Children

21 pages, 498 KiB

Open AccessEditor’s ChoiceReview

Precision Therapeutics in Lennox–Gastaut Syndrome: Targeting Molecular Pathophysiology in a Developmental and Epileptic Encephalopathy

by Debopam Samanta

Children 2025, 12(4), 481; https://doi.org/10.3390/children12040481 - 8 Apr 2025

Cited by 3 | Viewed by 1408

Abstract

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 [...] Read more.

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

(This article belongs to the Special Issue Childhood Epilepsy: Clinical Advances and Perspectives)

15 pages, 4593 KiB

Open AccessEditor’s ChoiceReview

Comparative Analysis of Early Class III Malocclusion Treatments—A Systematic Review and Meta-Analysis

by Andrei Otel, José María Montiel-Company and Álvaro Zubizarreta-Macho

Children 2025, 12(2), 177; https://doi.org/10.3390/children12020177 - 30 Jan 2025

Cited by 2 | Viewed by 1610

Abstract

Several therapeutic methods have been proposed for early class III malocclusion treatment; however, the existing literature does not provide evidence on the most recommended techniques or materials. The aim of the present systematic review and meta-analysis was to summarize the clinical evidence on [...] Read more.

Several therapeutic methods have been proposed for early class III malocclusion treatment; however, the existing literature does not provide evidence on the most recommended techniques or materials. The aim of the present systematic review and meta-analysis was to summarize the clinical evidence on the efficacy of each method. The PRISMA recommendations were followed. Four databases were searched for articles published up to February 2024. Controlled trials, randomized or non-randomized clinical trials, and prospective or retrospective studies with a control group and a minimum follow-up of 6 months were included. The risk of bias was assessed using the Cochrane collaboration tool. Inconsistency was assessed using the Q test, with a significance level of p < 0.05 and a forest plot. A total of 61 articles were identified, and eight were included in the meta-analysis, which examined three parameters: Sella-Nasion-A (SNA), Sella-Nasion-B (SNB), and A Point-Nasion-B (ANB) values. The meta-analysis was carried out using the random effects model and the inverse variance method. The effect size was determined as the difference between the means of the SNA, SNB, and ANB values in the initial and final intervention groups or between the intervention group and control group. Statistical significance was assessed using the z-test and was declared when p-value < 0.05. The heterogeneity of the meta-analysis was analyzed using the Q test and the I² statistical index. Publication bias was analyzed using the trim-and-fill method to adjust the skewness of the funnel plot. The risk of bias in the selected studies was assessed using the Cochrane collaboration tool to analyze the methodological quality assessment of the clinical trials. There were statistically significant differences between traditional maxillary disjunction and traction and the different types of Alt-RAMEC protocols, with the latter allowing greater skeletal corrections. Full article

(This article belongs to the Special Issue Oral Hygiene and Periodontal Status of Children: Progress and Prospects)

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11 pages, 505 KiB

Open AccessEditor’s ChoiceArticle

Quality Improvement Project to Improve Adherence to Best Practices to Decrease Incidence of Necrotizing Enterocolitis in Preterm Infants

by Ahreen Allana, Sidra Bashir and Ivan Hand

Children 2025, 12(2), 176; https://doi.org/10.3390/children12020176 - 30 Jan 2025

Cited by 3 | Viewed by 1288

Abstract

Background/Objectives: Necrotizing enterocolitis (NEC) is one of the most devastating gastrointestinal emergencies in preterm infants. This quality improvement (QI) project aimed to increase the utilization of accepted evidence-based practices in our neonatal intensive care unit (NICU) to ultimately decrease the incidence of NEC [...] Read more.

Background/Objectives: Necrotizing enterocolitis (NEC) is one of the most devastating gastrointestinal emergencies in preterm infants. This quality improvement (QI) project aimed to increase the utilization of accepted evidence-based practices in our neonatal intensive care unit (NICU) to ultimately decrease the incidence of NEC in our level III NICU. Methods: Our QI team implemented a bundle of nine of these evidenced-based practices for NEC prevention and disseminated information among the NICU team. Items in the bundle included delayed cord clamping, parental education on the importance of breast milk, obtaining early consent for donor breast milk, adherence to the unit’s feeding protocol, avoiding routine gastric residual checks, the discontinuation of antibiotics at 48 h once blood cultures were negative, restricting the use of antacids, nasogastric tube (NGT) replacement every 72 h and the removal of central lines once a feeding volume of 100 mL/kg/day was attained. The baseline incidence of clinically proven NEC was found to be 7% at the start of the intervention. We conducted two Plan-Do-Study-Act (PDSA) cycles over a 2-year period from 1 January 2021 to 31 December 2022. Results: There were 74 infants who met the inclusion criteria of being <1500 g and/or at <32 weeks of gestation. The adherence to our process measures improved over the course of our two PDSA cycles from 78% adherence to 91.6%, p < 0.05. The incidence of NEC decreased from 7% to 5.3% following the first PDSA cycle, a 24% reduction. Following the second PDSA cycle, the incidence decreased even further from 5.3% to 2.8%, a 60% reduction from baseline, although this was not statistically significant due to the small sample size. Conclusions: In this QI initiative, we achieved improved adherence to several evidence-based interventions over a two-year period with the aim of reducing the incidence of NEC at our institution. Full article

(This article belongs to the Section Pediatric Neonatology)

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14 pages, 1417 KiB

Open AccessEditor’s ChoiceArticle

Polypharmacy in Pediatric Palliative Care: Exploring Discrepancies Between Physicians and Pharmacists

by Daniele Mengato, Anna Zanin, Fernando Baratiri, Lisa Pivato, Laura Camuffo, Franca Benini and Francesca Venturini

Children 2025, 12(2), 124; https://doi.org/10.3390/children12020124 - 24 Jan 2025

Cited by 2 | Viewed by 903

Abstract

Background/Objectives: Off-label drug use is prevalent in pediatric care, particularly in pediatric palliative care (PPC), due to the scarcity of pediatric-specific formulations and clinical trials. Differences in perception between healthcare professionals regarding off-label prescriptions underscore the complexity of this practice and highlight [...] Read more.

Background/Objectives: Off-label drug use is prevalent in pediatric care, particularly in pediatric palliative care (PPC), due to the scarcity of pediatric-specific formulations and clinical trials. Differences in perception between healthcare professionals regarding off-label prescriptions underscore the complexity of this practice and highlight the need for improved collaboration to optimize therapeutic outcomes. Methods: A cross-sectional observational study was conducted from August to October 2021 at the PPC center of the University Hospital of Padova, Italy. Data were collected from medical records of 169 patients. Off-label prescriptions were independently assessed by two physicians and two clinical pharmacists using respective reference sources. Discrepancies were resolved through consensus. Statistical analyses included the χ²-test for categorical variables and t-tests for continuous data. Results: Among the 993 drug prescriptions analyzed, the pharmacists reported a higher proportion of off-label uses (32.9%) compared to the physicians (18.4%; p < 0.05). After a consensus, 26.5% of the prescriptions were identified as off-label, with 67.9% due to indications, 49.6% due to dosage, and 44.4% due to age discrepancies. Conclusions: This study suggests a high prevalence of off-label prescribing in pediatric palliative care (PPC) and highlights differing professional perspectives, underscoring the potential benefits of exploring standardized protocols and enhanced interdisciplinary collaboration. Enhanced communication between healthcare providers, alongside the development of registries and clinical trials, is essential for improving the safety and efficacy of off-label drug use in pediatric populations. A flexible regulatory framework and customized galenic formulations could further support these goals. Full article

(This article belongs to the Special Issue Advances of Polypharmacy Issues in Pediatrics)

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13 pages, 221 KiB

Open AccessEditor’s ChoiceArticle

The Impact of Physical Activity and Screen Time on Motor Creativity in Kindergarteners

by Rafat Ghanamah

Children 2025, 12(2), 116; https://doi.org/10.3390/children12020116 - 22 Jan 2025

Cited by 2 | Viewed by 2231

Abstract

Background/Objectives: Motor creativity and physical activity are essential to early childhood development, impacting physical, cognitive, and socio-emotional development. This study investigates the relationships among motor creativity, motor working memory (MSTM), screen time, and physical activity (PA) in kindergarten children, focusing on the mediating [...] Read more.

Background/Objectives: Motor creativity and physical activity are essential to early childhood development, impacting physical, cognitive, and socio-emotional development. This study investigates the relationships among motor creativity, motor working memory (MSTM), screen time, and physical activity (PA) in kindergarten children, focusing on the mediating roles of cognitive functions and screen time. Methods: Data were collected from 124 Arab Israeli kindergarten children through assessments of Thinking Creatively in Action and Movement (TCAM) for motor creativity and the Hand Movement Test for MSTM. Parents reported the children’s screen time and days engaged in moderate-to-vigorous physical activity (MVPA). Results: The results show significant positive associations between motor creativity and both MSTM and PA, underscoring the role of cognitive processes in creative motor expression. Linear regression and mediation analyses showed that MSTM significantly mediates the relationship between PA and motor creativity. Conversely, screen time negatively correlates with PA and motor creativity, serving as a significant mediator that restricts opportunities for physical and creative activities. Conclusions: This study emphasizes the bidirectional relationship between PA and motor creativity, wherein diverse physical activities stimulate creativity, and creative movements encourage active participation. The combined mediating effects of MSTM and screen time highlight the complexity of these relationships, suggesting the need for integrated interventions. The findings inform early childhood education by advocating for strategies that promote physical activity, enhance cognitive functions, and limit excessive screen time, fostering holistic development in young children. Full article

(This article belongs to the Special Issue Physical Activity and Lifestyle Habits in Children and Adolescents: 2nd Edition)

18 pages, 953 KiB

Open AccessEditor’s ChoiceReview

Severe Diabetic Ketoacidosis in Children with Type 1 Diabetes: Ongoing Challenges in Care

by Simone Foti Randazzese, Mariarosaria La Rocca, Bruno Bombaci, Alessandra Di Pisa, Elèna Giliberto, Teresa Inturri, Daniel Militi, Fortunato Lombardo, Eloisa Gitto, Giuseppina Salzano and Stefano Passanisi

Children 2025, 12(1), 110; https://doi.org/10.3390/children12010110 - 19 Jan 2025

Cited by 3 | Viewed by 4558

Abstract

Diabetic ketoacidosis is the most common acute complication in children and adolescents with type 1 diabetes, and contributes significantly to morbidity, mortality, and healthcare burden. This review aims to explore the multifaceted aspects of severe diabetic ketoacidosis in pediatric age, including its epidemiology, [...] Read more.

Diabetic ketoacidosis is the most common acute complication in children and adolescents with type 1 diabetes, and contributes significantly to morbidity, mortality, and healthcare burden. This review aims to explore the multifaceted aspects of severe diabetic ketoacidosis in pediatric age, including its epidemiology, pathogenesis, risk factors, complications and emphasizing advances in prevention strategies. Incidence rates vary due to influences from geographic, socioeconomic, cultural and demographic factors. Pathogenesis is linked to insulin deficiency and an excess of counter-regulatory hormones, which disrupt glucose, protein, and lipid metabolism, causing hyperglycemia, ketosis, acidosis, dehydration, and electrolyte imbalances. According to the International Society for Pediatric and Adolescent Diabetes guidelines, severe diabetic ketoacidosis is characterized by a pH < 7.1 or bicarbonate < 5 mmol/L. This condition can lead to a wide range of life-threatening complications, including cerebral edema that represents the leading cause of death. Several prevention strategies, including awareness campaigns, early diagnosis of diabetes, regular monitoring and management, effective insulin therapy, education, access to healthcare and technological assistance, may contribute to reduce the risk of severe diabetic ketoacidosis episodes in children and adolescents. Full article

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

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11 pages, 235 KiB

Open AccessEditor’s ChoiceArticle

Deciphering the Link Between Diagnosis-Related Group Weight and Nursing Care Complexity in Hospitalized Children: An Observational Study

by Manuele Cesare, Fabio D’Agostino, Emanuele Sebastiani, Nursing and Public Health Group, Gianfranco Damiani and Antonello Cocchieri

Children 2025, 12(1), 103; https://doi.org/10.3390/children12010103 - 17 Jan 2025

Cited by 4 | Viewed by 994

Abstract

Background/Objectives: The increasing medical and nursing care complexity in hospitalized children represents a significant challenge for healthcare systems. However, the link between these two dimensions remains partially explored. This study aims to decipher the relationship between Diagnosis-Related Group (DRG) weight and nursing care [...] Read more.

Background/Objectives: The increasing medical and nursing care complexity in hospitalized children represents a significant challenge for healthcare systems. However, the link between these two dimensions remains partially explored. This study aims to decipher the relationship between Diagnosis-Related Group (DRG) weight and nursing care complexity in hospitalized children and to identify the determinants of medical complexity. Methods: This retrospective study, conducted in an Italian university hospital, included children aged 2 to 11 years admitted to the hospital in 2022 with a minimum hospital stay of 2 days. Data were gathered from the Neonatal Pediatric Professional Assessment Instrument and the Hospital Discharge Register. DRG weight was used as an indicator of medical complexity, while the number of nursing diagnoses (NDs) documented in the first 24 h from hospital admission and the nursing actions (NAs) recorded during the patient’s hospital stay were used to measure nursing care complexity. Correlation analyses were conducted to explore the associations between DRG weight, NDs, and NAs. Stepwise regression was run to identify the key determinants of medical complexity across sociodemographic, clinical, organizational, and nursing variables. Results: Among 914 patients (mean age of 6.11 ± 2.90 years), the median DRG weight was 0.6982 (IQR: 0.5522). Patients had an average of 3.89 ± 2.83 NDs and a median of 17 NAs (IQR: 8). Significant correlations were found between NDs and NAs (r_s = 0.507; p < 0.001), as well as between DRG weight and the frequency of NDs (r_s = 0.232; p < 0.001) and NAs (r_s = 0.184; p < 0.001). Stepwise regression indicated that the number of NAs, surgical DRG, scheduled admissions, and ND frequency were significant determinants of DRG weight (R² = 0.311; adjusted R² = 0.308; p < 0.001). Conclusions: In children, DRG weight is also influenced by nursing care complexity, alongside clinical and organizational factors. An integrated approach is essential to enhance pediatric care and patient outcomes. Full article

(This article belongs to the Section Pediatric Nursing)

14 pages, 1798 KiB

Open AccessEditor’s ChoiceArticle

Dietary Habits and Nutritional Status of Youths Living in Rural and Semi-Urban Albania in the Ongoing Nutrition Transition: Preliminary Results

by Ruden Cakoni, Stefania Moramarco, Argjend Kosiqi, Angela Andreoli and Ersilia Buonomo

Children 2025, 12(1), 98; https://doi.org/10.3390/children12010098 - 16 Jan 2025

Cited by 3 | Viewed by 2192

Abstract

Background: Albania is undergoing a demographic, epidemiological, and nutrition transition leading to an increased prevalence of overweight and obesity among new generations. Comprehensive studies on the nutritional status and dietary patterns of youths in the country are still lacking. Methods: A cross-sectional study [...] Read more.

Background: Albania is undergoing a demographic, epidemiological, and nutrition transition leading to an increased prevalence of overweight and obesity among new generations. Comprehensive studies on the nutritional status and dietary patterns of youths in the country are still lacking. Methods: A cross-sectional study was conducted on a convenience sample of students (10–18 years) attending secondary schools in rural and semi-urban areas (October–November 2024). Information collected included socio-demographic data, anthropometric measurements (weight, height), and adherence to the Mediterranean Diet (MD) (KIDMED). Factors influencing dietary patterns were investigated, with a multivariate logistic regression performed to identify key drivers for poor MD adherence (AOR 95% CI). Results: In total, 426 children (47.2% females) were interviewed. Over 20% of the sample was overweight or obese, with the prevalence of these diseases decreasing with age regardless of gender. The KIDMED score highlighted suboptimal MD adherence (4.6 ± 2.5 SD), with significant differences between females and males (4.1 ± 2.4 SD vs. 5.1 ± 2.4 SD, p < 0.001), especially in rural areas (3.9 ± 2.4 SD vs. 4.9 ± 2.5 SD, p = 0.003). Dietary quality tended to decline with age. Female gender was the strongest predictor of poor MD adherence (AOR 2.08 CI: 1.34–3.22; p = 0.001). Conclusions: The MD is a cornerstone for ensuring the Albanian population’s long-term health and well-being. This study holds significant public health relevance in a country with high mortality rates due to cardiovascular diseases. Future nutrition interventions focused on the poor MD adherence of new generations should take into consideration geographic, cultural, and social dimensions, including gender equality. Full article

(This article belongs to the Special Issue Nutritional Status and Eating Patterns in Children and Adolescents: Prevalence, Screening and Prevention of Metabolic Disorders)

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20 pages, 264 KiB

Open AccessEditor’s ChoiceReview

Thematic Review of Endocrine Disruptors and Their Role in Shaping Pubertal Timing

by And Demir, Adem Aydin and Atilla Büyükgebiz

Children 2025, 12(1), 93; https://doi.org/10.3390/children12010093 - 16 Jan 2025

Cited by 3 | Viewed by 2232

Abstract

This review examines the inconsistent effects of endocrine-disrupting chemicals (EDCs) and pollutants on pubertal timing, emphasizing the methodological challenges contributing to variability in findings. Data from nine key studies reveal that chemicals such as BPA, phthalates, and PFAS impact pubertal onset differently based [...] Read more.

This review examines the inconsistent effects of endocrine-disrupting chemicals (EDCs) and pollutants on pubertal timing, emphasizing the methodological challenges contributing to variability in findings. Data from nine key studies reveal that chemicals such as BPA, phthalates, and PFAS impact pubertal onset differently based on exposure timing, dosage, and sex. For instance, BPA is linked to earlier puberty in girls but delayed onset in boys, while other EDCs show mixed effects across populations. These discrepancies often arise from challenges in study design, such as the difficulty in establishing reliable control groups, accurately measuring exposures, and accounting for confounding factors like socioeconomic status, diet, and obesity. Sex-specific differences and environmental shifts during the COVID-19 pandemic, including increased indoor exposure and stress, further complicate the picture. These factors highlight the urgent need for more robust research methodologies, including standardized exposure assessments and longitudinal studies, to clarify the mechanisms driving these effects. Despite these challenges, the findings stress the importance of public health interventions, such as stricter EDC regulations, improved pollutant monitoring, and minimizing exposures during sensitive developmental windows. Addressing methodological gaps is crucial for producing reliable, actionable insights to protect adolescent development from the adverse effects of EDCs. Full article

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

10 pages, 6304 KiB

Open AccessEditor’s ChoiceArticle

Foreign Bodies in Lower Airway in Children: Brief Review and Clinical Experience

by Stoyan Markov, Petya Markova, Ivanka Karavelikova and Hristina Halacheva

Children 2025, 12(1), 67; https://doi.org/10.3390/children12010067 - 7 Jan 2025

Cited by 1 | Viewed by 1116

Abstract

Background: Foreign body aspiration is a preventable occurrence that carries a high risk of mortality in the pediatric population. Clinically, foreign body aspiration manifests as cough, followed by choking, which might not be given any consideration by the caregivers of the child. An [...] Read more.

Background: Foreign body aspiration is a preventable occurrence that carries a high risk of mortality in the pediatric population. Clinically, foreign body aspiration manifests as cough, followed by choking, which might not be given any consideration by the caregivers of the child. An episode of sudden wheezing can also raise the suspicion of a foreign body in the lower respiratory tract. The clinical findings depend on the type, size, and localization of the foreign body and include persistent cough, localized airway resistance, localized or diffuse wheezing, and difficulty breathing. A bronchoscopy is the procedure of choice for the removal of foreign bodies. Flexible bronchoscopy is increasingly being used as the initial diagnostic procedure in children with an uncertain history of choking, in the absence of physical and radiological lung changes, and in chronic complaints requiring the exclusion of a foreign body in the airways. Thus, the aim of this study was to describe our clinical experience with lower respiratory tract foreign body extraction in children over a period of five years. Materials and Methods: Over a 5-year period, 154 patients under the age of 18 underwent a bronchoscopy due to a suspected foreign body in the lower respiratory tract. Of these patients, 92% had an incident leading to acute respiratory distress, and 8% had no definite data on such an event in the anamnesis. Results: A foreign body in the respiratory tract was found in and extracted from 50 patients, and foreign bodies were absent in 104 of the cases. Conclusions: If a foreign body enters the lower respiratory tract, immediate and adequate actions are required to solve the problem. A bronchoscopy should be conducted in every suspected case of foreign body aspiration. Full article

(This article belongs to the Special Issue Addressing Challenges in Pediatric Critical Care Medicine)

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15 pages, 791 KiB

Open AccessEditor’s ChoiceArticle

The Effects of a Web-Based Need-Supportive Intervention for Physical Education Teachers on Students’ Physical Activity and Related Outcomes: A Randomized Controlled Trial

by Hasso Paap, Andre Koka, Pille-Riin Meerits and Henri Tilga

Children 2025, 12(1), 56; https://doi.org/10.3390/children12010056 - 3 Jan 2025

Cited by 4 | Viewed by 1070

Abstract

Background/Objectives: Globally, adolescents are insufficiently active, highlighting the need for effective strategies to enhance their activity levels. This study evaluated a web-based intervention program designed for physical education (PE) teachers, aimed at fostering students’ basic psychological needs—autonomy, competence, and relatedness—in PE settings. Methods: [...] Read more.

Background/Objectives: Globally, adolescents are insufficiently active, highlighting the need for effective strategies to enhance their activity levels. This study evaluated a web-based intervention program designed for physical education (PE) teachers, aimed at fostering students’ basic psychological needs—autonomy, competence, and relatedness—in PE settings. Methods: Secondary school PE teachers and their students were randomly assigned into either an experimental (teachers n = 36; students n = 463, Mage = 13.94, SD = 0.88) or a control group (teachers n = 49; students n = 820, Mage = 13.93, SD = 0.87). Teachers in the experimental group underwent a 4-week web-based intervention program focused on autonomy-, competence-, and relatedness-supportive motivational techniques. Students completed questionnaires assessing psychological measures and self-reported physical activity (PA) before and after the teachers’ training. Results: Results indicated that students in the experimental group perceived significantly higher autonomy, competence, and relatedness support compared to their control group counterparts at post-test. Conclusions: Consequently, the web-based need-supportive intervention was effective in promoting need-supportive teacher behavior. As the developed training for PE teachers increased students’ perceptions of need support from their PE teachers, it holds promise for future PE teacher education. Furthermore, the web-based format offers scalability for broader implementation. Full article

(This article belongs to the Special Issue Physical Activity and Sedentary Behaviors in Children and Adolescents)

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16 pages, 302 KiB

Open AccessEditor’s ChoiceReview

Affective Touch in Preterm Infant Development: Neurobiological Mechanisms and Implications for Child–Caregiver Attachment and Neonatal Care

by Valentina Lucia La Rosa, Alessandra Geraci, Alice Iacono and Elena Commodari

Children 2024, 11(11), 1407; https://doi.org/10.3390/children11111407 - 20 Nov 2024

Cited by 13 | Viewed by 3960

Abstract

Background/Objectives: Affective touch is crucial in infant development, particularly in regulating emotional, cognitive, and physiological processes. Preterm infants are often deprived of essential tactile stimulation owing to their early exposure to the external environment, which may affect long-term developmental outcomes. This review aimed [...] Read more.

Background/Objectives: Affective touch is crucial in infant development, particularly in regulating emotional, cognitive, and physiological processes. Preterm infants are often deprived of essential tactile stimulation owing to their early exposure to the external environment, which may affect long-term developmental outcomes. This review aimed to examine the neurobiological mechanisms of affective touch and highlight effective interventions, such as skin-to-skin contact (SSC) and kangaroo care (KC), to promote development in preterm infants. Methods: This review summarizes recent studies in the literature on affective touch, the role of C-tactile fibers, and the effects of tactile interventions in neonatal care. Studies were selected based on their relevance to the care and development of preterm infants, with a focus on physiological and neurodevelopmental outcomes. Key interventions, including SSC and massage therapy, are discussed in relation to their effectiveness in the neonatal intensive care unit (NICU). Results: The results suggest that affective touch, mainly through activation of tactile C-fibers, improves caregiver–infant bonding, reduces stress responses, and supports neurodevelopment in preterm infants. Interventions such as SSC and KC have also been shown to improve physiological regulation in these infants, including heart rate, breathing, and temperature control while promoting emotional regulation and cognitive development. Conclusions: Affective touch is a key component of early development, particularly in preterm infants admitted to the NICU. Integrating tactile interventions such as SSC and KC into neonatal care practices may significantly improve long-term developmental outcomes. Future research should explore the epigenetic mechanisms underlying affective touch and further refine tactile interventions to optimize neonatal care. Full article

(This article belongs to the Special Issue Children with Specific Neurodevelopmental Disorders: Assessment and Intervention)

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27 pages, 1316 KiB

Open AccessEditor’s ChoiceReview

Digital Device Usage and Childhood Cognitive Development: Exploring Effects on Cognitive Abilities

by Vicente Javier Clemente-Suárez, Ana Isabel Beltrán-Velasco, Silvia Herrero-Roldán, Stephanie Rodriguez-Besteiro, Ismael Martínez-Guardado, Alexandra Martín-Rodríguez and Jose Francisco Tornero-Aguilera

Children 2024, 11(11), 1299; https://doi.org/10.3390/children11111299 - 27 Oct 2024

Cited by 12 | Viewed by 24358

Abstract

The increasing ubiquity of digital devices in childhood had outpaced the understanding of their effects on cognitive development, creating a significant research gap regarding their long-term impact. Objective: The present narrative overview explored the complex relationship between digital device usage and cognitive development [...] Read more.

The increasing ubiquity of digital devices in childhood had outpaced the understanding of their effects on cognitive development, creating a significant research gap regarding their long-term impact. Objective: The present narrative overview explored the complex relationship between digital device usage and cognitive development in childhood. Methods: We conducted a comprehensive literature search across multiple databases, including PubMed, Embase, Scopus, and Web of Science, to critically assess cognitive domains such as attention, memory, executive functions, problem-solving skills, and social cognition. Incorporating over 157 peer-reviewed studies published between 2001 and 2024, we used strict inclusion and exclusion criteria to ensure scientific rigor. Results: The review integrated empirical findings with established theoretical frameworks, particularly from cognitive development and media psychology, to highlight both the advantages and risks of early, frequent exposure to technology. The potential for digital devices to enhance cognitive skills, such as multitasking and information processing, was weighed against risks such as cognitive overload, diminished attention spans, and impaired social skills. We also examined psychological and behavioral outcomes, including identity formation, emotional regulation, and maladaptive behaviors associated with excessive screen time. Additionally, we identified strategies to mitigate negative effects, emphasizing structured digital engagement and parental involvement to support healthy cognitive and psychological growth. Our findings provided actionable recommendations for parents, educators, and policymakers, promoting optimal digital practices that enhanced cognitive development while safeguarding against potential harms. Conclusions: The review offered essential insights for stakeholders in child development, education, and policy-making, highlighting the need for balanced integration of digital tools in childhood learning environments. Full article

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

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14 pages, 1077 KiB

Open AccessEditor’s ChoiceArticle

Prevalence of Anxiety and Depression among Parents of Children with Cancer—A Preliminary Study

by Anna Lewandowska, Tomasz Lewandowski, Anna Bartosiewicz, Katalin Papp, Dana Zrubcová, Mária Šupínová, Aleksandra Stryjkowska-Góra, Barbara Laskowska, Gabriela Joniec and Serap Ejder Apay

Children 2024, 11(10), 1227; https://doi.org/10.3390/children11101227 - 10 Oct 2024

Cited by 5 | Viewed by 2705

Abstract

Background: A child’s cancer is a highly stressful experience for the entire family. Childhood cancer disrupts family functioning and is one of the most stressful and challenging events parents face, often beyond their control. Parents play a crucial role in providing emotional support [...] Read more.

Background: A child’s cancer is a highly stressful experience for the entire family. Childhood cancer disrupts family functioning and is one of the most stressful and challenging events parents face, often beyond their control. Parents play a crucial role in providing emotional support to children throughout their illness, and their ability to cope can help reduce the child’s negative emotions. The aim of this study was to assess the prevalence of anxiety and depression among parents of children with cancer. Methods: This cross-sectional study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines and included parents of children undergoing cancer treatment. Convenience sampling was used. The Beck Depression Inventory and the Hospital Anxiety and Depression Scale were utilized to assess the parents. Results: This study included 270 participants (73% women, 27% men) with children at an average age of 8.75 ± 4.82 years. Diagnoses included leukemia (53%), lymphoma (29%), and other cancers. On the Beck Depression Inventory, 33% of parents were mildly depressed, 12% moderately depressed, and 32% severely depressed, with an average score of 20.63 ± 12.39 points. The HADS-M scale indicated anxiety at 48.43 ± 20.78%, depression at 45.01 ± 22.8%, and aggression at 54.72 ± 28.71%. Conclusions: Most parents of children with cancer have symptoms of depression and anxiety, which are influenced by the duration of the child’s illness. A strong correlation was observed between the level of anxiety and the tendency for depression. Full article

(This article belongs to the Special Issue Children with Cancer Diseases: The Present and a Challenge for Future)

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14 pages, 958 KiB

Open AccessEditor’s ChoiceArticle

The Effects of Exergames on Physical Fitness, Body Composition and Enjoyment in Children: A Six-Month Intervention Study

by Santo Marsigliante, Giulia My, Gianmarco Mazzotta and Antonella Muscella

Children 2024, 11(10), 1172; https://doi.org/10.3390/children11101172 - 26 Sep 2024

Cited by 7 | Viewed by 2816

Abstract

Background/Objectives: Physical inactivity in children can lead to decreased physical fitness and reduced enjoyment of physical activity. This study aimed to evaluate the impact of exergaming on physical fitness, body composition and perceived enjoyment in elementary school children. Methods: Sixty-four male students (mean [...] Read more.

Background/Objectives: Physical inactivity in children can lead to decreased physical fitness and reduced enjoyment of physical activity. This study aimed to evaluate the impact of exergaming on physical fitness, body composition and perceived enjoyment in elementary school children. Methods: Sixty-four male students (mean age 9.5 years) were randomly assigned to an exergaming group (EG, n = 32), engaging in Kinect Adventures three times a week for six months, or a control group (CG, n = 32), which continued standard physical education. Assessments were conducted pre- and post-intervention, including anthropometric measures, physical fitness tests (standing long jump, countermovement jump, sit-and-reach, 20-m sprint), aerobic fitness (20-m shuttle run), and perceived enjoyment measured with the PACES scale. Results: The EG demonstrated significant reductions in body weight, BMI, and relative fat mass compared to the CG (p < 0.01). Improvements in physical fitness were evident in EG, with increases in standing long jump distance (+12.8%; p < 0.0001), countermovement jump height (+65%, p < 0.0001), and flexibility (+75%; p < 0.0001). Aerobic fitness improved significantly in EG (+87.8m) compared to CG. Perceived enjoyment was notably higher in EG, especially at week three, compared to CG (69.3 ± 5.8 vs. 44.2 ± 11.6; p < 0.0001). Conclusions: Exergaming offers benefits for physical fitness and body composition in children, while also enhancing enjoyment. Incorporating exergames into physical education programs could be an effective strategy for addressing childhood obesity, improving physical skills, and increasing student enjoyment, encouraging long-term physical activity adherence. Full article

(This article belongs to the Special Issue Movement Behaviors and Health-Related Physical Fitness in Pediatric Population)

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19 pages, 742 KiB

Open AccessEditor’s ChoiceArticle

Retinopathy of Prematurity in Eight Portuguese Neonatal Intensive Care Units: Incidence, Risk Factors, and Progression—A Prospective Multicenter Study

by Mariza Fevereiro-Martins, Ana Carolina Santos, Carlos Marques-Neves, Manuel Bicho, Hercília Guimarães and on behalf of the GenE-ROP Study Group

Children 2024, 11(10), 1154; https://doi.org/10.3390/children11101154 - 24 Sep 2024

Cited by 3 | Viewed by 1511

Abstract

Background/Objectives: Retinopathy of prematurity (ROP) is a retinal neovascular disease affecting preterm infants. Identifying risk factors for its development and progression is critical for effective screening and prevention. This study aimed to analyze the incidence of ROP and identify key risk factors for [...] Read more.

Background/Objectives: Retinopathy of prematurity (ROP) is a retinal neovascular disease affecting preterm infants. Identifying risk factors for its development and progression is critical for effective screening and prevention. This study aimed to analyze the incidence of ROP and identify key risk factors for its development and progression. Methods: We conducted a prospective, observational cohort study on 455 neonates (gestational age [GA] < 32 weeks or birth weight < 1500 g) across eight Portuguese NICUs. Results: ROP incidence was 37.8%, with 4.6% requiring treatment. Multivariate analysis identified low GA and the number of red blood cell (RBC) transfusions as significant factors for ROP development and progression. After adjusting for these variables, platelet transfusions, high maximum fraction of inspired oxygen (FiO₂) in the second week, and surfactant use remained significantly associated with ROP development, while early and late sepsis, maternal chronic hypertension, and delayed enteral nutrition were associated with progression to ROP requiring treatment. Conclusions: These findings underscore the importance of addressing low GAs and adult RBC transfusions in ROP risk management and suggest that maximum FiO₂, platelet transfusions, and sepsis also play crucial roles. Larger studies are needed to validate these results and explore preventive interventions, particularly regarding the impact of multiple adult RBC transfusions on fetal hemoglobin percentages. Full article

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14 pages, 268 KiB

Open AccessEditor’s ChoiceArticle

BMI, Dental Caries, and Risk Factors among Elementary School Children: A Cross-Sectional Study

by Deema J. Farsi

Children 2024, 11(9), 1145; https://doi.org/10.3390/children11091145 - 21 Sep 2024

Cited by 2 | Viewed by 1389

Abstract

Background/Objectives: Obesity and dental caries are multifactorial diseases with high prevalence amongst Saudi children. The aim of the study was to determine their association with common risk factors. Methods: This cross-sectional study examined 300 children attending elementary schools. After taking their height and [...] Read more.

Background/Objectives: Obesity and dental caries are multifactorial diseases with high prevalence amongst Saudi children. The aim of the study was to determine their association with common risk factors. Methods: This cross-sectional study examined 300 children attending elementary schools. After taking their height and weight, their body mass indices (BMIs) were calculated. Oral examination was performed to record the decayed, missed, and filled scores (dmft/DMFT). A thorough questionnaire was compiled and validated to gather information on diet and physical activity (PA). The KIDMED score was calculated from a 16-item questionnaire to assess diet. Junk food and PA scores were also calculated based on relevant questions. Nonparametric tests were used to assess the associations between the scores and health outcomes (dmft/DMFT and BMI). Results: Fifty-eight of the children had poor diets, which was associated with higher dmft/DMFT (p = 0.012). PA levels were very low, and the average PA score was 2.12 ± 0.61. No association was found between BMI percentiles and PA level, nor between BMI percentiles and diet quality. Older children had lower BMI percentiles compared with younger children (coefficient = −9.35, 95% CI: −17.05, −1.65), and a borderline significant negative association was observed between dmft/DMFT and BMI percentile. Conclusions: Poor diets and chips consumption were related to dental caries. Obesity was not related to diet quality nor PA level. Full article

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19 pages, 716 KiB

Open AccessEditor’s ChoiceArticle

Parental Knowledge, Attitudes, and Practices Regarding Early Childhood Caries in Bihor, Romania: A Cross-Sectional Study

by Abel Emanuel Moca, Raluca Iulia Juncar, Rahela Tabita Moca, Mihai Juncar, Rebeca Daniela Marton and Luminița Ligia Vaida

Children 2024, 11(9), 1131; https://doi.org/10.3390/children11091131 - 18 Sep 2024

Cited by 5 | Viewed by 1649

Abstract

Background/Objectives: Early childhood caries (ECC) is a significant global health issue, particularly affecting deciduous teeth in young children. ECC is prevalent in Romania, where nearly half of children experience dental caries. This study aimed to assess the influence of gender, age, and living [...] Read more.

Background/Objectives: Early childhood caries (ECC) is a significant global health issue, particularly affecting deciduous teeth in young children. ECC is prevalent in Romania, where nearly half of children experience dental caries. This study aimed to assess the influence of gender, age, and living environment on parents’ knowledge, attitudes, and practices (KAP) regarding ECC in Bihor County, Romania, using a KAP-type questionnaire. Methods: A cross-sectional study was conducted between March and September 2024, utilizing an online KAP questionnaire distributed via social networks. The sample comprised 419 parents of children under six years old. Respondents provided socio-demographic data and answered questions regarding their knowledge, attitudes, and practices concerning ECC prevention, treatment, and oral health. Statistical analysis was conducted using Chi-square tests to assess associations between demographic factors and parental KAP. A p-value of less than 0.05 was considered statistically significant. Results: Of the 419 respondents, 83.1% were female, and 62.5% were between the ages of 31 and 40. Significant gender-based differences were found in knowledge about pain from caries (93.7% of female participants vs. 81.7% of male participants, p = 0.004) and the importance of brushing twice daily (93.7% of female respondents vs. 80.3% of male respondents, p = 0.010). Younger parents (aged 18–30) were more likely to affirm the effectiveness of fluoride (65.4%) compared to those aged 31–40 (53.1%, p = 0.02). Urban parents were more likely to correctly identify the timing of tooth eruption (59.1% vs. 52.6% of rural parents, p = 0.021). Conclusions: The study highlights gender, age, and urban–rural disparities in parental knowledge and attitudes towards ECC. These findings underscore the need for targeted educational interventions to improve oral health outcomes and reduce ECC prevalence in the Bihor region. Tailored public health strategies addressing demographic factors could enhance preventive oral health behaviors and reduce the healthcare burden associated with untreated dental caries. Full article

(This article belongs to the Special Issue Public Health and Preventive Medicine for Children)

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32 pages, 850 KiB

Open AccessEditor’s ChoiceReview

Associations between Meal Patterns and Risk of Overweight/Obesity in Children and Adolescents in Western Countries: A Systematic Review of Longitudinal Studies and Randomised Controlled Trials

by Georgios Saltaouras, Athanasia Kyrkili, Eirini Bathrellou, Michael Georgoulis, Mary Yannakoulia, Vasiliki Bountziouka, Urška Smrke, George Dimitrakopoulos and Meropi D. Kontogianni

Children 2024, 11(9), 1100; https://doi.org/10.3390/children11091100 - 7 Sep 2024

Cited by 5 | Viewed by 3047

Abstract

Childhood overweight/obesity (OV/OB) is a major public health problem in Western countries, often accompanied with comorbidities (e.g., hypertension and insulin resistance) (i.e., metabolically unhealthy obesity—MUO). Among diet-related risk factors of OV/OB risk and MUO, meal patterns remain limitedly studied. The aim of this [...] Read more.

Childhood overweight/obesity (OV/OB) is a major public health problem in Western countries, often accompanied with comorbidities (e.g., hypertension and insulin resistance) (i.e., metabolically unhealthy obesity—MUO). Among diet-related risk factors of OV/OB risk and MUO, meal patterns remain limitedly studied. The aim of this systematic review was to explore associations between meal patterns and the risk of childhood OV/OB and MUO in children/adolescents aged 2–19 years. Longitudinal studies and randomised controlled trials from PUBMED and Scopus published between January 2013 and April 2024 were retrieved. Twenty-eight studies were included, all of which reported on OV/OB risk, with none on MUO risk. Regular consumption of breakfast (n = 3) and family meals (n = 4) and avoiding dining while watching TV (n = 4) may be protective factors against childhood OV/OB, whereas meal skipping (primarily breakfast; n = 4) may be a detrimental factor. Mixed effects of meal frequency on OV/OB risk were observed; no effects of frequency of lunch or of fast-food consumption and of meals served at school were found. There was insufficient evidence to support the role of other patterns (meal timing, eating in other social contexts). Meals were mainly participant-identified, leading to increased heterogeneity. Research focusing on childhood MUO and the use of harmonised definitions regarding the assessment of meal patterns are highly warranted. Full article

(This article belongs to the Special Issue Nutritional Status and Eating Patterns in Children and Adolescents: Prevalence, Screening and Prevention of Metabolic Disorders)

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11 pages, 575 KiB

Open AccessEditor’s ChoiceReview

Psychological and Clinical Challenges in the Management of Type 1 Diabetes during Adolescence: A Narrative Review

by Bruno Bombaci, Arianna Torre, Alessandro Longo, Maria Pecoraro, Mattia Papa, Lacrima Sorrenti, Mariarosaria La Rocca, Fortunato Lombardo and Giuseppina Salzano

Children 2024, 11(9), 1085; https://doi.org/10.3390/children11091085 - 4 Sep 2024

Cited by 14 | Viewed by 6115

Abstract

Adolescence, a critical period of physical and psychological development, presents unique challenges in type 1 diabetes (T1D) management due to endocrinological changes, reduced therapeutic adherence, and elevated susceptibility to psychological issues such as depression, anxiety, and eating disorders. This narrative review explores the [...] Read more.

Adolescence, a critical period of physical and psychological development, presents unique challenges in type 1 diabetes (T1D) management due to endocrinological changes, reduced therapeutic adherence, and elevated susceptibility to psychological issues such as depression, anxiety, and eating disorders. This narrative review explores the impact of psychological and behavioral factors on glycemic control in adolescents with T1D. We examine the prevalence and influence of mental health disorders, lifestyle factors, harmful behaviors, and social dynamics on diabetes management and glycemic outcomes. Strategies for improving metabolic control are also reviewed, including cognitive behavioral therapy, technological devices, and educational interventions. The importance of tailored psychological support, family involvement, and targeted interventions to improve adherence to treatment and glycemic control in adolescents with T1D should be emphasized. Full article

(This article belongs to the Special Issue Glycemic Control in Children and Adolescents with Type 1 Diabetes)

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12 pages, 235 KiB

Open AccessEditor’s ChoiceArticle

Vitamin D Deficiency—A Public Health Issue in Children

by Alexandru Herdea, Harun Marie, Adelina Ionescu, Diana-Mihaela Sandu, Sara-Teodora Pribeagu and Alexandru Ulici

Children 2024, 11(9), 1061; https://doi.org/10.3390/children11091061 - 30 Aug 2024

Cited by 8 | Viewed by 2068

Abstract

Background: 25-hydroxyvitamin D [25(OH)D] deficiency is a global health concern, particularly in pediatric populations, with implications for musculoskeletal health and overall well-being. This study aimed to evaluate serum 25(OH)D levels in a pediatric population and assess the prevalence of deficiency and insufficiency. Methods: [...] Read more.

Background: 25-hydroxyvitamin D [25(OH)D] deficiency is a global health concern, particularly in pediatric populations, with implications for musculoskeletal health and overall well-being. This study aimed to evaluate serum 25(OH)D levels in a pediatric population and assess the prevalence of deficiency and insufficiency. Methods: A retrospective analysis was conducted on data from 741 pediatric patients (2–17 years old) who visited an urban hospital for children for acute respiratory and gastrointestinal conditions in the span of 2 years. Serum 25(OH)D levels were measured using chemiluminescent microparticle immunoassay. Statistical analyses were performed to assess the prevalence of deficiency and insufficiency, seasonal variations, and correlations with age and daylight exposure. Results: Of the 739 pediatric patients analyzed, a substantial proportion exhibited insufficient (31.80%) or deficient (36.54%) serum 25(OH)D levels. While younger age groups generally had higher mean 25(OH)D levels, a negative correlation was observed between 25(OH)D levels and age. Sunlight exposure variations did not significantly impact serum 25(OH)D levels. Despite diverse daylight exposure patterns, there were no significant differences between longer and shorter daylight periods. Conclusions: This study highlights the high prevalence of 25(OH)D deficiency and insufficiency in the pediatric population, emphasizing the need for public health monitoring and targeted supplementation strategies. Findings underscore the importance of regular consultations with healthcare providers to ensure optimal 25(OH)D levels in children, with potential implications for revising current sufficiency thresholds. Addressing 25(OH)D deficiency is crucial for promoting musculoskeletal health and overall well-being in children. Full article

(This article belongs to the Section Global Pediatric Health)

16 pages, 867 KiB

Open AccessEditor’s ChoiceReview

The Transition from Childhood to Adolescence: Between Health and Vulnerability

by Francesca Mastorci, Maria Francesca Lodovica Lazzeri, Cristina Vassalle and Alessandro Pingitore

Children 2024, 11(8), 989; https://doi.org/10.3390/children11080989 - 14 Aug 2024

Cited by 8 | Viewed by 8553

Abstract

Transitioning from childhood into adolescence is an extraordinary time of life, associated with major physical, emotional, cognitive, and social changes and characterized by dynamic development in which interaction with the environment modulates the individual resources responsible for well-being and health. This sensitive period [...] Read more.

Transitioning from childhood into adolescence is an extraordinary time of life, associated with major physical, emotional, cognitive, and social changes and characterized by dynamic development in which interaction with the environment modulates the individual resources responsible for well-being and health. This sensitive period is the time when, in addition to hormonal, metabolic, and neural changes, certain behavioral strategies begin to take shape that will shortly go on to define the emotional, social, and cultural identity of the individual. This narrative review aimed to uncover the crucial processes underlying the transition by identifying processes that are responsible for cognitive, psychosocial, and emotional development, in the absence of disease. For this aim, we highlight (1) the physical, psychological, and social determinants during the transition from childhood to adolescence; (2) the role of health-related variables in resilience or vulnerability mechanisms; and (3) recent school-based strategies to promote health and well-being. Recognizing that health and well-being are the result of the interaction of many biological, psychological, social, cultural, and physical factors will lead to comprehensive health promotion involving all actors joining the growth process, from health professionals and the educational community to parents and community. Furthermore, it is important that psychosocial dimensions are strengthened already during childhood to prevent the onset of frailty and illness in adolescence. Full article

(This article belongs to the Section Global Pediatric Health)

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8 pages, 470 KiB

Open AccessEditor’s ChoiceArticle

Feasibility and Acceptability of a Newborn Screening Program Using Targeted Next-Generation Sequencing in One Maternity Hospital in Southern Belgium

by Tamara Dangouloff, Kristine Hovhannesyan, Davood Mashhadizadeh, Frederic Minner, Myriam Mni, Laura Helou, Flavia Piazzon, Leonor Palmeira, François Boemer and Laurent Servais

Children 2024, 11(8), 926; https://doi.org/10.3390/children11080926 - 30 Jul 2024

Cited by 4 | Viewed by 2218

Abstract

Purpose: Genomic newborn screening programs are emerging worldwide. With the support of the local pediatric team of Liege, Belgium, we developed a panel of 405 genes that are associated with 165 early-onset, treatable diseases with the goal of creating a newborn screening test [...] Read more.

Purpose: Genomic newborn screening programs are emerging worldwide. With the support of the local pediatric team of Liege, Belgium, we developed a panel of 405 genes that are associated with 165 early-onset, treatable diseases with the goal of creating a newborn screening test using targeted next-generation sequencing for all early-onset, treatable, and serious conditions. Methods: A process was developed that informed the future parents about the project and collected their consent during a face-to-face discussion with a trained investigator. The first baby was screened on 1 September 2022. The main objective of the study was to test the feasibility and the acceptability of targeted sequencing at birth as a first-tier newborn screening approach to detect treatable genetic conditions or genetic conditions for which a pre-symptomatic or early symptomatic clinical trial is available. Results: As of 20 June 2024, the parents of 4425 children had been offered the test; 4005 accepted (90.5%) and 420 refused (9.5%). The main reasons for refusal were the research nature of the project and the misunderstanding of what constitutes genetic conditions. Conclusions: These data demonstrate the high acceptability of genomic newborn screening in a properly informed population. Full article

(This article belongs to the Section Pediatric Neonatology)

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19 pages, 611 KiB

Open AccessEditor’s ChoiceReview

Efficacy and Safety of Vagus Nerve Stimulation in Lennox–Gastaut Syndrome: A Scoping Review

by Debopam Samanta

Children 2024, 11(8), 905; https://doi.org/10.3390/children11080905 - 27 Jul 2024

Cited by 7 | Viewed by 1986

Abstract

Lennox–Gastaut syndrome (LGS) is a severe developmental and epileptic encephalopathy characterized by drug-resistant seizures, cognitive impairments, and abnormal electroencephalographic patterns. Vagus nerve stimulation (VNS) is a widely used neuromodulation therapy for LGS, but its effects on seizure outcomes, different seizure types, non-seizure outcomes, [...] Read more.

Lennox–Gastaut syndrome (LGS) is a severe developmental and epileptic encephalopathy characterized by drug-resistant seizures, cognitive impairments, and abnormal electroencephalographic patterns. Vagus nerve stimulation (VNS) is a widely used neuromodulation therapy for LGS, but its effects on seizure outcomes, different seizure types, non-seizure outcomes, and adverse events in this population have not been comprehensively reviewed. To conduct a scoping review on the use of VNS in LGS, a literature search was performed in PubMed, OVID, Web of Science, and Embase from inception to 9 June 2024, using relevant keywords and without restrictions on study design. The search yielded forty eligible studies (twenty-four retrospective cohorts, fourteen prospective cohorts, and two registry analyses) comprising 1400 LGS patients treated with VNS. No randomized controlled trials were identified. Across studies, the median seizure reduction ranged from 20.6% to 65%, with 0% to 100% of patients achieving a ≥50% seizure reduction. No consistent preoperative biomarker of VNS responsiveness was identified in LGS. Although inconsistent among different studies, tonic, atonic, and tonic–clonic seizures responded best, while focal seizures responded worst. Improvements in seizure severity, alertness, and quality of life were reported in some studies, but cognitive and adaptive functioning generally remained unchanged. Adverse events were mostly mild and transient, including hoarseness, cough, and paresthesia. Device-related complications and infections were uncommon. In conclusion, further research is needed to better understand VNS’s position in the evolving LGS treatment landscape and its cost effectiveness. Full article

(This article belongs to the Special Issue Diagnosis and Treatment in Childhood Epilepsy)

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12 pages, 594 KiB

Open AccessEditor’s ChoiceArticle

Evaluating Malnutrition Practices and Mother’s Education on Children Failure to Thrive Symptoms Using Entropy-Weight and TOPSIS Method

by Maria Tzitiridou-Chatzopoulou, Georgia Zournatzidou, Eirini Orovou, Maria Lithoxopoulou, Eftychia Drogouti, George Sklavos, Evangelia Antoniou and Christos Tsakalidis

Children 2024, 11(8), 903; https://doi.org/10.3390/children11080903 - 26 Jul 2024

Cited by 9 | Viewed by 1517

Abstract

Background/Objectives: Failure to thrive (FTT) is mostly caused by insufficient consumption of nutrient-rich food, recurrent infections like diarrhea and intestinal worms, substandard caregiving practices, and limited availability of health and other vital services. Furthermore, there was a correlation between the educational level of [...] Read more.

Background/Objectives: Failure to thrive (FTT) is mostly caused by insufficient consumption of nutrient-rich food, recurrent infections like diarrhea and intestinal worms, substandard caregiving practices, and limited availability of health and other vital services. Furthermore, there was a correlation between the educational level of mothers and the occurrence of FTT in children aged 6–12 months. Thus, the objective of the current research is twofold: (i) to investigate other factors related to FTT and (ii) to evaluate the impact of them on FTT in Sub-Saharan African countries and their urban areas. Methods: We used weight entropy and TOPSIS methods to approach the research question. In particular, the entropy-weight method is effective for precisely evaluating the relative significance of the selected criteria for TOPSIS computation. Thus, data were retrieved from the database of UNICEF for the year 2019 for nine Sub-Saharan countries, and based on the methods used, five criteria have been selected for consideration. Those of mothers in higher education were identified as having a higher weight, which means that this can affect positively the ability of mothers to mitigate the situation of FTT and protect their children. Results: The findings of the study highlight the factors of maternal education at a higher level and unhealthy habits as those with the greatest weight and impact on the FTT. Moreover, the results indicate that the association between maternal education, and especially higher education, and FTT is stronger in Ethiopia. Despite the limited amount of research on the specified relationship in Sub-Saharan countries, this study is among the initial ones to examine it. Conclusions: The current study can aid policymakers in devising appropriate policies and implementing effective measures to tackle FTT in Sub-Saharan Africa, like enhancing the number of mothers in these countries to be integrated into the educational system to help both themselves and their children mitigate or avoid the symptoms of FTT. Full article

(This article belongs to the Special Issue Infant Feeding: Advances and Future Challenges: 2nd Edition)

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13 pages, 264 KiB

Open AccessEditor’s ChoiceArticle

Mepolizumab in Severe Pediatric Asthma: Certainties and Doubts through a Single-Center Experience and Review of the Literature

by Marco Maglione, Melissa Borrelli, Alessandro Dorato, Chiara Cimbalo, Luigi Antonio del Giudice and Francesca Santamaria

Children 2024, 11(8), 895; https://doi.org/10.3390/children11080895 - 25 Jul 2024

Cited by 3 | Viewed by 1912

Abstract

Background: Although, in most children with asthma, good symptom control is achieved with a low to moderate dose of inhaled corticosteroids, a small group of patients still experiences frequent symptoms, and even severe exacerbations, impairment of lung function, and reduced quality of life. [...] Read more.

Background: Although, in most children with asthma, good symptom control is achieved with a low to moderate dose of inhaled corticosteroids, a small group of patients still experiences frequent symptoms, and even severe exacerbations, impairment of lung function, and reduced quality of life. Some of these subjects with severe asthma require biologic drugs as add-on therapy. In the past decade, numerous monoclonal antibodies have been approved for children or adolescents with severe asthma, in addition to their increasing use in adult asthma. However, the available evidence on how to select the most appropriate biologic based on a single patient’s clinical, functional, and laboratory characteristics is still scant, and is insufficient to guide clinicians in the decision-making process of a personalized treatment. Materials and Methods: We report a case series of four patients with severe eosinophilic asthma treated with mepolizumab, an anti-interleukin-5 monoclonal antibody, and review the existing literature on this treatment in children and adolescents. Results: Our patients, all with blood eosinophilia and elevated fractional exhaled nitric oxide levels, developed poor symptom control despite prolonged treatment with high-dose inhaled corticosteroids plus a second controller, addressing the addition of a biologic drug. In all of them, a 12-month treatment with subcutaneous mepolizumab showed a reduction in the blood eosinophil count and in asthma exacerbations, as well as an improvement on the Asthma Control Test. The results of the literature search focused on the strengths and limitations of the pediatric use of mepolizumab and highlighted the areas worthy of further research. Conclusions: Mepolizumab has proven effective in improving symptom control in pediatric patients with severe asthma. Additional well-powered clinical trials will be helpful in developing evidence-based guidelines regarding biologic drugs in the pediatric population. Full article

(This article belongs to the Special Issue Molecular and Pathophysiological Mechanisms Underlying Asthma and Allergy in Children)

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15 pages, 459 KiB

Open AccessEditor’s ChoiceArticle

Assessment of Adolescents in Child-to-Parent Violence: Invariance, Prevalence, and Reasons

by Luis Burgos-Benavides, M. Carmen Cano-Lozano, Andrés Ramírez, Samuel P. León, Venus Medina-Maldonado and Francisco Javier Rodríguez-Díaz

Children 2024, 11(7), 845; https://doi.org/10.3390/children11070845 - 12 Jul 2024

Cited by 5 | Viewed by 2226

Abstract

Child-to-parent violence is a form of family violence where the children are the aggressors. Objective: This study first aimed to analyze the psychometric validity of the Child-to-Parent Violence Questionnaire (CPV-Q) among Ecuadorian adolescents. Second, the measurement invariance across the children’s sex was examined. [...] Read more.

Child-to-parent violence is a form of family violence where the children are the aggressors. Objective: This study first aimed to analyze the psychometric validity of the Child-to-Parent Violence Questionnaire (CPV-Q) among Ecuadorian adolescents. Second, the measurement invariance across the children’s sex was examined. Finally, the prevalence of child-to-parent violence (CPV) was also determined. Methods: A total of 2084 adolescents aged 12 to 18 years participated in this study. The participants were residents of two provinces in southern Ecuador. A higher percentage of participants were women. They lived mostly with their father and mother. The married marital status of the parents was the most frequently reported. Most of the fathers and mothers of the participants completed primary education. The sampling design was probabilistic, with proportional allocation by age and quotas according to the number of inhabitants per province. The sample size was determined by using a finite population formula. All the participants were randomly selected. The CPV-Q was used to assess child-to-parent violence. The items were adapted linguistically and tailored to the Ecuadorian context. Results: The questionnaire demonstrated excellent model fit and adequate reliability. Full measurement invariance was held for all scales except for the reasons subscale pertaining to fathers. Statistically significant differences were observed with respect to the sex of the aggressor, with control/domain behaviors toward both parents and psychological violence toward the mother being more frequent among daughters than sons. Similarly, reactive reasons were more frequent among daughters than sons. Conclusion: This study provides significant psychometric evidence on the CPV-Q in Ecuadorian adolescents along with data on the prevalence of violence against parents. Full article

(This article belongs to the Special Issue Children and Adolescent Mental Health Problems and Prevention)

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9 pages, 3016 KiB

Open AccessEditor’s ChoiceReview

Identifying Language Development in Children with ADHD: Differential Challenges, Interventions, and Collaborative Strategies

by Dimitra V. Katsarou, Efthymia Efthymiou, Georgios A. Kougioumtzis, Maria Sofologi and Maria Theodoratou

Children 2024, 11(7), 841; https://doi.org/10.3390/children11070841 - 10 Jul 2024

Cited by 6 | Viewed by 8574

Abstract

Attention Deficit Hyperactivity Disorder (ADHD) significantly influences children’s language acquisition and usage. This theoretical study explores the multifaceted impact of ADHD on language development, specifically focusing on reading and writing challenges. Existing research reveals that approximately 30% of children with ADHD show significant [...] Read more.

Attention Deficit Hyperactivity Disorder (ADHD) significantly influences children’s language acquisition and usage. This theoretical study explores the multifaceted impact of ADHD on language development, specifically focusing on reading and writing challenges. Existing research reveals that approximately 30% of children with ADHD show significant delays in reading proficiency. Additionally, about 40% of these children struggle with phonological processing, which directly impacts their reading and writing skills. Interventions targeting executive function training combined with phonics-based instruction have been shown to significantly improve language outcomes. This study introduces a comprehensive framework connecting these challenges to specific interventions and collaborative strategies, emphasizing the importance of a multi-disciplinary approach. This work provides perspectives on the specific connections between ADHD symptoms and language difficulties, offering detailed potential solutions based on empirical data. Moreover, it features the necessity of adopting integrated intervention strategies to advance academic outcomes and communicative competencies for children with ADHD, providing new understandings into effective educational practices. Full article

(This article belongs to the Special Issue Language Acquisition and Language Impairment in Children with and without Neurodevelopmental Disorders)

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9 pages, 230 KiB

Open AccessEditor’s ChoiceArticle

Different Eating Habits Are Observed in Overweight and Obese Children Than in Normal-Weight Peers

by Żaneta Malczyk, Agnieszka Pasztak-Opiłka and Agnieszka Zachurzok

Children 2024, 11(7), 834; https://doi.org/10.3390/children11070834 - 9 Jul 2024

Cited by 1 | Viewed by 1875

Abstract

Background: Obesity is diagnosed in 13.6% of early primary school children in Poland. Its presence at this age increases the risk of obesity occurrence in adulthood. Therefore, it is important to properly shape eating behaviors at the stage of childhood and identify incorrect [...] Read more.

Background: Obesity is diagnosed in 13.6% of early primary school children in Poland. Its presence at this age increases the risk of obesity occurrence in adulthood. Therefore, it is important to properly shape eating behaviors at the stage of childhood and identify incorrect eating styles. Methods: This study aimed to investigate whether overweight and obese children differ significantly from children with normal body weights in terms of their eating styles. For the materials and methods, 43 mothers of overweight or obese children aged 3–10 years and 88 mothers of normal-weight children aged 3–10 years completed a questionnaire related to sociodemographic factors and the Children’s Eating Behaviour Questionnaire. Results: The overweight and obese children, compared with normal-weight children, scored higher on the food responsiveness (p = 0.009) and emotional overeating (p = 0.013) scales and lower on the satiety responsiveness (p = 0.025) and slowness in eating scales (p < 0.0001). No significant difference was found for other subscales between the studied groups. In the group of overweight and obese children, the child’s age correlated negatively with enjoyment of food, as did the mother’s BMI with slowness in eating. Conclusions: The results indicate the presence of significant differences in eating styles between normal-weight children and overweight or obese children. Identifying families at high risk of inappropriate eating behaviors and educating them appropriately can reduce the risk of children becoming overweight or obese. Full article

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

17 pages, 300 KiB

Open AccessEditor’s ChoiceArticle

Nasal High-Frequency Oscillatory Ventilation Use in Romanian Neonatal Intensive Care Units—The Results of a Recent Survey

by Maria Livia Ognean, Anca Bivoleanu, Manuela Cucerea, Radu Galiș, Ioana Roșca, Monica Surdu, Silvia-Maria Stoicescu and Rangasamy Ramanathan

Children 2024, 11(7), 836; https://doi.org/10.3390/children11070836 - 9 Jul 2024

Cited by 1 | Viewed by 1978

Abstract

Background: Nasal high-frequency oscillatory ventilation (nHFOV) has emerged as an effective initial and rescue noninvasive respiratory support mode for preterm infants with respiratory distress syndrome (RDS); however, little is known about nHFOV use in Romanian neonatal intensive care units (NICUs). Objectives: We aimed [...] Read more.

Background: Nasal high-frequency oscillatory ventilation (nHFOV) has emerged as an effective initial and rescue noninvasive respiratory support mode for preterm infants with respiratory distress syndrome (RDS); however, little is known about nHFOV use in Romanian neonatal intensive care units (NICUs). Objectives: We aimed to identify the usage extent and clinical application of nHFOV in Romania. Methods: A structured web-based questionnaire was designed to find the rate of nHFOV use and knowledge of this new method of noninvasive respiratory support in Romanian level III NICUs. Using multiple-choice, open-ended, and yes/no questions, we collected information on the NICU’s size, noninvasive respiratory support modes used, nHFOV use, indications, settings, nasal interfaces, secondary effects, and equipment used. Descriptive statistics and comparisons were performed using IBM SPSS Statistics 26.0. Results: A total of 21/23 (91.3%) leaders from level III NICUs (median [IQR] number of beds of 10 [10–17.5]) responded to the survey. The most frequently used noninvasive ventilation modes were CPAP mode on mechanical ventilators (76.2%), followed by NIPPV (76.2%); heated, humidified high-flow nasal cannula (HHHFNC) (61.9%); and nHFOV (11/21 units; 52.4%). A total of 5/11 units reported frequent nHFOV use (in two or more newborns/month) in both term and preterm infants. The main indications reported for nHFOV use were CPAP failure (90.9%), hypercapnia (81.8%), and bronchopulmonary dysplasia (72.7%). Face/nasal masks and short binasal prongs are the most commonly used nasal interfaces (90.9% and 72.7%, respectively). Air leaks at the interface level (90.9%), thick secretions (81.8%), and airway obstruction (63.6%) were the most frequently mentioned adverse effects of nHFOV. Only three of the NICUs had a written protocol for nHFOV use. Most units not yet using nHFOV cited lack of equipment, experience, training, or insufficient information and evidence for the clinical use and outcome of nHFOV use in neonates as the main reasons for not implementing this noninvasive respiratory mode. Conclusions: Our survey showed that nHFOV is already used in more than half of the Romanian level III NICUs to support term and preterm infants with respiratory distress despite a lack of consensus regarding indications and settings during nHFOV. Full article

(This article belongs to the Special Issue Diagnosis and Management of Newborn Respiratory Distress Syndrome)

10 pages, 820 KiB

Open AccessEditor’s ChoiceArticle

Incidence and Characteristics of Pediatric Patients with Acute Otitis Hospitalized in a Romanian Infectious Diseases Hospital

by Vlad Ștefan Pleșca, Anca Streinu-Cercel, Oana Săndulescu, Anca Cristina Drăgănescu, Răzvan Hainăroșie and Anca Doina Pleșca

Children 2024, 11(7), 832; https://doi.org/10.3390/children11070832 - 8 Jul 2024

Cited by 2 | Viewed by 1389

Abstract

Background: Otic involvement is common in children during acute infectious diseases, and is an important cause of morbidity and health service utilization. Methods: We performed a retrospective analysis of pediatric cases hospitalized in the largest infectious disease hospital in Romania between 2018 and [...] Read more.

Background: Otic involvement is common in children during acute infectious diseases, and is an important cause of morbidity and health service utilization. Methods: We performed a retrospective analysis of pediatric cases hospitalized in the largest infectious disease hospital in Romania between 2018 and 2023, with the aim of quantifying the incidence and impact of acute otitis (AO) according to pediatric age subgroups. Results: A total of 1118 cases diagnosed with AO were eligible and included in the analysis. Acute congestive otitis media was the most common subtype, identified in 53.3% of cases, followed by acute purulent otitis media (APOM) in 26.7% of children. The majority of AO cases (69.9%) were diagnosed in the pre-pandemic period (2018–2019), and infants (10.6%), toddlers (49.4%), and preschoolers (29.2%) were the most affected age groups. A viral infection associated with the AO episode was documented in 49.6% of cases. Influenza viruses were most commonly reported (20.5%), followed by SARS-CoV-2 (5.8%), and adenovirus (4.9%). A total of 38 cases of AO were identified in children with measles. In 15.9% of APOM cases, Streptococcus pneumoniae was isolated by culture from otic secretions. The duration of hospitalization was longer in children with APOM and acute otitis externa compared to the other subtypes of AO (p < 0.001). Conclusions: Our study highlights the importance of ENT (ear, nose, and throat) monitoring in children hospitalized for acute infectious diseases, as the majority of AO cases occur in the context of a viral infection. These findings emphasize the necessity for tailored assessment and intervention in suspected cases of AO, especially in young children under 5 years of age. Full article

(This article belongs to the Special Issue Viral Respiratory Infections and Bacterial Superinfections in Children)

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11 pages, 2460 KiB

Open AccessEditor’s ChoiceArticle

Do Gender and BMI Affect the Motor Skills of Five-Year-Old Preschoolers Differently?

by Marcos Mecías-Calvo, Fernando Carregal-San Emeterio and Rubén Navarro-Patón

Children 2024, 11(7), 829; https://doi.org/10.3390/children11070829 - 7 Jul 2024

Cited by 1 | Viewed by 1396

Abstract

Background/Objective: Weight gain is associated with numerous health complications and constitutes a serious public health problem. Motor competence (MC) can be a protective factor since children’s participation and practice in physical activities can improve their health. The objective of this study was to [...] Read more.

Background/Objective: Weight gain is associated with numerous health complications and constitutes a serious public health problem. Motor competence (MC) can be a protective factor since children’s participation and practice in physical activities can improve their health. The objective of this study was to investigate the impact of gender and BMI on MC [i.e., manual dexterity (MD), aiming and catching (A&C), balance (Bal), and total MC percentile (TP)] depending on gender (boy/girl) and BMI (normal weight, overweight or obesity). Methods: The MABC-2 battery was applied in a sample of 368 preschool children (5.69 ± 0.28 years of age; 54.9% girls). Results: Boys and girls showed statistically significant differences in MC components: boys had higher scores in A&C (p = 0.002), while girls excelled in MD (p < 0.001), Bal (p = 0.035); TP (p < 0.001), and BMI [Bal (p = 0.009); TP (p = 0.050)], with a higher percentile in those children with overweight in both cases. Statistically significant differences were also found in the interactions between gender*BMI [MD (p < 0.001) and TP (p < 0.001)]. Conclusions: The findings showed that there were notable variations in total percentile, balance, and manual dexterity between boys and girls. In addition, girls outperformed boys in all categories save aiming and catching. However, males who were overweight or obese earned greater percentiles in both balance and the MABC-2 battery’s total percentile. Full article

(This article belongs to the Special Issue Motor Competence and Physical Activity in School Children)

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19 pages, 3304 KiB

Open AccessEditor’s ChoiceArticle

The Accuracy of Digital Impressions versus Conventional Impressions in Neonates with Cleft Lip and/or Palate: A Laboratory-Based Study

by Jyotsna Unnikrishnan, Mahmoud Bakr, Robert Love and Ghassan Idris

Children 2024, 11(7), 827; https://doi.org/10.3390/children11070827 - 6 Jul 2024

Cited by 4 | Viewed by 1863

Abstract

Cleft lip and palate (CL/P) are a common congenital craniofacial anomaly requiring precise impressions for effective treatment. Conventional impressions (CIs) pose challenges in neonates with CL/P due to their delicate oral anatomy. While digital impressions (DIs) are increasingly recognised for their potential benefits [...] Read more.

Cleft lip and palate (CL/P) are a common congenital craniofacial anomaly requiring precise impressions for effective treatment. Conventional impressions (CIs) pose challenges in neonates with CL/P due to their delicate oral anatomy. While digital impressions (DIs) are increasingly recognised for their potential benefits over conventional methods in dentistry, their accuracy and application in neonates with cleft lip and palate (CL/P) remain underexplored. This study aimed to assess the accuracy of DIs compared to CIs in neonates with CL/P, using alginate and putty materials as references. A laboratory-based case–control study was conducted, utilising soft acrylic models resembling neonatal mouths with CL/P. Alginate and putty impressions were obtained conventionally, while digital impressions were captured using an intraoral scanner (IOS). A total of 42 models were analysed, divided evenly into three groups, with each group comprising 14 models. Superimposition and surface discrepancy analyses were performed to evaluate impression accuracy. The results revealed no statistically significant differences between the digital and conventional impressions in their intra-arch measurements and surface discrepancies. The mean measurement values did not significantly differ among groups, with p values indicating no significant variations (p > 0.05), confirmed by an analysis of variance. High intra-examiner reliability with Intra Class Coefficient (ICC) values close to 1 indicated consistent measurements over time. The current study demonstrates that DIs are equally accurate as conventional alginate and putty impressions in neonates with cleft lip and palate, offering a viable and less invasive alternative for clinical practise. This advancement holds promise for improving the treatment planning process and enhancing patient comfort, particularly in vulnerable neonatal populations. Further research is warranted to explore the clinical implications and factors affecting DI accuracy in this population. Full article

(This article belongs to the Special Issue Congenital Cleft Lip and Palate: Diagnosis, Treatment and Management)

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9 pages, 222 KiB

Open AccessEditor’s ChoiceArticle

Orofacial Clefts and Maternal Risk Factors: A Population-Based Case–Control Study

by Michele Santoro, Lorena Mezzasalma, Alessio Coi and Anna Pierini

Children 2024, 11(7), 819; https://doi.org/10.3390/children11070819 - 4 Jul 2024

Cited by 2 | Viewed by 1497

Abstract

Background/Objectives: Orofacial clefts (OFCs) are some of the most common congenital anomalies worldwide. The aim of this case–control study was to evaluate the association of OFCs with selected maternal characteristics. Methods: Data on isolated non-syndromic cases of OFCs were extracted from the population-based [...] Read more.

Background/Objectives: Orofacial clefts (OFCs) are some of the most common congenital anomalies worldwide. The aim of this case–control study was to evaluate the association of OFCs with selected maternal characteristics. Methods: Data on isolated non-syndromic cases of OFCs were extracted from the population-based registry of congenital anomalies of Tuscany. A sample of live-born infants without any congenital anomaly was used as the control group. We investigated the association with sex and some maternal characteristics: age, body mass index, smoking, and education. Adjusted odds ratios (OR) were calculated using a logistic regression model. Analyses were performed for the total OFCs and separately for cleft lip (CL) and cleft palate (CP). Results: Data on 219 cases and 37,988 controls were analyzed. A higher proportion of males (57.9%) was observed, particularly for CL. A decreasing trend among the maternal age classes was observed (OR:0.81 (95%CI 0.70–0.94)). Underweight mothers had a higher prevalence of OFCs, in particular for CL (OR:1.88 (95%CI 1.08–3.26)). Conclusions: We found an association of OFCs with lower maternal age. The association with maternal age remains controversial and further epidemiological evidence is needed through multicenter studies. We observed that CL was more common in underweight mothers, suggesting actions of primary prevention. Full article

(This article belongs to the Special Issue Current Research on Cleft Lip in Children - 2nd Edition)

11 pages, 6142 KiB

Open AccessEditor’s ChoiceArticle

Sclerostin and Wnt Signaling in Idiopathic Juvenile Osteoporosis Using High-Resolution Confocal Microscopy for Three-Dimensional Analyses

by Renata C. Pereira, Kathleen J. Noche, Barbara Gales, Zhangying Chen, Isidro B. Salusky and Lauren V. Albrecht

Children 2024, 11(7), 820; https://doi.org/10.3390/children11070820 - 4 Jul 2024

Cited by 1 | Viewed by 1766

Abstract

Background: Idiopathic juvenile osteoporosis (IJO) is a rare condition characterized by low bone mass that can increase the risk of fractures in children. Treatment options for these patients are limited as the molecular mechanisms of disease initiation and progression are incompletely understood. Sclerostin [...] Read more.

Background: Idiopathic juvenile osteoporosis (IJO) is a rare condition characterized by low bone mass that can increase the risk of fractures in children. Treatment options for these patients are limited as the molecular mechanisms of disease initiation and progression are incompletely understood. Sclerostin inhibits canonical Wnt signaling, which is important for the bone formation activity of osteoblasts, and elevated sclerostin has been implicated in adult osteoporosis. Objective: To evaluate the role of sclerostin in IJO, high-resolution confocal microscopy analyses were performed on bone biopsies collected from 13 pediatric patients. Methods: Bone biopsies were stained with sclerostin, and β-catenin antibodies showed elevated expression across osteocytes and increased sclerostin-positive osteocytes in 8 of the 13 total IJO patients (62%). Results: Skeletal sclerostin was associated with static and dynamic histomorphometric parameters. Further, colocalization analyses showed that bone sclerostin colocalized with phosphorylated β-catenin, a hallmark of Wnt signaling that indicates Wnt inhibition. In contrast, sclerostin-positive osteocytes were not colocalized with an “active” unphosphorylated form of β-catenin. Conclusions: These results support a model that altered levels of sclerostin and Wnt signaling activity occur in IJO patients. Full article

(This article belongs to the Special Issue Pediatric Growth and Skeletal Disorders)

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14 pages, 1608 KiB

Open AccessEditor’s ChoiceArticle

Polypharmacy in Children with Medical Complexity: A Cross-Sectional Study in a Pediatric Palliative Care Center

by Anna Zanin, Fernando Baratiri, Barbara Roverato, Daniele Mengato, Lisa Pivato, Irene Avagnina, Irene Maghini, Antuan Divisic, Francesca Rusalen, Caterina Agosto, Francesca Venturini and Franca Benini

Children 2024, 11(7), 821; https://doi.org/10.3390/children11070821 - 4 Jul 2024

Cited by 4 | Viewed by 2061

Abstract

Background: Children with medical complexity (CMC) often require multiple medications, leading to polypharmacy, which seems to be linked to adverse effects, administration errors, and increased caregiver burden. This study aimed to describe the prevalence of polypharmacy, medication burden, off-label drug use, and associated [...] Read more.

Background: Children with medical complexity (CMC) often require multiple medications, leading to polypharmacy, which seems to be linked to adverse effects, administration errors, and increased caregiver burden. This study aimed to describe the prevalence of polypharmacy, medication burden, off-label drug use, and associated costs. Methods: Conducted at the Pediatric Palliative Care Center of Padua, Italy, from August to October 2021, this cross-sectional observational study included patients up to 23 years old with at least one prescribed drug. Data were collected from medical records and caregiver interviews. Drug costs were collected from the Italian Medicine Agency. Descriptive statistical analysis was performed. For comparisons among categorical variables, the Chi-square test was used, and for those among continuous variables, the ANOVA test was used. Results: This study analyzed treatment regimens of 169 patients with a median age of 12.5 years (0.3–23). Polypharmacy was present in 52.7% of patients, and medication burden was observed in 44.4%, both varying significantly by primary diagnosis (p < 0.001). The median daily cost per patient was EUR 2.2 (IQR 0.9–7.1), with significant variation among subgroups. Only 34.6% of prescriptions were off-label. Conclusions: polypharmacy and medication burden are frequent among our CMC population, with some differences according to primary diagnosis. Full article

(This article belongs to the Special Issue Recent Advances in Pediatric Palliative Home Care)

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15 pages, 693 KiB

Open AccessEditor’s ChoiceReview

Oral Health and Caries Prevention: How Tongue Hygiene Helps Maintain Balance of Microbiota and Overall Health in Pediatric Patients

by Giovanna Mosaico, Mara Pinna, Roberta Grassi, Germano Orrù, Andrea Scribante, Carolina Maiorani, Cinzia Casu, Gianna Maria Nardi and Andrea Butera

Children 2024, 11(7), 816; https://doi.org/10.3390/children11070816 - 3 Jul 2024

Cited by 3 | Viewed by 5220

Abstract

Background/Objectives: The tongue harbors about two-thirds of the microorganisms present in the mouth; the stable bacterial population consists mainly of aerobic and facultative anaerobic streptococci. These bacterial colonies, found more frequently on the tongue than on the outside of the hard part of [...] Read more.

Background/Objectives: The tongue harbors about two-thirds of the microorganisms present in the mouth; the stable bacterial population consists mainly of aerobic and facultative anaerobic streptococci. These bacterial colonies, found more frequently on the tongue than on the outside of the hard part of the dental enamel in children younger than 18 months, suggest that the tongue is a potential bacterial reservoir. The aim of this review is to examine the scientific literature to clarify whether the mechanical removal of bacterial biofilm on the tongue can have a positive effect on caries prevention, with the reduction in colony-forming unit (CFU) of salivary streptococcus and the whole-mouth plaque index (FMPS). Methods: An open literature search was conducted by using PubMed (MEDLINE), Cochrane Library and Google Scholar. The most studied age range was 9 to 12 years, with groups of children with no caries and groups with a minimum number of two teeth that were reconstructed, decayed and/or missing (DMFS/dmfs > 2) who experienced different tongue hygiene methods for the first time. Results: Four randomized trials met the search criteria and were included in this review. Conclusions: The results obtained suggest that specific tongue hygiene protocols, combined with a healthy diet and lifestyle, could be considered the gold standard to enable more effective primary prevention and improve the health of pediatric patients. This review improves the understanding of the impact of tongue hygiene in controlling the bacteria responsible for the onset of carious disease and its systemic correlates; however, further research with more data is needed to further confirm the findings of this research. Full article

(This article belongs to the Special Issue New Research Progress of Clinical Pediatric Dentistry)

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12 pages, 262 KiB

Open AccessEditor’s ChoiceArticle

Assessing the Relationship between Body Image Satisfaction and Physical Activity in Italian Adolescents: A Cross-Sectional Investigation

by Sabrina Masotti, Tommaso Piva, Valentina Zerbini, Andrea Raisi, Erica Menegatti, Anselmo Pagani, Costanza Bigoni, Elena Ballarin, Federica De Luca, Luciana Zaccagni, Natascia Rinaldo, Stefania Toselli, Emanuela Gualdi-Russo, Antonio Argentoni, Arli Veli, Gianni Mazzoni and Simona Mandini

Children 2024, 11(7), 818; https://doi.org/10.3390/children11070818 - 3 Jul 2024

Cited by 3 | Viewed by 2043

Abstract

Background: Body image perception can significantly influence various aspects of adolescent lives. The study analyzed the relationship between body image satisfaction and sports participation in adolescents, examining various factors that contribute to body image concerns and their implications for sports engagement. Methods: A [...] Read more.

Background: Body image perception can significantly influence various aspects of adolescent lives. The study analyzed the relationship between body image satisfaction and sports participation in adolescents, examining various factors that contribute to body image concerns and their implications for sports engagement. Methods: A total of 237 schoolchildren were recruited from lower secondary Italian schools. Anthropometric characteristics were measured directly. Assessment of body image perception was performed using Body Silhouette Charts for preadolescent children. The Italian version of the International Physical Activity Questionnaire for Adolescents questionnaire was administered to assess physical activity (PA) levels at school and during leisure time in the last 7 days. Analysis of variance was used to test differences in PA levels, while multiple regression models were carried out to assess possible predictors of body dissatisfaction. Results: In total, 42.6% of children were not satisfied with their figure and 23.2% were very dissatisfied; among them, the vast majority would have liked to be thinner. The dissatisfaction and satisfaction were similar in boys and girls. The frequency of satisfaction with one’s body image was higher in children who practiced extracurricular sports compared to those who did not. The percentage of dissatisfaction with one’s body image was similar in the two groups, but the frequency of children being very dissatisfied was double in the group that does not practice extracurricular sport (31.2% vs. 17.7%). Body dissatisfaction increases with increasing body mass index in both genders but decreases in children involved in extracurricular sports. Conclusions: Encouraging teenagers to engage in regular physical activity should be a key component of therapies supporting positive body image. This study found a relationship between extracurricular sports and body image satisfaction, suggesting that physical activity protects teenagers’ body image satisfaction. Full article

(This article belongs to the Special Issue Health Benefits of Physical Activity for Children and Adolescents)

16 pages, 279 KiB

Open AccessEditor’s ChoiceArticle

Machine Learning Approach for Predicting the Impact of Food Insecurity on Nutrient Consumption and Malnutrition in Children Aged 6 Months to 5 Years

by Radwan Qasrawi, Sabri Sgahir, Maysaa Nemer, Mousa Halaikah, Manal Badrasawi, Malak Amro, Stephanny Vicuna Polo, Diala Abu Al-Halawa, Doa’a Mujahed, Lara Nasreddine, Ibrahim Elmadfa, Siham Atari and Ayoub Al-Jawaldeh

Children 2024, 11(7), 810; https://doi.org/10.3390/children11070810 - 2 Jul 2024

Cited by 5 | Viewed by 2793

Abstract

Background: Food insecurity significantly impacts children’s health, affecting their development across cognitive, physical, and socio-emotional dimensions. This study explores the impact of food insecurity among children aged 6 months to 5 years, focusing on nutrient intake and its relationship with various forms of [...] Read more.

Background: Food insecurity significantly impacts children’s health, affecting their development across cognitive, physical, and socio-emotional dimensions. This study explores the impact of food insecurity among children aged 6 months to 5 years, focusing on nutrient intake and its relationship with various forms of malnutrition. Methods: Utilizing machine learning algorithms, this study analyzed data from 819 children in the West Bank to investigate sociodemographic and health factors associated with food insecurity and its effects on nutritional status. The average age of the children was 33 months, with 52% boys and 48% girls. Results: The analysis revealed that 18.1% of children faced food insecurity, with household education, family income, locality, district, and age emerging as significant determinants. Children from food-insecure environments exhibited lower average weight, height, and mid-upper arm circumference compared to their food-secure counterparts, indicating a direct correlation between food insecurity and reduced nutritional and growth metrics. Moreover, the machine learning models observed vitamin B1 as a key indicator of all forms of malnutrition, alongside vitamin K1, vitamin A, and zinc. Specific nutrients like choline in the “underweight” category and carbohydrates in the “wasting” category were identified as unique nutritional priorities. Conclusion: This study provides insights into the differential risks for growth issues among children, offering valuable information for targeted interventions and policymaking. Full article

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

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13 pages, 258 KiB

Open AccessEditor’s ChoiceArticle

Investigating the Sociodemographic and Health Characteristics of Non-Sugar Sweeteners Consumption in Greek School-Aged Children: A Cross-Sectional Study

by Kyriaki Apergi, Olga Malisova, Antonis Vlassopoulos, Philippa Fidanoglou, Aikaterini Kandyliari and Maria Kapsokefalou

Children 2024, 11(7), 813; https://doi.org/10.3390/children11070813 - 2 Jul 2024

Cited by 1 | Viewed by 1249

Abstract

Background/Objectives: The childhood consumption of non-sugar-sweetened (NSS) soft drinks is a growing concern due to its potential health implications. This study investigated demographic, anthropometric, and lifestyle factors influencing NSS soft drink consumption among children. Methods: A sample of 1304 children and their parents [...] Read more.

Background/Objectives: The childhood consumption of non-sugar-sweetened (NSS) soft drinks is a growing concern due to its potential health implications. This study investigated demographic, anthropometric, and lifestyle factors influencing NSS soft drink consumption among children. Methods: A sample of 1304 children and their parents were surveyed. Results: Analysis revealed that nearly 60% reported consuming NSS soft drinks at least once a week. Also, positive associations were found between NSS soft drink consumption and lower socioeconomic status, increased total beverage consumption, higher maternal BMI, and parental soft drink habits. However, upon employing multivariable models, only the association between total and NSS soft drinks consumption remained statistically significant (OR = 18.925, p < 0.05 for children; OR = 3.801, p < 0.05 for parents), highlighting the pivotal role of parental behavior in shaping children’s consumption patterns. Conclusions: These findings emphasize the importance of tracking parental habits, revealing a strong correlation between parental behavior and children’s soft drink consumption patterns. Understanding these factors is crucial for developing effective public health strategies for children, which should prioritize not only individual behaviors but also parental modeling and household dynamics. Full article

(This article belongs to the Special Issue Advances in the Management of Children and Adolescents with Obesity)

8 pages, 402 KiB

Open AccessEditor’s ChoiceReview

Chronic Kidney Disease and Growth Failure in Children

by Tommaso Todisco, Grazia Maria Ubertini, Carla Bizzarri, Sandro Loche and Marco Cappa

Children 2024, 11(7), 808; https://doi.org/10.3390/children11070808 - 1 Jul 2024

Cited by 2 | Viewed by 4190

Abstract

Chronic kidney disease (CKD) is a significant challenge for pediatric endocrinologists, as children with CKD may present a variety of endocrine complications. Growth failure is common in CKD, and its severity is correlated with the degree of renal insufficiency. Management strategies include addressing [...] Read more.

Chronic kidney disease (CKD) is a significant challenge for pediatric endocrinologists, as children with CKD may present a variety of endocrine complications. Growth failure is common in CKD, and its severity is correlated with the degree of renal insufficiency. Management strategies include addressing reversible comorbidities, optimizing nutrition, and ensuring metabolic control. Kidney replacement therapy, including transplantation, determines a significant improvement in growth. According to a recent Consensus Statement, children with CKD stage 3—or on dialysis older >6 months—are eligible for treatment with recombinant growth hormone (rGH) in the case of persistent growth failure. Treatment with rGH may be considered for those with height between the 3rd and 10th percentile and persistent growth deceleration. In children who received kidney transplantation but continue to experience growth failure, initiation of GH therapy is recommended one year post-transplantation if spontaneous catch-up growth does not occur and steroid-free immunosuppression is not an option. In children with CKD, due to nephropathic cystinosis and persistent growth failure, GH therapy should be considered at all stages of CKD. Potential adverse effects and benefits must be regularly assessed during therapy. Treatment with GH is safe in children with CKD. However, its general efficacy is still controversial. All possible problems with a negative impact on growth should be timely addressed and resolved, whenever possible with a personalized approach to the patient. GH therapy may be useful in promoting catch-up growth in children with residual growth potential. Future research should focus on refining effective therapeutic strategies and establishing consensus guidelines to optimize growth outcomes in this population. Full article

(This article belongs to the Special Issue New Research Progress on Endocrine Disorders in Infants, Children, and Adolescents)

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26 pages, 457 KiB

Open AccessEditor’s ChoiceReview

Neurodevelopmental Disorders Associated with Gut Microbiome Dysbiosis in Children

by Alejandro Borrego-Ruiz and Juan J. Borrego

Children 2024, 11(7), 796; https://doi.org/10.3390/children11070796 - 28 Jun 2024

Cited by 18 | Viewed by 4826

Abstract

The formation of the human gut microbiome initiates in utero, and its maturation is established during the first 2–3 years of life. Numerous factors alter the composition of the gut microbiome and its functions, including mode of delivery, early onset of breastfeeding, exposure [...] Read more.

The formation of the human gut microbiome initiates in utero, and its maturation is established during the first 2–3 years of life. Numerous factors alter the composition of the gut microbiome and its functions, including mode of delivery, early onset of breastfeeding, exposure to antibiotics and chemicals, and maternal stress, among others. The gut microbiome–brain axis refers to the interconnection of biological networks that allow bidirectional communication between the gut microbiome and the brain, involving the nervous, endocrine, and immune systems. Evidence suggests that the gut microbiome and its metabolic byproducts are actively implicated in the regulation of the early brain development. Any disturbance during this stage may adversely affect brain functions, resulting in a variety of neurodevelopmental disorders (NDDs). In the present study, we reviewed recent evidence regarding the impact of the gut microbiome on early brain development, alongside its correlation with significant NDDs, such as autism spectrum disorder, attention-deficit/hyperactivity disorder, Tourette syndrome, cerebral palsy, fetal alcohol spectrum disorders, and genetic NDDs (Rett, Down, Angelman, and Turner syndromes). Understanding changes in the gut microbiome in NDDs may provide new chances for their treatment in the future. Full article

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

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13 pages, 543 KiB

Open AccessEditor’s ChoiceArticle

Consensus Guidelines for the Use of Vosoritide in Children with Achondroplasia in Australia

by Louise Tofts, Penny Ireland, Tracy Tate, Supriya Raj, Theresa Carroll, Craig F. Munns, Stephen Knipe, Katherine Langdon, Lesley McGregor, Fiona McKenzie, Andreas Zankl and Ravi Savarirayan

Children 2024, 11(7), 789; https://doi.org/10.3390/children11070789 - 28 Jun 2024

Cited by 4 | Viewed by 4387

Abstract

Background: Achondroplasia, the most prevalent skeletal dysplasia, stems from a functional mutation in the fibroblast growth factor receptor 3 gene, leading to growth impairment. This condition presents multifaceted medical, functional and psychosocial challenges throughout childhood, adolescence and adulthood. Current management strategies aim to [...] Read more.

Background: Achondroplasia, the most prevalent skeletal dysplasia, stems from a functional mutation in the fibroblast growth factor receptor 3 gene, leading to growth impairment. This condition presents multifaceted medical, functional and psychosocial challenges throughout childhood, adolescence and adulthood. Current management strategies aim to minimise medical complications, optimise functional capabilities and provide comprehensive supportive care. Vosoritide (trade name: VOXZOGO^®, BioMarin Pharmaceuticals) is the first disease-modifying pharmaceutical treatment approved for the management of patients with achondroplasia and became available in Australia in May 2023. Methods: Standardised clinical guidelines for its optimal use are not yet widely available. To address this gap, a multidisciplinary Australian Vosoritide Working Group, comprising 12 experts with experience in achondroplasia management from across Australia, developed recommendations to guide the use of vosoritide in clinical practice. Results: The recommendations, which are expert opinions of the Australian Vosoritide Working Group, aim to (i) standardise the use of vosoritide across Australia, (ii) support the safe clinical rollout of vosoritide and (iii) support universal access. Conclusions: These recommendations have been developed for healthcare professionals and institutions that are engaged in using vosoritide in the management of achondroplasia and will be revised using a formal framework for clinical guideline development once more evidence is available. Full article

(This article belongs to the Special Issue Pediatric Growth and Skeletal Disorders)

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11 pages, 1356 KiB

Open AccessEditor’s ChoiceReview

A Systematic Review of Telehealth Utilization for Bowel Management Programs in Pediatric Colorectal Surgery

by Elizaveta Bokova, Ismael Elhalaby, Seth Saylors, Irene Isabel P. Lim and Rebecca M. Rentea

Children 2024, 11(7), 786; https://doi.org/10.3390/children11070786 - 27 Jun 2024

Cited by 3 | Viewed by 2274

Abstract

Recent advancements in pediatric surgery have embraced telehealth (TH) modalities, transitioning from traditional in-person consultations to virtual care. This shift has broadened access to healthcare, potentially enhancing affordability, patient and caregiver satisfaction, and clinical outcomes. In pediatric colorectal surgery, telehealth has been effectively [...] Read more.

Recent advancements in pediatric surgery have embraced telehealth (TH) modalities, transitioning from traditional in-person consultations to virtual care. This shift has broadened access to healthcare, potentially enhancing affordability, patient and caregiver satisfaction, and clinical outcomes. In pediatric colorectal surgery, telehealth has been effectively utilized to support Bowel Management Programs (BMPs) for children suffering from constipation and fecal incontinence. A systematic review was conducted to assess the effectiveness of virtual BMPs, analyzing studies from January 2010 to December 2023, sourced from MEDLINE (via PubMed), Embase, and the Cochrane Library, with five studies included. Remote BMPs, implemented through video or telephone consultations, reported satisfaction rates exceeding 75% among families, indicating a strong preference for virtual interactions over traditional visits. Significant findings from the studies include improvements in Vancouver and Baylor scores, reductions in the duration of multidisciplinary consultations, enhancements in pediatric quality of life and Cleveland scores, and decreased frequency of laxative treatments. The implementation of TH has facilitated patient-led care, enabling timely adjustments in treatment and efficient distribution of medical supplies. The findings suggest that virtual BMPs are a viable and effective alternative to conventional approaches, yielding high caregiver satisfaction and superior clinical outcomes while promoting patient independence. Full article

(This article belongs to the Section Pediatric Neonatology)

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18 pages, 616 KiB

Open AccessEditor’s ChoiceArticle

“Preparation Is Key”: Parents’ and Nurses’ Perceptions of Combined Parent-Delivered Pain Management in Neonatal Care

by Martina Carlsen Misic, Emma Olsson, Ylva Thernström Blomqvist and Alexandra Ullsten

Children 2024, 11(7), 781; https://doi.org/10.3390/children11070781 - 27 Jun 2024

Cited by 2 | Viewed by 2966

Abstract

Background: There is a knowledge-to-practice gap regarding parent-delivered pain management, and few studies have investigated parents’ and nurses’ participation in and acceptance of combined parent-delivered pain-alleviating interventions such as skin-to-skin contact (SSC), breastfeeding, and parental musical presence. This study investigated parents’ and nurses’ [...] Read more.

Background: There is a knowledge-to-practice gap regarding parent-delivered pain management, and few studies have investigated parents’ and nurses’ participation in and acceptance of combined parent-delivered pain-alleviating interventions such as skin-to-skin contact (SSC), breastfeeding, and parental musical presence. This study investigated parents’ and nurses’ perceptions of and reflections on experiencing combined parent-delivered pain management. Methods: This qualitative study applies a collaborative participatory action research design using ethnographic data collection methods such as focus groups, video observations, and video-stimulated recall interviews with parents and nurses. Results: The results concern three main categories, i.e., preparation, participation, and closeness, as well as various sub-categories. Preparations were central to enabling combined parent-delivered pain management. Participation was facilitated by parental musical presence, in which parents shifted their attention toward their infant. Closeness and presence during neonatal care helped parents become active during their infant’s painful procedures. Parental lullaby singing created a calm and trusting atmosphere and after the procedure, both parents and nurses felt that they had successfully supported the infant through a potentially painful procedure. Conclusions: Mental and practical preparation is central to implementing combined parent-delivered pain management. When parents and nurses explored the interventions, they found the methods feasible, promoting self-efficacy and confidence in both parents and nurses. Full article

(This article belongs to the Special Issue Parental Involvement in Neonatal and Infant Pain Prevention and Management: Evidence, Opportunities and Challenges)

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9 pages, 256 KiB

Open AccessEditor’s ChoiceArticle

The Relevance of β-Thalassemia Heterozygosity in Pediatric Clinical Practice: Croatian Experience

by Ana Dordevic, Milena Ugrin, Ines Mrakovcic Sutic, Jelena Roganovic and Sonja Pavlovic

Children 2024, 11(7), 785; https://doi.org/10.3390/children11070785 - 27 Jun 2024

Cited by 1 | Viewed by 1631

Abstract

(1) Background: Thalassemia syndromes are common monogenic disorders that represent a significant global health issue. No systematic epidemiological or molecular investigations on thalassemias in the Croatian population have been reported to date. (2) Methods: This prospective study included 70 children with a presumptive [...] Read more.

(1) Background: Thalassemia syndromes are common monogenic disorders that represent a significant global health issue. No systematic epidemiological or molecular investigations on thalassemias in the Croatian population have been reported to date. (2) Methods: This prospective study included 70 children with a presumptive diagnosis of thalassemia and their 42 first-degree relatives. Molecular characterization was performed using direct sequencing and gap-PCR methods. (3) Results: We identified 46 (30 children and 16 first-degree relatives) β-thalassemia heterozygous carriers from 24 unrelated families, carrying eight different mutations and one hemoglobin variant. Five variants account for approximately 85% of all affected β-globin alleles: Hb Lepore-Boston-Washington (32.6%), HBB:c.93-21G>A (19.6%), HBB:c.315+1G>A (13.1%), HBB:c.92+1G>A (10.9%), and HBB:c.92+6T>C (8.7%) variants. (4) Conclusions: β-thalassemia carriers need more detailed genetic profiling since genetic modifiers can significantly impact their phenotype. Our study provides important new insights into the relevance of β-thalassemia heterozygosity in pediatric clinical practice. Full article

(This article belongs to the Section Pediatric Hematology & Oncology)

13 pages, 243 KiB

Open AccessEditor’s ChoiceArticle

Medical Complexity of Children with Special Healthcare Needs and Healthcare Experiences

by Hye-Jung Yun, M. L. Parker, Cynthia B. Wilson and Ming Cui

Children 2024, 11(7), 775; https://doi.org/10.3390/children11070775 - 27 Jun 2024

Cited by 3 | Viewed by 1822

Abstract

The rising prevalence of CSHCN has led to significant challenges for caregivers, particularly mothers, who face difficulties from caregiving demands and managing complex healthcare interactions. The objective of this study was to examine the association between the medical complexity of CSHCN and the [...] Read more.

The rising prevalence of CSHCN has led to significant challenges for caregivers, particularly mothers, who face difficulties from caregiving demands and managing complex healthcare interactions. The objective of this study was to examine the association between the medical complexity of CSHCN and the healthcare experiences of their mothers while exploring the influence of sociodemographic factors on these associations. The study utilized data from the 2016–2020 National Survey of Children’s Health (NSCH), involving 17,434 mothers of CSHCN. Mothers provided information on the medical complexity of CSHCN, healthcare experiences (care coordination, family-centered care, and shared decision-making), and sociodemographic information (race, community, insurance, child sex, age, and federal poverty level). Results from multiple regressions revealed that greater medical complexity was associated with more negative healthcare experiences. Minoritized mothers, those in rural areas, and families with lower income reported lower levels of family-centered care, indicating significant disparities. Additionally, the negative association between medical complexity and healthcare experiences was pronounced for White families and those with private insurance compared to minoritized families and those with public insurance. This study highlights the necessity for targeted interventions to improve care coordination, family-centered care, and shared decision-making, emphasizing the need for a comprehensive, family-centered approach to address healthcare disparities and promote health equity for CSHCN and their families. Full article

(This article belongs to the Special Issue Parenting in the Face of Health Challenges: Research and Interventions Update)

17 pages, 774 KiB

Open AccessEditor’s ChoiceArticle

Who Benefits Most from the Family Education and Support Program in Cape Verde? A Cluster Analysis

by Adriana Correia, Cátia Martins, Rita dos Santos, Victoria Hidalgo, Saúl Neves de Jesus and Cristina Nunes

Children 2024, 11(7), 782; https://doi.org/10.3390/children11070782 - 27 Jun 2024

Cited by 1 | Viewed by 1389

Abstract

Background/Objectives: Child parenting programs can enhance parental skills, prevent future issues in child development, and improve children’s quality of life. The present research aimed to study the changes promoted by the Family Education and Support Program (FAF) implemented in Cape Verde, regarding parental [...] Read more.

Background/Objectives: Child parenting programs can enhance parental skills, prevent future issues in child development, and improve children’s quality of life. The present research aimed to study the changes promoted by the Family Education and Support Program (FAF) implemented in Cape Verde, regarding parental educational practices, perceived parental efficacy, and attitudes and beliefs of Cape Verdean parents. Methods: To this end, 37 participants were evaluated through a pretest-postest design. The evaluated dimensions were perceived parental competence, parenting practices, Parental attitudes and beliefs, mental health and perceived child quality of life. Results: A cluster analysis was conducted, distinguishing two groups. Both groups benefited from the program. Cluster 1 reported more significant gains in dimensions of parental efficacy and satisfaction, inadequate expectations, affection and support, and reactivity, while cluster 2 showed a greater difference in regulation and reactivity. Conclusions: Overall, the FAF intervention contributed to an increase in positive parenting practices. By analyzing potential underlying profiles in the change process, this study suggests that there are participants who benefit more than others from the intervention, and this information may be relevant for professionals and researchers in the field. Full article

(This article belongs to the Special Issue Parenting and Child/Adolescent Development: Current Updates and Global Perspectives)

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11 pages, 735 KiB

Open AccessEditor’s ChoiceArticle

The Role of Parental Mediation and Age in the Associations between Cyberbullying Victimization and Bystanding and Children’s and Adolescents’ Depression

by Michelle F. Wright

Children 2024, 11(7), 777; https://doi.org/10.3390/children11070777 - 27 Jun 2024

Cited by 2 | Viewed by 1953

Abstract

Background/Objectives: The primary objective of this research was to assess age differences in the associations between cyberbullying victimization and bystanding and depression among 234 elementary school students (4th and 5th graders; 51% female), 363 middle school students (6th to 8th grades; 53% female), [...] Read more.

Background/Objectives: The primary objective of this research was to assess age differences in the associations between cyberbullying victimization and bystanding and depression among 234 elementary school students (4th and 5th graders; 51% female), 363 middle school students (6th to 8th grades; 53% female), and 341 high school students (9th to 12th grades; 51% female) as well as the moderating effect of parental mediation in these relationships. Methods: Participants completed self-report questionnaires on their cyberbullying victimization and bystanding, as well as depressive symptoms. Results: The findings revealed that high levels of instructive mediation buffered against depression associated with cyberbullying victimization and bystanding across all age groups, with the strongest effects found for middle school students. Lower levels of instructive mediation and higher levels of restrictive mediation increased the positive relationships between cyberbullying victimization and bystanding and depression. Co-viewing mediation did not moderate any of the associations. Conclusions: Parental mediation of technology use has the potential to alleviate the negative consequences associated with cyberbullying victimization and bystanding. The findings highlight the importance of tailoring prevention and intervention strategies to specific age groups and to parents. Full article

(This article belongs to the Special Issue New Challenges of Cyberbullying in Children and Adolescents)

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16 pages, 1251 KiB

Open AccessEditor’s ChoiceArticle

Utility of the Post-Reflux Swallow-Induced Peristaltic Wave Index and Mean Nocturnal Baseline Impedance for the Diagnosis of Gastroesophageal Reflux Disease Phenotypes in Children

by Radu Samuel Pop, Daniela Pop, Lăcrămioara Eliza Chiperi, Vlad-Ionuț Nechita, Sorin Claudiu Man and Dan Lucian Dumitrașcu

Children 2024, 11(7), 773; https://doi.org/10.3390/children11070773 - 26 Jun 2024

Cited by 2 | Viewed by 1517

Abstract

(1) Objectives: Assessment of novel impedance parameters such as the post-reflux swallow-induced peristaltic wave (PSPW) index and mean nocturnal baseline impedance (MNBI) have been proposed to enhance the accuracy of gastroesophageal reflux disease (GERD) diagnosis. We aimed to evaluate the clinical value of [...] Read more.

(1) Objectives: Assessment of novel impedance parameters such as the post-reflux swallow-induced peristaltic wave (PSPW) index and mean nocturnal baseline impedance (MNBI) have been proposed to enhance the accuracy of gastroesophageal reflux disease (GERD) diagnosis. We aimed to evaluate the clinical value of MNBI and the PSPW index in discerning different phenotypes of GERD in children. (2) Methods: We conducted a prospective, observational study that included 49 children aged 5–18 years, referred for MII-pH monitoring due to negative endoscopy and persisting gastroesophageal reflux symptoms despite acid-suppressant treatment. The PSPW index and MNBI were assessed along with conventional metrics. (3) Results: Using a receiver operating characteristic (ROC) curve analysis, MNBI (AUC 0.864) and the PSPW index (AUC 0.83) had very good performance in differentiating between non-erosive reflux disease (NERD) and functional phenotypes. The PSPW index (AUC 0.87) discriminated better between functional heartburn (FH) and reflux hypersensitivity (RH) compared to the MNBI (AUC 0.712). A PSPW cut-off value of 65% provided a sensitivity of 76.9% and a specificity of 90% in distinguishing FH and RH. The PSPW index (AUC 0.87) proved to have better performance than the MNBI (AUC 0.802) in differentiating between FH and non-FH patients. MNBI diagnosed FH with a sensitivity of 84% and a specificity of 80.6% at a cut-off value of 2563 Ω. (4) Conclusions: The PSPW index and MNBI are useful to distinguish between GERD phenotypes in pediatric patients. Full article

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