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Children, Adolescents and Urine Hydration Indices—A Systematic Literature Review on Athletes and Non-Athletes
Oral Breathing Effects on Malocclusions and Mandibular Posture: Complex Consequences on Dentofacial Development in Pediatric Orthodontics

Journal Description

Children

Children is an international, peer-reviewed, open access journal on children’s health published monthly online by MDPI.

Open Access— free for readers, with article processing charges (APC) paid by authors or their institutions.
High Visibility: indexed within Scopus, SCIE (Web of Science), PubMed, PMC, Embase, and other databases.
Journal Rank: JCR - Q2 (Pediatrics) / CiteScore - Q2 (Pediatrics, Perinatology and Child Health)
Rapid Publication: manuscripts are peer-reviewed and a first decision is provided to authors approximately 14 days after submission; acceptance to publication is undertaken in 2.4 days (median values for papers published in this journal in the second half of 2024).
Recognition of Reviewers: reviewers who provide timely, thorough peer-review reports receive vouchers entitling them to a discount on the APC of their next publication in any MDPI journal, in appreciation of the work done.

Impact Factor: 2.0 (2023); 5-Year Impact Factor: 2.1 (2023)

Imprint Information Journal Flyer Open Access ISSN: 2227-9067

Latest Articles

19 pages, 3379 KiB

Open AccessArticle

Patient Empowerment Among Children and Adolescents with Inflammatory Bowel Disease (IBD) and Parents of IBD Patients—Use of Counseling Services and Lack of Knowledge About Transition

by Kalina Kaul, Stefan Schumann, Jakob Felder, Jan Däbritz and Jan de Laffolie

Children 2025, 12(5), 620; https://doi.org/10.3390/children12050620 (registering DOI) - 10 May 2025

Background: Children and adolescents with pediatric inflammatory bowel diseases (PIBD) face significant challenges, including emotional stress, social isolation, and interrupted education due to symptoms. Effective counseling and education empower these young patients and their families to actively participate in healthcare. This paper [...] Read more.

Background: Children and adolescents with pediatric inflammatory bowel diseases (PIBD) face significant challenges, including emotional stress, social isolation, and interrupted education due to symptoms. Effective counseling and education empower these young patients and their families to actively participate in healthcare. This paper investigates the IBD needs analysis (CEDNA), focusing on counseling and transition services. Methods: The Study Group distributed questionnaires to PIBD patients and the parents of children and adolescents with PIBD across Germany, with all responses provided anonymously. We conducted a subgroup analysis based on patient age and time since diagnosis, as well as aspects of regional distribution and city size. Parents’ responses were analyzed by corresponding age groups to facilitate comparison with the patients’ responses. Results: From October 2021 to April 2022, 1158 questionnaires (patients 38.9%, n = 450; parents 61.1%, n = 708) were completed. In the group of 16–17-year-old patients, only 14.1% (n = 239) feel well informed about transition programs (parents 6.7% of n = 360). Depending on the disease duration, 2.1% to 6.9% of the patients surveyed (n = 292) feel well informed about PIBD (parents 3.3% to 7.5%, n = 361). Nutritional counseling is the most requested support service (patients 49.2%, n = 382; parents: service used for their children 41.9%, n = 578; parents: service used for themselves 46.1%, n = 575). Conclusions: PIBD patients, especially aged 12–17, lack knowledge and preparation for transition to adult care. While general PIBD management awareness is fair, targeted educational efforts are necessary. Trustworthy information sources and early, tailored counseling services could enhance transition experiences and improve long-term disease management and patient outcomes. Full article

(This article belongs to the Special Issue Bowel Management in Paediatric Colorectal Disease)

12 pages, 767 KiB

Open AccessArticle

Effect of Relative Age on Gross Motor Coordination Development, Considering Biological Maturity and Sex

by Xiaoyu Zhang, Gaël Ennequin, Anthony J. Blazevich and Sébastien Ratel

Children 2025, 12(5), 619; https://doi.org/10.3390/children12050619 (registering DOI) - 10 May 2025

Objective: This study aimed to investigate the effect of relative age on gross motor coordination (GMC) development, taking into account biological maturity and sex. Methods: 729 participants aged 10 to 16 years completed three GMC tests newly designed to minimize the potentially confounding [...] Read more.

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

(This article belongs to the Special Issue Effects of Exercise Interventions on Children)

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9 pages, 874 KiB

Open AccessReview

Use of Endoscopic Ultrasound with Bronchoscope-Guided Fine-Needle Aspiration (EUS-B-FNA) in Pediatric Cases

by Xiaowei Chen, Xiaofen Tao, Shuxian Li, Hujun Wu, Fang Jin and Lei Wu

Children 2025, 12(5), 618; https://doi.org/10.3390/children12050618 - 9 May 2025

The intricate airway anatomy and poorly understood etiology of pediatric conditions render the diagnosis of mediastinal disorders particularly challenging. Traditional diagnostic methods, such as mediastinoscopy and thoracotomy, carry high risks and are often impractical in children. Endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) [...] Read more.

The intricate airway anatomy and poorly understood etiology of pediatric conditions render the diagnosis of mediastinal disorders particularly challenging. Traditional diagnostic methods, such as mediastinoscopy and thoracotomy, carry high risks and are often impractical in children. Endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) enables a minimally invasive, esophageal route to mediastinal lesions, providing a diagnostic approach that is new to pediatrics compared with conventional techniques. We review the technical characteristics, clinical benefits, and prospective role of EUS-B-FNA in pediatric diagnostic investigation. We also review the clinical applications of EUS-B-FNA to date and aim to promote its use as a novel adjunct for the evaluation of complex mediastinal pathology in pediatric medicine. Full article

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

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13 pages, 1466 KiB

Open AccessArticle

The Significance of Inflammatory Markers in Pediatric Patients with Acute Gastroenteritis Presenting to the Emergency Department

by Hazem Alhazmi, Abeer Alzahrani, Saud Alshaikh, Lein Azzhary, Fatimah Alhaddad, Zeyad Alshamrani and Raghad Alwagdani

Children 2025, 12(5), 617; https://doi.org/10.3390/children12050617 - 9 May 2025

Background: Considerable mortality and morbidity rates linked to AGE are well documented in the literature. Many inflammatory markers have been studied in the context of research on AGE as tools to predict the clinical course of the disease and determine the need for [...] Read more.

Background: Considerable mortality and morbidity rates linked to AGE are well documented in the literature. Many inflammatory markers have been studied in the context of research on AGE as tools to predict the clinical course of the disease and determine the need for the use of antimicrobials. This study focuses on CRP, PCT, and WBC counts as inflammatory markers of AGE. Methods: A retrospective chart review study was conducted at King Abdullah Specialized Children’s Hospital, Jeddah. Using a non-probability consecutive sampling technique, all patients under the age of 14 diagnosed with gastroenteritis over four years (2020–2024) were included. Results: The sample population consisted of 84 individuals. Pathogen prevalence was identified in only 15%. Salmonella was the most frequently identified bacterial pathogen. While the WBC count and ESR were reassuring in most cases, the CRP and PCT measurements were almost always elevated. Compared to the stronger association observed with WBC counts, the correlation between PCT levels and ED visits were less significant. Higher CRP levels were associated with an increased use of antibiotics. Conclusion: The results of this study highlight that CRP is useful in identifying patients who are likely to have bacterial AGE and require antibiotics. Moreover, the WBC count is a helpful tool in predicting those likely to present to the ED again. Full article

(This article belongs to the Section Pediatric Emergency Medicine & Intensive Care Medicine)

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20 pages, 907 KiB

Open AccessReview

Growth Failure in Children with Congenital Heart Disease

by Jihye Lee, Teresa Marshall, Harleah Buck, Mulder Pamela and Sandra Daack-Hirsch

Children 2025, 12(5), 616; https://doi.org/10.3390/children12050616 - 9 May 2025

Background/Objectives: Growth failure is a common complication in children with congenital heart disease (CHD), yet its underlying mechanisms and consequences remain incompletely understood. This review aims to provide a comprehensive overview of growth failure in children with CHD and outline a framework [...] Read more.

Background/Objectives: Growth failure is a common complication in children with congenital heart disease (CHD), yet its underlying mechanisms and consequences remain incompletely understood. This review aims to provide a comprehensive overview of growth failure in children with CHD and outline a framework of factors contributing to this condition. Methods: To lay the foundation for this narrative review, several databases were searched using broad search terms related to CHD and growth failure. Results: Growth failure is most pronounced during the first year of life, but often improves after achieving hemodynamic stability through surgical or medical interventions. However, children with complex conditions, such as single-ventricle physiology or multiple heart defects, may experience persistent growth impairment due to chronic disease effects. Specific features of CHD—cyanosis, pulmonary hypertension, and low cardiac output—can further hinder growth by disrupting endocrine function and impairing musculoskeletal development. Long-term use of medications and exposure to repeated diagnostic procedures also contribute to growth failure. Beyond physical effects, growth failure profoundly influences neurodevelopment, psychosocial well-being, and survival outcomes. Based on our review, we have developed a knowledge map to better understand the complexities of growth failure in children with CHD. Conclusions: A thorough understanding of the multifaceted contributors to growth failure in CHD is essential for identifying high-risk children and devising strategies to support optimal growth. Integrating this knowledge into clinical practice can improve long-term outcomes for children with CHD. Full article

(This article belongs to the Section Pediatric Cardiology)

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16 pages, 491 KiB

Open AccessArticle

Neonatal and Two-Year Prognosis of Eutrophic Newborns from Monochorionic Diamniotic Twin Pregnancies Complicated by Selective Intrauterine Growth Restriction

by Marie-Anne Jarry, Nayri Topalian, Lauréline Cosnard, Claude D’Ercole, Cécile Chau and Barthélémy Tosello

Children 2025, 12(5), 615; https://doi.org/10.3390/children12050615 - 8 May 2025

Background: Monochorionic diamniotic (MCDA) twin pregnancies are at risk of complications, particularly selective intrauterine growth restriction. The objective of this study was to evaluate the two-year neurologic outcomes of the eutrophic newborns from monochorionic diamniotic twin pregnancies who were complicated by selective intrauterine [...] Read more.

Background: Monochorionic diamniotic (MCDA) twin pregnancies are at risk of complications, particularly selective intrauterine growth restriction. The objective of this study was to evaluate the two-year neurologic outcomes of the eutrophic newborns from monochorionic diamniotic twin pregnancies who were complicated by selective intrauterine growth restriction, compared to newborns from uncomplicated MCDA pregnancies. Our hypothesis was to determine whether selective IUGR in these pregnancies was specifically associated with a risk of delayed psychomotor development at two years old. Methods: We conducted a retrospective–prospective observational cohort study of children from pregnancies and deliveries which were monitored at Hospital Nord of Marseille between 2012 and 2021. The primary outcome measure was the comparison of the Ages and Stages Questionnaire (ASQ) scores at the age of two years between the two groups. The secondary outcome measure was a composite score including the following: neonatal death, grade III or IV intraventricular hemorrhage (IVH) at cerebral MRI or cranial ultrasound, periventricular leucomalacia (PVL) at brain MRI, bronchopulmonary dysplasia (BPD), and necrotizing enterocolitis (NEC) of stages II or III. Results: A total of 57 eutrophic children were included in the group from monochorionic twin pregnancies complicated by selective IUGR and 270 children in the group from MCDA twin pregnancies with no complications. The composite morbidity and mortality criterion, including neonatal death, grade III or IV IVH, the presence of PVL, BPD, and/or stage II or III NEC, was 11% in eutrophic newborns from the MCDA group with IUGR and 5% in the uncomplicated MCDA group, with no statistically significant difference (p = 0.18). The 2-year follow-up allowed for the comparison of a total of 38 eutrophic children from complicated pregnancies and 134 children from uncomplicated pregnancies. The median ASQ score at 24 months was 255 in the complicated pregnancy group and 240 in the uncomplicated pregnancy group, with no statistically significant difference (p = 0.27) after adjustment. Conclusions: Our study did not show a statistically significant difference in the neurodevelopmental follow-up of eutrophic children from monochorionic diamniotic twin pregnancies with selective intrauterine growth restriction compared to newborns from the same pregnancies without complications. Full article

(This article belongs to the Section Pediatric Neonatology)

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17 pages, 528 KiB

Open AccessReview

Pediatric Chronic Kidney Disease: Mind the Gap Between Reality and Expectations

by Chien-Ning Hsu, Pei-Chen Lu, Wei-Ting Liao and You-Lin Tain

Children 2025, 12(5), 614; https://doi.org/10.3390/children12050614 - 8 May 2025

Pediatric chronic kidney disease (CKD) is a growing concern that often originates early in life, yet significant challenges remain in translating clinical guidelines into real-world practice. World Kidney Day 2025 highlights the importance of early detection, but the three levels of preventive strategies [...] Read more.

Pediatric chronic kidney disease (CKD) is a growing concern that often originates early in life, yet significant challenges remain in translating clinical guidelines into real-world practice. World Kidney Day 2025 highlights the importance of early detection, but the three levels of preventive strategies commonly recommended for adults may not be directly applicable to children. Unlike adult CKD, primary prevention in pediatrics should focus on prenatal, neonatal, and early-life factors such as congenital anomalies of the kidney and urinary tract (CAKUT), preterm birth, maternal health, and environmental exposures. Secondary prevention, involving early detection through screening, is crucial, yet the effectiveness of mass urinary screening in children remains a subject of global debate. Several key challenges persist, including the accurate estimation of glomerular filtration rate (eGFR), consistent definition and diagnosis of pediatric hypertension, identification of reliable biomarkers, and targeted screening in specific pediatric populations. Although clear guidelines exist to manage CKD progression and enhance quality of life, a critical gap remains between what is known and what is practiced. Closing this gap requires robust evidence to inform best practices, improve health-related quality of life, and advance pediatric kidney replacement therapies. To protect and improve kidney health for every child worldwide, these challenges must be acknowledged, and sustainable, evidence-based solutions must be developed and implemented without further delay. Full article

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

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14 pages, 869 KiB

Open AccessReview

Congenital Cytomegalovirus (cCMV) Infection as a Leading Cause of Pediatric Hearing Loss: Review

by Amber Cradeur, Aaron Jackson, Erin Ware, Torrey L. Fourrier and Gauri Mankekar

Children 2025, 12(5), 613; https://doi.org/10.3390/children12050613 - 8 May 2025

Background/Objectives: Congenital cytomegalovirus (cCMV) infection is a significant cause of pediatric hearing loss. However, the prevalence and characteristics of cCMV-related hearing loss remain unclear. Methods: A comprehensive search of major databases (PubMed, Scopus, and Web of Science) was conducted to identify studies [...] Read more.

Background/Objectives: Congenital cytomegalovirus (cCMV) infection is a significant cause of pediatric hearing loss. However, the prevalence and characteristics of cCMV-related hearing loss remain unclear. Methods: A comprehensive search of major databases (PubMed, Scopus, and Web of Science) was conducted to identify studies and reviews published between 2000 and 2024 that investigated cCMV infection, testing for cCMV, and pediatric hearing loss. Studies were included if they reported on the prevalence, characteristics, current policies, and recommendations for universal cCMV testing in newborns. Results: This review highlights key issues: cCMV is a significant and treatable cause of pediatric hearing loss; most cCMV-related hearing loss cases presented with bilateral and profound hearing impairment; and cCMV testing is performed only for babies who fail newborn hearing screening. Conclusions: This narrative review highlights the significant association between cCMV infection and pediatric hearing loss. Currently, targeted cCMV testing is recommended for newborns who fail newborn hearing screening. Universal cCMV testing may facilitate early diagnosis and directed intervention and could be cost-effective in the long run. Full article

(This article belongs to the Special Issue Hearing Loss in Children: The Present and a Challenge for Future)

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20 pages, 2168 KiB

Open AccessArticle

Parental Attitude Toward the Engagement in Physical Activity of Their Children with Type 1 Diabetes Mellitus in Hungary

by Ildikó Balatoni

Children 2025, 12(5), 612; https://doi.org/10.3390/children12050612 - 7 May 2025

Background/Objectives: Physical activity plays an essential role in a healthy lifestyle. For children, the development of an encouraging attitude toward exercise can define a positive life-long behaviour. Type 1 diabetes mellitus (T1DM) is a metabolic disorder that usually develops in early childhood and [...] Read more.

Background/Objectives: Physical activity plays an essential role in a healthy lifestyle. For children, the development of an encouraging attitude toward exercise can define a positive life-long behaviour. Type 1 diabetes mellitus (T1DM) is a metabolic disorder that usually develops in early childhood and severely affects glucose metabolism. Associated hypo- and hyperglycaemic conditions can dramatically interfere with the patient’s everyday life. Since exercise significantly alters the glucose consumption of the body, this might influence how T1DM patients view physical activity. As parental guidance is critical in their children’s behaviour, we investigate how parents of T1DM children relate to the engagement in physical activity of their children as compared to parents of healthy children. Methods: A self-reported survey was conducted among those parents whose T1DM children were cared for at the Paediatric Clinic of the University of Debrecen, Hungary. All together, 318 children, 140 with T1DM and 178 healthy peers, participated in the study. Results: We found no significant difference in the body mass index of healthy and T1DM children and, furthermore, no significant difference was observed in HbA1c levels in exercising and non-exercising T1DM children. Nevertheless, while 67.6% of the healthy children regularly engage in physical activity, only 57.5% of T1DM children do so (p = 0.044). Importantly, parents whose T1DM child exercised regularly believed that daily PhysEd classes improved their children’s health and had positive effects on their attitude toward exercise. In contrast, parents of children who did not regularly exercise were significantly less convinced. Conclusions: These findings highlight the importance of targeted educational efforts to foster positive attitudes toward physical activity among families with T1DM children and contribute valuable insights into how parental perceptions may influence children’s engagement in exercise. Full article

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

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34 pages, 1830 KiB

Open AccessReview

The Role of miRNA Expression in Congenital Heart Disease: Insights into the Mechanisms and Biomarker Potential

by Savina Mannarino, Valeria Calcaterra, Filippo Puricelli, Giulia Cecconi, Claudia Chillemi, Irene Raso, Erika Cordaro and Gianvincenzo Zuccotti

Children 2025, 12(5), 611; https://doi.org/10.3390/children12050611 - 7 May 2025

Congenital heart diseases (CHDs) are among the most common congenital malformations. Despite significant advancements in understanding the embryonic development of the heart, the etiology of CHDs remains largely unknown. The complexity of the processes involved in heart formation limits our ability to identify [...] Read more.

Congenital heart diseases (CHDs) are among the most common congenital malformations. Despite significant advancements in understanding the embryonic development of the heart, the etiology of CHDs remains largely unknown. The complexity of the processes involved in heart formation limits our ability to identify all molecular mechanisms underlying CHDs. Recently, microRNAs (miRNAs) have provided new insights into the molecular mechanisms of CHDs. This narrative review evaluates the evidence linking expression to CHDs and discusses the potential of RNA expression regulation as a promising avenue for therapeutic biomarker development. A search of the literature, focusing on the role of miRNAs in CHDs, was carried out to identify pertinent studies published over the last decade. The literature search was performed utilizing the PubMed and Scopus databases. The selection criteria included peer-reviewed original studies, clinical research, meta-analyses, and review articles written in English. Multiple investigations have highlighted the essential role of miRNAs in cardiac development and function, showing that their distinct expression patterns can broadly and specifically influence cellular signaling pathways involved in heart abnormalities. The regulation of mRNA expression emerges as a key factor in the pathogenesis of CHD, paving the way for the identification of novel molecular biomarkers. Alterations in transcriptional profiles could offer innovative and highly specific tools for risk stratification and the clinical monitoring of patients. In conclusion, although further studies are needed to validate the efficacy and clinical applicability of these biomarkers, the mRNA-based approach stands out as a promising perspective for precision medicine in the CHD context. Full article

(This article belongs to the Section Pediatric Cardiology)

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8 pages, 939 KiB

Open AccessArticle

Evaluation of Different Forms of Topical Anesthesia Agents in Dental Practice

by Kenan Cantekin

Children 2025, 12(5), 610; https://doi.org/10.3390/children12050610 - 7 May 2025

Purpose: The objective of this research was to compare the pain-reducing effects of two topical anesthetic agents, 10% atomized lidocaine spray and an EMLA, cream before needle injection applied at different time intervals using parameters of visual analog scale (VAS) score and heart [...] Read more.

Purpose: The objective of this research was to compare the pain-reducing effects of two topical anesthetic agents, 10% atomized lidocaine spray and an EMLA, cream before needle injection applied at different time intervals using parameters of visual analog scale (VAS) score and heart rate (HR). Methods: The randomized split-mouth study included 30 patients (17 boys, 13 girls) aged 8.22 ± 1.8 years. The application of atomized lidocaine spray or cream was randomly used in the maxillary second premolar region. The parameters were measured prior to and following each needle insertion after being applied for 10, 30, 60, and 120 sec. Paired t-test and independent t-test were used for statistic analyses. Results: Compared with the first applications (10 s), atomized lidocaine and EMLA cream applications significantly decreased scores of VAS at the 30 and 120 s applications, respectively. Despite atomized lidocaine showing an early effect compared with EMLA, there were no significant differences in VAS scores between the atomized lidocaine and EMLA cream at the 60 and 120 s measurements. Although HR significantly increased at first anesthetic administration with the atomized lidocaine spray, HR significantly decreased at 30 and 120 s administrations. Conclusions: Atomized 10% lidocaine-based topical anesthetics significantly reduced pain more rapidly and better than EMLA from needle pricks in the buccal mucosa. Therefore, atomized lidocaine topical anesthesia could be used as a substitute for EMLA cream prior to buccal anesthetic administration. On the other hand, further comprehensive studies are required to explore the effects of several doses of atomized lidocaine in various areas of the oral cavity. Full article

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

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19 pages, 633 KiB

Open AccessReview

Ocular Manifestations in Children with Vernal Keratoconjunctivitis

by Matteo Capobianco, Marco Zeppieri, Giuseppe Gagliano, Federico Visalli, Fabiana D’Esposito, Roberta Foti, Ludovica Cannizzaro, Daniele Tognetto and Caterina Gagliano

Children 2025, 12(5), 609; https://doi.org/10.3390/children12050609 - 7 May 2025

Background: Vernal keratoconjunctivitis (VKC) is a chronic, recurrent, and frequently severe allergic ocular condition predominantly impacting children and adolescents in tropical and subtropical areas. It profoundly affects patients’ quality of life owing to its chronic symptoms and possible vision-threatening effects. Notwithstanding progress in [...] Read more.

Background: Vernal keratoconjunctivitis (VKC) is a chronic, recurrent, and frequently severe allergic ocular condition predominantly impacting children and adolescents in tropical and subtropical areas. It profoundly affects patients’ quality of life owing to its chronic symptoms and possible vision-threatening effects. Notwithstanding progress in comprehending VKC, its ocular symptoms and therapeutic approaches necessitate ongoing assessment. Aims: This review summarizes the main factors to consider when diagnosing, treating, and managing patients with VKC based on the current literature in this field. Methods: This comprehensive review examined peer-reviewed literature from 2010 to 2024 obtained from PubMed. The selection criteria encompassed research addressing the clinical presentation, diagnostic difficulties, and therapy of visual symptoms in pediatric patients with VKC. The publications chosen were those focusing on those that elucidate the pathophysiology, consequences, and innovations in treatment methodologies. Results: The ocular manifestations of VKC are varied and characterized by prominent symptoms such as severe itching, photophobia, lacrimation, and a viscous mucoid discharge. Clinical manifestations range from conjunctival hyperemia and limbal thickening to severe consequences that jeopardize vision, including shield ulcers and keratoconus. Improvements in imaging techniques such as anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy have enhanced diagnostic accuracy. The pharmacological approach has transitioned to steroid-sparing techniques, prioritizing mast cell stabilizers, antihistamines, and immunomodulators such as cyclosporine. Novel therapies, including biologics that target interleukin pathways, demonstrate potential in refractory instances. Nonetheless, access to modern medicines is restricted in resource-limited environments. Conclusions: VKC poses considerable diagnostic and treatment difficulties due to its chronic nature and possible consequences. This review emphasizes the necessity for prompt diagnosis and customized management approaches to avert vision impairment. Despite considerable advancements in comprehending VKC’s etiology and therapy, inequalities in access to sophisticated care highlight the necessity for global activities to guarantee equitable treatment alternatives. Full article

(This article belongs to the Section Pediatric Ophthalmology)

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15 pages, 1112 KiB

Open AccessArticle

Identification and Functional Characterization of a Novel SOX4 Mutation Predisposing to Coffin–Siris Syndromic Congenital Heart Disease

by Zi Yan, Bin-Bin Dong, Yan-Jie Li, Chen-Xi Yang, Ying-Jia Xu, Ri-Tai Huang, Xing-Yuan Liu and Yi-Qing Yang

Children 2025, 12(5), 608; https://doi.org/10.3390/children12050608 - 7 May 2025

Background/Objectives: Congenital heart disease (CHD) occurs in ~1% of all live neonates globally, rendering it the most prevalent developmental anomaly affecting humans; this condition confers substantial infant morbidity and mortality worldwide. Although there is ample evidence to suggest a paramount genetic basis for [...] Read more.

Background/Objectives: Congenital heart disease (CHD) occurs in ~1% of all live neonates globally, rendering it the most prevalent developmental anomaly affecting humans; this condition confers substantial infant morbidity and mortality worldwide. Although there is ample evidence to suggest a paramount genetic basis for CHD, the genetic etiologies underpinning the majority of CHD remain elusive. In the present study, SOX4 was selected as a significant candidate gene for human CHD, mainly because SOX4 is abundantly expressed in both human and murine hearts during embryogenesis, and the knockout of Sox4 in mice causes embryonic demise predominantly attributable to cardiovascular developmental defects. Methods: Sequencing analysis of SOX4 was fulfilled in 248 probands affected with various types of CHD and the available relatives of the identified variation carrier as well as 262 unrelated healthy individuals. Functional analysis of the mutant SOX4 protein was conducted by utilizing a dual-reporter gene system. Results: a novel heterozygous SOX4 variation, NM_003107.3:c.331G>T;p.(Glu111*), was discovered in a male proband with Coffin–Siris syndromic CHD. Genetic investigation of the proband’s available relatives revealed that the truncating variation co-segregated with the phenotype in the whole family. The nonsense variation was absent from 262 healthy controls. Functional analysis demonstrated that the Glu111*-mutant SOX4 lost transactivation on NKX2.5 and GATA4, two well-established genes that are causative factors for CHD. Moreover, the Glu111* mutation nullified the synergistic transactivation between SOX4 and TBX20, another CHD-causing gene. Conclusions: These findings support SOX4 as a causative gene accountable for familial Coffin–Siris syndromic CHD in humans. These findings may aid in developing personalized preventive and therapeutic strategies for patients with Coffin–Siris syndromic CHD. Full article

(This article belongs to the Section Pediatric Cardiology)

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16 pages, 1355 KiB

Open AccessSystematic Review

Investigation of Pre- and Postnatal Abnormalities Caused by Prenatal CMV Infection—Systematic Review

by Virág Bartek and Artur Beke

Children 2025, 12(5), 607; https://doi.org/10.3390/children12050607 - 6 May 2025

Background/Objectives: CMV (cytomegalovirus) is associated with several developmental disorders. The incidence of congenital cytomegalovirus infection is around 1%, depending on the region. Previous prospective studies have shown that certain ultrasound findings are predictive factors for prenatal CMV infection. Methods: During this systematic review, [...] Read more.

Background/Objectives: CMV (cytomegalovirus) is associated with several developmental disorders. The incidence of congenital cytomegalovirus infection is around 1%, depending on the region. Previous prospective studies have shown that certain ultrasound findings are predictive factors for prenatal CMV infection. Methods: During this systematic review, we searched PubMed and Embas. Out of 569 results, 19 met our search criteria (we included cases where prenatally positive amniocentesis PCR for CMV was performed or autopsy confirmed the CMV diagnosis). A total of 237 cases were reported from 19 studies. Results: In 64 cases, abortion or perinatal death occurred. The most common prenatal abnormalities were small for gestational age (n = 47), ventriculomegaly (n = 51), and hyperechogenic bowels (n = 39). A subependymal cyst was the most common prenatal MRI abnormality (n = 20). Hearing loss was observed in 61 cases (42 mild, 19 severe). Among prenatal signs, we found a correlation between hearing loss and ventriculomegaly (Fisher’s exact test, p = 0.0052). The most common neurological complication was speech delay. We were able to demonstrate a prenatal association with neurological complications and subependymal cyst (Fisher’s exact test, p = 0.00003547), but this pattern could only be reliably seen with MRI. Conclusions: In prenatally diagnosed CMV infection, ultrasound signals may be suitable for estimating the outcome. Conducting a prospective study and establishing a score would be worthwhile for its clinical application. In cases of ultrasound abnormalities and suspicion of CMV, it is worth performing a prenatal MRI, even in everyday practice. Full article

(This article belongs to the Special Issue Advances in Prenatal Diagnosis and Their Impact on Neonatal Outcomes)

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12 pages, 3528 KiB

Open AccessTechnical Note

Considerations and Challenges of Resorbable Intramedullary Nailing in Pediatric Forearm Fractures

by Gergő Józsa, Tamás Kassai, Marcell Varga, Ádám L. Dávid, Zoltán Tóth, Tibor Molnár, Eszter Antal, Anna Gabriella Lamberti, Hermann Nudelman and Aba Lőrincz

Children 2025, 12(5), 606; https://doi.org/10.3390/children12050606 - 6 May 2025

Background: Pediatric diaphyseal forearm fractures, often caused by sports or leisure activities, require treatment based on fracture stability. While stable fractures can be managed conservatively, unstable fractures typically require surgery, with elastic stable intramedullary (IM) nailing (ESIN) being the gold standard. Bioabsorbable [...] Read more.

Background: Pediatric diaphyseal forearm fractures, often caused by sports or leisure activities, require treatment based on fracture stability. While stable fractures can be managed conservatively, unstable fractures typically require surgery, with elastic stable intramedullary (IM) nailing (ESIN) being the gold standard. Bioabsorbable IM nails (BINs) offer an alternative by eliminating the need for implant removal surgery. Methods: Between May 2023 and January 2025, we consecutively managed 161 children with poly-L-lactic-co-glycolic acid (PLGA) BINs in two healthcare centers for diaphyseal forearm fracture and evaluated every reported difficulty and complication of resorbable IM nails. Results: Seven unique peri- or postoperative events occurred during the study period. Even with a high success rate, some complications occurred during the study period. Difficulties and complications were mainly dependent on the surgical technique. Iatrogenic complications such as bone cortex perforation and implant end split were evaluated, along with anatomical variations like focal and general medullary cavity stenosis narrowings that affected implant insertion. Secondary malalignment, one early (2 months) refracture, and one recurrent fracture (2 years) were also noted. Conclusions: Although BINs reduce the need for a second surgery, careful planning, technique, and follow-up are crucial for optimal outcomes. Further research is needed to assess long-term results and complications. Full article

(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)

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10 pages, 392 KiB

Open AccessArticle

Efficacy of Intravascular Therapeutic Hypothermia for Moderate to Severe Hypoxic–Ischemic Encephalopathy

by Tomonori Kurimoto, Takuya Tokuhisa, Itaru Hayasaka, Tsuyoshi Yamamoto, Eiji Hirakawa, Hiroshi Ohashi, Masaya Kibe, Asataro Yara, Takatsugu Maeda, Masato Kamitomo and Satoshi Ibara

Children 2025, 12(5), 605; https://doi.org/10.3390/children12050605 - 6 May 2025

Background/Objectives: Hypoxic–ischemic encephalopathy (HIE), affecting 1.3–1.7/1000 live births, is treated with conventional therapeutic hypothermia (TH) but carries significant mortality and neurological impairment. Here, we compared intravascular cooling with extracorporeal membrane oxygenation (ECMO) and conventional TH in neonates with moderate to severe HIE. Methods: [...] Read more.

Background/Objectives: Hypoxic–ischemic encephalopathy (HIE), affecting 1.3–1.7/1000 live births, is treated with conventional therapeutic hypothermia (TH) but carries significant mortality and neurological impairment. Here, we compared intravascular cooling with extracorporeal membrane oxygenation (ECMO) and conventional TH in neonates with moderate to severe HIE. Methods: We retrospectively analyzed single-center neonates born in 2000–2022. Neonates with a 10 min Apgar score ≤ 3 or umbilical artery pH ≤ 6.7, along with persistent pulmonary hypertension of the newborn and an oxygenation index of ≥25 to <40, were divided into ECMO (n = 17) and conventional TH (n = 18) groups and administered the Kyoto Scale of Psychological Development at 18 months. Results: Neonatal and maternal characteristics were similar between the groups. A significantly higher proportion of the ECMO group (70.6% vs. 33.3%) achieved a developmental quotient ≥ 70. Conclusions: Intravascular cooling with ECMO may improve the neurodevelopmental outcomes of neonates with HIE, severe acidosis, and low Apgar scores. Full article

(This article belongs to the Special Issue Issues Involving Prenatal Findings and Neonatal Outcomes)

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12 pages, 2913 KiB

Open AccessArticle

Exploring Conscious Sedation in Pediatric Oral Surgery: A Non-Randomized Clinical Trial on Safety and Efficacy

by Niccolò Cenzato, Lorenzo Pasquali, Gregorio Menozzi and Cinzia Maspero

Children 2025, 12(5), 604; https://doi.org/10.3390/children12050604 - 5 May 2025

Background: Conscious sedation is a well-established technique used in pediatric dentistry that reduces perioperative stress and pain while maintaining verbal contact with the patient. It is particularly beneficial for anxious, very young, or disabled children, improving cooperation and ensuring airway safety. The objective [...] Read more.

Background: Conscious sedation is a well-established technique used in pediatric dentistry that reduces perioperative stress and pain while maintaining verbal contact with the patient. It is particularly beneficial for anxious, very young, or disabled children, improving cooperation and ensuring airway safety. The objective of this study is to assess the safety and efficacy of conscious sedation in pediatric oral surgery by analyzing vital parameters before and after treatment. Methods: A total of 57 pediatric patients [29 females; 28 males], aged 5–14 years [mean: 9.4], were treated at the Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico of Milan between September 2022 and June 2024. The patients were divided into two groups: nitrous oxide sedation [Group A] and benzodiazepine sedation [Group B]. Informant consent, medical and dental history, vital signs, and anxiety levels were recorded. A statistical analysis was performed using the Wilcoxon test. Due to the non-randomized design of this study, potential selection bias and limitations in internal validity must be acknowledged. Results: The post-sedation diastolic pressure was significantly higher [p = 0.02] in Group b, while other vital parameters remained stable. Anxiety significantly decreased in both groups [p < 0.01], with a greater reduction in Group A. Conclusions: Conscious sedation is a safe and effective approach, maintaining stable vital parameters. The increase in diastolic pressure in Group B may be explained by preexisting anxiety and benzodiazepine pharmacodynamics. However, the absence of randomization may have influenced group allocation and outcome interpretation. Given the small sample size and the wide age range of the participants, further studies with larger and more homogeneous populations are necessary to refine and validate pediatric sedation protocols. Full article

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

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18 pages, 504 KiB

Open AccessArticle

Left Behind in Lockdown: How COVID-19 Deepened the Crisis in K-12 Physical Education

by Da’Shay Templeton, Ruslan Korchagin and Bree Valla

Children 2025, 12(5), 603; https://doi.org/10.3390/children12050603 - 5 May 2025

Background/Objectives: The COVID-19 pandemic has notably disrupted K–12 education globally, significantly impacting physical education and student health outcomes. This qualitative study investigates how the pandemic affected student physical fitness, motivation, and equitable access to fitness opportunities, particularly from the perspective of physical education [...] Read more.

Background/Objectives: The COVID-19 pandemic has notably disrupted K–12 education globally, significantly impacting physical education and student health outcomes. This qualitative study investigates how the pandemic affected student physical fitness, motivation, and equitable access to fitness opportunities, particularly from the perspective of physical education teachers. Guided by the Social Ecological Model, the research addresses how intrapersonal, interpersonal, organizational, community, and policy factors collectively influenced student physical fitness outcomes post-pandemic. Methods: A phenomenological methodology was employed, utilizing semi-structured interviews conducted via Zoom with eleven K–12 physical education teachers in Ventura County, Southern California. Participants were selected using criterion sampling, targeting educators experienced in teaching before, during, and after the pandemic. Thematic analysis with initial in vivo coding was used to authentically capture participant perspectives, supported by strategies like peer debriefing and member checking to enhance analytical rigor. Results: Findings highlighted significant declines in student physical fitness post-pandemic, including reduced endurance, flexibility, and strength, accompanied by increased sedentary behaviors. Teachers reported pronounced decreases in student motivation and engagement, with heightened resistance to structured physical activities. Socioeconomic disparities deepened, disproportionately impacting economically disadvantaged students’ access to fitness opportunities and nutrition. Additionally, physical education experienced systemic undervaluation, resulting in inadequate resources, inconsistent policy enforcement, and difficulties in accurately assessing students’ fitness levels. Conclusions: This study underscores the urgent necessity for systemic reforms to rejuvenate physical education programs and promote equitable health outcomes. Recommendations include increased funding, improved facilities, reduced class sizes, consistent policy enforcement, and enhanced administrative support. Full article

(This article belongs to the Special Issue Promotion of Physical Activity in Children and Adolescents from the School Setting)

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17 pages, 913 KiB

Open AccessArticle

The Individual and Combined Effects of Prenatal Micronutrient Supplementations on Neurobehavioral Developmental Disorders in Preschool Children

by Liwen Ding, Esben Strodl, Maolin Zhang and Weiqing Chen

Children 2025, 12(5), 602; https://doi.org/10.3390/children12050602 - 5 May 2025

Background: Neurobehavioral developmental disorders significantly affect children’s future well-being and contribute to the global disease burden. While prenatal micronutrient supplementation is crucial for fetal neural development, their individual and combined effects on subsequent neurobehavioral outcomes in childhood remain poorly understood. This study aimed [...] Read more.

Background: Neurobehavioral developmental disorders significantly affect children’s future well-being and contribute to the global disease burden. While prenatal micronutrient supplementation is crucial for fetal neural development, their individual and combined effects on subsequent neurobehavioral outcomes in childhood remain poorly understood. This study aimed to examine the individual and combined effects of prenatal micronutrient supplementation on neurobehavioral developmental disorders in preschool children, and to explore their effects across specific developmental domains. Methods: 15,636 mother-child dyads were recruited from the 2022 children’s survey in Shenzhen, China. Mothers provided information on prenatal supplementation of calcium, folic acid, iron, and multivitamins. Five domains of children’s neurobehavioral functioning were assessed using the Ages and Stages Questionnaire-Third Edition (communication, gross motor, fine motor, problem-solving, and personal-social status). Logistic regression models were used to estimate the effect of micronutrient supplementations on NDDs across crude, adjusted, and full-inclusion models. Combined effects were assessed by multiplicative and additive interactions calculated from crossover analysis. Results: 11.7% of preschool children were identified as at risk for neurobehavioral developmental disorders, with the highest prevalence in the gross motor domain. Prenatal multivitamin supplementation showed a protective effect against neurobehavioral developmental disorders (OR = 0.73, 95% CI = 0.66–0.81). Interaction analysis revealed that the combination of iron and multivitamins further enhanced this protection, with both multiplicative (IOR = 1.26, 95% CI = 1.02–1.57) and additive interactions (RERI = 0.18, 95% CI = 0.02–0.35). The problem-solving domain consistently showed the greatest benefit from the supplementation of these micronutrients individually and in combination. Conclusions: Prenatal multivitamin supplementation reduces the risk of neurobehavioral developmental disorders, especially when combined with iron supplementation. These findings highlight the potential benefits of prenatal co-supplementation strategies to improve neurobehavioral outcomes in offspring. Further studies are recommended to confirm these findings and explore underlying mechanisms. Full article

(This article belongs to the Special Issue Cognitive Development in Children)

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11 pages, 382 KiB

Open AccessArticle

Child-Centrism as an Adaptive Parenting Style: A Prospective Study in Motherhood from Women’s Life Satisfaction Including Cognitive–Emotional Resources

by Celia Arribas, Patricia Catalá, Cecilia Peñacoba, Maria Crespo and Miri Kestler-Peleg

Children 2025, 12(5), 601; https://doi.org/10.3390/children12050601 - 5 May 2025

Background: Child-centrism refers to a parenting style where parents prioritize children’s needs above their own. Early research suggested that it could harm parental well-being, yet recent findings indicate that mothers adopting this style may experience greater psychological well-being and meaning in child-rearing. This [...] Read more.

Background: Child-centrism refers to a parenting style where parents prioritize children’s needs above their own. Early research suggested that it could harm parental well-being, yet recent findings indicate that mothers adopting this style may experience greater psychological well-being and meaning in child-rearing. This study examines child-centrism as a complex, context-dependent style and aims to clarify its adaptive or non-adaptive nature through a prospective, longitudinal approach. Methods: A four-wave design included 231 mothers assessed at (T1) third trimester of pregnancy, (T2) eight weeks postpartum, (T3) five months postpartum, and (T4) five years postpartum. Self-reported measures included life satisfaction (T1), maternal self-efficacy (T2), positive affect (T3), and child-centrism (T4). Sociodemographic data (age, family status, education, income, working) were also collected. Statistical analyses tested a serial mediation model. Results: Life satisfaction at T1 significantly predicted maternal self-efficacy at T2 (p = 0.002), which in turn enhanced positive affect at T3 (p < 0.001). Positive affect at T3 then positively influenced child-centrism at T4 (p = 0.023). However, life satisfaction did not directly affect child-centrism (p = 0.970), indicating a sequential mediation pathway rather than a direct link. Conclusions: These findings highlight that higher prenatal life satisfaction indirectly fosters an adaptive form of child-centrism through maternal self-efficacy and positive affect. Integrating motherhood into a woman’s sense of identity appears to be a protective factor, promoting healthier cognitive and affective parenting resources. Preventive interventions could focus on strengthening women’s life satisfaction and self-efficacy early in pregnancy, thereby enhancing affective well-being and potentially leading to a more meaningful, child-centric parenting style. Further research should include broader maternal and child well-being indicators. Full article

(This article belongs to the Special Issue Screen Time, Adverse Childhood Experiences and Childhood Mental Health on Child and Adolescent Development: Current Research and Future Directions)

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