Search Results (2,073)

Idiopathic scoliosis (IS) is a three-dimensional spinal deformity often associated with secondary postural deviations (pelvic asymmetry, altered kyphosis/lordosis, and postural imbalance), which may negatively affect psychological well-being and quality of life (QoL). Physiotherapy interventions designed specifically for scoliosis, known as Physiotherapy scoliosis-specific exercises (PSSE), have shown effectiveness in improving primary structural outcomes such as Cobb angle (CA) and angle of trunk rotation (ATR); however, their influence on secondary postural deviations is still unclear. This scoping review aimed to summarize current evidence of PSSE on secondary postural deviations in children, adolescents, and young adults with mild to moderate IS: Following PRISMA-ScR guidelines, searches were conducted in PEDro, PubMed, Scopus and Google Scholar for studies published in the last 10 years. Eligible studies were appraised using study design-specific quality assessment tools. Randomized controlled trials (RCT) were evaluated using the Physiotherapy Evidence Database Scale (PEDro), the retrospective cohort study was assessed using the Newcastle–Ottawa Scale (NOS), and the prospective observational study was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. Outcomes included pelvic asymmetry, spinal deviations, mobility, trunk symmetry/morphology, balance, proprioception, sensorimotor control, and QoL. Six studies involving 230 participants with mild-to-moderate IS were included. PSSE was associated with improvements in CA, ATR, postural alignment, spinal mobility, and QoL. Adjunctive interventions, including manual therapy (MT), proprioceptive neuromuscular facilitation (PNF), and hippotherapy, generally produced greater improvements in postural symmetry, pelvic alignment, proprioception, and sensorimotor control than PSSE alone. PSSE appears to improve structural, postural, and functional outcomes in individuals with IS, with adjunctive interventions potentially enhancing these effects. However, current evidence is limited by heterogeneity, highlighting the need for high-quality RCTs with standardized protocols and long-term follow-up. Full article

Background: This study applies Buysse’s sleep health framework to examine sleep in children and adolescents with neurofibromatosis type 1 (NF1). By examining sleep timing, daytime sleepiness, sleep quality, sleep behavior, sleep duration, and sleep efficiency together, this framework captures the multidimensional nature of sleep and its relationship with biopsychosocial factors and health-related quality of life (HR-QoL) in NF1. Methods: This multi-site, prospective, cross-sectional study included 131 children and adolescents with NF1 and 71 typically developing (TD) controls aged 6 to 16 years. A sleep health composite was derived from carer rating scales and 7 days of actigraphy. A biopsychosocial framework was used to examine factors associated with sleep health in NF1, including sociodemographic, cognitive, psychopathology, and biological variables. Independent predictors of QoL were examined to assess the unique contributions of sleep quality, sleep duration, and previously established predictors of HR-QoL in NF1. Results: Poorer sleep health was evident in children with NF1. Compared with TD controls, children with NF1 were five times as likely to have poor sleep quality, with almost 78% demonstrating impaired sleep efficiency and nearly half not obtaining sufficient sleep at night. The strongest risk factors were being male, elevated pain, and having greater levels of ADHD and autism spectrum disorder traits. Conclusions: Findings suggest sleep health in NF1 is interconnected with multiple biopsychosocial factors. A better understanding of these relationships will help identify early risk markers, improve prediction of clinical trajectories, and guide the development of targeted multimodal interventions for sleep disruption in NF1. Full article

Objectives: Hypospadias is one of the most common congenital malformations of the male genitourinary system, and postoperative complications remain a major concern affecting surgical outcomes and patients‘ quality of life. Whether machine learning models can effectively predict complication risk using routinely available clinical variables remains unclear. Methods: A retrospective analysis was performed on 671 hypospadias patients who underwent urethroplasty at the Department of Urology, Capital Children’s Medical Center, between December 2015 and September 2024. The final dataset included 671 patients (training set: 536; validation set: 135). The median follow-up duration was 48 months (range: 19 to 72 months). Least absolute shrinkage and selection operator (LASSO) regression with nested cross-validation within the training set was used for feature selection, followed by the development of five machine learning models (Random Forest, XGBoost, LightGBM, Logistic Regression, and Support Vector Machine). Model performance was evaluated using AUC, calibration curves, Brier score, and decision curve analysis. Feature importance was assessed using SHapley Additive exPlanations (SHAP). Results: LASSO retained four features for model development: hypospadias type, surgical technique, surgeon experience, and patient age. The overall complication rate was 22.9% (154/671). Among the models evaluated, the Support Vector Machine (SVM) showed the most balanced performance in the validation set, achieving an AUC of 0.810 and a Brier score of 0.157. LightGBM demonstrated comparable performance (AUC: 0.802). SHAP analysis identified surgical technique as the most influential predictor, followed by surgeon volume and hypospadias type, though these findings should be interpreted with caution given the confounding between surgical complexity and disease severity. Conclusions: An interpretable SVM-based prediction model was developed and internally validated to stratify risk for postoperative complications after hypospadias repair using routinely available clinical variables. SHAP provided clinicians with visual insights into key risk-associated factors. However, given the single-center retrospective design and lack of external validation, further multicenter prospective studies are warranted to confirm the generalizability of these findings before clinical implementation. Full article

Background: Disease-modifying therapies have profoundly changed the natural history of spinal muscular atrophy (SMA) type I, shifting rehabilitation priorities beyond survival and motor function toward participation, autonomy, and quality of life. However, rehabilitation models have not evolved at the same pace, and the role of early powered mobility in this new clinical scenario remains insufficiently conceptualized. Methods: This narrative review integrates current evidence on early powered mobility in children with severe motor disabilities with contemporary rehabilitation frameworks, including the International Classification of Functioning, Disability and Health (ICF), participation-based therapy, family-centered care, and the concept of on-time mobility. Evidence from the AMEsobreRuedas research program is incorporated to develop a conceptual framework for early powered mobility in children with SMA type I receiving disease-modifying therapies. Results: Current evidence suggests that early powered mobility should be understood as a developmental rehabilitation intervention rather than solely as an assistive technology for transportation. Independent mobility facilitates exploration, play, social interaction, autonomy, and participation, while positively influencing family experiences and expectations. Findings from the AMEsobreRuedas program further indicate that the benefits of powered mobility extend beyond driving skill acquisition, supporting participation, quality of life, and family well-being when implemented within meaningful daily contexts. Based on this evidence, a conceptual framework is proposed in which independent mobility acts as an early facilitator of developmental opportunities, with participation emerging through the interaction between the child, family, and environment. Conclusions: In the era of disease-modifying therapies, rehabilitation in SMA should move from a motor-centered approach toward a participation-oriented model. Early powered mobility represents a key intervention for promoting developmental opportunities and meaningful participation rather than simply compensating for motor impairment. The proposed conceptual framework may support clinical decision making and provide a foundation for future rehabilitation research in pediatric neuromuscular disorders. Full article

Background: Allergic rhinitis (AR) is a chronic condition that affects children’s quality of life. Studies show that adding bacterial lysates (BLs) to treatment can improve outcomes, but their effects on the immune system are still not fully understood. Objectives: This study aimed to evaluate the immunomodulatory impact of sublingually administered polyvalent mechanical BL (PMBL) on the expression of T helper (Th) cell-associated transcription factors and cytokines in children with grass pollen-induced AR. Methods: Immunological analyses were performed on blood samples collected during a previously conducted randomised, double-blind, placebo-controlled clinical trial (NCT04802616). Children aged 5–17 years with grass pollen-induced AR received either sublingual PMBL or placebo in three 10-day treatment cycles, each followed by a 20-day break. Peripheral blood mononuclear cells were collected at baseline before the grass pollen season (V1) and after completion of the study treatment during natural peak pollen exposure (V2) and analysed by flow cytometry to assess the expression of transcription factors and cytokines associated with Th1, Th2, Th10, Th17, and Treg-like immune responses. Results: In the PMBL group, there was a significant increase in the expression of T-bet, E4BP4, FoxP3, IFN-γ, and IL-10, along with a reduction in GATA3 and IL-4 expression (p < 0.001). The placebo group exhibited increased expression of GATA3 (p < 0.001), RORγT (p < 0.001), and IL-4 (p = 0.004) and a reduction in T-bet expression (p = 0.007). Between-group comparisons at V2 revealed significantly higher expression of Th1-, Th10-, and Treg-associated markers, and lower Th2- and Th17-associated markers in the PMBL group compared to placebo. Conclusions: Sublingual PMBL administration modulates the expression of Th cell-associated transcription factors and cytokines in children with grass pollen-induced AR, consistent with enhanced Th1-, Th10-, and Treg-like immune responses and reduced Th2-associated activity. Full article

Background and Objectives: Children with cerebral palsy (CP) are at increased risk for oral health problems, yet prospective evidence on the impact of dental rehabilitation on oral health-related quality of life (OHRQoL) in this population remains limited. This study aimed to prospectively evaluate the effects of comprehensive chairside dental rehabilitation on OHRQoL in children with spastic-type CP across two age groups, and to compare outcomes with healthy controls over a 12-month follow-up period. Materials and Methods:This prospective controlled pilot study included 22 children (11 with spastic-type CP, 11 healthy controls), individually matched by age, sex, and caries index (dmft/DMFT). Participants were divided into two subgroups based on dentition stage: the primary dentition group (n = 12; 6 CP, 6 controls; ages 4–6, assessed with the parent-reported ECOHIS) and the mixed dentition group (n = 10; 5 CP, 5 controls; ages 7–10, assessed with the POQL, which incorporates both child-reported and parent-reported forms). OHRQoL was measured at baseline, 3, 6, and 12 months. Comprehensive chairside dental rehabilitation was performed in accordance with AAPD guidelines. The Friedman test and Mann–Whitney U test were used for within-group and between-group comparisons, respectively. Effect sizes (Kendall’s W and r) and 95% confidence intervals were calculated for statistically significant findings. Results: Parent-reported POQL scores demonstrated statistically significant improvement over 12 months in both the CP (p = 0.004) and control (p = 0.007) groups, with the most pronounced change occurring between baseline and the 12th month. ECOHIS scores and child-reported POQL scores decreased across time points without reaching statistical significance. No significant between-group differences were detected at any time point. Conclusions: Comprehensive chairside dental rehabilitation was associated with significant improvements in parent-reported OHRQoL in both children with CP and healthy controls, whereas ECOHIS and child-reported POQL scores showed numerical improvements that did not reach significance. These findings indicate that high-functioning children with spastic-type CP can benefit from dental rehabilitation comparably to their healthy peers, though larger and more heterogeneous samples are needed to confirm and generalize these preliminary results. Full article

Ultra-processed foods (UPFs) are increasingly prevalent in global diets and have been consistently associated with adverse health outcomes. Their consumption during sensitive life stages, such as pregnancy and early childhood, raises significant public health concerns due to potential intergenerational effects. This narrative review critically examines the impact of UPF consumption during pregnancy and early life, with a focus on maternal and child health outcomes, including alterations in gut microbiota composition. Accumulating evidence indicates that UPF consumption is linked to increased risks of obesity, type 2 diabetes, cardiovascular disease, and all-cause mortality. During pregnancy, high UPF intake is associated with poorer diet quality, excessive gestational weight gain, increased inflammation, and unfavorable neonatal outcomes, including altered microbiota transmission and impaired neurodevelopment. In early childhood, UPFs were linked to microbiota dysbiosis, obesity, micronutrient deficiencies, and allergic conditions. Notably, maternal dietary pattern strongly influences the early and sustained incorporation of UPFs into children’s diets. Overall, UPF consumption during pregnancy and early childhood represents a modifiable risk factor with far-reaching health implications. A deeper understanding of the dietary–microbiome–health axis is essential for developing effective nutritional strategies to optimize maternal and child health outcomes and reduce long-term disease risks. Full article

Background/Objectives: Minimally verbal autistic children face profound communication challenges that significantly affect daily functioning, including social interaction, behavioral regulation, and overall well-being. Identifying effective interventions is a key clinical-educational priority. This systematic review examines communication-focused interventions for these children, including both spoken language approaches and augmentative and alternative communication (AAC) strategies. Methods: The review was registered in PROSPERO and conducted following PRISMA-S guidelines. Four electronic databases were searched, and 18 studies met the inclusion criteria. Due to heterogeneity in study designs and outcome measures, a narrative synthesis was conducted, with subgroup analyses exploring sample characteristics, intervention types, targeted outcomes, and reported effects. Methodological quality of randomized controlled trials was assessed using the Cochrane Risk of Bias tool. Results: Interventions were implemented across clinical, educational, and home settings, using strategies such as Joint Attention, Symbolic Play, and Emotion Regulation, often combined with AAC technologies. Most included studies reported improvements in at least one communication outcome, although findings were heterogeneous and several studies reported mixed, subgroup-specific, or non-significant effects. The most consistent improvements were observed in spontaneous communication, particularly in interventions integrating developmental approaches with technological support. Conclusions: These findings highlight the value of individualized interventions. Future research should establish standardized definitions of “minimally verbal”, assess long-term outcomes, and adopt broader measures capturing both language and social-emotional development to enhance quality of life and inclusion. Full article

Background/Objectives: Chemotherapy-related fatigue (CRF) affects 50–80% of children receiving chemotherapy and significantly impairs quality of life. Despite the family-centered care framework guiding pediatric oncology practice, evidence on parent-delivered, home-based non-pharmacological interventions for CRF remains limited. This study aimed to evaluate the effect of a parent-delivered warm-water foot bath on CRF in children aged 7–12 years undergoing chemotherapy. Methods: A two-arm parallel randomized controlled trial (NCT06529484; October 2024–May 2025) was conducted at a university hospital pediatric hematology–oncology outpatient clinic. Sixty-one children with stage 3–4 Non-Hodgkin Lymphoma (intervention, n = 29; control, n = 32) were randomized using computer-generated allocation and sequentially numbered, opaque, sealed envelopes. Following structured family education, parents delivered nightly foot baths (38–40 °C, 20 min) at home for 7 consecutive days after chemotherapy administration. Adherence and fidelity were monitored via a daily WhatsApp communication protocol. Fatigue was assessed daily using the Oncology Nursing Society Visual Fatigue Scale (ONS-VFS; primary outcome) and pre/post analysis using the Pediatric Oncology Fatigue Assessment Scale (child and parent forms). Reporting followed CONSORT 2025. Results: Median ONS-VFS scores declined significantly over the 7 days in both groups (Friedman p < 0.001 for each), from 5 (Day 1) to 2 (Day 7); between-group comparisons showed no statistically significant differences on any day (all p > 0.05). On the Pediatric Oncology Fatigue Assessment Scale, no between-group differences favored the intervention; a single child-report subscale difference favored the control group and is most plausibly attributable to multiple comparisons. Adherence was complete (100%), no adverse events occurred, and all 61 participants completed the protocol. Conclusions: A parent-delivered foot bath is a safe, feasible, and well-accepted family-centered nursing intervention, with complete adherence and no adverse events. This trial was not powered to detect between-group differences and did not demonstrate superiority over standard care; adequately powered trials are needed to determine efficacy. Full article

Severe treatment-resistant asthma (STRA) in children is often sustained by type 2 inflammation and eosinophil-dependent airway disease that persists despite optimized inhaled therapy and the mitigation of modifiable factors. This review summarizes the clinical and translational evidence on monoclonal antibodies targeting the interleukin-5 (IL-5) axis (anti-IL-5 and anti-IL-5Rα) available in pediatric severe asthma. PubMed/MEDLINE was searched up to January 2026 for English-language studies in patients aged 0–18 years addressing mepolizumab and benralizumab, including randomized trials, high-quality observational studies, meta-analyses, and international guidance. Mepolizumab has the most robust pediatric data, showing consistent reductions in exacerbations and blood eosinophils, and improvements in symptom control and quality of life, with safety broadly comparable to adults. The pediatric evidence for benralizumab is more limited but shows rapid eosinophil depletion, improved outcomes in selected children, and acceptable safety; further trials are ongoing. Overall, IL-5–directed biologics represent a key add-on option for carefully selected children with severe eosinophilic asthma, while pediatric-specific predictors of response, comparative effectiveness, and standardized long-term monitoring and stopping criteria remain priorities. Full article

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease that commonly begins in early childhood and substantially impairs quality of life. Patient-Oriented Eczema Measure (POEM) is a validated patient-reported outcome, whereas SCORing Atopic Dermatitis (SCORAD) is a widely used clinician-assessed severity index for AD. Methods: In this single-center observational analytical pilot study, 90 pediatric patients (1 month–15 years) diagnosed with AD, according to Hanifin and Rajka criteria, were recruited at Saint Constantin Hospital, Brașov, Romania (September 2025–February 2026). During one visit, caregivers and/or children completed the Romanian version of the POEM, and a dermatologist assessed disease severity using SCORAD. Demographic and clinical data were recorded. Descriptive statistics, group comparisons, linear regression, and correlation analyses (Pearson/Spearman) were performed (significance p < 0.05). The main objectives of the study were to translate and adapt the POEM questionnaire into Romanian for use in children with AD and to assess the relationship between POEM and SCORAD scores. Secondary objectives were to explore the influence of clinical and perinatal factors (sex, prematurity, mode of delivery, in vitro fertilization, breastfeeding) and the presence of other atopic diseases on AD severity. Results: POEM and SCORAD scores showed a strong positive correlation (rho = 0.841, p < 0.001), indicating that patient-reported symptom burden closely paralleled clinician-assessed disease severity. The presence of another atopic condition was independently associated with higher POEM (B = 4.31, p < 0.001) and SCORAD scores (B = 15.34, p < 0.001). No other demographic or perinatal factor showed a consistent independent association with disease severity. No significant independent associations were found for sex, age, prematurity, in vitro fertilization, or breastfeeding. Conclusions: This first Romanian pilot study in pediatric AD demonstrates a strong correlation between POEM and SCORAD and supports the concurrent use of POEM as a practical patient-reported tool alongside SCORAD in clinical practice, while recognizing the limitations of a relatively small cohort and single-visit design. Full article

Background/Objectives: Therapeutic education for children and adolescents with Type 1 Diabetes Mellitus (T1DM) is a continuous and essential process in the effective management of the disease. These programs consider the unique characteristics and developmental needs of each child or adolescent, aiming to empower them to take responsibility for their disease self-management, improve quality of life, and prevent complications. The purpose of this systematic review was to evaluate the impact of therapeutic education in children and adolescents with T1DM on self-management of their disease. Methods: International bibliography was reviewed using electronic databases such as PubMed, Cochrane Library, and Scopus. Key words such as “Therapeutic Education”, “Type 1 diabetes”, “children”, “self-management”, “glycemic control”, and “educational programs” in combination with Boolean operators (AND, OR) were used in English language to search for studies conducted during 2014–2024. Results: A total of 23 studies met the inclusion criteria. Most reported improvements in glycemic control, though not all showed statistically significant reductions in glycated hemoglobin (HbA1c). Enhanced treatment adherence and increased diabetes-related knowledge were common outcomes. Combined educational approaches incorporating psychoeducational interventions demonstrated greater effectiveness in promoting self-management. Digital tools, such as Continuous Glucose Monitoring (CGM), further supported adherence. Quality-of-life improvements were noted but were not always sustained long-term. Parental involvement appeared to improve children’s confidence in disease management. The critical role of interdisciplinary diabetes care teams, particularly nurses’ role, was also highlighted. Conclusions: Therapeutic education appears to support self-management among children and adolescents with T1DM, particularly when programs are individualized, family-centered, multidisciplinary, and supported by psychosocial or technological components. However, effects on glycemic control were not consistent across studies, and further research is needed to confirm long-term outcomes. Full article

Background: Traditional orthopaedic casting has remained the cornerstone of non-surgical fracture management for more than a century. Although plaster and fiberglass casts reliably stabilize fractures, they are associated with physical, psychological, emotional, social, and economic burdens that extend beyond bone healing. Children, older adults, and individuals with pre-existing vulnerabilities may be disproportionately affected. Despite increasing recognition of these complications, existing orthopaedic literature has historically prioritized radiographic healing and biomechanical stability, with limited synthesis of the broader multidimensional patient impact of traditional casting. Emerging technologies such as light-cured polymer mesh (LCPM) systems and 3D-printed lattice immobilizers have been developed to address these limitations and better align fracture care with patient-centered principles. Methods: A narrative review was conducted using a structured and transparent literature identification approach informed by PRISMA reporting principles; however, this study was not conducted as a formal systematic review and did not include risk-of-bias assessment or quantitative synthesis. A broad search of PubMed, Scopus, Web of Science, and Google Scholar was performed for studies published between January 2000 and July 2025. Search strategies combined MeSH terms and free-text keywords relating to orthopaedic casting, complications, psychosocial impacts, LCPM, and 3D-printed immobilizers. Following duplicate removal and a structured review process, 87 studies were included in the final narrative synthesis. Eligible studies included randomized controlled trials, observational studies, qualitative research, case series, and systematic reviews. Data were synthesized narratively across five domains: physical, psychological, emotional/social, economic, and technological alternatives. Results: Traditional plaster and fiberglass casts were consistently associated with musculoskeletal deterioration, joint stiffness, dermatological complications, and hygiene challenges. Psychological and emotional consequences included cast-induced anxiety, claustrophobia, depressive symptoms, and diminished autonomy. Social participation was frequently reduced due to mobility restrictions and perceived stigma, while economic impacts included hidden out-of-pocket expenses, caregiver burden, lost wages, and disparities in access to follow-up care. In contrast, emerging alternatives demonstrated promising advantages. LCPM systems improved ventilation, comfort, and hygiene, while reducing saw-related anxiety. Preliminary evidence suggests that both LCPM and 3D-printed systems may support improved patient experience and earlier return to selected activities, although larger comparative studies are needed to confirm effects on complication rates and long-term outcomes. Over time, these benefits may help offset higher upfront material costs. Conclusions: Fracture care should be evaluated not only by radiographic healing but also by patient-centered outcomes such as comfort, independence, and quality of life. Traditional casting imposes significant multidimensional burdens, whereas newer technologies such as LCPM and 3D-printed systems may offer a more holistic approach to immobilization while maintaining acceptable fracture stability in appropriately selected patient populations. While current evidence indicates potential physical, psychological, and economic advantages, large-scale comparative trials remain necessary to confirm long-term clinical, psychosocial, and cost-effectiveness outcomes across diverse populations. Future integration of emerging immobilization technologies into clinical practice may support more patient-centered, function-oriented, and cost-conscious approaches to fracture care. Full article

Background. Children’s health-related quality of life (HRQoL) has been associated with both individual and family-related factors, including internalizing symptoms and parental psychological well-being. Although previous research has highlighted the role of parental mental health, evidence from non-clinical community samples remains limited, particularly when parent-proxy reports are used. Methods. A cross-sectional study was conducted among 242 parents of children aged 8–12 years in Northern Greece. Parents completed proxy measures of children’s HRQoL and internalizing symptoms, as well as self-reported measures of their own HRQoL and anxiety. Nonparametric tests were used for bivariate analyses, and multiple linear regression was applied to identify independent predictors of children’s HRQoL. Results. Higher parental mental HRQoL was positively associated with children’s HRQoL (ρ = 0.213, p = 0.031), while parental anxiety (trait anxiety: ρ = −0.204, p = 0.004; state anxiety: ρ = −0.314, p < 0.001) and parent-reported child internalizing symptoms (depression: ρ = −0.369, p < 0.001; anxiety: ρ = −0.322, p < 0.001) were negatively associated with HRQoL; however, in the multivariable model, only parental mental HRQoL (B = 0.344, p = 0.020) and parental education (B = −2.944, p = 0.044) remained significantly associated with parent-proxy child HRQoL, explaining 29.2% of the variance in children’s HRQoL (R² = 0.292). Conclusions. The findings suggest that parent-proxy child HRQoL is associated with parental psychosocial functioning in this community-based sample. Parental mental HRQoL was the strongest independent correlate of parent-proxy child HRQoL. However, given the exclusive use of parent-proxy reports and the convenience-based sample, these findings should be interpreted cautiously, as shared method variance, rater-related effects, and limited generalizability may have contributed to the observed associations. Further multi-informant and longitudinal studies conducted in more diverse populations are warranted. Full article

Allergic diseases are increasing globally, particularly among children, who are highly vulnerable due to critical windows of immune development. This review examines climate change as a key environmental determinant driving the rising burden of pediatric allergic diseases, including asthma, allergic rhinitis (AR), atopic dermatitis (AD), and food allergy (FA). Climate change influences disease risk through interconnected pathways, such as increased air pollution, altered aeroallergen patterns, and more frequent extreme weather events. Elevated carbon dioxide (CO₂) levels and rising temperatures prolong pollen seasons and enhance allergenicity, while pollutants such as ozone (O₃) and particulate matter (PM) exacerbate airway inflammation and immune dysregulation. Emerging evidence emphasizes the role of early-life exposure, particularly during prenatal and early postnatal periods, when environmental insults can induce long-term effects via epigenetic modifications and immune reprogramming. These mechanisms may increase susceptibility to allergic sensitization and subsequent disease development. Epidemiological studies consistently link exposure to air pollution, including PM_2.5 (PM with aerodynamic diameter < 2.5 μm) and nitrogen dioxide (NO₂), with increased risk of allergic diseases in children. Additionally, climate change-related events such as wildfires, sand and dust storms, and thunderstorms further elevate exposure to allergens and pollutants, contributing to acute exacerbations and disease progression. Climate change may also contribute to allergic diseases through microbiome dysbiosis, as altered environmental microbial exposures, biodiversity loss, air pollution, and antibiotic-associated microbial disruption may impair immune tolerance and promote allergic sensitization in children. Addressing this growing public health challenge requires integrated mitigation strategies to reduce greenhouse gas (GHG) emissions and improve air quality, alongside adaptive interventions to enhance resilience and reduce exposure. Understanding these mechanisms is essential for developing targeted prevention strategies and protecting child health in a changing climate. Full article