Editor’s Choice Articles

Background/Objectives: Socioeconomic stressors, such as financial strain, rising living costs, and perceived price burden, have gained relevance in the post-pandemic period and may adversely affect adolescent mental health. This study examined the association between subjective financial stress and symptoms of depression, anxiety, and emotional/behavioral difficulties among adolescents in Northern Italy. Methods: Data were obtained from the 2025 Corona and Psyche South Tyrol (COP-S) population survey. A total of 2554 adolescents aged 11–19 years and their parents participated; 1598 adolescents provided complete data for analyses of socioeconomic stressors (parent-reported Family Affluence Scale III, adolescent self-reported and parent proxy and self-reported burden due to price increases). Mental health outcomes included depressive symptoms (PHQ-2), generalized anxiety (SCARED-GAD), and emotional/behavioral difficulties (SDQ). Associations were assessed using chi-square tests, Kendall’s tau correlations, and two-factor ANOVA models. Results: Elevated depressive symptoms were present in 10.7% of adolescents, emotional/behavioral difficulties in 13.9%, and anxiety symptoms in 27.9% of adolescents. Female adolescents consistently showed higher symptom levels in all domains. Self-reported financial burden was the strongest and most consistent correlate of mental health problems, demonstrating small-to-moderate positive correlations with depressive symptoms (τ = 0.20, p < 0.001), emotional/behavioral difficulties (τ = 0.14, p < 0.001), and anxiety (τ = 0.25, p < 0.001). Parent-reported burden showed weaker and less consistent associations, and the Family Affluence Scale III was not significantly related to any of the mental health outcomes. ANOVA models indicated that adolescents’ own perception of financial burden significantly predicted anxiety levels in both age groups (11–14 and 15–19 years), whereas discrepancies between adolescent and parent burden perceptions were particularly relevant among younger adolescents. Conclusions: In this affluent European region, subjective financial strain, especially adolescents’ perception of burden due to rising prices, is a stronger determinant of depressive symptoms, anxiety, and psychosocial difficulties than parental burden reports or structural affluence indicators. Adolescents, especially females, appear to be particularly vulnerable. These findings underscore the importance of addressing subjective financial stress in adolescent mental health and public health strategies. Full article

Background/Objectives: School violence represents a significant concern for educational communities worldwide, affecting student well-being and academic development. While prior research has documented prevalence rates and risk factors, limited studies have examined social–cognitive factors associated with antisocial behavior specifically within vocational education contexts using integrated analytical approaches. This exploratory cross-sectional study examined social–cognitive factors—specifically self-reported attitudes about aggression norms, prosocial attitudes, and school climate perceptions—associated with violence-supportive attitudes among Greek vocational students. Methods: A cross-sectional design employed validated self-report instruments and traditional statistical methods. The sample comprised 76 vocational high school students (38.2% male; ages 14–18; response rate 75.2%) from one school in Patras, Greece. Validated instruments assessed attitudes toward interpersonal peer violence (α = 0.87), peer aggression norms across four subscales (α = 0.83–0.90), and school climate dimensions (α = 0.70–0.75). Analyses included descriptive statistics, Pearson correlations with bootstrapped confidence intervals, MANOVA for multivariate group comparisons, independent samples t-tests, propensity score matching for urban–rural comparisons, polynomial regression for developmental patterns, and path analysis for theoretical model testing. Results: Strong associations emerged between perceived school-level and individual-level aggression norms (r = 0.80, p < 0.001, 95% CI [0.71, 0.87]), representing one of the strongest relationships documented in school violence research. Violence-supportive attitudes demonstrated inverse associations with prosocial alternative norms (r = −0.37, p < 0.001, 95% CI [−0.55, −0.16]). Significant gender differences emerged for teacher–student relationships (d = −0.78, p = 0.002), with females reporting substantially more positive perceptions. Propensity-matched urban students demonstrated higher aggression norm endorsement compared to rural students across multiple indicators (d = 0.61–0.78, all p < 0.020). Polynomial regression revealed curvilinear developmental patterns with optimal teacher relationship quality during mid-adolescence (ages 15–16). Path analysis supported a sequential association model wherein school-level norms related to individual attitudes through prosocial alternative beliefs (indirect effect β = −0.22, p = 0.002, 95% CI [−0.34, −0.11]). Conclusions: This preliminary investigation identified social–cognitive factors—particularly normative beliefs about aggression at both individual and environmental levels—as strongly associated with violence-supportive attitudes in Greek vocational education. The exceptionally strong alignment between school-level and individual-level aggression norms (r = 0.80) suggests that environmental normative contexts may play a more substantial role in attitude formation than previously recognized in this educational setting. Gender and urban–rural differences indicate meaningful heterogeneity requiring differentiated approaches. Future research should employ longitudinal designs with multi-informant assessment and larger multi-site samples to establish temporal precedence, reduce method variance, and test causal hypotheses regarding relationships between normative beliefs and behavioral outcomes. Full article

Wearable technology is rapidly evolving, with increasing efforts to integrate a wide range of sensors capable of capturing real-time physiological and behavioral health data from users. These devices have shown significant promise in supporting health monitoring and promoting well-being by providing continuous, objective feedback based on data analytics. Importantly, they enable early detection of potential health issues, allowing for timely intervention and more personalized healthcare. While a wide variety of commercially available wearable devices are designed for adults—tracking metrics such as physical activity, heart rate, body temperature, electrocardiograms (ECG), and oxygen saturation—there remains a notable gap in the availability and development of wearable technologies specifically tailored to the pediatric population. This narrative review paper focuses on non-invasive wearable technologies developed for individuals under the age of 18, with an emphasis on health-related applications. We examine the current landscape of pediatric wearable research, including devices aimed at monitoring developmental progress and chronic health conditions. Particular attention is given to the limited research on wearables for younger children, where physiological and developmental differences pose additional challenges. Furthermore, we explore emerging applications, identify key barriers to adoption, and discuss opportunities for future development, including improvements in design, data privacy, and age-appropriate functionality. Full article

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

Background/Objectives: Legislative changes in educational systems have influenced how student learning is understood and promoted. In physical education (PE), there has been a shift from behaviorist models to more holistic approaches. In this context, physical literacy (PL) is presented as an emerging pedagogical model in school PE, aimed at fostering students’ motor competence in a safe, efficient, and meaningful way. The aim of this study is to analyze the origins, foundations, methodological elements, and educational value of PL, highlighting its potential to promote holistic and inclusive learning as the basis for an emerging PL model. Methods: A narrative review was conducted through a literature search in the Web of Science, PubMed, Scopus, and SportDiscus databases up to June 2025, focusing on scientific literature related to PL and PE. The analysis included its historical background, philosophical and theoretical foundations, and the key methodological elements and interventions that support its use as a pedagogical model. Results/Discussion: The findings indicate that the PL model can be grounded in key principles, such as student autonomy, teacher training, connection with the environment, inclusion, and collaboration. Additionally, motivation, enjoyment, creativity, and continuous assessment are identified as essential components for effective implementation. Moreover, this model not only guides and supports teachers in the field of PL but also promotes comprehensive benefits for students at the physical, cognitive, affective, and social levels, while encouraging increased levels of physical activity (PA). Conclusions: PL is understood as a dynamic and lifelong process that should be cultivated from early childhood to encourage sustained and active participation in PA. As a pedagogical model, PL represents an effective tool to enhance student learning and well-being in PE classes. Full article

Background: Anxiety and depression are among the most common mental health disorders affecting adolescents worldwide. Skipping breakfast is a prevalent dietary behaviour linked to inadequate nutrient intake, which may contribute to the development or exacerbation of mental health issues in this age group. Despite growing interest, a comprehensive synthesis of evidence on the association between breakfast omission and adolescent anxiety or depression remains limited. Objectives: This scoping review aimed to synthesise existing research on the association between skipping breakfast and the risk of anxiety and/or depression in adolescents. Methods: A systematic scoping review was conducted using the Joanna Briggs Institute (JBI) methodological framework. A comprehensive search of PubMed, ProQuest, and EBSCOhost databases was performed, focusing on studies published in English between 2014 and 2024. Keywords included “skipping breakfast,” “risk,” “anxiety,” “depression,” and “adolescen*.” Studies were screened and selected based on predefined inclusion and exclusion criteria. Results: Out of 1671 initially identified studies, 12 met the inclusion criteria. The majority were cross-sectional (n = 9), with one prospective cohort study, one secondary data analysis, and one systematic review with meta-analysis. Most studies reported a significant association between breakfast skipping and increased risk of anxiety and depression in adolescents. Only one study reported no significant relationship between the two variables. Conclusions: This review underscores a consistent association between skipping breakfast and elevated risk of anxiety and depression among adolescents. While causality remains to be established, breakfast omission emerges as a modifiable lifestyle factor with potential public health implications. These findings highlight the need for prospective research, as well as the importance of community- and school-based health promotion strategies that advocate for regular and nutritious breakfast consumption as part of broader mental health support efforts. Full article

Obstructive sleep apnea syndrome (OSAS) in children and adolescents is a prevalent and multifactorial disorder associated with significant short- and long-term health consequences. While adenotonsillectomy (AT) remains the first-line treatment, a substantial proportion of patients—especially those with obesity, craniofacial anomalies, or comorbid conditions—exhibit persistent or recurrent symptoms, underscoring the need for individualized and multimodal approaches. This review provides an updated and comprehensive overview of current and emerging treatments for pediatric OSAS, with a focus on both surgical and non-surgical options, including pharmacological, orthodontic, and myofunctional therapies. A narrative synthesis of recent literature was conducted, including systematic reviews, randomized controlled trials, and large cohort studies published in the last 10 years. The review emphasizes evidence-based indications, mechanisms of action, efficacy outcomes, safety profiles, and limitations of each therapeutic modality. Adjunctive and alternative treatments such as rapid maxillary expansion, mandibular advancement devices, myofunctional therapy, intranasal corticosteroids, leukotriene receptor antagonists, and hypoglossal nerve stimulation show promising results in selected patient populations. Personalized treatment plans based on anatomical, functional, and developmental characteristics are essential to optimize outcomes. Combination therapies appear particularly effective in children with residual disease after AT or with specific phenotypes such as Down syndrome or maxillary constriction. Pediatric OSAS requires a tailored, multidisciplinary approach that evolves with the child’s growth and clinical profile. Understanding the full spectrum of available therapies allows clinicians to move beyond a one-size-fits-all model, offering more precise and durable treatment pathways. Emerging strategies may further redefine the therapeutic landscape in the coming years. Full article

Background/Objectives: Sensory Processing Sensitivity (SPS), particularly its aesthetic subcomponent (Aesthetic Sensitivity; AES), has been linked to individual differences in emotional processing. This study examined whether parental visual attention to emotional facial expressions predicts corresponding attentional patterns in their children, and whether this intergenerational concordance is mediated by child AES and moderated by child empathy. Methods: A sample of 124 Greek Cypriot parent–child dyads (children aged 7–12 years) participated in an eye-tracking experiment. Both parents and children viewed static emotional facial expressions (angry, sad, fearful, happy). Parents also completed questionnaires assessing their child’s SPS, empathy (cognitive and affective), and emotional functioning. Regression analyses and moderated mediation models were employed to explore associations between parental and child gaze patterns. Results: Children’s fixation on angry eyes was significantly predicted by parental fixation duration on the same region, as well as by child AES and empathy levels. Moderated mediation analyses revealed that the association between parent and child gaze to angry eyes was significantly mediated by child AES. However, neither cognitive nor affective empathy significantly moderated this mediation effect. Conclusions: Findings suggest that child AES plays a key mediating role in the intergenerational transmission of attentional biases to emotional stimuli. While empathy was independently associated with children’s gaze behavior, it did not moderate the AES-mediated pathway. These results highlight the importance of trait-level child sensitivity in shaping shared emotional attention patterns within families. Full article

Background: Music therapy and music-based interventions are increasingly recognized as valuable adjuncts in pediatric neurorehabilitation, leveraging rhythm, singing, instrument playing, and improvisation to support children with neurological disabilities. Objective/Method: This narrative review synthesizes evidence from studies published between 2000 and 2025, focusing on children aged 3 to 18 years receiving neurorehabilitation. Results: The literature demonstrates that music therapy and music-based interventions can improve motor function—particularly gait and upper limb coordination—as well as speech production, while also reducing anxiety and enhancing participation. Techniques such as rhythmic auditory stimulation and melodic intonation therapy have shown promise in targeting movement and communication deficits. Music therapy is further associated with positive effects on vital signs and emotional well-being, supporting its role in holistic care. Neurobiological findings suggest that music-based interventions may promote neuroplasticity and strengthen brain connectivity, though high-quality mechanistic studies remain limited. Conclusions: Despite methodological heterogeneity and small sample sizes in the current literature, the overall evidence supports music therapy and music-based interventions as accessible, cost-effective, and child-centered complements to standard neurorehabilitation. Future research should prioritize rigorous clinical trials and neurobiological investigations to clarify mechanisms and optimize therapeutic protocols. Full article

Background: Adverse childhood experiences (ACEs) such as abuse (defined as emotional, physical, or sexual abuse without distinguishing type or severity) have long been linked to mental health challenges in adulthood. However, less is known about how these effects differ by sex/gender in global samples, particularly using large-scale, multi-country panel data. Objectives: To examine whether the long-term association between childhood abuse and changes in depressive symptoms during adulthood differ between men and women, after adjusting for demographic and socioeconomic factors. Methods: We conducted a secondary analysis of Waves 1 and 2 of the Global Flourishing Study (GFS), a longitudinal panel study covering 22 diverse countries. The sample included adult participants with complete data on childhood abuse (yes/no); depression at baseline and follow-up; sex/gender; and relevant covariates (age; education; marital status; immigration status; smoking status; and employment). Depression was measured using a two-item scale. Multi-group structural equation models were used to test the effect of ACE on changes in depression over time where groups were defined based on sex/gender. Results: Overall, childhood abuse was associated with a statistically significant increase in depression scores between Wave 1 and Wave 2. This association was significant among women but not among men. Conclusions: Our findings suggest that the mental health consequences of childhood abuse extend into adulthood and disproportionately affect women. These sex/gender differences may reflect variations in stress processing; coping; and social roles. Interventions addressing early adversity may need to be tailored to recognize and respond to such sex/gender-specific vulnerabilities. Full article

Infant motor development has traditionally been studied through child-centered frameworks that often overlook the vital role parents play in shaping early outcomes. This paper provides a renewed ecological approach, foregrounding parental perspectives—knowledge, beliefs, attitudes, theories, and expectations—and examining how they directly and indirectly guide infants’ motor trajectories. Drawing on cross-cultural evidence, we illustrate how differences in parental priorities and caregiving behaviors can either accelerate or delay the emergence of crucial motor skills. We also highlight the reciprocal relationship between parent and child: while parental views shape caregiving practices, children’s developing abilities and behaviors can, in turn, alter their parents’ perspectives. Building on existing theories, including Bronfenbrenner’s ecological systems theory and dynamic systems theory, our integrated model situates the parent–child dyad within broader socioeconomic, cultural, and environmental contexts. This model shows the dynamic, ever-evolving interplay between parents and children and demonstrates the importance of aligning parental cognition with targeted interventions to optimize motor development. By examining how cultural norms, individual experiences, and contextual factors converge, this paper offers both a theoretical framework and practical implications for supporting infants’ growth. This paper will inform future research by encouraging parent-focused developmental studies and guiding practitioners to design culturally informed interventions in the field of motor development. Full article

Background: Emotional and behavioral difficulties are prevalent among children and adolescents referred for psychiatric care. This study examined how these challenges vary across age and gender, including regulatory functioning. It also explored whether emotion regulation mediates the relationship between depressive symptoms and internalizing problems and whether this mediating effect is moderated by gender and age. Methods: A cross-sectional study was conducted among 661 children and adolescents (aged 9–17 years) referred to a psychiatric outpatient clinic. Participants completed self-report questionnaires assessing depressive symptoms (MFQ-C), anxiety (SCARED-C), emotion regulation (DERS), and emotional/behavioral problems (SDQ). Statistical analyses included group comparisons and moderated mediation modeling using SPSS 27. Results: Adolescents aged 15–17 years reported significantly higher levels of depressive symptoms, emotion regulation difficulties, and anxiety-related symptoms compared to younger participants. Girls exhibited higher levels of internalizing symptoms and greater emotion regulation difficulties than boys, whereas boys showed more conduct problems. A significant gender × age interaction was found for depressive symptoms. Depressive symptoms indirectly affected internalizing problems through emotion regulation, with the strongest effect among adolescent girls. Conclusions: The findings emphasize the need for developmentally tailored assessment and intervention strategies in youth psychiatric care. Emotion regulation emerged as a central mechanism linking depressive symptoms to internalizing difficulties, particularly in older adolescent girls, supporting the design of targeted interventions to reduce emotional distress. Full article

This overview explores the complex relationship between environmental factors, particularly obesity, and the timing of puberty, with a focus on how hormonal and genetic interactions are influenced by external conditions. Puberty (gonadarche) is characterised by the activation of the hypothalamic–pituitary–gonadal (HPG) axis. The onset and progression of puberty vary significantly among individuals, primarily due to genetic factors, with key genes like kisspeptin 1 (KISS1) and makorin ring finger protein 3 (MKRN3) playing a crucial role. Cohesively, this paper emphasises that environmental factors, particularly obesity and exposure to endocrine-disrupting chemicals (EDCs), have become significant influences on the timing of puberty. Childhood obesity has risen significantly in recent decades and the age of pubertal onset has declined over the same period. Obesity greatly disrupts hormone regulation in pre-pubertal children. Leptin accelerates the onset of puberty in girls but not in boys. The underlying mechanism is proposed to be the increase in Kiss1/GnRH signalling. On the contrary, excess leptin in boys suppresses testosterone production by increasing oestrogen conversion. Low adiponectin in obese girls may contribute to earlier puberty due to a reduced inhibition of Kiss1/GnRH signalling. Low adiponectin in boys is linked to delayed puberty due to its role in maintaining insulin sensitivity and testosterone production. Hyperinsulinemia influences pubertal timing through central and peripheral mechanisms. Insulin acting synergistically with leptin promotes the earlier onset of puberty in girls but not in boys. The effects of exposure to certain EDCs—mostly obesogenic chemicals that mimic the action of natural hormones—on the timing of puberty remain unclear; hence, further research on this topic is needed. Addressing and preventing obesity in children could potentially mitigate these alterations in pubertal timing. Full article

Objective: This study aimed to investigate the effect of relative age on gross motor coordination (GMC) development, taking into account biological maturity and sex. Methods: 729 participants aged 10 to 16 years completed three GMC tests newly designed to minimize the potentially confounding effects of physical fitness. The tests included a Hand-Foot coordination test, Dribbling-Targeting test (DT test), and a T balance and agility test (T test). Relative age was determined using birth quartiles: BQ₁ (January–March); BQ₂ (April–June); BQ₃ (July–September); and BQ₄ (October–December). Regarding biological maturity, the participants were categorized according to their estimated peak height velocity (pre- and post-PHV). Results: Relative age did not significantly impact the overall GMC score. In contrast, biological maturity emerged as a significant determinant of GMC, with post-PHV participants outperforming their pre-PHV counterparts in the three tests (p < 0.001). The results also showed a significant main effect of sex in the DT and T tests, i.e., in tasks involving dynamic coordination and agility, with boys consistently outperforming girls (p < 0.001). Significant biological maturity × sex interactions in the DT and T tests also indicated an advantage of boys over girls with advancing biological maturity (p < 0.05). Conclusions: these findings highlight the importance of considering biological maturity and sex rather than relative age in GMC development from childhood through adolescence. Full article

Supracondylar humeral fractures are the most common type of elbow fractures in children. The treatment methods vary depending on the type of fracture (Gartland classification), which can be conservative or surgical. There is no clear consensus or guidelines to dictate the treatment of complicated supracondylar humeral fractures (Gartland types II and III). Gartland type II and III fractures are most frequently treated with closed reduction and percutaneous Kirchner-wire pinning or open reduction with K-wire pinning, depending on the degree of displacement and the orthopedic surgeon’s preference. Most studies recommend avoiding open reduction because of prolonged hospitalization and higher rates of complications. Orthopedic surgeons have different opinions regarding the Kirschner pin placement technique. Studies suggest that only lateral pinning is safe and effective, but medial and lateral pinning is proven to give more stability; there is always a risk of iatrogenic ulnar nerve damage during surgery. Modern treatment of supracondylar humeral fracture in children should focus on minimally invasive techniques and avoid open reduction, when possible, to ensure the best outcome for the patients. This scoping review’s purpose is to gather the available information on the topic in one place and to underline the lack of clear protocols. Full article

Pulmonary disfunction is frequent in repaired congenital heart diseases. Both pulmonary regurgitation and pulmonary stenosis are possible complications over time. In the past, the surgical approach was the only feasible management but exposed the patient to a redo-surgery with its consequent risks. Nowadays, the development of novel devices and techniques has made possible a transcatheter pulmonary valve implantation. The Melody Transcatheter Pulmonary Valve (TPV) (Medtronic Inc., Minneapolis, MN, USA) and the Edwards Sapien XT and S3 Transcatheter Heart Valve (Edwards Lifesciences LLC, Irvine, CA, USA) are balloon-expandable valvular bioprostheses approved for pulmonary position. Venus P-Valve (Venus Medtech, Shanghai, China) and Harmony TPV (Medtronic Inc., Minneapolis, MN, USA) are self-expandable pulmonary valves. Alterra Adaptive Prestent (Edwards Lifesciences LLC, Irvine, CA, USA) is an hourglass self-expandable stent that reduces the size of large right ventricular outflow tracts, creating a suitable landing zone to implant an Edwards Sapien S3 THV 29 mm. Novel stents and percutaneous valves are being planned and experimented with to widen the field of transcatheter approach. The aim of this review is to describe both the current approaches, strategies, and techniques as well as the future perspective to deal with the patients with significant pulmonary stenosis and/or regurgitation. Full article

Background/Objectives: Developmental dysgraphia, a graphomotor difficulty affecting handwriting, significantly impacts children’s academic performance, emotional well-being, and overall development. Over the past two decades, intervention strategies have transitioned from traditional task-oriented motor training to more innovative, technology-driven, and holistic approaches. This paper aims to synthesise key developments in dysgraphia interventions, categorising them into distinct thematic areas and evaluating their effectiveness in improving handwriting outcomes. Methods: A review of 12 key studies was conducted, classifying interventions into four primary categories: (1) task-oriented and sensorimotor-based interventions; (2) technology-assisted solutions; (3) self-regulated and individualised approaches; and (4) integrated methodologies. Each study was analysed based on its methodology, intervention design, target population, and reported outcomes to assess the effectiveness and feasibility of different approaches. Results: The findings indicate significant advancements in handwriting interventions, with technology-assisted and integrated approaches demonstrating promising results in engagement, accessibility, and skill development. However, challenges remain in terms of scalability, cultural adaptability, and long-term sustainability. While self-regulated and individualised approaches offer tailored support, their effectiveness depends on factors such as learner motivation and instructional design. Conclusions: Despite progress in intervention strategies for developmental dysgraphia, further research is needed to optimise hybrid models that combine the strengths of multiple approaches. A more inclusive and adaptable framework is required to ensure equitable access to effective handwriting interventions. This study highlights the need for continued collaboration among researchers, educators, and policymakers to advance evidence-based interventions, fostering equitable learning opportunities for all children with dysgraphia. Full article

Background: Obsessive–compulsive disorder (OCD) in youth commonly co-occurs with other affective disorders (e.g., anxiety, depression). Exposure and response prevention (ERP) is the front-line treatment for OCD but may require significant adaptation to treat co-occurring symptoms or complex comorbidity patterns. Preliminary evidence suggests that the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A) are effective in reducing OCD symptoms. Still, it is not yet known if the UP-C/A are comparably effective to treat OCD as they are for anxiety and depression, the disorders for which there is the most robust empirical support. Methods: This study compared trajectories of OCD, anxiety, and depression symptom change among 388 youth who received UP-C/A treatment (M = 15 sessions) at a university-based research clinic. We also examined whether youth with (n = 60) and without (n = 328) an OCD diagnosis demonstrated comparable improvements in anxiety, depression, and transdiagnostic treatment targets (i.e., anxiety sensitivity, cognitive flexibility, and distress tolerance). Results: OCD symptoms improved at a slower rate than anxiety and depression symptoms during the first half of UP-C/A treatment but at a comparable rate to anxiety and depression symptoms during the second half of treatment. Youth with and without OCD exhibited comparable improvements in anxiety, depression, anxiety sensitivity, cognitive flexibility, and distress tolerance across the treatment course. Conclusions: Findings support the efficacy of UP-C/A treatment for co-occurring OCD and affective disorders but suggest that initiating exposure earlier in the treatment course may confer additional benefits. Full article

Low social affiliation has been described as a phenotypic marker of antisocial behaviors by disrupting children’s initiation and enjoyment of positive physical and emotional connections with others. Laboratory studies have shown that, in early childhood, low social affiliation rates are preceded by lower attention to faces. In addition, while low social affiliation has also been associated with behavioral outcomes when accounting for parenting influences, the effect that parental environmental sensitivity may have on contributing to the link between emotional processing early in life and later behavioral manifestations associated with antisocial behavior is currently unknown. Objectives: The present eye-tracking study aims to delineate the potential contribution of parental Sensory Processing Sensitivity (SPS) to the link between children’s rates of social affiliation and their attentional patterns in response to emotional faces. Methods: For the needs of this study, children performed a lab-based, computerized facial processing task (N = 153; Mage = 9.97; SDage = 1.28; 48.8% females). In addition, one of the children’s parents completed questionnaires for their children’s and their own behavior (N = 153; Mage = 40.9; SDage = 4.85; 87.7% females). Results: The results underline the contributing role of parental SPS on the associations between social affiliation and visual scanning when viewing angry emotional faces. In particular, children with low rates of social affiliation spent significantly more time fixating on the mouth regions of angry faces only when their parents had higher SPS. Conclusions: This study unveils the possibility for the contextual influence of parental environmental sensitivity on the early emotional processing mechanisms in children with low rates of social affiliation. These findings suggest that interventions aimed at improving emotional processing in children at risk for antisocial behavior should consider parental SPS as a contributing factor. Tailoring parent-based interventions to address how highly sensitive parents interpret and respond to emotional challenges may reduce children’s attentional biases to threats and support healthier socioemotional development. Full article

Background: Indocyanine green (ICG) fluorescence imaging has revolutionized pediatric surgery by enhancing precision, safety, and outcomes across various specialties. In recent years, its use has spread through the framework of pediatric surgery, where its ability to illuminate anatomical structures and pathological conditions has improved surgical outcomes. Methods: We conducted a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search was performed using the term “Indocyanine green” in all fields, including papers about pediatric patients (aged 0–18 years) published between January 2014 and July 2024. Results: This review systematically explores ICG applications, dosing regimens, timing of administration, and integration into modern surgical technologies, including robotics and minimally invasive platforms. ICG resulted in an excellent safety profile and enables the real-time visualization of anatomical structures and pathological conditions, proving invaluable in pediatric cases characterized by smaller anatomical dimensions and congenital anomalies. Conclusions: This review highlights ICG fluorescence imaging as an indispensable tool in pediatric surgery, offering transformative potential for improving surgical outcomes and patient safety. Despite its advantages, it is necessary to standardize dosing and timing protocols to maximize its utility. The aim of this review is to explore the various applications of ICG in pediatric surgery, report the dosage and administration times across different surgical fields, and establish best practices to guide its future use. Full article

Necrotizing enterocolitis remains one of the most severe gastrointestinal diseases in neonates, particularly affecting preterm infants. It is characterized by intestinal inflammation and necrosis, with significant morbidity and mortality despite advancements in neonatal care. Recent advancements in artificial intelligence (AI) and machine learning (ML) have shown potential in improving NEC prediction, early diagnosis, and management. A systematic search was conducted across multiple databases to explore the application of AI and ML in predicting NEC risk, diagnosing the condition at early stages, and optimizing treatment strategies.AI-based models demonstrated enhanced accuracy in NEC risk stratification compared to traditional clinical approaches. Machine learning algorithms identified novel biomarkers associated with disease onset and severity. Additionally, deep learning applied to medical imaging improved NEC diagnosis by detecting abnormalities earlier than conventional methods. The integration of AI and ML in NEC research provides promising insights into patient-specific risk assessment. However, challenges such as data heterogeneity, model interpretability, and the need for large-scale validation studies remain. Future research should focus on translating AI-driven findings into clinical practice, ensuring ethical considerations and regulatory compliance. Full article

Background/Objectives: Growth in childhood and adolescence is influenced by a complex interaction of genetic, environmental, and hormonal factors, with growth hormone (GH) and insulin-like growth factor 1 (IGF-1) playing crucial roles in linear growth and development. However, chronic inflammation, often detected in situations like inflammatory bowel disease and juvenile idiopathic arthritis, can significantly disrupt the GH/IGF-1 axis, causing a relevant growth impairment. Methods: We conducted a retrospective review focusing on the role of cytokines in the GH-IGF-1 axis and growth. Results: Inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-6 have been shown to contribute to GH resistance through an array of mechanisms that involve the downregulation of GH receptors and alterations in IGF-1 metabolism. This disruption negatively impacts the growth plate, particularly by impairing chondrocyte proliferation and differentiation, which are essential for proper bone elongation. This review delves into the intricate relationship among growth, chronic inflammation, and GH-IGF-1 axis, emphasizing the contribution of inflammatory cytokines in modulating GH signaling. It also highlights how cytokines can interfere with the molecular pathways that regulate skeletal growth, ultimately leading to growth disturbances in children suffering from chronic inflammatory diseases. Conclusions: The findings underscore the importance of controlling inflammation in affected individuals to mitigate its detrimental effects on growth and ensure that children may reach their growth full potential. Full article

Objectives: Early difficulties in emotion regulation are associated with psychopathological, broader social, and developmental outcomes, underscoring the need for robust assessment tools at a young age. However, most of the existing instruments for preschoolers measure emotion regulation in general, without focusing on specific emotion regulation strategies. This study addresses a critical gap by validating a Dutch version of the Early Emotion Regulation Behavior Questionnaire (EERBQ), enabling researchers and practitioners to assess preschoolers’ emotion regulation strategies in both positive- as well as negative-emotion-eliciting situations outside of laboratory settings. Methods: Through a rigorous back-translation process, the parental questionnaire was adapted into Dutch (EERBQ-Dutch) and subsequently validated with a sample of 299 Dutch-speaking caregivers of typically developing 2–7-year-old children. The test underwent psychometric analysis including inter-item correlations, item–total correlations, test–retest reliability, and confirmatory factor analysis. Finally, potential sociodemographic predictors (i.e., age, sex, and socioeconomic status (SES)) of specific emotion regulation strategies were investigated. Results: Psychometric analyses demonstrated strong reliability and validity, and a factor structure consistent with the original English questionnaire. Age and sex were found to be significant predictors of certain emotion regulation strategies, with more proficient use of adaptive emotion regulation strategies over time and girls employing more Verbal Help-Seeking and less Physical Venting and Reactivity compared to boys. SES only contributed to Emotional Reactivity with a higher SES predicting more Reactivity. Conclusions: Our findings support the EERBQ-Dutch as a reliable and culturally appropriate instrument for assessing early emotion regulation and provide insight into key predictors of emotion regulation strategies. Full article

Lennox–Gastaut syndrome (LGS) is a severe childhood-onset developmental and epileptic encephalopathy characterized by multiple drug-resistant seizure types, cognitive impairment, and distinctive electroencephalographic patterns. Current treatments primarily focus on symptom management through antiseizure medications (ASMs), dietary therapy, epilepsy surgery, and neuromodulation, but often fail to address the underlying pathophysiology or improve cognitive outcomes. As genetic causes are identified in 30–40% of LGS cases, precision therapeutics targeting specific molecular mechanisms are emerging as promising disease-modifying approaches. This narrative review explores precision therapeutic strategies for LGS based on molecular pathophysiology, including channelopathies (SCN2A, SCN8A, KCNQ2, KCNA2, KCNT1, CACNA1A), receptor and ligand dysfunction (GABA/glutamate systems), cell signaling abnormalities (mTOR pathway), synaptopathies (STXBP1, IQSEC2, DNM1), epigenetic dysregulation (CHD2), and CDKL5 deficiency disorder. Treatment modalities discussed include traditional ASMs, dietary therapy, targeted pharmacotherapy, antisense oligonucleotides, gene therapy, and the repurposing of existing medications with mechanism-specific effects. Early intervention with precision therapeutics may not only improve seizure control but could also potentially prevent progression to LGS in susceptible populations. Future directions include developing computable phenotypes for accurate diagnosis, refining molecular subgrouping, enhancing drug development, advancing gene-based therapies, personalizing neuromodulation, implementing adaptive clinical trial designs, and ensuring equitable access to precision therapeutic approaches. While significant challenges remain, integrating biological insights with innovative clinical strategies offers new hope for transforming LGS treatment from symptomatic management to targeted disease modification. Full article

Background/Objectives: One of the metabolic complications of obesity is known as Metabolic Syndrome (MetS). This narrative review aims to synthesize current research on MetS in young populations, identify knowledge gaps, and guide future studies and funding priorities. It provides evidence-based insights into screening, diagnosis, and treatment, offering practical guidance for healthcare professionals. Methods: A comprehensive search of the literature was conducted to identify relevant studies on obesity in MetS in PubMed and Google Academic electronic database. The search was performed using a combination of “obesity”, “complications”, “metabolic syndrome”, “children”, and “adolescents” keywords. Studies were selected based on predefined inclusion and exclusion criteria to ensure relevance and methodological rigor. Results: The lack of universally accepted diagnostic criteria for MetS in children has led to inconsistencies in its definition across medical literature. Irrespective of the chosen diagnostic approach, the prevalence of MetS in children and adolescents has exhibited a concurrent rise with the increasing rates of obesity in this age group. The pathophysiology of MetS remains incompletely understood, with ongoing discussions on the interplay of genetic, epigenetic, environmental, dietary, and lifestyle factors. Screening for MetS is recommended for overweight and obese children. Conclusions: Establishing global, consensus-driven criteria that account for ethnicity, gender, and age would enhance diagnostic accuracy and treatment approaches. The prevention of excessive weight among children and adolescents stands as a paramount objective within modern society’s healthcare system. Considering the complexity of the disease and the treatment, the team must be multidisciplinary. Full article

Background: Expanded Newborn Screening (ENS) allows the early identification of many inherited metabolic diseases (IMDs) for which timely treatment can modify the natural history. For most IMDs, diagnosis by ENS is pre-clinical. However, clinical symptoms may emerge for certain conditions before screening results become available. Methods: We describe six cases of patients with early-onset IMDs born between 2013 and 2023, who were admitted or transferred to Sant’Orsola University Hospital in Bologna (Italy). Results: Over the study period, 379,013 newborns underwent ENS in the Italian region of Emilia-Romagna. Excluding cases of congenital hypothyroidism, pre-clinical diagnoses from ENS were 410. In addition, six cases of IMD presented with early-onset clinical symptomatology, an antecedent to the outcome of newborn screening (incidence over 11 years of 1.58 cases per 100,000 infants). Among these patients, three were diagnosed with Urea Cycle Disorders (UCDs)—two with Citrullinemia type I (CIT1) and one with Argininosuccinic Acidemia (ASA); two were diagnosed with Methylmalonic Acidemia (MMA); and one was found to have Medium-Chain Acyl-CoA Dehydrogenase Deficiency (MCADD). Conclusions: Our 11-year experience with ENS has shown that clinical onset can occur between the second and fourth day of life, though rare. Even if dried blood spot (DBS) collection was performed 24–48 h after birth, the time required for sample transportation and processing would still delay result availability, making early intervention unlikely. Therefore, our experience supports performing ENS at 48–72 h, as currently implemented in Italy, while also highlighting the advantages and limitations of earlier screening. Full article

Background/Objectives: Some children with medical complexity (CMC) require home nursing (HN) to maintain their health, but many families have difficulty staffing approved HN hours. Little is known about the relationship between understaffed HN, the acute care encounter rate, and family wellbeing. This study examined the association between understaffed HN, acute care encounters, and family wellbeing among CMC. Methods: We completed a cross-sectional survey study of caregivers of CMC age 0–17 years at a children’s hospital in the Midwest US. The primary predictors were the proportion of staffed to approved HN hours and the acute care rate. The primary outcome was family wellbeing, measured as parental stress, family impact, interpersonal support, parental empowerment, and financial hardship. General linear models were used to model continuous family wellbeing outcomes. Poisson models were used to calculate the financial hardship summed score ([0–4]). Results: Receipt of <50% of approved HN hours was associated with family financial hardship in adjusted analyses. Total family impact and health-related quality of life (HRQL) scores were associated with the acute care rate, with more positive scores among CMC within the middle tertile for the acute care rate compared to the lowest tertile. There was no association between HN staffing and family wellbeing, or between acute care rate and family financial hardship. Conclusions: High levels of financial hardship were significantly associated with understaffed HN hours. Family impact and parental HRQL were associated with the acute care rate. Access to HN services carries potential family-level and system-level benefits for this complex and high acuity pediatric population. Full article

Background/Objectives: Emotional regulation and attention are markedly underdeveloped in institutionalized children (IC) relative to non-institutionalized children (NIC). Caregivers in temporary institutional settings tend to exhibit contingency-responsive behaviors with limited affective engagement, which may restrict optimal socio-emotional development. Despite the critical role that sleep routines play in child development, their association with emotional regulation and attention in the context of institutionalization remains insufficiently explored. The present study aimed to assess the impact of institutionalization on emotional regulation, attention, and sleep hygiene in childhood, as well as to investigate whether sleep mediates the relationship between emotional regulation and attention. Methods: A total of 110 children aged 7 to 11 years (N = 55 IC; N = 55 NIC) were assessed using the Emotion Regulation Checklist (ERC), the Cancellation Test (Toulouse-Piéron), and the Children’s Chronotype Questionnaire. Results: Regression analyses and parametric tests revealed significant differences between IC and NIC groups. IC exhibited lower emotional regulation (β = 8.018, p < 0.05) and poorer attention (β = 3.818, p < 0.05) compared with NIC. Additionally, the MidSleep Point (MSP) was significantly different between groups, with NIC demonstrating shorter sleep periods (β = −1158.545, p < 0.05), contrary to expectations. Conclusions: These findings suggest that prolonged institutionalization impairs socio-emotional development, with downstream effects on cognitive functioning, particularly attention. While differences in sleep routines between IC and NIC were observed, sleep did not appear to directly mediate the relationship between emotional regulation and attention, nor did it present a primary risk factor compared with the broader developmental challenges associated with institutional care. Full article

The completion of the Human Genome Project in 2003 has led to significant advances in patient care in medicine, particularly in diagnosing and managing genetic diseases and cancer. In the realm of genetic diseases, approximately 15% of critically ill infants born in the U.S.A. are diagnosed with genetic disorders, which comprise a significant cause of mortality in neonatal and pediatric intensive care units. The introduction of rapid whole-genome sequencing (rWGS) as a first-tier test in critically ill children with suspected, undiagnosed genetic diseases is a breakthrough in the diagnosis and subsequent clinical management of such infants and older children in intensive care units. Rapid genome sequencing is currently being used clinically in the USA, the UK, the Netherlands, Sweden, and Australia, among other countries. This review is intended for students and clinical practitioners, including non-experts in genetics, for whom it provides a historical background and a chronological review of the relevant published literature for the progression of pediatric diagnostic genomic sequencing leading to the development of pediatric rWGS in critically ill infants and older children with suspected but undiagnosed genetic diseases. Factors that will help to develop rWGS as a clinical test in critically ill infants and the limitations are briefly discussed, including an evaluation of the clinical utility and accessibility of genetic testing, education for parents and providers, cost-effectiveness, ethical challenges, consent issues, secondary findings, data privacy concerns, false-positive and false-negative results, challenges in variant interpretation, costs and reimbursement, the limited availability of genetic counselors, and the development of evidence-based guidelines, which would all need to be addressed to facilitate the implementation of pediatric genomic sequencing in an effective widespread manner in the era of precision medicine. Full article

Cardiovascular magnetic resonance (CMR) imaging is essential for the management of congenital heart disease (CHD), due to the ability to perform anatomic and physiologic assessments of patients. However, CMR scans can be time-consuming to perform and analyze, creating roadblocks to broader use of CMR in CHD. Recent publications have shown artificial intelligence (AI) has the potential to increase efficiency, improve image quality, and reduce errors. This review examines the use of AI techniques to improve CMR in CHD, by focusing on deep learning techniques applied to image acquisition and reconstruction, image processing and reporting, clinical use cases, and future directions. Full article

Background: Projective instruments have historically been used to explore unconscious dynamics and personality traits in children and adolescents. However, concerns about their psychometric properties have led to ongoing debates in clinical psychology. This review aims to critically reassess the use of construction projective techniques in clinical settings for individuals aged 4 to 18 years, also examining the available psychometric data reported in recent scientific literature, excluding the Rorschach Test due to its extensive coverage in existing literature. Methods: A systematic review was conducted following PRISMA guidelines. PubMed, Psychoanalytic Electronic Publishing (PEP), and the Cochrane Library were searched for studies published between 2010 and 2024. Inclusion criteria encompassed studies focusing on construction projective techniques administered to clinical and non-clinical samples aged 4 to 18 years. Results: From an initial pool of 641 articles, 25 met the inclusion criteria. These studies indicate that construction projective techniques remain valuable in accessing children’s and adolescents’ inner worlds, particularly in diagnostic and therapeutic contexts. However, 13 of the 25 analyzed studies lack detailed psychometric evaluations, and the overall methodological quality was medium-low (4.4/9). Recent adaptations of these techniques show promise in increasing their applicability and relevance. Conclusions: Constructive projective tests continue to offer unique insights into the psychological functioning of young individuals. While not definitive diagnostic tools, they serve as effective supplements in clinical assessments and therapeutic interventions when applied with awareness of their limitations. Full article

Background/Objectives: The relationship between chronological age, dental age, and cervical vertebral maturation is critical for assessing the reliability of dental age as an indicator of skeletal age and for identifying the patient’s growth peak. This assessment facilitates the planning of appropriate orthodontic-orthopedic treatment. Methods: This retrospective observational study analyzed data from the Clinical Department of Orthodontics and Dento-Facial Orthopedics in Cluj-Napoca, Romania. The sample included 73 patients with Class II malocclusion (31 males and 42 females), with data obtained from orthopantomography and lateral cephalometric radiographs. Dental age was evaluated using both the Demirjian method and the Chronology of Eruption method. Skeletal age was determined based on Baccetti’s cervical vertebral maturation (CVM) staging method. Results: A strong and statistically significant correlation was found between cervical vertebral maturation and chronological age (r = 0.81, p < 0.001), as well as between cervical vertebral maturation and dental age assessed using the Demirjian method (rs = 0.72, p < 0.001). Additionally, a significant correlation was observed between cervical vertebral maturation and dental age assessed using the Chronology of Eruption method (rs = 0.78, p < 0.001). Conclusions: The correlation found between dental age and skeletal maturity suggests that dental age (DA) assessment might serve as a supplementary tool for estimating a patient’s growth peak in Class II malocclusion cases. Future research exploring the use of artificial intelligence (AI) in panoramic radiograph analysis could improve the accuracy and consistency of DA assessment, contributing to more reliable skeletal maturity evaluations. Full article

Background/Objectives: Preterm infants represent a population group at increased risk for vitamin D deficiency (VDD) and for its negative impact on various outcomes like metabolic bone disease or rickets, respiratory complications like respiratory distress syndrome and the development of bronchopulmonary dysplasia, necrotizing enterocolitis, or retinopathy of prematurity. Methods: Despite the growing interest in vitamin D research, there is still uncertainty regarding clear recommendations for each high-risk category of premature infants concerning the optimal dosage, optimal product, and timing for initiating vitamin D supplementation to prevent VDD. Results: An analysis of the literature suggests that early intervention for the optimal enteral supplementation of vitamin D is not only successful in achieving higher 25-hydroxi-vitamin D (25(OH)D) at one month but is also linked with improved outcomes. Conclusions: The traditional concepts and current recommendations for assessing vitamin D status and optimal supplementation need to be revised. Since parenteral nutrition, fortified mothers’ own milk, and special formula for preterm infants cannot provide adequate vitamin D levels, initiating oral supplementation soon after birth is essential to correct VDD in preterm infants. Full article

Background/Objectives: Childhood eating behaviors result from a complex interplay of familial, social, and environmental factors, influenced by socioeconomic and cultural contexts. These behaviors impact dietary habits, nutritional status, and long-term health. Using the Social Ecological Model (SEM), this narrative review synthesizes evidence on key determinants of childhood eating behaviors and proposes a framework for multi-level interventions. Methods: A structured literature search was conducted across PubMed, PsycINFO, and CINAHL, focusing on studies published between January 2014 and September 2024. Keywords related to childhood eating behaviors, familial determinants, and social influences were used to identify relevant studies. Inclusion criteria centered on empirical research examining how social and familial factors impact childhood eating behaviors within the SEM framework. Results: The review highlights critical determinants, including parental feeding practices, home food environments, peer influences, screen time, school meal programs, and socioeconomic disparities. These factors interact across multiple levels, emphasizing the importance of holistic interventions that target both individual behaviors and broader systemic influences. Conclusions: Addressing childhood eating behaviors requires a multi-level approach that integrates caregiver education, peer-led interventions, improved food environments, and supportive policies. Healthcare providers and policymakers play a crucial role in implementing strategies that foster healthier dietary behaviors and mitigate childhood obesity risks. Full article

Background: The prone position is one of the most frequently used treatment options for infants with Robin sequence (RS), but its effect and its safety regarding the increased risk of sudden infant death syndrome are controversial. Methods: In a prospective randomized crossover study, we investigated the effects of the prone versus supine position on obstructive sleep apnea (OSA) using polygraphy. Infants with RS admitted to the University Hospital Tuebingen between 4/2021 and 5/2023 were analyzed for their obstructive apnea index (OAI), oxygen desaturation index < 80%, minimum and basal oxygen saturation, basal and highest transcutaneous carbon dioxide level, and respiratory and heart rate in both sleep positions. Results: A total of 29 children were analyzed. A total of 21/29 children were measured in both positions, while 6/29 children were only measured in the supine position and 2/29 only in the prone position. We found no significant difference in the OAI for the supine versus prone position in main effects analyses. In unadjusted linear model analysis, infants in the supine position had an OAI of 9.9 (95% CI, −2.4, 22.3) events/h higher than those in the prone position. A total of 13/21 infants benefitted from the prone position, whilst 8/21 had a worsening of their OSA. We found no evidence of a significant interaction between sleeping position and syndromic status. Conclusions: Prone positioning improves, but does not eliminate, OSA symptoms in infants with RS, and severe OSA may often persist. There are infants in whom a change to the prone position leads to a worsening of their OSA. Full article

Background: Children with disabilities face an increased risk of neglect and maltreatment due to their dependence on caregivers, social isolation, and challenges in seeking help. While extensive research has examined child abuse, neglect remains an underexplored yet pervasive issue affecting this vulnerable population. Objective: This scoping review synthesizes literature from the past decade to assess the prevalence, characteristics, and risk factors of neglect among children with disabilities, aiming to identify gaps in research and inform policy and intervention efforts. Methods: Following the PRISMA-ScR guidelines, a systematic search was conducted across multiple electronic databases, including PsycNET, Social Services Abstracts, ERIC, PubMed, and EBSCO. Studies were included if they focused on neglect among children with disabilities and were published in English within the last ten years. Thematic analysis was employed to extract and categorize findings. Results: Sixteen studies met the inclusion criteria, revealing a significantly higher prevalence of neglect among children with disabilities compared to their typically developing peers. The type and severity of disability influenced the likelihood and nature of neglect, with children with intellectual disabilities (ID), autism spectrum disorder (ASD), and sensory impairments facing particularly high risks. Key risk factors included parental stress, economic hardship, limited access to resources, and systemic failures in early identification and intervention. Despite the severity of neglect, evidence-based preventive strategies remain scarce, and existing child protection frameworks often fail to account for the unique needs of children with disabilities. Conclusions: The findings underscore the urgent need for targeted interventions, specialized training for professionals, and policy reforms to address the neglect of children with disabilities. Future research should focus on developing and evaluating culturally sensitive and disability-specific support systems to mitigate the long-term consequences of neglect. Full article

Background/Objectives: Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by difficulties in social interaction, communication, and repetitive behaviors. Recent evidence indicates a significant relationship between ASD and imbalances in microbiota, particularly in the oral and gastrointestinal areas. This review examines the impact of oral microbiota, self-injurious behaviors (SIB), sensory sensitivity, and dietary choices on the comorbidities associated with ASD. Methods: An extensive literature review was conducted using PubMed and Scopus. The focus was on human studies with full-text availability, utilizing search terms related to ASD, oral health, oral microbiota, and neurodevelopmental disorders. The research was evaluated for methodological quality and its relevance to the connections between microbiota, oral health, and ASD. Results: Individuals with ASD face unique oral health challenges, including injuries from self-injurious behaviors and increased sensory sensitivity, which complicate oral hygiene and care. Selective eating can lead to nutritional deficiencies and worsen oral health issues. Dysbiosis in oral and gut microbiota, marked by altered levels of acetate, propionate, and butyrate, interferes with gut-brain and oral-brain connections, contributing to behavioral and neurological symptoms. Treatment options such as probiotics, fecal microbiota transfer, and sensory integration therapies can potentially alleviate symptoms and improve quality of life. Conclusions: The relationship between ASD, oral health, and microbiota suggests a bidirectional influence through neuroinflammatory mechanisms and metabolic disturbances. Proactive strategies focusing on microbiota and dental health may help reduce comorbidities and enhance the overall management of ASD, underscoring the need for further research into microbiota–host interactions and their therapeutic potential. Full article

Background: The use of patient-reported outcomes is essential to understand and manage health-related quality of life (HRQOL) in youth with lifelong disabilities. This study evaluated HRQOL in youth with physical disorders and examined its relationship with mobility. Methods: We conducted an IRB-approved retrospective study in which we administered the parent-reported Pediatric Outcomes Data Collection Instrument (PODCI) and Gross Motor Function Measure section D (GMFM-D) to ambulatory youth aged 2–18 years with cerebral palsy (CP; Gross Motor Function Classification System II; n = 258), arthrogryposis (n = 138), achondroplasia (n = 102), and Morquio syndrome (n = 52) during clinical visits to a gait lab. The PODCI has two validated versions, child and adolescent, that assess perceptions about mobility, happiness, and pain. Differences in HRQOL between diagnostic groups, between age groups, and compared with non-disabled youth were examined using non-parametric tests. The relationship between GMFM-D and PODCI scores was analyzed with Pearson’s correlations. Results: Both age cohorts within all diagnosis groups demonstrated higher pain and lower mobility compared with non-disabled youth (p < 0.015). Happiness was lower for both age groups with CP and arthrogryposis, and for the child group with Morquio syndrome compared with non-disabled youth (p < 0.002). In diagnostic groups in both age spans, Global Function was higher (p < 0.0001) for those with achondroplasia compared with other groups. Despite functional differences, there were no significant differences between diagnostic groups in pain scores (p > 0.10). Happiness was lower in the group with CP compared with that with achondroplasia (p = 0.01). GMFM-D was related to PODCI mobility scores for all diagnoses (r = 0.31 to 0.79, p < 0.03) but was not correlated with happiness (r = −0.16 to 0.092; p > 0.14); GMFM-D and PODCI pain scores were associated only for the child group with achondroplasia (r = 0.355; p < 0.001). Conclusions: Significant limitations in HRQOL are present in youth with physical disabilities. Pain levels were higher than those of non-disabled youth, but pain was not related to lower motor function. Happiness was not related to gross motor function, suggesting the need to examine other factors when mental health concerns are present in youth with disabilities. Full article

Background/Objectives: Mental health disorders among children and adolescents represent a significant global health challenge, with approximately 50% of conditions emerging before age 14. Despite substantial investment in services, persistent barriers such as provider shortages, stigma, and accessibility issues continue to limit effective care delivery. This narrative review examines the emerging application of conversational artificial intelligence (AI) in pediatric mental health contexts, mapping the current evidence base, identifying therapeutic mechanisms, and exploring unique developmental considerations required for implementation. Methods: We searched multiple electronic databases (PubMed/MEDLINE, PsycINFO, ACM Digital Library, IEEE Xplore, and Scopus) for literature published between January 2010 and February 2025 that addressed conversational AI applications relevant to pediatric mental health. We employed a narrative synthesis approach with thematic analysis to organize findings across technological approaches, therapeutic applications, developmental considerations, implementation contexts, and ethical frameworks. Results: The review identified promising applications for conversational AI in pediatric mental health, particularly for common conditions like anxiety and depression, psychoeducation, skills practice, and bridging to traditional care. However, most robust empirical research has focused on adult populations, with pediatric applications only beginning to receive dedicated investigation. Key therapeutic mechanisms identified include reduced barriers to self-disclosure, cognitive change, emotional validation, and behavioral activation. Developmental considerations emerged as fundamental challenges, necessitating age-appropriate adaptations across cognitive, emotional, linguistic, and ethical dimensions rather than simple modifications of adult-oriented systems. Conclusions: Conversational AI has potential to address significant unmet needs in pediatric mental health as a complement to, rather than replacement for, human-delivered care. Future research should prioritize developmental validation, longitudinal outcomes, implementation science, safety monitoring, and equity-focused design. Interdisciplinary collaboration involving children and families is essential to ensure these technologies effectively address the unique mental health needs of young people while mitigating potential risks. Full article

Introduction: Neonatal sepsis is a severe and life-threatening condition caused by pathogens in the systemic circulation within the first 28 days of life. The classical definition of neonatal sepsis implies positive central cultures, but recent findings discuss culture-negative sepsis (clinical sepsis associated with laboratory findings). Since infected neonates initially express few non-specific clinical signs and there are unreliable biochemical markers to identify sepsis in the early stages, it is essential to improve the accuracy of diagnosis and reduce unnecessary antibiotic exposure. Objective: Our study aims to assess the influence of risk factors and the utility of currently used biomarkers in culture-negative neonatal early-onset sepsis (CN-EOS). Materials and methods: We performed a retrospective study at Bucharest University Hospital, which included 131 preterm and term newborns at risk for EOS admitted in the Neonatal Intensive Care Unit (NICU) over 12 months. The neonates included were classified into two groups: confirmed negative-culture early-onset sepsis (CN-EOS) and suspected early-onset sepsis (S-EOS). Patients from both groups received antibiotic therapy from the first day of life; the type and duration of antibiotic therapy were different in the two groups. For all the patients, we measured C-reactive protein (CRP), procalcitonin (PCT) and white blood count (WBC) at birth and after 72 h, tested blood culture in the first 24 h of life and correlated the results with clinical signs and prenatal risk factors. Categorical variables were presented as frequencies and percentages, while the continuous variables were the mean and the standard deviation. The differences between the continuous variable groups were determined by Student’s t-test or the Mann–Whitney U test, whereas for the categorical variables, the Chi-square test (X²) was employed. The performance of laboratory biomarkers (CRP and PCT) in diagnosing confirmed EOS was calculated. All the tests were statistically significant at a p-value < 0.05. Results: The findings support the significance of low birth weight and gestational age and low Apgar scores as potential indicators for EOS; PROM diagnosed with chorioamnionitis and smoking during the pregnancy were also important predictive risk factors. Respiratory signs, such as apnea and respiratory distress syndrome, were most encountered in the clinical evaluation of infants with CN-EOS. Inflammatory markers were inconsistent in CN-EOS cases, proving that they are not reliable enough for initiating, continuing or stopping antibiotic therapy. Conclusions: Culture-negative neonatal sepsis remains a significant challenge for the neonatologist, since the time elapsed between the moment sepsis is suspected and the initiation of empirical therapy can make the difference between survival and death. Continued efforts are needed to develop more reliable and effective diagnostic tools for timely and appropriate intervention. Full article

Neonatal mortality, particularly due to early-onset sepsis (EOS), remains a pressing issue in Eastern Europe, with Romania experiencing one of the highest neonatal mortality rates in the European Union. EOS, caused by bacterial infections within the first 72 h of life, significantly contributes to neonatal deaths, particularly in rural and underserved areas where healthcare resources are limited. Disparities in prenatal care access, maternal demographics, and systemic healthcare gaps worsen this issue, highlighting the need for comprehensive interventions. Objectives: This review aims to examine the prevalence of neonatal mortality due to EOS in Romania and the broader Eastern European context, focusing on current prenatal care monitoring protocols and maternal demographics, and comparing the available literature with new data. By evaluating disparities in healthcare access, costs, and outcomes, this study identifies systemic barriers to maternal and neonatal care. Methods: A systematic review of 100 articles was conducted using PRISMA guidelines. Key sources included PubMed, Google Scholar, and open-access journals, with 25 articles meeting the inclusion criteria. The analysis encompassed maternal age, parity, literacy levels, marital status, and their impact on neonatal outcomes, alongside the financial burden of prenatal care. Results: The findings underscore stark inequalities in healthcare delivery between rural and urban regions, where limited prenatal visits, out-of-pocket costs, and cultural barriers hinder prompt EOS prevention and management. Advanced maternal age, low literacy, and socioeconomic disparities were identified as critical risk factors. Conclusions: To reduce neonatal mortality due to EOS, targeted efforts must address healthcare accessibility, improve prenatal care protocols, and integrate culturally sensitive practices. These interventions can bridge systemic gaps and promote equitable health outcomes for mothers and newborns across Eastern Europe. Full article

Background: Attention Deficit Hyperactivity Disorder (ADHD) has been described as a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity affecting cognitive, emotional, and social functioning. While pharmacological and behavioral treatments remain primary, physical activity (PA) (digital and non-digital versions) has emerged as a great complementary intervention due to its potential impact on executive functions, emotional regulation, and neurobiological markers. Objectives: This study aimed to assess the effects of PA on ADHD symptoms, executive function, and emotional regulation, exploring its potential impact and new practical applications in digital and non-digital treatment. Methods: This narrative review assessed 132 studies published between 1 January 2010 and January 2025, ensuring the inclusion of the most recent and relevant findings. The review was conducted in Scopus, PubMed, and Web of Science, using a predefined combination of terms related to ADHD, physical activity, executive function, neuroplasticity, and emotional regulation. Results: Regular PA improves executive functions, attention, inhibitory control, and cognitive flexibility in ADHD. Aerobic exercise enhances sustained attention, high-intensity training improves impulse control, and coordinative activities boost cognitive flexibility. Non-digital and digital innovations, such as exergaming and wearable fitness trackers, offer promising solutions to improve adherence to PA regimens, reinforcing their role as a key intervention in ADHD management. Conclusions: PA could be a valuable complementary intervention for ADHD through a hybrid approach that may improve cognitive and emotional functioning while addressing comorbidities. Full article

Background/Objectives: Central precocious puberty (CPP) is defined by the premature onset of secondary sexual characteristics prior to the age of 8 and 9 years in girls and boys, respectively. The administration of GnRH analogs (GnRH-a) has become a cornerstone in the management of CPP, but effects on metabolic processes, particularly body mass index (BMI), remain a subject of ongoing investigation. This study aimed to investigate the relationship between GnRH-a treatment and BMI changes in a cohort of Italian children with CPP. Methods: We conducted a retrospective cohort study of 34 girls with idiopathic CPP, all treated with GnRH-a. Anthropometric parameters including BMI were collected at three time points: baseline, one year after treatment, and one year after treatment cessation. A comprehensive review of the medical literature concerning GnRH-a and BMI was performed. Results: Statistical analysis using the Wilcoxon and McNemar tests revealed a significant increase in BMI-for-age z-scores after one year of GnRH-a, with a slight increase also observed one year post-treatment of CPP. These findings suggest that GnRH-a treatment contributes to an increase in BMI, particularly in CPP children with a normal weight at baseline, although the overall impact on the progression of obesity remains minimal. A review of the existing literature supports the notion that changes in BMI during GnRH-a treatment are influenced by various factors, including baseline BMI, gender, and metabolic processes. Conclusions: Despite our findings suggesting the potential impact of GnRH-a on BMI, further longitudinal studies are necessary to fully understand the long-term metabolic consequences of GnRH-a therapy in children with CPP. Full article

Background: Among the potential indications for growth hormone (GH) therapy is the presence of mutations in the SHOX (short stature homeobox-containing) gene, located in the telomeric pseudotautosomal region (PAR1) on the short arm of both sex chromosomes. Despite general recommendations supporting GH therapy in these cases, there is a lack of comprehensive evidence specifically evaluating its efficacy and safety in this subgroup of pediatric patients. Aim: The objective of this scoping review was to evaluate the efficacy and safety of growth hormone therapy in patients with SHOX gene variants, providing a narrative synthesis of the included studies. Materials and Methods: This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. We summarized information extracted from 22 articles identified by our search strategy. Currently, only one randomized clinical trial has analyzed the efficacy profile of GH in patients with SHOX mutations. Results: Growth hormone is a valuable therapeutic aid for these patients. However, its prescription in children with SHOX gene mutations should consider the specific characteristics of each patient, similar to the approach taken for patients with idiopathic growth hormone deficiency (GHD). Conclusion: Growth hormone therapy in patients with SHOX gene alterations appears to be both safe and effective. However, longitudinal prospective studies and targeted clinical trials are necessary to confirm these findings. Despite this, GH remains one of the preferred hormonal therapies for patients with short stature and confirmed SHOX gene mutations. Full article

Background: The primary goal of our study is to assess the national US prevalence of autism spectrum disorder (ASD), along with its socio-demographic characteristics, severity, and co-occurring medical and psychiatric disorders, using data from the 2020–2021 National Survey of Children’s Health (NSCH). Methods: We analyzed 2020–2021 NSCH data to estimate the prevalence of ever-diagnosed and current ASD among 79,182 children and adolescents (3–17 years). Univariate and multivariate regression models were used to examine associations between medical and psychiatric co-morbidities, socio-demographic factors, and ASD severity. Results: Adolescents (11–17 years) and males were more likely to have ASD, with males comprising 78.7% of the ASD group. The mean age of the sample was 10.1 ± 4.6 years, and 3.2% had an ASD diagnosis. Children from lower-income households and those with caregivers who completed only a high school education were more likely to have ASD. Nearly 96.4% of children with ASD had at least one co-morbid condition. The most common neuropsychiatric co-morbidities were developmental delay (64%), behavioral and conduct problems (57.8%), and anxiety disorder (45.7%), while the most common medical conditions were allergies (32.4%), genetic disorders (26.2%), and asthma (12.6%). Gender disparities in ASD presentation were evident that females with ASD were more likely to experience vision problems, cerebral palsy, epilepsy, depression, and intellectual disability but had lower odds of ADHD and anxiety problems. Greater ASD severity was linked to higher odds of intellectual disability (OR: 5.8, p < 0.001), developmental delay (OR: 5.0, p < 0.001), epilepsy, Down syndrome (OR: 3.4, p < 0.001), vision problems (OR: 2.5, p < 0.001), and genetic disorders (OR: 2.3, p < 0.001). Conclusions: This study provides updated prevalence estimates of ASD and highlights the high burden of co-morbidities, emphasizing the need for comprehensive, multidisciplinary approaches in ASD management. Additionally, our findings emphasize gender differences in ASD presentation, which should be considered in future research and clinical practice to ensure more tailored diagnostic and intervention strategies. Full article

Oral health is fundamental to overall well-being, especially in childhood, when dental structures and lifelong habits are established. This review provides a comprehensive analysis of children’s dental development, common oral health challenges, and evidence-based preventive strategies. Key topics include the mechanisms of tooth development, the eruption processes of primary and permanent dentition, and the management of developmental abnormalities. The prevalence, risk factors, and health impacts of dental caries in children are examined, underscoring the need for early intervention and targeted prevention. This review evaluates the effectiveness of preventive measures such as dental sealants, fluoride varnishes, and fluoride mouth rinses while highlighting the influence of dietary habits, toothbrush selection, and parental involvement on oral health outcomes. Additionally, it explores the synergistic benefits of combining preventive approaches, such as the concurrent use of dental sealants and fluoride applications, which have demonstrated superior caries prevention compared to either method alone. The effectiveness of these strategies is analyzed across different age groups, from early childhood to adolescence, with tailored recommendations for each developmental stage. Furthermore, the role of education, policy interventions, and community-based programs in addressing oral health disparities is discussed. By integrating developmental insights with epidemiological data and clinical evidence, this review provides a comprehensive framework for advancing pediatric dentistry, informing best practices, and enhancing preventive strategies to reduce the burden of oral diseases in diverse pediatric populations. Full article

Background/Objectives: Peer popularity is often associated with children’s and adolescents’ Theory of Mind (ToM), as well as with self-perceptions. This paper describes two cross-sectional studies that investigate the individual differences and associations among peer popularity, ToM, and self-perceptions (i.e., several dimensions of self-esteem, including global, academic, or physical self-esteem). Methods: Study 1 involved 229 German children aged 5 to 8 years. Study 2 involved 127 Canadian adolescents aged 10 to 12 years. Participants in both studies completed measures of ToM, self-perceptions, and peer popularity. Results: Study 1 found significant associations among children’s ToM and self-perceptions (their global self-esteem) but found no associations with children’s peer popularity. Study 2 revealed significant positive associations between adolescents’ ToM and their peer popularity, as well as between ToM and self-perceptions (in particular, adolescents’ academic self-esteem). Conclusions: Our findings support the view that ToM matters for children’s and young adolescents’ self-perceptions and plays an increasingly important role in their everyday social life. Curricular implications for ToM, identity formation (self-perceptions), and peer relations are discussed. Full article

Objective: To determine the association between foods habits with mental health (i.e., anxiety, depression, and stress) and executive function (i.e., attention, inhibition, working memory, and cognitive flexibility) in Chilean children and adolescents. Methods: A cross-sectional study with 498 children and adolescents (52.6% female) aged 10–17 years participated. The Krece Plus questionnaire (Food habits), Depression Anxiety Stress Scales (DASS-21, metal health), and the CogniFit (executive functions) test were used to assess the study variables. Results: The poor and moderate food habits groups reported higher prevalence of extremely severe anxiety (poor, 40.8%; moderate, 41.4%; good, 21.6%; p = 0.013) and extremely severe depression (poor, 20.4%; moderate, 21.3%; good, 5.7%; p < 0.001). The food habits were linked inversely to anxiety (β −0.07, 95%CI −0.11 to −0.03, p = 0.001), depression (β −0.08, 95%CI −0.12 to −0.04, p < 0.001), stress (β −0.07, 95%CI −0.11 to −0.02, p = 0.004), and total score of negative mental health (β −0.03, 95%CI −0.04 to −0.01, p < 0.001). Conclusions: The food habits were inversely associated with negative metal health in Chilean children and adolescents, where the good food habits group reported better mental health in all dimensions. Full article

Background/Objectives: Although child-to-parent violence (CPV), peer violence (PV), and dating violence (DV) share risk factors and tend to co-occur, little is known about the common and differential mechanisms involved in the development of these types of youth violence. This study aims to (1) analyze the relationship between youth violence (CPV, PV, and DV) and perceived parental warmth and moral disengagement mechanisms and (2) explore the mediating role of moral disengagement mechanisms in the relationship between the lack of perceived parental warmth and youth violence. Methods: A cross-sectional population-based survey study was conducted. The sample consisted of 2124 Spanish adolescents (57.9% girls) aged between 13 and 17 years from educational centers. Results: The lack of perceived parental warmth (parental criticism-rejection in particular) is a common risk factor for all three types of violence and, more relevantly, is related to youth violence through moral disengagement mechanisms, highlighting a differential contribution of these mechanisms according to the type of violence. In particular, advantageous comparison and attribution of blame are specific mediators of CPV, and moral justification and distortion of consequences are specific to PV, whereas euphemistic language seems to be a common mediator of PV and DV. Conclusions: This study suggests that adolescents who perceive a lack of parental warmth are more likely to develop different dysfunctional cognitive mechanisms, which in turn are related to different types of youth violence. It would be important to promote warm parenting practices and address the cognitive mechanisms underlying youth violence. Full article

Background/Objectives: This study aimed to determine the malnutrition status, prevalence of intestinal parasites and anaemia, and the hygiene and sanitation conditions of children participating in the nutritional recovery programme at Las Salinas school of the ONG Bel Avenir in Toliara (Madagascar). The ultimate goal of the ONG Bel Avenir is to apply synergistic strategies to effectively combat malnutrition. Methods: A total of 49 schoolchildren aged 6 to 17 years enrolled in the nutritional recovery programme were studied. Data collection included sociodemographic information, hygiene and sanitation practices, and haematological and anthropometric measurements. Results: All participants were found to have anaemia. Regarding intestinal parasites, Giardia intestinalis was detected in 93.9% of cases, and Trichuris trichiura was identified in 28.6% of cases. Nutritional assessments revealed that 100% of the participants experienced thinness or acute malnutrition, while 32.6% exhibited stunting or impaired growth. Conclusions: The findings underscore the critical relationship between nutritional status and factors such as parasitology, haematology, and hygiene. Tools like the Nutrimetry assessment enable more specific diagnostics, guiding targeted interventions to address malnutrition. This study highlights the urgent need for policies and collaborative actions to improve the health conditions of the children in Madagascar. Full article