Search Results (706)

Background/Objective: The COVID-19 pandemic profoundly transformed social life worldwide, indiscriminately affecting individuals across all age groups. Children have not been exempted from the risk of severe illness and death caused by COVID-19. Objective: This paper sought to describe the clinical findings, laboratory and imaging results, and hospital care provided for severe and critical cases of COVID-19 in unvaccinated children, with or without severe asthma, hospitalized in a public referral service for COVID-19 treatment in the Brazilian state of Pernambuco. Methods: This was a case series study of severe and critical COVID-19 in hospitalized, unvaccinated children, with or without severe asthma, conducted in a public referral hospital between March 2020 and June 2021. Results: The case series included 80 children, aged from 1 month to 11 years, with the highest frequency among those under 2 years old (58.8%) and a predominance of males (65%). Respiratory diseases, including severe asthma, were present in 73.8% of the cases. Pediatric multisystem inflammatory syndrome occurred in 15% of the children, some of whom presented with cardiac involvement. Oxygen therapy was required in 65% of the cases, mechanical ventilation in 15%, and 33.7% of the children required intensive care in a pediatric intensive care unit. Pulmonary infiltrates and ground-glass opacities were common findings on chest X-rays and CT scans; inflammatory markers were elevated, and the most commonly used medications were antibiotics, bronchodilators, and corticosteroids. Conclusions: This case series has identified key characteristics of children with severe and critical COVID-19 during a period when vaccines were not yet available in Brazil for the study age group. However, the persistence of low vaccination coverage, largely due to parental vaccine hesitancy, continues to leave children vulnerable to potentially severe illness from COVID-19. These findings may inform the development of public health emergency contingency plans, as well as clinical protocols and care pathways, which can guide decision-making in pediatric care and ensure appropriate clinical management, ultimately improving the quality of care provided. Full article

Research on children’s singing development is extensive. Different ages, approaches, and variables have been taken into consideration. However, research on singing with text or a neutral syllable is scarce, and findings are inconclusive. This study investigated the influence of singing with text and a neutral syllable on children’s vocal performance. Children aged 4 to 9 (n = 135) participated in two periods of instruction and assessment. In Period One, Song 1 was taught with text and Song 2 with a neutral syllable, and in Period Two, the text was added to Song 2. In each period, children were individually audio-recorded singing both songs. Three independent raters scored the songs’ vocal performances using two researcher-designed rating scales, one for each song, which included the assessment of tonal and rhythm dimensions. Before data analysis, the validity and reliability of the rating scales used to assess vocal performance were examined and assured. The results revealed that 4-, 5-, and 7-year-olds sang Song 1 significantly better in Period One, and 4- and 5-year-olds sang Song 1 significantly better in Period Two. Thus, singing with text seems to favour younger children’s vocal performance. Findings also revealed that girls scored significantly higher than boys for Song 1 in both periods, but not for Song 2 in Period One. The implications of incorporating songs with text and neutral syllables into music programs, as well as the instruments used to assess vocal performances, are discussed. Full article

An increase in invasive group A streptococcal (iGAS) infections among children under 15 years of age was reported in several countries between late 2022 and early 2023. This retrospective study aims to describe the epidemiology and clinical features of iGAS infections in children in Cyprus during the same period. Medical records of patients under 16 years old admitted with iGAS infection to the Archbishop Makarios Hospital, the only tertiary paediatric referral centre in Cyprus, between 1 January 2021 and 30 June 2024, were reviewed. Twenty-two cases were identified, of which twenty were classified as confirmed and two as probable. Half of the cases occurred in children aged 0–4 years, and 59% were recorded between December 2022 and April 2023. Scarlet fever was diagnosed in six children, five of whom developed pneumonia and empyema. Streptococcal toxic shock syndrome (STSS) was observed in five patients, resulting in two deaths and one case requiring prolonged extracorporeal membrane oxygenation (ECMO). The overall case fatality rate was 9.1%. Emm 1, belonging to the M1UK clone, was the predominant strain (66.6%). The findings underscore the severity of iGAS infections, particularly in younger children, and highlight the importance of timely diagnosis, appropriate management and continued epidemiological surveillance. Full article

Children are not only concerned about fairness but also care for others. This study examined how experimentally induced empathic concern influences children’s responses to inequity, particularly when fairness considerations may conflict with empathy-driven motivations. A sample of 10- to 12-year-old children (N = 111, 62 boys, 49 girls) from China were randomly assigned to an empathic or non-empathic condition and completed multiple rounds of ultimatum and dictator games, acting as recipients and proposers. The results showed that children in the empathic concern condition were more likely to accept disadvantageous offers (F (1, 109) = 10.723, p = 0.001) and reject advantageous offers (F (1, 109) = 11.200, p = 0.001) than those in the non-empathic condition. Furthermore, in the dictator game, children in the empathic condition shared significantly more resources with the same protagonist (F (1, 109) = 110.740, p < 0.001). These findings suggest that empathic concern affects children’s inequity aversion and that empathic concern takes priority in guiding children’s inequity aversion when it conflicts with the fairness criterion. Moreover, our findings suggest that altruistic motivations potentially play a role in children’s responses to their inequity aversion. Full article

Background/Objectives: Biofeedback interventions are increasingly utilized in pediatric and adult care, with evidence in treating specific medical conditions and specific symptoms. However, evidence supporting their efficacy among children and adolescents and young adults (AYAs, aged 15–39) with cancer is limited. The aims of this systematic review are to present, assess, and synthesize the existing research on biofeedback in pediatric and AYA oncology, identify gaps in biofeedback research within this population, and provide recommendations for future research and clinical implications. Methods: A systematic search for articles was conducted using six bibliographic databases—PubMed/MEDLINE (NLM), EMBASE (Elsevier), CINAHL (EBSCO), SPORTDiscus (EBSCO), PsycINFO (OVID), and PEDro (NeuRA)—with an update on 5/7/2025. Included were studies involving pediatric/AYA oncology participants (0–39 years old) and those receiving at least one biofeedback modality. The methodological quality and risk of bias among included articles were assessed using the Cochrane Risk of Bias (ROB) Tool (modified version for non-randomized studies). A narrative synthesis of included studies examined the type of cancer studied, type of biofeedback used, study designs and methodological quality, and key outcomes evaluated. Results: While the literature suggests that biofeedback may offer beneficial outcomes for managing various pediatric/AYA oncology-related symptoms, such as pain, anxiety, and fatigue, only 8 studies out of 1013 screened (<1%) met inclusion criteria. Limitations included low study quality (small sample sizes, lack of control groups, and methodological inconsistencies). Conclusions: While biofeedback shows promise as a feasible and effective intervention, there is a call to action for well-designed, methodologically rigorous studies to substantiate its effectiveness and inform evidence-based practice specifically for pediatric/AYA oncology patients and clinicians. Full article

Introduction: Dental caries and molar–incisor hypomineralisation (MIH) are prevalent conditions affecting children’s oral health, with functional, aesthetic, and psychosocial implications. In Spain, previous studies have highlighted geographic and sociodemographic disparities in their distribution, particularly among rural and migrant populations. Objective: To characterise oral health status, in terms of caries and MIH, among 6–7-year-old children from the towns of Palos de la Frontera, Mazagón, and San Bartolomé. Methods: A cross-sectional study was conducted involving 229 children recruited from public primary schools. Sociodemographic, anthropometric, and behavioural data were collected through clinical examination and interview. Statistical analysis included univariate and multivariate logistic regression. The study protocol was approved by the Ethics Committee of Huelva. Results: The prevalence of caries (DMFT ≥ 1) was 53.3%, with mean DMFT and dft indices of 1.78 and 0.31, respectively. MIH affected 32.8% of the cohort, with a predominance in the first permanent molars (teeth 36 and 26). Multivariate analysis identified independent predictors of caries: African (OR = 7.47; 95% CI: 2.84–23.8) and European (OR = 4.56; 95% CI: 1.26–22.3) parental origin, poor oral hygiene (OR = 3.07; 95% CI: 1.60–6.03), and the presence of MIH (OR = 3.20; 95% CI: 1.64–6.42). The municipality of San Bartolomé was associated with a higher risk of MIH (OR = 2.90; 95% CI: 1.21–7.45). Conclusions: The high prevalence of caries and MIH in the Condado-Campiña district, exceeding national averages, reflects oral health inequities linked to social determinants (migrant origin, locality) and clinical factors (MIH, oral hygiene). Targeted preventive interventions are urgently needed in high-risk populations, including culturally tailored education and policies ensuring equitable access to dental care services. Full article

The climate crisis poses profound risks to present and future generations. Nonetheless, the perspectives of children and young people internationally, and more specifically in Brazil, remain underexplored. Based on a multi-discipline literature review on climate anxiety and nature (dis)connectedness, the hypothesis is that the effects and symptoms of increasing (dis)connection with natural environments have short-, medium-, and long-term consequences. Access to natural spaces is a vital response to counteract the negative impacts of climate change. This article discusses findings from a study conducted in urban Brazil with 200 young people aged 12 to 18 years old, with the aim of addressing three research questions from ten questions that comprised the complete survey. The major research questions were as follows: 1. ‘Climate change worries me’: How do you relate to this statement? 2. How does climate change affect you?, and 3. Do you think some young people are more affected by climate change than others? The results show that young people care about and are preoccupied with climate change, especially when they reflect on their futures and the future generations. Although young participants are deeply concerned about climate change and feel its effects personally in the form of anxiety, fear, and insecurity, they often lack clear pathways for contributing to broader environmental efforts beyond individual actions. These findings highlight an urgent need to foster community-based approaches and enhance education and resources for enlarging and improving youth engagement, especially to rethink the everyday strategies addressing these challenges, and to foster new paradigms of interaction with the natural world based on (re)connection with natural spaces. The correlation between climate anxiety and nature (dis)connection offers an approach that is still little explored, especially concerning children and young people. Full article

Acute Rheumatic Fever (ARF) is more common in children in the developing world. The current incidence in the United Kingdom is reported to be less than 1 in 100,000 children. It is, however, rare in the developed world, particularly in the adult Caucasian population. We present a case of ARF in a 39-year-old Caucasian female who needed multiple hospital admissions before the ARF diagnosis was made. A comprehensive, up-to-date literature review of ARF in Caucasians is lacking. Therefore, a systematic literature review (SLR) of Medline, PubMed, and Google Scholar was conducted to investigate the characteristics, management, and prognostic outcomes of new cases of ARF among Caucasians. A total of 10 cases were reported from six countries between 1990 and 2022. The mean age of patients was 33.2 (range 18–41), and most were females (6, 60%). The most common presenting symptoms were fever, arthralgia, and malaise. All patients met the modified Jones criteria for ARF diagnosis. All patients received antibiotics, with only one patient requiring corticosteroids. Two patients developed rheumatic heart disease (RHD), and none died as a result of ARF. This case-based literature review underscores the critical importance of a high index of clinical suspicion in promptly diagnosing ARF to mitigate long-term sequelae of RHD. Full article

Background and Clinical Significance: Acquired myenteric hypoganglionosis is a rare dysmotility disorder that can present in childhood and adulthood, characterized by a reduced number of ganglion cells within Auerbach’s plexus. Due to the rarity of the pathology, few case reports of acquired myenteric hypoganglionosis in adolescents have been described. This case report explores the presentation, risk factors, and surgical complications associated with the ultimate diagnosis of myenteric hypoganglionosis. Case Presentation: We present a case of a 12-year-old male with a history of constipation and achalasia, presenting with constipation and abdominal distention, who underwent a colonoscopy, which was converted to an exploratory laparotomy with loop ileostomy creation due to persistent significant abdominal distention. This was complicated by colonic perforation, most likely secondary to stercoral colitis, requiring takeback to the operating room on postoperative day 11 for an exploratory laparotomy with bowel resection and mucous fistula creation. The patient was then referred to Boston Children’s Hospital for motility studies, which revealed poor colonic motility and plans to reassess motility in 1 year. Conclusions: Although rare, it is important to have high clinical suspicion for acquired myenteric hypoganglionosis in children, especially males, with severe constipation. Full article

Tetanus is a life-threatening, vaccine-preventable disease caused by tetanospasmin and tetanolysin, which are potent neurotoxins produced by Clostridium tetani, an anaerobic, spore-forming bacterium. Due to the widespread presence of spores in the environment, the disease cannot be eradicated. However, global tetanus prevention initiatives have contributed to a significant decline in tetanus incidence worldwide. Aiming to present the tetanus trends in Romania, we conducted a retrospective analysis of the tetanus surveillance data. During the study period (2010–2023), 97 cases of tetanus were reported in Romania (median: 6.5; IQR: 5–7) with an average incidence rate of 0.03 per 100,000 inhabitants (95% CI: 0.02–0.04; range: 0.01–0.09). The highest incidence rates were recorded among people aged 1 to 14 years old (0.09 per 100,000 inhabitants, 95% CI: 0.06–0.13; range: 0.00–0.20), male (0.05 per 100,000 inhabitants; 95% CI: 0.03–0.06; range: 0.03–0.12), and from rural areas (0.05 per 100,000 inhabitants; 95% CI: 0.03–0.08; range: 0.01–0.17). A decline in the number of tetanus cases of 7% by year was observed, which is supported by the statistical analysis showing a p-value of 0.005 (IRR: 0.93; 95% CI: 0.88–0.98). However, the same decline in tetanus incidence was not supported by the statistical analysis (IRR: 0.93; 95% CI: 0.44–1.98; p = 0.9). Forty-seven tetanus deaths were recorded, with an average case fatality ratio of 42% (95% CI: 25.62–57.92; range: 0–100), showing a decreasing trend of 9% by year (IRR: 0.91; 95% CI: 0.89–0.93). Although the annual number of tetanus cases in Romania has shown a slight downwards trend, its situation has remained relatively stable, as shown by the tetanus incidence. Moreover, the case fatality rate continues to be high. Therefore, our study emphasizes the importance of achieving high vaccination uptake among children and adolescents, raising awareness of the importance of booster doses in adults, and improving the management of tetanus-prone wounds. Full article

Background: Trauma-related injuries are among the most common reasons for paediatric hospital presentations and represent a substantial component of orthopaedic care. Their management poses unique challenges due to ongoing skeletal development in children. While most reported fractures occur at home or during sports, prior studies have primarily used data from urban European populations, limiting the relevance of their findings for rural and regional settings. Urban-centred research often informs public healthcare guidelines, treatment algorithms, and infrastructure planning, introducing a bias when findings are generalised outside of metropolitan populations. This study addresses that gap by analysing fracture data from two rural trauma centres in New South Wales, Australia. This study assesses paediatric fractures resulting from severe injury mechanisms in rural areas, identifying common fracture types, underlying mechanisms, and treatment approaches to highlight differences in demographics. These findings aim to cast a light on healthcare challenges that regional areas face and to improve the overall cultural safety of children who live and grow up outside of the metropolitan trauma networks. Methods: We analysed data from two major rural referral hospitals in New South Wales (NSW) for paediatric injuries presenting between 1 January 2018 and 31 December 2022. This study included 150 patients presenting with fractures following severe mechanisms of injury, triaged into Australasian Triage Scale (ATS) categories 1 and 2 upon initial presentation. Results: A total of 150 severe fractures were identified, primarily affecting the upper and lower limbs. Males presented more frequently than females, and children aged 10–14 years old were most commonly affected. High-energy trauma from motorcycle (dirt bike) accidents was the leading mechanism of injury among all patients, and accounted for >50% of injuries among 10–14-year-old patients. The most common fractures sustained in these events were upper limb fractures, notably of the clavicle (n = 26, 17.3%) and combined radius/ulna fractures (n = 26, 17.3%). Conclusions: Paediatric trauma in regional Australia presents a unique and under-reported challenge, with high-energy injuries frequently linked to unregulated underage dirt bike use. Unlike urban centres where low-energy mechanisms dominate, rural areas require targeted prevention strategies. While most cases were appropriately managed locally, some were transferred to tertiary centres. These findings lay the groundwork for multi-centre research, and support the need for region-specific policy reform in the form of improved formal injury surveillance, injury prevention initiatives, and the regulation of under-aged off-road vehicular usage. Full article

Suicide in children is a major global health crisis, with profound impacts on families, friends, and society. Understanding ways to ameliorate the rate of suicide attempt (SA) is critical given that it is a key factor in predicting future suicide risk. SA is the deliberate act of causing physical injury to oneself with the intent of death. The incidence of SA may be influenced by physical activity (PA). PA includes bodily movement via skeletal muscles that results in energy expenditure and physical fitness. While there is evidence to suggest that PA improves dysregulation of the parasympathetic nervous system which underpins the physiology of suicidal behaviour, evaluating the impact of PA on SA in children is required. Objectives: This systematic review aims to determine the relationship between PA and SA in children to inform alternative preventative and interventional strategies. Methods: This systematic review was registered with PROSPERO: CRD42023389415. Eight electronic databases were systematically searched. References were transferred to Covidence software for title and abstract screening and full text review were performed based on eligibility criteria: (1) children aged 6–18 years old; (2) participated in PA (individual, group exercise, or team sports); and (3) examined SA as a dependent variable. The JBI Checklist was used to measure the quality and level of bias of included studies. Results: Of the 2322 studies identified, 21 were included in the final analysis of the review. Twenty studies were cross-sectional in design, and one implemented a prospective study design. Thirteen studies (61.9%) yielded statistically significant results, indicating that increased PA, particularly team sport, may be associated with reduced odds of SA. There was some evidence to suggest that certain intensities and frequencies of PA may be beneficial to some and detrimental to other subgroups. Conclusions: The results suggest that PA may reduce the risk of suicide attempts. Although PA may be associated with reduced SA in children, future research is required, which (1) uses standardised outcome variables; (2) adopts longitudinal and experimental study designs; (3) explores qualitative research to determine distinctive factors that influence participation in PA not captured by quantitative research; and (4) examines different target populations such as children with a broad range of mental health issues. Full article

The research on teaching scaffolding for preschool children’s oral language development (OLD) has become an important topic in the academic world. However, there remains a lack of evidence-based research on the integration of scaffolding strategies integrated into creative art contexts to support children’s creative expression and language production. In this study, a qualitative case study was conducted to analyze the non-participatory observation and artwork analysis of five-year-old children’s drawing activities in a kindergarten in China based on socio-cultural and scaffolding theories. Three types of core scaffolding strategies were summarized. The findings reveal that the three strategies work together dynamically within the children’s Zone of Proximal Development (ZPD): (1) the visual prompt strategy enriches the vocabulary diversity of metaphors, adjectives, and ordinal words; (2) dialogic narrative co-construction effectively improves narrative coherence across exposition, rising action, climax, and resolution; and (3) emotional engagement strategies foster a safe expressive environment, promoting the integration of affective vocabulary with intrinsic motivation. Accordingly, a three-dimensional integrated “visual-linguistic-emotional” scaffolding model was constructed, emphasizing the practical guidelines of simultaneous scaffolding and gradual scaffolding withdrawal during the warm-up, creation, and sharing sessions of the drawing activity. This study expands the application of scaffolding theory in unstructured art contexts, and provides a systematic practical framework for the design of cross-contextual language support strategies and teacher training in preschool education. Full article

Adverse childhood experiences (ACEs) in early childhood may increase the risk of emotional behavioral problems (EBPs); however, few studies have explored the longitudinal effect of ACEs in early childhood on later EBPs and their underlying mechanisms. This study examined the serial mediating role of psychological resilience (PR) and problematic media use (PMU) in the relationship between ACEs in early childhood and EBPs. Participants included 534 three-year-old children (mean age of 33.29 years, SD = 3.97) and their parents from Wuhu, China. The parents completed online questionnaires measuring children’s ACEs, PR, and demographic information in September 2022 (Time 1), children’s PMU in September 2023 (Time 2), and EBPs in September 2024 (Time 3). Macro Process 6 was used to test the serial mediating effects of PR and PMU. A total of 5000 bootstrap samples were used to estimate the 95% confidence intervals. The results revealed that ACEs in early childhood did not directly predict EPBs. PR (b = 0.132 (95% CI [0.051, 0.221])) mediated the relationship between ACEs and children’s EBPs. PR and PMU also played a serial mediating role in the association of ACEs and children’s EBPs (b = 0.026, 95% CI [0.008, 0.054]). Our findings highlight the importance of improving PR and addressing PMU when designing interventions targeting Chinese preschoolers exposed to ACEs. Full article

Severe Acute Respiratory Syndrome (SARS) represents a significant cause of morbidity and mortality in children under one year of age, a particularly vulnerable population due to immunological and respiratory immaturity. The diverse etiology includes multiple respiratory viruses such as Respiratory Syncytial Virus (RSV), influenza, rhinovirus, and SARS-CoV-2, each with distinct potential to cause severe illness and death. Understanding the specific incidence and lethality by etiological agents in the recent Brazilian context (2024), after the COVID-19 pandemic, is essential to guide surveillance and public health strategies. This study aimed to analyze the risk of incidence and lethality by specific etiology of SARS in children under one year of age hospitalized in Brazil during the year 2024. A descriptive cross-sectional study was performed using secondary data from the 2024 Influenza Epidemiological Surveillance Information System (SIVEP-Gripe), obtained via OpenDataSUS. Reported cases of SARS hospitalized in children <1 year of age in Brazil were included. Distribution by final classification and epidemiological week (EW) was analyzed; the incidence rate by Federative Unit (FU) (cases/100,000 < 1 year) with risk classification (Low/Moderate/High) was assessed; and, for cases with positive viral RT-PCR, the etiological frequency and virus-specific lethality rate (deaths/total cases of etiology ×100), also with risk classification, were extracted. A multivariate logistic regression model was performed for the risk factors of death. A total of 66,170 cases of SARS were reported in children under 1 year old (national incidence: 2663/100,000), with a seasonal peak between April and May. The majority of cases were classified as “SARS due to another respiratory virus” (49.06%) or “unspecified” (37.46%). Among 36,009 cases with positive RT-PCR, RSV (50.06%) and rhinovirus (26.97%) were the most frequent. The overall lethality in RT-PCR-positive cases was 1.28%. Viruses such as parainfluenza 4 (8.57%), influenza B (2.86%), parainfluenza 3 (2.49%), and SARS-CoV-2 (2.47%) had higher lethality. The multivariate model identified parainfluenza 4 (OR = 6.806), chronic kidney disease (OR = 3.820), immunodeficiency (OR = 3.680), Down Syndrome (OR = 3.590), heart disease (OR = 3.129), neurological disease (OR = 2.250), low O₂ saturation (OR = 1.758), SARS-CoV-2 (OR = 1.569) and respiratory distress (OR = 1.390) as risk factors for death. Cough (OR = 0.477) and RSV (OR = 0.736) were associated with a lower chance of death. The model had good calibration (Hosmer–Lemeshow p = 0.693) and overall significance (p < 0.001). SARS represented a substantial burden of hospitalizations, with marked seasonal and geographic patterns. RSV and rhinovirus were the main agents responsible for the volume of confirmed cases but had a relatively low to moderate risk of lethality. In contrast, less frequent viruses such as parainfluenza 4, influenza B, parainfluenza 3, and SARS-CoV-2 were associated with a significantly higher risk of death. These findings highlight the importance of dissociating frequency from lethality and reinforce the need to strengthen etiological surveillance, improve diagnosis, and direct preventive strategies (such as immunizations) considering the specific risk of each pathogen for this vulnerable population. Full article