Search Results (3,094)

Background/Objectives: Within Paediatric Palliative Care (PPC), motherhood in the context of severe cognitive impairment is shaped by unique emotional, relational, and identity-related challenges. Traditional understandings of maternal identity are strained when verbal communication and typical developmental milestones are absent. Although caregiving in PPC has been widely studied, the subjective and symbolic dimensions of motherhood in this setting have received far less attention. This study sought to explore how mothers construct, interpret, and make sense of their maternal identity while caring for a child with severe cognitive impairment in a PPC context, and to underscore the clinical relevance of these identity-related processes. Methods: A qualitative study was conducted involving nine mothers of children receiving paediatric palliative care services at a regional centre in Italy. Participants engaged in three online focus groups, totalling 270 min. Reflexive thematic analysis was employed to interpret the transcribed data, using ATLAS.ti software, version 25.0.1 ATLAS.ti Scientific Software Development GmbH, Berlin, Germany, for support. Member reflections were incorporated to validate the findings. Results: Three interconnected themes emerged from the reflexive thematic analysis. First, mothers described the development of a fusion-like, enmeshed mother–child relationship, characterised by embodied attunement, specialised interpretive expertise, and lifelong care dependency. Second, mothers detailed the construction of their maternal role, shaped by emotional labour, identity negotiation, sacrifice, loneliness, and peer support, alongside the construction of the child’s role, in which children were perceived as unique, symbolically meaningful beings whose social presence and limited reciprocity shaped maternal identity. Third, mothers articulated a search for meaning that sustained them throughout the caregiving journey, reframing their experience within a broader existential and relational perspective. Conclusions: Maternal caregiving in PPC encompasses distinct emotional, relational, and symbolic dimensions that extend beyond conventional understandings of motherhood. Grasping these identity-related dynamics has direct clinical relevance: it enables more attuned communication, strengthens the therapeutic alliance, and supports personalised, meaning-oriented care. These insights highlight the need for tailored interventions and further qualitative research to inform health care professionals and interdisciplinary practice. Full article

Gastrointestinal infections are a major cause of morbidity worldwide. Rotavirus (RVA) is the most frequent cause of severe diarrheal disease in children and is associated with high direct and indirect costs. Symptoms of RVA infection are nonspecific, so diagnostic confirmation requires laboratory testing, which is not routinely performed due to its high cost. For this reason, only a small proportion of hospitalizations are correctly classified. In this context, this study was conducted to determine the prevalence of RVA and 19 other potential etiological agents in 642 samples from pediatric patients with gastrointestinal symptoms at the Social Security Mexican Institute (IMSS). The findings revealed a prevalence of RVA of 26.8%. When analyzing the 321 samples that were processed for the full panel, the positivity rate was 94.4% (for any of the etiological agents tested) and a high percentage of coinfections were detected (69.8%), including up to seven different etiological agents in the same child. The RVA was more frequent in children under 1 year of age, with higher circulation in winter and spring, while bacterial infections showed a seasonal trend in summer. The proportion of hospitalizations was higher in coinfections than in monoinfections, and RVA was the pathogen with the highest percentage of hospitalizations. The results emphasize the etiological complexity of gastrointestinal infections in the pediatric population, highlighting the importance of using multiplex diagnostic tests for appropriate clinical care and effective epidemiological control strategies. Full article

Survival rates for children treated for malignant diseases continue to improve, yet many survivors face persistent late oral complications that affect function, aesthetics, and quality of life. Oncological therapy, especially at a young age and following head and neck radiotherapy or intensive chemotherapy, can disrupt dental and craniofacial development, resulting in dental developmental disorders, enamel defects, salivary gland dysfunction, caries susceptibility, periodontal problems, trismus, and osteoradionecrosis of the jaw. Although these effects are partially known, they are frequently underrecognized in routine practice, and many children do not receive adequate long-term dental follow-up. A key challenge highlighted in the recent literature is the absence of structured, evidence-based guidelines for monitoring and managing late oral effects. The article emphasizes the need for clearer recommendations, better communication of oncological treatment histories, and stronger integration of dental professionals within survivorship care. Developing standardized follow-up protocols will be essential to ensure timely detection, consistent management, and improved oral health outcomes for childhood cancer survivors. This article is intended as a narrative review, synthesizing available evidence from key publications to highlight clinically relevant late oral complications and gaps in current survivorship care. Full article

Parents’ awareness, attitudes, and perceptions of barriers to orthodontic care for children significantly influence decisions regarding early orthodontic interventions. This mixed-methods study explored parents’ perceptions of their child’s orthodontic needs and examined their experiences and perceived barriers to accessing early orthodontic treatment (EOT) among children aged 6–12 years. Methods: Quantitative data were collected using a 12-item validated questionnaire, while qualitative insights were obtained through structured interviews and analyzed thematically. Results: Parents’ perception of their child’s orthodontic needs was significantly associated with their attitude toward seeking consultation or treatment (p < 0.001). Among parents who sought consultation, only 38.7% had initiated the required orthodontic treatment. The most frequently reported barriers were high cost (32.1%), long appointment wait times (30.6%), and lack of insurance coverage (22.5%). Thematic analysis revealed four major barriers: financial, structural, cognitive, and psychological. Conclusions: These findings highlight critical challenges to accessing EOT for children, including affordability, long waiting times, limited parental awareness, and inadequate, timely referrals. Addressing these challenges through combined efforts at both the individual and community levels could significantly enhance the uptake of early orthodontic services in children. Full article

Liver function plays a pivotal role in the management of hepatocellular carcinoma (HCC). Consequently, managing HCC requires a dual focus on both tumour staging and liver function assessment to guide therapeutic decisions. Comprehensive liver function evaluation involves clinical tools such as the Child–Pugh classification and the Model for End-Stage Liver Disease (MELD) score. This is supplemented by newer metrics, including the MELD-Na score, the albumin–bilirubin (ALBI) grade and liver stiffness measurements. These assessments are integral to tailoring treatments, ranging from curative approaches such as surgical resection and liver transplantation to locoregional options (percutaneous ablation, transarterial chemoembolisation and radioembolisation), and systemic therapies. This review explores strategies for balancing the aggressiveness of cancer therapy with the need to preserve hepatic function, particularly in patients with advanced liver dysfunction. A multidisciplinary approach, incorporating expertise from hepatology, oncology, radiology and surgery, is essential for optimising outcomes. Advanced imaging techniques and biochemical markers also improve decision-making and ensure individualised care. Full article

As in adults, urolithiasis is a significant health problem in children from an early age, having a very negative impact on health and quality of life and potentially leading to kidney function impairment. The occurrence of deposits in the urinary tract in a child is almost always the result of significant predisposing factors, including metabolic defects involving the kidney or the entire body (often inherited in a Mendelian fashion), urinary tract defects, or urinary tract infections. Among metabolic disturbances, idiopathic hypercalciuria, preceded by hypocitraturia, is the most common one. Any child with nephrolithiasis requires a careful metabolic evaluation, including blood tests, urinalysis, and, in many cases, molecular diagnosis. This narrative review presents the epidemiology, pathophysiology, and diagnostic process in children with nephrolithiasis. Special emphasis is put on pathophysiological pathways leading to metabolic kidney stone disease and metabolic diagnostic steps in children with urolithiasis, as metabolic disturbances are the most common cause of recurrent urolithiasis in Europe and North America. Nephrolithiasis should be treated as a symptom of renal or systemic disorders, and in every child, the cause of these disorders should be sought to prevent recurrence. Full article

Refugee-serving primary health centres/clinics (PHCs) provide culturally safe, integrated care for refugee children, yet little is known about how their health conditions and outcomes are assessed. This scoping review examines the current literature on the health conditions and outcomes of refugee children aged 0–5 years and how they are measured in refugee-serving PHCs in Canada. In partnership with the New Canadians Health Centre and guided by Joanna Briggs Institute methodological guidelines, we systematically searched Medline, CINAHL, Scopus, and Embase. Included studies focused on refugee children in Canada and reported health conditions, outcomes, and their measurements within PHCs. Twenty-five studies (2008–2024) met the inclusion criteria, most from Ontario (n = 11), followed by Alberta and Saskatchewan (n = 4 each). Reported health conditions or outcomes (n = 24) spanned the physical (n = 19), developmental, and mental health domains (n = 5). Communicable (e.g., gastrointestinal infections, hepatitis) and non-communicable conditions (e.g., malnutrition, vitamin D deficiency) were mostly reported. Although some standardized approaches were used, substantial variability exists across provinces and conditions or outcomes measured. Findings reveal a disproportionate focus on physical health and notable variability and gaps in child health measures, limited cultural adaptation, and lack of longitudinal data. Standardized, culturally responsive, and age-appropriate measurement approaches are needed to enhance health equity and inform evidence-based policy for refugee children in Canada. Full article

Background/Objectives: Pediatric trauma systems require accurate metrics for evaluating triage decisions. Undertriage occurs when an injured child requires pediatric trauma center resources but is treated at a center lacking those resources. Current undertriage definitions utilize mortality-based scores, including the Injury Severity Score (ISS) > 15 or the International Classification of Disease (ICD) Injury Severity Score (ICISS). However, resource-based metrics like the ICD Critical Care Severity Score (ICASS) may be preferable in children. This study evaluated the relationship of ISS, ICISS and ICASS to the need for pediatric trauma resources (NFPTCR) to derive a more empiric definition of undertriage. Methods: The American College of Surgeons Trauma Quality Improvement Program database was queried for patients aged ≤ 15 years old. NFPTCR was defined as blood product transfusion within 4 h, invasive procedure for cardiopulmonary stabilization/contamination/bleeding within 72 h, initial admission to intensive care unit (ICU) or ICU stay ≥ 3 days, intubation, mechanical ventilation and general anesthesia ≤ 5 years old, or physical child abuse. ICASS and ICISS were derived from 2014 to 2018 datasets and applied to the 2019 dataset. The ability of ISS, ICISS and ICASS to distinguish NFPTCR patients was assessed using multivariable logistic regression and receiver–operator characteristic (ROC) analysis. Results: Out of 97,773 children, 15,985 (16%) were NFPTCR+. ISS, ICISS and ICASS had areas under the curve of 0.760, 0.701 and 0.812 for NFPTCR+, respectively (all p < 0.001). ISS had 36% sensitivity at 15; whereas ICASS had 95%, 93% and 89% sensitivity at 5, 10 and 15, respectively. Conclusions: ICASS was superior to ISS and ICISS for identifying NFPTCR. Consideration should be given to redefining pediatric trauma undertriage based on resource-based metrics, like ICASS. Full article

Background: Maternal overweight and obesity, which show a rising trend globally, are associated with adverse pregnancy outcomes and long-term health risks for both mother and child. Awareness and understanding of these risks among women of reproductive age are essential for effective prevention and early intervention. Methods: We conducted a cross-sectional survey among 958 women planning pregnancy, currently pregnant or breastfeeding to assess their knowledge and attitudes regarding overweight and obesity in the perinatal period. The questionnaire covered lifestyle behaviors, breastfeeding practices, and knowledge related to overweight and obesity in pregnancy. Results: Overall knowledge regarding the consequences of maternal overweight and obesity was low, with notable deficits in understanding the associated health risks and frequent misconceptions about dietary recommendations during pregnancy. Awareness gaps were particularly noticeable in domains related to fetal outcomes and recommended energy requirements across pregnancy. Excessive gestational weight gain was reported in over 75% of pregnancies, including among women with normal body mass index. Participation in antenatal classes, current breastfeeding and older age were significantly associated with higher knowledge; however, these factors together explained only 6.2% of variability. Still, several key aspects were not well recognized despite high educational attainment and frequent contact with maternity care services. Conclusions: Our study highlights a clear and urgent need for better, more targeted educational strategies to improve women’s understanding of metabolic health and nutrition before and during pregnancy. The low explained variance indicates that maternal knowledge is influenced by multifactorial and not easily captured determinants, emphasizing the need for comprehensive and individualized educational approaches. Enhancing maternal awareness could support better health outcomes for both mothers and their offspring. Full article

Grounded in stress-reactivity accounts and the Prosocial Classroom model, this study examines how preschool teachers’ responses to children’s negative emotions are associated with teacher job stress and age in Greek early childhood education settings. These frameworks suggest that elevated job stress may erode teachers’ regulatory resources and responsiveness, increasing non-supportive reactions and reducing supportive emotion coaching during emotionally charged classroom interactions. A sample of 101 full-time preschool educators (M age = 42.3 years; 97% female) completed two instruments: the Coping with Children’s Negative Emotions Scale (CCNES) and the Child Care Workers’ Job Stress Inventory (CCW-JSI). Age-controlled partial correlations indicated that higher job stress was associated with more frequent use of non-supportive reactions, including punitive and minimizing responses, and less frequent use of supportive strategies, such as emotion-focused, problem-focused, and expressive encouragement responses. Older teachers tended to report higher supportive response scores, particularly for problem-focused reactions and expressive encouragement. These findings highlight the importance of teacher well-being for the emotional climate of preschool classrooms and suggest that job stress may undermine educators’ capacity to consistently engage in supportive emotion socialization. The study contributes to the education literature by linking teacher stress and emotion socialization practices in a policy context where early childhood education is expanding but remains under-resourced. Implications for teacher education, professional development, and system-level initiatives to support educators’ social-emotional competence are discussed. Full article

This comparative study, the first to date, examines how representative samples of citizens across 40 OECD countries (N = 41,232) balance religion and child welfare when deciding whether to move a five-year-old thriving in foster care to match parental religion. Using a vignette experiment and six hypotheses, the analysis links religiosity, perceived religious rights, authoritarian values, institutional context, and confidence in child protection to placement preferences. A large majority (88%) would not move the child, prioritising stability and well-being. The results show a trust “paradox” in which higher confidence in child protection correlates with support for moving the child. Justifications show broad appeal to the best interest principle across opposing choices. Deference to professional assessment varies markedly across countries, indicating divergent authority of social work expertise. Findings underscore the need to operationalise the best interests standard and to account for institutional context, while policymakers should recognise stable placements as the public default. Full article

Although the American Academy of Pediatrics has long recommended universal autism-specific screening at well-child pediatric visits, implementation challenges in primary care settings interfere with high-fidelity universal autism screening. These challenges delay autism identification for some children, leading to delays in needed services and supports. Prior findings indicate that new solutions must be developed to bridge the gap in access to autism screening for families, particularly among those who are under-resourced. One approach is expanding screening to other community settings, such as childcare centers, but there are barriers to this approach, which this commentary aims to address. We discuss challenges and barriers in childcare screening identified through our recently completed pilot study screening for autism in childcare centers, with suggested strategies to address them. These challenges include hesitation among childcare staff to guide conversations or concerns about autism, and stigma around autism diagnosis and presentation. Other challenges relate to emerging concerns regarding legal, ethical, and professional roles and responsibilities surrounding informed consent and data privacy, as well as the identification of children without timely follow-up evaluation and services. There is a need for increasing public awareness as an essential component of autism screening across settings. Our commentary discusses different considerations and practice strategies to meet these needs. Full article

Sleep disturbances are prevalent among children receiving pediatric palliative care (PPC) and have a substantial negative impact on the quality of life of both patients and their families. This scoping review aims to examine further key factors contributing to sleep disturbances in PPC by analyzing available clinical studies, focusing on child-related aspects such as pain, repositioning, and epilepsy, as well as environmental factors such as light, noise, and the care setting. In addition, we discuss the critical role of interdisciplinary collaboration in improving sleep outcomes for this population and provide clinical implications. Future research should prioritize developing evidence-based interventions to optimize sleep and enhance the well-being of children with PPC needs and their caregivers. Full article

Children with special health care needs require health and related services beyond those required by children in general, which may affect their participation and inclusion in school. School nurses play a key role in supporting these children through a range of health-related interventions within the school setting. However, evidence on school nurse–led interventions for this population remains fragmented. This scoping review will follow the JBI methodology and aims to map the nature and extent of interventions developed by school nurses for children with special health care needs in school settings worldwide. The review will provide an overview of current practices and may inform the development of school health policies and evidence-informed nursing interventions. This research is registered on the Open Science Framework platform since 10 June 2024, with data updated on 26 August 2025. Full article