Children

10 pages, 739 KB

Open AccessEditor’s ChoiceArticle

Barriers to the Successful Health Care Transition of Patients with Kidney Disease: A Mixed-Methods Study on the Perspectives of Adult Nephrologists

by Jenny Prüfe, Lars Pape and Martin Kreuzer

Children 2022, 9(6), 803; https://doi.org/10.3390/children9060803 - 30 May 2022

Cited by 8 | Viewed by 2655

Abstract

The transition from paediatric to adult-based health care is a challenging period bearing a high risk of medication nonadherence and transplant loss in adolescents and young adults after kidney transplantation. Successful transition asks for the cooperation of many, not least the adult physicians. [...] Read more.

The transition from paediatric to adult-based health care is a challenging period bearing a high risk of medication nonadherence and transplant loss in adolescents and young adults after kidney transplantation. Successful transition asks for the cooperation of many, not least the adult physicians. Yet little is known about their thoughts and attitudes on the transition. We conducted a cross-sectional mixed-methods study, inviting all nephrologists registered with the German Society of Nephrology. A total of 119/1984 nephrologists answered an online survey, and 9 nephrologists participated in expert interviews on transition experiences and perceived barriers. Interviews were thematically analysed. Based on the results, 30 key statements were listed and returned to participants for a ranking of their relevance. The main themes extracted are (1) available resources, (2) patient-related factors, (3) qualification and (4) preparation of and cooperation with the paediatric setting. In conclusion, it became evident that successful transition faces multiple obstacles. At the least, it asks for time, staff, and money. Rigid structures in health care leave little room for addressing the specific needs of this small group of patients. Transition becomes a topic one wants to and is able to afford. Full article

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

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13 pages, 602 KB

Open AccessEditor’s ChoiceArticle

National Cross-Sectional Study of Mental Health Screening Practices for Primary Caregivers of NICU Infants

by Cooper Bloyd, Snehal Murthy, Clara Song, Linda S. Franck and Christina Mangurian

Children 2022, 9(6), 793; https://doi.org/10.3390/children9060793 - 28 May 2022

Cited by 19 | Viewed by 4776

Abstract

Universal screening for postpartum mood and anxiety disorders (PMADs) has been recommended for all new parents at outpatient postpartum and well-child visits. However, parents of newborns admitted to the NICU are rarely able to access these services during their infant’s prolonged hospitalization. The [...] Read more.

Universal screening for postpartum mood and anxiety disorders (PMADs) has been recommended for all new parents at outpatient postpartum and well-child visits. However, parents of newborns admitted to the NICU are rarely able to access these services during their infant’s prolonged hospitalization. The objective of this study was to determine the prevalence of mental health screening and treatment programs for parents or other primary caregivers in NICUs across the country. In this cross-sectional study, US NICU medical directors were invited to complete an online survey about current practices in mental health education, screening, and treatment for primary caregivers of preterm and ill infants in the NICU. Comparative analyses using Fisher’s exact test were performed to evaluate differences in practices among various NICU practice settings. Survey responses were obtained from 75 out of 700 potential sites (10.7%). Of participating NICUs, less than half routinely provided caregivers with psychoeducation about mental health self-care (n = 35, 47%) or routinely screened caregivers for PPD or other mental health disorders (n = 33, 44%). Nearly one-quarter of the NICUs did not provide any PMAD screening (n = 17, 23%). Despite consensus that postpartum psychosocial care is essential, routine mental health care of primary caregivers in the NICU remains inadequate. Full article

(This article belongs to the Section Pediatric Neonatology)

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16 pages, 367 KB

Open AccessFeature PaperEditor’s ChoiceReview

The Challenges of Eradicating Pediatric Helicobacter pylori Infection in the Era of Probiotics

by Lorena Elena Meliț, Cristina Oana Mărginean and Maria Oana Săsăran

Children 2022, 9(6), 795; https://doi.org/10.3390/children9060795 - 28 May 2022

Cited by 13 | Viewed by 5042

Abstract

Helicobacter pylori (H. pylori), the most common infection of childhood, results in life-threatening complications during adulthood if left untreated. Most of these complications are related to H. pylori-induced chronic inflammation. The dysbiosis caused by H. pylori is not limited to [...] Read more.

Helicobacter pylori (H. pylori), the most common infection of childhood, results in life-threatening complications during adulthood if left untreated. Most of these complications are related to H. pylori-induced chronic inflammation. The dysbiosis caused by H. pylori is not limited to the gastric microenvironment, but it affects the entire gastrointestinal tract. Eradication of H. pylori has recently become a real challenge for clinicians due to both the persistent increase in antibiotic resistance worldwide and the wide spectrum of side effects associated with the eradication regimens resulting; therefore, there is an urgent need for more effective and less noxious treatment options. Thus, probiotics might be a promising choice in both adults and children with H. pylori infection since their role in improving the eradication rate of this infection has been proved in multiple studies. The positive effects of probiotics might be explained by their abilities to produce antimicrobial compounds and antioxidants, alter local gastric pH, and subsequently decrease H. pylori colonization and adherence to gastric epithelial cells. Nevertheless, if used alone probiotics do not considerably increase the eradication rate. Full article

(This article belongs to the Special Issue Childhood Helicobacter pylori Infection: Treatment and Prevention)

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14 pages, 301 KB

Open AccessEditor’s ChoiceArticle

Adolescents with Higher Cognitive and Affective Domains of Physical Literacy Possess Better Physical Fitness: The Importance of Developing the Concept of Physical Literacy in High Schools

by Barbara Gilic, Pavle Malovic, Mirela Sunda, Nevenka Maras and Natasa Zenic

Children 2022, 9(6), 796; https://doi.org/10.3390/children9060796 - 28 May 2022

Cited by 23 | Viewed by 5712

Abstract

Physical literacy (PL) is thought to facilitate engagement in physical activity, which could lead to better physical fitness (PF). The aim of this study was to examine the reliability of the Croatian version of two frequently applied PL questionnaires that evaluate knowledge and [...] Read more.

Physical literacy (PL) is thought to facilitate engagement in physical activity, which could lead to better physical fitness (PF). The aim of this study was to examine the reliability of the Croatian version of two frequently applied PL questionnaires that evaluate knowledge and understanding, perceived competence, environment, and value for literacy, numeracy, and PL and validity regarding correlation with objectively evaluated PF in adolescents. Five hundred forty-four high school students (403 females, 141 males) from Croatia were tested on PF (standing long jump, sit-ups for 30 s, sit-and-reach test, multilevel endurance test) and two PL questionnaires. The reliability of the Croatian version of the Canadian Assessment of Physical Literacy knowledge and understanding (CAPL-2-KU) and PLAYself was good (α = 0.71–0.81 for PLAYself subscales, κ = 0.39–0.69 for CAPL-2-KU). Genders differed in the self-description dimension of PLAYself, with higher results in boys (Z = 3.72, p < 0.001). CAPL-2-KU and PLAYself total score were associated with PF in boys and girls, with PLAYself having stronger associations with PF. This research supports the idea of PL as an essential determinant for the development of PF, highlighting the necessity of the development of cognitive and affective domains of PL in physical education throughout a specifically tailored pedagogical process. Full article

(This article belongs to the Special Issue Monitoring and Promoting Physical Activity, Physical Fitness and Motor Competence in Children)

10 pages, 612 KB

Open AccessEditor’s ChoiceSystematic Review

Bullying and Health Related Quality of Life among Adolescents—A Systematic Review

by Viney Prakash Dubey, Justina Kievišienė, Alona Rauckiene-Michealsson, Sigute Norkiene, Artūras Razbadauskas and Cesar Agostinis-Sobrinho

Children 2022, 9(6), 766; https://doi.org/10.3390/children9060766 - 24 May 2022

Cited by 34 | Viewed by 5813

Abstract

Health-related quality of life is among global health goals not only in adulthood but also in childhood and adolescence. Being a multi-component construct, health-related quality of life covers various domains, such as physical and psychological wellbeing and social and environmental areas. Bullying might [...] Read more.

Health-related quality of life is among global health goals not only in adulthood but also in childhood and adolescence. Being a multi-component construct, health-related quality of life covers various domains, such as physical and psychological wellbeing and social and environmental areas. Bullying might significantly influence those domains especially in adolescence, a period of life when numerous personal and interpersonal transformations are experienced. Therefore, the aim of the current systematic review was to provide a comprehensive overview of the relationship of bullying with the health-related quality of adolescents’ lives. An electronic literature search was performed using PubMed, Embase, and Cochrane Library, and 3621 full-text articles were identified. After a selection process, 12 studies covering diagnosis, prevention and treatment for each of the three sections “adolescents”, “health related quality of life” and “bullying” were reviewed. An overall reduction in health-related quality of life in regard to bullying appeared from the studies analyzed, as well as a decline in adolescent mental health. Different bullying types were identified as causing harm to various adolescents‘ health-related quality of life domains. These findings may contribute to effective bullying management in schools and/or societal settings, and inform intervention strategies for maintaining the quality of life of adolescents being bullied. Full article

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12 pages, 761 KB

Open AccessEditor’s ChoiceArticle

Controlling the Progression of Curvature in Children and Adolescent Idiopathic Scoliosis Following the Administration of Melatonin, Calcium, and Vitamin D

by Alexandru Herdea, Mihai-Codrut Dragomirescu, Alexandru Ulici, Claudiu N. Lungu and Adham Charkaoui

Children 2022, 9(5), 758; https://doi.org/10.3390/children9050758 - 21 May 2022

Cited by 14 | Viewed by 6171

Abstract

Idiopathic scoliosis affects a severe number of children. Their quality of life and development are also disturbed. Some therapeutic strategies have been developed to control illness progression and to optimize the quality of life. In this perspective, randomized, case-control, interventional study, the impact [...] Read more.

Idiopathic scoliosis affects a severe number of children. Their quality of life and development are also disturbed. Some therapeutic strategies have been developed to control illness progression and to optimize the quality of life. In this perspective, randomized, case-control, interventional study, the impact of using melatonin, calcium, and vitamin D, respectively, on idiopathic scoliosis patients was analyzed. Our preliminary results showed that these drugs positively affected the illness progression quantified by the spine curvature. Patients with idiopathic scoliosis may benefit from a novel treatment by supplementation with vitamin D, calcium, and melatonin. Full article

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13 pages, 1703 KB

Open AccessEditor’s ChoiceArticle

Pilot Study and Preliminary Results of Biodegradable Intramedullary Nailing of Forearm Fractures in Children

by Christoph Roeder, Cristina Alves, Andreas Balslev-Clausen, Federico Canavese, Erol Gercek, Tamás Kassai, Thomas Klestil, Louise Klingenberg, Nicolas Lutz, Marcell Varga, Gergo Jozsa, Annelie Weinberg and Ludger Tüshaus

Children 2022, 9(5), 754; https://doi.org/10.3390/children9050754 - 20 May 2022

Cited by 13 | Viewed by 5155

Abstract

(1) Background: Diaphyseal forearm fractures are a common injury in children and adolescents. When operative treatment is needed, elastic stable intramedullary nailing (ESIN) is the most common surgical procedure. Although there is no clear evidence, hardware removal after fracture healing is performed in [...] Read more.

(1) Background: Diaphyseal forearm fractures are a common injury in children and adolescents. When operative treatment is needed, elastic stable intramedullary nailing (ESIN) is the most common surgical procedure. Although there is no clear evidence, hardware removal after fracture healing is performed in many patients. Often, the primary minimal invasive incision needs to be widened during implant removal. In order to decrease the burden of care of pediatric fractures, significant efforts were made to develop biodegradable implants, which make hardware removal unnecessary. Our study will conduct an observational trial on the clinical use of the Activa IM-Nail™ in forearm fractures in children between 3 and 13 years of age. The objective of this trial is to evaluate the risks and benefits of the Activa IM-Nail™. Among other objectives, the rate of refracture will be determined. (2) Methods: An international Europe-based, multicenter, prospective, single-arm, open-label study will be performed to ascertain the rate of refracture and to determine the subjective benefits of Activa IM-Nail™ for patients, parents and other caregivers. The study will include clinical follow-up including early post-operative complication, radiographs until bony healing and an additional follow-up after 1 year. At this stage, preliminary results and early complications on 76 patients are analyzed in this study and presented. (3) Results: As of April 2022, 76 patients were enrolled as per study protocol. There were 31 girls (40.8%) and 45 boys (59.2%). The mean age at the time of inclusion was 8.9 years (±2.4 years). The mean operation time was 58.9 ± 22.9 min (range, 15–119 min). The mean follow-up time was 8.9 ± 5.1 months (range, 0.2–18.6). Up to now, one refracture has occurred in one child falling from a height of about one meter 7 months after index surgery (1/76; 1.3%). (4) Conclusion: The research project assesses the safety and effectiveness of Activa IM-Nails™ as part of the surgical treatment of dislocated forearm fractures in children in the context of a PMCF study. The use of Activa IM-Nails™ with regard to various objectives, including postoperative complications and refracture rate, seems to be equal to the standard titan ESIN procedure compared to the literature. Preliminary results are encouraging and are made available. Full article

(This article belongs to the Special Issue Current Development of Pediatric Minimally Invasive Surgery)

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13 pages, 287 KB

Open AccessEditor’s ChoiceArticle

Relationship between Adverse Childhood Experiences and Mental Health in Chinese Adolescents: Differences among Girls and Boys

by Weiwei Jiang, Mingxia Ji, Xinli Chi and Xiaojiao Sun

Children 2022, 9(5), 689; https://doi.org/10.3390/children9050689 - 9 May 2022

Cited by 21 | Viewed by 4576

Abstract

The negative effects of adverse childhood experiences (ACEs) on individual mental health have been widely demonstrated, yet fewer studies have examined the impact of ACEs on depression and anxiety of Chinese adolescents and their sex differences. This cross-sectional study surveyed 12421 adolescents aged [...] Read more.

The negative effects of adverse childhood experiences (ACEs) on individual mental health have been widely demonstrated, yet fewer studies have examined the impact of ACEs on depression and anxiety of Chinese adolescents and their sex differences. This cross-sectional study surveyed 12421 adolescents aged 10–17 in Hechi City, Guangxi Province, to measure their levels of ACEs, depression symptoms, and anxiety symptoms. The results found that: (1) Girls were more likely to experience ACEs than boys (37.67% vs. 32.25%, χ² = 39.97, p < 0.001). (2) Emotion-related ACEs were more likely to occur among girls, while physical maltreatment, violence, and family dysfunction related ACEs were more likely to occur among boys. (3) Adolescents with ACEs were more likely to develop depression (OR = 4.40) and anxiety symptoms (OR = 4.60) than those without ACEs; adolescents who have encountered “peer isolation” and “emotional neglect” are most likely to develop depression (OR = 6.09/5.04) and anxiety symptoms (OR = 6.14/4.94). (4) The dose-response relationship between the level of ACE exposure and the risk of depression/anxiety symptoms was significant (p < 0.05), i.e., the risk increased as ACE level increased. (5) Girls were more likely to develop depression and anxiety symptoms than boys with the same ACE level. This study deepens the understanding of the prevalence of ACEs, the effect of ACEs on depression and anxiety symptoms, and their sex differences among Chinese adolescents in the underdeveloped regions of China. It provides more empirical support for future work on adolescent mental health protection. Full article

(This article belongs to the Special Issue Anxiety Disorders in Children)

14 pages, 2158 KB

Open AccessEditor’s ChoiceArticle

Illness Characteristics of COVID-19 in Children Infected with the SARS-CoV-2 Delta Variant

by Erika Molteni, Carole H. Sudre, Liane Dos Santos Canas, Sunil S. Bhopal, Robert C. Hughes, Liyuan Chen, Jie Deng, Benjamin Murray, Eric Kerfoot, Michela Antonelli, Mark Graham, Kerstin Kläser, Anna May, Christina Hu, Joan Capdevila Pujol, Jonathan Wolf, Alexander Hammers, Timothy D. Spector, Sebastien Ourselin, Marc Modat, Claire J. Steves, Michael Absoud and Emma L. Duncan Show full author list Hide full author list

Children 2022, 9(5), 652; https://doi.org/10.3390/children9050652 - 3 May 2022

Cited by 33 | Viewed by 4714

Abstract

Background: The Delta (B.1.617.2) SARS-CoV-2 variant was the predominant UK circulating strain between May and November 2021. We investigated whether COVID-19 from Delta infection differed from infection with previous variants in children. Methods: Through the prospective COVID Symptom Study, 109,626 UK school-aged children [...] Read more.

Background: The Delta (B.1.617.2) SARS-CoV-2 variant was the predominant UK circulating strain between May and November 2021. We investigated whether COVID-19 from Delta infection differed from infection with previous variants in children. Methods: Through the prospective COVID Symptom Study, 109,626 UK school-aged children were proxy-reported between 28 December 2020 and 8 July 2021. We selected all symptomatic children who tested positive for SARS-CoV-2 and were proxy-reported at least weekly, within two timeframes: 28 December 2020 to 6 May 2021 (Alpha (B.1.1.7), the main UK circulating variant) and 26 May to 8 July 2021 (Delta, the main UK circulating variant), with all children unvaccinated (as per national policy at the time). We assessed illness profiles (symptom prevalence, duration, and burden), hospital presentation, and presence of long (≥28 day) illness, and calculated odds ratios for symptoms presenting within the first 28 days of illness. Results: 694 (276 younger (5–11 years), 418 older (12–17 years)) symptomatic children tested positive for SARS-CoV-2 with Alpha infection and 706 (227 younger and 479 older) children with Delta infection. Median illness duration was short with either variant (overall cohort: 5 days (IQR 2–9.75) with Alpha, 5 days (IQR 2–9) with Delta). The seven most prevalent symptoms were common to both variants. Symptom burden over the first 28 days was slightly greater with Delta compared with Alpha infection (in younger children, 3 (IQR 2–5) symptoms with Alpha, 4 (IQR 2–7) with Delta; in older children, 5 (IQR 3–8) symptoms with Alpha, 6 (IQR 3–9) with Delta infection ). The odds of presenting several symptoms were higher with Delta than Alpha infection, including headache and fever. Few children presented to hospital, and long illness duration was uncommon, with either variant. Conclusions: COVID-19 in UK school-aged children due to SARS-CoV-2 Delta strain B.1.617.2 resembles illness due to the Alpha variant B.1.1.7., with short duration and similar symptom burden. Full article

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8 pages, 1416 KB

Open AccessEditor’s ChoiceReview

VOSviewer-Based Bibliometric Network Analysis for Evaluating Research on Juvenile Primary Fibromyalgia Syndrome (JPFS)

by Alessandro Vittori, Marco Cascella, Marianna Leonardi, Federica Monaco, Davide Nocerino, Arturo Cuomo, Alessandro Ottaiano, Francesco Perri, Ilaria Mascilini, Elisa Francia, Emiliano Petrucci, Franco Marinangeli and Sergio Giuseppe Picardo

Children 2022, 9(5), 637; https://doi.org/10.3390/children9050637 - 28 Apr 2022

Cited by 30 | Viewed by 4112

Abstract

Background: Juvenile primary fibromyalgia syndrome (JPFS) is a chronic musculoskeletal pain syndrome that affects children and adolescents. Methods: A VOSviewer-based bibliometric network analysis was performed by scanning the global literature on JPFS in the Web of Science (WOS) online database. The search string [...] Read more.

Background: Juvenile primary fibromyalgia syndrome (JPFS) is a chronic musculoskeletal pain syndrome that affects children and adolescents. Methods: A VOSviewer-based bibliometric network analysis was performed by scanning the global literature on JPFS in the Web of Science (WOS) online database. The search string applied to identify the closest matching articles was “juvenile primary fibromyalgia syndrome (all field)”. Results: A total of 67 articles on JPFS were published from 1985 to March 2022, in the WOS. Regarding article types, 39 were research manuscripts, 16 reviews, 8 meeting abstracts, 2 letters, 1 book chapter, 1 correction, and 1 proceeding paper. The Quartile analysis demonstrated that 44% of papers were published in Q1, 37% in Q2, 8% in Q3, and 11% in Q4. Conclusions: Our analysis highlights that more efforts are warranted to increase the production of quality papers and enhance the connections between the various research groups. JFPS represents a research field still to be explored and which deserves greater investments to obtain quality scientific evidence. Full article

(This article belongs to the Special Issue Management of Chronic Pain in Adolescents and Children)

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13 pages, 1339 KB

Open AccessEditor’s ChoiceReview

Retropharyngeal, Parapharyngeal and Peritonsillar Abscesses

by Susanna Esposito, Claudia De Guido, Marco Pappalardo, Serena Laudisio, Giuseppe Meccariello, Gaia Capoferri, Sofia Rahman, Claudio Vicini and Nicola Principi

Children 2022, 9(5), 618; https://doi.org/10.3390/children9050618 - 26 Apr 2022

Cited by 21 | Viewed by 14405

Abstract

Deep neck infections (DNIs) include all the infections sited in the potential spaces and fascial planes of the neck within the limits of the deep layer of the cervical fascia. Parapharyngeal and retropharyngeal infections leading to parapharyngeal abscess (PPA) and retropharyngeal abscess (RPA) [...] Read more.

Deep neck infections (DNIs) include all the infections sited in the potential spaces and fascial planes of the neck within the limits of the deep layer of the cervical fascia. Parapharyngeal and retropharyngeal infections leading to parapharyngeal abscess (PPA) and retropharyngeal abscess (RPA) are the most common. DNIs remain an important health problem, especially in children. The aim of this narrative review is to describe the management of peritonsillar, retropharyngeal and parapharyngeal abscesses in pediatric age. Despite relatively uncommon, pediatric DNIs deserve particular attention as they can have a very severe course and lead to hospitalization, admission to the intensive care unit and, although very rarely, death. They generally follow a mild upper respiratory infection and can initially present with signs and symptoms that could be underestimated. A definite diagnosis can be made using imaging techniques. Pus collection from the site of infection, when possible, is strongly recommended for definition of diseases etiology. Blood tests that measure the inflammatory response of the patient may contribute to monitor disease evolution. The therapeutic approach should be targeted toward the individual patient. Regardless of the surgical treatment, antibiotics are critical for pediatric DNI prognosis. The diagnostic-therapeutic procedure to be followed in the individual patient is not universally shared because it has not been established which is the most valid radiological approach and which are the criteria to be followed for the differentiation of cases to be treated only with antibiotics and those in which surgery is mandatory. Further studies are needed to ensure the best possible care for all children with DNIs, especially in this era of increased antimicrobial resistance. Full article

(This article belongs to the Special Issue Pediatric Otolaryngology-Expert Reviews and Advances)

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22 pages, 318 KB

Open AccessEditor’s ChoiceReview

Adolescent Idiopathic Scoliosis and Mental Health Disorders: A Narrative Review of the Literature

by Ioanna Mitsiaki, Athanasios Thirios, Eleni Panagouli, Flora Bacopoulou, Dimitris Pasparakis, Theodora Psaltopoulou, Theodoros N. Sergentanis and Artemis Tsitsika

Children 2022, 9(5), 597; https://doi.org/10.3390/children9050597 - 22 Apr 2022

Cited by 49 | Viewed by 7890

Abstract

Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis. The condition begins in puberty, affects 1–4% of adolescents, and disproportionately affects young women. Our aim was to comprehensively examine the association between AIS and risk for depression, anxiety, eating disorders, psychotic [...] Read more.

Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis. The condition begins in puberty, affects 1–4% of adolescents, and disproportionately affects young women. Our aim was to comprehensively examine the association between AIS and risk for depression, anxiety, eating disorders, psychotic disorders, and personality dysfunctional mechanisms. Methods: Literature review of related articles published in PubMed, Google Scholar, and Scopus up to 15 July 2021. Results: A total of 30 studies were deemed eligible, examining the effects of AIS upon mental health, and using appropriate psychometric inventories. Studies highlighted the association of brace treatment with elevated anxiety. In addition, mental health conditions and traits (e.g., anxiety and depressive symptoms, neuroticism) were detected more frequently amongst AIS patients compared to healthy controls. Conclusions: AIS represents a risk factor for mental health disorders. More longitudinal studies, utilizing accurate psychometric instruments, are warranted, to reveal the current impact of AIS on the mental health of youngsters, along with the tailoring of well-targeted interventions to reduce the burden of mental health issues in adulthood. Full article

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

17 pages, 343 KB

Open AccessEditor’s ChoiceReview

The Genetic and Molecular Basis of Developmental Language Disorder: A Review

by Hayley S. Mountford, Ruth Braden, Dianne F. Newbury and Angela T. Morgan

Children 2022, 9(5), 586; https://doi.org/10.3390/children9050586 - 20 Apr 2022

Cited by 29 | Viewed by 13669

Abstract

Language disorders are highly heritable and are influenced by complex interactions between genetic and environmental factors. Despite more than twenty years of research, we still lack critical understanding of the biological underpinnings of language. This review provides an overview of the genetic landscape [...] Read more.

Language disorders are highly heritable and are influenced by complex interactions between genetic and environmental factors. Despite more than twenty years of research, we still lack critical understanding of the biological underpinnings of language. This review provides an overview of the genetic landscape of developmental language disorders (DLD), with an emphasis on the importance of defining the specific features (the phenotype) of DLD to inform gene discovery. We review the specific phenotype of DLD in the genetic literature, and the influence of historic variation in diagnostic inclusion criteria on researchers’ ability to compare and replicate genotype–phenotype studies. This review provides an overview of the recently identified gene pathways in populations with DLD and explores current state-of-the-art approaches to genetic analysis based on the hypothesised architecture of DLD. We will show how recent global efforts to unify diagnostic criteria have vastly increased sample size and allow for large multi-cohort metanalyses, leading the identification of a growing number of contributory loci. We emphasise the important role of estimating the genetic architecture of DLD to decipher underlying genetic associations. Finally, we explore the potential for epigenetics and environmental interactions to further unravel the biological basis of language disorders. Full article

(This article belongs to the Special Issue Current Research on Developmental Speech and Language Delays and Disorders)

7 pages, 210 KB

Open AccessEditor’s ChoiceArticle

Oral Health Preventive Program in Patients with Autism Spectrum Disorder

by Elisabetta Carli, Marco Pasini, Francesca Pardossi, Isabella Capotosti, Antonio Narzisi and Lisa Lardani

Children 2022, 9(4), 535; https://doi.org/10.3390/children9040535 - 10 Apr 2022

Cited by 23 | Viewed by 4316

Abstract

The aim of the study was to evaluate clinical hygienic parameters, patient collaboration, and dental habits in patients with ASD (autism spectrum disorder) before and after a tailored prevention program. A total of 100 patients (78 males and 22 females, mean age 8 [...] Read more.

The aim of the study was to evaluate clinical hygienic parameters, patient collaboration, and dental habits in patients with ASD (autism spectrum disorder) before and after a tailored prevention program. A total of 100 patients (78 males and 22 females, mean age 8 ± 0.7 years old) was recruited, with ages ranging from 7 to 16 years old, and diagnoses of ASD. We evaluated the plaque index (IP), gingival index (IG), the dmft/DMFT, the frequency of tooth brushing, and the frequency of snacks for each patient. Patient behaviour was evaluated with the Frankl scale, and each patient was individually reassessed after five visits from the first one by the same operator. The t test was used to compare the parameters before and after the inclusion in the dedicated dental pathway. From T1 to T2 we found a significant improvement of the IP (p < 0.001), IG (p < 0.001), and the frequency of tooth brushing (p < 0.001). Concerning the frequency of snacks and the parameter dmft/DMFT, the differences in the observed averages were not significant (p > 0.05). The difference in collaboration between T1 and T2 evaluated by the Frankl scale was statistically significant (p < 0.001). It was found that the prevention program allowed a significant improvement in both clinical parameters and patient behaviour. The personalized digital supports can have a key role for success in familiarization and desensitization processes of patients affected by ASD, leading an increase in their collaboration. Full article

(This article belongs to the Special Issue Autism and Children)

26 pages, 1627 KB

Open AccessEditor’s ChoiceReview

Essential Management of Pediatric Brain Tumors

by Katharina Lutz, Stephanie T. Jünger and Martina Messing-Jünger

Children 2022, 9(4), 498; https://doi.org/10.3390/children9040498 - 2 Apr 2022

Cited by 24 | Viewed by 8076

Abstract

Brain tumors are the most common solid tumors in children and are associated with high mortality. The most common childhood brain tumors are grouped as low-grade gliomas (LGG), high grade gliomas (HGG), ependymomas, and embryonal tumors, according to the World Health Organization (WHO). [...] Read more.

Brain tumors are the most common solid tumors in children and are associated with high mortality. The most common childhood brain tumors are grouped as low-grade gliomas (LGG), high grade gliomas (HGG), ependymomas, and embryonal tumors, according to the World Health Organization (WHO). Advances in molecular genetics have led to a shift from pure histopathological diagnosis to integrated diagnosis. For the first time, these new criteria were included in the WHO classification published in 2016 and has been further updated in the 2021 edition. Integrated diagnosis is based on molecular genomic similarities of the tumor subclasses, and it can better explain the differences in clinical courses of previously histopathologically identical entities. Important advances have also been made in pediatric neuro-oncology. A growing understanding of the molecular-genetic background of tumorigenesis has improved the diagnostic accuracy. Re-stratification of treatment protocols and the development of targeted therapies will significantly affect overall survival and quality of life. For some pediatric tumors, these advances have significantly improved therapeutic management and prognosis in certain tumor subgroups. Some therapeutic approaches also have serious long-term consequences. Therefore, optimized treatments are greatly needed. Here, we discuss the importance of multidisciplinary collaboration and the role of (pediatric) neurosurgery by briefly describing the most common childhood brain tumors and their currently recognized molecular subgroups. Full article

(This article belongs to the Special Issue Management of Brain Tumors in Children)

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13 pages, 249 KB

Open AccessEditor’s ChoiceArticle

The Needs of Adolescents and Young Adults with Chronic Illness: Results of a Quality Improvement Survey

by Taryn Allen, Stephanie Reda, Staci Martin, Phoebe Long, Alexis Franklin, Sima Zadeh Bedoya, Lori Wiener and Pamela L. Wolters

Children 2022, 9(4), 500; https://doi.org/10.3390/children9040500 - 2 Apr 2022

Cited by 36 | Viewed by 4797

Abstract

Adolescent and young adults (AYAs) with chronic illnesses cope with complex issues that require unique psychological support and healthcare services to reduce psychosocial difficulties, improve disease management, and facilitate positive transitions to adult care. Engaging patients and caregivers can help providers understand the [...] Read more.

Adolescent and young adults (AYAs) with chronic illnesses cope with complex issues that require unique psychological support and healthcare services to reduce psychosocial difficulties, improve disease management, and facilitate positive transitions to adult care. Engaging patients and caregivers can help providers understand the specific needs of this population and identify the perceived areas of support. The purpose of this quality improvement initiative is to assess the needs of AYAs with chronic medical conditions at a large government research hospital. Eighty-nine AYA patients (age = 23.5 years; range 13–34) with neurofibromatosis type 1, cancer, primary immunodeficiencies, or sickle cell disease, and a sample of caregivers (n = 37, age = 52 years; range: 41–65), completed an anonymized survey that assessed their preferences for a wide range of informational and service-related needs. The results indicate an overwhelming desire for information about general health and wellbeing and disease-specific medical knowledge. The most endorsed item was the need for more information about an individual’s medical condition (72%), which was a primary concern across disease, racial, and gender groups. Demographic and disease-specific needs were also identified. Thus, providing information to AYA patients and caregivers is a critical and largely unmet component of care, which requires the development and implementation of targeted educational and psychosocial interventions. Full article

(This article belongs to the Special Issue Psychosocial Considerations for Children and Adolescents Living with Rare Diseases)

14 pages, 1004 KB

Open AccessEditor’s ChoiceReview

The Effects of Ayres Sensory Integration and Related Sensory Based Interventions in Children with Cerebral Palsy: A Scoping Review

by Jiří Kantor, Lucie Hlaváčková, Jian Du, Petra Dvořáková, Zuzana Svobodová, Kristýna Karasová and Lucia Kantorová

Children 2022, 9(4), 483; https://doi.org/10.3390/children9040483 - 1 Apr 2022

Cited by 22 | Viewed by 9642

Abstract

The theory of Ayres Sensory Integration^® was formulated in the 1960s, and is also known as sensory integration (SI). It has been used in people with cerebral palsy (CP), though the research evidence for its effects in this population is contradictory and [...] Read more.

The theory of Ayres Sensory Integration^® was formulated in the 1960s, and is also known as sensory integration (SI). It has been used in people with cerebral palsy (CP), though the research evidence for its effects in this population is contradictory and inconclusive. To fill in this knowledge gap, we conducted a scoping review of the body of literature on the topic, including any type of quantitative or qualitative research of SI in people with CP without any restrictions of age, language, geography, professionals involved, etc. In September 2020, we searched Scopus, ProQuest Central, MEDLINE (via PubMed), CINAHL Plus and the Academic Search Ultimate and Web of Science, as well as the grey literature sources OpenGrey and MedNar. Two reviewers independently screened the texts and the references lists of the included papers. We finally included seven relevant papers (four randomized controlled trials, two quasi-experimental studies and one case series), though not all fidelity measures required for Ayres SI were reported in the papers. The age of participants ranged from 3 months to 15 years; no studies were identified on adults. There is some evidence that SI or related sensory-based interventions (SBI) may be useful for movement development and other outcomes (attention span, therapy of sensory processing disorders, body perception and therapy of strabismus), but there is only scarce and low-quality evidence comparing interventions. We recommend to conduct well-designed randomized controlled trials (RCTs) with an optimal sample size on the effectiveness of formal Ayres SI for the motor development or other outcomes (as attention span or self-care abilities) using standardized measurement tools. Full article

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17 pages, 1896 KB

Open AccessEditor’s ChoiceArticle

Effects of Occupational Therapy via Telerehabilitation on Occupational Balance, Well-Being, Intrinsic Motivation and Quality of Life in Syrian Refugee Children in COVID-19 Lockdown: A Randomized Controlled Trial

by Sümeyye Belhan Çelik, Esma Özkan and Gonca Bumin

Children 2022, 9(4), 485; https://doi.org/10.3390/children9040485 - 1 Apr 2022

Cited by 15 | Viewed by 4837

Abstract

We aimed to evaluate the effects of an occupational training program via telerehabilitation on well-being (WB), occupational balance (OB), intrinsic motivation (IM), and quality of life (QoL) in Syrian refugee children resettled in Turkey during the COVID-19 pandemic. This was a single-center, prospective, [...] Read more.

We aimed to evaluate the effects of an occupational training program via telerehabilitation on well-being (WB), occupational balance (OB), intrinsic motivation (IM), and quality of life (QoL) in Syrian refugee children resettled in Turkey during the COVID-19 pandemic. This was a single-center, prospective, randomized, non-blinded trial in which children aged 13–15 years and attending a secondary school were recruited. OB, WB, IM, and QoL were evaluated via the OB Questionnaire (OBQ11), the Well-Star Scale (WSS), the IM Scale (IMS), and the Pediatric Quality of Life Inventory (PedsQL). The intervention group attended online occupational therapy classes. Online classes were carried out as five sessions per week, each session lasting 1 h, for 3 weeks. Questionnaires were performed at the outset of the study and following the training program. Overall, 52 refugee children were randomized into the intervention and control groups, each including 26 children. The mean OBQ11, WSS, IMS, and PedsQL scores significantly improved more in the intervention group than in the control group. This was the first study investigating the effects of a customized online training course on OB, WB, IM, and QoL in Syrian refugee children, also affected unfavorably by the COVID-19 lockdown. Our results showed significant improvements in all the study scales that we used to quantify the alterations in the aforementioned traits. Full article

(This article belongs to the Section Pediatric Mental Health)

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12 pages, 1100 KB

Open AccessEditor’s ChoiceReview

Formulation Challenges and Strategies to Develop Pediatric Dosage Forms

by Wedad A. Malkawi, Enas AlRafayah, Mohammad AlHazabreh, Salam AbuLaila and Abeer M. Al-Ghananeem

Children 2022, 9(4), 488; https://doi.org/10.3390/children9040488 - 1 Apr 2022

Cited by 41 | Viewed by 10606

Abstract

The development of pediatric-specific dose forms is particularly difficult due to a variety of factors relating to pediatric population differences from adult populations. The buccal dosage form is considered a good alternative to oral dosage form if the latter cannot be used in [...] Read more.

The development of pediatric-specific dose forms is particularly difficult due to a variety of factors relating to pediatric population differences from adult populations. The buccal dosage form is considered a good alternative to oral dosage form if the latter cannot be used in pediatric patients. Both oral and buccal dosage formulations uphold great application qualities for pediatric patients. This review sheds light on both oral and buccal, as they are the most convenient dosage forms for pediatrics. The use of adult drugs to treat children is a legislation concern, as it may result in incorrect dose, safety, and efficacy. The Best Pharmaceuticals for Children Act (BPCA) and the Pediatric Research Equity Act (PREA) are two key pieces of legislation that encourage and regulate pediatric medication research. Both contribute to a well-balanced approach to emphasizing critical safety and efficacy warnings for the of medications within pediatric populations. These contributions are what enable companies to continue making significant investments in pediatric drug developments. Despite the importance of investigating medicines for children, there is still a demand for pediatric-specific formulations and dosage forms. Many formulations and dosage forms can be designed, among which the buccal drug delivery seems a good modality for pediatric-friendly dosage forms. The main issues associated with these pediatric dosage forms development, particularly clinical and physiological factors, are discussed in this review. In addition, formulation developments and regulatory expectations are highlighted. In turn, suggestions are made to potentially improve future pediatric formulation development. Full article

(This article belongs to the Special Issue Advances in Pediatric Formulations Update)

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15 pages, 883 KB

Open AccessEditor’s ChoiceArticle

Epidemiology, Microbiology and Severity of Bronchiolitis in the First Post-Lockdown Cold Season in Three Different Geographical Areas in Italy: A Prospective, Observational Study

by Anna Camporesi, Rosa Morello, Valentina Ferro, Luca Pierantoni, Alessandro Rocca, Marcello Lanari, Gian Luca Trobia, Tiziana Sciacca, Agata Giuseppina Bellinvia, Alessandra De Ferrari, Piero Valentini, Damian Roland and Danilo Buonsenso

Children 2022, 9(4), 491; https://doi.org/10.3390/children9040491 - 1 Apr 2022

Cited by 42 | Viewed by 5509

Abstract

The aim of this study was to understand the epidemiology, disease severity, and microbiology of bronchiolitis in Italy during the 2021–2022 cold season, outside of lockdowns. Before COVID-19, the usual bronchiolitis season in Italy would begin in November and end in April, peaking [...] Read more.

The aim of this study was to understand the epidemiology, disease severity, and microbiology of bronchiolitis in Italy during the 2021–2022 cold season, outside of lockdowns. Before COVID-19, the usual bronchiolitis season in Italy would begin in November and end in April, peaking in February. We performed a prospective observational study in four referral pediatric centers located in different geographical areas in Italy (two in the north, one in the center and one in the south). From 1 July 2021 to 31 January 2022, we collected all new clinical diagnoses of bronchiolitis in children younger than two years of age recording demographic, clinical and microbiological data. A total of 657 children with a clinical diagnosis of bronchiolitis were enrolled; 56% children were admitted and 5.9% required PICU admission. The first cases were detected during the summer, peaking in November 2021 and declining into December 2021 with only a few cases detected in January 2022. RSV was the commonest etiological agent, while SARS-CoV-2 was rarely detected and only since the end of December 2021. Disease severity was similar in children with RSV vs. non-RSV bronchiolitis, and in those with a single infectious agent detected compared with children with co-infections. The 2021–2022 bronchiolitis season in Italy started and peaked earlier than the usual pre-pandemic seasons, but had a shorter duration. Importantly, the current bronchiolitis season was not more severe when data were compared with Italian published data, and SARS-CoV-2 was rarely a cause of bronchiolitis in children younger than 24 months of age. Full article

(This article belongs to the Section Pediatric Infectious Diseases)

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14 pages, 639 KB

Open AccessEditor’s ChoiceArticle

Supportive Neighborhoods, Family Resilience and Flourishing in Childhood and Adolescence

by Sheila Barnhart, Molly Bode, Michael C. Gearhart and Kathryn Maguire-Jack

Children 2022, 9(4), 495; https://doi.org/10.3390/children9040495 - 1 Apr 2022

Cited by 25 | Viewed by 6229

Abstract

Flourishing is linked with health and well-being in childhood and adulthood. This study applied a promotive factors model to examine how neighborhood assets might benefit child and adolescent flourishing by promoting family resilience. Using data from the combined 2018 and 2019 National Survey [...] Read more.

Flourishing is linked with health and well-being in childhood and adulthood. This study applied a promotive factors model to examine how neighborhood assets might benefit child and adolescent flourishing by promoting family resilience. Using data from the combined 2018 and 2019 National Survey of Children’s Health, structural equation models tested direct and indirect relationships between neighborhood physical environment, neighborhood social cohesion, family resilience, and flourishing among 18,396 children and 24,817 adolescents. After controlling for multiple covariates that may influence flourishing, the models supported that higher levels of neighborhood social cohesion were directly associated with higher levels of flourishing adolescents, and indirectly by positive associations with family resilience for both children and adolescents. No indirect effects between neighborhood physical environments and flourishing were supported by the data for either children or adolescents. However, neighborhood physical environments were positively associated with adolescent flourishing. Understanding social environmental factors that strengthen and enhance child and adolescent flourishing are critical toward designing prevention, intervention, and policy efforts that can build on the existing strengths of families and their communities. Full article

(This article belongs to the Special Issue Family Risk and Protective Factors and Child Development)

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19 pages, 2477 KB

Open AccessEditor’s ChoiceReview

Effectiveness of Mental Health Literacy Programs in Primary and Secondary Schools: A Systematic Review with Meta-Analysis

by Isaac Daniel Amado-Rodríguez, Rocio Casañas, Laia Mas-Expósito, Pere Castellví, Juan Francisco Roldan-Merino, Irma Casas, Lluís Lalucat-Jo and Mª Isabel Fernández-San Martín

Children 2022, 9(4), 480; https://doi.org/10.3390/children9040480 - 31 Mar 2022

Cited by 50 | Viewed by 12715

Abstract

In recent years, there has been an increase in studies evaluating the effectiveness of mental health literacy programs within the context of education as a universal, preventive intervention. A systematic review and meta-analysis regarding the effectiveness of mental health literacy interventions in schools, [...] Read more.

In recent years, there has been an increase in studies evaluating the effectiveness of mental health literacy programs within the context of education as a universal, preventive intervention. A systematic review and meta-analysis regarding the effectiveness of mental health literacy interventions in schools, from 2013 to the present, on mental health knowledge, stigma, and help-seeking is conducted. Of the 795 identified references, 15 studies met the inclusion criteria. Mental health knowledge increased after the interventions (standardized mean difference: SMD = 0.61; 95% CI (0.05, 0.74)), at two months (SMD = 0.60; 95% CI (0.4, 1.07)) and six months (SMD = 0.39; 95% CI (0.27, 0.51)). No significant differences were observed between stigma and improving help-seeking. Mental health literacy interventions are effective in augmenting mental health knowledge, but not in reducing stigma or improving help-seeking behavior. Full article

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13 pages, 2864 KB

Open AccessEditor’s ChoiceReview

Making Hardware Removal Unnecessary by Using Resorbable Implants for Osteosynthesis in Children

by Pascal Heye, Christoph Matissek, Clemens Seidl, Marcell Varga, Tamas Kassai, Gergö Jozsa and Thomas Krebs

Children 2022, 9(4), 471; https://doi.org/10.3390/children9040471 - 29 Mar 2022

Cited by 22 | Viewed by 4583

Abstract

Introduction: Following osteosynthesis, children generally require a second surgery to remove the hardware. This becomes unnecessary, by using resorbable implants. Limiting the number of required surgeries and their associated risks, this technique provides critical aspects of minimally invasive surgery. This review focuses on [...] Read more.

Introduction: Following osteosynthesis, children generally require a second surgery to remove the hardware. This becomes unnecessary, by using resorbable implants. Limiting the number of required surgeries and their associated risks, this technique provides critical aspects of minimally invasive surgery. This review focuses on resorbable implants for osteosynthesis for the treatment of fractures in children and discusses their clinical features. Method: We provide an overview of the two most common technologies used in resorbable osteosynthesis materials: polymer- and magnesium-based alloys. Clinical examples of osteosynthesis are presented using polymer-based ActivaTM products and magnesium-based Magnezix^® products. Results: Polymer-based implants demonstrate surgical safety and efficacy. Due to their elasticity, initial placement of polymer-based products may demonstrate technical challenges. However, stability is maintained over the course of healing. While maintaining good biocompatibility, the rate of polymer-resorption may be controlled by varying the composition of polyesters and copolymers. Similarly, magnesium-based implants demonstrate good mechanical stability and resorption rates, while these characteristics may be controlled by varying alloy components. One of the significant shortcomings of magnesium is that metabolism results in the production of hydrogen gas. Both technologies provide equally good results clinically and radiographically, when compared to non-resorbable implants. Conclusion: Resorbable osteosynthesis materials demonstrate similar therapeutic results as conventional materials for osteosynthesis. Resorbable implants may have the potential to improve patient outcomes, by sparing children a second surgery for hardware removal. Full article

(This article belongs to the Special Issue Current Development of Pediatric Minimally Invasive Surgery)

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13 pages, 549 KB

Open AccessEditor’s ChoiceArticle

A Cross-Temporal Meta-Analysis of Changes in Left-Behind Children’s Mental Health in China

by Xiaoyi Zhang, Zhoudao Dai, Collins Opoku Antwi and Jun Ren

Children 2022, 9(4), 464; https://doi.org/10.3390/children9040464 - 25 Mar 2022

Cited by 9 | Viewed by 3838

Abstract

A considerable body of research using the Mental Health Test (MHT) has explored the psychological repercussions of the physical separation of children from one or both parents as they pursue better economic prospects in cities. Generally, these studies compare the mental health status [...] Read more.

A considerable body of research using the Mental Health Test (MHT) has explored the psychological repercussions of the physical separation of children from one or both parents as they pursue better economic prospects in cities. Generally, these studies compare the mental health status (MHS) between left-behind children (LBC) and non-left-behind children (NLBC). That notwithstanding, little is known about the real policy impact of these studies on the ground over the years. Using a relevant search strategy and selection criteria, we identified qualified studies (N = 102: 2004 to 2019). Cross-temporal meta-analysis (CTMA) was performed on these studies for dynamic trends. Our results demonstrate: (1) a slight but significant change in MHS of both LBC and NLBC, with LBC being significantly worse off over time; (2) a significant deterioration in MHS of LBC over time, particularly among left-behind boys (LBBs); (3) a stable and significant decline in MHS of left-behind junior high and elementary school students, respectively; and (4) a more substantial degradation in MHS of LBC with both parents absent compared with LBC with a parent present. The findings reveal that the efforts of, and collaboration among, researchers, policy experts and politicians are producing results. Nevertheless, more targeted research is needed to unearth the underlying issues that generate the differences among subpopulations of LBC to better inform pragmatic interventions for collective psychological wellness of LBC. Full article

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12 pages, 487 KB

Open AccessEditor’s ChoiceReview

New Directions in Understanding Atopic March Starting from Atopic Dermatitis

by Nunzia Maiello, Pasquale Comberiati, Arianna Giannetti, Giampaolo Ricci, Rossella Carello and Elena Galli

Children 2022, 9(4), 450; https://doi.org/10.3390/children9040450 - 23 Mar 2022

Cited by 35 | Viewed by 7204

Abstract

Recent evidence showed that the postulated linear progression of the atopic march, from atopic dermatitis to food and respiratory allergies, does not capture the heterogeneity of allergic phenotypes, which are influenced by complex interactions between environmental, genetic, and psychosocial factors. Indeed, multiple atopic [...] Read more.

Recent evidence showed that the postulated linear progression of the atopic march, from atopic dermatitis to food and respiratory allergies, does not capture the heterogeneity of allergic phenotypes, which are influenced by complex interactions between environmental, genetic, and psychosocial factors. Indeed, multiple atopic trajectories are possible in addition to the classic atopic march. Nevertheless, atopic dermatitis is often the first manifestation of an atopic march. Improved understanding of atopic dermatitis pathogenesis is warranted as this could represent a turning point in the prevention of atopic march. In this review, we outline the recent findings on the pathogenetic mechanisms leading to atopic dermatitis that could be targeted by intervention strategies for the prevention of atopic march. Full article

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

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14 pages, 649 KB

Open AccessEditor’s ChoiceArticle

One-Year Clinical Performance of Activa™ Bioactive-Restorative Composite in Primary Molars

by Lisa Lardani, Giacomo Derchi, Vincenzo Marchio and Elisabetta Carli

Children 2022, 9(3), 433; https://doi.org/10.3390/children9030433 - 19 Mar 2022

Cited by 54 | Viewed by 7182

Abstract

Restorative procedures for caries affecting primary molars are a daily challenge for pediatric dentistry, and one of the main factors influencing the results of these restorative procedures is the choice of dental material used: bioactive materials were recently introduced, combining the strength of [...] Read more.

Restorative procedures for caries affecting primary molars are a daily challenge for pediatric dentistry, and one of the main factors influencing the results of these restorative procedures is the choice of dental material used: bioactive materials were recently introduced, combining the strength of composites and the benefits of glass ionomers. The present study’s objective is to clinically evaluate the aesthetic, functional and biological properties of Activa™ Bioactive composite in approximal and occlusal carious lesions for 1 year using the FDI criteria for evaluating direct dental restorations. Forty-five children with occlusal or approximal caries in first or second primary molars were included in the study: the cavities were then randomized to be restored with either Activa BioActive or SDR Bulk-fill and evaluated over time according to Federation Dentaire Internationale (FDI) criteria. Results showed that Activa BioActive composite has similar performance over time compared to Bulk-fill composite, for both functional and aesthetic properties. Thus, within the limitations of this study, including the short follow-up period, it can be concluded that bioactive materials might be the material of choice to restore primary molars. A longer follow-up period is desirable to confirm these findings. Full article

(This article belongs to the Special Issue Advance Research in Pediatric Dental Disease)

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11 pages, 1014 KB

Open AccessEditor’s ChoiceArticle

Internet Gaming Disorder in Children and Adolescents with Attention Deficit Hyperactivity Disorder

by Stefano Berloffa, Andrea Salvati, Giulia D’Acunto, Pamela Fantozzi, Emanuela Inguaggiato, Francesca Lenzi, Annarita Milone, Pietro Muratori, Chiara Pfanner, Federica Ricci, Laura Ruglioni, Annalisa Tacchi, Chiara Tessa, Arianna Villafranca and Gabriele Masi

Children 2022, 9(3), 428; https://doi.org/10.3390/children9030428 - 18 Mar 2022

Cited by 27 | Viewed by 7283

Abstract

Although Attention Deficit Hyperactivity Disorder (ADHD) has been related to an increased risk for behavioral addictions, the relationship between ADHD and Internet Gaming Disorder (IGD) is still debated. The aim of this study is to address this topic by exploring the prevalence of [...] Read more.

Although Attention Deficit Hyperactivity Disorder (ADHD) has been related to an increased risk for behavioral addictions, the relationship between ADHD and Internet Gaming Disorder (IGD) is still debated. The aim of this study is to address this topic by exploring the prevalence of IGD in a consecutive sample of ADHD youth, compared to a normal control group, and by assessing selected psychopathological and cognitive features in ADHD patients with and without IGD. One hundred and eight patients with ADHD (mean age 11.7 ± 2.6 years, 96 males) and 147 normal controls (NC) (mean age 13.9 ± 3.0 years, 114 males) were included in the study and received structured measures for IGD. In the ADHD group, 44% of the sample were above the IGD cut-off, compared to 9.5% in the NC group. ADHD patients with IGD presented with greater severity and impairment, more severe ADHD symptomatology, more internalizing symptoms, particularly withdrawal/depression and socialization problems, and more prominence of addiction and evasion dimensions. A binary logistic regression showed that the degree of inattention presented a greater weight in determining IGD. These findings may be helpful for identifying, among ADHD patients, those at higher risk for developing a superimposed IGD. Full article

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

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11 pages, 1117 KB

Open AccessEditor’s ChoiceReview

Treatment of Unspecific Back Pain in Children and Adolescents: Results of an Evidence-Based Interdisciplinary Guideline

by Michael Frosch, Stina Leinwather, Stefan Bielack, Susanne Blödt, Uta Dirksen, Michael Dobe, Florian Geiger, Renate Häfner, Lea Höfel, Bettina Hübner-Möhler, Thekla von Kalle, Burkhard Lawrenz, Andreas Leutner, Frauke Mecher, Kiril Mladenov, Heike Norda, Lorin Stahlschmidt, Marc Steinborn, Ralf Stücker, Ralf Trauzeddel, Regina Trollmann, Julia Wager and Boris Zernikow Show full author list Hide full author list

Children 2022, 9(3), 417; https://doi.org/10.3390/children9030417 - 15 Mar 2022

Cited by 13 | Viewed by 6655

Abstract

Using a structured approach and expert consensus, we developed an evidence-based guideline on the treatment and prevention of non-specific back pain in children and adolescents. A comprehensive and systematic literature search identified relevant guidelines and studies. Based on the findings of this literature [...] Read more.

Using a structured approach and expert consensus, we developed an evidence-based guideline on the treatment and prevention of non-specific back pain in children and adolescents. A comprehensive and systematic literature search identified relevant guidelines and studies. Based on the findings of this literature search, recommendations on treatment and prevention were formulated and voted on by experts in a structured consensus-building process. Physical therapy (particularly physical activity) and psychotherapy (particularly cognitive behavioral therapy) are recommended for treating pediatric non-specific back pain. Intensive interdisciplinary treatment programs should be provided for chronic and severe pain. Drug therapy should not be applied in children and adolescents. Further research on non-specific back pain in childhood and adolescence is strongly needed to reduce the imbalance between the high burden of non-specific back pain in childhood and adolescence and the low research activity in this field. Full article

(This article belongs to the Section Pediatric Anesthesiology, Perioperative and Pain Medicine)

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16 pages, 291 KB

Open AccessEditor’s ChoiceReview

Obstructive Sleep Apnea in Neonates

by Indira Chandrasekar, Mary Anne Tablizo, Manisha Witmans, Jose Maria Cruz, Marcus Cummins and Wendy Estrellado-Cruz

Children 2022, 9(3), 419; https://doi.org/10.3390/children9030419 - 15 Mar 2022

Cited by 18 | Viewed by 5490

Abstract

Neonates have distinctive anatomic and physiologic features that predispose them to obstructive sleep apnea (OSA). The overall prevalence of neonatal OSA is unknown, although an increase in prevalence has been reported in neonates with craniofacial malformations, neurological disorders, and airway malformations. If remained [...] Read more.

Neonates have distinctive anatomic and physiologic features that predispose them to obstructive sleep apnea (OSA). The overall prevalence of neonatal OSA is unknown, although an increase in prevalence has been reported in neonates with craniofacial malformations, neurological disorders, and airway malformations. If remained unrecognized and untreated, neonatal OSA can lead to impaired growth and development, cardiovascular morbidity, and can even be life threatening. Polysomnography and direct visualization of the airway are essential diagnostic modalities in neonatal OSA. Treatment of neonatal OSA is based on the severity of OSA and associated co-morbidities. This may include medical and surgical interventions individualized for the affected neonate. Based on this, it is expected that infants with OSA have more significant healthcare utilization. Full article

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

7 pages, 1714 KB

Open AccessEditor’s ChoiceCase Report

Incidental Finding in Pre-Orthodontic Treatment Radiographs of an Aural Foreign Body: A Case Report

by Cinzia Maspero, Andrea Abate, Francesco Inchingolo, Claudia Dolci, Maria Grazia Cagetti and Gianluca Martino Tartaglia

Children 2022, 9(3), 421; https://doi.org/10.3390/children9030421 - 15 Mar 2022

Cited by 23 | Viewed by 3788

Abstract

The presence of foreign bodies in the external auditory canal of young patients may cause, if left untreated, severe permanent damage to the adjacent anatomical structures, and infections. A 10-year-old patient with an intellectual disability underwent orthodontic evaluation. An aural radiopaque finding was [...] Read more.

The presence of foreign bodies in the external auditory canal of young patients may cause, if left untreated, severe permanent damage to the adjacent anatomical structures, and infections. A 10-year-old patient with an intellectual disability underwent orthodontic evaluation. An aural radiopaque finding was visible in the lateral cephalogram and in the orthopantomography. The patient’s mother reported that her son never showed any ear discomfort, except for a mild hearing impairment that was never investigated. The patient was referred to an ear, nose and throat (ENT) specialist that removed the foreign body located in the left external auditory meatus. The careful evaluation of dental radiographs, including pre-orthodontic and interim orthodontic radiographs, may help to identify silent incidental findings that may otherwise lead to severe complications if left untreated. Full article

(This article belongs to the Special Issue Oral Health Related Quality of Life of Children)

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11 pages, 1032 KB

Open AccessEditor’s ChoiceArticle

Behavioural Differences in Sensorimotor Profiles: A Comparison of Preschool-Aged Children with Sensory Processing Disorder and Autism Spectrum Disorders

by Giulia Purpura, Francesco Cerroni, Marco Carotenuto, Renata Nacinovich and Luca Tagliabue

Children 2022, 9(3), 408; https://doi.org/10.3390/children9030408 - 14 Mar 2022

Cited by 21 | Viewed by 6922

Abstract

Sensory Processing Disorders (SPDs) define dysfunctions in modulating, organising, and using information from several sensory channels for regulating motor, behavioural, emotional and attention responses. Although SPD can be identified also as an isolated condition in young children, its presence in Autism Spectrum Disorder [...] Read more.

Sensory Processing Disorders (SPDs) define dysfunctions in modulating, organising, and using information from several sensory channels for regulating motor, behavioural, emotional and attention responses. Although SPD can be identified also as an isolated condition in young children, its presence in Autism Spectrum Disorder (ASD) population is really frequent. The study purpose is to explore the SPD clinical expression and the putative correlation with several behavioural aspects both in children with ASD and in those with isolated SPD. Therefore, 43 preschool-aged children (25 ASD vs. 18 SPD) were recruited, and their parents completed three questionnaires (Developmental Profile-3, Sensory Processing Measure–Preschool, Repetitive Behaviour Scale-Revised) to evaluate behavioural alterations and developmental levels. The main result is that both ASD and SPD groups had significantly sensory-related behavioural symptoms, although ASD children seem to be more impaired in all areas. Several significant correlations were found between sensory processing difficulties and repetitive behaviours, but in the SPD group a specific relationship between Body Awareness and Ritualistic/Sameness Behaviour was found. Conversely, in the ASD group, more diffuse interlinks between sensory processing difficulties and motor behaviours were significant. In conclusion, the present study confirms the key role of sensory–motor skills in early diagnosis and intervention among children at risk for neurodevelopmental disorders. Full article

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

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10 pages, 2582 KB

Open AccessEditor’s ChoiceArticle

Comparison of MTA versus Biodentine in Apexification Procedure for Nonvital Immature First Permanent Molars: A Randomized Clinical Trial

by Yasser Alsayed Tolibah, Chaza Kouchaji, Thuraya Lazkani, Ibrahim Ali Ahmad and Ziad D. Baghdadi

Children 2022, 9(3), 410; https://doi.org/10.3390/children9030410 - 14 Mar 2022

Cited by 21 | Viewed by 11113

Abstract

This study aimed to evaluate the radiological and clinical outcomes of Biodentine apical plugs compared to mineral trioxide aggregate (MTA) in treating immature molars with apical lesions in children. Materials and Methods: Thirty immature roots of 24 permanent lower first molars with apical [...] Read more.

This study aimed to evaluate the radiological and clinical outcomes of Biodentine apical plugs compared to mineral trioxide aggregate (MTA) in treating immature molars with apical lesions in children. Materials and Methods: Thirty immature roots of 24 permanent lower first molars with apical lesions were randomly divided into two groups: group 1 (15 roots) treated with MTA apical plugs and group 2 (15 roots) treated with Biodentine apical plugs. Treatment radiological outcomes were assessed using the periapical index (PAI) scale after 6 and 12 months of treatment. The presence or absence of apical calcified barrier (ACB) was assessed after 12 months of treatment. The visual analog scale (VAS) was used to compare the postoperative pain between the two groups after 1, 3, 7, and 14 days of treatment. PAI scores between the two groups were compared using the Mann–Whitney U test, the presence or absence of the ACB was compared using the chi-square test, and the VAS scores were compared using the t-test. The statistical significance threshold was set at 0.05. Results: There were no statistically significant differences in the PAI between the two groups at 6 and 12 months postoperatively. After 12 months, four cases in the Biodentine group showed ACB formation, whereas ACB was not found in any case treated with MTA. The VAS scores were statistically lower in the MTA group on the first day after treatment. Nevertheless, these scores were not statistically significantly different after 3, 7, and 14 days of treatment between the two groups. Conclusions: Biodentine can be used as an apical plug to treat immature permanent molars with apical lesions in a single visit in children. Biodentine showed favorable outcomes in apical lesions healing, which was comparable to MTA but with a decreased treatment time associated with its use. Full article

(This article belongs to the Collection Advance in Pediatric Dentistry)

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16 pages, 701 KB

Open AccessEditor’s ChoiceReview

Biomechanical Characteristics of the Typically Developing Toddler Gait: A Narrative Review

by Wei Liu, Qichang Mei, Peimin Yu, Zixiang Gao, Qiuli Hu, Gustav Fekete, Bíró István and Yaodong Gu

Children 2022, 9(3), 406; https://doi.org/10.3390/children9030406 - 13 Mar 2022

Cited by 10 | Viewed by 7418

Abstract

Independent ambulation is one of the most important motor skills in typically developing toddlers. Gait analysis is a key evaluation method in basic and clinical research. A narrative review on the literature of toddler gait development was conducted following inclusion criteria, explicitly including [...] Read more.

Independent ambulation is one of the most important motor skills in typically developing toddlers. Gait analysis is a key evaluation method in basic and clinical research. A narrative review on the literature of toddler gait development was conducted following inclusion criteria, explicitly including the factors of English article, age range, no external intervention during the experimental process of studies involved, the non-symptomatic toddler, and no pathological gait. Studies about toddlers’ morphological, physiological, and biomechanical aspects at this developmental stage were identified. Remarkable gait characteristics and specific development rules of toddlers at different ages were reported. Changes in gait biomechanics are age and walking experience-dependent. Gait patterns are related to the maturation of the neuro and musculoskeletal systems. This review thus provides critical and theoretical information and the nature of toddler walking development for clinicians and other scientific researchers. Future studies may systematically recruit subjects with more explicit criteria with larger samples for longitudinal studies. A particular design could be conducted to analyze empirically before practical application. Additionally, the influence of external interventions on the development of toddler gait may need consideration for gait development in the toddler cohort. Full article

(This article belongs to the Special Issue Orthopaedics and Biomechanics in Children)

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21 pages, 381 KB

Open AccessEditor’s ChoiceReview

A Critical Review on the Complex Interplay between Social Determinants of Health and Maternal and Infant Mortality

by Rada K. Dagher and Deborah E. Linares

Children 2022, 9(3), 394; https://doi.org/10.3390/children9030394 - 10 Mar 2022

Cited by 61 | Viewed by 27393

Abstract

Background: U.S. maternal and infant mortality rates constitute an important public health problem, because these rates surpass those in developed countries and are characterized by stark disparities for racial/ethnic minorities, rural residents, and individuals with less privileged socioeconomic status due to social determinants [...] Read more.

Background: U.S. maternal and infant mortality rates constitute an important public health problem, because these rates surpass those in developed countries and are characterized by stark disparities for racial/ethnic minorities, rural residents, and individuals with less privileged socioeconomic status due to social determinants of health (SDoH). Methods: A critical review of the maternal and infant mortality literature was performed to determine multilevel SDoH factors leading to mortality disparities with a life course lens. Results: Black mothers and infants fared the worst in terms of mortality rates, likely due to the accumulation of SDoH experienced as a result of structural racism across the life course. Upstream SDoH are important contributors to disparities in maternal and infant mortality. More research is needed on the effectiveness of continuous quality improvement initiatives for the maternal–infant dyad, and expanding programs such as paid maternity leave, quality, stable and affordable housing, and social safety-nets (Medicaid, CHIP, WIC), in reducing maternal and infant mortality. Finally, it is important to address research gaps in individual, interpersonal, community, and societal factors, because they affect maternal and infant mortality and related disparities. Conclusion: Key SDoH at multiple levels affect maternal and infant health. These SDoH shape and perpetuate disparities across the lifespan and are implicated in maternal and infant mortality disparities. Full article

(This article belongs to the Special Issue Social Determinants of Disparities in Maternal and Infant Health Outcomes)

19 pages, 371 KB

Open AccessEditor’s ChoiceReview

Myopia Genetics and Heredity

by Yu-Meng Wang, Shi-Yao Lu, Xiu-Juan Zhang, Li-Jia Chen, Chi-Pui Pang and Jason C. Yam

Children 2022, 9(3), 382; https://doi.org/10.3390/children9030382 - 9 Mar 2022

Cited by 45 | Viewed by 12771

Abstract

Myopia is the most common eye condition leading to visual impairment and is greatly influenced by genetics. Over the last two decades, more than 400 associated gene loci have been mapped for myopia and refractive errors via family linkage analyses, candidate gene studies, [...] Read more.

Myopia is the most common eye condition leading to visual impairment and is greatly influenced by genetics. Over the last two decades, more than 400 associated gene loci have been mapped for myopia and refractive errors via family linkage analyses, candidate gene studies, genome-wide association studies (GWAS), and next-generation sequencing (NGS). Lifestyle factors, such as excessive near work and short outdoor time, are the primary external factors affecting myopia onset and progression. Notably, besides becoming a global health issue, myopia is more prevalent and severe among East Asians than among Caucasians, especially individuals of Chinese, Japanese, and Korean ancestry. Myopia, especially high myopia, can be serious in consequences. The etiology of high myopia is complex. Prediction for progression of myopia to high myopia can help with prevention and early interventions. Prediction models are thus warranted for risk stratification. There have been vigorous investigations on molecular genetics and lifestyle factors to establish polygenic risk estimations for myopia. However, genes causing myopia have to be identified in order to shed light on pathogenesis and pathway mechanisms. This report aims to examine current evidence regarding (1) the genetic architecture of myopia; (2) currently associated myopia loci identified from the OMIM database, genetic association studies, and NGS studies; (3) gene-environment interactions; and (4) the prediction of myopia via polygenic risk scores (PRSs). The report also discusses various perspectives on myopia genetics and heredity. Full article

(This article belongs to the Special Issue Prevalence and Progression of Myopia in Children and Adolescents)

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Open AccessEditor’s ChoiceArticle

The Eating Healthy and Daily Life Activities (EHDLA) Study

by José Francisco López-Gil

Children 2022, 9(3), 370; https://doi.org/10.3390/children9030370 - 7 Mar 2022

Cited by 53 | Viewed by 11971

Abstract

Background: Childhood obesity is one of the greatest public health concerns facing advanced societies, Spain being one of the countries with the highest incidence. In this sense, the Region of Murcia has been pointed out as the Spanish autonomous community with the highest [...] Read more.

Background: Childhood obesity is one of the greatest public health concerns facing advanced societies, Spain being one of the countries with the highest incidence. In this sense, the Region of Murcia has been pointed out as the Spanish autonomous community with the highest prevalence of excess weight among young people. More specifically, the Valle de Ricote has shown an even greater proportion of excess weight among young people. Several sociodemographic, environmental, lifestyle, health-related, cognitive, and psychological factors are related to excess weight. Based on the lack of information, this research project will try to provide relevant information to design intervention programs, as well as to implement effective public policies to try and reverse this alarming situation. Therefore, this research project aims (1) to obtain cross-sectional and longitudinal data on the excess weight and their potential sociodemographic, environmental, lifestyle, health-related, cognitive, and psychological factors associated among adolescents from the Valle de Ricote (Region of Murcia, Spain) (aged 12–17 years), and (2) to examine the association between excess weight and their potential sociodemographic, environmental, lifestyle, health-related, cognitive, and psychological factors associated among this population. Methods: A cross-sectional study and follow-up study will be performed. This research project will involve adolescents using a simple random sampling technique. A total of three secondary schools from the Valle de Ricote (Region of Murcia, Spain) will be included in this project. The minimum sample size will be 1138, establishing a 95% confidence interval, a 40% prevalence of excess weight, a 3% margin of error, and a non-response rate of 10%. Primary outcome measures will be: (1) anthropometric measurements, (2) sociodemographic factors, (3) environmental factors, (4) lifestyle factors, (5) health-related factors, (6) cognitive factors, and (7) psychological factors. Conclusion: This research project will aim to determine the prevalence of excess weight and interrelate their potential sociodemographic, environmental, lifestyle, health-related, cognitive, and psychological factors associated. The obtained results will help to manage and propose possible multidisciplinary interventions and strategies in order to prevent and reduce the excess weight in adolescents from the Valle de Ricote. Furthermore, orientations will be given to transfer the obtained results to the public sector to evaluate or change the adopted policies. Full article

(This article belongs to the Special Issue Childhood and Adolescent Obesity and Weight Management: 2nd Edition)

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14 pages, 305 KB

Open AccessEditor’s ChoiceReview

Orthorexia Nervosa in Adolescents and Young Adults: A Literature Review

by Maria Gkiouleka, Christina Stavraki, Theodoros N. Sergentanis and Tonia Vassilakou

Children 2022, 9(3), 365; https://doi.org/10.3390/children9030365 - 4 Mar 2022

Cited by 20 | Viewed by 10242

Abstract

Adolescents are a nutritionally vulnerable population; eating disorders are more common among adolescents and young adults. Orthorexia nervosa (ON) is a non-formally recognized condition characterized by an obsessive preoccupation with eating healthy and “pure” foods; the quality and not the quantity of food [...] Read more.

Adolescents are a nutritionally vulnerable population; eating disorders are more common among adolescents and young adults. Orthorexia nervosa (ON) is a non-formally recognized condition characterized by an obsessive preoccupation with eating healthy and “pure” foods; the quality and not the quantity of food is pivotal in ON. ON is a complex entity which can be associated with severe diet restrictions, a negative impact on social relationships, and with physical and mental health conditions, including obsessive–compulsive disorder. In light of this, a literature review regarding the background, diagnosis, features, risk factors, interplay with the social media, and management of ON is presented in this article, with a focus on adolescents and young adults. Full article

(This article belongs to the Special Issue Body Image, Weight Pressure and Disordered Eating Behaviors among Children and Adolescents)

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18 pages, 953 KB

Open AccessEditor’s ChoiceReview

Compensation or Displacement of Physical Activity in Children and Adolescents: A Systematic Review of Empirical Studies

by Franziska Beck, Florian A. Engel and Anne Kerstin Reimers

Children 2022, 9(3), 351; https://doi.org/10.3390/children9030351 - 3 Mar 2022

Cited by 20 | Viewed by 5105

Abstract

Regular physical activity during childhood and adolescence is associated with health benefits. Consequently, numerous health promotion programs for children and adolescents emphasize the enhancement of physical activity. However, the ActivityStat hypothesis states that increases in physical activity in one domain are compensated for [...] Read more.

Regular physical activity during childhood and adolescence is associated with health benefits. Consequently, numerous health promotion programs for children and adolescents emphasize the enhancement of physical activity. However, the ActivityStat hypothesis states that increases in physical activity in one domain are compensated for by decreasing physical activity in another domain. Currently, little is known about how physical activity varies in children and adolescents within intervals of one day or multiple days. This systematic review provides an overview of studies that analyzed changes in (overall) physical activity, which were assessed with objective measurements, or compensatory mechanisms caused by increases or decreases in physical activity in a specific domain in children and adolescents. A systematic search of electronic databases (PubMed, Scopus, Web of Science, SportDiscus) was performed with a priori defined inclusion criteria. Two independent researchers screened the literature and identified and rated the methodological quality of the studies. A total of 77 peer-reviewed articles were included that analyzed changes in overall physical activity with multiple methodological approaches resulting in compensation or displacement. Of 40,829 participants, 16,265 indicated compensation associated with physical activity. Subgroup analyses separated by study design, participants, measurement instrument, physical activity context, and intervention duration also showed mixed results toward an indication of compensation. Quality assessment of the included studies revealed that they were of high quality (mean = 0.866). This review provides inconclusive results about compensation in relation to physical activity. A trend toward increased compensation in interventional studies and in interventions of longer duration have been observed. Full article

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8 pages, 1063 KB

Open AccessEditor’s ChoiceArticle

Gastroesophageal Reflux in Children with Asthma

by Vasile Valeriu Lupu, Ingrith Miron, Elena Tarca, Laura Mihaela Trandafir, Dana-Teodora Anton-Paduraru, Stefana Maria Moisa, Magdalena Starcea, Andrei Cernomaz, Lucian Miron and Ancuta Lupu

Children 2022, 9(3), 336; https://doi.org/10.3390/children9030336 - 2 Mar 2022

Cited by 17 | Viewed by 4205

Abstract

Background: Nowadays it is considered that a specific causal relationship exists between asthma and gastroesophageal reflux (GER), because of the aspiration of gastric refluate which leads to and maintain spasticity even real crisis of paroxystic expiratory dyspnea. This study explores this relationship and [...] Read more.

Background: Nowadays it is considered that a specific causal relationship exists between asthma and gastroesophageal reflux (GER), because of the aspiration of gastric refluate which leads to and maintain spasticity even real crisis of paroxystic expiratory dyspnea. This study explores this relationship and evaluates the results after treatment. Methods: 56 children diagnosed with asthma, hospitalized in a regional center of pediatric gastroenterology in Northeast Romania, underwent 24-hour continuous esophageal pH monitoring in order to establish the presence of GER. The Boix-Ochoa score was used to interpret the results. Proton pump inhibitors were administered to those with GER and the patients were reevaluated after 2 months. Results: 39 patients (69.64%) had GER, with a Boix-Ochoa score above normal (N < 11.99), and 17 patients (30.36%) had normal score. After administering proton pump inhibitors for 2 months, 7 patients still had high Boix-Ochoa score (17.95%). The result of this analysis shows that the presence of asthma increases the chance of GER by 2.86 times. Conclusions: In children with asthma we have to look for GER in order to treat, because it can help the treatment of asthma or even solve some cases resistant to standard treatment. Full article

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8 pages, 7700 KB

Open AccessEditor’s ChoiceCase Report

Dupilumab Improves Pruritus in Netherton Syndrome: A Case Study

by Yutaka Inaba, Nobuo Kanazawa, Kyoko Muraoka, Azusa Yariyama, Ami Kawaguchi, Kayo Kunimoto, Chikako Kaminaka, Yuki Yamamoto, Kaoru Tsujioka, Akira Yoshida, Teruki Yanagi and Masatoshi Jinnin

Children 2022, 9(3), 310; https://doi.org/10.3390/children9030310 - 24 Feb 2022

Cited by 17 | Viewed by 6360

Abstract

The patient was a 26-year-old male. He had red and scaling skin of the entire body since birth, as well as an elevated level of serum IgE. Genetic testing revealed a mutation in the SPINK5 gene, which had confirmed the diagnosis with Netherton [...] Read more.

The patient was a 26-year-old male. He had red and scaling skin of the entire body since birth, as well as an elevated level of serum IgE. Genetic testing revealed a mutation in the SPINK5 gene, which had confirmed the diagnosis with Netherton syndrome. He has had significant pruritis since birth, and subsequently had symptoms of sleeping disorders and concentration difficulty throughout the day. Since treatment with various antihistamines were not effective, we administered dupilumab and found that it was effective in immediate elimination of pruritus and gradual reduction of the rash. Dupilumab has been administered for one year without any adverse events or recurrence of symptoms. Although studies have previously described cases who used dupilumab for Netherton syndrome, reported effects have been limited or transient. Additional studies are needed to confirm the effect of dupilumab for Netherton syndrome, which currently lack any effective treatment strategies. Full article

(This article belongs to the Special Issue Current Research on Pediatric Allergy and Immunodeficiency)

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18 pages, 427 KB

Open AccessEditor’s ChoiceReview

Early Motor Signs in Autism Spectrum Disorder

by Annio Posar and Paola Visconti

Children 2022, 9(2), 294; https://doi.org/10.3390/children9020294 - 21 Feb 2022

Cited by 46 | Viewed by 11192

Abstract

A growing number of literature data suggest the presence of early impairments in the motor development of children with autism spectrum disorder, which could be often recognized even before the appearance of the classical social communication deficits of autism. In this narrative review, [...] Read more.

A growing number of literature data suggest the presence of early impairments in the motor development of children with autism spectrum disorder, which could be often recognized even before the appearance of the classical social communication deficits of autism. In this narrative review, we aimed at performing an update about the available data on the early motor function in children with autism spectrum disorder. Early motor impairment in these children can manifest itself both as a mere delay of motor development and as the presence of atypicalities of motor function, such as a higher rate and a larger inventory, of stereotyped movements both with and without objects. In the perspective of a timely diagnosis, the presence of early motor signs can be an important clue, especially in an individual considered at high risk for autism. Motor and communication (both verbal and non-verbal) skills are connected and a pathogenetic role of early motor dysfunctions in the development of autism can be hypothesized. From this, derives the importance of an early enabling intervention aimed at improving motor skills, which could also have favorable effects on other aspects of development. Full article

(This article belongs to the Special Issue Autism and Children)

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10 pages, 648 KB

Open AccessEditor’s ChoiceArticle

Anterior Chamber Angle in Adults Born Extremely, Very, and Moderately Preterm with and without Retinopathy of Prematurity—Results of the Gutenberg Prematurity Eye Study

by Achim Fieß, Sandra Gißler, Eva Mildenberger, Michael S. Urschitz, Agnes Fauer, Heike M. Elflein, Fred Zepp, Bernhard Stoffelns, Norbert Pfeiffer and Alexander K. Schuster

Children 2022, 9(2), 281; https://doi.org/10.3390/children9020281 - 18 Feb 2022

Cited by 20 | Viewed by 2897

Abstract

Purpose: To determine whether prematurity and associated factors affect the anterior chamber angle (ACA) width in adulthood. Methods: The Gutenberg Prematurity Eye Study (GPES) is a retrospective cohort study with a prospective ophthalmologic examination of adults (age 18–52 years) in Germany. All participants [...] Read more.

Purpose: To determine whether prematurity and associated factors affect the anterior chamber angle (ACA) width in adulthood. Methods: The Gutenberg Prematurity Eye Study (GPES) is a retrospective cohort study with a prospective ophthalmologic examination of adults (age 18–52 years) in Germany. All participants were examined with Scheimpflug imaging (Pentacam HR, Oculus Optikgeräte GmbH, Wetzlar, Germany) using linear regression analysis to assess the associations of ACA in the different sectors with gestational age (GA), birth weight, birth weight percentile, retinopathy of prematurity (ROP), ROP treatment, placental insufficiency, preeclampsia, and breastfeeding. Results: In total, 516 eyes of 319 preterm and full-term individuals (aged 28.9 ± 8.8 years, 188 females) were examined. ROP treatment was associated with smaller ACA width in the nasal (B = −9.6 [95%CI: −14.7; −4.5] degree; p < 0.001) and temporal positions (B = −11.5 [95%CI: −17.7; −5.3] degree; p = 0.001), whereas non-treated individuals with ROP had an unaltered ACA width, as did individuals with low gestational age without ROP. Conclusion: Advanced stages of ROP following treatment with laser- and cryocoagulation lead to a smaller ACA width until adulthood, and hence may increase the risk of angle closure in later life. Full article

(This article belongs to the Special Issue Prematurity, Preterm-Born Adults, and Long-Term Effects on Children and Adults)

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18 pages, 1349 KB

Open AccessFeature PaperEditor’s ChoiceArticle

Finding the True Number of Females with Autistic Spectrum Disorder by Estimating the Biases in Initial Recognition and Clinical Diagnosis

by Robert McCrossin

Children 2022, 9(2), 272; https://doi.org/10.3390/children9020272 - 17 Feb 2022

Cited by 41 | Viewed by 37433

Abstract

The proportion of females whose ASD diagnosis is missed is unknown. The ratio of males to females with ASD is generally quoted as 4:1, though it is believed that there are biases preventing females from being diagnosed and that the true ratio is [...] Read more.

The proportion of females whose ASD diagnosis is missed is unknown. The ratio of males to females with ASD is generally quoted as 4:1, though it is believed that there are biases preventing females from being diagnosed and that the true ratio is lower. These biases have not been clearly identified or quantified. Starting with a clinical dataset of 1711 children <18 years old, four different methods were employed in an inductive study to identify and quantify the biases and calculate the proportion of females missed. A mathematical model was constructed to compare the findings with current published data. The true male-to-female ratio appears to be 3:4. Eighty percent of females remain undiagnosed at age 18, which has serious consequences for the mental health of young women. Full article

(This article belongs to the Special Issue New Frontiers in Adolescent Health and Development)

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11 pages, 942 KB

Open AccessEditor’s ChoiceArticle

The Mental Health of Black Youth Affected by Community Violence: Family and School Context as Pathways to Resilience

by Donte T. Boyd, Kristian V. Jones, Camille R. Quinn, Adrian Gale, Ed-Dee G. Williams and Husain Lateef

Children 2022, 9(2), 259; https://doi.org/10.3390/children9020259 - 15 Feb 2022

Cited by 18 | Viewed by 6364

Abstract

Black youth who experience community violence occupy multiple environments with varying levels of influence on how they display resiliency to prevent adverse mental health outcomes. Considering the recent rise of mental health concerns (i.e., increase in suicidal outcomes) among Black youth, along with [...] Read more.

Black youth who experience community violence occupy multiple environments with varying levels of influence on how they display resiliency to prevent adverse mental health outcomes. Considering the recent rise of mental health concerns (i.e., increase in suicidal outcomes) among Black youth, along with the abundance of research illustrating the detrimental impact of community violence, more research is needed to examine how different environmental factors (e.g., family and school) shape how youth protect their mental health while displaying resiliency navigating community violence. The purpose of this study was to examine how family and school contexts predict Black youths’ ability to display resiliency to navigate community violence and prevent adverse mental health outcomes. This study utilized a path analysis to examine the associations between parent relationships, parent bonding, school climate, resilience to adverse community experiences, community violence, and mental health among 548 Black adolescents in Chicago. Findings highlight that parent relationships, parent bonding, and school climate influence the association between resilience to community violence and mental health outcomes among Black youth. Implications for mental health practice and policy among Black youth are discussed. Full article

(This article belongs to the Special Issue Family Risk and Protective Factors and Child Development)

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16 pages, 828 KB

Open AccessEditor’s ChoiceReview

You Cannot Hit Snooze on OSA: Sequelae of Pediatric Obstructive Sleep Apnea

by Selena Thomas, Shefali Patel, Prabhavathi Gummalla, Mary Anne Tablizo and Catherine Kier

Children 2022, 9(2), 261; https://doi.org/10.3390/children9020261 - 15 Feb 2022

Cited by 34 | Viewed by 9815

Abstract

Pediatric obstructive sleep apnea (OSA) has been shown to not only affect the quality of sleep, but also overall health in general. Untreated or inadequately treated OSA can lead to long-term sequelae involving cardiovascular, endothelial, metabolic, endocrine, neurocognitive, and psychological consequences. The physiological [...] Read more.

Pediatric obstructive sleep apnea (OSA) has been shown to not only affect the quality of sleep, but also overall health in general. Untreated or inadequately treated OSA can lead to long-term sequelae involving cardiovascular, endothelial, metabolic, endocrine, neurocognitive, and psychological consequences. The physiological effects of pediatric OSA eventually become pathological. As the complex effects of pediatric OSA are discovered, they must be identified early so that healthcare providers can be better equipped to treat and even prevent them. Ultimately, adequate management of OSA improves overall quality of life. Full article

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

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14 pages, 570 KB

Open AccessEditor’s ChoiceReview

Evaluation of Children Caries Risk Factors: A Narrative Review of Nutritional Aspects, Oral Hygiene Habits, and Bacterial Alterations

by Andrea Butera, Carolina Maiorani, Annalaura Morandini, Manuela Simonini, Stefania Morittu, Julia Trombini and Andrea Scribante

Children 2022, 9(2), 262; https://doi.org/10.3390/children9020262 - 15 Feb 2022

Cited by 81 | Viewed by 16280

Abstract

Dental caries is one of the most common diseases—both in adults and children—that occurs due to the demineralization of enamel and dentine by the organic acids formed from bacteria present in dental plaques through anaerobic metabolism of dietary sugars. The aim of this [...] Read more.

Dental caries is one of the most common diseases—both in adults and children—that occurs due to the demineralization of enamel and dentine by the organic acids formed from bacteria present in dental plaques through anaerobic metabolism of dietary sugars. The aim of this article is to provide a guideline to assess the risk of caries by looking for the main factors involved. Literature research was performed for studies that analyzed the factors most involved in the development of child caries, such as poor oral hygiene, bad eating habits (or food disorders), and an alteration of the oral bacterial flora—with an increase of Streptococci spp., Lactobacilli spp., Candida albicans, Cryptococcus neoformans, and Candida sake. It is therefore essential to assess the risk of caries in children, based on the assessment of risk factors, in order to be able to establish preventive and/or therapeutic approaches that will reduce or stop the development of dental caries. The use of fluoride products, products made from casein phosphopeptide-amorphous calcium phosphate, substituted zinc biomimetic hydroxyapatite products, or products containing self-assembling oligopeptide SAP-P₁₁-4 are useful. In terms of the clinical approach, a communicative approach should be added to learn about the eating habits and the oral hygiene habits of the child and parents; in addition, the use of a simple method to frame the factors involved, and subsequently establish the risk of carious lesions in the child, allows the reduction of the DMFT (Decayed Missing Filled Teeth) or ICDAS (International Caries Detection and Assessment System) index on large scales. Full article

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

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15 pages, 643 KB

Open AccessEditor’s ChoiceArticle

Weight Pressures and Eating Disorder Symptoms among Adolescent Female Gymnasts of Different Performance Levels in Greece

by Ioanna Kontele, Tonia Vassilakou and Olyvia Donti

Children 2022, 9(2), 254; https://doi.org/10.3390/children9020254 - 14 Feb 2022

Cited by 21 | Viewed by 7278

Abstract

This study examined the weight pressures within the gymnastics environment and explored associations between these pressures and eating disorder (ED) symptoms in adolescent female gymnasts. One hundred and forty-seven competitive gymnasts and 122 recreational-level gymnasts (11–17 years old) completed the Eating Attitudes Test [...] Read more.

This study examined the weight pressures within the gymnastics environment and explored associations between these pressures and eating disorder (ED) symptoms in adolescent female gymnasts. One hundred and forty-seven competitive gymnasts and 122 recreational-level gymnasts (11–17 years old) completed the Eating Attitudes Test (EAT-26), the Weight-Pressures in Sport-Females (WPS-F), the Social Desirability Scale (SDS) and provided information on their training. It was found that 16.3% of competitive gymnasts and 7.4% of non-competitive gymnasts scored ≥20 in EAT-26, indicating disordered eating behavior. Competitive gymnasts scored higher than non-competitive in the total score of EAT-26 (p = 0.027), as well as in the total score of WPS-F, the sport and coaches weight pressures sub-scale and the appearance and performance weight pressures sub-scale (p < 0.001). Multiple regression analyses indicated that sport and coaches weight pressures, appearance and performance weight pressures and body mass index accounted for 30.3% of the variance of EAT-26 in competitive gymnasts, while the appearance and performance weight pressures sub-scale accounted for 16.3% of the variance of EAT-26 in non-competitive gymnasts. Sport and coaches weight pressures are associated with ED in competitive gymnasts, while body appearance and performance demands correlate with ED in female gymnasts irrespective of competitive level. Full article

(This article belongs to the Special Issue Body Image, Weight Pressure and Disordered Eating Behaviors among Children and Adolescents)

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28 pages, 2148 KB

Open AccessEditor’s ChoiceReview

COVID-19 Infection in Children and Infants: Current Status on Therapies and Vaccines

by Giuseppina Malcangi, Alessio Danilo Inchingolo, Angelo Michele Inchingolo, Fabio Piras, Vito Settanni, Grazia Garofoli, Giulia Palmieri, Sabino Ceci, Assunta Patano, Antonio Mancini, Luigi Vimercati, Damiano Nemore, Arnaldo Scardapane, Biagio Rapone, Alexandra Semjonova, Maria Teresa D’Oria, Luigi Macchia, Ioana Roxana Bordea, Giovanni Migliore, Antonio Scarano, Felice Lorusso, Gianluca Martino Tartaglia, Delia Giovanniello, Ludovica Nucci, Nicola Maggialetti, Antonio Parisi, Marina Di Domenico, Nicola Brienza, Silvio Tafuri, Pasquale Stefanizzi, Luigi Curatoli, Alberto Corriero, Maria Contaldo, Francesco Inchingolo and Gianna Dipalma Show full author list Hide full author list

Children 2022, 9(2), 249; https://doi.org/10.3390/children9020249 - 12 Feb 2022

Cited by 74 | Viewed by 6463

Abstract

Since the beginning in December 2019, the SARS-CoV-2 outbreak appeared to affect mostly the adult population, sparing the vast majority of children who only showed mild symptoms. The purpose of this investigation is to assess the status on the mechanisms that give children [...] Read more.

Since the beginning in December 2019, the SARS-CoV-2 outbreak appeared to affect mostly the adult population, sparing the vast majority of children who only showed mild symptoms. The purpose of this investigation is to assess the status on the mechanisms that give children and infants this variation in epidemiology compared to the adult population and its impact on therapies and vaccines that are aimed towards them. A literature review, including in vitro studies, reviews, published guidelines and clinical trials was performed. Clinical trials concerned topics that allowed a descriptive synthesis to be produced. Four underlying mechanisms were found that may play a key role in providing COVID-19 protection in babies. No guidelines are available yet for therapy due to insufficient data; support therapy remains the most used. Only two vaccines are approved by the World Health Organization to be used in children from 12 years of age, and there are currently no efficacy or safety data for children below the age of 12 years. The COVID-19 clinical frame infection is milder in children and adolescents. This section of the population can act as vectors and reservoirs and play a key role in the transmission of the infection; therefore, vaccines are paramount. More evidence is required to guide safely the vaccination campaign. Full article

(This article belongs to the Special Issue Children’s Emotion and Learning during COVID-19 Pandemic)

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12 pages, 272 KB

Open AccessEditor’s ChoiceArticle

The Associations of Child’s Clinical Conditions and Behavioral Problems with Parenting Stress among Families of Preschool-Aged Children: 2018–2019 National Survey of Child Health

by Soyang Kwon, Meghan E. O’Neill and Carolyn C. Foster

Children 2022, 9(2), 241; https://doi.org/10.3390/children9020241 - 11 Feb 2022

Cited by 13 | Viewed by 3023

Abstract

To understand parental stress resulting from parenting young children, the current literature has primarily focused on families of children with clinical conditions, but has placed far less attention on the general population. The aim of this study was to examine parenting stress related [...] Read more.

To understand parental stress resulting from parenting young children, the current literature has primarily focused on families of children with clinical conditions, but has placed far less attention on the general population. The aim of this study was to examine parenting stress related to children’s clinical conditions and behavioral problems in a nationally representative sample of US children aged 3 to 5 years. The study sample included 8454 children aged 3 to 5 years and their parents who participated in the 2018–2019 US National Survey of Child Health (NSCH). Using online/paper NSCH questionnaires, parents reported their children’s special health care needs (SHCN), clinically diagnosed mental, emotional, developmental, and behavioral (MEDB) problems (e.g., anxiety problem, developmental delay), and externalizing behaviors. Parents also reported the frequency of feeling aggravated from parenting the participating child as an indicator of elevated parenting stress. In the sample, the prevalence of elevated parenting stress was 5.1% overall (95% CI = 4.2, 6.0); however, it was significantly higher among parents of children with SHCN (20.8%; 95% CI = 16.7, 24.9), with MEDB problems (24.8%; 95% CI = 19.9, 29.8), and with externalizing behavior problems (14.7%; 95% CI = 11.8, 17.6). A multivariable logistic regression model showed that elevated parenting stress was associated with the child’s SHCN (adjusted odds ratio [AOR] = 2.3; 1.3, 3.9), MEDB problems (AOR = 4.8; 95% CI = 2.5, 9.1), and externalizing behavior problems (AOR = 5.4; 95% CI = 3.1, 9.4). Even in children without SHCN or MEDB problems, externalizing behavior problems were associated with elevated parenting stress (AOR = 6.4; 95% CI = 3.3, 12.7). The findings call for greater attention to subclinical or yet to be diagnosed externalizing behavior problems among the general preschool-aged child population and their underestimated impact on parenting stress. Full article

(This article belongs to the Section Pediatric Mental Health)

17 pages, 1091 KB

Open AccessEditor’s ChoiceReview

Presentation of Congenital Portosystemic Shunts in Children

by Atessa Bahadori, Beatrice Kuhlmann, Dominique Debray, Stephanie Franchi-Abella, Julie Wacker, Maurice Beghetti, Barbara E. Wildhaber, Valérie Anne McLin and on behalf of the IRCPSS

Children 2022, 9(2), 243; https://doi.org/10.3390/children9020243 - 11 Feb 2022

Cited by 24 | Viewed by 12784

Abstract

Background: Congenital portosystemic shunts (CPSS) are rare vascular anomalies resulting in communications between the portal venous system and the systemic venous circulation, affecting an estimated 30,000 to 50,000 live births. CPSS can present at any age as a multi-system disease of variable severity [...] Read more.

Background: Congenital portosystemic shunts (CPSS) are rare vascular anomalies resulting in communications between the portal venous system and the systemic venous circulation, affecting an estimated 30,000 to 50,000 live births. CPSS can present at any age as a multi-system disease of variable severity mimicking both common and rare pediatric conditions. Case presentations: Case A: A vascular malformation was identified in the liver of a 10-year-old girl with tall stature, advanced somatic maturation, insulin resistance with hyperinsulinemia, hyperandrogenemia and transient hematuria. Work-up also suggested elevated pulmonary pressures. Case B: A young girl with trisomy 8 mosaicism with a history of neonatal hypoglycemia, transient neonatal cholestasis and tall stature presented newly increased aminotransferase levels at 6 years of age. Case C: A 3-year-old boy with speech delay, tall stature and abdominal pain underwent abdominal ultrasound (US) showing multiple liver nodules, diagnosed as liver hemangiomas by hepatic magnetic resonance imaging (MRI). Management and outcome: After identification of a venous malformation on liver Doppler US, all three patients were referred to a specialized liver center for further work-up within 12 to 18 months from diagnosis. Angio-computed tomography (CT) scan confirmed the presence of either an intrahepatic or extrahepatic CPSS with multiples liver nodules. All three had a hyperintense signal in the globus pallidus on T1 weighted cerebral MRI. Right heart catheterization confirmed pulmonary hypertension in cases A and C. Shunts were closed either using an endovascular or surgical approach. Liver nodules were either surgically removed if there was a risk of malignant degeneration or closely monitored by serial imaging when benign. Conclusion: These cases illustrate most of the common chief complaints and manifestations of CPSS. Liver Doppler US is the key to diagnosis. Considering portosystemic shunts in the diagnostic work-up of a patient with unexplained endocrine, liver, gastro-intestinal, cardiovascular, hematological, renal or neurocognitive disorder is important as prompt referral to a specialized center may significantly impact patient outcome. Full article

(This article belongs to the Special Issue Pediatric Vascular Anomalies: Clinical Diagnosis and Treatment)

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