Editor’s Choice Articles

Editor’s Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. Editors select a small number of articles recently published in the journal that they believe will be particularly interesting to readers, or important in the respective research area. The aim is to provide a snapshot of some of the most exciting work published in the various research areas of the journal.

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16 pages, 1818 KiB  
Article
A Comparison of the Effects of Supervised versus Home Schroth Exercise Programs with Adolescent Idiopathic Scoliosis
by Kadriye Tombak, İnci Yüksel, Umut Ozsoy, Yılmaz Yıldırım and Sezen Karaşin
Children 2024, 11(3), 354; https://doi.org/10.3390/children11030354 - 17 Mar 2024
Cited by 5 | Viewed by 5128
Abstract
(1) Background: Schroth exercise can reduce the deformity of the spine and improve the life quality and the body image of patients with adolescent idiopathic scoliosis (AIS). (2) Methods: The study began with 49 participants, aged 10–16 years old, who were diagnosed with [...] Read more.
(1) Background: Schroth exercise can reduce the deformity of the spine and improve the life quality and the body image of patients with adolescent idiopathic scoliosis (AIS). (2) Methods: The study began with 49 participants, aged 10–16 years old, who were diagnosed with AIS. At the end of the study, 37 patients were randomly assigned to either the Supervised (n = 19) or Home-Based Schroth Exercise Group (n = 18) and completed the study. Both groups were treated for seven days a week over twelve weeks. For all patients, body rotation measurements were performed with a scoliometer, surface asymmetry analysis was carried out using an Artec Eva 3D scanner, health-related quality of life was evaluated by the Scoliosis Research Society-22 (SRS-22) questionnaire, and the perception of the cosmetic deformity was assessed by the Walter Reed Visual Assessment Scale (WRVAS). All the measurements were repeated before and after the 12-week treatment. (3) Results: Post-treatment scoliometric measurements showed a significant decrease in body rotation in both groups (p < 0.05). Similarly, both groups observed significant positive changes in SRS-22 and WRVAS scores (p < 005). RMS values were statistically significant in both groups; the difference was only statistically significant in the thoracic anterior arm subparameter (p < 0.05). (4) Conclusion: The Schroth exercise for both groups with AIS improved body symmetry, quality of life, and body image. Full article
(This article belongs to the Special Issue New Trends in Physical Therapy for Children)
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11 pages, 225 KiB  
Article
Understanding Experiences of Youth with Long COVID: A Qualitative Approach
by Chelsea Torres, Kensei Maeda, Madeline Johnson and Leonard A. Jason
Children 2024, 11(3), 335; https://doi.org/10.3390/children11030335 - 12 Mar 2024
Cited by 6 | Viewed by 5782
Abstract
There is limited information on the specific impacts of Long COVID in youth. Long COVID presents as persisting or new symptoms following initial COVID-19 infection. The aim of this study was to better understand how children and their families describe their experiences seeking [...] Read more.
There is limited information on the specific impacts of Long COVID in youth. Long COVID presents as persisting or new symptoms following initial COVID-19 infection. The aim of this study was to better understand how children and their families describe their experiences seeking diagnosis and support following the onset of symptoms of Long COVID. Six children and five caregivers located in the United States participated in this study. Study procedures included an online video interview with caregiver–child dyads. Interview transcriptions were then analyzed using a conventional approach to content analysis, with two independent coders generating themes. Eight themes emerged from this analysis including the severity of illness and symptomatology, difficulty surrounding the diagnostic process and not being believed, the impact on family and social connections, poor school functioning, positive coping, subsequent positive medical experiences, mental health, and knowledge of the medical field and healthcare experience. Themes revealed difficulty for youth and families in navigating the medical system and functioning in areas of daily life as well as areas of positive experiences related to coping and medical involvement. These findings also highlighted areas of needed improvement for the medical community and for research on Long COVID in youth. Full article
(This article belongs to the Section Pediatric Infectious Diseases)
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28 pages, 350 KiB  
Article
Clinical Symptomatology of Anxiety and Family Function in Adolescents—The Self-Esteem Mediator
by Ignatia Farmakopoulou, Maria Lekka and Evgenia Gkintoni
Children 2024, 11(3), 338; https://doi.org/10.3390/children11030338 - 12 Mar 2024
Cited by 12 | Viewed by 7373
Abstract
Background: Family, the child’s first environment, shapes their psycho-emotional balance. The literature links adolescent anxiety to family relationships, interactions, and dynamics. The self-esteem of adolescents appears to protect their mental health. Goal: This study examines whether family cohesion and adaptability affect adolescent anxiety [...] Read more.
Background: Family, the child’s first environment, shapes their psycho-emotional balance. The literature links adolescent anxiety to family relationships, interactions, and dynamics. The self-esteem of adolescents appears to protect their mental health. Goal: This study examines whether family cohesion and adaptability affect adolescent anxiety symptoms. It also examines whether teen self-esteem mediates this relationship. Method: This cross-sectional, descriptive study included 166 Attica youth aged 12–18 from schools and educational units. The adolescents completed Olson’s FACES-III cohesion and adaptability scale, Spielberger’s STAI-C, Rosenberg’s self-esteem scale, and a socio-demographic questionnaire. Results: Family cohesion, but not adaptability, was negatively correlated with state (rho = −0.25, p = 0.001) and trait (rho = −0.46, p < 0.001) anxiety in the adolescents. Teenagers from extreme families with the lowest cohesion and adaptability had higher trait anxiety (x2(2) = 6.91, p = 0.032) than those from moderately balanced/balanced families. Self-esteem mediated the relationship between the family cohesion functioning and adolescent’s state anxiety (p = 0.005) and trait anxiety (p = 0.011). Conclusions: The findings show that family dysfunction negatively impacts adolescent anxiety, as well as their self-esteem, which protects mental balance. Full article
11 pages, 521 KiB  
Review
Melatonin Use in Pediatrics: A Clinical Review on Indications, Multisystem Effects, and Toxicity
by Pranita Shenoy, Adriana Etcheverry, Jalyn Ia, Manisha Witmans and Mary Anne Tablizo
Children 2024, 11(3), 323; https://doi.org/10.3390/children11030323 - 9 Mar 2024
Cited by 14 | Viewed by 9728
Abstract
Exogenous melatonin is typically used for sleep regulation in the context of insomnia either in healthy children or those with neurodevelopmental disabilities. It is also used for the management of circadian rhythm sleep disorders in pediatric and adolescent patients. There are also many [...] Read more.
Exogenous melatonin is typically used for sleep regulation in the context of insomnia either in healthy children or those with neurodevelopmental disabilities. It is also used for the management of circadian rhythm sleep disorders in pediatric and adolescent patients. There are also many other possible indications that we will discuss in this paper beyond the role of melatonin for sleep regulation, including its potential use for various areas of medicine such as inflammatory conditions. Since melatonin is unregulated in the United States, distributed over the counter and perceived to be natural and safe, it has become available in many forms in the last two decades. With increasing sleep disturbances and mental health problems after the COVID-19 pandemic, melatonin has become even more popular and studies have shown a dramatic increase in use as well as resulting side effects, including melatonin overdose. As melatonin is generally viewed by physicians as a benign medication, we hope to increase awareness of melatonin’s properties as well as negative side effects to optimize its use in the pediatric population. Full article
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14 pages, 448 KiB  
Article
Unilateral Sensorineural Hearing Loss in Children: Etiology, Audiological Characteristics, and Treatment
by Mirko Aldè, Diego Zanetti, Umberto Ambrosetti, Eleonora Monaco, Anna Maria Gasbarre, Lorenzo Pignataro, Giovanna Cantarella and Stefania Barozzi
Children 2024, 11(3), 324; https://doi.org/10.3390/children11030324 - 9 Mar 2024
Cited by 7 | Viewed by 4301
Abstract
The aim of this study was to evaluate audiological characteristics and parents’ opinions on hearing device use in children with unilateral sensorineural hearing loss (USNHL) who attended a tertiary-level audiologic center. The medical charts of 70 children aged 6 to 12 years with [...] Read more.
The aim of this study was to evaluate audiological characteristics and parents’ opinions on hearing device use in children with unilateral sensorineural hearing loss (USNHL) who attended a tertiary-level audiologic center. The medical charts of 70 children aged 6 to 12 years with USNHL were reviewed. In 51.4% of cases, the children were diagnosed with USNHL after the age of 2 years. The main causes of USNHL were congenital cytomegalovirus infection (21.4%) and unilateral cochlear nerve hypoplasia (12.9%). The percentage of patients wearing a hearing device was 45.7% (32/70); of these, 28 (87.5%) wore a conventional hearing aid, 2 (6.3%) a CROS device, and 2 (6.3%) a cochlear implant. Regarding the choice to use a hearing device, no significant differences were found between the subcategories of hearing loss degree (p = 0.55) and audiometric configuration (p = 0.54). Most parents of children with mild-to-severe USNHL observed improved attention (90.9%), and reduced fatigue and restlessness (86.4%) using the hearing aid. These children performed significantly better on all audiological tests (speech perception in quiet and in noise conditions, and sound localization) while wearing the hearing aid (p < 0.001). More efforts should be made to raise awareness among professionals and parents about the negative consequences of uncorrected USNHL. Full article
(This article belongs to the Special Issue Diagnosis and Management of Pediatric Ear and Vestibular Disorders)
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9 pages, 243 KiB  
Review
The Global Occurrences of Cleft Lip and Palate in Pediatric Patients and Their Association with Demographic Factors: A Narrative Review
by Farah Asnely Putri, Madhuri Pattamatta, Sheylla Edu September Anita and Tantry Maulina
Children 2024, 11(3), 322; https://doi.org/10.3390/children11030322 - 8 Mar 2024
Cited by 16 | Viewed by 7887
Abstract
Objective: Orofacial clefts are one of the most common abnormalities that occur in the orofacial area. Due to their high prevalence, special attention provided to risk factors and their possible involvement in the occurrence of orofacial clefts is of importance. The objective of [...] Read more.
Objective: Orofacial clefts are one of the most common abnormalities that occur in the orofacial area. Due to their high prevalence, special attention provided to risk factors and their possible involvement in the occurrence of orofacial clefts is of importance. The objective of this study was to review the current global occurrence of orofacial clefts and the possible linkage of previously investigated risk factors to the occurrence of orofacial clefts. Review: The risk factors of orofacial clefts can be classified into two groups, modifiable risk factors and non-modifiable risk factors. Due to the extent of elaboration of each risk factor in each group, this current narrative review is limited to several mostly investigated risk factors, which included a review of parental age, sexual disparities, educational attainment, and income. Studies indicate that Asians are more likely than other races to have orofacial clefts, with a higher incidence rate in men than in women. There is evidence that the age of the parents is associated with the chance of the occurrence of orofacial cleft. The prevention of orofacial clefts and the distribution of medical resources depend heavily on a thorough understanding of epidemiology on a global scale. Nevertheless, the earlier studies concentrated on more developed nations or areas, and registry data from low-income nations had significant gaps. The findings of this narrative review can be used as the scientific basis for further research within this area. Conclusion: The occurrence rate of orofacial clefts remains high in several regions. Possible associations between parental age, sexual disparities, educational attainment, and family income to the occurrence of orofacial clefts remain contradictory, indicating the importance of further research to obtain more insights. Full article
(This article belongs to the Special Issue Oral Epidemiology and Pathology in Children)
25 pages, 481 KiB  
Review
Nutritional Challenges among African Refugee and Internally Displaced Children: A Comprehensive Scoping Review
by Claire Gooding, Salwa Musa, Tina Lavin, Lindiwe Sibeko, Chizoma Millicent Ndikom, Stella Iwuagwu, Mary Ani-Amponsah, Aloysius Nwabugo Maduforo and Bukola Salami
Children 2024, 11(3), 318; https://doi.org/10.3390/children11030318 - 7 Mar 2024
Cited by 4 | Viewed by 4132
Abstract
Background: Children’s nutrition in Africa, especially among those displaced by conflicts, is a critical global health concern. Adequate nutrition is pivotal for children’s well-being and development, yet those affected by displacement confront distinctive challenges. This scoping review seeks to enhance our current knowledge, [...] Read more.
Background: Children’s nutrition in Africa, especially among those displaced by conflicts, is a critical global health concern. Adequate nutrition is pivotal for children’s well-being and development, yet those affected by displacement confront distinctive challenges. This scoping review seeks to enhance our current knowledge, filling gaps in understanding nutritional and associated health risks within this vulnerable population. Objective: We conducted a scoping review of the literature on the nutritional status and associated health outcomes of this vulnerable population with the goal of informing targeted interventions, policy development, and future research efforts to enhance the well-being of African refugee and internally displaced children. Methods: This scoping review adopted Arksey and O’Malley (2005)’s methodology and considered studies published between 2000 and 2021. Results: Twenty-three published articles met the inclusion criteria. These articles highlighted a wide variation in the levels of malnutrition among African refugee/internally displaced (IDP) children, with the prevalence of chronic malnutrition (stunting) and acute malnutrition (wasting) ranging from 18.8 to 52.1% and 0.04 to 29.3%, respectively. Chronic malnutrition was of ‘high’ or ‘very high’ severity (according to recent WHO classifications) in 80% of studies, while acute malnutrition was of ‘high’ or ‘very high’ severity in 50% of studies. In addition, anemia prevalence was higher than the 40% level considered to indicate a severe public health problem in 80% of the studies reviewed. Conclusion: In many settings, acute, chronic, and micronutrient malnutrition are at levels of great concern. Many countries hosting large, displaced populations are not represented in the literature, and research among older children is also lacking. Qualitative and intervention-focused research are urgently needed. Full article
(This article belongs to the Special Issue Nutrition to Improve Child and Adolescent Health)
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17 pages, 263 KiB  
Article
Non-Suicidal Self-Injury (NSSI) Patterns in Adolescents from a Romanian Child Psychiatry Inpatient Clinic
by Lucia Emanuela Andrei, Magdalena Efrim-Budisteanu, Ilinca Mihailescu, Alexandra Mariana Buică, Mihaela Moise and Florina Rad
Children 2024, 11(3), 297; https://doi.org/10.3390/children11030297 - 1 Mar 2024
Cited by 5 | Viewed by 3017
Abstract
Non-Suicidal Self-Injury (NSSI) involves deliberately causing harm to one’s body without the intention of suicide. As the numbers of adolescents presenting NSSI have been steadily increasing during the last years, we intended to investigate adolescent patients exhibiting NSSI, admitted to our clinic—a Romanian [...] Read more.
Non-Suicidal Self-Injury (NSSI) involves deliberately causing harm to one’s body without the intention of suicide. As the numbers of adolescents presenting NSSI have been steadily increasing during the last years, we intended to investigate adolescent patients exhibiting NSSI, admitted to our clinic—a Romanian child psychiatry inpatient clinic, over the course of five years. A total of 100 adolescents (80 females, 20 males, mean age: 14.9 years) hospitalized for various neuropsychiatric disorders and engaging in self-harm were studied. The self-harm methods most frequently used in our sample were, for the female group: cutting (all), skin tearing (76%), scratching/pinching (72%), and for males: cutting (all), wound-healing hindrance (85%), striking objects (80%). The initial motivations for NSSI were represented by distress (females 89%, males 90%) and seeking pleasure (females 84%). In terms of the roles of NSSI, it was primarily used for emotional regulation (females 89%) and anger management (males 90%). This study highlights the prevalence of self-harm in hospitalized adolescents, differences in methods and motivations between genders, and the need for more targeted therapy interventions. By documenting trends, investigating underlying motivations and functions, and proposing hypotheses for further research, our findings offer valuable insights on adolescent NSSI and have the potential to increase awareness among various clinicians and specialists who interact with adolescents, thus addressing the escalating prevalence of self-harm behaviours among teenagers. Full article
(This article belongs to the Section Pediatric Mental Health)
18 pages, 516 KiB  
Review
Trends in Physical Activity and Motor Development in Young People—Decline or Improvement? A Review
by Cristiana D’Anna, Pasqualina Forte and Elisa Pugliese
Children 2024, 11(3), 298; https://doi.org/10.3390/children11030298 - 1 Mar 2024
Cited by 10 | Viewed by 4354
Abstract
This paper aims to analyse studies and research conducted in EU and non-EU member states to identify and compare trends in physical activity and motor skills. Thus, a comparative overview of the state of the art in the two pre-pandemic decades that can [...] Read more.
This paper aims to analyse studies and research conducted in EU and non-EU member states to identify and compare trends in physical activity and motor skills. Thus, a comparative overview of the state of the art in the two pre-pandemic decades that can facilitate an understanding of the different territorial realities and training needs to be conducted, considering the different cultural situations. A scoping review was conducted by analysing a series of studies published between 1990 and 2022, including only those studies that collected data in the pre-pandemic period. The search was carried out on databases such as PubMed, Google Scholar, and ScienceDirect. The following keywords were used for the acquisition of relevant studies: children, decline, motor skills, physical activity, and young people. From the literature review emerged clearly in all the longitudinal surveys a negative trend of body mass index (BMI), which was increasing in all the countries analysed, and cardiorespiratory fitness, which, in close relation to the increase in overweight levels, was in decline. If an unambiguous trend could be declared for the variables just mentioned, it was not possible to declare the same trend for the other variables analysed, which showed discordant results between the different countries. Full article
(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)
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28 pages, 1737 KiB  
Review
Children’s Health, Wellbeing and Academic Outcomes over the Summer Holidays: A Scoping Review
by Emily Eglitis, Aaron Miatke, Rosa Virgara, Amanda Machell, Timothy Olds, Mandy Richardson and Carol Maher
Children 2024, 11(3), 287; https://doi.org/10.3390/children11030287 - 27 Feb 2024
Cited by 8 | Viewed by 5940
Abstract
Background: The school day provides a supportive and stimulating environment that may protect children and adolescents (5–18 years) from behaviours that are adverse for health and wellbeing. Objective: To review the literature regarding changes in children’s academic achievement or overall wellbeing during the [...] Read more.
Background: The school day provides a supportive and stimulating environment that may protect children and adolescents (5–18 years) from behaviours that are adverse for health and wellbeing. Objective: To review the literature regarding changes in children’s academic achievement or overall wellbeing during the extended school summer break and evaluate if the outcomes are different for children experiencing disadvantage. Methods: The peer-reviewed literature was searched across six electronic databases for studies tracking changes in any academic, health or wellbeing outcome in children over the summer holidays. Studies were screened in duplicate for inclusion. Data were extracted using a standardized data extraction form. Outcomes were coded as decline (suggestive or significant), increase (suggestive or significant) or mixed/neutral and then compared to the school year or according to disadvantaged. Results: Seventy-six studies (n = 14,230,846 participants) were included. Strong evidence was found of a decline in academic outcomes and increases in adiposity, sedentary behaviour and screen time. There was moderate evidence of declines in cardiovascular fitness and physical activity. These patterns were magnified for disadvantaged children. Limited data were available on muscular fitness, sleep, diet quality and social, emotional or mental wellbeing. A total of 80% of studies were from the United States. Most data were from children 12 years of age and younger. Conclusions: Over the summer break, children’s academic and health outcomes decline. Children experiencing disadvantage display magnified losses that warrant further investigation. The summer holidays present an opportunity to improve children’s health and wellbeing. Full article
(This article belongs to the Section Pediatric Mental Health)
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18 pages, 343 KiB  
Review
Antimicrobial Stewardship in Pediatric Emergency Medicine: A Narrative Exploration of Antibiotic Overprescribing, Stewardship Interventions, and Performance Metrics
by Kevin Meesters and Danilo Buonsenso
Children 2024, 11(3), 276; https://doi.org/10.3390/children11030276 - 23 Feb 2024
Cited by 7 | Viewed by 3398
Abstract
Antibiotic overprescribing is prevalent in pediatric emergency medicine, influenced by clinician–caregiver dynamics and diagnostic uncertainties, and poses substantial risks such as increasing antibacterial resistance, adverse drug reactions, and increased healthcare expenditures. While antimicrobial stewardship programs have proven effective in optimizing antibiotic use within [...] Read more.
Antibiotic overprescribing is prevalent in pediatric emergency medicine, influenced by clinician–caregiver dynamics and diagnostic uncertainties, and poses substantial risks such as increasing antibacterial resistance, adverse drug reactions, and increased healthcare expenditures. While antimicrobial stewardship programs have proven effective in optimizing antibiotic use within inpatient healthcare settings, their implementation in pediatric emergency medicine presents specific challenges. Existing biomarkers like white blood cell count, C-reactive protein, procalcitonin, and presepsin have limitations in their ability to distinguish (serious) bacterial infections from other etiologies of fever. Furthermore, rapid antigen detection tests and guidelines aimed at guiding antibiotic prescriptions for children have not consistently reduced unnecessary antibiotic use. To improve antibiotic prescribing practices, potential strategies include the utilization of decision support tools, audit and feedback, establishing follow-up procedures, implementing safety netting systems, and delivering comprehensive training and supervision. Notably, host genome signatures have also gained attention for their potential to facilitate rapid and precise diagnoses of inflammatory syndromes. Standardized metrics are crucial for evaluating antimicrobial use within pediatric healthcare settings, enabling the establishment of benchmarks for assessing antibiotic utilization, quality enhancement initiatives, and research endeavors. Full article
(This article belongs to the Special Issue Pediatric Emergency Medicine)
17 pages, 1521 KiB  
Review
Small Scale, High Precision: Robotic Surgery in Neonatal and Pediatric Patients—A Narrative Review
by Emil Radu Iacob, Roxana Iacob, Laura Andreea Ghenciu, Tudor-Alexandru Popoiu, Emil Robert Stoicescu and Calin Marius Popoiu
Children 2024, 11(3), 270; https://doi.org/10.3390/children11030270 - 21 Feb 2024
Cited by 7 | Viewed by 3186
Abstract
This narrative review explores the evolution and implications of robotic-assisted surgery in pediatric and neonatal cases, focusing on its advantages, drawbacks, and the specific diseases amenable to this innovative technology. Following PRISMA guidelines, 56 relevant articles from the past five years were selected, [...] Read more.
This narrative review explores the evolution and implications of robotic-assisted surgery in pediatric and neonatal cases, focusing on its advantages, drawbacks, and the specific diseases amenable to this innovative technology. Following PRISMA guidelines, 56 relevant articles from the past five years were selected, emphasizing advancements in precision, reduced trauma, and expedited recovery times for pediatric patients. Despite challenges like cost and training, ongoing research shapes pediatric robotic-assisted surgery, promising improved outcomes. The technology’s benefits include enhanced precision, minimized scarring, and faster recovery, addressing the challenges in delicate pediatric procedures. Challenges encompass cost, training, and instrument design, but ongoing refinements aim to overcome these. This review underscores psychological and musculoskeletal considerations for patients and surgeons. While acknowledging limitations and preferred pathologies, this review outlines the transformative potential of robotic-assisted surgery in reshaping pediatric surgical care. This comprehensive assessment concludes that, despite challenges, ongoing advancements promise a future of enhanced precision and tailored care in pediatric surgery. Full article
(This article belongs to the Special Issue Advances in Pediatric Surgery Volume II)
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12 pages, 454 KiB  
Article
Associations among Motor Competence, Physical Activity, Perceived Motor Competence, and Aerobic Fitness in 10–15-Year-Old Youth
by Dawn P. Coe, Emily M. Post, Eugene C. Fitzhugh, Jeffrey T. Fairbrother and E. Kipling Webster
Children 2024, 11(2), 260; https://doi.org/10.3390/children11020260 - 17 Feb 2024
Cited by 5 | Viewed by 2881
Abstract
(1) Background: The developmental model describes possible mechanisms that could impact the trajectory of children and adolescents’ health behaviors related to obesity; however, few data are available that support this model in the adolescent population. This study investigated the associations among motor competence [...] Read more.
(1) Background: The developmental model describes possible mechanisms that could impact the trajectory of children and adolescents’ health behaviors related to obesity; however, few data are available that support this model in the adolescent population. This study investigated the associations among motor competence (MC), moderate-to-vigorous physical activity (MVPA), perceived motor competence (PMC), and aerobic fitness in children and adolescents and the mediating and moderating effects of PMC, aerobic fitness, and weight status on the MC–MVPA relationship. (2) Methods: Participants included 47 adolescents (12.2 ± 1.6 y; 55% male) who completed the Bruininks–Oseretsky Test of Motor Proficiency, 2nd Edition (MC), Harter’s perceived self-competency questionnaire (PMC), and the PACER test (aerobic fitness) and whose MVPA was measured via accelerometry. The body mass index (BMI) was calculated from measured height and weight. (3) Results: There were positive correlations between MC and fitness [rs(47) = 0.469, p < 0.01], PMC and fitness [rs(47) = 0.682, p < 0.01], and PMC and MC [rs(47) = 0.416, p < 0.01]. There were no associations among MVPA and MC, PMC, or fitness (p > 0.05). There were inverse associations between BMI and both MVPA [rs(44) = −0.410, p < 0.01] and fitness [rs(47) = 0.295, p < 0.05]. The association between MC and MVPA was mediated by fitness (β = 0.3984; 95% CI (0.0564–0.7985)). (4) Conclusions: The associations among MC, PMC, and fitness highlight the critical role of MC in health and partially support the proposed developmental model concerning the relationships that exist among MC, MVPA, PMC, fitness, and BMI. Full article
(This article belongs to the Special Issue Motor Competence and Physical Activity in School Children)
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12 pages, 1517 KiB  
Article
Integrating Artificial Intelligence in Pediatric Healthcare: Parental Perceptions and Ethical Implications
by Elena Camelia Berghea, Marcela Daniela Ionescu, Radu Marian Gheorghiu, Iulia Florentina Tincu, Claudia Oana Cobilinschi, Mihai Craiu, Mihaela Bălgrădean and Florian Berghea
Children 2024, 11(2), 240; https://doi.org/10.3390/children11020240 - 14 Feb 2024
Cited by 11 | Viewed by 3883
Abstract
Background: Our study aimed to explore the way artificial intelligence (AI) utilization is perceived in pediatric medicine, examining its acceptance among patients (in this case represented by their adult parents), and identify the challenges it presents in order to understand the factors influencing [...] Read more.
Background: Our study aimed to explore the way artificial intelligence (AI) utilization is perceived in pediatric medicine, examining its acceptance among patients (in this case represented by their adult parents), and identify the challenges it presents in order to understand the factors influencing its adoption in clinical settings. Methods: A structured questionnaire was applied to caregivers (parents or grandparents) of children who presented in tertiary pediatric clinics. Results: The most significant differentiations were identified in relation to the level of education (e.g., aversion to AI involvement was 22.2% among those with postgraduate degrees, 43.9% among those with university degrees, and 54.5% among those who only completed high school). The greatest fear among respondents regarding the medical use of AI was related to the possibility of errors occurring (70.1%). Conclusions: The general attitude toward the use of AI can be considered positive, provided that it remains human-supervised, and that the technology used is explained in detail by the physician. However, there were large differences among groups (mainly defined by education level) in the way AI is perceived and accepted. Full article
(This article belongs to the Section Global Pediatric Health)
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11 pages, 753 KiB  
Review
Exploring Interleukin Levels in Type 1 Diabetes and Periodontitis: A Review with a Focus on Childhood
by Silvia D’Agostino, Giulia Valentini and Marco Dolci
Children 2024, 11(2), 238; https://doi.org/10.3390/children11020238 - 13 Feb 2024
Cited by 7 | Viewed by 2225
Abstract
Diabetes can trigger an increase in cytokine levels leading to the production of C-reactive protein and fibrinogen. These molecules promote subclinical inflammation, causing the expression of adhesive molecules and endothelial dysfunction. Despite the lack of a comprehensive panel for single-nucleotide polymorphisms (SNPs) for [...] Read more.
Diabetes can trigger an increase in cytokine levels leading to the production of C-reactive protein and fibrinogen. These molecules promote subclinical inflammation, causing the expression of adhesive molecules and endothelial dysfunction. Despite the lack of a comprehensive panel for single-nucleotide polymorphisms (SNPs) for interleukins associated with type 1 diabetes mellitus (T1DM), understanding the inflammatory role of SNPs is crucial because periodontitis, the sixth complication of diabetes, is influenced via these genetic variations. This review focuses on the interleukin levels in T1DM patients with and without periodontitis, with a particular focus on childhood and on SNPs when reported. A search of PubMed and Scopus identified 21 relevant studies from the past five years. Several ILs were analyzed, emphasizing that T1DM still needs to be thoroughly explored regarding an IL polymorphisms panel; however, the last five years have led to the increased independence of this condition, causing autonomous inflammatory effects, which require further investigation. The periodontitis and T1DM association in children and adolescents represents a severe gap in the literature that should be filled; this scarce presence of studies serves as motivation for further clinical research. Full article
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15 pages, 449 KiB  
Review
The Sleep Patterns of Children and Adolescents with Chronic Conditions and Their Families: An Integrative Literature Review
by Welker da Silva Xavier, Madalena Paulos Abreu, Michelle Darezzo Rodrigues Nunes, Fernanda Machado Silva-Rodrigues, Liliane Faria da Silva, Barbara Bertolossi Marta de Araújo, Paula Saud De Bortoli, Rhyquelle Rhibna Neris and Lucila Castanheira Nascimento
Children 2024, 11(2), 207; https://doi.org/10.3390/children11020207 - 6 Feb 2024
Cited by 5 | Viewed by 3552
Abstract
Sleep is of vital necessity for health, and it has a restorative and protective function for children and adolescents with chronic conditions and their families. The purpose of this study was to identify the scientific production on sleep patterns in children and adolescents [...] Read more.
Sleep is of vital necessity for health, and it has a restorative and protective function for children and adolescents with chronic conditions and their families. The purpose of this study was to identify the scientific production on sleep patterns in children and adolescents with chronic conditions and their families. This integrative review was conducted between March and June 2022 using the databases of MEDLINE, Web of Science, CINAHL and PsycINFO. The articles included were original papers published between January 2007 and mid-2022. Excluded were review studies that did not evaluate sleep and whose participants did not have chronic conditions or were not children, adolescents and/or their families. The searches returned 814 abstracts. After exclusions, 47 studies were selected to be read in full; of these, 29 were selected and were grouped empirically into four categories: major alterations in the sleep patterns of children and adolescents with chronic conditions; the relationship between sleep disorders and symptoms in children and adolescents with chronic conditions; the impaired sleep patterns of families of children and adolescents with chronic conditions; and sleep alterations and their relationship with other problems in families of children and adolescents with chronic conditions. All studies showed sleep pattern impairment in children and adolescents with chronic conditions as well as their families. Full article
(This article belongs to the Special Issue Supporting Children with Chronic Illness and Their Families)
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11 pages, 260 KiB  
Article
Discordance between Glucose Management Indicator and Glycated Hemoglobin in a Pediatric Cohort with Type 1 Diabetes: A Real-World Study
by Simone Foti Randazzese, Bruno Bombaci, Serena Costantino, Ylenia Giorgianni, Fortunato Lombardo and Giuseppina Salzano
Children 2024, 11(2), 210; https://doi.org/10.3390/children11020210 - 6 Feb 2024
Cited by 5 | Viewed by 2305
Abstract
The introduction of continuous glucose monitoring (CGM) systems in clinical practice has allowed a more detailed picture of the intra- and interdaily glycemic fluctuations of individuals with type 1 diabetes (T1D). However, CGM-measured glucose control indicators may be occasionally inaccurate. This study aims [...] Read more.
The introduction of continuous glucose monitoring (CGM) systems in clinical practice has allowed a more detailed picture of the intra- and interdaily glycemic fluctuations of individuals with type 1 diabetes (T1D). However, CGM-measured glucose control indicators may be occasionally inaccurate. This study aims to assess the discrepancy between the glucose management indicator (GMI) and glycated hemoglobin (HbA1c) (ΔGMI-HbA1c) within a cohort of children and adolescents with T1D, exploring its correlation with other CGM metrics and blood count parameters. In this single-center, cross-sectional study, we gathered demographic and clinical data, including blood count parameters, HbA1c values, and CGM metrics, from 128 pediatric subjects with T1D (43% female; mean age, 13.4 ± 3.6 years). Our findings revealed higher levels of the coefficient of variation (CV) (p < 0.001) and time above range > 250 mg/dL (p = 0.033) among subjects with ΔGMI-HbA1c > 0.3%. No association was observed between blood count parameters and ΔGMI-HbA1c. In conclusion, despite the advancements and the widespread adoption of CGM systems, HbA1c remains an essential parameter for the assessment of glycemic control, especially in individuals with suboptimal metabolic control and extreme glycemic variability. Full article
(This article belongs to the Special Issue Glycemic Control in Children and Adolescents with Type 1 Diabetes)
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12 pages, 442 KiB  
Article
Treating Children and Adolescents with Obesity: Predictors of Early Dropout in Pediatric Weight-Management Programs
by Giovanni Luppino, Malgorzata Wasniewska, Celeste Casto, Chiara Ferraloro, Alessandra Li Pomi, Giorgia Pepe, Letteria Anna Morabito, Angela Alibrandi, Domenico Corica and Tommaso Aversa
Children 2024, 11(2), 205; https://doi.org/10.3390/children11020205 - 5 Feb 2024
Cited by 5 | Viewed by 2152
Abstract
Background: Possible therapeutic failure of pediatric obesity is influenced by the high dropout rate. The aim of this study was to evaluate the rate of dropout and the rate of weight loss over the 24 months of follow-up. Methods: The retrospective, single-center study, [...] Read more.
Background: Possible therapeutic failure of pediatric obesity is influenced by the high dropout rate. The aim of this study was to evaluate the rate of dropout and the rate of weight loss over the 24 months of follow-up. Methods: The retrospective, single-center study, involved 489 patients followed for obesity in the period 2016–2020. Patients’ auxological data and blood samples were collected during the first (V1) and last visit (V2). Dropout was defined as a follow-up of less than 12 months and/or including less than one visit every 6 months. Patients were divided into two groups and compared: Group A of dropout (297 patients) and Group B of non-dropout (192 patients). Results: In the follow-up period, which had a mean duration of 24 months, the dropout rate was 60.7%. In Group A, the percentage of patients with BMI ≥ 3 SD at V2 was significantly higher than that in Group B. In Group B, the percentage of patients with pathological HOMA-IR and with fasting glucose >100 mg/dL was higher than group A. The probability of dropout was positively associated with pubertal stage and negatively with impaired fasting glycemia and pathological insulinemia at V1. Conclusion: The study demonstrated a high dropout rate during follow-up, mainly among adolescents and patients with no glucometabolic alterations. Full article
(This article belongs to the Special Issue Childhood and Adolescent Obesity and Weight Management: 3rd Edition)
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30 pages, 1478 KiB  
Review
Theoretical–Methodological Foundations for the Global Integration Method (Método de Integração Global—MIG) in the Treatment of Autism Spectrum Disorder
by Renato Guimarães Loffi, Thalita Karla Flores Cruz, Giulia Moreira Paiva, Deisiane Oliveira Souto, Simone Rosa Barreto, Patrícia Aparecida Neves Santana, Amanda Aparecida Alves Cunha Nascimento, Fabiana Rachel Martins Costa, Elisa Braz Cota and Vitor Geraldi Haase
Children 2024, 11(2), 191; https://doi.org/10.3390/children11020191 - 2 Feb 2024
Cited by 8 | Viewed by 4698
Abstract
Currently, there is no intervention model for autism spectrum disorder (ASD) that addresses all levels and factors of the International Classification of Functioning, Disability and Health (ICF, WHO). The most researched programs focus on naturalistic, developmental and behavioral approaches to socio-communication. Less attention [...] Read more.
Currently, there is no intervention model for autism spectrum disorder (ASD) that addresses all levels and factors of the International Classification of Functioning, Disability and Health (ICF, WHO). The most researched programs focus on naturalistic, developmental and behavioral approaches to socio-communication. Less attention has been paid to motor and environmental reactivity aspects (behavior/interest restriction and sensory reactivity). The evidence rationale for the Global Integration Method (MIG, “Método de Integração Global”), a model addressing sensorimotor reactivity in addition to socio-communication, is presented. MIG is an integrative, interdisciplinary, family-oriented intervention and naturalistic program that addresses all levels and moderating factors of ASD’s impact. MIG’s theoretical rationale is based on the predictive coding impairment and embodied cognition hypotheses. MIG incorporates both bottom-up (flexible therapeutic suit, social-motor synchronization) and top-down (schematic social information processing, narratives, imagery) strategies to promote the building and use of accurate, flexible and context-sensitive internal predictive models. MIG is based on the premises that predictive coding improves both socio-communication and environmental reactivity, and that the postural stabilization provided by the flexible therapeutic suit frees information processing resources for socio-cognitive learning. MIG builds on interdisciplinary, professionally and parentally mediated work based on behavioral principles of intensive training in a situated environment. Full article
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11 pages, 223 KiB  
Article
Examining the Prevalence of Congenital Anomalies in Newborns: A Cross-Sectional Study at a Tertiary Care Maternity Hospital in Saudi Arabia
by Bayapa Reddy Narapureddy, Yousef Zahrani, Hind Eissa Musa Alqahtani, Bharat Kumar Mamilla Mugaiahgari, Lingala Kalyan Viswanath Reddy, Shaik Mohammed Asif, Mohammad Ali Abdullah Almoyad, Ali Mohieldin and Adam Dawria
Children 2024, 11(2), 188; https://doi.org/10.3390/children11020188 - 2 Feb 2024
Cited by 6 | Viewed by 4274
Abstract
Background: Congenital anomalies, representing structural or functional abnormalities present at birth, pose a substantial global health challenge, affecting 8 million newborns annually. With 3.3 million succumbing before age five and 3.2 million facing physical or mental disability, their diverse causes necessitate comprehensive understanding [...] Read more.
Background: Congenital anomalies, representing structural or functional abnormalities present at birth, pose a substantial global health challenge, affecting 8 million newborns annually. With 3.3 million succumbing before age five and 3.2 million facing physical or mental disability, their diverse causes necessitate comprehensive understanding for effective healthcare planning. This study explores the prevalence of congenital anomalies among newborns in the Abha Maternity and Children Hospital (MCH) in Abha, Kingdom of Saudi Arabia. Methodology: A descriptive cross-sectional record-based study was conducted on newborns born between 2018 and 2022. Data were gathered in 4 months from September to December 2023. Purposive sampling was employed to select the case records of newborns with congenital anomalies after careful screening and considering inclusion and exclusion criteria. Data was acquired through a self-designed study tool, and the data were entered into Google Forms. Results: Congenital anomalies’ five-year prevalence was 3.21%, and one year, in 2022, the prevalence was 4.02%. Female neonates exhibited higher anomalies (59.3%), and preterm births accounted for 39.6%, emphasizing their vulnerability. The findings indicate that consanguineous marriages are linked to 63.3% of anomalies, notably neural tube defects (25%) and congenital heart diseases (19.7%). Anomalies are not significantly associated with consanguinity or birth order, but maternal age, education, employment, and antenatal maternal medical issues are associated considerably. Conclusions: These study insights contribute to health planners planning targeted interventions and awareness programs that are crucial to mitigate risks associated with preterm births and consanguineous marriages. The promotion of 100% antenatal screening and prophylactic medication for high-risk women and couples is necessary to prevent inherited deformities. In future the Ministry of Health must plan large-group prospective research to better understand the associated risk factors that will help public health initiatives minimize congenital-associated neonatal mortality and improve pregnancy outcomes. Full article
12 pages, 318 KiB  
Article
Role of Satisfaction with Life, Sex and Body Mass Index in Physical Literacy of Spanish Children
by Javier Urbano-Mairena, María Mendoza-Muñoz, Jorge Carlos-Vivas, Raquel Pastor-Cisneros, Antonio Castillo-Paredes, Miguel Rodal and Laura Muñoz-Bermejo
Children 2024, 11(2), 181; https://doi.org/10.3390/children11020181 - 1 Feb 2024
Cited by 7 | Viewed by 2415
Abstract
Physical activity (PL) is essential to achieve good health, prevent cardiovascular diseases, obesity and overweight, as well as to achieve a better quality of life. Therefore, PL could become the tool to increase the practice of physical activity among young people, thus increasing [...] Read more.
Physical activity (PL) is essential to achieve good health, prevent cardiovascular diseases, obesity and overweight, as well as to achieve a better quality of life. Therefore, PL could become the tool to increase the practice of physical activity among young people, thus increasing life satisfaction (LS) given its positive relationship with physical activity. A single-measure cross-sectional correlational study was carried out, involving 135 children aged 8–12 years from Extremadura. They were administered the SWLS questionnaire and the Canadian assessment of physical literacy (CAPL-2). Significantly higher levels of PL (p = 0.010) were found in normal-weight children compared to overweight and obese children, due to the physical competence domain score (p < 0.001). PL was directly related to SWLS (p < 0.001), but inversely related to BMI (p = 0.018). The daily physical activity behaviour domain was explained by SWLS (p < 0.001) and sex (p < 0.001). Physical competence was described by SWLS (p < 0.001) and BMI (p = 0.045). Finally, the motivation and confidence domain were only significantly associated with SWLS (p < 0.001). It was concluded that boys and girls of normal weight achieved higher levels of PL and LS than those with overweight and obesity, establishing a negative relationship of PL with BMI and positive with LS. Full article
(This article belongs to the Special Issue Developing Physical Literacy in Children)
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10 pages, 415 KiB  
Article
Early Assessment of Efficacy and Safety of Biologics in Pediatric Allergic Diseases: Preliminary Results from a Prospective Real-World Study
by Lucia Caminiti, Francesca Galletta, Simone Foti Randazzese, Paolo Barraco, Stefano Passanisi, Antonella Gambadauro, Giuseppe Crisafulli, Mariella Valenzise and Sara Manti
Children 2024, 11(2), 170; https://doi.org/10.3390/children11020170 - 28 Jan 2024
Cited by 8 | Viewed by 2599
Abstract
Background: Despite the increasing interest in biologics for the management of allergic diseases, sparse real-world data are still available in the pediatric population. This study aimed to evaluate the early real-life efficacy and safety of omalizumab for patients with moderate-to-severe asthma and chronic [...] Read more.
Background: Despite the increasing interest in biologics for the management of allergic diseases, sparse real-world data are still available in the pediatric population. This study aimed to evaluate the early real-life efficacy and safety of omalizumab for patients with moderate-to-severe asthma and chronic spontaneous urticaria (CSU), and Dupilumab for patients with moderate-to-severe atopic dermatitis (AD). Methods: A prospective study enrolling children aged 6–18 years was designed to assess the efficacy and safety of biologic drugs at 16 weeks of treatment (T1). The effectiveness was measured using validated questionnaires (ACQ-5 for asthma, UAS7 for CSU, and EASI score for AD). Secondary outcome measures included reductions in inhaled corticosteroid (ICS) dosages, asthma-related hospitalizations/exacerbations, and quality of life (QoL) indicators (iNRS, sNRS, DLQI/cDLQI) for CSU and AD. Safety was expressed according to the descriptions of adverse events provided by EMA and FDA. Results: The study cohort consisted of eighteen children (mean age 12.9 ± 3.4 years). The omalizumab treatment significantly reduced ACQ-5 and UAS7 scores (p = 0.002 and p < 0.001, respectively). In patients with asthma, decreased ICS dosage and hospitalization/exacerbation rates were observed. QoL parameters significantly improved in CSU and AD patients. No severe adverse events were reported for either treatment. Conclusions: Our findings validate omalizumab and dupilumab as effective and safe therapeutic options for managing moderate-to-severe allergic diseases in children and adolescents. Full article
(This article belongs to the Section Pediatric Allergy and Immunology)
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12 pages, 1189 KiB  
Article
COVID-19 Pediatric Follow-Up: Respiratory Long COVID-Associated Comorbidities and Lung Ultrasound Alterations in a Cohort of Italian Children
by Cristiana Indolfi, Angela Klain, Giulio Dinardo, Elisabetta D’Addio, Serena Ferrara, Fabio Decimo, Giorgio Ciprandi, Maria Angela Tosca and Michele Miraglia del Giudice
Children 2024, 11(2), 166; https://doi.org/10.3390/children11020166 - 27 Jan 2024
Cited by 8 | Viewed by 2235
Abstract
In children, the factors that influence COVID-19 disease and its medium- and long-term effects are little known. Our investigation sought to evaluate the presence of comorbidity factors associated with respiratory long COVID manifestations in children and to study ultrasound abnormalities following SARS-CoV-2 infection. [...] Read more.
In children, the factors that influence COVID-19 disease and its medium- and long-term effects are little known. Our investigation sought to evaluate the presence of comorbidity factors associated with respiratory long COVID manifestations in children and to study ultrasound abnormalities following SARS-CoV-2 infection. Children, who arrived at the ‘Respiratory Diseases of Pediatric Interest Unit’ at the Department of Woman, Child, and General and Specialized Surgery of the University of Campania ‘Luigi Vanvitelli’, were selected during the timeframe from September 2021 to October 2022. The children were diagnosed with a SARS-CoV-2 infection that occurred at least one month before the visit. All patients followed a COVID-19 follow-up protocol, developed by the Italian Society of Pediatric Respiratory Diseases (SIMRI), which included: collection of data regarding SARS-CoV-2 illness and history of known respiratory and allergic diseases; physical examination; BMI assessment; baseline spirometry and after bronchodilation test; six-minute walking test; and lung ultrasound (LUS). In a cohort of 104 participants with respiratory long COVID symptoms (64.7% male, average age 8.92 years), 46.1% had fever with other symptoms, and 1% required hospitalization. BMI analysis showed 58.4% of the cohort was overweight. The LUS was positive in 27.0% of cases. A significant BMI association was observed with COVID-19 symptoms and LUS score (p-value < 0.05). No associations were found with asthma or atopy. Full article
(This article belongs to the Section Pediatric Allergy and Immunology)
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14 pages, 2525 KiB  
Article
A Survey of the Union of European Neonatal and Perinatal Societies on Neonatal Respiratory Care in Neonatal Intensive Care Units
by Corrado Moretti, Camilla Gizzi, Luigi Gagliardi, Flavia Petrillo, Maria Luisa Ventura, Daniele Trevisanuto, Gianluca Lista, Raffaele L. Dellacà, Artur Beke, Giuseppe Buonocore, Antonia Charitou, Manuela Cucerea, Boris Filipović-Grčić, Nelly Georgieva Jeckova, Esin Koç, Joana Saldanha, Manuel Sanchez-Luna, Dalia Stoniene, Heili Varendi, Giulia Vertecchi and Fabio Moscaadd Show full author list remove Hide full author list
Children 2024, 11(2), 158; https://doi.org/10.3390/children11020158 - 26 Jan 2024
Cited by 7 | Viewed by 3343
Abstract
(1) Background: Our survey aimed to gather information on respiratory care in Neonatal Intensive Care Units (NICUs) in the European and Mediterranean region. (2) Methods: Cross-sectional electronic survey. An 89-item questionnaire focusing on the current modes, devices, and strategies employed in neonatal units [...] Read more.
(1) Background: Our survey aimed to gather information on respiratory care in Neonatal Intensive Care Units (NICUs) in the European and Mediterranean region. (2) Methods: Cross-sectional electronic survey. An 89-item questionnaire focusing on the current modes, devices, and strategies employed in neonatal units in the domain of respiratory care was sent to directors/heads of 528 NICUs. The adherence to the “European consensus guidelines on the management of respiratory distress syndrome” was assessed for comparison. (3) Results: The response rate was 75% (397/528 units). In most Delivery Rooms (DRs), full resuscitation is given from 22 to 23 weeks gestational age. A T-piece device with facial masks or short binasal prongs are commonly used for respiratory stabilization. Initial FiO2 is set as per guidelines. Most units use heated humidified gases to prevent heat loss. SpO2 and ECG monitoring are largely performed. Surfactant in the DR is preferentially given through Intubation-Surfactant-Extubation (INSURE) or Less-Invasive-Surfactant-Administration (LISA) techniques. DR caffeine is widespread. In the NICUs, most of the non-invasive modes used are nasal CPAP and nasal intermittent positive-pressure ventilation. Volume-targeted, synchronized intermittent positive-pressure ventilation is the preferred invasive mode to treat acute respiratory distress. Pulmonary recruitment maneuvers are common approaches. During NICU stay, surfactant administration is primarily guided by FiO2 and SpO2/FiO2 ratio, and it is mostly performed through LISA or INSURE. Steroids are used to facilitate extubation and prevent bronchopulmonary dysplasia. (4) Conclusions: Overall, clinical practices are in line with the 2022 European Guidelines, but there are some divergences. These data will allow stakeholders to make comparisons and to identify opportunities for improvement. Full article
(This article belongs to the Special Issue Neonatal Airway Management)
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14 pages, 496 KiB  
Review
Ensuring Optimal Outcomes for Preterm Infants after NICU Discharge: A Life Course Health Development Approach to High-Risk Infant Follow-Up
by Jonathan S. Litt, Neal Halfon, Michael E. Msall, Shirley Ann Russ and Susan R. Hintz
Children 2024, 11(2), 146; https://doi.org/10.3390/children11020146 - 24 Jan 2024
Cited by 10 | Viewed by 4943
Abstract
Children born prematurely (<37 weeks’ gestation) have an increased risk for chronic health problems and developmental challenges compared to their term-born peers. The threats to health and development posed by prematurity, the unintended effects of life-sustaining neonatal intensive care, the associated neonatal morbidities, [...] Read more.
Children born prematurely (<37 weeks’ gestation) have an increased risk for chronic health problems and developmental challenges compared to their term-born peers. The threats to health and development posed by prematurity, the unintended effects of life-sustaining neonatal intensive care, the associated neonatal morbidities, and the profound stressors to families affect well-being during infancy, childhood, adolescence, and beyond. Specialized clinical programs provide medical and developmental follow-up care for preterm infants after hospital discharge. High-risk infant follow-up, like most post-discharge health services, has many shortcomings, including unclear goals, inadequate support for infants, parents, and families, fragmented service provisions, poor coordination among providers, and an artificially foreshortened time horizon. There are well-documented inequities in care access and delivery. We propose applying a life course health development framework to clinical follow-up for children born prematurely that is contextually appropriate, developmentally responsive, and equitably deployed. The concepts of health development, unfolding, complexity, timing, plasticity, thriving, and harmony can be mapped to key components of follow-up care delivery to address pressing health challenges. This new approach envisions a more effective version of clinical follow-up to support the best possible functional outcomes and the opportunity for every premature infant to thrive within their family and community environments over their life course. Full article
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17 pages, 885 KiB  
Review
Non-Cariogenic Effect of Milk and Dairy Products on Oral Health in Children and Adolescents: A Scoping Review
by Flavia Vitiello, Denis Bourgeois, Giulia Orilisi, Giovanna Orsini and Florence Carrouel
Children 2024, 11(2), 149; https://doi.org/10.3390/children11020149 - 24 Jan 2024
Cited by 9 | Viewed by 3698
Abstract
Diet plays an important role in the etiopathology of dental caries. Milk and dairy products (DPs), especially in children and adolescents, are important sources of protein, calcium and phosphorus and could have an effect on dental and oral health. The aim of this [...] Read more.
Diet plays an important role in the etiopathology of dental caries. Milk and dairy products (DPs), especially in children and adolescents, are important sources of protein, calcium and phosphorus and could have an effect on dental and oral health. The aim of this scoping review was to analyze the scientific literature on the non-cariogenic effect of milk and DPs, with a focus on their potential to prevent dental caries in children and adolescents. PubMed, EMBASE, and Web of Science were searched for publications relevant to our topic from January 2013 to 30 September 2023. Thirty-eight studies were included in the qualitative analysis. The included studies highlight the properties of milk and DPs that contribute to enamel remineralization, exhibit antibacterial action, inhibit the growth of cariogenic bacteria, and promote a balanced oral microbiome. With regard to the addition of probiotics (PBs) and fluoride (F) to DPs, the mixed results of the studies analyzed did not allow a clear statement to be made about their non-cariogenic effects. However, several studies show that the addition of PBs can reduce cariogenic bacteria, create a protective barrier against pathogens and support the host’s natural defense mechanisms. Further long-term and high-quality studies are needed to understand the impact of milk and its constituents on oral health in order to promote effective caries prevention strategies in children and adolescents. Full article
(This article belongs to the Special Issue Advance Research in Pediatric Dental Disease: 2nd Edition)
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16 pages, 2664 KiB  
Article
High-Fat, High-Calorie Breast Milk in Women with Overweight or Obesity and Its Association with Maternal Serum Insulin Concentration and Triglycerides Levels
by Michael G. Ross, Manasa P. Kavasery, MacKenzie K. Cervantes, Guang Han, Bernardo Horta, Kelly P. Coca, Suleyma O. Costa and Mina Desai
Children 2024, 11(2), 141; https://doi.org/10.3390/children11020141 - 23 Jan 2024
Cited by 8 | Viewed by 3321
Abstract
The childhood obesity epidemic continues to be a challenge. Maternal obesity and excessive infant weight gain are strong predictors of childhood obesity, which itself is a major risk factor for adult obesity. The primary source of nutrition during early life is breast milk, [...] Read more.
The childhood obesity epidemic continues to be a challenge. Maternal obesity and excessive infant weight gain are strong predictors of childhood obesity, which itself is a major risk factor for adult obesity. The primary source of nutrition during early life is breast milk, and its composition is impacted by maternal habitus and diet. We thus studied the relationship between maternal BMI, serum lipids and insulin, and breast milk fat and calorie content from foremilk to hindmilk. Women who were exclusively breastfeeding at 7–8 weeks postpartum were BMI classified as Normal (18.5–24.9, n = 9) and women with Overweight/Obese (OW/OB ≥ 25, n = 13). Maternal blood and continuous breast milk samples obtained from foremilk to hindmilk were analyzed, and infant milk intake was assessed. Women with OW/OB had significantly higher milk fat and calorie content in the first foremilk and last hindmilk sample as compared to Normal BMI women. Amongst all women, maternal serum triglycerides, insulin, and HOMA were significantly correlated with foremilk triglyceride concentration, suggesting that maternal serum triglyceride and insulin action contribute to human milk fat content. As the milk fat content of OW/OB women has caloric implications for infant growth and childhood obesity, these results suggest the potential for modulating milk fat content by a reduction in maternal serum lipids or insulin. Full article
(This article belongs to the Special Issue Promoting Breastfeeding and Human Milk in Infants)
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17 pages, 299 KiB  
Review
Harnessing the Power of Artificial Intelligence in Cleft Lip and Palate: An In-Depth Analysis from Diagnosis to Treatment, a Comprehensive Review
by Khalid A. Almoammar
Children 2024, 11(2), 140; https://doi.org/10.3390/children11020140 - 23 Jan 2024
Cited by 8 | Viewed by 3974
Abstract
Cleft lip and palate (CLP) is the most common craniofacial malformation, with a range of physical, psychological, and aesthetic consequences. In this comprehensive review, our main objective is to thoroughly examine the relationship between CLP anomalies and the use of artificial intelligence (AI) [...] Read more.
Cleft lip and palate (CLP) is the most common craniofacial malformation, with a range of physical, psychological, and aesthetic consequences. In this comprehensive review, our main objective is to thoroughly examine the relationship between CLP anomalies and the use of artificial intelligence (AI) in children. Additionally, we aim to explore how the integration of AI technology can bring about significant advancements in the fields of diagnosis, treatment methods, and predictive outcomes. By analyzing the existing evidence, we will highlight state-of-the-art algorithms and predictive AI models that play a crucial role in achieving precise diagnosis, susceptibility assessment, and treatment planning for children with CLP anomalies. Our focus will specifically be on the efficacy of alveolar bone graft and orthodontic interventions. The findings of this review showed that deep learning (DL) models revolutionize the diagnostic process, predict susceptibility to CLP, and enhance alveolar bone grafts and orthodontic treatment. DL models surpass human capabilities in terms of precision, and AI algorithms applied to large datasets can uncover the intricate genetic and environmental factors contributing to CLP. Additionally, Machine learning aids in preoperative planning for alveolar bone grafts and provides personalized treatment plans in orthodontic treatment. In conclusion, these advancements inspire optimism for a future where AI seamlessly integrates with CLP management, augmenting its analytical capabilities. Full article
(This article belongs to the Section Pediatric Dentistry & Oral Medicine)
18 pages, 358 KiB  
Article
Family Functioning, Maternal Depression, and Adolescent Cognitive Flexibility and Its Associations with Adolescent Depression: A Cross-Sectional Study
by Justyna Urbańska-Grosz, Emilia J. Sitek, Anna Pakalska, Bożena Pietraszczyk-Kędziora, Kalina Skwarska and Maciej Walkiewicz
Children 2024, 11(1), 131; https://doi.org/10.3390/children11010131 - 22 Jan 2024
Cited by 9 | Viewed by 5651
Abstract
Background: This study explores family functioning and its associations with adolescent major depressive disorder (MDD), comparing its dynamics with healthy counterparts. Family functioning (cohesion, flexibility, communication, and satisfaction), maternal depressive symptoms, postpartum depression history, parental divorce, parental alcohol abuse, and the adolescents’ cognitive [...] Read more.
Background: This study explores family functioning and its associations with adolescent major depressive disorder (MDD), comparing its dynamics with healthy counterparts. Family functioning (cohesion, flexibility, communication, and satisfaction), maternal depressive symptoms, postpartum depression history, parental divorce, parental alcohol abuse, and the adolescents’ cognitive flexibility, are examined. The research incorporates the perspectives of both adolescents and mothers. Methods: The sample includes 63 mother-teenager dyads in the clinical group and 43 in the control group. Instruments encompass the Family Adaptability and Cohesion Evaluation Scales (FACES IV), Children’s Depression Inventory (CDI-2), Beck Depression Inventory (BDI-II), The Brixton Spatial Anticipation Test, and structured interviews. Results: Families of adolescents with MDD exhibit lower flexibility, cohesion, communication, and overall satisfaction. Depressed adolescents display reduced cognitive flexibility. Discrepancies were observed between adolescents’ and mothers’ perspectives as associated with adolescents’ MDD. Teenagers emphasized the severity of maternal depressive symptoms, while mothers highlighted the importance of family cohesion and flexibility. Conclusions: This study emphasizes a holistic strategy in addressing adolescent depression, including family-based assessment and therapy. Screening for maternal depressive symptoms is identified as valuable. Cognitive flexibility also needs to be addressed during therapy for depression in adolescence. Full article
(This article belongs to the Special Issue Child and Adolescent Psychiatry and Mental Health Progress)
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15 pages, 590 KiB  
Article
Experiences and Challenges of Health Professionals in Implementing Family-Centred Planning: A Qualitative Study
by Lorena Cuenca-Sánchez, David Sánchez-Teruel and Maria Auxiliadora Robles-Bello
Children 2024, 11(1), 132; https://doi.org/10.3390/children11010132 - 22 Jan 2024
Cited by 5 | Viewed by 2696
Abstract
Early childhood intervention is crucial for the development of minors with disabilities or at risk. Family-centred planning (FCP), which involves families in care, stands out in this context. Despite its importance, little is known about professionals’ experiences of its implementation. FCP aims to [...] Read more.
Early childhood intervention is crucial for the development of minors with disabilities or at risk. Family-centred planning (FCP), which involves families in care, stands out in this context. Despite its importance, little is known about professionals’ experiences of its implementation. FCP aims to tailor services to the needs of the family and the child within the Spanish health system. This study highlights the importance of assessing professionals’ perceptions of FCP. Professionals rooted in traditional approaches may resist change. To assess the implementation of FCPs, the study explores the perspectives of 25 healthcare professionals using qualitative methods to assess their experiences. The qualitative descriptive phenomenological design, following Giorgi’s modified Husserlian approach, seeks to understand the essence of the phenomenon from the participants’ perspective. Two main themes emerged: (1) a social and work organization that perpetuates rehabilitation or early stimulation practices and (2) a socio-family and work organization that promotes FCP adherence, along with subthemes and units of meaning. The evaluation reveals common challenges, such as the need for solid training and institutional support. Evaluating the experience of professionals is essential to overcome barriers and ensure the successful implementation of FCPs. Administrators have an important role to play in providing social, health, and educational alternatives. Full article
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15 pages, 666 KiB  
Review
Plant Sterols and Stanols for Pediatric Patients with Increased Cardiovascular Risk
by Cristina Pederiva, Giacomo Biasucci, Giuseppe Banderali and Maria Elena Capra
Children 2024, 11(1), 129; https://doi.org/10.3390/children11010129 - 20 Jan 2024
Cited by 6 | Viewed by 3531
Abstract
The atherosclerotic process begins in childhood and progresses throughout adult age. Hypercholesterolemia, especially familial hypercholesterolemia (FH) and metabolic dysfunctions linked to weight excess and obesity, are the main atherosclerosis risk factors in pediatric patients and can be detected and treated starting from childhood. [...] Read more.
The atherosclerotic process begins in childhood and progresses throughout adult age. Hypercholesterolemia, especially familial hypercholesterolemia (FH) and metabolic dysfunctions linked to weight excess and obesity, are the main atherosclerosis risk factors in pediatric patients and can be detected and treated starting from childhood. Nutritional intervention and a healthy-heart lifestyle are cornerstones and first-line treatments, with which, if necessary, drug therapy should be associated. For several years, functional foods enriched with plant sterols and stanols have been studied in the treatment of hypercholesterolemia, mainly as nutritional complements that can reduce LDL cholesterol; however, there is a lack of randomized controlled trials defining their long-term efficacy and safety, especially in pediatric age. This review aims to evaluate what the main published studies on sterols and stanols in pediatric subjects with dyslipidemia have taught us, providing an updated picture of the possible use of these dietary supplements in children and adolescents with dyslipidemia and increased cardiovascular risk. Nowadays, we can state that plant sterols and stanols should be considered as a valuable therapy in pediatric patients with hypercholesterolemia, bearing in mind that nutritional and lifestyle counseling and, when necessary, pharmacologic therapy, are the cornerstones of the treatment in developmental age. Full article
(This article belongs to the Section Global Pediatric Health)
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15 pages, 1998 KiB  
Review
Fostering Motivation: Exploring the Impact of ICTs on the Learning of Students with Autism
by José María Fernández-Batanero, Marta Montenegro-Rueda, José Fernández-Cerero and Eloy López-Meneses
Children 2024, 11(1), 119; https://doi.org/10.3390/children11010119 - 18 Jan 2024
Cited by 4 | Viewed by 4333
Abstract
Currently, the use of digital tools has led to significant changes in the educational system, favouring equity and the inclusion of students with educational needs. In this context, students with autism spectrum disorder (ASD) benefit from using these electronic devices to improve their [...] Read more.
Currently, the use of digital tools has led to significant changes in the educational system, favouring equity and the inclusion of students with educational needs. In this context, students with autism spectrum disorder (ASD) benefit from using these electronic devices to improve their learning experience. This study focuses on conducting a bibliometric analysis of the impact of information and communication technologies on the learning of students with ASD, with the aim of addressing two research questions. Through the analysis of three databases (Scopus, Dialnet, and Web of Science), a total of 24 articles related to the subject were collected. The results show that the use of different technological devices has numerous benefits for these students. Among the most prominent are the use of augmented reality and educational robotics, mainly providing improvements in academic performance, motivation and improved retention of knowledge acquired in the classroom. In conclusion, the clear need to train teachers in digital competencies and to intensify efforts in this line of research in order to improve the education of students, as well as to enrich the knowledge available to the scientific community, is highlighted. Full article
(This article belongs to the Special Issue Research on the Academic Motivation of Children and Adolescents)
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17 pages, 6549 KiB  
Review
Imaging of Acute Complications of Community-Acquired Pneumonia in the Paediatric Population—From Chest Radiography to MRI
by Efthymia Alexopoulou, Spyridon Prountzos, Maria Raissaki, Argyro Mazioti, Pablo Caro-Dominguez, Franz Wolfgang Hirsch, Jovan Lovrenski and Pierluigi Ciet
Children 2024, 11(1), 122; https://doi.org/10.3390/children11010122 - 18 Jan 2024
Cited by 7 | Viewed by 7296
Abstract
The most common acute infection and leading cause of death in children worldwide is pneumonia. Clinical and laboratory tests essentially diagnose community-acquired pneumonia (CAP). CAP can be caused by bacteria, viruses, or atypical microorganisms. Imaging is usually reserved for children who do not [...] Read more.
The most common acute infection and leading cause of death in children worldwide is pneumonia. Clinical and laboratory tests essentially diagnose community-acquired pneumonia (CAP). CAP can be caused by bacteria, viruses, or atypical microorganisms. Imaging is usually reserved for children who do not respond to treatment, need hospitalisation, or have hospital-acquired pneumonia. This review discusses the imaging findings for acute CAP complications and the diagnostic role of each imaging modality. Pleural effusion, empyema, necrotizing pneumonia, abscess, pneumatocele, pleural fistulas, and paediatric acute respiratory distress syndrome (PARDS) are acute CAP complications. When evaluating complicated CAP patients, chest radiography, lung ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) can be used, with each having their own pros and cons. Imaging is usually not needed for CAP diagnosis, but it is essential for complicated cases and follow-ups. Lung ultrasound can supplement chest radiography (CR), which starts the diagnostic algorithm. Contrast-enhanced computed tomography (CECT) is used for complex cases. Advances in MRI protocols make it a viable alternative for diagnosing CAP and its complications. Full article
(This article belongs to the Special Issue Pediatric Respiratory Diseases: Diagnosis, Treatment, and Prevention)
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21 pages, 1538 KiB  
Article
Trait Anxiety, Emotion Regulation, and Metacognitive Beliefs: An Observational Study Incorporating Separate Network and Correlation Analyses to Examine Associations with Executive Functions and Academic Achievement
by François-Xavier Cécillon, Martial Mermillod, Christophe Leys, Jean-Philippe Lachaux, Sarah Le Vigouroux and Rebecca Shankland
Children 2024, 11(1), 123; https://doi.org/10.3390/children11010123 - 18 Jan 2024
Cited by 6 | Viewed by 4228
Abstract
Trait anxiety, emotion regulation strategies, and metacognitive beliefs influence executive functions (EFs) and academic achievement. This study examines their interplay and impact on academic success. In total, 275 adolescents (10–17 years) and parents completed an online questionnaire assessing trait anxiety, emotion regulation strategies, [...] Read more.
Trait anxiety, emotion regulation strategies, and metacognitive beliefs influence executive functions (EFs) and academic achievement. This study examines their interplay and impact on academic success. In total, 275 adolescents (10–17 years) and parents completed an online questionnaire assessing trait anxiety, emotion regulation strategies, metacognition, parent-reported behaviors related to executive functioning, and overall school average. Preliminary analyses confirmed consistency with the existing literature for each variable and their interaction. Furthermore, we conducted a network analysis among the main variables. This analysis supports the need to pay more attention to reflective variables—maladaptive emotion regulation strategies and metacognitive beliefs about worry—when studying trait anxiety. These variables were linked to problematic executive functioning in adolescents, and the latter was negatively linked to academic achievement. This study offers innovative insights by investigating relationships less explored in the scientific literature. It reveals high and significant correlations between metacognitive beliefs, maladaptive emotion regulation strategies, and trait anxiety (r > 0.500, p < 0.001) but also between these variables and both executive functioning and academic achievement. These findings offer new perspectives for research and underscore the importance of holistically examining the psychological factors related to academic success. Full article
(This article belongs to the Section Pediatric Mental Health)
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13 pages, 609 KiB  
Article
Outcomes of a Parent-Delivered Baby-mCIMT Model for Infants at High Risk of Unilateral Cerebral Palsy Using Remote Coaching in Telerehabilitation
by Katarina Svensson, Heléne Sundelin and Ann-Christin Eliasson
Children 2024, 11(1), 101; https://doi.org/10.3390/children11010101 - 15 Jan 2024
Cited by 4 | Viewed by 2176
Abstract
There is growing evidence of the positive effects of constraint-induced movement therapy (CIMT) for infants at high risk of unilateral cerebral palsy (UCP) when provided by parents with in-person coaching/supervision from occupational therapists during home visits. The aim of this study is to [...] Read more.
There is growing evidence of the positive effects of constraint-induced movement therapy (CIMT) for infants at high risk of unilateral cerebral palsy (UCP) when provided by parents with in-person coaching/supervision from occupational therapists during home visits. The aim of this study is to investigate whether Baby-mCIMT (modifiedCIMT) can be as effective if parents are coached/supervised remotely. In this case-control study, we recruited 20 infants and re-used 18 controls, 4–8-month-old infants in both groups at high risk of UCP. The same protocol regarding inclusion criteria, data collection, and training volume was used in both groups. The training was conducted for two 6-week periods, separated by a 6-week break, consisting of daily 30 min sessions conducted by parents, supported by therapist coaching once a week. The primary outcome was measured using the Hand Assessment for Infants (HAI). There was no difference in the change of HAI units (p = 0.803) or that of the affected-hand raw score (p = 0.942) between the two groups. The remote coaching method was well received by parents. In conclusion, this demonstrates that remote coaching/supervision is as effective as the in-person approach, requiring less time and effort for both families and healthcare providers. Full article
(This article belongs to the Special Issue Research in Rehabilitation for Children with Motor Disability)
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14 pages, 255 KiB  
Article
The Role of Systemic Family Psychotherapy in Glycemic Control for Children with Type 1 Diabetes
by Andreea Salcudean and Maria Melania Lica
Children 2024, 11(1), 104; https://doi.org/10.3390/children11010104 - 15 Jan 2024
Cited by 12 | Viewed by 2090
Abstract
(1) Background: Family factors play an important role in the management of diabetes, establishing a relationship between conflicts and non-adherence to therapy. High values of HbA1c are involved in specific complications of the disease (retinopathy, nephropathy, neuropathy, ketoacidosis). This study aimed to determine [...] Read more.
(1) Background: Family factors play an important role in the management of diabetes, establishing a relationship between conflicts and non-adherence to therapy. High values of HbA1c are involved in specific complications of the disease (retinopathy, nephropathy, neuropathy, ketoacidosis). This study aimed to determine the role of systemic family psychotherapeutic interventions in increasing the quality of parent–child/adolescent relationships and in optimizing the child’s glycemic control. (2) Methods: In this prospective observational study, 64 parents of children and adolescents with type 1 diabetes were evaluated regarding their relationship with their children, using the Child–Parent Relationship Scale-Short Form (CPRS-short form). The children were divided into three groups: one participated for 6 months in systemic family psychotherapy with children and their parents (FT), the second group participated in individual psychotherapy (IT), and the control group (CG) received no intervention. HbA1c values were recorded before and after the interventions. (3) Results: HbA1c means decreased significantly after the family psychotherapy program. The scores on closeness in the family therapy group increased significantly, and the scores on conflict decreased significantly after the intervention, compared with IT and CG. (4) Conclusions: Systemic family psychotherapy produces better results in disease management and in strengthening parent–child relationships. Full article
(This article belongs to the Special Issue Advances in Gastrointestinal Diseases in Children and Adolescents)
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11 pages, 502 KiB  
Article
How Do Children “Think outside the Box”? Fluid Intelligence and Divergent Thinking: A Moderated Mediation Study of Field Dependent-Independent Cognitive Style and Gender
by Marco Giancola, Massimiliano Palmiero, Maria Chiara Pino, Marta Sannino and Simonetta D’Amico
Children 2024, 11(1), 89; https://doi.org/10.3390/children11010089 - 11 Jan 2024
Cited by 4 | Viewed by 2536
Abstract
The interplay between fluid intelligence (Gf) and divergent thinking (DT) has widely characterized current research in the psychology of creativity. Nevertheless, the evidence on the main factors involved in this association during childhood remains a matter of debate. Present research has addressed the [...] Read more.
The interplay between fluid intelligence (Gf) and divergent thinking (DT) has widely characterized current research in the psychology of creativity. Nevertheless, the evidence on the main factors involved in this association during childhood remains a matter of debate. Present research has addressed the interplay between Gf and DT, exploring the mediating role of a field dependent-independent cognitive style (FDI) and the moderating effect of gender in 101 children (Mage = 8.02; SDage = 1.43). Participants carried out Raven’s Colored Progressive Matrices, the Children Embedded Figure Test, and the Alternative Uses Task. The results revealed the mediating effect of FDI in the association between Gf and DT, providing evidence that this cognitive style represents a function of controlled mental processes underpinned by Gf, which are useful to thinking divergently. In addition, the findings reported that the interplay between FDI and DT was moderated by gender, suggesting that the impact of FDI on DT was stronger among boys. Through a multidimensional approach, these current research findings provide further insight into the primary children’s factors involved in the ability to find alternative solutions and think divergently. Full article
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10 pages, 523 KiB  
Article
Physical Activity, Body Composition, Physical Fitness, and Body Dissatisfaction in Physical Education of Extremadura Adolescents: An Exploratory Study
by María Isabel Moreno-Díaz, Miguel Vaquero-Solís, Miguel Ángel Tapia-Serrano and Pedro Antonio Sánchez-Miguel
Children 2024, 11(1), 83; https://doi.org/10.3390/children11010083 - 10 Jan 2024
Cited by 9 | Viewed by 3371
Abstract
In recent years, physical activity levels among youths have declined significantly. This has led to a decline in adherence to physical activity recommendations. In this sense, physical education offers an ideal environment that contributes positively to improving adherence to physical activity recommendations, as [...] Read more.
In recent years, physical activity levels among youths have declined significantly. This has led to a decline in adherence to physical activity recommendations. In this sense, physical education offers an ideal environment that contributes positively to improving adherence to physical activity recommendations, as it teaches students movement-related skills and knowledge. The objective of the present research was to investigate the relationship between physical activity levels, body composition, fitness in Physical Education, and body dissatisfaction levels, and to analyse sex differences in relation to the study variables. The sample was formed of 1166 participants from the 1st and 2nd secondary compulsory education, of which 642 were boys (age 13.16 ± 0.91), and 524 girls (age 13.08 ± 0.85). The measure of physical activity was the Physical Activity Questionnaire for Adolescents (PAQ-A). Body composition was assessed using weight and height to calculate their body mass index. Cardiorespiratory capacity was assessed using the Course-Navette test in Physical Education lessons. The results showed the relationship between physical activity and body mass index, cardiorespiratory capacity, and body satisfaction. It was also confirmed that higher levels of physical activity were associated with a lower body mass index, improvements in cardiorespiratory fitness, and lower levels of body dissatisfaction to a greater extent in boys than in girls. The study concludes that improvements in the study variables were associated with increased physical activity. In addition, it seems necessary to promote healthy lifestyles in physical education lessons, especially during adolescence, as they could serve as a gateway for the improvement of health-related fitness in future generations. Increasing the amount of physical activity among young people is vital. Therefore, it would be essential to develop intervention programs in physical education classes, especially during adolescence, aimed at promoting and increasing physical activity and its benefits. Full article
(This article belongs to the Special Issue Motor Competence and Physical Activity in School Children)
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11 pages, 229 KiB  
Article
The Associations between the Number of School Sports Teams That a Student Regularly Participates in and Factors Such as Perceived Stress, Loneliness, and Sleep Satisfaction among Korean Adolescents Who Have Attempted Suicide
by Jeonga Kwon and Jusun Jang
Children 2024, 11(1), 77; https://doi.org/10.3390/children11010077 - 9 Jan 2024
Cited by 5 | Viewed by 2068
Abstract
Adolescents who have attempted suicide are more likely to experience a recurrence of suicidal behavior, thus necessitating systematic follow-ups and management. We aimed to investigate the association between the number of school sports teams that a student regularly participates in and psychological factors [...] Read more.
Adolescents who have attempted suicide are more likely to experience a recurrence of suicidal behavior, thus necessitating systematic follow-ups and management. We aimed to investigate the association between the number of school sports teams that a student regularly participates in and psychological factors such as perceived stress, loneliness, and sleep satisfaction among 1393 Korean adolescents who have attempted suicide by using data from the 2022 Korea Youth Risk Behavior Survey. Frequency analyses were performed to evaluate participant characteristics. Chi-square analyses were used to examine the differences in participant characteristics according to the number of teams. Multivariate logistic regression analysis was used to examine the associations between the number of teams and perceived stress, loneliness, and sleep satisfaction. Our results indicated that participating in a greater number of sports teams at school was more strongly associated with reduced perceived stress, reduced loneliness, and increased sleep satisfaction. Specifically, the odds ratio (OR) for feeling very much stressed was 0.613 (range: 0.387–0.969; p = 0.036) among the participants who belonged to one team. Among those who belonged to two teams, the OR for feeling very much stressed was 0.482 (range: 0.281–0.286; p = 0.008). Among those who belonged to two teams, the OR for feeling a lot of stress was 0.514 (range: 0.304–0.870; p = 0.013), and that for not feeling much stress was 2.663 (range: 1.103–6.426; p = 0.029). The OR for not feeling much stress was 4.697 for those who belonged to three teams (range: 1.531–14.408; p = 0.007) and 6.671 for those who belonged to four or more teams (range: 1.858–23.953; p = 0.004). The OR for feeling no stress at all was 11.629 (range: 2.229–60.661; p = 0.004) for those who belonged to three teams and 93.531 (range: 19.260–454.207; p < 0.001) for those who belonged to four or more teams. In terms of loneliness, the OR for rarely feeling lonely was 2.651 (range: 1.148–6.123; p = 0.022) among those who belonged to one team. The OR for feeling lonely all the time was 0.370 (range: 0.155–0.884; p = 0.025) among those who belonged to two teams. In terms of sleep satisfaction, the OR for having very sufficient sleep was 4.371 (range: 1.627–11.742; p = 0.003) for those who belonged to four or more teams. These results suggest that school sports are an advantageous tool for suicide prevention, given their low costs, absence of side effects, and ease of participation. Full article
(This article belongs to the Special Issue Childhood Physical Activity and Health)
11 pages, 227 KiB  
Article
Real-World Use of Dalbavancin for Treatment of Soft Tissue and Bone Infection in Children: Safe, Effective and Hospital-Time Sparing
by Désirée Caselli, Marcello Mariani, Claudia Colomba, Chiara Ferrecchi, Claudio Cafagno, Daniela Trotta, Ines Carloni, Daniela Dibello, Elio Castagnola and Maurizio Aricò
Children 2024, 11(1), 78; https://doi.org/10.3390/children11010078 - 9 Jan 2024
Cited by 13 | Viewed by 2533
Abstract
Acute bacterial skin and skin structure infections (ABSSSI) and osteoarticular infections compound the burden of morbidity, mortality and prolonged hospitalizations among gram-positive infections. Dalbavancin, a second-generation, intravenous lipoglycopeptide, due to its prolonged half-life, can be a valuable alternative in their treatment when administered [...] Read more.
Acute bacterial skin and skin structure infections (ABSSSI) and osteoarticular infections compound the burden of morbidity, mortality and prolonged hospitalizations among gram-positive infections. Dalbavancin, a second-generation, intravenous lipoglycopeptide, due to its prolonged half-life, can be a valuable alternative in their treatment when administered as inpatient treatment at the price of an extended hospital stay. Between October 2019 and September 2023, 31 children and adolescents were treated with dalbavancin because of bone and joint infections (n = 12 patients, 39%), ABSSSI (n = 13 patients, 42%), mainly for the limbs, facial cellulitis or complicated ABSSSI (n = 6 patients, 19%), at five Italian pediatric centers. Microbiological study provided gram-positive bacterial isolate in 16 cases, in 11 cases from a positive blood culture; 9 of them were MRSA. Twenty-five patients were initially treated with a different antibiotic therapy: beta-lactam-based in 18 patients (58%), glycopeptide-based in 15 patients (48%) and daptomycin in 6 (19%). The median time that elapsed between admission and start of dalbavancin was 18 days. A total of 61 doses of dalbavancin were administered to the 31 patients: 16 received a single dose while the remaining 15 patients received between two (n = 9) and nine doses. The frequency of administration was weekly in five cases or fortnightly in nine patients. Median length of stay in hospital was 16 days. Median time to discharge after the first dose of dalbavancin was 1 day. Treatment was very well-tolerated: of the 61 administered doses, only four doses, administered to four patients, were associated with an adverse event: drug extravasation during intravenous administration occurred in two patients, with no sequelae; however, in two patients the first administration was stopped soon after infusion start: in one (ID #11), due to headache and vomiting; in another (ID #12) due to a systemic reaction. In both patients, drug infusion was not repeated. None of the remaining 29 patients reported treatment failure (resistant or recurrent disease) or an adverse effect during a median follow-up time of two months. The use of dalbavancin was safe, feasible and also effective in shortening the hospital stay in children and adolescents. Full article
(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)
13 pages, 554 KiB  
Article
Inflammatory and Hematologic Liver and Platelet (HALP) Scores in Hypothermia-Treated Hypoxic–Ischemic Encephalopathy (HIE)
by Handan Hakyemez Toptan, Kübra Gökçe Tezel, Oğuzhan Tezel, Ömer Ataç, Gonca Vardar, Sinem Gülcan Kersin and Eren Özek
Children 2024, 11(1), 72; https://doi.org/10.3390/children11010072 - 8 Jan 2024
Cited by 6 | Viewed by 1873
Abstract
Objective: This study examined systemic inflammatory indices and “Hemoglobin, Albumin, Lymphocyte, Platelet (HALP) scores” in neonates with hypoxic–ischemic encephalopathy (HIE). Methods: A total of 43 neonates with moderate-to-severe HIE at 36 weeks’ gestation were assessed. Systemic inflammatory markers were measured before HT commenced [...] Read more.
Objective: This study examined systemic inflammatory indices and “Hemoglobin, Albumin, Lymphocyte, Platelet (HALP) scores” in neonates with hypoxic–ischemic encephalopathy (HIE). Methods: A total of 43 neonates with moderate-to-severe HIE at 36 weeks’ gestation were assessed. Systemic inflammatory markers were measured before HT commenced within 0–6 h after birth and between 60 and 72 h during and after therapy or before adjusting for hypothermia. Results: Platelet counts, hemoglobin levels, and platelet indices in the HIE group were significantly lower at both time points (p = 0.001). Both the neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) decreased in the HIE group after hypothermia therapy (p = 0.001). Seizures, PVL, and kidney injuries were associated with higher HALP scores. The AUCs of NLR, PLR, MLR, SII, SIRI, and platelet, neutrophil, monocyte, and lymphocyte Index (PIV) showed significant sensitivity and specified HIE, with area under the curve (AUC) values of 0.654, 0.751, 0.766, 0.700, 0.722, and 0.749, respectively. Conclusions: A significant difference in systemic inflammatory markers was found between the HIE and control groups after hypothermia treatment, with significant reductions in the MLR and NLR. These markers, particularly MLR, were significant predictors of adverse clinical outcomes including seizures, PVL, and kidney damage. Full article
(This article belongs to the Section Pediatric Neurology & Neurodevelopmental Disorders)
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19 pages, 1106 KiB  
Review
Wilson’s Disease with Acute Hepatic Onset: How to Diagnose and Treat It
by Valeria Delle Cave, Fabiola Di Dato and Raffaele Iorio
Children 2024, 11(1), 68; https://doi.org/10.3390/children11010068 - 6 Jan 2024
Cited by 6 | Viewed by 4663
Abstract
Wilson’s disease (WD) with acute onset poses a diagnostic challenge because it is clinically indistinguishable from other acute liver diseases. In addition, serum ceruloplasmin and urinary copper excretion, the first-line diagnostic tools for WD, can show false positive results in the case of [...] Read more.
Wilson’s disease (WD) with acute onset poses a diagnostic challenge because it is clinically indistinguishable from other acute liver diseases. In addition, serum ceruloplasmin and urinary copper excretion, the first-line diagnostic tools for WD, can show false positive results in the case of acute liver failure, and the diagnostic role of genetic analysis is limited by the time required to perform it. In the case of fulminant onset, there is a clear indication of liver transplantation. “New Wilson Index” is frequently used to discriminate between patients who need liver transplantation versus those who can be successfully managed by medical treatment, but its reliability remains controversial. Timely referral of patients with acute liver failure due to WD may be a key factor in improving patient survival. Although liver transplant very often represents the only chance for such patients, maximum effort should be made to promote survival with a native liver. The management of these aspects of WD is still a matter of debate and will be the subject of this review. Full article
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15 pages, 318 KiB  
Review
Updates in the Management of Congenital Melanocytic Nevi
by Mia A. Mologousis, Serena Yun-Chen Tsai, Kristin A. Tissera, Yakir S. Levin and Elena B. Hawryluk
Children 2024, 11(1), 62; https://doi.org/10.3390/children11010062 - 2 Jan 2024
Cited by 9 | Viewed by 8111
Abstract
Congenital melanocytic nevi (CMN) carry an increased risk of melanoma and may be disfiguring, and consensus regarding treatment recommendations is lacking. While clinical monitoring is the standard of care, many caregivers are interested in its removal to prevent psychosocial burden or to decrease [...] Read more.
Congenital melanocytic nevi (CMN) carry an increased risk of melanoma and may be disfiguring, and consensus regarding treatment recommendations is lacking. While clinical monitoring is the standard of care, many caregivers are interested in its removal to prevent psychosocial burden or to decrease risk. Although melanoma can occur regardless of CMN removal, there are a variety of treatments that may offer improved cosmesis or local symptom control, including surgical excision, laser therapy, and other superficially destructive techniques. Regardless of the selected management, these patients are monitored for ongoing melanoma risk. An extensive discussion with families regarding the risks and benefits of observation versus active intervention is essential. To facilitate these discussions, we herein summarize current CMN management strategies and considerations. Full article
(This article belongs to the Section Pediatric Dermatology)
13 pages, 595 KiB  
Article
Guided Growth Technique for Epiphysiodesis and Hemiepiphysiodesis: Safety and Performance Evaluation
by Giovanni Luigi Di Gennaro, Giovanni Trisolino, Stefano Stallone, Marco Ramella, Gino Rocca and Giovanni Gallone
Children 2024, 11(1), 49; https://doi.org/10.3390/children11010049 - 29 Dec 2023
Cited by 6 | Viewed by 3138
Abstract
Background: Guided-growth modulation is a first-line treatment widely adopted to correct lower-limb angular deformities and limb-length discrepancies (LLD) in the paediatric population. Methods: We conducted a retrospective study to evaluate the safety and performance of a new construct (8-Plate Plus or Guided-Growth Plate [...] Read more.
Background: Guided-growth modulation is a first-line treatment widely adopted to correct lower-limb angular deformities and limb-length discrepancies (LLD) in the paediatric population. Methods: We conducted a retrospective study to evaluate the safety and performance of a new construct (8-Plate Plus or Guided-Growth Plate System Plus, Orthofix S.r.l) used to correct angular deformities and LLD in non-skeletally mature children. The primary endpoint was safety (from plate implantation to removal). The secondary endpoint was performance; patients treated for LLD achieved complete correction if a pre- and post-surgery difference of <0 was observed; angular deformities performance was measured in terms of IMD, ICD, mMPTA, and mLDFA. Results: We performed 69 procedures in 41 patients. A total of 10 patients had an LLD, and 31 had an angular deformity. We observed nine minor complications in the hemiepiphysiodesis group. One patient experienced rebound. All 10 LLD patient treatments were successful. A total of 30/31 patients with an angular deformity had a successful treatment; the remaining patient had a partial correction. Conclusions: Guided-growth by temporary epiphysiodesis or hemiepiphysiodesis was safe and effective for angular deformities and limb-length discrepancies. Further prospective and/or randomized controlled trial studies assessing more significant cohorts of patients and a comparison group could add evidence to our findings. Full article
(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)
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20 pages, 835 KiB  
Review
Update on Fever of Unknown Origin in Children: Focus on Etiologies and Clinical Approach
by Sandra Trapani, Adele Fiordelisi, Mariangela Stinco and Massimo Resti
Children 2024, 11(1), 20; https://doi.org/10.3390/children11010020 - 24 Dec 2023
Cited by 11 | Viewed by 9586
Abstract
Fever of unknown origin (FUO) can be caused by four etiological categories of diseases. The most common cause of FUO in children is represented by infections, followed by inflammatory conditions and neoplastic causes; a decreasing quote remains still without diagnosis. Despite the fact [...] Read more.
Fever of unknown origin (FUO) can be caused by four etiological categories of diseases. The most common cause of FUO in children is represented by infections, followed by inflammatory conditions and neoplastic causes; a decreasing quote remains still without diagnosis. Despite the fact that several diagnostic and therapeutic approaches have been proposed since the first definition of FUO, none of them has been fully validated in pediatric populations. A focused review of the patient’s history and a thorough physical examination may offer helpful hints in suggesting a likely diagnosis. The diagnostic algorithm should proceed sequentially, and invasive testing should be performed only in select cases, possibly targeted by a diagnostic suspect. Pioneering serum biomarkers have been developed and validated; however, they are still far from becoming part of routine clinical practice. Novel noninvasive imaging techniques have shown promising diagnostic accuracy; however, their positioning in the diagnostic algorithm of pediatric FUO is still not clear. This narrative review aims to provide a synopsis of the existent literature on FUO in children, with its major causes and possible diagnostic workup, to help the clinician tackle the complex spectrum of pediatric FUO in everyday clinical practice. Full article
(This article belongs to the Section Pediatric Allergy and Immunology)
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11 pages, 866 KiB  
Article
Incidence and Management of Appendiceal Neuroendocrine Tumors in Pediatric Population: A Bicentric Experience with 6285 Appendectomies
by Zenon Pogorelić, Vladimir Ercegović, Marko Bašković, Miro Jukić, Ivana Karaman and Ivana Mrklić
Children 2023, 10(12), 1899; https://doi.org/10.3390/children10121899 - 8 Dec 2023
Cited by 10 | Viewed by 3089
Abstract
Background: Neuroendocrine tumors (NETs) are rare tumors that arise from neuroendocrine cells and are the most common tumors of the appendix. NETs of the appendix usually cause no symptoms and often go unnoticed until they cause acute appendicitis or are discovered during an [...] Read more.
Background: Neuroendocrine tumors (NETs) are rare tumors that arise from neuroendocrine cells and are the most common tumors of the appendix. NETs of the appendix usually cause no symptoms and often go unnoticed until they cause acute appendicitis or are discovered during an accidental appendectomy. As the trend towards the conservative treatment of acute appendicitis increases in the pediatric population, the question arises as to whether the majority of NETs go undetected and are only discovered at an advanced stage. The purpose of the proposed study is to review the incidence and outcomes of treatment for NETs of the appendix in children and include the data presented in the data pool for further review. Methods: From 1 January 2009 to 1 November 2023, a total of 6285 appendectomies were performed in two large pediatric centers in Croatia. After a retrospective review of the case records and histopathologic findings, a total of 31 children (0.49%) were diagnosed with NET of the appendix and included in the further analysis. The primary outcome of this study was the incidence and treatment outcome of pediatric patients diagnosed with NET of the appendix. Secondary outcomes included the patients’ demographic, clinical, and laboratory data and the histopathologic characteristics of tumor species. Results: The overall incidence of NETs of the appendix was stable over the study years, with minor fluctuations. The median age of patients was 14 (interquartile range—IQR: 12, 16) years, with a female predominance (64.5%). The majority of patients (96.8%) presented with acute abdominal pain and underwent appendectomy because acute appendicitis was suspected. Acute appendicitis was confirmed by histopathology in 18 (58%) cases. NETs of the appendix were not detected preoperatively in any of the patients. Among patients with confirmed acute appendicitis, most (n = 14; 77.8%) were found to have non-perforated acute appendicitis. In most children, the tumor was located at the tip of the appendix (n = 18; 58.1%), and the majority of tumors had a diameter of less than 1 cm (n = 21, 67.7%). The mitotic count (n = 25, 80.6%) and Ki-67 proliferation index (n = 23, 74.2%) were low in most patients, so most tumors were classified as NET G1 (n = 25, 80.6%), while NET G2 and NET G3 were found in four (12.9%) and two (6.5%) patients, respectively. All children were treated with appendectomy only. The median follow-up time was 54 (IQR: 24, 95) months. Conclusions: The incidence of appendiceal NET among pediatric patients is very low. NET occurs most frequently in adolescents, with a female predominance. Most tumors are less than 1 cm in diameter, located at the tip, and associated with non-perforated appendicitis. Appendectomy is the treatment of choice, and major surgery was not necessary in our cohort. Full article
(This article belongs to the Special Issue Advances in Gastrointestinal Surgery in Children)
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14 pages, 593 KiB  
Article
Bullying Victimization and Adolescent Depression, Anxiety and Stress: The Mediation of Cognitive Emotion Regulation
by Mariacarolina Vacca, Silvia Cerolini, Anna Zegretti, Andrea Zagaria and Caterina Lombardo
Children 2023, 10(12), 1897; https://doi.org/10.3390/children10121897 - 7 Dec 2023
Cited by 11 | Viewed by 6463
Abstract
Background: Existing research has revealed a robust association between bullying victimization and psychological distress, but less is known about the underlying mechanism of this link. cognitive emotion regulation (CER) strategies could be a potential mediator. The current study examined the role of functional [...] Read more.
Background: Existing research has revealed a robust association between bullying victimization and psychological distress, but less is known about the underlying mechanism of this link. cognitive emotion regulation (CER) strategies could be a potential mediator. The current study examined the role of functional and dysfunctional CER strategies as potential mediators of the association between bullying victimization and depression, anxiety, and stress symptoms among 638 high school students (53.9% boys; Mean age = 15.65, SD = 1.32). Method: Participants completed a series of questionnaires assessing bullying victimization (Olweus Bully/Victim Questionnaire), CER strategies (CERQ-18), and symptoms of depression, anxiety, and stress (DASS-21). The indirect relationships between bullying victimization and psychopathological symptoms via functional and dysfunctional CER strategies were tested through structural equation modeling. Results: Dysfunctional CER strategies mediated the impact of bullying victimization on depression, anxiety, and stress. In contrast, bullying victimization did not significantly influence functional CER strategies. Conclusions: The findings provide additional support for the detrimental role of bullying victimization on mental distress, also suggesting that this effect is not only direct, but indirect is well. These results are particularly relevant in light of the absence of mediation by protective factors such as the use of positive emotion regulation strategies. Full article
(This article belongs to the Special Issue School Bullying during Childhood and Adolescence)
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16 pages, 7451 KiB  
Review
Elastodontic Appliances for the Interception of Malocclusion in Children: A Systematic Narrative Hybrid Review
by Vincenzo Ronsivalle, Ludovica Nucci, Nicolò Bua, Giuseppe Palazzo and Salvatore La Rosa
Children 2023, 10(11), 1821; https://doi.org/10.3390/children10111821 - 17 Nov 2023
Cited by 12 | Viewed by 3154
Abstract
Background. Interceptive orthodontic treatment aims to eliminate factors that prevent the harmonious development of the maxillary and mandibular arches during childhood, and elastodontic appliances (EAs) represent a group of devices with an increasingly important role. This systematic narrative hybrid review (HR) aims to [...] Read more.
Background. Interceptive orthodontic treatment aims to eliminate factors that prevent the harmonious development of the maxillary and mandibular arches during childhood, and elastodontic appliances (EAs) represent a group of devices with an increasingly important role. This systematic narrative hybrid review (HR) aims to provide an overview of the clinical indications for the use of EAs according to the available evidence and to identify potential research areas for unexplored applications. Materials and methods. To assess the available literature on the subject, selective database searches were performed between July 2023 and September 2023. With the assistance of a health sciences librarian, a search strategy that utilized terms related to elastodontic therapy was developed. Embase, Scopus, PubMed, and Web of Science were the databases used. Results. The current literature addressing the usability of EAs is scarce and mostly limited to case reports and case series. After 2168 citations were found through the searches, 13 studies were ultimately included. In this regard, information about the clinical use and effectiveness of EAs are reported in a narrative form, defining specific domains of the application that are clinically oriented, including sagittal and transversal discrepancies, atypical swallowing, teeth malposition, two-phase orthodontics and a lack of teeth retention. Conclusions. Within the intrinsic quality limitation of the available literature, it seems that EAs may represent a promising treatment alternative for managing mild-to-moderate malocclusion in children as an adjuvant therapy to the interruption of spoiled habits. Full article
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18 pages, 738 KiB  
Article
Effects of Smartphone Activities on Postural Balance in Adolescents with Intellectual Disabilities
by Ghada Jouira, Cristina Ioana Alexe, Julien Narcis Herlo, Cristina Elena Moraru, Mihaela Bogdan, Dan Iulian Alexe, Gabriel Mareș and Sonia Sahli
Children 2023, 10(11), 1810; https://doi.org/10.3390/children10111810 - 14 Nov 2023
Cited by 8 | Viewed by 2310
Abstract
Considering the rising prevalence of smartphone usage among adolescents with intellectual disabilities and their frequent motor challenges, understanding its impact on their physical well-being is important. This study aims to investigate the impact of smartphone activities on postural balance in adolescents with intellectual [...] Read more.
Considering the rising prevalence of smartphone usage among adolescents with intellectual disabilities and their frequent motor challenges, understanding its impact on their physical well-being is important. This study aims to investigate the impact of smartphone activities on postural balance in adolescents with intellectual disabilities. Two groups of adolescents participated in the study: an intellectual disability group (IDG) (n = 16) and atypical development group (TDG) (n = 12). Static postural balance, using a stabilometric platform on firm and foam surfaces, and dynamic balance, using the Timed Up-and-Go Test (TUGT), were performed under various conditions, such as playing a game, watching videos, video calls, and listening to music. The center of pressure (CoP) values significantly increased (p < 0.05) during all smartphone activities (except listening to music) compared to the control condition in both groups, with the IDG demonstrated a more pronounced increase (p < 0.05) during playing video games and video calls on the firm surface. TUGT scores significantly increased (p < 0.05) during smartphone activities, with greater changes observed in the IDG (p < 0.05), and significantly decreased (p < 0.01) during listening to music in both groups. Our study suggests that adolescents with intellectual disabilities need special tools and guidance to ensure their safety and well-being when using smartphones. Full article
(This article belongs to the Section Global Pediatric Health)
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13 pages, 5174 KiB  
Review
Managing Dental Phobia in Children with the Use of Virtual Reality: A Systematic Review of the Current Literature
by Alessio Rosa, Alberto Maria Pujia, Raffaella Docimo and Claudio Arcuri
Children 2023, 10(11), 1763; https://doi.org/10.3390/children10111763 - 30 Oct 2023
Cited by 16 | Viewed by 4510
Abstract
Background: It is common today to encounter anxiety in patients facing dental treatment. Virtual reality (VR) is presented as a high-performing and innovative procedure because it can distract patients undergoing dental procedures or prepare them for such treatments. In addition, this meta-analysis has [...] Read more.
Background: It is common today to encounter anxiety in patients facing dental treatment. Virtual reality (VR) is presented as a high-performing and innovative procedure because it can distract patients undergoing dental procedures or prepare them for such treatments. In addition, this meta-analysis has gathered evidence on VR and its ability to reduce dental anxiety in pediatric patients undergoing different treatments. Methods: The major Scopus, PubMed, EMBASE and Web of Science databases were searched for scientific articles published up to 2023. Studies in which VR was used for children and adults as a measure against anxiety during dental treatments were included. VR was defined as a three-dimensional place where patients experience a sense of immersion as they find themselves in attractive and interactive environments that detach them from reality. Anxiety and pain were examined and measured during dental treatments in which VR was used by comparing them with standard care situations. Results: Twenty-five studies were identified, of which eleven met the inclusion criteria. The effect of VR was studied mainly in the pediatric population as a distractive method. Only two studies (not significant) on an adult population were considered. Conclusions: this review shows that VR is an excellent distraction method that is effective in reducing anxiety before dental treatment; however, due to the few studies in this area, further research on VR as a tool to prepare patients for dental treatment is needed. Full article
(This article belongs to the Section Pediatric Dentistry & Oral Medicine)
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