Children

15 pages, 449 KB

Open AccessArticle

The Role of Spirometry and MMEF in Pediatric Asthma Monitoring and Prediction of Exacerbations

by Paraschiva Chereches-Panta, Ioana Marica, Valentina Sas, Alina Petronela Bouari-Coblișan and Sorin Claudiu Man

Children 2025, 12(10), 1398; https://doi.org/10.3390/children12101398 - 16 Oct 2025

Abstract

Background: Asthma is the most common chronic disease during childhood. Spirometry is recommended as a reliable lung function test. Several studies have demonstrated the lack of use of spirometry for both diagnostic confirmation and monitoring. Using subjective symptom control tests alone may [...] Read more.

Background: Asthma is the most common chronic disease during childhood. Spirometry is recommended as a reliable lung function test. Several studies have demonstrated the lack of use of spirometry for both diagnostic confirmation and monitoring. Using subjective symptom control tests alone may underestimate the risk for future asthma attacks. Methods/Objectives: We conducted a retrospective, observational study in a single pediatric centre in Romania. The main objectives of the study were to analyse the quality of spirometry in children and to emphasise the importance of performing accurate spirometry for asthma monitoring. The secondary objective was to evaluate if forced expiratory volume in the first second (FEV1) and mid-maximum expiratory flow (MMEF) values are predictive markers for future exacerbations in children with asthma. Results: The study group included 416 patients between 5 and 18 years who performed at least one spirometry. The success rate for spirometry in our study was 66.3%. In a subsequent study group of 88 patients we monitored spirometry initially and after 12 months. We found a statistically significant difference between FEV1 and MMEF in the controlled, partially controlled and uncontrolled groups (p = 0.0102 and p = 0.0001). Our study showed no association between FEV1 and risk for exacerbations (Rs = −0.156, p = 0.146) and an acceptably negative (Rs = −0.30) and statistically significant (p = 0.040) correlation between initial MMEF values and the number of exacerbations. Conclusions: Low initial MMEF values correlate with the number of exacerbations in a 12-month follow-up period. This suggests that evaluating MMEF alongside FEV1 in children with asthma could contribute to better identification of the risk of exacerbation. Full article

(This article belongs to the Special Issue Pulmonary Function in Children with Respiratory Symptoms)

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17 pages, 725 KB

Open AccessArticle

Quality of Life and Mental Health Problems in Pediatric Cardiac Arrest Survivors

by Tina Schwartz, Michael Weidenbach, Ingo Dähnert, Christian Paech and Franziska Markel

Children 2025, 12(10), 1397; https://doi.org/10.3390/children12101397 - 16 Oct 2025

Abstract

Background: Current research is paying more attention to neurological outcomes and quality of life after life-threatening events. Children with heart disease are particularly vulnerable, especially after resuscitation events. While newer data show that adults with heart failure and a left-ventricular assist device suffer [...] Read more.

Background: Current research is paying more attention to neurological outcomes and quality of life after life-threatening events. Children with heart disease are particularly vulnerable, especially after resuscitation events. While newer data show that adults with heart failure and a left-ventricular assist device suffer from a higher incidence of depression, mental health in pediatric heart disease patients is poorly understood. This is the first study in Germany to examine the quality of life and psychological burden in cardiac arrest survivors with congenital or acquired heart disease. Methods: This monocentric study retrospectively analyzed survival outcomes of pediatric heart disease patients who underwent in-hospital resuscitation between 2008 and 2022. The PedsQL and Strength and difficulties questionnaires were prospectively administered to survivors to assess quality of life and emotional/behavioral problems, while academic achievements were additionally documented. Results: Of 127 patients experiencing cardiac arrest, 91 (71.7%) survived to discharge. Most had complex congenital heart diseases; mean cardiopulmonary resuscitation duration was 14 min. Five patients received extracorporeal cardiopulmonary resuscitation. Of the 22 patients who were receiving follow-up care at the pediatric cardiology outpatient clinic at the time of the study, 14 completed questionnaires were received. Overall quality of life was comparable to healthy controls, though those with prolonged or multiple resuscitations showed lower physical, emotional, social, and school functioning scores. The Strengths and Difficulties Questionnaire revealed no pathological scores but elevated average values for hyperactivity and emotional problems in parent reports, and emotional and peer difficulties in self-reports, indicating increased psychological burden. Conclusions: While survival rates are comparable to international data, gaps exist in structured follow-up and neuropsychological care, especially for high-risk subgroups like ECMO survivors. Routine neuropsychological screening and multidisciplinary outpatient programs are essential to improve long-term follow-up care. Full article

(This article belongs to the Special Issue Evaluation and Management of Children with Congenital Heart Disease)

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12 pages, 925 KB

Open AccessArticle

Screen Time and Sleep Bruxism—A Comparison Between the Present Time and the COVID-19 Pandemic

by Nadezhda Mitova and Marianna Dimitrova

Children 2025, 12(10), 1396; https://doi.org/10.3390/children12101396 - 16 Oct 2025

Abstract

Objectives: The aim of this study is to assess the impact of screen time on the incidence of sleep bruxism in children during the COVID-19 pandemic. Methods: The parents of 266 children, aged 3–14 years, participated in the present study. They [...] Read more.

Objectives: The aim of this study is to assess the impact of screen time on the incidence of sleep bruxism in children during the COVID-19 pandemic. Methods: The parents of 266 children, aged 3–14 years, participated in the present study. They were provided with a 36-item questionnaire in order to collect data about their child’s personal information, general health, sleep bruxism, and the effects of the COVID-19 pandemic on them. The collected data were analyzed statistically using a chi-square (χ²) test, ANOVA with post hoc analysis (Tukey’s HSD), and a t-test. Results: Screen time increased significantly during the pandemic, especially among children using screens ≥180 min/day. The proportion of children spending 180–360 min/day doubled to 24.4%. Lower secondary school children had the highest screen time, with an increase of ~60 min/day during the pandemic. Smartphones were the most used device (50.8%), and on average, children with bruxism spent 32 min longer in front of screens than children without bruxism (p < 0.05). Conclusions: Daily screen use is common in children, and this increased during the COVID-19 pandemic. Children with sleep bruxism exhibit longer screen time than those without bruxism, suggesting that the former is a potential risk factor for the latter. Full article

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

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13 pages, 350 KB

Open AccessArticle

Navigating Parenting in Pediatric Oncology: Merging Psychodynamic Theory and Evidence-Based Practice

by Yael L. E. Ankri and Amichai Ben-Ari

Children 2025, 12(10), 1395; https://doi.org/10.3390/children12101395 - 16 Oct 2025

Abstract

Background/Objectives: Parenting a child with a chronic illness such as cancer presents distinct psychological challenges that often disrupt normative parenting patterns. Parents frequently struggle to maintain boundaries in response to their child’s heightened emotional needs, leading to overprotective or permissive behaviors. This study [...] Read more.

Background/Objectives: Parenting a child with a chronic illness such as cancer presents distinct psychological challenges that often disrupt normative parenting patterns. Parents frequently struggle to maintain boundaries in response to their child’s heightened emotional needs, leading to overprotective or permissive behaviors. This study revisits Winnicott’s theory of the “good enough parent” and explores its application in the context of pediatric oncology. We aim to examine how a psychodynamic framework can be integrated with evidence-based practices to support parental functioning and promote child resilience during cancer treatment. Methods: This conceptual paper employs a qualitative, theory-driven case study approach. We analyze the case of a 6.5-year-old girl diagnosed with acute lymphoblastic leukemia (ALL), focusing on the evolving dynamics between the child’s regressive behaviors and the parents’ emotional responses. Winnicott’s developmental model is expanded to conceptualize parenting as a continuous balance between responsiveness and structure. Clinical dialogues illustrate the therapeutic process of guiding parents toward a more adaptive stance. Results: The analysis highlights how permissive parenting, driven by parental guilt and fear, may initially reduce child distress, but can inadvertently reinforce emotional dysregulation and dependency. The application of a dialectical interpretation of Winnicott’s theory allowed for a therapeutic shift, supporting parents in setting empathic yet firm boundaries. Conclusions: A balanced, dialectical approach to parenting—one that integrates emotional attunement with appropriate demands—can enhance a child’s psychological resilience during cancer treatment. Incorporating psychodynamic insights into clinical practice can help professionals guide families toward more adaptive, developmentally supportive caregiving strategies. Full article

(This article belongs to the Special Issue Medical Trauma in Children: Actual Challenges)

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14 pages, 591 KB

Open AccessArticle

The Impact of Expressive Arts Therapy on Alexithymia Levels in Adolescent Inpatients with Severe Anorexia Nervosa

by Flavia Cirillo, Giulia Spina, Mariangela Irrera, Elena Bozzola, Cristina Mascolo, Livia Gargiullo, Valentina Burla, Marco Roversi, Carla Maria Carlevaris, Stefania Dusi, Italo Pretelli and Maria Rosaria Marchili

Children 2025, 12(10), 1394; https://doi.org/10.3390/children12101394 - 16 Oct 2025

Abstract

Background: Anorexia nervosa (AN) is a complex psychiatric disorder that requires a multidisciplinary approach. The World Health Organization recognizes the therapeutic value of expressive arts, including drama, in enhancing emotional, cognitive, and relational domains in severe mental illnesses such as AN. Expressive arts [...] Read more.

Background: Anorexia nervosa (AN) is a complex psychiatric disorder that requires a multidisciplinary approach. The World Health Organization recognizes the therapeutic value of expressive arts, including drama, in enhancing emotional, cognitive, and relational domains in severe mental illnesses such as AN. Expressive arts interventions may improve emotional intelligence, empathy, and self-awareness while reducing anxiety and alexithymia. This study evaluated the impact of an adjunctive expressive arts program on alexithymia in pediatric inpatients with AN. Methods: We enrolled patients aged 11–18 years hospitalized for AN, according to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, at the Pediatric Unit of Bambino Gesù Children’s Hospital, Rome. The study period ran from December 2024 to April 2025. Participants attended drama therapy sessions and expressive arts workshops in a dedicated recreational space integrated into a multidisciplinary treatment plan. Alexithymia was assessed at admission and discharge using the Toronto Alexithymia Scale (TAS-20), with scores ≥ 61 indicating alexithymia. At the end of the program, participants completed a semi-structured satisfaction questionnaire to evaluate subjective experiences and mood. Results: Thirty patients met inclusion criteria. The TAS-20 scores were statistically different between pre-/post-theater activity (p < 0.001). The proportion of alexithymic participants declined from 73.3% at baseline to 26.7% at discharge. Most participants reported mood improvements: 66.6% “somewhat” and 26.7% “greatly.” Additionally, 90% reported improved peer relationships. Conclusions: Expressive arts, particularly drama-based interventions, may represent an effective adjunctive therapy for adolescents with AN, supporting emotional awareness, self-regulation, and social connectedness. Arts-based interventions are associated with nonverbal avenues for emotional processing and may promote neuroplasticity, representing valuable complementary strategies for AN treatment. Full article

(This article belongs to the Special Issue Prevention and Treatment of Diet-Related Diseases Among Children and Adolescents)

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12 pages, 1972 KB

Open AccessArticle

Residual Adenoid Tissue After Conventional Adenoidectomy and the Role of Intraoperative Nasal Endoscopy: A Prospective Cohort Study

by Goran Latif Omer, Aland Salih Abdullah, Sahand Soran Ali, Stefano Di Girolamo, Sveva Viola, Andrea Bravetti, Maria Grazia Maglie, Sara Maurantonio, Laura Borghesi, Othman Hussein Ahmed, Aso Khasraw Ahmed, Amanj Hamaamin Hamaamin, Hemn Hussein Othman and Giuseppe De Donato

Children 2025, 12(10), 1393; https://doi.org/10.3390/children12101393 - 16 Oct 2025

Abstract

Background/Objectives: Conventional curettage adenoidectomy is widely performed but may leave residual tissue in anatomically hidden nasopharyngeal areas. We evaluated the impact of age and revision status on residual adenoidal tissue after conventional adenoidectomy and assessed outcomes following endoscopic completion. Methods: A [...] Read more.

Background/Objectives: Conventional curettage adenoidectomy is widely performed but may leave residual tissue in anatomically hidden nasopharyngeal areas. We evaluated the impact of age and revision status on residual adenoidal tissue after conventional adenoidectomy and assessed outcomes following endoscopic completion. Methods: A prospective cohort study included 178 patients undergoing conventional adenoidectomy followed by intraoperative nasal endoscopy. Residual tissue in the nasopharyngeal roof, Fossa of Rosenmüller, and around the Eustachian tube was resected using a microdebrider. Patients were categorized into four groups based on age (<9 or ≥9 years) and surgical history (primary vs. revision). Pediatric Sleep Questionnaire (PSQ) or STOP-BANG scores were collected pre- and postoperatively. Receiver operating characteristic (ROC) and logistic regression analyses were used to identify predictors of residual tissue. Results: Residual adenoid tissue was detected in 61.8% of patients after conventional adenoidectomy, highest among those ≥9 years undergoing revision (36.4%). Age ≥ 7.5 years and revision status predicted residual tissue (AUC = 0.71). Significant postoperative symptom improvement was observed (PSQ and STOP-BANG, p < 0.001). Complication rates were low (13.5%), with no recurrences reported. Conclusions: Conventional curettage often leaves residual adenoidal tissue in older and revision cases. Endoscopic completion improves outcomes. Primary endoscopic adenoidectomy is recommended for patients aged ≥7.5 years and those undergoing revision procedures. Full article

(This article belongs to the Section Pediatric Otolaryngology)

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16 pages, 1107 KB

Open AccessArticle

Diagnostic Accuracy and Clinical Impact of Handheld Point-of-Care Ultrasound in Pediatric Odontogenic Infections: A Prospective Cohort Study

by Hanna Frid, Amir Bilder, Ahmad Hija and Omri Emodi

Children 2025, 12(10), 1392; https://doi.org/10.3390/children12101392 - 15 Oct 2025

Abstract

Background: Pediatric odontogenic infections pose significant diagnostic challenges, particularly in distinguishing between cellulitis and abscess. Accurate differentiation is crucial for guiding appropriate management—antibiotics alone for cellulitis versus surgical incision and drainage (I&D) for an abscess—but can be difficult without specialized expertise or advanced [...] Read more.

Background: Pediatric odontogenic infections pose significant diagnostic challenges, particularly in distinguishing between cellulitis and abscess. Accurate differentiation is crucial for guiding appropriate management—antibiotics alone for cellulitis versus surgical incision and drainage (I&D) for an abscess—but can be difficult without specialized expertise or advanced imaging. Objective: We aimed to evaluate the diagnostic accuracy of handheld point-of-care ultrasound (POCUS; Philips Lumify), utilized by non-specialist clinicians, in differentiating cellulitis from abscess in pediatric odontogenic infections. A secondary objective was to assess its impact on reducing hospital admissions and emergency department (ED) burden. Methods: This prospective cohort study involved 111 pediatric patients (aged 1–17 years) presenting with maxillofacial odontogenic infections to a tertiary care academic medical center. Following clinical evaluations, handheld POCUS assessments were performed by trained non-specialist clinicians. Findings from I&D or clinical resolution with antibiotics served as the reference standard. Ninety cases were included in the final diagnostic accuracy analysis after 21 exclusions. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy with 95% confidence intervals (CIs) were calculated. Hospital admission trends were compared before (2017–2021) and after POCUS implementation (January 2022–April 2025). Interpretation should consider potential verification bias from the asymmetric reference standard (I&D for abscess vs. clinical resolution for cellulitis). Results: Handheld POCUS exhibited a sensitivity of 72.97% (95% CI: 57.02–84.60%), specificity of 73.58% (95% CI: 60.42–83.56%), PPV of 65.85% (95% CI: 50.55–78.44%), NPV of 79.59% (95% CI: 66.36–88.52%), and overall accuracy of 73.33% (95% CI: 63.38–81.38%). Following POCUS implementation, the annualized hospital admission rate for pediatric facial odontogenic infections decreased from 60.0 to 19.5 admissions/year; rate ratio (RR) = 0.33 (95% CI: 0.25–0.42), p < 0.001 (Poisson regression with log-offset for period length). Conclusions: Handheld POCUS, operated by non-specialist clinicians after a defined training protocol, was associated with a lower annualized admission rate and demonstrated moderate diagnostic accuracy. Its adoption was associated with a notable reduction in hospitalizations, suggesting its potential for alleviating ED overcrowding, reducing healthcare costs, and minimizing pediatric stress. Wider adoption, supported by standardized training, could enhance healthcare efficiency and quality in managing this common pediatric condition. Full article

(This article belongs to the Special Issue Pediatric Oral and Facial Surgery: Advances and Future Challenges)

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13 pages, 461 KB

Open AccessArticle

Sex-Specific Associations Between 2D:4D Digit Ratio and Physical Fitness in Prepubertal Children: Evidence from Standardized Agility, Strength, and Endurance Assessments

by Fatih Akgül, Ahmet Kurtoğlu, Rukiye Çiftçi, Özgür Eken, Bekir Çar, Alperen Şanal and Monira I. Aldhahi

Children 2025, 12(10), 1391; https://doi.org/10.3390/children12101391 - 15 Oct 2025

Abstract

Background: The second-to-fourth digit ratio (2D:4D) serves as a non-invasive proxy for prenatal androgen exposure. While its relationship with adult athletic ability is well documented, evidence for its association with childhood physical fitness remains inconsistent, and links between 2D:4D and objective fitness measures [...] Read more.

Background: The second-to-fourth digit ratio (2D:4D) serves as a non-invasive proxy for prenatal androgen exposure. While its relationship with adult athletic ability is well documented, evidence for its association with childhood physical fitness remains inconsistent, and links between 2D:4D and objective fitness measures in prepubertal children are unclear. Methods: In this cross-sectional study, 338 prepubertal children (181 girls, 157 boys; aged 5–12 years) underwent precise measurement of right- and left-hand 2D:4D ratios (intra-class correlation coefficient = 0.94). Physical fitness was evaluated using standardized tests: the Illinois agility run, bent-arm hang, and standing long jump. Results: Among boys, higher 2D:4D ratios were modestly associated with prolonged bent-arm hang performance (β = 0.19, q = 0.04) and shorter Illinois agility times (β = −0.19, q = 0.04). No significant associations were observed in girls. All effect sizes were small, suggesting subtle, sex-dependent influences rather than robust predictors of performance. Conclusions: These findings indicate that prenatal hormonal environment may exert a limited, sex-specific influence on early physical fitness characteristics. Although biologically informative, the observed associations are insufficient for direct application in talent identification in sports. Longitudinal research incorporating direct hormonal measurements and broader populations is recommended to clarify developmental mechanisms and causal pathways. Full article

(This article belongs to the Section Global Pediatric Health)

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19 pages, 695 KB

Open AccessReview

Updates on Anti-Obesity Medications in Children and Adolescents

by Mostafa Salama, Doha Hassan and Seema Kumar

Children 2025, 12(10), 1390; https://doi.org/10.3390/children12101390 - 15 Oct 2025

Abstract

Childhood obesity has assumed epidemic proportions; it results from a complex interplay of genetic, physiological, socioeconomic, and environmental factors. It is associated with numerous short- and long-term health complications, including cardiometabolic and psychosocial consequences. While lifestyle modifications remain the cornerstone of treatment, their [...] Read more.

Childhood obesity has assumed epidemic proportions; it results from a complex interplay of genetic, physiological, socioeconomic, and environmental factors. It is associated with numerous short- and long-term health complications, including cardiometabolic and psychosocial consequences. While lifestyle modifications remain the cornerstone of treatment, their overall impact is modest. As a result, pharmacotherapy is increasingly recommended as an adjunct in selected pediatric patients, particularly those with severe or refractory obesity. In recent years, several anti-obesity medications, including glucagon-like peptide-1 (GLP-1) receptor agonists, have shown promise in pediatric populations, particularly adolescents. However, the pharmacologic options remain limited for younger children. This review summarizes current evidence on the efficacy and safety of available anti-obesity medications in children and adolescents, offering practical, age-based strategies to guide the appropriate clinical use of these medications as part of a comprehensive obesity-management plan. Full article

(This article belongs to the Section Pediatric Endocrinology & Diabetes)

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15 pages, 936 KB

Open AccessArticle

Personalized Management and Timing of Thymectomy in Juvenile Myasthenia Gravis: Insights from Routine Clinical Scale Use in a Single-Center Retrospective Cohort—A Case Series

by Gulten Ozturk, Olcay Unver, Elif Acar Arslan, Nezih Onur Ermerak, Bilgihan Bıkmazer, Hakkı Akbeyaz, Burcu Karakayali, Sermin Aksoy Ozcan, Gulcan Akyuz, Pınar Ergenekon, Yasemin Gokdemir, Ela Erdem Eralp, Pınar Kahraman Koytak, Kayıhan Uluc and Dilsad Turkdogan

Children 2025, 12(10), 1389; https://doi.org/10.3390/children12101389 - 15 Oct 2025

Abstract

Introduction: Juvenile myasthenia gravis (JMG) is a rare autoimmune disorder with a variable clinical course and limited pediatric-specific treatment guidelines. Objective clinical scales, such as the Quantitative Myasthenia Gravis (QMG) Score and the Pediatric Myasthenia Gravis Quality of Life 15 (PM-QOL15), may support [...] Read more.

Introduction: Juvenile myasthenia gravis (JMG) is a rare autoimmune disorder with a variable clinical course and limited pediatric-specific treatment guidelines. Objective clinical scales, such as the Quantitative Myasthenia Gravis (QMG) Score and the Pediatric Myasthenia Gravis Quality of Life 15 (PM-QOL15), may support individualized management, but their role in routine practice remains underexplored. Methods: We retrospectively reviewed 10 seropositive JMG patients followed at a single tertiary neuromuscular clinic between 2014 and 2024. All patients underwent a systematic assessment with QMG at each visit, while PM-QOL15 was administered at the final visit. Clinical data, comorbidities, antibody status, treatment modalities, and outcomes were analyzed. Associations between treatment strategies, comorbidities, and scale scores were explored using appropriate statistical methods. Results: Seven patients (70%) underwent thymectomy, resulting in a reduction in mean QMG scores from 7.7 to 2.4, though residual relapses were observed. Chronic intravenous immunoglobulin (IVIG) therapy, administered to 70% of patients, did not significantly reduce relapse rates or steroid exposure and was associated with higher QMG scores in the second year, suggesting use in more severe phenotypes rather than therapeutic efficacy. Prolonged corticosteroid therapy did not improve remission time or relapse frequency and was complicated by major adverse effects in two patients. Timing of azathioprine initiation showed no significant correlation with relapse frequency. PM-QOL15 correlated strongly with mean QMG (r = 0.88, p < 0.001), reflecting cumulative disease burden. Patients with comorbidities required longer stabilization, although differences were not statistically significant. Conclusions: The routine integration of QMG and PM-QOL15 into follow-up may facilitate the earlier recognition of subclinical deterioration, provide objective measures of treatment response, and guide personalized management in JMG. Thymectomy showed benefit in selected patients, while the long-term roles of IVIG and corticosteroids remain uncertain. Larger multicenter prospective studies are warranted to confirm these findings and refine evidence-based strategies for pediatric JMG. Full article

(This article belongs to the Section Pediatric Neurology & Neurodevelopmental Disorders)

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14 pages, 737 KB

Open AccessArticle

Assessment of Physical Fitness in Children and Adolescents with Simple Obesity

by Jacek Podogrodzki, Mieczysław Szalecki, Anna Wrona and Aldona Wierzbicka-Rucińska

Children 2025, 12(10), 1388; https://doi.org/10.3390/children12101388 - 15 Oct 2025

Abstract

Objectives: The systematic increase in the number of overweight and obese people in recent years has led to the recognition of this condition as a chronic, non-infectious disease of civilization, declared a global epidemic by WHO in 1997. This phenomenon is particularly dangerous [...] Read more.

Objectives: The systematic increase in the number of overweight and obese people in recent years has led to the recognition of this condition as a chronic, non-infectious disease of civilization, declared a global epidemic by WHO in 1997. This phenomenon is particularly dangerous in children, because it negatively affects their later existence in the health, mental and social spheres. This phenomenon is particularly concerning in the pediatric population, as it may have long-term adverse effects on physical health, psychological well-being, and social functioning. Objective: The aim of this study was to assess anthropometric parameters and physical fitness using the EUROFIT test in children and adolescents diagnosed with obesity. Materials and Methods: The study group consisted of 123 pediatric patients attending the Endocrinology and Diabetology Clinic and Pediatric Rehabilitation IP-CZD aged 8–16 (64 boys—52% and 59 girls—48%) with diagnosed simple obesity. Obesity was diagnosed according to the CDC standard using percentile charts from the OLAF study. Physical fitness was assessed using the EUROFIT test using 8 samples, and body mass composition was examined using the bioimpedance method with the BC 418 Tanita analyzer. Results: The results of our own research obtained in this study were compared to population standards. The total results of the EUROFIT test in the study group were statistically significantly lower than the norm. The results of the balance, upper limb movement speed, jumping, trunk strength, functional strength and agility tests were lower than the norm, the flexibility result was within the norm, and only hand strength was higher than the norm. In 4 out of 8 fitness tests, girls achieved significantly better results than boys. Conclusions: Reduced physical fitness is characteristic of children and adolescents with simple obesity. Worse physical fitness shows significant correlations with the results of anthropometric measurements. Full article

(This article belongs to the Special Issue Lifestyle and Children's Health Development)

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18 pages, 568 KB

Open AccessArticle

Uncovering the Relationship Between Bullying, Social Communication Challenges, and the Emergence of Mental Health Problems Among Saudi Children with Autism Spectrum Disorder

by Mahmoud Abdelwahab Khedr, Nada Alqarawi and Rasha Mohammed Hussein

Children 2025, 12(10), 1387; https://doi.org/10.3390/children12101387 - 14 Oct 2025

Abstract

Background/Objective: Children with ASD are particularly vulnerable to bullying, which may exacerbate mental health issues. This study aims to explore the intricate relationships between bullying, social communication challenges, and the emergence of mental health problems among Saudi children with ASD. Additionally, it examines [...] Read more.

Background/Objective: Children with ASD are particularly vulnerable to bullying, which may exacerbate mental health issues. This study aims to explore the intricate relationships between bullying, social communication challenges, and the emergence of mental health problems among Saudi children with ASD. Additionally, it examines the mediating role of social communication challenges in these associations. Methods: A cross-sectional study was conducted with 150 children diagnosed with ASD at the Abdullah Altamimi Centre. Data were collected using the Child–Adolescent Bullying Scale, Social Communication Questionnaire, and Strengths and Difficulties Questionnaire. The data collection period lasted for three months, from the beginning of December 2024 to the end of February 2025. Results: The mean child–adolescent bullying score was 46.37, indicating prevalent bullying experiences. The mean Strengths and Difficulties Questionnaire score was 21.35, revealing significant emotional and behavioral difficulties. Positive correlations were found between bullying and social challenges (r = 0.306, p < 0.001) and emotional problems (r = 0.247, p = 0.002). Mediation analysis indicated that social communication challenges significantly mediated the relationship between bullying and strengths and difficulties scores (p < 0.001). Conclusions: Bullying significantly affects the mental health of Saudi children with ASD, highlighting the need for targeted interventions to enhance social communication skills and mitigate the impacts of bullying. These findings underscore the need to address these challenges within the cultural context of Saudi Arabia to enhance the well-being of this vulnerable population. Full article

(This article belongs to the Section Pediatric Mental Health)

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19 pages, 1919 KB

Open AccessReview

Essential Concepts in Artificial Intelligence: A Guide for Pediatric Providers

by Laura Elena Mendoza Bolivar and Michael Satzer

Children 2025, 12(10), 1386; https://doi.org/10.3390/children12101386 - 14 Oct 2025

Abstract

Artificial intelligence (AI) has exploded in public awareness over recent years and is already beginning to reshape the health care sector. Yet, even as AI becomes more prevalent, it remains a mystery to many providers who lack hands-on exposure during their training or [...] Read more.

Artificial intelligence (AI) has exploded in public awareness over recent years and is already beginning to reshape the health care sector. Yet, even as AI becomes more prevalent, it remains a mystery to many providers who lack hands-on exposure during their training or on the job. Intended for medical professionals, this article defines essential concepts in AI interspersed with illustrations of how such concepts may be applied within cardiology and radiology—fields that have garnered the most approved medical AI applications to date. No experience in the field of AI is requisite before reading. To assist providers encountering novel machine learning tools, we also present an AI model checklist to empower critical assessment. We finally discuss hurdles in the path of developing pediatric AI tools—including challenges distinct from the adult setting—and discuss potential solutions, including various methods of multisite collaboration. This article aims to increase the engagement of health care professionals who may encounter AI models in practice or who seek to become involved in AI development themselves. We encourage the reader the freedom to either peruse this article in its entirety or to reference specific concepts individually. Terminology central to machine learning is emphasized in bold. Full article

(This article belongs to the Section Pediatric Cardiology)

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16 pages, 863 KB

Open AccessArticle

Maternal Overweight and Obesity Alter Neurodevelopmental Trajectories During the First Year of Life: Findings from the OBESO Cohort

by Arturo Alejandro Canul-Euan, Jonatan Alejandro Mendoza-Ortega, Juan Mario Solis-Paredes, Héctor Borboa-Olivares, Sandra Martínez-Medina, Carmen Hernández-Chávez, Gabriela Gil-Martínez, Erika Osorio-Valencia, Mariana Torres-Calapiz, Blanca Vianey Suárez-Rico, Isabel González-Ludlow, Carolina Rodríguez-Hernández, Ameyalli Rodríguez-Cano, Enrique Reyes-Muñoz, Ignacio Camacho-Arroyo, Sonia L. Hernandez, Otilia Perichart-Perera and Guadalupe Estrada-Gutierrez

Children 2025, 12(10), 1385; https://doi.org/10.3390/children12101385 - 14 Oct 2025

Abstract

Background/Objectives: Overweight and obesity during pregnancy are metabolic risk factors that may compromise offspring brain development. The first 1000 days of life represent a critical window in which neurodevelopmental trajectories are shaped by intrauterine and early-life exposures. The 6- and 12-month milestones are [...] Read more.

Background/Objectives: Overweight and obesity during pregnancy are metabolic risk factors that may compromise offspring brain development. The first 1000 days of life represent a critical window in which neurodevelopmental trajectories are shaped by intrauterine and early-life exposures. The 6- and 12-month milestones are key checkpoints where deviations may emerge, and interventions are most effective. This study evaluated the association between maternal pregestational weight status and infant neurodevelopment at 6 and 12 months of age. Methods: Mother and infant pairs from the OBESO perinatal cohort in Mexico City were included. Women in the first trimester of pregnancy were classified as normal weight and overweight/obesity according to their pregestational body mass index (pBMI), calculated from self-reported pre-pregnancy weight. Infant neurodevelopment was assessed at 6 and 12 months using the Bayley Scales of Infant Development III, Third Edition (BSID-III). Descriptive, bivariate and multiple linear regression analyses with mixed effects correction were conducted. Results: Among 97 mother–infant pairs, infants of mothers with overweight/obesity had lower language and socio-emotional scores at 12 months. Higher maternal pBMI was correlated with lower motor scores at 6 and 12 months, and with lower language scores at 12 months. Longitudinal analysis showed that maternal overweight/obesity was associated with a significant decline in language development from 6 to 12 months. (p = 0.002). Conclusions: Maternal pregestational overweight or obesity may negatively influence early neurodevelopment, particularly affecting language and cognitive domains during the first year of life. These early deficits could reflect alterations in intrauterine programming associated with maternal metabolic status. Full article

(This article belongs to the Special Issue Neurodevelopmental Disorders in Pediatrics: 2nd Edition)

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20 pages, 1180 KB

Open AccessReview

Can Functional Cognitive Assessments for Children/Adolescents Be Transformed into Digital Platforms? A Conceptual Review

by Yael Fogel, Naomi Josman, Ortal Cohen Elimelech and Sharon Zlotnik

Children 2025, 12(10), 1384; https://doi.org/10.3390/children12101384 - 14 Oct 2025

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Abstract

Background/Objectives: Functional cognition, integrating cognitive abilities during real-life task performance, is essential for understanding daily functioning in children and adolescents. Traditional paper-based cognitive assessments in controlled environments often lack ecological validity. Although performance-based assessments more accurately represent functioning in natural contexts, most have [...] Read more.

Background/Objectives: Functional cognition, integrating cognitive abilities during real-life task performance, is essential for understanding daily functioning in children and adolescents. Traditional paper-based cognitive assessments in controlled environments often lack ecological validity. Although performance-based assessments more accurately represent functioning in natural contexts, most have not been transformed into digital formats. With technology increasingly embedded in education and healthcare, examining the extent/nature of adaptations, benefits, and challenges of digitizing these tools is important. This conceptual review aimed to (1) examine the extent/nature of traditional performance-based cognitive assessments adapted into digital platforms, (2) compare ecological validity/scoring metrics of traditional and digital tools, and (3) identify opportunities and propose recommendations for future development. Methods: We used an AI-based tool (Elicit Pro, Elicit Plus 2024) to conduct a literature search for publications from the past decade, focusing on transformations of traditional assessments into digital platforms for children and adolescents. This initial search yielded 240 items. After screening, 45 were retained for manual review. Studies were extracted based on their discussion of the assessments (traditional or digital) and assessment tools used. Ultimately, 13 papers that met the inclusion criteria were evaluated based on units of analysis. Results: The analysis yielded three units. The first unit focused on digital transformation trends: four assessments (31%) were converted to digital platforms, two (15%) were developed as native digital tools, and the majority (seven, 54%) remained traditional. In the second unit, assessments were evaluated according to ecological validity and digital availability, demonstrating that assessments with high ecological validity tended not to be digitally accessible. The third unit synthesized scoring metrics, identifying eight distinct cognitive domains. Conclusions: Digitizing functional cognitive assessments offers greater accessibility, precision, and scalability, but replicating real-world contexts remains challenging. Emerging technologies may enhance ecological validity and support development of effective, technology-enhanced assessment practices. Full article

(This article belongs to the Special Issue Children and Adolescents with Neurodevelopmental Disabilities: Ecological Assessment Tools and Cognitive Analysis)

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20 pages, 1324 KB

Open AccessArticle

Cardiac Manifestations and Persistent Myocardial Dysfunction in Multisystem Inflammatory Syndrome in Children: Insights from Conventional and Strain Echocardiography

by Carmen Corina Șuteu, Liliana Gozar, Nicola Șuteu, Beatrix-Julia Hack and Iolanda Muntean

Children 2025, 12(10), 1383; https://doi.org/10.3390/children12101383 - 14 Oct 2025

Viewed by 41

Abstract

Background: Multisystem inflammatory syndrome in children (MIS-C) is a severe post-infectious complication of SARS-CoV-2, often with cardiac involvement. Myocardial strain imaging may detect dysfunction missed by conventional echocardiography. The objectives of this study are to characterize cardiac manifestations of MIS-C and assess the [...] Read more.

Background: Multisystem inflammatory syndrome in children (MIS-C) is a severe post-infectious complication of SARS-CoV-2, often with cardiac involvement. Myocardial strain imaging may detect dysfunction missed by conventional echocardiography. The objectives of this study are to characterize cardiac manifestations of MIS-C and assess the value of strain imaging in children with preserved and reduced left ventricular ejection fraction (LV-EF). Methods: We retrospectively analyzed 22 MIS-C patients admitted between September 2020 and January 2024, all with cardiac involvement. Clinical, laboratory, and echocardiographic data—including 2D and speckle-tracking strain—were collected at the day of worst dysfunction (DWD) and discharge (DD) and compared with 22 matched controls. Results: Median age was 4.65 years; 59% male; 45% overweight/obese. LV systolic dysfunction (LV-EF < 50%) occurred in 54.5%, coronary abnormalities in 36.4%, and pericardial effusion in 95.5%. LV global longitudinal strain (LVGLS) was significantly lower than controls at the DWD (−15.45 ± 4.76%, p < 0.0001) and DD (−20.63 ± 4.66%, p = 0.014). Strain abnormalities persisted despite LV-EF recovery, and even patients with preserved LV-EF showed significant segmental strain reduction. LVGLS and apical infero-septal strain were strongest predictors of reduced LV-EF. Conclusions: MIS-C often causes systolic dysfunction and coronary changes, but strain imaging reveals persistent subclinical myocardial injury. Long-term cardiac monitoring is warranted. Full article

(This article belongs to the Special Issue Research Progress of the Pediatric Cardiology: 3rd Edition)

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14 pages, 1658 KB

Open AccessSystematic Review

Music Therapy for Managing Dental Anxiety in Children: A Systematic Review and Meta-Analysis of Clinical Evidence

by Laura Marqués-Martínez, Jorge Andrés, Esther García-Miralles, Carla Borell-García, Juan Ignacio Aura-Tormos and Clara Guinot Barona

Children 2025, 12(10), 1382; https://doi.org/10.3390/children12101382 - 13 Oct 2025

Viewed by 175

Abstract

Background: Dental anxiety is a common challenge in paediatric dentistry, often leading to avoidance of treatment and compromised oral health. Non-pharmacological interventions such as music therapy have gained increasing attention as safe and cost-effective alternatives to pharmacological approaches. Although several clinical studies have [...] Read more.

Background: Dental anxiety is a common challenge in paediatric dentistry, often leading to avoidance of treatment and compromised oral health. Non-pharmacological interventions such as music therapy have gained increasing attention as safe and cost-effective alternatives to pharmacological approaches. Although several clinical studies have examined the impact of music on children’s dental anxiety, the evidence has not yet been systematically summarised with quantitative synthesis. Objective: This systematic review and meta-analysis aimed to evaluate the effectiveness of music therapy in reducing dental anxiety and fear among paediatric patients. Methods: A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library from inception to August 2025. Randomised controlled trials (RCTs) evaluating music therapy for dental anxiety in children were included. Primary outcomes were self-reported dental anxiety/fear scales and physiological measures (heart rate, blood pressure, oxygen saturation). Risk of bias was assessed using the revised Cochrane risk of bias tool (RoB 2, version 2019; Cochrane Collaboration, London, UK) Meta-analyses were performed using a random-effects model with Review Manager (RevMan, version 5.4; Cochrane Collaboration, London, UK). Results: Seven randomized controlled trials (RCTs) involving 476 children aged 4–14 years were included. Music therapy significantly reduced self-re-ported dental anxiety compared with control groups (SMD = −0.48, 95% CI: −0.72 to −0.25, p < 0.001). Heart rate was also significantly reduced (SMD = −0.42, 95% CI: −0.68 to −0.16, p = 0.002), whereas changes in blood pressure and oxygen saturation were not statistically significant. The overall risk of bias was moderate, with most concerns related to blinding. Conclusions: Music therapy is an effective non-pharmacological intervention to reduce dental anxiety in children, particularly improving subjective anxiety and physiological arousal as measured by heart rate. Its integration into paediatric dental practice may enhance cooperation and treatment outcomes, offering a safe, inexpensive, and child-friendly approach. Full article

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

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14 pages, 248 KB

Open AccessArticle

Thinking, Feeling, and Moving in Kindergarten Children: How Motor Competence Shapes Executive Function Skills and Emotion Comprehension in Girls

by Elena A. Chichinina, Aleksander N. Veraksa, Olga V. Almazova and Linda S. Pagani

Children 2025, 12(10), 1381; https://doi.org/10.3390/children12101381 - 13 Oct 2025

Viewed by 132

Abstract

Background/Objectives: Increased screen time partially replaces social interaction, physical activity, and outdoor play in kindergarten children, leading to a risk of decreased cognitive, emotional, and motor skills. Children with high motor skills are more likely to have access to challenging joint activities [...] Read more.

Background/Objectives: Increased screen time partially replaces social interaction, physical activity, and outdoor play in kindergarten children, leading to a risk of decreased cognitive, emotional, and motor skills. Children with high motor skills are more likely to have access to challenging joint activities that promote their cognitive and emotional development. This study examines the moderating role of motor competence in the relationship between executive function skills and emotion comprehension. Methods: A sample of 220 kindergarten children (101 girls, 119 boys) completed the NEPSY-II subtests and the ‘Dimensional Change Card Sort’ tool for executive function skills assessment, the Movement Assessment Battery for Children—Second Edition (MABC-2) for motor competence, and the Test of Emotion Comprehension (TEC) for emotion comprehension. Executive function skills and motor competence were assessed when children were in their penultimate year of kindergarten (children were aged on average 5 years 10 months), and emotion comprehension was assessed one year later, when children were in their final year of kindergarten. When children were in their penultimate year of kindergarten, caregivers also reported on children’s passive and active screen time, maternal education, and family income, which were used as control variables. Results: For girls, motor competence moderated the relationship between cognitive flexibility and later emotion comprehension. High motor competence amplified this relationship (B = 0.171; SE = 0.066; 95% CI [0.041, 0.302]; p = 0.011). For boys, there were no significant moderation effects. Conclusions: High motor competence can improve emotion comprehension in kindergarten girls. Emotional development may benefit from effective shared motor interventions for children. Full article

(This article belongs to the Special Issue Physical and Motor Development in Children)

10 pages, 1086 KB

Open AccessArticle

Testicular Cancer Education—Hidden Potential Ways to Improve Awareness and Early Diagnosis in Young Men?

by Marc Kidess, Jan Goedeke, Franz Aschl, Nikolaos Pyrgidis, Yannic Volz, Troya Georgieva, Regina Stredele, Benedikt Ebner, Michael Atzler, Darjusch Askari, Martina Heinrich, Kristina Becker, Julian Hermans, Julian Marcon, Maria Apfelbeck, Oliver Muensterer, Christian G. Stief and Michael Chaloupka

Children 2025, 12(10), 1380; https://doi.org/10.3390/children12101380 - 13 Oct 2025

Viewed by 128

Abstract

Introduction: Testicular cancer is the most common cancer in young men. Studies show that general awareness among the risk group is low, and anticipatory guidance is of paramount importance for early detection. We queried pediatricians and pediatric surgeons on their perceived role and [...] Read more.

Introduction: Testicular cancer is the most common cancer in young men. Studies show that general awareness among the risk group is low, and anticipatory guidance is of paramount importance for early detection. We queried pediatricians and pediatric surgeons on their perceived role and their interaction with patients regarding education on this issue. Materials and Methods: A survey was sent to pediatricians and pediatric surgeons in Germany to assess the extent of genitourinary examinations, health education about testicular cancer, and instructions for testicular self-examination during well-child visits and clinic contacts. Statistics were processed using R software (Version 4.5.1). Results: Data from 150 participating pediatricians and 21 pediatric surgeons were analyzed. Genitourinary examinations were performed routinely by the majority of participants, especially those in solo or group practices (p < 0.05). In particular, physicians who provide health education about testicular cancer perform testicular examinations significantly more often than those who do not provide such education (p < 0.05). Four percent of the participants offered a special consultation for male adolescents to provide information about male sexual diseases. There was a significant correlation between the length of experience of physicians and the level of health education (p < 0.01). Discussion: Although the majority of participants perform regular genitourinary examinations, only a minority provide special health education about testicular cancer or provide instructions for testicular self-examination. Most participating pediatricians and pediatric surgeons asked for more support regarding testicular cancer screening and health education. Full article

(This article belongs to the Section Pediatric Surgery)

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6 pages, 570 KB

Open AccessCase Report

Pediatric Cardiac Arrest Secondary to Guillain-Barré Syndrome-Induced Dysautonomia

by Po-Jung Chen, Yi-Ting Cheng, Shao-Hsuan Hsia, Oi-Wa Chan, En-Pei Lee, Kuang-Lin Lin and Jainn-Jim Lin

Children 2025, 12(10), 1379; https://doi.org/10.3390/children12101379 - 13 Oct 2025

Viewed by 143

Abstract

Background: Guillain-Barré syndrome (GBS) is an acute immune-mediated polyneuropathy often associated with autonomic dysfunction. Although transient cardiovascular instability is common, severe dysautonomia leading to cardiac arrest is rarely documented in children. Methods: We report the case of an 11-year-old previously healthy boy who [...] Read more.

Background: Guillain-Barré syndrome (GBS) is an acute immune-mediated polyneuropathy often associated with autonomic dysfunction. Although transient cardiovascular instability is common, severe dysautonomia leading to cardiac arrest is rarely documented in children. Methods: We report the case of an 11-year-old previously healthy boy who initially presented with acute ophthalmoplegia and rapidly progressed to quadriplegia and areflexia. He developed fluctuating blood pressure and bradycardia, culminating in cardiac arrest due to asystole at 24 h after admission, requiring 17 min of resuscitation. Results: Electrophysiological studies confirmed a demyelinating polyneuropathy. Although intravenous immunoglobulin (IVIG) was initiated 5 h after admission, clinical improvement was achieved only after subsequent plasmapheresis on day 20, with the recovery of autonomic function by day 35. He was extubated on day 45 and discharged on day 83 with a near-complete recovery after prolonged intensive care and rehabilitation. Conclusion: This case highlights the potential for rapid and life-threatening autonomic instability in pediatric GBS. Unlike typical cases, the patient progressed to cardiac arrest within 24 h despite IVIG, highlighting the need to consider plasmapheresis for non-responders. Continuous hemodynamic monitoring is essential to prevent fatal outcomes, even in patients with initially mild or atypical presentations. Full article

(This article belongs to the Section Pediatric Neurology & Neurodevelopmental Disorders)

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12 pages, 775 KB

Open AccessArticle

Assessment of Fine Motor Abilities Among Children with Spinal Muscular Atrophy Treated with Nusinersen Using a New Touchscreen Application: A Pilot Study

by Inbal Klemm, Alexandra Danial-Saad, Alexis R. Karlin, Rya Nassar-Yassien, Iuliana Eshel, Hagit Levine, Tamar Steinberg and Sharon Aharoni

Children 2025, 12(10), 1378; https://doi.org/10.3390/children12101378 - 12 Oct 2025

Viewed by 151

Abstract

Background/Objectives: Spinal Muscular Atrophy (SMA) is a genetic neurodegenerative disease characterized by severe muscle weakness and atrophy. Advances in disease-modifying therapies have dramatically changed the natural history of SMA and the outcome measures that are used to assess the clinical response to therapy. [...] Read more.

Background/Objectives: Spinal Muscular Atrophy (SMA) is a genetic neurodegenerative disease characterized by severe muscle weakness and atrophy. Advances in disease-modifying therapies have dramatically changed the natural history of SMA and the outcome measures that are used to assess the clinical response to therapy. Standard assessment methods for SMA are limited in their ability to detect minor changes in fine motor abilities and in patients’ daily functions. The aim of this pilot study was to evaluate the feasibility and preliminary use of the Touchscreen-Assessment Tool (TATOO) alongside standardized tools to detect changes in upper extremity motor function among individuals with SMA receiving nusinersen therapy. Methods: Thirteen individuals with genetically-confirmed SMA, aged 6–23 years, eight with SMA type 2, and five with SMA type 3, participated. The patients continued the maintenance dosing of nusinersen during the study period. They were evaluated at the onset of the study, then twice more at intervals at least six months apart. Upper extremity functional assessments were performed via the TATOO and standardized tools: the Hand Grip Dynamometer (HGD), Pinch Dynamometer (PD), Revised Upper Limb Module (RULM), and Nine-Hole Peg Test (NHPT). Results: Significant changes in fine motor function were detected using the TATOO together with other standardized tools. Participants demonstrated notable improvements in hand grip strength and fine motor performance, as measured by the NHPT. The RULM results were not statistically significant for the total study group, particularly in ambulatory patients with SMA type 3. TATOO provided detailed metrics, and revealed enhancements in accuracy and speed across various tasks. However, given the small sample size, the lack of a control group, and the lack of baseline assessment before receiving therapy, these findings should be considered preliminary and exploratory. Conclusions: The findings suggest that the TATOO, alongside traditional assessment tools, offers a sensitive measure of fine motor function changes in patients with SMA. This study highlights the potential of touchscreen-based assessments to address gaps in current outcome measures and emphasizes the need for larger, multicenter studies that will include pre-treatment, baseline, and control data. Full article

(This article belongs to the Special Issue Children and Adolescents with Neurodevelopmental Disabilities: Ecological Assessment Tools and Cognitive Analysis)

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17 pages, 835 KB

Open AccessReview

Managing Cough in Pediatric Neuromuscular Disorders: Lung Function and Care Strategies

by Simone Foti Randazzese, Grazia Fenu, Claudia Calogero, Enrico Lombardi and Sara Manti

Children 2025, 12(10), 1377; https://doi.org/10.3390/children12101377 - 12 Oct 2025

Viewed by 193

Abstract

Children with neuromuscular disorders (NMDs) are at high risk for respiratory complications due to impaired cough and weakness of respiratory muscles. Effective cough is essential for airway clearance, infections’ prevention, and maintaining lung function. This narrative review explores the physiology of cough, the [...] Read more.

Children with neuromuscular disorders (NMDs) are at high risk for respiratory complications due to impaired cough and weakness of respiratory muscles. Effective cough is essential for airway clearance, infections’ prevention, and maintaining lung function. This narrative review explores the physiology of cough, the consequences of cough insufficiency, and methods for assessing respiratory function in pediatric NMDs. It discusses current care strategies including airway clearance techniques, respiratory muscle training, and preventive and supportive interventions. Emphasis is placed on multidisciplinary management and early intervention to improve outcomes and quality of life. Full article

(This article belongs to the Special Issue Lung Function and Respiratory Diseases in Children and Infants)

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19 pages, 815 KB

Open AccessReview

Quality of Life in Mothers of Children with ADHD: A Scoping Review

by Giuseppe Quatrosi, Dario Genovese, Karine Lyko-Pousson and Gabriele Tripi

Children 2025, 12(10), 1376; https://doi.org/10.3390/children12101376 - 12 Oct 2025

Viewed by 244

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) affects not only children but also their families. Mothers, as primary caregivers, frequently experience high stress and reduced well-being. This scoping review mapped recent literature (2015–2025) on the quality of life (QoL) of mothers of children with ADHD and [...] Read more.

Background: Attention-deficit/hyperactivity disorder (ADHD) affects not only children but also their families. Mothers, as primary caregivers, frequently experience high stress and reduced well-being. This scoping review mapped recent literature (2015–2025) on the quality of life (QoL) of mothers of children with ADHD and identified key factors influencing maternal QoL. Methods: Following the Arksey and O’Malley framework and Joanna Briggs Institute guidance for scoping reviews, we searched PubMed, Scopus, and ERIC in June 2025 for peer-reviewed quantitative studies in English. Eligible studies focused on mothers of children (6–18 years) with ADHD and used validated parent QoL measures. Eight studies met inclusion criteria. Results: Eight studies published between 2015 and 2025 satisfied the inclusion criteria. Mothers regularly indicated a worse quality of life relative to control groups, demonstrating shortcomings in physical, psychological, social, and environmental domains. Severe ADHD symptoms in children, accompanying disruptive disorders, parental distress or anxiety, and inadequate social support were important variables. Adaptive coping strategies correlated with enhanced outcomes, and a longitudinal study showed that effective ADHD intervention reduced familial stress over several months. Several studies have identified maternal depression, child comorbidities, and inadequate social support as key factors that adversely affect parental quality of life. Conclusions: Mothers of children with ADHD are at heightened risk for compromised QoL. Family-centered strategies that support maternal mental health, strengthen social support, and enhance coping—alongside the child’s ADHD care—are warranted. Heterogeneity in QoL measures and limited longitudinal evidence highlight priorities for future research. Full article

(This article belongs to the Special Issue Early Detection and Intervention of ADHD in Children and Adolescents)

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22 pages, 304 KB

Open AccessArticle

Adolescents’ Life Satisfaction, Physical Activity, and the Moderating Role of Gender: A Cross-Country, Multilevel Analysis in 64 Countries

by Carmel Cefai, Beatriz Barrado, Gregorio Gimenez and Valeria Cavioni

Children 2025, 12(10), 1375; https://doi.org/10.3390/children12101375 - 11 Oct 2025

Viewed by 247

Abstract

Background: Engaging in physical activity (PA) is especially significant for adolescents, as this is a key developmental stage for establishing lifelong habits. While the physical, mental, and cognitive health benefits of PA are well-documented, less is known about its relationship with adolescents’ life [...] Read more.

Background: Engaging in physical activity (PA) is especially significant for adolescents, as this is a key developmental stage for establishing lifelong habits. While the physical, mental, and cognitive health benefits of PA are well-documented, less is known about its relationship with adolescents’ life satisfaction (LS). Most existing evidence often involves small sample sizes, focusing particularly on developed regions, and few studies use large-scale comparative data. Methods: This study examines the association between adolescents’ LS and PA using data from the 2022 Programme for International Student Assessment (PISA), the world’s largest comparative education survey of adolescents. Our analysis included 399,794 adolescents from 64 high- and middle-income countries and economies. We used three-level multilevel regressions. Results: We found that, after controlling for individual, family, and school factors, PA is positively and significantly associated with LS. This finding holds for the pooled sample and across the 64 countries analysed. For most countries, we did not find a significant gender moderator effect, suggesting that the positive association between PA and LS did not vary by gender. Conclusions: The findings suggest a global health promotion strategy to promote PA amongst adolescents as a normative developmental process necessary for their well-being and mental health. Full article

(This article belongs to the Section Pediatric Mental Health)

12 pages, 1344 KB

Open AccessArticle

The Short-Term Impact of Decompressive Craniectomy in Pediatric Patients with Severe Traumatic Brain Injury: A Retrospective Matched Cohort Study

by Jingjing Xu, Run Zhou, Jing Li, Chengjun Liu and Hongxing Dang

Children 2025, 12(10), 1374; https://doi.org/10.3390/children12101374 - 11 Oct 2025

Viewed by 113

Abstract

Background/Objectives: Decompressive craniectomy (DC) is commonly applied to manage refractory intracranial hypertension in severe traumatic brain injury (TBI). However, its role and benefits in pediatric populations remain uncertain. Clarifying whether DC provides measurable clinical advantages in children with severe TBI may inform [...] Read more.

Background/Objectives: Decompressive craniectomy (DC) is commonly applied to manage refractory intracranial hypertension in severe traumatic brain injury (TBI). However, its role and benefits in pediatric populations remain uncertain. Clarifying whether DC provides measurable clinical advantages in children with severe TBI may inform treatment strategies and family counseling. Methods: We conducted a retrospective, one-to-one matched cohort study at a tertiary pediatric center (2014–2023). Fifty-three children with severe TBI who underwent DC were matched with fifty-three non-DC patients based on age, Glasgow Coma Scale score, cranial CT findings, and pupillary response at admission to ensure comparable injury severity. Demographic data, clinical features, and outcomes were collected. Primary outcomes were in-hospital mortality and Pediatric Cerebral Performance Category (PCPC) scores at discharge and 3 months. Secondary outcomes included duration of mechanical ventilation, intensive care unit (ICU) stay, and total hospital stay. Results: Mortality did not differ significantly between DC and non-DC groups (17.0% vs. 26.4%, p = 0.239). DC patients had better PCPC scores at discharge (p = 0.029). At 3 months, the between-group difference was not statistically significant but showed a near-significant trend (p = 0.057). No significant differences were observed in duration of ventilation (p = 0.100), ICU stay (p = 0.348), or hospital stay (p = 0.678). Conclusions: DC may not reduce short-term mortality in pediatric severe TBI but appears to be associated with more favorable neurological outcomes at discharge. Larger, adequately powered studies with standardized monitoring and longer follow-up are needed to clarify the durability and scope of potential benefits in this population. Full article

(This article belongs to the Special Issue Advances in Pediatric Surgery: Innovative Approaches and Emerging Technologies)

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15 pages, 510 KB

Open AccessArticle

Effects of Medical Cannabis Treatment for Autistic Children on Family Accommodation: An Open-Label Mixed-Methods Study

by Ayelet David, Eynat Gal, Ayelet Ben-Sasson, Elkana Kohn, Matitiahu Berkovitch and Orit Stolar

Children 2025, 12(10), 1373; https://doi.org/10.3390/children12101373 - 11 Oct 2025

Viewed by 243

Abstract

Background/Objectives: Parents of autistic children often face behavioral and participation challenges of their children, leading them to make accommodations to maintain a stable daily family routine. These family accommodations (FA) involve adapting family routines, actively engaging with the child’s support needs and symptoms, [...] Read more.

Background/Objectives: Parents of autistic children often face behavioral and participation challenges of their children, leading them to make accommodations to maintain a stable daily family routine. These family accommodations (FA) involve adapting family routines, actively engaging with the child’s support needs and symptoms, and avoiding specific situations. Methods: This open-label, mixed-methods study investigated the impact of CBD-rich cannabis treatment on FA. In the quantitative phase, analyses included 44 parents (from 87 initially recruited) who had complete FAS-RRB data at baseline, 3 months, and 6 months. In the following qualitative phase, 15 parents from the full sample participated in semi-structured interviews. Results: Quantitative results showed reductions in FA frequency and parental distress at 3 and 6 months. Qualitative findings revealed positive changes in family routines, enhanced well-being, and improved parental engagement in meaningful activities and social interactions. Conclusions: This study provides preliminary evidence that CBD-rich cannabis treatment may reduce family accommodation (FA) and parental distress, while improving family routines and well-being. However, given the open-label design and observed adverse events and withdrawals, the findings should be interpreted with caution. Full article

(This article belongs to the Special Issue Children and Adolescents with Neurodevelopmental Disabilities: Ecological Assessment Tools and Cognitive Analysis)

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23 pages, 2817 KB

Open AccessArticle

Feasibility, Safety, and Tolerability of Remote Ischemic Conditioning in Children with Unilateral Cerebral Palsy: A Randomized Controlled Trial

by Swati M. Surkar, Shailesh Gardas, John Willson, Joseph Kakyomya and Charity Moore Patterson

Children 2025, 12(10), 1372; https://doi.org/10.3390/children12101372 - 11 Oct 2025

Viewed by 100

Abstract

Background: Remote ischemic conditioning (RIC) has shown promise as a neuroprotective strategy, but its application in children with cerebral palsy (CP) remains unexplored. We conducted a randomized controlled trial to evaluate the feasibility, safety, and tolerability of repeated, 6–7 sessions of RIC in [...] Read more.

Background: Remote ischemic conditioning (RIC) has shown promise as a neuroprotective strategy, but its application in children with cerebral palsy (CP) remains unexplored. We conducted a randomized controlled trial to evaluate the feasibility, safety, and tolerability of repeated, 6–7 sessions of RIC in children with unilateral CP. Methods: Fifty-one children aged 6–16 years with unilateral CP were randomized (1:1) to receive RIC or sham conditioning on the more affected arm. Primary feasibility outcomes included recruitment metrics, intervention adherence, retention, and protocol fidelity. Safety endpoints included continuous monitoring of oxygen saturation, blood pressure, heart rate, and adverse event incidence. Tolerability was assessed via child-reported pain ratings, conditioning pressure tolerance, skin integrity evaluations, and session adherence. Results: Of 148 children screened, 51 were randomized to RIC (n = 25), sham (n = 26) groups; 48 (94.1%) completed the intervention as allocated. Recruitment yielded 2.04 participants/month. Intervention adherence was 100% in both groups. RIC was well tolerated, with mean pain scores 2.8 ± 3.1 during inflation in RIC and 0.3 ± 0.8 in Sham group. No serious adverse events occurred. Physiological parameters remained stable across 314 conditioning sessions; no clinically significant hypoxemia, blood pressure derangements, or arrhythmias were detected. Minor adverse events (transient erythema, mild discomfort) were rare (2.22%) and self-limiting. Skin integrity was preserved, and no participants required session termination. Conclusions: Repeated RIC is feasible, safe, and tolerable in children with unilateral CP. These findings support the design of future trials using RIC as a priming agent to enhance pediatric neurorehabilitation outcomes. Full article

(This article belongs to the Special Issue Children with Cerebral Palsy and Other Developmental Disabilities)

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12 pages, 399 KB

Open AccessArticle

Associations Between Parent–Child Attachment and Psychosocial- and Health-Related Symptoms in Children with Functional Abdominal Pain Disorders

by Camden E. Matherne, Tasha B. Murphy, Rona L. Levy, Shelby L. Langer, Joan M. Romano and Miranda A. L. van Tilburg

Children 2025, 12(10), 1371; https://doi.org/10.3390/children12101371 - 11 Oct 2025

Viewed by 192

Abstract

Background and Objectives: The attachment-diathesis model of chronic pain, which associates insecure attachment with pain catastrophizing and worse pain-related outcomes, is well-supported in adults. Although Functional Abdominal Pain Disorders (FAPDs) are common in youth, with symptoms influenced by the parent–child dynamic, an attachment-diathesis [...] Read more.

Background and Objectives: The attachment-diathesis model of chronic pain, which associates insecure attachment with pain catastrophizing and worse pain-related outcomes, is well-supported in adults. Although Functional Abdominal Pain Disorders (FAPDs) are common in youth, with symptoms influenced by the parent–child dynamic, an attachment-diathesis model of FAPDs is unexplored. The aim of this study was to investigate if insecure parental attachment is associated with pain catastrophizing and pain-related variables in youth with FAPDs. Methods: Baseline questionnaire data from an RCT of cognitive behavioral therapy for children with FAPDs (n = 200, 73% girls, 93% White, and a mean age of 11.2 years old) were used to examine relationships between parental attachment (subscales include Alienation, Trust, and Communication), catastrophizing, and pain-related variables (depression, disability, and gastrointestinal (GI) symptom severity). Results: Alienation was significantly correlated with depression (r = 0.39), GI symptom severity (r = 0.30), and disability (r = 0.22; ps < 0.05). Trust was also correlated with depression (r = −0.39), GI symptom severity (r = −0.19), and disability (r = −0.19; ps < 0.05). Communication was associated with depression (r = −0.30, p < 0.01). Catastrophizing mediated these associations, accounting for 22–89% of the relationship between attachment and pain-related variables. Conclusions: Children who report a less secure attachment to their parents report more physical and psychological symptomatology than children who describe their attachment as more secure. This association is partly explained by child catastrophizing. Results suggest that parent–child attachment and catastrophizing may be important treatment targets in children with FAPDs. Full article

(This article belongs to the Section Pediatric Mental Health)

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10 pages, 382 KB

Open AccessArticle

The Relationship Between Refeeding Syndrome and Preterm Morbidities in Preterm Infants

by Aybuke Yazici, Ipek Guney Varal, Gaffari Tunc, Onur Bagci and Ayse Oren

Children 2025, 12(10), 1370; https://doi.org/10.3390/children12101370 - 10 Oct 2025

Viewed by 186

Abstract

Objective: This study was conducted to determine the risk factors for refeeding syndrome (RFS) in preterm infants and evaluate its relationship with preterm morbidities. Methods: Preterm infants born before 30 weeks of gestation were retrospectively evaluated. RFS was diagnosed as phosphorus [...] Read more.

Objective: This study was conducted to determine the risk factors for refeeding syndrome (RFS) in preterm infants and evaluate its relationship with preterm morbidities. Methods: Preterm infants born before 30 weeks of gestation were retrospectively evaluated. RFS was diagnosed as phosphorus <4 mg/dL and/or calcium >11 mg/dL on postnatal day 7. Demographic and clinical findings were compared between preterm infants with and without RFS. Results: A total of 174 infants who met the inclusion criteria were analyzed. RFS was diagnosed with 60 infants (34.5%). The mean gestational age (GA) was 27 (range, 25–28) weeks in the RFS group and 28 (range, 26–30) weeks in the non-RFS group (p = 0.038). Mean birth weight (BW) in each group was 790 (range, 630–1000) grams and 1033 (range, 800–1310) grams, respectively (p < 0.001). The RFS group had a lower rate of antenatal steroid (ANS) administration, lower APGAR, length of hospital stay, and higher rates of small for gestational age status, respiratory distress syndrome (RDS), bronchopulmonary dysplasia, and patent ductus arteriosus (p < 0.05). On postnatal day 7, the RFS group had lower phosphorus and higher calcium levels (p < 0.001). After adjustment for GA, BW, Apgar score, and ANS, the frequency of RDS was higher among infants with RFS (p < 0.05). Conclusions: Preterm infants with RDS were more likely to develop RFS. Our results suggest that these infants require more frequent laboratory testing and closer follow-up to monitor for RFS and ensure timely electrolyte support. Full article

(This article belongs to the Section Pediatric Neonatology)

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12 pages, 2110 KB

Open AccessArticle

Cord Blood Mitochondrial DNA Copy Number and Physical Growth in Infancy and Toddlerhood: A Birth Cohort Analysis

by Hisanori Fukunaga, Takeshi Yamaguchi, Hiroyoshi Iwata and Atsuko Ikeda

Children 2025, 12(10), 1369; https://doi.org/10.3390/children12101369 - 10 Oct 2025

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Abstract

Background/Objectives: Cord blood mitochondrial DNA copy number (mtDNAcn) has been proposed as a biomarker reflecting environmental influences during fetal life, with reported associations with perinatal outcomes such as birth weight and length. Within the framework of the Developmental Origins of Health and Disease [...] Read more.

Background/Objectives: Cord blood mitochondrial DNA copy number (mtDNAcn) has been proposed as a biomarker reflecting environmental influences during fetal life, with reported associations with perinatal outcomes such as birth weight and length. Within the framework of the Developmental Origins of Health and Disease (DOHaD) theory, this study aimed to investigate whether cord blood mtDNAcn is related to postnatal physical growth in early childhood. Methods: We analyzed data from 150 newborns (68 females and 82 males) enrolled in the Tohoku Medical Megabank Birth and Three-Generation Cohort Study in Japan. Cord blood mtDNAcn was quantified using real-time PCR, and standard deviation scores for weight and height were assessed at 1, 2–3, 4–6, 18–24, and 36–48 months of age. Correlation analyses were conducted separately by sex. Results: Cord blood mtDNAcn showed no significant associations with body weight or height at any of the postnatal time points up to 48 months of age. Growth trajectories of infants with higher or lower mtDNAcn values at birth tended to converge toward the population mean during infancy and toddlerhood. Conclusions: Although no significant relationships were observed, this exploratory, hypothesis-generating study provides a foundation for future investigations. Larger cohorts with extended follow-up are needed to clarify the potential significance of cord blood mtDNAcn in early-life research on child growth and health. Full article

(This article belongs to the Section Global Pediatric Health)

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Children, Volume 12, Issue 10 (October 2025) – 121 articles

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