Children

12 pages, 482 KiB

Open AccessArticle

The Interpersonal Antecedents of Attachment Security in Early Adulthood

by Julie A. Blake, James G. Scott, Jake M. Najman and Hannah J. Thomas

Children 2025, 12(2), 255; https://doi.org/10.3390/children12020255 - 19 Feb 2025

Background/Objectives: The relevance of adult attachment security for physical and emotional wellbeing is increasingly evident. Developing a better understanding of the interpersonal antecedents of secure attachment in childhood and adolescence could enable opportunities for its promotion when attachment styles are more easily [...] Read more.

Background/Objectives: The relevance of adult attachment security for physical and emotional wellbeing is increasingly evident. Developing a better understanding of the interpersonal antecedents of secure attachment in childhood and adolescence could enable opportunities for its promotion when attachment styles are more easily modifiable. Methods: Data from 3648 participants in a longitudinal birth cohort study were examined. At 21 years, participants completed the confidence (in self and others) subscale of the Attachment Style Questionnaire, a measure of attachment security. Path analysis was used to longitudinally examine the influence of maternal and child-reported interpersonal variables at birth, 5, and 14 years on attachment security in early adulthood. Results: Two pathways were identified. Firstly, child and family social relations at birth and 5 years predicted attachment security via the number of the child’s close friends at 14 years (β = 0.11, p < 0.001). Secondly, attuned caregiving at 14 years predicted attachment security via the recalled experiences of parental care up to 16 years, measured at 21 years (β = 0.28, p < 0.001). Greater adolescent family satisfaction directly predicted increased attachment security in early adulthood (β = 0.10, p < 0.001). Conclusions: Child and family social relationships from birth and throughout childhood and adolescence, along with attuned caregiving, led to increased attachment security in early adulthood. Public health and policy initiatives aimed at strengthening social support systems for caregivers and their children throughout childhood, and increasing the uptake of parenting programmes aimed at strengthening attuned caregiving, may lead to long-term improvements in the attachment security of offspring. Full article

(This article belongs to the Section Pediatric Mental Health)

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14 pages, 2015 KiB

Open AccessArticle

Elucidation of Factors Affecting Anterior Occlusion in Primary Dentition Based on the Japan Environment and Children’s Study

by Risa Ishiko, Kotaro Sena, Ichie Koseki, Masumi Sasai, Chiharu Ota and Takeyoshi Koseki

Children 2025, 12(2), 254; https://doi.org/10.3390/children12020254 - 19 Feb 2025

Abstract

Background/Objectives: Malocclusion in primary dentition affects permanent dentition. However, the factors contributing to malocclusion in the oral cavities of children have not been fully elucidated. We hypothesized that environmental factors affect malocclusion in the primary dentition of the Japanese population and aimed [...] Read more.

Background/Objectives: Malocclusion in primary dentition affects permanent dentition. However, the factors contributing to malocclusion in the oral cavities of children have not been fully elucidated. We hypothesized that environmental factors affect malocclusion in the primary dentition of the Japanese population and aimed to identify factors associated with anterior occlusion in primary dentition. Methods: The study involved 3793 parent–child pairs from the Miyagi Regional Centre as part of a supplementary survey to the Japan Environment and Children’s Study, a cohort study. A questionnaire assessing oral development and environmental factors was administered to parent-child pairs who consented to participate. Parents assessed anterior occlusion when their children were 3.5 years old. Results: The maxillary primary central incisors tended to erupt earlier in the open bite group. Significantly more children in this group were breastfed until 1 year and drank ionic beverages at 1.5 years. In addition, thumb sucking or pacifier use was significantly common at 2 years of age. A correlation was observed between the mother’s body mass index (BMI) before and after pregnancy and anterior occlusion. Conclusions: In the open bite group, the occlusion status of the anterior teeth at 3.5 years of age showed distinctive results influenced by the eruption period of the primary anterior teeth, oral habits, intake of sweetened beverages, and maternal BMI. These findings suggest that parental observation could be useful for screening children for malocclusion until the eruption of permanent dentition. Full article

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

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13 pages, 244 KiB

Open AccessReview

Sedation and Pain Management in Neonates Undergoing Therapeutic Hypothermia for Hypoxic-Ischemic Encephalopathy

by Artemiy Kokhanov and Peggy Chen

Children 2025, 12(2), 253; https://doi.org/10.3390/children12020253 - 19 Feb 2025

Abstract

Hypoxic-ischemic encephalopathy (HIE) is a common cause of significant neonatal morbidity and mortality. The stronghold of the treatment for moderate-to-severe HIE is therapeutic hypothermia (TH) which provides a neuroprotective effect. However, it also is associated with pain and stress. Moreover, neonates with HIE [...] Read more.

Hypoxic-ischemic encephalopathy (HIE) is a common cause of significant neonatal morbidity and mortality. The stronghold of the treatment for moderate-to-severe HIE is therapeutic hypothermia (TH) which provides a neuroprotective effect. However, it also is associated with pain and stress. Moreover, neonates with HIE are subjected to a significant number of painful procedures. Untreated pain during the early neonatal period may entail future challenges such as impaired brain growth and development as well as impaired pain sensitivity later in life. Hereby, the provision of adequate sedation and alleviation of pain and discomfort is essential. There are currently no universally accepted guidelines for sedation and pain management for this patient population. In this review, we highlight non-pharmacologic and pharmacologic methods currently in use to provide comfort and sedation to patients with HIE undergoing TH. Full article

(This article belongs to the Special Issue Neurological and Developmental Outcomes following Neonatal Encephalopathy)

14 pages, 217 KiB

Open AccessArticle

Child Poverty and Its Associated Issues in A City, Tokyo: Insights from Community-Based Participatory Research

by Shinpei Ikeda, Yuriko Iwabuchi, Masato Nakamura, Kanta Ohno and Hirotomo Shibahashi

Children 2025, 12(2), 252; https://doi.org/10.3390/children12020252 - 19 Feb 2025

Abstract

Background/Objectives: In recent years, despite growing awareness of child poverty in Japan, research examining its impact on the daily lives of children and their families within schools and communities remains limited. This study aims to clarify the extent of child poverty and associated [...] Read more.

Background/Objectives: In recent years, despite growing awareness of child poverty in Japan, research examining its impact on the daily lives of children and their families within schools and communities remains limited. This study aims to clarify the extent of child poverty and associated issues in A City, Tokyo, through qualitative research conducted as part of the Community-Based Participatory Research (CBPR) process. Methods: Twelve research participants were selected, including Vice Principals of schools, Community and Child Welfare Officers, and other stakeholders involved in supporting economically disadvantaged households raising children. A focus group discussion (FGD) was conducted on 16 October 2021 to examine the current state of child poverty in A City and local initiatives addressing the issue. Data were analyzed using a qualitative descriptive approach. Results: Three categories emerged from the analysis: (1) Children Disadvantaged by Their Family’s Financial Situation, (2) Challenges in Supporting Financially Struggling Families in Schools and Communities, and (3) the Necessity of Establishing Comprehensive Systems to Support Families. These findings highlight the complex challenges schools and communities face in supporting economically disadvantaged families. Conclusions: Addressing child poverty in A City requires strengthening collaboration between the education sector and community stakeholders, enhancing early detection of poverty-related issues, and establishing comprehensive support systems for timely intervention. However, cultural norms in Japan, such as the reluctance to impose a burden on others, might create barriers to seeking assistance. To overcome these challenges, CBPR is expected to play a key role in fostering networks among children, parents, and support providers. Full article

(This article belongs to the Special Issue Childhood and Teenage Learning, Lifestyle, Health Factors and Physical Activity in Children)

10 pages, 1128 KiB

Open AccessArticle

Determinant Factors and Characteristics of Injuries Among Preschool Children in Public Daycare Centers

by Olga Kouli, Eleftheria Morela, Elissavet Papanikolaou, Antonis Dalakis, Maria Karageorgopoulou and Antonis Kambas

Children 2025, 12(2), 251; https://doi.org/10.3390/children12020251 - 19 Feb 2025

Abstract

Background/Objective: Evidence suggests that preschool children experience significantly higher rates of injury-related mortality and disability compared to older age groups of children. However, there seems to be a lack of recorded data on unintentional injuries among preschoolers in public daycare centers in Greece. [...] Read more.

Background/Objective: Evidence suggests that preschool children experience significantly higher rates of injury-related mortality and disability compared to older age groups of children. However, there seems to be a lack of recorded data on unintentional injuries among preschoolers in public daycare centers in Greece. Therefore, the present study aims to identify determinant factors and characteristics of unintentional injuries among preschool children in public daycare centers. Methods: The sample consisted of 6 daycare centers in the Municipality of Xanthi in Greece, with 444 preschool children (M = 3.73 ± 0.47 years of age). Educators completed reports detailing the number and characteristics of unintentional injuries sustained and provided specific information about each. During the study (10 months), 351 injury reports were completed. Results: Frequency analyses showed that children who were most frequently injured were between 3.5 and 4 years old, while boys were more susceptible. The leading causes of injuries were falls and acute overload. Cuts and wounds were the most common type of injury, and the body part that was more frequently injured was the head. The majority of injuries occurred in classrooms during free play. Conclusions: The results highlight the need for injury prevention strategies in daycare centers, including modifications to play areas, increased supervision during free play, and educator training on risk reduction. Full article

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

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14 pages, 5500 KiB

Open AccessArticle

Literature Review of Various Treatments in CNPAS and a Proposed Novel Clinical Treatment Algorithm

by Omri Emodi, Nidal Zeineh, Ahmad Hija, Amir Bilder, Chaim Ohayon, Dekel Shilo, Miri Tzemach, Talia Gazit-Rappaport, Arie Gordin, Adi Rachmiel and Tal Capucha

Children 2025, 12(2), 250; https://doi.org/10.3390/children12020250 - 19 Feb 2025

Abstract

Background: Congenital nasal pyriform aperture stenosis (CNPAS) is a rare disorder characterized by a narrowed pyriform aperture and nasal obstruction. Children with CNPAS often exhibit a bony ridge on the underside of the secondary palate, a solitary central incisor, and a triangular-shaped palate. [...] Read more.

Background: Congenital nasal pyriform aperture stenosis (CNPAS) is a rare disorder characterized by a narrowed pyriform aperture and nasal obstruction. Children with CNPAS often exhibit a bony ridge on the underside of the secondary palate, a solitary central incisor, and a triangular-shaped palate. Due to its rarity, limited research exists, and there is no established treatment algorithm, which complicates management, particularly in craniofacial treatments and long-term follow-up. Aims: This study aimed to develop a comprehensive treatment algorithm based on long-term follow-up, focusing on maxillofacial deformities, dental considerations, and upper airway assessment. Methods: We conducted a retrospective study of four CNPAS patients treated at our institute. We performed a literature review, and a comparison was executed with our data in order to introduce our novel, age-specific clinical treatment framework. Results: A literature review was conducted, and different clinical parameters were examined. Previously published data were compared to our patients-related findings to develop our clinical treatment algorithm based on patients’ age. Patients were monitored for respiratory distress during the first two years of life. Children with cyclic cyanosis underwent surgical widening of the pyriform aperture through bony excess removal and nasal tubing to ensure airway patency. For those with ongoing desaturation events, neonatal palatal expansion was performed. At ages 10–12, additional evaluations using polysomnography and orthodontic assessments were conducted. Based on these findings, patients received surgically assisted rapid palatal expansion (SARPE) and further surgical widening of the pyriform aperture if obstructive sleep apnea (OSA) was present. Subsequent treatments included orthodontic care and restoration of the missing central incisor. Conclusions: We propose an age-based clinical treatment algorithm for CNPAS tailored to address individual patient needs throughout their growth. Full article

(This article belongs to the Section Pediatric Otolaryngology)

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9 pages, 219 KiB

Open AccessArticle

Correlation of Neuroanatomical Structures Related to Speech in Cerebral Palsy Patients Aged 0–17: A Retrospective MRI Study

by Erhan Berk, Rümeysa Üzümcüoğlu, Feyza İnceoğlu, Merve Aydın, Muhammed Furkan Arpacı, Ahmet Sığırcı and Hıdır Pekmez

Children 2025, 12(2), 249; https://doi.org/10.3390/children12020249 - 19 Feb 2025

Abstract

Background/Objectives: Cerebral Palsy (CP) is a non-progressive clinical condition characterized by secondary issues, including speech impairments. Our study aims to evaluate the volumes of brain areas related to speech in patients diagnosed with CP between the ages of 0–17. Methods: this [...] Read more.

Background/Objectives: Cerebral Palsy (CP) is a non-progressive clinical condition characterized by secondary issues, including speech impairments. Our study aims to evaluate the volumes of brain areas related to speech in patients diagnosed with CP between the ages of 0–17. Methods: this study includes the images of 84 children: 42 in the control group who applied to the hospital between the specified dates and were reported as healthy by MRI from the patient records, and 42 patients with CP. Results: in the CP group, white and gray matter, cerebrum, cerebellum, thalamus, lobus frontalis, lobus temporalis, lobus parietalis, lobus insularis, gyrus cinguli, and nuclei basales volumes were observed to decrease statistically significantly compared to the control group (p ˂ 0.001). Conclusions: we found a significant decrease in the volumes of speech-related brain areas in CP patients, indicating that CP can significantly impact the brain’s speech-related regions. Full article

(This article belongs to the Section Pediatric Radiology)

8 pages, 1248 KiB

Open AccessArticle

Incidence and Characteristics of Pediatric Eosinophilic Esophagitis: A Midwestern State Analysis

by Jose L. Zamora-Sifuentes, Andrew Rorie, Sharad Kunnath, Rosemary Pauley, Andrew Huang Pacheco and Russell Hopp

Children 2025, 12(2), 248; https://doi.org/10.3390/children12020248 - 19 Feb 2025

Abstract

Background: Eosinophilic esophagitis (EoE) is a chronic disease defined by esophageal dysfunction and >15 eosinophils per high-power-field on biopsy. Despite its increased incidence across the United States, studies evaluating its incidence at any state level are lacking. Methods: Record review of pediatric patients [...] Read more.

Background: Eosinophilic esophagitis (EoE) is a chronic disease defined by esophageal dysfunction and >15 eosinophils per high-power-field on biopsy. Despite its increased incidence across the United States, studies evaluating its incidence at any state level are lacking. Methods: Record review of pediatric patients (<18 years) newly diagnosed with EoE based on ICD coding seen at the main two pediatric gastroenterology centers in the state: Children’s Nebraska (1 January 2016–31 December 2022) and Boys Town National Research Hospital (1 January 2022–31 December 2022). Data included demographics, age, and zip codes. Descriptive analysis focused on Nebraska residents. Results: The average point incidence of EoE between 2016 and 2022 was 10.84/100,000 inhabitants based on data from Children’s Nebraska. Considering both centers, the point incidence in Nebraska for 2022 was 32.45/100,000 inhabitants. Caucasians were 3.7 times more likely to be affected and older at time of diagnosis (average 9.7 years) compared to African Americans (7.0), Hispanics (7.4), and Asians (4.4). Conclusions: This is the first study evaluating the incidence of EoE in a specific U.S.A state. Studies at the state level are important to direct policy and interventions aiming limit its burden in communities. Full article

(This article belongs to the Special Issue Diagnosis, Treatment and Care of Pediatric Allergy)

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15 pages, 223 KiB

Open AccessArticle

Adolescents’ Evaluation of Their Parents in Terms of Helicopter Parenting Attitudes

by Melike Yavaş Çelik

Children 2025, 12(2), 247; https://doi.org/10.3390/children12020247 - 18 Feb 2025

Abstract

Background/Objectives: Helicopter parenting is likened to a helicopter constantly hovering over the child. Every action the child takes or attempts to take is monitored by the parents and the child is continuously subjected to parental pressure. This study aims to evaluate the parents [...] Read more.

Background/Objectives: Helicopter parenting is likened to a helicopter constantly hovering over the child. Every action the child takes or attempts to take is monitored by the parents and the child is continuously subjected to parental pressure. This study aims to evaluate the parents of adolescents in terms of helicopter parenting attitudes. Methods: The present study was conducted with a total of 697 adolescents. The data were collected using a question form and the Helicopter Parent Attitude/s Scale (HPAS). Results: The mean HPAS score of the mothers was found to be 35.81 ± 9.43, and the mean HPAS score of the fathers was 32.64 ± 9.50. The results indicated a statistically significant difference in the average HPAS score of the mothers and fathers. It was found that the HPAS scores of mothers seen by the adolescents as having overprotective attitudes were higher than those of mothers with other attitudes. It was found that the average HPAS scores of fathers who were seen by adolescents as having indifferent attitudes were lower than those of fathers with different attitudes. Conclusions: Mothers may have more helicopter parenting attitudes than fathers. There may also be a relationship between overprotective attitudes, indifferent attitudes, and helicopter parenting attitudes. The mediating roles of helicopter parenting should be evaluated in more detail and should help them fulfill their parenting roles. Full article

(This article belongs to the Special Issue The Impact of Family Education on Children and Adolescents)

19 pages, 1464 KiB

Open AccessArticle

Mediating Role of Moral Disengagement Mechanisms in the Relationship Between Perceived Parental Warmth and Youth Violence

by María J. Navas-Martínez, Lourdes Contreras and M. Carmen Cano-Lozano

Children 2025, 12(2), 246; https://doi.org/10.3390/children12020246 - 18 Feb 2025

Abstract

Background/Objectives: Although child-to-parent violence (CPV), peer violence (PV), and dating violence (DV) share risk factors and tend to co-occur, little is known about the common and differential mechanisms involved in the development of these types of youth violence. This study aims to (1) [...] Read more.

Background/Objectives: Although child-to-parent violence (CPV), peer violence (PV), and dating violence (DV) share risk factors and tend to co-occur, little is known about the common and differential mechanisms involved in the development of these types of youth violence. This study aims to (1) analyze the relationship between youth violence (CPV, PV, and DV) and perceived parental warmth and moral disengagement mechanisms and (2) explore the mediating role of moral disengagement mechanisms in the relationship between the lack of perceived parental warmth and youth violence. Methods: A cross-sectional population-based survey study was conducted. The sample consisted of 2124 Spanish adolescents (57.9% girls) aged between 13 and 17 years from educational centers. Results: The lack of perceived parental warmth (parental criticism-rejection in particular) is a common risk factor for all three types of violence and, more relevantly, is related to youth violence through moral disengagement mechanisms, highlighting a differential contribution of these mechanisms according to the type of violence. In particular, advantageous comparison and attribution of blame are specific mediators of CPV, and moral justification and distortion of consequences are specific to PV, whereas euphemistic language seems to be a common mediator of PV and DV. Conclusions: This study suggests that adolescents who perceive a lack of parental warmth are more likely to develop different dysfunctional cognitive mechanisms, which in turn are related to different types of youth violence. It would be important to promote warm parenting practices and address the cognitive mechanisms underlying youth violence. Full article

(This article belongs to the Special Issue Adverse Childhood Experiences: Assessment and Long-Term Outcomes)

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15 pages, 634 KiB

Open AccessArticle

The Contribution of FMRP to the Development of Speech and Vocabulary in Young Boys with Fragile X Syndrome: A Retrospective Examination

by Stephen R. Hooper, John Sideris, Deborah R. Hatton and Joanne R. Roberts

Children 2025, 12(2), 245; https://doi.org/10.3390/children12020245 - 18 Feb 2025

Abstract

Background/Objectives: This study examined the development of speech, expressive vocabulary, and receptive vocabulary in boys with Fragile X Syndrome (FXS), with a focus on the contribution of the Fragile X Messenger Ribonucleoprotein (FMRP), while controlling for the effects of nonverbal IQ, maternal education, [...] Read more.

Background/Objectives: This study examined the development of speech, expressive vocabulary, and receptive vocabulary in boys with Fragile X Syndrome (FXS), with a focus on the contribution of the Fragile X Messenger Ribonucleoprotein (FMRP), while controlling for the effects of nonverbal IQ, maternal education, and Autism status on the development of these skills. Methods: Participants included 45 boys with full mutation FXS, ranging in age from 2.9 to 14.0 years, who were subdivided into those with FXS only (FXS-Only) and those with FXS and Autism (FXS-Autism). Speech, expressive vocabulary, and receptive vocabulary skills were assessed over three years for each participant. Results: There was a significant relationship between each of the outcome measures and the child’s nonverbal mental level, and between for both outcome measures of vocabulary and Autism status, but these relationships were moderated by the level of FMRP. Specifically, higher levels of FMRP seemed to increase the relationship between developmental level of speech, receptive, and expressive vocabulary for boys with FXS with and without Autism; however, at lower levels of FMRP, these relationships seemed to weaken significantly for both groups. Conclusions: These findings implicate increased complexity in the relationship between various contributors to the rates of growth of speech, expressive vocabulary, and receptive vocabulary in boys with FXS, with FMRP being a key variable potentially moderating the relationship between nonverbal abilities, Autism status, and speech and vocabulary development. Full article

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

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17 pages, 467 KiB

Open AccessReview

Applications of Machine Learning in the Diagnosis and Prognosis of Patients with Chiari Malformation Type I: A Scoping Review

by Solonas Symeou, Marios Lampros, Panagiota Zagorianakou, Spyridon Voulgaris and George A. Alexiou

Children 2025, 12(2), 244; https://doi.org/10.3390/children12020244 - 18 Feb 2025

Abstract

Background: The implementation of machine learning (ML) models has significantly impacted neuroimaging. Recent data suggest that these models may improve the accuracy of diagnosing and predicting outcomes in patients with Chiari malformation type I (CMI). Methods: A scoping review was conducted according [...] Read more.

Background: The implementation of machine learning (ML) models has significantly impacted neuroimaging. Recent data suggest that these models may improve the accuracy of diagnosing and predicting outcomes in patients with Chiari malformation type I (CMI). Methods: A scoping review was conducted according to the guidelines put forth by PRISMA. The literature search was performed in PubMed/MEDLINE, SCOPUS, and ScienceDirect databases. We included observational or experimental studies focusing on the applications of ML in patients with CMI. Results: A total of 9 articles were included. All the included articles were retrospective. Five out of the nine studies investigated the applicability of machine learning models for diagnosing CMI, whereas the remaining studies focused on the prognosis of the patients treated for CM. Overall, the accuracy of the machine learning models utilized for the diagnosis ranged from 0.555 to 1.00, whereas the specificity and sensitivity ranged from 0.714 to 1.00 and 0.690 to 1.00, respectively. The accuracy of the prognostic ML models ranged from 0.402 to 0.820, and the AUC ranged from 0.340 to 0.990. The most utilized ML model for the diagnosis of CMI is logistic regression (LR), whereas the support vector machine (SVM) is the most utilized model for postoperative prognosis. Conclusions: In the present review, both conventional and novel ML models were utilized to diagnose CMI or predict patient outcomes following surgical treatment. While these models demonstrated significant potential, none were highly validated. Therefore, further research and validation are required before their actual implementation in standard medical practice. Full article

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

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17 pages, 294 KiB

Open AccessArticle

Child-to-Parent Violence Among Adolescents: A Preliminary Analysis of Its Association with Sociodemographic Variables, Dating Violence, and Antisocial Traits

by Alba Espuig, Laura Lacomba-Trejo and Francisco González-Sala

Children 2025, 12(2), 243; https://doi.org/10.3390/children12020243 - 18 Feb 2025

Abstract

Introduction: Child-to-parent violence (CPV) is influenced by factors such as sex, age, dating violence, psychopathy traits, and antisocial and law-violating behaviors. This study explores how these variables relate to aggression towards parents, identifying key explanatory factors. Methods: This research engaged 136 Spanish adolescents [...] Read more.

Introduction: Child-to-parent violence (CPV) is influenced by factors such as sex, age, dating violence, psychopathy traits, and antisocial and law-violating behaviors. This study explores how these variables relate to aggression towards parents, identifying key explanatory factors. Methods: This research engaged 136 Spanish adolescents aged 15–18 (mean age = 16.47; 51% female). Assessments included the Conflict in Adolescent Dating Relationships Inventory (CADRI) for dating violence, the Psychopathy Content Scale (P-16) for psychopathy, the Antisocial and Criminal Behavior Scale in Adolescents (ECADA) for antisocial and law-violating behaviors, and the Conflict Tactics Scales (CTS2) for CPV. Analyses of associations included linear regression and qualitative comparative analysis (QCA). Results: Females exhibited higher levels of verbal violence, less delinquency, and more frequent CPV towards mothers. Psychopathy, antisocial and law-violating behaviors, and exposure to verbal violence were correlated with filial aggression. Violence towards mothers was associated with older age, female sex, verbal violence exposure, and psychopathy (47% variance explained), while violence towards fathers was linked to younger age and psychopathy (28% variance explained). QCA results indicated that specific combinations of having experienced violence and psychopathic traits contribute to CPV towards both parents. Conclusions: These findings highlight the importance of addressing psychological and sociodemographic risk factors for CPV. Prevention efforts should focus on reducing exposure to violence, identifying at-risk adolescents, and implementing targeted interventions to promote family well-being. Full article

(This article belongs to the Section Pediatric Mental Health)

11 pages, 998 KiB

Open AccessArticle

Pediatric Pleural Effusion and Pneumococcal Vaccination Trends in the Pre- and Post-COVID Era: A Single-Centre Retrospective Study

by Denisa Lavinia Atanasiu, Maria Mitrica, Luciana Petrescu, Oana Falup-Pecurariu, Laura Bleotu, Raluca Ileana Lixandru, David Greenberg and Alexandra Grecu

Children 2025, 12(2), 242; https://doi.org/10.3390/children12020242 - 18 Feb 2025

Abstract

Background/Objectives: Pleural effusion represents an accumulation of fluid in the pleural cavity, frequently associated with pneumonia. There has been a gradual increase in cases among children in recent years, with a notable rise during the post-pandemic period, potentially due to immune debt, [...] Read more.

Background/Objectives: Pleural effusion represents an accumulation of fluid in the pleural cavity, frequently associated with pneumonia. There has been a gradual increase in cases among children in recent years, with a notable rise during the post-pandemic period, potentially due to immune debt, decreased vaccination coverage, and changes in pathogen dynamics. Methods: We enrolled 66 children with pleural effusion treated at the Children’s Emergency Clinical Hospital, Brasov, between January 2019 and September 2024. We analyzed the data on demographics, symptoms, vaccination status, hospitalization, and treatments to assess the trends in the incidence and clinical features. Results: The median age was 5 years (ranging from 3 months to 17 years). Most patients were male (57.5%) from rural areas (34.8%). Only 40.9% fulfilled the vaccination schedule of Romania. We observed a rise in hospitalizations in the last two years, with 16 cases in 2023 and 15 in 2024, and most were being admitted in April (15.5%). Patients mainly had severe (36%) and medium (26%) acute respiratory failure. S. pneumoniae was the most common isolate with two cases each of serotype 1, 14, and 23A, and one case each of serotype 3, 31, and 34, followed by H. influenzae and P. aeruginosa. Treatment was mostly with ceftriaxone (69.6%), Vancomycin (63.6%), Meropenem (53.0%), and Teicoplanin (25.7%). Some children required thoracic drainage (34.8%). Complications like pneumothorax (16.6%), polyserositis (4.5%), and pneumomediastinum (3.0%) were found. Conclusions: The rise in pleural effusion cases may be influenced by various factors, such as changes in pathogen behavior or host immune responses following the pandemic. Further research is needed to understand these potential mechanisms. The emergence of non-PCV20 strains and the common occurrence of serotype 3 infections point out the need to study serotype trends and evaluate whether expanding vaccine programs could be beneficial. Full article

(This article belongs to the Section Pediatric Infectious Diseases)

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23 pages, 2955 KiB

Open AccessArticle

Paediatric Major Trauma Psychology Service Evaluation: An Early Review of an Integrated Model of Care

by Rebecca Bundy, Jade Taktak, Zoe Berger, Ewa Nowotny and Idit Albert

Children 2025, 12(2), 241; https://doi.org/10.3390/children12020241 - 18 Feb 2025

Abstract

Major trauma is a leading cause of death and disability in children and young people (CYP) in the United Kingdom (UK). Since 2012, major trauma centres (MTCs) have been created with specialist expertise to treat patients suffering with lifechanging injuries. Much research has [...] Read more.

Major trauma is a leading cause of death and disability in children and young people (CYP) in the United Kingdom (UK). Since 2012, major trauma centres (MTCs) have been created with specialist expertise to treat patients suffering with lifechanging injuries. Much research has focused on the physical recovery of patients; however, the psychological and psychosocial impacts of major trauma are significant and often neglected/deprioritised. Less is known about this area in relation to a paediatric population. This service evaluation reports on the first year of an integrated psychological pathway within a London paediatric MTC. The proactive approach involves inpatient and outpatient psychological support, screening children and families for trauma symptoms and emotional distress, offering psychological intervention where required, and liaison with community mental health teams, social care services and third sector organisations. Descriptive statistics are reported on the patient demographics and mechanism of injury, as well as screening scores at 6 weeks and 3 months following the traumatic incident. Patient feedback is also presented. The results demonstrate a significant increase in the numbers of children and families offered psychological support following the creation of the pathway and an overwhelmingly positive response from service users. Clinical implications are outlined, and areas for further development are discussed. Full article

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

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8 pages, 528 KiB

Open AccessArticle

Small Intestinal Atresia: Should We Preserve the Peel or Toss It?

by Benedetta Marino, Giulia Mottadelli, Marta Bisol, Maria Sergio, Piergiorgio Gamba and Elisa Zambaiti

Children 2025, 12(2), 240; https://doi.org/10.3390/children12020240 - 17 Feb 2025

Abstract

Background: Apple peel atresia (APA) is a rare and severe form of intestinal atresia, but little is known on long-term outcomes. We compared outcomes of apple-peel atresia based on different surgical approaches. Methods: a retrospective review from two institutions compared APA-resected and APA-preserved [...] Read more.

Background: Apple peel atresia (APA) is a rare and severe form of intestinal atresia, but little is known on long-term outcomes. We compared outcomes of apple-peel atresia based on different surgical approaches. Methods: a retrospective review from two institutions compared APA-resected and APA-preserved patients. Demographics, operative details, postoperative courses and long-term outcomes were analyzed. Results: Of the 16 APA neonates, 10 (62.5%) were in APA-resected and 6 (37.5%) in APA-preserved groups. Early postoperative complications occurred in 7 patients (43.75%) including vomiting, infection, intestinal occlusion, anastomotic dehiscence, multiorgan failure, equally distributed among groups. Length-of-stay is higher in the APA-preserved group (median 67 vs. 27 days, p = 0.14). Overall survival at discharge was 87.5%. Twelve children (75%) were followed for an average of 5 years. Reoperation was required in 4 children owing to anastomotic obstruction and adhesive intestinal obstruction, two in each group. Conclusion: to prevent intestinal failure, keeping the APA shows not inferior results compared to resection, even though it may have a longer first-postoperative course. Full article

(This article belongs to the Special Issue Prevention of Intestinal Atresia and Necrotizing Enterocolitis in Infants)

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15 pages, 1769 KiB

Open AccessArticle

Switching to the CKD-EPI but Not Modified FAS eGFR Formula Underdetects CKD Among Adolescents and Young Adults in México

by Alethia Paulina Monserrat Guzmán Núñez, Guido Filler, Olivier C. Barbier, Elodia Rojas Lima, Pablo Mendez-Hernández, Manolo Ortega-Romero, Maria Esther Díaz González de Ferris and Mara Medeiros

Children 2025, 12(2), 239; https://doi.org/10.3390/children12020239 - 17 Feb 2025

Abstract

Background: Guidelines recommend switching the glomerular filtration rate (eGFR) estimation from the CKiD-U25 to the CKD-EPI formula at age 18. We investigated how this would affect chronic kidney disease (CKD) classification. Methods: Serum creatinine was enzymatically measured in 1061 samples from 914 community-based [...] Read more.

Background: Guidelines recommend switching the glomerular filtration rate (eGFR) estimation from the CKiD-U25 to the CKD-EPI formula at age 18. We investigated how this would affect chronic kidney disease (CKD) classification. Methods: Serum creatinine was enzymatically measured in 1061 samples from 914 community-based 10–23-year-olds from Tlaxcala, Mexico, a region where urinary biomarkers demonstrated early kidney damage associated with exposure to inorganic toxins in a pediatric population. We calculated their eGFR using CKiD-U25, modified Schwartz, the first and modified Pottel full-age spectrum (FAS), and CKD-EPI formulae. Correlation analysis characterized the CKD stage stratified by age and sex. Results: At baseline, the median age was 13 (IQR: 12, 15) years, and 55% were female. Median CKiD-U25 eGFR was 96.9 (IQR: 83.3, 113.3) mL/min/1.73 m², significantly lower than the CKD-EPI eGFR, which was 140.8 (IQR: 129.9, 149.3) mL/min/1.73 m² (p < 0.0001, Wilcoxon rank test). The mean bias was 36.99 ± 12.89 mL/min/1.73 m². Pearson correlation was r = 0.8296 (95% confidence interval 0.0898–0.8474). There was a better correlation between the modified Schwartz (r = 0.9421 (0.9349, 0.9485)) and the Pottel FAS (r = 0.9299 (0.9212, 0.9376)) formulae. Agreement was deficient when the eGFR was >75 mL/min/1.73 m² in younger age and female sex. Modified Schwartz identified 281 (26.4%) measurements as having CKD 2 and 3 (2+), U25 identified 401 (37.7%) measurements as having CKD 2+, FAS identified 267 (25.1%) and modified FAS identified 282 (30%) measurements as having CKD 2+, and CKD-EPI identified 51 (4.8%) measurements as having CKD 2+, respectively. Conclusions: In this population, there needed to be better agreement between the various eGFR formulae. CKD-EPI identifies substantially fewer at-risk participants as having CKD. Full article

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

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17 pages, 913 KiB

Open AccessArticle

Key Nutrient Intakes at Risk Among US Children in the National Health and Nutrition Examination Survey (NHANES) 2015–2016 Stratified by Age and Gender

by John Lasekan, Qi Yao, Yong Choe, Grace M. Niemiro and Penni Hicks

Children 2025, 12(2), 238; https://doi.org/10.3390/children12020238 - 17 Feb 2025

Abstract

Background/Objective: Inadequate nutrient intake in childhood can have lasting detrimental developmental and health outcomes. The objective of this study was to identify key nutrient intake gaps among US children. Method: Using the National Health and Nutrition Examination Survey 2015–2016 data, we compared nutrient [...] Read more.

Background/Objective: Inadequate nutrient intake in childhood can have lasting detrimental developmental and health outcomes. The objective of this study was to identify key nutrient intake gaps among US children. Method: Using the National Health and Nutrition Examination Survey 2015–2016 data, we compared nutrient intakes against dietary reference intakes (DRIs). Participants were grouped by age (in years): 0–0.5, 0.6–1, 1–4, 5–8, 9–14, and 15–19. Gender differences were assessed in the two older groups. Results: Linoleic acid, linolenic acid, vitamin D, and choline were the most consumed at lesser than DRIs in all age groups. Additionally, dietary fiber, vitamin A, vitamin E, vitamin K, folate, iron, and calcium were consumed at lesser than DRIs in 1–19 year olds. They also had an inadequate intake of docosahexaenoic acid (DHA). Children with nutrient intake gaps increased from infancy and toddlerhood to school-age period, with the inflection point at 5–8 years of age when parents have limited control on children’s nutrient intake. Above 9 years of age, females had greater nutrient intake gaps than males. Females in the 15–19-year-old segment especially had higher nutrient intake gaps (p < 0.05) for vitamin D, thiamin, riboflavin, vitamin B12, folate, iron, calcium, magnesium, phosphorus, and potassium compared to males. Selected laboratory biomarkers were used to verify the nutrient intake data. Conclusions: Key nutrient intake gaps were identified among different age groups of children in the US, which may have implications for future dietary interventions and target food formulations to help narrow these gaps. Full article

(This article belongs to the Special Issue Infant and Early Childhood Nutrition)

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12 pages, 186 KiB

Open AccessCase Report

The Clinical Phenotype of Early Selective Mutism and Later Autism Spectrum Disorder in Girls: A Case Series Analysis

by Hagit Nagar Shimoni, Efrat Zilbershot Fink and Yael Leitner

Children 2025, 12(2), 237; https://doi.org/10.3390/children12020237 - 16 Feb 2025

Abstract

Background: The presentation of autism spectrum disorder (ASD) in girls often differs from that of boys, leading to delayed diagnosis. Selective mutism presenting at a young age can obscure autism symptoms, particularly in girls who exhibit “masking” behaviors. In this study, we examined [...] Read more.

Background: The presentation of autism spectrum disorder (ASD) in girls often differs from that of boys, leading to delayed diagnosis. Selective mutism presenting at a young age can obscure autism symptoms, particularly in girls who exhibit “masking” behaviors. In this study, we examined the early manifestation of selective mutism in four girls who were later diagnosed with ASD. Method: The study describes four case studies of girls who underwent an ASD diagnostic process. All were either diagnosed at an early age with selective mutism or had selective mutism suspected as a potential diagnosis during their preschool years. Clinical information was collected through detailed developmental history and clinical evaluations by a multidisciplinary team. Results: All girls were diagnosed at a young age with selective mutism by a child psychiatrist and later with ASD by a multidisciplinary team. They all demonstrated normal-range intelligence. This is in agreement with Muris and Steffenburg asserting that in a certain group of children, an early manifestation of selective mutism may be an early marker of ASD. Conclusions: Special follow-up should be given to girls diagnosed with selective mutism during their preschool years because this could be an early marker for a later ASD diagnosis. Full article

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

9 pages, 829 KiB

Open AccessArticle

Continuous Gastric pH Monitoring in Children Facilitates Better Understanding of Gastroesophageal Reflux Disease: A Prospective Observational Study

by Shiva Sharma, Devendra I. Mehta, Nishant Patel, Arun Ajmera, Jeffrey Bornstein and Florence George

Children 2025, 12(2), 236; https://doi.org/10.3390/children12020236 - 15 Feb 2025

Abstract

Objectives: Gastroesophageal reflux disease (GERD) is commonly encountered in adults and children. A subset of patients with GERD are refractory to acid suppressants, implicating other factors in the refluxate. Duodenogastric reflux (DGR) produces similar symptoms through reflux of non-acidic duodenal content and the [...] Read more.

Objectives: Gastroesophageal reflux disease (GERD) is commonly encountered in adults and children. A subset of patients with GERD are refractory to acid suppressants, implicating other factors in the refluxate. Duodenogastric reflux (DGR) produces similar symptoms through reflux of non-acidic duodenal content and the cytotoxic effect of bile in the esophageal mucosa. Various methods have been utilized to detect DGR using a Bilitec device or Hepatobiliary scintigraphy, amongst the most common, each with their own limitations. We aimed to use combined multichannel intraluminal impedance and pH (MII-pH) monitoring with an additional gastric pH sensor to collect information about acidic and non-acidic gastroesophageal refluxes and to assess whether continuous gastric pH measurement in children provides indirect evidence of DGR for better understanding of the symptoms. Methods: From 2022 through 2023, clinically symptomatic pediatric patients scheduled for esophagogastroduodenoscopy (EGD) and MII-pH at Arnold Palmer Hospital for Children in the United States were included (n = 26). Exclusions included patients taking acid suppressants prior to the start of this study. The data were analyzed for subjects completing at least 18 h of the study protocol. Results: Subjects with a normal pH impedance (n = 5) showed a median non-meal gastric pH of 1.8. Subjects with an abnormal pH impedance (n = 21) showed a median non-meal gastric pH of 2.2. Of the 26 subjects enrolled, the duration of non-meal gastric pH 4.0–7.0 was positively correlated with non-acidic gastroesophageal refluxes. Although all acidic reflux events occurred at gastric pH < 4.0, there was no correlation between the duration of non-meal gastric pH < 4.0 and impedance changes or reflux index. Conclusions: The results showed daily variability in the non-meal gastric pH of pediatric patients and a statistically significant correlation between its duration at pH 4.0 to 7.0 and non-acidic refluxes suggestive of the implication of DGR. Further research is required to assess this association with gastroesophageal reflux and dyspeptic symptoms to investigate the diagnostic tools and therapeutic interventions, including the role of prokinetics and surface protective agents for DGR. Full article

(This article belongs to the Section Pediatric Gastroenterology and Nutrition)

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16 pages, 428 KiB

Open AccessArticle

Impact of Mental Health Literacy on Improving Quality of Life Among Adolescents in Barcelona

by Isaac Daniel Amado-Rodríguez, Rocio Casañas, Jaume Juan-Parra, Juan Francisco Roldan-Merino, Lluís Lalucat-Jo and Mª Isabel Fernandez-San-Martín

Children 2025, 12(2), 235; https://doi.org/10.3390/children12020235 - 15 Feb 2025

Abstract

Background/Objectives: We aim to assess the effect of the Espaijove.net mental health literacy program on adolescents’ quality of life (QOL). Additionally, we aim to describe their QOL and mental well-being. Methods: A multicenter, randomized, controlled trial was conducted, with pre- and [...] Read more.

Background/Objectives: We aim to assess the effect of the Espaijove.net mental health literacy program on adolescents’ quality of life (QOL). Additionally, we aim to describe their QOL and mental well-being. Methods: A multicenter, randomized, controlled trial was conducted, with pre- and post-intervention assessments and 6- and 12-month follow-ups. A total of 1032 students aged 13–14 from 18 schools in Barcelona participated in one of the three following mental health literacy (MHL) programs or were placed in a control group (CG): (1) a 1 h awareness session (G1h); (2) a 6 h MHL program (G6h); (3) a 7 h MHL program with stigma reduction (G7h). Measures: (1) Mental well-being: Strengths and Difficulties Questionnaire (SDQ); (2) QOL: EuroQol 5D-5L with its two parts: the EuroQol 5D-5L Index (0–1) and EuroQol 5D-5L visual analog scale (EQ-VAS) (0–100). Analyses were conducted on an intention-to-treat basis, using data imputation methods for missing data. Intervention effects were assessed using multilevel models. Results: Baseline EQ-VAS and EQ-5D-5L index scores were 77.84 (CI = 76.77–78.91) and 0.91 (CI = 0.90–0.92), respectively. Boys reported higher QOL and SDQ scores (p < 0.001), whereas participants of foreign nationality showed lower scores in QOL (EQ-VAS; p = 0.039) and mental well-being (p < 0.001). Post-intervention, all groups (intervention and control), except G6h, showed QOL improvements. However, in the 6-month follow-up, the CG outperformed the other groups. At 12 months, G7h achieved the highest EQ-VAS scores compared to the other groups. Conclusions: MHL-based interventions improved short-term QOL but failed to sustain these improvements over time. Groups with lower QOL and SDQ scores included girls and adolescents of foreign nationality. Full article

(This article belongs to the Section Pediatric Mental Health)

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9 pages, 982 KiB

Open AccessArticle

Do Most Children with Functional Constipation Meet the Commonly Used Clinical Trial Endpoints?

by Samantha Arrizabalo, Carlos Alberto Velasco-Benitez, Daniela Alejandra Velasco-Suarez, Rafael Giner and Miguel Saps

Children 2025, 12(2), 234; https://doi.org/10.3390/children12020234 - 15 Feb 2025

Abstract

Background/Objectives: Functional constipation (FC) is diagnosed using the Rome IV criteria, which require at least two of seven symptoms for diagnosis. Clinical trials evaluating FC treatments commonly use bowel movement frequency, stool consistency, and fecal incontinence as primary endpoints. However, there is limited [...] Read more.

Background/Objectives: Functional constipation (FC) is diagnosed using the Rome IV criteria, which require at least two of seven symptoms for diagnosis. Clinical trials evaluating FC treatments commonly use bowel movement frequency, stool consistency, and fecal incontinence as primary endpoints. However, there is limited data on whether these endpoints accurately represent the symptom distribution in children with FC. This study assessed the frequency of each criterion in a large children’s community sample to determine whether commonly used clinical trial endpoints accurately reflect symptom distribution. Methods: A cross-sectional study of school children aged 8–18 years was conducted across seven Colombian cities. Participants completed the Pediatric Gastrointestinal Symptoms Rome IV Questionnaire (QPGS-IV). The prevalence of FC and the distribution of diagnostic criteria were analyzed, calculating the percentage of each criterion. Results: 6611 children completed the questionnaires. FC was diagnosed in 12.8% of participants, making it the most common disorder of gut–brain interaction. The most reported criteria were fewer than two stools per week (66.1%) and painful bowel movements (65%), while fecal incontinence was uncommon (6.9%). 60.5% of participants met only two criteria, with two or fewer defecations per week and painful bowel movements being the most common combination. Conclusions: This study reveals significant variability in Rome IV criteria prevalence for FC, highlighting disparities between the most common endpoints in clinical trials and symptom distribution in a community-based cohort. Painful bowel movements emerged as a critical diagnostic component but remain underutilized as an endpoint in pediatric trials. These findings suggest the possible need to reassess endpoint selection in clinical trials. Full article

(This article belongs to the Special Issue Advances in Pediatric Gastroenterology)

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10 pages, 209 KiB

Open AccessArticle

Predictors of Friendship Skills for Adolescents with Asthma: An Analysis of Parent Report on the 2022 National Survey of Children’s Health

by Brandon Workman, Laura A. Nabors, Danielle Pierre Hixon, Ashley L. Merianos, Cathleen Odar Stough, Joshua S. Bernstein and Jonathan A. Bernstein

Children 2025, 12(2), 233; https://doi.org/10.3390/children12020233 - 15 Feb 2025

Abstract

Background/Objectives: This study assesses parent reports of adolescent- and parent-level factors related to friendships among adolescents with asthma. This study serves to inform physicians and other health care professionals of factors related to difficulties making friends for adolescents with asthma, providing information from [...] Read more.

Background/Objectives: This study assesses parent reports of adolescent- and parent-level factors related to friendships among adolescents with asthma. This study serves to inform physicians and other health care professionals of factors related to difficulties making friends for adolescents with asthma, providing information from parent reports to identify risk and resilience factors related to friendships. Methods: Adolescents aged 12–17 years with current asthma from the 2022 National Survey of Children’s Health (NSCH) were selected for the study (n = 1812). A weighted logistic regression analysis was performed to explore predictors related to making and keeping friends. Adolescent-level predictors were asthma severity, allergies, body mass index, having behavioral problems, and adolescent sex and race/ethnicity (non-Hispanic White, and others, including Hispanic). Parent-level predictors were parent stress and coping. Results: Adolescents who were female, non-Hispanic White, had moderate/severe asthma symptoms, had current allergies, were overweight, and had behavioral problems were more likely to have difficulty making and keeping friends than adolescents who were male, non-White, had mild asthma, did not have allergies, were a normal weight or underweight, and did not have behavioral problems. Parents who reported difficulty coping with parenthood and its associated stressors were more likely to report that their adolescents had difficulty making friends. Conclusions: Pediatric moderate-to-severe asthma patients whose parents had difficulty coping with stress were more likely to exhibit greater difficulty making and keeping friends. Health care professionals managing these patients should incorporate questions into their history that address behavioral problems and parental household stress growing up to determine optimal strategies for improving friendship relationships. Whether this strategy leads to better asthma control and outcomes requires further investigation. In future studies, case studies with information about changes in friendships over time for adolescents with asthma should be carried out. The case studies could potentially highlight social strategies to use to improve friendship skills, and ultimately friendship-making for this vulnerable group. Full article

(This article belongs to the Special Issue Pediatric Respiratory Diseases: Diagnosis, Treatment, and Prevention)

11 pages, 523 KiB

Open AccessArticle

Arterial Stiffness and Subclinical Inflammation in Children with Familial Mediterranean Fever: A Comprehensive Analysis

by Nadide Melike Sav, Hasan Baki Altinsoy, Betul Turen and Ayşe Gökçe

Children 2025, 12(2), 232; https://doi.org/10.3390/children12020232 - 14 Feb 2025

Abstract

Background/Objectives: Familial Mediterranean fever (FMF) is a chronic autoinflammatory disease. Throughout the disease, subclinical inflammation persists into the remission period. It is known that chronic inflammation causes endothelial dysfunction and, as a consequence, arterial stiffness occurs. In this study, carotid and aortic [...] Read more.

Background/Objectives: Familial Mediterranean fever (FMF) is a chronic autoinflammatory disease. Throughout the disease, subclinical inflammation persists into the remission period. It is known that chronic inflammation causes endothelial dysfunction and, as a consequence, arterial stiffness occurs. In this study, carotid and aortic intima–media thicknesses (IMT) and arterial stiffness were measured in FMF patients to evaluate the risk of possible vascular damage due to chronic inflammation. Methods: The study included pediatric patients with FMF who had been in remission for a minimum of 3 months. Carotid and aortic IMT and arterial stiffness measurements were conducted using sonoelastography. The acute-phase reactants were also evaluated in all participants. Results: Carotid artery stiffness measurements by strain elastography were significantly higher in the patient group than in the control group. However, the aortic and carotid IMT were similar between the two groups. The acute-phase reactants were significantly higher in the patient group than in the control group. Conclusions: This study demonstrated that arterial stiffness increased in pediatric FMF patients. According to the results of the present study, the effects of chronic inflammation on arterial tissues may lead to atherosclerotic changes in the later stages of the disease and may pose a risk for coronary diseases. Arterial ultrasonographic and elastographic measurements to be performed periodically in children with FMF are noninvasive methods that can be used to evaluate the course of endothelial damage. We aimed to show that arterial stiffness may be a marker of early cardiovascular disease. Full article

(This article belongs to the Special Issue Pediatric Radiologic Imaging: The Current Status and Further Prospects)

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9 pages, 875 KiB

Open AccessSystematic Review

Hypo- and Hypernatremia in Extremely Low Birth Weight Infants in the First 10 Days of Life: A Review

by Myrna Pace, Stijn van Sas, Thomas Salaets, Annouschka Laenen, Anke Raaijmakers and Karel Allegaert

Children 2025, 12(2), 231; https://doi.org/10.3390/children12020231 - 13 Feb 2025

Abstract

Background/Objectives: Sodium regulation is critical in extremely low birth weight (ELBW, <1000 g) infants. This study aimed to provide a comprehensive overview of sodium dynamics and related variables in ELBW infants in their first 10 days of life through a structured literature review. [...] Read more.

Background/Objectives: Sodium regulation is critical in extremely low birth weight (ELBW, <1000 g) infants. This study aimed to provide a comprehensive overview of sodium dynamics and related variables in ELBW infants in their first 10 days of life through a structured literature review. Methods: Applying PRISMA guidelines, six databases were searched (1 August 2023) on sodium measurements in ELBW cohorts, with quality assessment (RoB2, ROBINS-1, Newcastle Ottawa scale) of retained papers, and subsequent data extraction in line with these PRISMA guidelines to describe findings. Results: Only eight heterogeneous studies could be retained, including observational cohort studies (n = 5), case–control studies (n = 2, Tegaderm application yes/no, gestational age < 24 or 24–28 weeks), and only one randomized trial (sodium restriction versus no sodium restriction). Definitions of hyper- or hyponatremia were also heterogeneous, with incidence ranges for hyper- (8–92.2%) and hyponatremia (0–52.9%). Peak sodium values were observed on days 2–4 in the individual studies. When pooled and compared to the cohort mean sodium values, the highest increases in mean serum sodium values were observed on day 3 (+4, range, −0.6 to +8.6 mEq). Variables of sodium values were related to care factors [incubator settings (open/closed, double-/not double-walled, humidity), fluid regimens (water volume, sodium supplementation), occlusive skin care], as well as related maturational factors (postnatal age, gestational age, small versus appropriate for gestational age, SGA/AGA). Conclusions: Based on a structured literature review, patterns of sodium changes over postnatal age in ELBW cases were documented. Besides incubator settings, fluid regimens, or occlusive skin care, these patterns also depend on maturational factors of the ELBW infant (gestational age, postnatal age, SGA/AGA). These complexities emphasize the need for nuanced interpretation, the relevance of standardizing clinical practices and research definitions, and the need to report on additional datasets. Full article

(This article belongs to the Special Issue Renal and Cardiovascular Consequences of Prematurity)

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13 pages, 1933 KiB

Open AccessSystematic Review

Chest Compression Superimposed with Sustained Inflation or 3:1 Compression/Ventilation Ratio During Neonatal Cardiopulmonary Resuscitation in the Delivery Room: A Systematic Review and Meta-Analysis

by Jenny Koo, Anup C. Katheria, Brenda Law, Anne Lee Solevåg, Gerhard Pichler and Georg M. Schmölzer

Children 2025, 12(2), 230; https://doi.org/10.3390/children12020230 - 13 Feb 2025

Abstract

Background: Current resuscitation guidelines recommend a 3:1 chest compression/ventilation (C:V) ratio, which is associated with high morbidity and mortality. An alternative might be continuous chest compression superimposed with high distending pressure or sustained inflation (CC + SI). Objective: To compare CC + SI [...] Read more.

Background: Current resuscitation guidelines recommend a 3:1 chest compression/ventilation (C:V) ratio, which is associated with high morbidity and mortality. An alternative might be continuous chest compression superimposed with high distending pressure or sustained inflation (CC + SI). Objective: To compare CC + SI with 3:1 C:V during neonatal cardiopulmonary resuscitation (CPR). Methods: MEDLINE (through PubMed), Google Scholar, EMBASE, and Clinical Trials.gov through June 2024. Randomized controlled trials comparing CC + SI with 3:1 C:V during neonatal CPR in the delivery room were included. Data Analysis included Risk of bias was assessed using the Covidence collaboration tool, and results were pooled into a meta-analysis using a fixed effects model. Main outcomes were In-hospital mortality (primary). Time to return of spontaneous circulation (ROSC) and air leak (secondary). Results: Two studies were included. The pooled data suggests no difference in infant mortality between CC + SI versus 3:1 C:V during neonatal CPR (RR 0.64, 95% CI 0.21,1.7, p = 0.33, I² = 63%). The use of CC + SI during neonatal CPR could result in 182 fewer per 1000 (from 351 fewer to 311 more) infant deaths. The pooled data suggested a significant reduction in time to ROSC with CC + SI versus 3:1 C:V during neonatal CPR (mean difference 115 s (from 184.75 to 45.36 s), p = 0.001, I² = 26%). Air leak was not different between groups. Conclusions: While in-hospital mortality and air leak were not different between groups, time to ROSC was significantly reduced. A large clinical trial is warranted to assess if CC + SI improves outcomes. Full article

(This article belongs to the Special Issue Advances in Neonatal Resuscitation and Intensive Care)

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12 pages, 356 KiB

Open AccessArticle

Sodium Glycerophosphate vs. Inorganic Phosphate Use in Parenteral Nutrition for Preterm Infants: A Retrospective Study

by Jung-Ting Chang, Yu-Jun Chang, Lih-Ju Chen, Cheng-Han Lee, Hsiao-Neng Chen, Jia-Yuh Chen and Chien-Chou Hsiao

Children 2025, 12(2), 229; https://doi.org/10.3390/children12020229 - 13 Feb 2025

Abstract

Background/Objectives: Sodium glycerophosphate improves the adverse side effects of parenteral nutrition. Therefore, this study aimed to evaluate different outcomes, including metabolic bone disease and electrolyte imbalance, associated with the use of sodium glycerophosphate or inorganic phosphate in parenteral nutrition for preterm neonates. Methods: [...] Read more.

Background/Objectives: Sodium glycerophosphate improves the adverse side effects of parenteral nutrition. Therefore, this study aimed to evaluate different outcomes, including metabolic bone disease and electrolyte imbalance, associated with the use of sodium glycerophosphate or inorganic phosphate in parenteral nutrition for preterm neonates. Methods: This retrospective cohort study enrolled 402 newborns admitted to the neonatal intensive care unit of one medical center between January 2019 and September 2021. Of them, 205 received sodium glycerophosphate as parenteral nutrition, while the other 197 received inorganic phosphate. Baseline characteristics and growth parameters, including body weight, body length, and head circumference in the first year of life; calcium and phosphate content of parenteral nutrition in the first 4 weeks; calcium, phosphorus, alkaline phosphatase (ALP), and creatinine levels; and morbidities were compared. Results: During the first 4 weeks, the calcium and phosphate contents of parenteral nutrition were significantly higher in the sodium glycerophosphate vs. inorganic phosphate group. Growth parameters did not differ significantly between groups. The sodium glycerophosphate group showed a higher mean serum phosphate level (4.0 ± 1.2 mg/dL vs. 3.5 ± 1.3 mg/dL, p = 0.001), lower serum ALP level (402.8 ± 202.8 U/L vs. 466.4 ± 228.6 U/L, p = 0.004), lower seizure incidence (4.9% vs. 13.2%, p = 0.003), and higher hypocalcemia incidence (41.5% vs. 31.5%, p = 0.038). However, there were no significant intergroup differences in other common morbidities such as metabolic bone diseases of prematurity, bronchopulmonary dysplasia, electrolyte imbalance, hypoglycemia, retinopathy of prematurity, or intraventricular hemorrhage. Conclusions: Compared to inorganic phosphate, sodium glycerophosphate is associated with higher serum phosphate levels, lower ALP levels, and reduced seizure incidence in premature infants. However, as the study was retrospective and single-center, further randomized controlled trials are needed to confirm these findings. Full article

(This article belongs to the Section Pediatric Neonatology)

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16 pages, 212 KiB

Open AccessArticle

Perceived Impact of Epilepsy and Its Treatment on Pediatric Patients and Their Families

by Redab Al-Ghawanmeh, Ala’a F. Al-Shaikh, Salma Burayzat, Ruba M. Jaber, Mohammad Al-Tamimi, Osama Zidan and Samah Aburahmeh

Children 2025, 12(2), 228; https://doi.org/10.3390/children12020228 - 13 Feb 2025

Abstract

Background: Epilepsy is the most common chronic neurological condition in children, with a prevalence of 0.3% in Jordan. It significantly impacts patients’ and their families’ lives, shaped by cultural and socioeconomic factors. This study assessed the perceived impact of epilepsy on children and [...] Read more.

Background: Epilepsy is the most common chronic neurological condition in children, with a prevalence of 0.3% in Jordan. It significantly impacts patients’ and their families’ lives, shaped by cultural and socioeconomic factors. This study assessed the perceived impact of epilepsy on children and their families in Jordan. Method: This was a hospital-based, cross-sectional study recruiting 184 children under 18 years with epilepsy using a custom-designed questionnaire. Results: Nearly half of the patients experienced epilepsy onset before age three, and seizures were controlled in 73%. Around 60% of parents were satisfied with their understanding of the disease. Male gender and older age at diagnosis were associated with greater perceived severity, while older age at diagnosis correlated with a negative impact on caregivers’ earning potential. Patients with more anti-epileptic drugs reported more social constraints and older children expressed concerns about medication and seizure-related injuries. Cultural factors, such as family size and history, were associated with higher caregiver burden, emphasizing the importance of culturally sensitive assessment tools. Conclusions: Effective seizure control and quality of life improvements should be priorities in managing epilepsy in children. Cultural factors are strongly linked to caregiver burden, emphasizing the need for culturally sensitive assessment tools for enhancing support and care outcomes across diverse populations. Full article

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

14 pages, 1796 KiB

Open AccessSystematic Review

Changes in the Upper Airway Dimension Following the Use of Functional Appliances in Children with Obstructive Sleep Apnea: A Systematic Review

by Andrea Scribante, Maurizio Pascadopoli, Paolo Zampetti, Chiara Rocchi, Francesca Falsarone and Maria Francesca Sfondrini

Children 2025, 12(2), 227; https://doi.org/10.3390/children12020227 - 13 Feb 2025

Abstract

Introduction: Obstructive Sleep Apnea Syndrome (OSAS) is a sleep-related breathing disorder common in children, often linked to craniofacial anomalies like retrognathic mandibles in Class II malocclusions. Functional appliances (FAs) have been proposed as non-invasive treatments to improve OSAS symptoms by modifying upper [...] Read more.

Introduction: Obstructive Sleep Apnea Syndrome (OSAS) is a sleep-related breathing disorder common in children, often linked to craniofacial anomalies like retrognathic mandibles in Class II malocclusions. Functional appliances (FAs) have been proposed as non-invasive treatments to improve OSAS symptoms by modifying upper airway dimensions. Objective: this systematic review evaluates the effectiveness of functional appliances in improving upper airway structures in children with OSAS. Materials and Methods: the study was conducted according to PRISMA guidelines, analyzing studies published between 2004 and 2024 on PubMed, Scopus, Web of Science, Embase, and Cochrane Library databases. Inclusion criteria focused on growing patients (≤14 years) with OSAS and Class II skeletal malocclusions treated with FAs. Results: Of 1298 articles screened, four studies met the inclusion criteria. All studies reported a significant increase in upper airway dimensions of approximately 21% after treatment with FAs. Specifically, the cephalometric and tomographic evaluations revealed a clear enlargement of the superior posterior airway space of about 0.5 mm and a consequent improvement of the respiratory function. Discrepancies arose regarding changes in soft palate length and hyoid bone position, perhaps due to the measurement methods’ variation. Conclusions: Functional appliances appear effective in improving upper airway dimensions and alleviating OSAS symptoms in children. However, the limited number of studies, small sample sizes, and short follow-up periods emphasize the need for further research to confirm long-term efficacy and standardize evaluation protocols. Full article

(This article belongs to the Special Issue Sleep Disorders in Children: Presentation, Early Identification and Treatment)

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19 pages, 581 KiB

Open AccessArticle

The Factors Influencing Feeding Practices of Primary Caregivers of Preschoolers: A Theory-Based Cross-Sectional Study

by Qutaibah Oudat, Rebecca C. Lee, Elaine L. Miller, Sarah Collins Couch and Tamilyn Bakas

Children 2025, 12(2), 226; https://doi.org/10.3390/children12020226 - 13 Feb 2025

Abstract

Background/Objectives: Primary caregivers play a pivotal role in shaping children’s dietary behaviors, which are critical in preventing childhood obesity. This study aimed to examine the extent to which demographic characteristics and caregiver factors, including dietary beliefs and intentions to provide a healthy diet, [...] Read more.

Background/Objectives: Primary caregivers play a pivotal role in shaping children’s dietary behaviors, which are critical in preventing childhood obesity. This study aimed to examine the extent to which demographic characteristics and caregiver factors, including dietary beliefs and intentions to provide a healthy diet, influence feeding practices among primary caregivers of preschool-aged children. Methods: This study included a cross-sectional dataset comprising data collected from 146 primary caregivers of preschool-aged children (3–5 years). Participants were recruited using snowball and convenience sampling from Facebook and community settings in Cincinnati, Ohio. Feeding practices were assessed using the Comprehensive Feeding Practices Questionnaire (CFPQ), while caregiver demographic characteristics, dietary beliefs, and intentions were measured through self-administered surveys. Hierarchical multiple linear regression was employed to identify predictors of feeding practices. Results: The findings reveal that primary caregivers’ feeding practices were shaped by multiple factors, including dietary beliefs (behavioral, normative, and control), intentions, and demographic characteristics. Each subscale of feeding practices was predicted by different factors, highlighting the unique influence of these factors on feeding behaviors. Conclusions: This study underscores the complex interplay between caregiver cognitive (dietary beliefs and intentions) and demographic factors in shaping feeding practices. The findings highlight the importance of targeting caregiver beliefs and intentions in interventions aimed at promoting healthier feeding practices, contributing to the prevention of childhood obesity. Importantly, future research is needed to explore these factors in more diverse populations and validate cognitive measures for broader application. Full article

(This article belongs to the Special Issue Update on Pediatric Nutritional and Metabolic Disorders)

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