency-matched control groups comprising 30 patients with migraine and 31 with TTH without gastrointestinal disease were included for comparison. Multivariable logistic regression analysis was performed to identify factors independently associated with migraine and TTH. Results: Primary headache disorders were identified in 61% of patients, including migraine in 30% and TTH in 31%. Migraine was significantly associated with female sex, increasing age, and a family history of headache. Compared with patients with migraine without IBS, those with IBS-associated migraine had a significantly higher prevalence of nausea (93.3% vs. 60.0%, p = 0.002), whereas headache frequency, duration, severity, photophobia, phonophobia, and vomiting were similar. No significant clinical differences were observed between IBS-associated and non-IBS TTH. Conclusions: Primary headache disorders, particularly migraine, are highly prevalent in pediatric IBS. The markedly increased frequency of nausea without differences in other headache characteristics represents a hypothesis-generating observation and may reflect an interaction between migraine-associated symptoms and the underlying gastrointestinal susceptibility associated with IBS, rather than evidence of a distinct migraine phenotype. Routine neurological assessment should be considered in children with IBS, particularly in female adolescents and those with a family history of headache. Full article

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

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27 pages, 469 KB

Open AccessReview

The Unique Features of Pediatric Sports Injuries: The Hip

by Leah Henry, Karli Funk, Yi-Meng Yen and Joshua Abzug

Children 2026, 13(9), 1229; https://doi.org/10.3390/children13091229 - 11 Sep 2026

Abstract

Sports-related injuries of the hip and groin have demonstrated increasing prevalence in pediatric and adolescent athletes. Pediatric injuries require specific consideration of unique factors such as skeletal maturity, apophyseal vulnerability, physeal closure status, and growth-related changes in injury pattern. These injuries include a [...] Read more.

Sports-related injuries of the hip and groin have demonstrated increasing prevalence in pediatric and adolescent athletes. Pediatric injuries require specific consideration of unique factors such as skeletal maturity, apophyseal vulnerability, physeal closure status, and growth-related changes in injury pattern. These injuries include a variety of conditions, including apophyseal injuries, hip dislocations, coxa saltans (snapping hip), femoroacetabular impingement syndrome (FAIS), and stress fractures. Injuries such as hip dislocation and high-risk femoral neck stress fracture require urgent diagnosis and management; however, timely diagnosis and appropriate management is necessary for all pediatric hip injuries to prevent delays in return to sport and long-term complications. The literature synthesized in this narrative review includes randomized controlled trials, systematic reviews, prospective and retrospective studies, and consensus statements to provide a summary of each injury. An overview of pediatric sports injuries of the hip, with emphasis on the epidemiology, presentation, diagnosis, management, and complications, is presented. Full article

(This article belongs to the Special Issue Musculoskeletal Disorders in Children: Symptoms, Risks and Prevention)

26 pages, 821 KB

Open AccessArticle

From Recognition to Diagnosis: Caregiver Response, Help-Seeking Pathways, and Access-Related Factors Associated with Autism Diagnostic Delay in Jordan

by Hana Taha, Mohammad AlAhmad, Zaid Altawil, Abdalrahman Albakri, Mohammad Alshamasneh, Omar Daas, Amira Masri, Laila Tutunji and Linus Jönsson

Children 2026, 13(9), 1228; https://doi.org/10.3390/children13091228 - 11 Sep 2026

Abstract

Background: Autism spectrum disorder (ASD) is often diagnosed well after developmental concerns first emerge, and evidence on factors associated with the duration of the recognition-to-diagnosis pathway remains limited in the Middle East. This study aimed to identify factors associated with the overall recognition-to-diagnosis [...] Read more.

Background: Autism spectrum disorder (ASD) is often diagnosed well after developmental concerns first emerge, and evidence on factors associated with the duration of the recognition-to-diagnosis pathway remains limited in the Middle East. This study aimed to identify factors associated with the overall recognition-to-diagnosis interval and potential areas for earlier recognition, referral, and access to appropriate assessment. Methods: This multisite cross-sectional survey of 384 caregivers of children with confirmed ASD was conducted across Jordanian governorates. Diagnostic timing was known for 338 participants. Five sequential nested ordinal logistic regression models were fitted on a common complete-case sample (N = 299), successively adding background characteristics, recognition, caregiver response, help-seeking route, and access/professional response variables. Robustness was assessed via grouping-specific binary models, multiple imputation, and bootstrap resampling. Results: Caregivers reported first concerns at a median age of 2.0 years. Among those with known diagnostic timing, 60.7% were in the “6 Months to 1 Year” delay category or longer, 46.2% were in the “1–2 Years” category or longer, and 24.0% were in the “More than 2 Years” category. The background characteristics model showed limited explanatory capacity (Nagelkerke R² = 0.021), and adding recognition variables did not improve model fit (p = 0.562). Fit improved significantly with caregiver response (p = 0.001), help-seeking route (p = 0.008), and access/professional response (p < 0.001). The final model reached a Nagelkerke R² = 0.178, indicating modest overall explanatory capacity. Longer diagnostic delay was independently associated with caregivers who reported that early signs had initially not been acted upon because they were interpreted as part of normal development (AOR = 2.21). It was also associated with first contact via a speech/learning center (AOR = 2.27) or other service (AOR = 2.72) rather than a pediatrician. Caregiver-reported previous professional reassurance that the child did not have ASD was also associated with longer delay (AOR = 2.18). Professional reassurance was the most consistent correlate across sensitivity analyses. Definite appointment difficulty showed a significant Yes-versus-No contrast (AOR = 1.81), although the appointment difficulty variable was not statistically significant in the global test. Sociodemographic factors showed no independent association. Among 11 exploratory barriers, only prior misdiagnosis survived multiplicity correction (AOR = 2.21). Conclusions: In this Jordanian cohort, the length of the recognition-to-diagnosis interval was associated with factors operating after developmental concerns were first recognized, rather than with the timing or breadth of recognition itself. Caregiver response, entry route into care, and professional response emerged as potentially important pathway markers. However, the modest explanatory capacity of the final model indicates that substantial variability in diagnostic delay remains unaccounted for by the measured variables. These findings support provider- and system-level measures, including clearer referral pathways, explicit follow-up when reassurance is provided, improved appointment access, and expanded diagnostic capacity, complemented by caregiver-facing information and support. Full article

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

22 pages, 859 KB

Open AccessArticle

Development and Preliminary Evaluation of a Questionnaire on Parental Informed Consent in Neonatal Research

by Maria Lampridou, Abraham Pouliakis, Vasiliki Mougiou, Eleni Katsianou, Aikaterini Konstantinidi, Martha Theodoraki, Zoi Iliodromiti, Theodora Boutsikou, Nicoletta Iacovidou and Rozeta Sokou

Children 2026, 13(9), 1227; https://doi.org/10.3390/children13091227 - 10 Sep 2026

Abstract

Background: Advances in neonatology and paediatric pharmacology have markedly improved neonatal survival, particularly among preterm and critically ill infants. At the same time, clinical research constitutes the cornerstone for generation of evidence on the safety and efficacy of therapeutic interventions. However, neonatal participation [...] Read more.

Background: Advances in neonatology and paediatric pharmacology have markedly improved neonatal survival, particularly among preterm and critically ill infants. At the same time, clinical research constitutes the cornerstone for generation of evidence on the safety and efficacy of therapeutic interventions. However, neonatal participation in research relies on parental informed consent, a complex and multifactorial process shaped by cognitive, emotional, and cultural factors. In Greece, evidence regarding the determinants of parental consent for neonatal clinical research remains scarce. The aim of this study was to develop and conduct a preliminary evaluation of a questionnaire designed to assess parents’ perceptions and attitudes toward informed consent for participation of their offspring in neonatal clinical studies. Methods: A structured questionnaire was developed based on the international literature and the principles of informed consent. The instrument comprised five domains assessing knowledge and understanding of research, the informed consent process, trust in healthcare professionals, parental emotions, and sociodemographic characteristics. Content validity was assessed by an expert panel, followed by pilot testing in 20 parents. Preliminary evaluation of temporal stability was performed using Cohen’s kappa coefficient and weighted kappa. The study was conducted in accordance with the principles of the Declaration of Helsinki. Results: The questionnaire showed variable test–retest agreement across items and domains in the pilot sample. Domains covering cognitive aspects of research participation exhibited greater stability over time compared with emotional dimensions, which showed higher variability between measurements. Questions related to study type and trust in healthcare professionals demonstrated higher levels of reliability. Conclusions: This study describes the development and preliminary evaluation of a questionnaire designed to explore factors potentially influencing parental consent for participation in neonatal research in Greece. The findings provide preliminary evidence regarding the temporal stability of individual questionnaire items while also identifying items that may require further evaluation or refinement. Further evaluation in larger and more diverse populations, including a more comprehensive assessment of its measurement properties, is warranted before broader research application. Full article

(This article belongs to the Special Issue Optimizing Evidence-Based Interventions for Enhancing Development in Early Childhood)

20 pages, 1593 KB

Open AccessArticle

Pediatric DOCK8 Deficiency Beyond Infections and Atopy: An Immunoactinopathy with Immune Dysregulation and Multisystem Involvement

by Figen Çelebi Çelik, Necmi Can Yüksel, Ömer Akçal, Emre Fırat, Aymen Hişmioğulları, Soner Günder, Gülçin Kaymakoğlu, Nesrin Gülez and Ferah Genel

Children 2026, 13(9), 1226; https://doi.org/10.3390/children13091226 - 10 Sep 2026

Abstract

Background/Objectives: Dedicator of cytokinesis 8 (DOCK8) deficiency is an autosomal recessive combined immunodeficiency and an actin cytoskeleton-related inborn error of immunity characterized by severe atopy, recurrent infections, and broad immune dysregulation. We aimed to describe the clinical, immunological, genetic, treatment-related, and outcome [...] Read more.

Background/Objectives: Dedicator of cytokinesis 8 (DOCK8) deficiency is an autosomal recessive combined immunodeficiency and an actin cytoskeleton-related inborn error of immunity characterized by severe atopy, recurrent infections, and broad immune dysregulation. We aimed to describe the clinical, immunological, genetic, treatment-related, and outcome features of children with genetically confirmed DOCK8 deficiency, emphasizing immune dysregulation and systemic involvement. Methods: We retrospectively reviewed 17 pediatric patients from 14 unrelated kindreds with genetically confirmed DOCK8 deficiency followed at a tertiary pediatric immunology center between 2005 and 2026. Demographic data, infectious and allergic manifestations, autoimmune and hematological findings, organ involvement, malignancy, laboratory parameters, genetic findings, hematopoietic stem cell transplantation (HSCT) status, and survival outcomes were analyzed descriptively. Results: Twelve patients were male (70.6%), and parental consanguinity was present in 13 patients (76.5%). The median age at symptom onset was 5 months (IQR, 3–10), whereas the median age at diagnosis was 44 months (IQR, 23–56). A history of eczema was documented in all patients. Recurrent skin infections occurred in 16 patients (94.1%), recurrent pneumonia in 13 (76.5%), mucocutaneous candidiasis in 10 (58.8%), and cytomegalovirus infection in four (23.5%). Confirmed autoimmune manifestations were documented in two patients, including autoimmune hepatitis and autoimmune hemolytic anemia. Malignancy occurred in two patients: gastrointestinal stromal tumor and cutaneous squamous cell carcinoma. Additional uncommon systemic manifestations included sclerosing cholangitis, giant aortic aneurysm, and chronic pancreatitis. HSCT was performed in 12 patients (70.6%); complete clinical recovery was achieved in 11, whereas one patient died after transplantation. Four of five non-transplanted patients died during follow-up. Conclusions: Pediatric DOCK8 deficiency showed an early-onset, severe, multisystem phenotype. Beyond infections and atopy, immune dysregulation-related and systemic manifestations were clinically important. Favorable HSCT outcomes were consistent with previous evidence supporting early molecular diagnosis and timely transplant evaluation. Full article

(This article belongs to the Special Issue Pediatric Immunodeficiency: Diagnosis and Management in Clinical Practice)

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11 pages, 480 KB

Open AccessArticle

Disparity and Inequity of Elementary School Children’s Vision Health and Basic Clinic Resources in Rural and Urban Areas in Taiwan

by Jui-Yu Lin, Fu-Gong Lin, Rouh-Mei Hu and Jung-Kai Tseng

Children 2026, 13(9), 1225; https://doi.org/10.3390/children13091225 - 10 Sep 2026

Abstract

Background/Objectives: Myopia is a major global public health concern, particularly in East Asia. Taiwan’s exceptionally high prevalence of childhood myopia provides a valuable population model for investigating refractive development and prevention. This study examined geographic disparities in visual acuity, refractive errors, and [...] Read more.

Background/Objectives: Myopia is a major global public health concern, particularly in East Asia. Taiwan’s exceptionally high prevalence of childhood myopia provides a valuable population model for investigating refractive development and prevention. This study examined geographic disparities in visual acuity, refractive errors, and optometric resources among Taiwanese elementary school children. Methods: This retrospective nationwide study analyzed anonymized screening data from 10,610 elementary school children collected from 2014 to 2023. Children were classified as urban, rural, remote, or especially/extremely remote according to governmental criteria. Comprehensive vision examinations were performed by licensed optometrists. Refraction was assessed using autorefraction and retinoscopy without cycloplegia. Refractive errors and healthcare resources were compared across regions using multivariable logistic and linear regression analyses. Results: Myopia was present in 86.4% of male and 87.0% of female children, while measurable astigmatism (≥0.25 D) was present in 98.4% of both sexes. High myopia and high astigmatism affected 2.3% and 4.5% of children, respectively. Myopia prevalence varied across grade levels and was 88.9% among sixth-grade children. Compared with urban children, those living in especially or extremely remote areas and rural areas had higher odds of measurable astigmatism (OR = 2.81 and 1.63, respectively; p < 0.01). Rural children had significantly lower odds of myopia, while no significant association with myopia was observed among children living in specially or extremely remote areas. Optometry clinics were more concentrated in urban areas, and a higher density of optometry clinics was associated with lower odds of myopia. Conclusions: Taiwan provides a valuable model population for understanding geographic, environmental, and healthcare-related factors in childhood myopia. Better visual acuity does not necessarily indicate lower refractive risk. Region-specific strategies should strengthen comprehensive screening and referral, improve optometric access and affordable correction in remote areas, and promote lifestyle and environmental interventions in urban settings. Full article

(This article belongs to the Special Issue Vision Disorders and Eye Care in Children)

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12 pages, 260 KB

Open AccessArticle

Factors Associated with Self-Harm Attempts Among Female Adolescents with Self-Reported Reclusive Tendencies in Republic of Korea

by So-Hyun Moon, Hyeon Na and A Ra Kim

Children 2026, 13(9), 1224; https://doi.org/10.3390/children13091224 - 10 Sep 2026

Abstract

Background/Objectives: Self-harm attempts among adolescents represent a major public health concern, often associated with depression, low self-esteem, and social withdrawal. While excessive smartphone use is generally linked to internalizing distress, digital engagement might play complex roles among socially isolated youth. This study examined [...] Read more.

Background/Objectives: Self-harm attempts among adolescents represent a major public health concern, often associated with depression, low self-esteem, and social withdrawal. While excessive smartphone use is generally linked to internalizing distress, digital engagement might play complex roles among socially isolated youth. This study examined factors associated with self-harm attempts among female adolescents with self-reported reclusive tendencies in South Korea, with a specific focus on evaluating the exploratory role of smartphone overdependence. Methods: Secondary data analysis was conducted on 893 female adolescents with self-reported reclusive tendencies who utilized or were admitted to crisis youth support organizations, drawn from the nationwide Survey on the Living Conditions of Users of Crisis Youth Support Organizations. Statistical procedures incorporated complex-sample descriptive statistics, Rao–Scott chi-square tests, and complex-sample hierarchical logistic regression. Results: In univariate analyses, economic status, self-esteem, self-control, depression, and parent–child relationships differed significantly according to self-harm history. In multivariable hierarchical logistic regression, higher self-esteem (OR = 0.44, p < 0.001) and positive parent–child relationships (OR = 0.57, p = 0.004) were associated with lower odds of self-harm attempts, whereas depression (OR = 2.23, p = 0.001) and lower self-control (OR = 1.40, p = 0.009) were associated with higher odds. The inclusion of smartphone overdependence in Step 3 (yielding a modest increase in explanatory power, ΔR² = 0.02) revealed that being in the smartphone overdependence risk group was associated with lower odds of self-harm attempts (OR = 0.55, p = 0.003). Conclusions: Self-harm attempts in this service-using population are strongly associated with core psychological and familial distress. The inverse multivariable association regarding smartphone overdependence is preliminary and hypothesis-generating; it may reflect statistical suppression, unmeasured confounding, or indirect digital connection among isolated youth, rather than a direct protective function. Findings apply specifically to crisis-service-using female youth and underscore the need for longitudinal research with refined clinical measures. Full article

(This article belongs to the Special Issue Factors Associated with Adolescent and Young Risk Behaviors and Intervention Measures)

23 pages, 3650 KB

Open AccessReview

Extrapolation of Adult Evidence to Pediatric Practice: Bridging the Gap in Pediatric Heart Failure Pharmacotherapy

by Adelina-Mihaela Sorescu, Cristina Isabel Viorica Ghiță, Smaranda Stoleru, Gabriela Duică, Alin Marcel Nicolescu, Eliza Elena Cinteză, Ion Fulga and Oana Andreia Coman

Children 2026, 13(9), 1223; https://doi.org/10.3390/children13091223 - 10 Sep 2026

Abstract

Heart failure (HF) is a complex clinical syndrome that represents an increasingly relevant health issue, associated with substantial morbidity and mortality in pediatric patients. While considerable therapeutic advances have transformed the prognosis of adult patients with heart failure over the past three decades, [...] Read more.

Heart failure (HF) is a complex clinical syndrome that represents an increasingly relevant health issue, associated with substantial morbidity and mortality in pediatric patients. While considerable therapeutic advances have transformed the prognosis of adult patients with heart failure over the past three decades, progress in pediatric heart failure has been considerably slower. In adult patients, large randomized controlled trials (RCTs) have established angiotensin-converting enzyme inhibitors (ACE inhibitors), beta-blockers, mineralocorticoid receptor antagonists (MRAs), angiotensin receptor-neprilysin inhibitors (ARNIs), and, more recently, sodium-glucose cotransporter-2 (SGLT2) inhibitors as the cornerstone of guideline-directed medical therapy. Evidence supporting pharmacological therapy in pediatric heart failure remains scarce and frequently inconclusive, with most available studies being limited by small sample sizes and heterogeneous patient populations. Therefore, heart failure treatment in children is mostly extrapolated from adult studies and guidelines. However, developmental differences in myocardial structure and function, neurohormonal signaling, pharmacokinetics and pharmacodynamics may substantially influence therapeutic response. In addition, the rarity and the etiological heterogeneity of pediatric HF create major methodological challenges for adequately powered clinical trials. This review compares the pharmacological management of HF in adult and pediatric populations, examines the strength of evidence for contemporary therapies and discusses the biological and methodological limitations of translating adult evidence into pediatric practice. Multicenter collaborative studies and well-designed pediatric randomized controlled trials are essential for establishing truly evidence-based pharmacological strategies for children with HF. Full article

(This article belongs to the Section Pediatric Cardiology)

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13 pages, 573 KB

Open AccessArticle

Sleep Disturbances and Their Associations with Child and Family Quality of Life in School-Aged Children Born Before 32 Weeks of Gestation: A Cross-Sectional Comparative Study

by Ercan Yılmaz, Nezihe Koker Ozer, Hatice Turgut, Erdem Topal, Ramazan Özdemir, Recep Günakın and Mehmet Aslan

Children 2026, 13(9), 1222; https://doi.org/10.3390/children13091222 - 10 Sep 2026

Abstract

Aim: To compare sleep disturbances, quality of life, and physical activity levels between school-aged children born before 32 weeks of gestation and healthy term-born peers, and to examine the associations of sleep disturbances with physical activity and quality of life in both children [...] Read more.

Aim: To compare sleep disturbances, quality of life, and physical activity levels between school-aged children born before 32 weeks of gestation and healthy term-born peers, and to examine the associations of sleep disturbances with physical activity and quality of life in both children and their parents. Methods: This cross-sectional comparative study included 55 children aged 7–8 years who were born before 32 weeks of gestation and 55 healthy term-born controls. Controls were frequency matched to the preterm group by age and sex to ensure comparable distributions of these key demographic characteristics. Sleep disturbances were assessed using the Sleep Disturbance Scale for Children (SDSC), children’s quality of life using the Pediatric Quality of Life Inventory (PedsQL), parental quality of life using the PedsQL Family Impact Module, and physical activity using the Physical Activity Questionnaire for Older Children (PAQ-C). Results: The total SDSC score was significantly higher in preterm children than in the control group (p = 0.044). Significant differences were observed particularly in the subscales assessing difficulties initiating and maintaining sleep (p = 0.007) and sleep–wake transition disorders (p = 0.019). Regarding children’s quality of life, only the emotional functioning subscale was significantly poorer in the preterm group (p = 0.002). For parental quality of life, the emotional functioning (p = 0.01) and daily activities (p = 0.04) subscales were significantly impaired, whereas physical activity levels were comparable between the groups. No significant associations were found between sleep disturbance and either children’s quality of life or physical activity in the preterm group. In multivariable analysis, children’s quality of life and total sleep disturbance score were identified as independent predictors of parental quality of life. Conclusions: School-aged children born before 32 weeks of gestation experience a greater burden of sleep problems, particularly disturbances involving sleep initiation and maintenance and the transition between sleep and wakefulness. Sleep disturbances were independently associated with poorer parental quality of life, regardless of children’s quality of life. These results emphasize the need to incorporate regular evaluation of sleep and a family-centered perspective into the long-term care of children born preterm. Full article

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

15 pages, 1203 KB

Open AccessArticle

Clinical Characteristics and Thyroid Findings in Children with Isolated Premature Adrenarche

by Sibel Aka, Seymanur Kocyigit, Saygin Abali and Serap Semiz

Children 2026, 13(9), 1221; https://doi.org/10.3390/children13091221 - 9 Sep 2026

Abstract

Objectives: Premature adrenarche (PA) is associated with accelerated adrenal maturation, but data regarding thyroid characteristics in children with isolated PA are limited. We aimed to describe the clinical features of children with idiopathic PA and investigate the relationships between thyroid function, thyroid [...] Read more.

Objectives: Premature adrenarche (PA) is associated with accelerated adrenal maturation, but data regarding thyroid characteristics in children with isolated PA are limited. We aimed to describe the clinical features of children with idiopathic PA and investigate the relationships between thyroid function, thyroid autoimmunity, and adrenal androgen secretion. Methods: This retrospective single-center study included 435 children (378 girls, 57 boys) with idiopathic PA evaluated between 2014 and 2024. Clinical, anthropometric, biochemical, and thyroid data were analyzed. Associations between adrenal and thyroid parameters were examined using correlation and group comparison analyses. Results: Girls accounted for 86.9% of the cohort. Children were generally taller than their genetic target height and frequently had excess weight. Boys exhibited higher serum dehydroepiandrosterone sulfate (DHEAS) concentrations than girls and more often met criteria for exaggerated adrenarche despite less advanced clinical androgenization. Lower birth weight (BW) was associated with higher DHEAS concentrations, and children born with low BW more frequently demonstrated exaggerated adrenarche. BW SDS showed a significant inverse correlation with DHEAS concentrations. In contrast, DHEAS concentrations were unrelated to body mass index (BMI) SDS or bone age advancement. Height SDS increased progressively with increasing BMI category in both sexes, whereas DHEAS concentrations remained comparable across weight groups. Thyroid abnormalities were identified in 8.0% of the cohort. Free thyroxine and thyroid-stimulating hormone concentrations were within the normal range in most children and showed no association with DHEAS concentrations or exaggerated adrenarche status. Although thyroid autoantibody positivity was frequent among the tested subgroup, it was not associated with adrenal androgen concentrations. Conclusions: Idiopathic PA is characterized by accelerated linear growth, frequent excess weight, and an inverse relationship between birth weight and adrenal androgen secretion. Thyroid function was not associated with adrenal androgen production within this PA cohort. The frequent thyroid autoantibody positivity observed in the selected tested subgroup should be interpreted cautiously and cannot be considered PA-specific in the absence of healthy control groups; prospective controlled studies are needed. Full article

(This article belongs to the Section Pediatric Endocrinology & Diabetes)

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17 pages, 273 KB

Open AccessArticle

Clinical Profile of First-Time Diagnosis of Autism Spectrum Disorder in School-Aged Youth

by Kimberly Burkhart, Alyssa Palumbo, Kristen Sanford, Anna Olczyk and Nori Minich

Children 2026, 13(9), 1220; https://doi.org/10.3390/children13091220 - 9 Sep 2026

Abstract

Background/Objectives: There is limited research on clinical profiles of school-aged children receiving a first-time diagnosis of autism spectrum disorder (ASD) Level 1 and mixed findings related to sex differences in phenotype. This study aimed to describe the clinical profile of school-aged children receiving [...] Read more.

Background/Objectives: There is limited research on clinical profiles of school-aged children receiving a first-time diagnosis of autism spectrum disorder (ASD) Level 1 and mixed findings related to sex differences in phenotype. This study aimed to describe the clinical profile of school-aged children receiving a first-time diagnosis of ASD Level 1, explore sex differences in phenotype by symptom severity and symptom domain profiles, and compare parent and teacher ratings on standardized measures of social, emotional, and behavioral functioning. Methods: A retrospective chart review of an ASD assessment clinic was completed. Eighty-one school-aged children were diagnosed with ASD Level 1. Measures of social, emotional, adaptive, and behavioral functioning were completed. Results: Females were significantly older at the time of diagnosis (M = 9.7 years) in comparison to males (M = 8.5 years). Additionally, over half of children diagnosed with ASD Level 1 presented with ADHD and over a third presented with an anxiety disorder. Approximately one-fourth of those diagnosed were currently taking psychotropic medication, and a substantial proportion had reported speech or language delay. Approximately half presented with food selectivity and sleep problems, with only 38% currently receiving behavioral health therapy services. Caregivers reported significantly higher internalizing symptoms and externalizing behavior on all Achenbach scales in comparison to teachers. Caregivers also reported significantly greater autism-specific social concerns. No statistically significant sex differences were found in parent or teacher ratings of domain scores. Based on caregiver reports, males demonstrated greater severity of aggressive behavior. Females displayed greater deficits in social communication and motivation based on both parent and teacher reports. Overall cognitive ability fell in the average range, while adaptive behavioral functioning was in the moderately low range. Conclusions: ASD Level 1 in school-aged children presents a distinct clinical profile marked by high rates of co-occurring conditions (ADHD and anxiety), existing academic accommodations/modifications, physician referral for evaluation, and varied symptom severity by informant type, all of which may contribute to diagnostic overshadowing and delay, especially in females. Full article

(This article belongs to the Collection Emotional and Behavioral Problems in Children and Adolescents: Assessment and Intervention)

16 pages, 2840 KB

Open AccessArticle

Universal Newborn Screening for Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency in a Safety-Net Well-Baby Nursery: A Quality Improvement Initiative

by Sheetal Sriraman, Charlotte Banayan, Sana Usmani, Saema Khandakar and Ivan Hand

Children 2026, 13(9), 1219; https://doi.org/10.3390/children13091219 - 9 Sep 2026

Abstract

Background: G6PD deficiency is among the leading causes of neonatal hyperbilirubinemia and kernicterus. Following a 2022 New York State Department of Health recommendation to test high-risk neonates, we implemented universal G6PD deficiency screening in the well-baby nursery. Objectives: We aimed to [...] Read more.

Background: G6PD deficiency is among the leading causes of neonatal hyperbilirubinemia and kernicterus. Following a 2022 New York State Department of Health recommendation to test high-risk neonates, we implemented universal G6PD deficiency screening in the well-baby nursery. Objectives: We aimed to increase the proportion of infants screened from 0% to more than 75% within 6 months and to describe the prevalence of G6PD deficiency and the early outcomes of affected neonates. Methods: This quality improvement (QI) initiative, guided by the Model for Improvement, included a cross-sectional analysis of screening yield and early neonatal outcomes. A statistical process control p-chart tracked monthly screening. Outcomes were compared between screen-positive and screen-negative infants using the Fisher exact test. Results: Screening rose from 0% to a sustained mean of 81.1%, exceeding the 75% aim. Of 580 screened neonates, 52 (9.0%) screened positive for G6PD deficiency. Screen-positive infants were more likely than screen-negative infants to undergo repeat serum bilirubin testing (38.5% vs. 19.3%; p = 0.002) and to reach a peak bilirubin above 10 mg/dL (30.8% vs. 10.2%; p < 0.001). A higher rate of readmission for phototherapy was also observed (5.8% vs. 0.9%; p = 0.028), though based on few events. Phototherapy during the birth hospitalization, IVIG, and exchange transfusion did not differ. Conclusions: Universal G6PD screening was feasibly implemented and sustained in a high-risk well-baby nursery through routine workflow changes, without additional phlebotomy. Nearly 1 in 11 screened neonates tested positive for G6PD deficiency. Full article

(This article belongs to the Section Pediatric Neonatology)

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