Children

18 pages, 2236 KB

Open AccessStudy Protocol

ACT-ON-DIP: Study Protocol of a Randomized Controlled Trial of a Home-Based ACTion Observation Tele-RehabilitatioN for Upper Limb in Children with DIPlegic Cerebral Palsy

by Elena Beani, Elisa Matteucci, Elisa Sicola, Giada Martini, Maria Chiara Di Lieto, Clara Bombonato, Valentina Menici, Annalisa Cotardo, Marta Rizzo, Silvia Filogna, Federica Camuncoli, Laura Biagi, Giovanni Cioni, Francesca Fedeli, Chiara Gelmini, Rita Neviani, Olivia Vecchi, Silvia Perazza, Silvia Faccioli, Antonino Errante, Alessandro Piras, Eleonora Sicuri, Francesca Bozzetti, Roslyn N. Boyd, Adriano Ferrari, Leonardo Fogassi and Giuseppina Sgandurra Show full author list Hide full author list

Children 2025, 12(9), 1229; https://doi.org/10.3390/children12091229 (registering DOI) - 14 Sep 2025

Abstract

Background: Children with diplegic Cerebral Palsy often exhibit upper-limb (UL) motor impairments compounded by deficits in visuospatial, sensory, and executive functions. Despite this, research has primarily focused on lower-limb rehabilitation, leaving the treatment of UL function in diplegic Cerebral Palsy underexplored. Action [...] Read more.

Background: Children with diplegic Cerebral Palsy often exhibit upper-limb (UL) motor impairments compounded by deficits in visuospatial, sensory, and executive functions. Despite this, research has primarily focused on lower-limb rehabilitation, leaving the treatment of UL function in diplegic Cerebral Palsy underexplored. Action Observation Therapy (AOT), based on Mirror Neuron System activation, has shown promise in promoting motor recovery, but evidence specific to this population is limited. This exploratory randomized controlled trial (RCT) aims to assess the feasibility and effectiveness of a home-based AOT program—ACT ON DIP—for improving upper-limb function in children and adolescents with diplegic Cerebral Palsy. Methods: Fifty-four participants with spastic diplegic Cerebral Palsy (MACS and GMFCS levels I–III, aged 5–16 years) will be randomly assigned to an experimental group (receiving an 8-week home-based AOT program) or a control group (receiving standard care). The ACT ON DIP system includes an ad hoc software, kits of objects for daily tasks, and wearable sensors. The system allows for delivering structured uni- and bimanual AOT activities tailored to the child’s profile. Primary outcome is the Both Hands Assessment (BoHA); secondary outcomes include motor (MA-2, BBT, ABILHAND), neuropsychological (NEPSY-II, Corsi Test, BRIEF), and participation measures (COPM, PEM-CY, CP-QOL). A subgroup will undergo fMRI to explore neural correlates of training-related changes. Results: Feasibility, compliance, and user experience with the home-based system will be assessed. This study will evaluate short-, medium-, and long-term changes in UL performance and related neuropsychological functions. Conclusions: ACT ON DIP represents a novel, personalized, and accessible tele-rehabilitation intervention for children with diplegic Cerebral Palsy. If effective, it could expand treatment opportunities for UL rehabilitation in this population and support broader implementation of home-based AOT. Full article

(This article belongs to the Special Issue Physical Rehabilitation and Exercise Science in Pediatric Neurodevelopmental Disorders)

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13 pages, 1096 KB

Open AccessArticle

Effect of the Virtual Reality-Infused Movement and Activity Program (V-MAP) on Physical Activity and Cognition in Head Start Preschoolers

by Xiangli Gu, Samantha Moss, Xiaoxia Zhang, Tao Zhang and Tracy L. Greer

Children 2025, 12(9), 1228; https://doi.org/10.3390/children12091228 (registering DOI) - 14 Sep 2025

Abstract

Background/Objectives: This study examined the efficacy of a physical activity (PA) intervention augmented by a non-immersive Virtual Reality (VR) gaming system (i.e., Virtual Reality-infused Movement and Activity Program; V-MAP) on physical activity (i.e., sedentary behavior, moderate-to-vigorous PA [MVPA], vigorous PA [VPA]) and cognitive [...] Read more.

Background/Objectives: This study examined the efficacy of a physical activity (PA) intervention augmented by a non-immersive Virtual Reality (VR) gaming system (i.e., Virtual Reality-infused Movement and Activity Program; V-MAP) on physical activity (i.e., sedentary behavior, moderate-to-vigorous PA [MVPA], vigorous PA [VPA]) and cognitive skills (i.e., response error, movement latency and reaction time) in Head Start preschoolers. Methods: Using a repeated-measure with 1-month follow-up design, a sample of 13 Head Start preschoolers (Mage = 67.08 ± 4.32 months; 36.2% boys) engaged in a 6-week V-MAP intervention (30-min session; 8 sessions) that focused on non-immersive VR based movement integration. The Cambridge Neuropsychological Test Automated Battery (CANTAB) was used to measure cognition; school-based PA and sedentary behavior were assessed by ActiGraph accelerometer. Pedometers were used to monitor real time engagement and implementation over eight intervention sessions. Results: On average, children obtained 1105 steps during the 30-min intervention (36.85 steps/min). There was a significant increase in VPA after the V-MAP intervention, whereas no significant changes in MVPA or sedentary behavior were observed (ps > 0.05). Although we did not observe significant improvement in studied cognitive function variables (ps > 0.05) after the V-MAP intervention, some delayed effects were observed in the follow-up test (Cohen’s d ranges from −0.41 to −0.73). Conclusions: This efficacy trial provides preliminary support that implementing V-MAP in recess may help Head Start preschoolers achieve or accumulate the recommended daily 60-min MVPA guideline during preschool years. The findings also provide insights that VR-based PA for as little as 30 min per day may benefit cognitive capability. Full article

(This article belongs to the Section Global Pediatric Health)

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20 pages, 362 KB

Open AccessReview

Does Breastfeeding Small for Gestational Age Neonates Promote a Healthier Growth Pattern? A Narrative Review

by Natalia Atzemoglou, Nikolaos P. Tzavellas, Niki Dermitzaki, Maria Baltogianni, Foteini Balomenou, Anastasios Serbis and Vasileios Giapros

Children 2025, 12(9), 1227; https://doi.org/10.3390/children12091227 (registering DOI) - 13 Sep 2025

Abstract

Background: Small for gestational age neonates represent a population at risk of growth failure or deviant growth patterns and long-term metabolic complications. Breastfeeding has been identified as a critical factor in promoting healthier growth and long-term metabolic health in both full-term and [...] Read more.

Background: Small for gestational age neonates represent a population at risk of growth failure or deviant growth patterns and long-term metabolic complications. Breastfeeding has been identified as a critical factor in promoting healthier growth and long-term metabolic health in both full-term and preterm appropriate for gestational age infants, but similar studies in small for gestational age infants are limited. The aim of this narrative review is to assess the impact of breastfeeding on growth and body composition in small for gestational age neonates. Methods: The PubMed and Google Scholar databases were screened for the relevant literature. The following terms, were used: “low birth weight”, “in utero growth restriction”, “small for gestational age”, “human milk”, and “growth”. The initial screening identified 57 relevant studies. Thirteen of them fulfilled the eligibility criteria and were included in this narrative review. Results: In preterm small for gestational age neonates, human milk nutrition was associated with healthier catch-up growth without excessive fat accumulation. Fortification strategies were associated with enhanced growth outcomes without increased incidence of neonatal morbidities. In the context of full-term, small for gestational age neonates, exclusive breastfeeding has been demonstrated to be associated with healthy catch-up growth. Furthermore, human milk nutrition has been shown to mitigate the predisposition of these children to obesity and cardiometabolic complications. Conclusions: According to the limited extant literature, human milk feeding has been identified as a potentially protective factor for small for gestational age neonates, promoting healthier growth patterns and long-term cardiometabolic health. However, larger prospective studies are needed to evaluate human milk feeding and human milk fortification in association with growth and long-term outcomes in small for gestational age infants. Full article

(This article belongs to the Special Issue Benefits and Effectiveness of Breastfeeding)

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17 pages, 682 KB

Open AccessArticle

Social Media Engagement and Usage Patterns, Mental Health Comorbidities, and Empathic Measures in an Italian Adolescent Sample: A Comparative Study

by Ilaria Accorinti, Giulia Mutti, Pamela Fantozzi, Annarita Milone, Gianluca Sesso, Greta Tolomei, Elena Valente, Antonio Narzisi, Edoardo Martinelli, Maria Rosaria Cordella, Gabriele Masi and Stefano Berloffa

Children 2025, 12(9), 1226; https://doi.org/10.3390/children12091226 (registering DOI) - 13 Sep 2025

Abstract

Background: The link between problematic social media (SM) use and socio-emotional deficits has limited clinical evidence. This study compares SM addiction risk and empathic abilities between psychiatric outpatients and healthy peers, exploring how SM categories and/or diagnostic category may modulate these relations. Methods: [...] Read more.

Background: The link between problematic social media (SM) use and socio-emotional deficits has limited clinical evidence. This study compares SM addiction risk and empathic abilities between psychiatric outpatients and healthy peers, exploring how SM categories and/or diagnostic category may modulate these relations. Methods: A total of 362 Italian adolescents (11–18 years; 147 cases, 215 controls) completed the Social-Media Disorder Scale (SOMEDIS), Bergen Social-Media Addiction Scale (BSMAS), Interpersonal Reactivity Index (IRI), and Reading the Mind in the Eyes test (RME). Self-reported daily online time and most used social media platforms were recorded. Results: Clinical participants showed higher mean SOMEDIS (M = 18.37) and BSMAS scores (M = 11.71) compared with controls (both p < 0.001). Females reported longer daily SM use (χ² = 5.4, p = 0.020). Positive associations were observed between SM addiction risk and age. Within the clinical group, adolescents with emotional dysregulation displayed higher problematic use scores; a modest correlation emerged with internalizing symptoms (withdrawn—depression). Regarding empathy, higher SM addiction risk correlated with lower cognitive empathy (IRI Perspective Taking, Fantasy) and higher Personal Distress. Platform type showed small differences: users of “Profiling” platforms reported lower empathy scores compared to “Entertainment” users. Conclusions: Adolescents with psychiatric conditions appear more vulnerable to problematic SM use and reduced empathic abilities. Associations were modest, and platform effects were limited. These findings should be considered exploratory; larger longitudinal studies are needed to clarify causal pathways between SM use, empathy, and adolescent mental health. Full article

(This article belongs to the Section Pediatric Mental Health)

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11 pages, 1582 KB

Open AccessSystematic Review

Video-Assisted Thoracoscopic Surgery Versus Tube Thoracostomy with Fibrinolytics for Treatment of Empyema in Children: A Meta-Analysis of Randomized Controlled Studies

by Maria Enrica Miscia, Giuseppe Lauriti, Dacia Di Renzo, Valentina Cascini and Gabriele Lisi

Children 2025, 12(9), 1225; https://doi.org/10.3390/children12091225 (registering DOI) - 13 Sep 2025

Abstract

Background: The British Thoracic Society recommended tube thoracostomy plus intra-pleural fibrinolytics to treat empyema in children in 2005. However, numerous comparative studies have suggested Video-Assisted Thoracoscopic Surgery (VATS) as a first line of treatment for pediatric empyema due to its superior outcomes, [...] Read more.

Background: The British Thoracic Society recommended tube thoracostomy plus intra-pleural fibrinolytics to treat empyema in children in 2005. However, numerous comparative studies have suggested Video-Assisted Thoracoscopic Surgery (VATS) as a first line of treatment for pediatric empyema due to its superior outcomes, including shorter length of hospital stay (LOS). This meta-analysis aimed to compare the following: (1) the LOS for VATS versus fibrinolytics to treat empyema in children; (2) secondary post-operative outcomes (fever, O₂ support, time taken for chest tube removal, analgesia, complications, failure, and abnormal chest X-ray at follow-up). Methods: The study was conducted according to PRISMA guidelines. A systematic search of PubMed, Cochrane, Web of Science, and Scopus was conducted according to PRISMA guidelines. Two independent investigators identified relevant studies, excluding case reports, opinion articles, and gray literature publications. A meta-analysis of randomized controlled trials (RCTs) was performed using RevMan 5.4, with data expressed as mean ± standard deviation (SD). Results: Of 1374 abstracts screened, 104 full-text articles were analyzed, and 6 RCTs (345 patients) were included in the meta-analysis. Patients undergoing VATS had significantly shorter LOS compared to those receiving fibrinolytics (9.1 ± 1.8 vs. 11.5 ± 2.5 days, p = 0.05). VATS patients also experienced shorter postoperative fever duration (4.2 ± 0.8 vs. 6.9 ± 4.6 days, p = 0.007) and earlier chest tube removal (5.0 ± 2.6 vs. 9.5 ± 3.3 days, p = 0.01). No significant differences were found between the two groups for other secondary outcomes. Conclusions: Children with empyema appear to benefit from VATS compared to tube thoracostomy plus fibrinolytics, with improved outcomes. Further RCTs are needed to corroborate these results. Full article

(This article belongs to the Section Pediatric Surgery)

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7 pages, 1555 KB

Open AccessCase Report

Bluish-Green Coloration of the Nipples: A Diagnostic Clue for Retroareolar Cysts

by Tea Curic, Francesco Bellinato, Paolo Gisondi and Giampiero Girolomoni

Children 2025, 12(9), 1224; https://doi.org/10.3390/children12091224 (registering DOI) - 13 Sep 2025

Abstract

Background/Objectives: Bluish-green discoloration of the nipples in pubertal girls often poses a diagnostic dilemma. Methods: We describe the case of an 11-year-old girl who developed bilateral and symmetrical bluish-green macules in the retroareolar area over eight months. Dermoscopic and ultrasound examinations revealed benign [...] Read more.

Background/Objectives: Bluish-green discoloration of the nipples in pubertal girls often poses a diagnostic dilemma. Methods: We describe the case of an 11-year-old girl who developed bilateral and symmetrical bluish-green macules in the retroareolar area over eight months. Dermoscopic and ultrasound examinations revealed benign retroareolar cysts, with no signs of malignancy or other alarming features. Differential diagnoses such as vascular malformations, hemangiomas, hematomas, and blue nevi were carefully considered and excluded based on clinical and imaging findings. Results: A diagnosis of bilateral retroareolar cysts was established. The patient underwent conservative management, and ultrasound follow-ups over one year showed no changes. Conclusions: This case underscores the importance of thorough evaluation to avoid unnecessary invasive procedures and to protect the delicate development of the pubertal breast. Full article

(This article belongs to the Section Global Pediatric Health)

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19 pages, 1672 KB

Open AccessSystematic Review

The Identification and Management of Refeeding Syndrome in Inpatient Severely Acutely Malnourished Children Aged 6 to 59 Months in Sub-Saharan African Countries: A Systematic Review and Meta-Analysis

by Tshegofatso Mogase, Annette Van Onselen, Nidia Rodriguez-Sanchez and Stuart D. R. Galloway

Children 2025, 12(9), 1223; https://doi.org/10.3390/children12091223 (registering DOI) - 12 Sep 2025

Abstract

Background: Refeeding syndrome is a potentially fatal complication that occurs in inpatient, severely acutely malnourished children during the early phase of nutritional management. Its early identification and management are critical to preventing adverse outcomes. Addressing refeeding syndrome in inpatient settings is critical in [...] Read more.

Background: Refeeding syndrome is a potentially fatal complication that occurs in inpatient, severely acutely malnourished children during the early phase of nutritional management. Its early identification and management are critical to preventing adverse outcomes. Addressing refeeding syndrome in inpatient settings is critical in Sub-Saharan Africa, where severe acute malnutrition is common and under-researched. Objective: To systematically review and meta-analyse current evidence on the identification and management of refeeding syndrome in hospitalised severely malnourished children (6 to 59 months) in Sub-Saharan Africa. Methods: A comprehensive search was conducted across academic databases such as PubMed and the Cochrane Library, from 2010 to 2024. Articles reporting on the identification and management of refeeding syndrome in inpatient children with severe acute malnutrition in Sub-Saharan Africa were included. Data extractions were performed by two reviewers using Rayyan software. A meta-analysis of proportions was conducted using STATA 19. Results: Nine studies were included. The identification and management of refeeding syndrome were impacted by the lack of a standardised definition. Significant heterogeneity (Q = 27.17, p < 0.001) was observed, indicating a significant variation in the prevalence rates ranging from 8.7% to 34.8%. Management strategies varied; most studies adhered to World Health Organisation guidelines for severe acute malnutrition but lacked specific protocols for refeeding syndrome. Conclusions: Evidence highlights the need for standardised, evidence-based and context-specific protocols for refeeding syndrome in children with severe acute malnutrition. Early screening, electrolyte monitoring, and cautious feeding remain important, although current evidence is of low certainty. Future prospective studies are needed to develop effective management strategies. Full article

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

11 pages, 864 KB

Open AccessArticle

Optimizing Vagus Nerve Stimulation Parameters in Pediatric Drug-Resistant Epilepsy: A Retrospective Two-Center Study

by Müge Baykan, Özge Baykan Çopuroğlu, Elif Didinmez Taşkırdı, Pınar Gençpınar and Nihal Olgaç Dündar

Children 2025, 12(9), 1222; https://doi.org/10.3390/children12091222 - 12 Sep 2025

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Abstract

Objectives: Drug-resistant epilepsy (DRE) remains a major challenge in pediatric neurology, as many children fail to achieve seizure control despite appropriate medications. Vagus nerve stimulation (VNS) offers an effective adjunctive treatment; however, optimal stimulation parameters for children are not well defined and are [...] Read more.

Objectives: Drug-resistant epilepsy (DRE) remains a major challenge in pediatric neurology, as many children fail to achieve seizure control despite appropriate medications. Vagus nerve stimulation (VNS) offers an effective adjunctive treatment; however, optimal stimulation parameters for children are not well defined and are often extrapolated from adult protocols. This retrospective two-center cohort study aimed to evaluate the clinical effectiveness of VNS in pediatric DRE and to determine stimulation thresholds—particularly output current and duty cycle—most strongly associated with seizure reduction. Methods: Fifty-two pediatric patients (aged 0–18 years) with DRE who underwent VNS implantation and were followed for at least 12 months were retrospectively analyzed. Stimulation frequency and pulse width were fixed at 30 Hz and 250 µs, while output current and duty cycle were titrated based on clinical response. Seizure outcomes were derived from caregiver-maintained seizure diaries and confirmed during structured follow-up visits. Treatment response was defined as a ≥50% reduction in seizure frequency compared to baseline. Results: At 12 months post-implantation, 76.9% of patients achieved ≥ 50% seizure reduction, 32.7% experienced ≥ 90% reduction, and 11.5% attained complete seizure freedom. Optimal outcomes were associated with output currents of approximately 1.5 mA and duty cycles of 10%. Conclusions: VNS is a highly effective and well-tolerated treatment for pediatric DRE. Stabilization at an output current of 1.5 mA and a 10% duty cycle may serve as a clinically useful programming target. These findings support the use of individualized, age-specific stimulation strategies to optimize outcomes in pediatric VNS therapy. Full article

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

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14 pages, 1641 KB

Open AccessArticle

Deep Learning for Heart Sound Abnormality of Infants: Proof-of-Concept Study of 1D and 2D Representations

by Eashita Wazed, Jimin Lee and Hieyong Jeong

Children 2025, 12(9), 1221; https://doi.org/10.3390/children12091221 - 12 Sep 2025

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Abstract

Introduction: Advanced identification and intervention for Congenital Heart Defects (CHDs) in pediatric populations are crucial, as approximately 1% of neonates worldwide present with these conditions. Traditional methods of diagnosing CHDs often rely on stethoscope auscultation, which heavily depends on the clinician’s expertise and [...] Read more.

Introduction: Advanced identification and intervention for Congenital Heart Defects (CHDs) in pediatric populations are crucial, as approximately 1% of neonates worldwide present with these conditions. Traditional methods of diagnosing CHDs often rely on stethoscope auscultation, which heavily depends on the clinician’s expertise and may lead to the oversight of subtle acoustic indicators. Objectives: This study introduces an innovative deep-learning framework designed for the early diagnosis of congenital heart disease. It utilizes time-series data obtained from cardiac auditory signals captured through stethoscopes. Methods: The audio signals were processed into time–frequency representations using Mel-Frequency Cepstral Coefficients (MFCCs). The architecture of the model combines Convolutional Neural Networks (CNNs) for effective feature extraction with Long Short-Term Memory (LSTM) networks to accurately model temporal dependencies. Impressively, the model achieved an accuracy of 98.91% in the early detection of CHDs. Results: While traditional diagnostic tools like Electrocardiograms (ECG) and Phonocardiograms (PCG) remain indispensable for confirming diagnoses, many AI studies have primarily targeted ECG and PCG datasets. This approach emphasizes the potential of cardiac acoustics for the early diagnosis of CHDs, which could lead to improved clinical outcomes for infants. Notably, the dataset used in this research is publicly available, enabling wider application and model training within the research community. Full article

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

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9 pages, 484 KB

Open AccessArticle

Utility of Clinical Signs in the Diagnosis of Testicular Torsion in Pediatric Age: Optimization of Timing in a Time-Sensitive Pathology

by Fabiola Cassaro, Salvatore Arena, Roberta Bonfiglio, Angela Alibrandi, Santi D’Antoni, Carmelo Romeo and Pietro Impellizzeri

Children 2025, 12(9), 1220; https://doi.org/10.3390/children12091220 - 12 Sep 2025

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Abstract

Background/Objectives: Acute scrotal pain in children and adolescents requires prompt evaluation to differentiate testicular torsion from other scrotal pathologies. Testicular torsion, a surgical emergency, can lead to irreversible testicular damage if not managed rapidly. This study aims to assess the clinical signs, [...] Read more.

Background/Objectives: Acute scrotal pain in children and adolescents requires prompt evaluation to differentiate testicular torsion from other scrotal pathologies. Testicular torsion, a surgical emergency, can lead to irreversible testicular damage if not managed rapidly. This study aims to assess the clinical signs, diagnostic tools, and outcomes related to testicular torsion in patients presenting with acute scrotal pain. Methods: A retrospective analysis was conducted on 111 patients diagnosed with acute scrotal conditions. Clinical signs, presentation times, ultrasound findings, and treatment outcomes (surgical intervention, orchiectomy, or medical management) were evaluated. The statistical analysis was performed with a p-value < 0.05 being considered significant. Correlations between clinical signs, diagnostic imaging, and treatment modalities were assessed. Results: The most prevalent clinical signs were scrotal swelling (92.2%), pain on palpation (93.5%), and scrotal hyperemia (84.4%). Testicular torsion was strongly associated with the absence of the cremasteric reflex (p < 0.0001) and testicular retraction (p < 0.0001). Ultrasound findings, including absent blood flow and testicular heterogeneity, were highly predictive of surgical intervention (p < 0.01). Patients presenting within 8 h of symptom onset had higher success rates of detorsion and testicular preservation. Conclusions: Timely and accurate clinical assessment, including the identification of key signs such as the absence of the cremasteric reflex and testicular retraction, is critical for differentiating testicular torsion from other conditions. Ultrasound findings are pivotal in guiding treatment decisions in cases of clinical uncertainty. Early intervention significantly improves testicular viability and outcomes, underscoring the importance of rapid diagnosis and management. Full article

(This article belongs to the Special Issue Progress in the Treatment of Urinary System Diseases in Children)

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10 pages, 1366 KB

Open AccessCase Report

Using Functional Education Appliance on One Patient with Class III Malocclusion in Mixed Dentition: A Case Report

by Chun-Yuan Chiu, Shang-Wen Chiu and Chung-Hsing Li

Children 2025, 12(9), 1219; https://doi.org/10.3390/children12091219 - 11 Sep 2025

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Abstract

Background/objective: Class III malocclusion is a relatively common clinical problem among Asian patients, which is caused by skeletal discrepancies and involves complex factors. In growing patients, early intervention with myofunctional appliances can help correct jaw relationships more effectively. This case report presents the [...] Read more.

Background/objective: Class III malocclusion is a relatively common clinical problem among Asian patients, which is caused by skeletal discrepancies and involves complex factors. In growing patients, early intervention with myofunctional appliances can help correct jaw relationships more effectively. This case report presents the use of prefabricated myofunctional appliances (EF and MRC) to address Class III malocclusion through growth modification. Case description: A 9-year-old girl was diagnosed with skeletal Class III and a complete anterior crossbite. She underwent treatment with the prefabricated myofunctional appliances, worn during sleep and an additional two hours during the day for 51 months. The outcomes resulted from a combination of skeletal and dental changes, including a decrease in skeletal discrepancy (ANB: −5° to −2°), upper incisor proclination (U1 to SN: 112.5° to 123°), uprighting of the lower incisor (L1 to MP: 93.5° to 90°), and an increase in cranial flexure angle (123° to 125°) with a vertical mandibular growth pattern. The treatment improved facial profile, reduced skeletal discrepancy, corrected the anterior crossbite, and enhanced interdigitation. Conclusions: Prefabricated myofunctional appliances are effective options for managing skeletal Class III malocclusion in pediatric patients with vertical mandibular growth patterns, producing favorable skeletal and dentoalveolar changes. Full article

(This article belongs to the Special Issue Early Orthodontic Treatment in Children: A Focus on Behavior Intervention and Management)

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10 pages, 1332 KB

Open AccessArticle

Unique Bone Marrow Findings of FDG-PET/CT in Acute Leukemia in Children: Comparison to Inflammatory Diseases

by Yuta Suenaga, Kazuo Kubota, Motohiro Matsui, Atsushi Makimoto, Junko Yamanaka, Shinji Mochizuki, Masatoshi Hotta, Miyako Morooka Chikanishi and Hiroyuki Shichino

Children 2025, 12(9), 1218; https://doi.org/10.3390/children12091218 - 11 Sep 2025

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Abstract

Background/Objectives: Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is a valuable imaging modality for detecting malignancies and diagnosing fever of unknown origin (FUO). However, data regarding FDG accumulation in bone marrow among pediatric acute leukemia (AL) cases are limited. In this study, we [...] Read more.

Background/Objectives: Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is a valuable imaging modality for detecting malignancies and diagnosing fever of unknown origin (FUO). However, data regarding FDG accumulation in bone marrow among pediatric acute leukemia (AL) cases are limited. In this study, we aimed to compare FDG-PET/CT findings between children with AL and those with inflammatory diseases (IDs), including FUO, and develop a scoring system for differential diagnoses. Methods: We retrospectively analyzed FDG-PET/CT findings in six children with AL and 22 with IDs. The maximum standardized uptake value (SUV max), visual score (VS), and spread score (SS) were evaluated across various bone marrow sites, including vertebrae, pelvic bone, humerus, forearm, and femur. Statistical analysis consisted of Mann–Whitney U test for group comparisons and receiver operating characteristic curve (ROC)/area under the curve (AUC) analyses to assess diagnostic performance. Results: SUV max, VS, and SS were significantly higher in children with AL across all evaluated sites. The combined VS + SS scoring system yielded the highest diagnostic accuracy. A simplified version using only the VS of the middle humerus and femur plus the SS showed comparable effectiveness. Conclusions: FDG-PET/CT in children with AL showed high FDG accumulation in bone marrow areas in the whole body. The simple scoring system, which comprises FDG accumulation in the middle portion of the extremities and the whole body, appears to be helpful in distinguishing AL from IDs in children. FDG-PET/CT-based visual scoring may provide supportive information alongside conventional diagnostics in pediatric acute leukemia. Full article

(This article belongs to the Special Issue Childhood Hematologic and Oncologic Diseases: Emerging Insights and Next-Generation Solutions)

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11 pages, 229 KB

Open AccessArticle

Executive Functions and Child Psychopathology: Contextual Differences and Predictors for Detection and Psychoeducational Intervention

by Juan Manuel Núñez, Ana Soto-Rubio and Marián Pérez-Marín

Children 2025, 12(9), 1217; https://doi.org/10.3390/children12091217 - 11 Sep 2025

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Abstract

Background/Objectives: Executive functions (EFs) play a fundamental role in children’s cognitive and emotional regulation and have been identified as key transdiagnostic predictors of psychopathology. Children with Special Educational Needs (SENs) are particularly vulnerable to difficulties with EFs and emotional–behavioural adjustment. This study aimed [...] Read more.

Background/Objectives: Executive functions (EFs) play a fundamental role in children’s cognitive and emotional regulation and have been identified as key transdiagnostic predictors of psychopathology. Children with Special Educational Needs (SENs) are particularly vulnerable to difficulties with EFs and emotional–behavioural adjustment. This study aimed to examine the differences in the psychopathological symptoms between pupils with and without SENs and to explore the predictive ability of dimensions of EFs for psychopathology detection in both school and family contexts. Methods: A total of 123 primary school children (aged 6–12 years) participated in the study. Their psychopathology was assessed using the SPECI questionnaire completed by their teachers, while their EFs were measured using the BRIEF-2 from school and family perspectives. The analyses included mean difference tests and a backward stepwise multiple regression using the predictors that showed significant Pearson’s correlations with the psychopathological dimensions. Results: The students with SENs showed significantly higher levels of psychopathological symptoms, particularly in their attention, anxiety, and clinical global scores. The regression models revealed that several dimensions of EFs, such as inhibition, planning, task monitoring, and cognitive regulation, significantly predicted internalising, externalising, and total symptoms. The school-based models demonstrated greater explanatory power compared to the family-based models, suggesting that school contexts may be more sensitive for detecting EF-related difficulties. Conclusions: The results underline the transdiagnostic relevance of EFs in child psychopathology and support their integration into early detection and intervention strategies, especially in educational contexts. Strengthening the assessment of EFs in schools could contribute to a more accurate identification of at-risk pupils and inform targeted support for children with SENs. Full article

(This article belongs to the Section Global Pediatric Health)

13 pages, 265 KB

Open AccessArticle

Effects of Paediatric Post-COVID-19 Condition on Physical Function and Daily Functioning: A Cross-Sectional Study

by Aroia Goicoechea-Calvo, Roser Coll-Fernández, Natalia Navarro Expósito, Marc Colomer Giralt, Alba González-Aumatell, María Méndez-Hernández, Clara Carreras-Abad, Natàlia Pallarès Fontanet, Cristian Tebe Cordomi, M. J. Durà Mata and Carlos Rodrigo

Children 2025, 12(9), 1216; https://doi.org/10.3390/children12091216 - 10 Sep 2025

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Abstract

Background/Objectives: Lack of objective evidence exists regarding changes in physical function and impact on daily functioning in paediatric post-COVID-19 condition (PPCC). This study aimed to assess exercise capacity, fatigue, and peripheral and respiratory muscle strength in PPCC patients compared with healthy controls. Additionally, [...] Read more.

Background/Objectives: Lack of objective evidence exists regarding changes in physical function and impact on daily functioning in paediatric post-COVID-19 condition (PPCC). This study aimed to assess exercise capacity, fatigue, and peripheral and respiratory muscle strength in PPCC patients compared with healthy controls. Additionally, the impact of PPCC on domains of daily life was evaluated. Methods: A cross-sectional study was performed. Study variables: exercise capacity (6 min walk test, 6MWT), inspiratory muscle strength (maximal inspiratory pressure, PImax), handgrip strength (handheld dynamometer, HHD), quadriceps femoris muscle thickness (QF MT), rectus femoris muscle thickness (RF MT), rectus femoris cross-sectional area (RF CSA), rectus femoris echo-intensity (RF EI), fatigue (Paediatric Functional Assessment of Chronic Illness Therapy-Fatigue, pedsFACIT-F), and physical activity (Assessment of Physical Activity Levels Questionnaire, APALQ). Results: A total of 115 PPCC patients and 227 healthy controls were included. The PPCC group had lower 6MWT (509.00 ± 86.12, p < 0.001), PImax (68.71 ± 26.23, p < 0.001), HHD (82.84 ± 29.09, p < 0.001), APALQ (7.94 ± 3.14, p < 0.001), pedsFACIT-F (24.51 ± 11.01, p < 0.001), QF MT mid-thigh (33.21 ± 7.99, p = 0.011), and higher RF EI (p < 0.001) vs. controls. Only 37.63% of the PPCC group resumed previous sports, 43.48% were unable to attend school full-time and 28.7% could not participate in after-school activities. Conclusions: Paediatric post-COVID-19 condition patients exhibited significant impairments in terms of physical function, with a high impact on daily functioning. This knowledge is necessary to provide targeted therapeutic interventions. Full article

(This article belongs to the Special Issue Viral Respiratory Infections and Bacterial Superinfections in Children)

14 pages, 523 KB

Open AccessArticle

Red Cell Distribution Width-to-Platelet Ratio and Other Hematological Markers as Early Predictors of Bronchopulmonary Dysplasia in Preterm Infants

by Baran Cengiz Arcagok and Ibrahim Kandemir

Children 2025, 12(9), 1215; https://doi.org/10.3390/children12091215 - 10 Sep 2025

Viewed by 93

Abstract

Background/Objectives: Bronchopulmonary dysplasia (BPD) frequently affects preterm infants and is associated with lasting morbidity. Early prediction remains challenging. The present study investigated whether hematological inflammatory markers—platelet-to-lymphocyte ratio (PLR), red cell distribution width (RDW), and red cell distribution width-to-platelet ratio (RPR)—can predict the development [...] Read more.

Background/Objectives: Bronchopulmonary dysplasia (BPD) frequently affects preterm infants and is associated with lasting morbidity. Early prediction remains challenging. The present study investigated whether hematological inflammatory markers—platelet-to-lymphocyte ratio (PLR), red cell distribution width (RDW), and red cell distribution width-to-platelet ratio (RPR)—can predict the development of BPD in preterm neonates. Methods: We performed a retrospective cohort study involving 100 infants born at less than 32 weeks’ gestation. Complete blood count (CBC) parameters were collected at birth, 72 h, 1 week, and 2 weeks of life. Associations between PLR, RDW, RPR, and BPD development were analyzed. Multivariate regression and receiver operating characteristic (ROC) curve analyses were carried out to evaluate the predictive performance of the markers. Results: Forty-nine percent of infants developed BPD. Those with BPD had significantly higher RDW, PLR, and RPR values, and lower lymphocyte and platelet counts at various time points. Gestational age, respiratory distress syndrome, and hematological indices independently predicted BPD. ROC analysis showed that RDW ≥ 67.2 and PLR ≥ 98.13 at 72 h, and RPR ≥ 0.3 at 7 and 14 days had good predictive performance. A combined scoring system, including clinical and hematological markers, achieved high sensitivity and specificity. Conclusions: Hematological inflammatory markers, especially RPR, PLR, and RDW, derived from routine CBC tests may serve as accessible, cost-effective tools for early BPD risk stratification in preterm infants. Additional studies are needed to confirm these results and better define their relevance in clinical practice. Full article

(This article belongs to the Section Pediatric Neonatology)

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12 pages, 836 KB

Open AccessSystematic Review

Pediatric Spinal Solitary Fibrous Tumor: A Systematic Review of a Rare Condition

by Andrea Trezza, Chiara B. Rui, Stefano Chiaravalli, Veronica Biassoni, Elisabetta Schiavello, Sabina Vennarini, Ester Orlandi, Giorgio G. Carrabba, Maura Massimino and Carlo G. Giussani

Children 2025, 12(9), 1214; https://doi.org/10.3390/children12091214 - 10 Sep 2025

Viewed by 163

Abstract

Background: Spinal solitary fibrous tumors (SFTs) are a rare oncological entity, almost anecdotal in the pediatric population. They have a high relapse rate and represent an ongoing oncological challenge. Methods: In this article, we conducted a systematic review starting from a case report [...] Read more.

Background: Spinal solitary fibrous tumors (SFTs) are a rare oncological entity, almost anecdotal in the pediatric population. They have a high relapse rate and represent an ongoing oncological challenge. Methods: In this article, we conducted a systematic review starting from a case report to highlight the current state of the art in managing these tumors. Results: Spinal solitary fibrous tumors (SFTs) are rare, slow-growing neoplasms that can be either intra- or extramedullary. Only a limited number of studies focus on primary pediatric spinal cord localization. Five pediatric cases of spinal SFT have been documented in the literature. On MRI, they typically present as highly vascularized, contrast-enhancing masses. Histologically, they are composed of spindle-shaped cells within a collagenous stroma featuring staghorn-shaped blood vessels. More aggressive subtypes, such as dedifferentiated SFTs, resemble high-grade sarcomas. The NAB2–STAT6 fusion is a key marker, driving EGFR signaling, collagen production, and fibrosis. Additional diagnostic markers include CD34, CD99, and Bcl-2. Surgical resection remains the primary treatment. In metastatic cases, chemotherapy—mainly with anthracyclines, dacarbazine, or temozolomide—is employed, although no standardized pediatric protocols exist. Anti-angiogenic agents, including tyrosine kinase inhibitors, have shown promise. Radiotherapy is used postoperatively for local disease control, but its impact on survival is still under investigation. Conclusions: Surgery remains the cornerstone of treatment, significantly impacting the natural history of the disease and symptom control. While clinical trials exploring radiotherapy and chemotherapy are ongoing in adults, no specific treatment protocol has been established for pediatric patients. Full article

(This article belongs to the Section Pediatric Hematology & Oncology)

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10 pages, 212 KB

Open AccessArticle

Risk Factors for Early Neonatal Hypocalcemia in Preterm Neonates Born After 32 Weeks Gestation

by Jelena Sabljić, Edita Runjić, Klara Čogelja, Blagoja Markoski, Marijana Barbača and Boris Bačić

Children 2025, 12(9), 1213; https://doi.org/10.3390/children12091213 - 10 Sep 2025

Viewed by 124

Abstract

Background/Objectives: Early neonatal hypocalcemia is a common metabolic disorder in premature neonates with various risk factors, including perinatal asphyxia and fetal growth restriction (FGR). We aimed to investigate the incidence of early neonatal hypocalcemia in preterm neonates with and without FGR and [...] Read more.

Background/Objectives: Early neonatal hypocalcemia is a common metabolic disorder in premature neonates with various risk factors, including perinatal asphyxia and fetal growth restriction (FGR). We aimed to investigate the incidence of early neonatal hypocalcemia in preterm neonates with and without FGR and to explore several maternal and neonatal risk factors for early neonatal hypocalcemia. Cardiotocography (three-tiered fetal heart rate categorization) was a novel risk factor. Materials and methods: This was a secondary analysis of the retrospective, single-center, case-control study of neonates admitted to a neonatal intensive care unit (NICU) between January 2021 and December 2023. The study included 24 neonates with FGR and 124 control neonates without FGR born at 33 to 36 6/7 gestational weeks. Results: Total serum Ca was significantly lower in control neonates (2.042 (SD 0.208)) compared to neonates with FGR (2.178 (SD 0.180)) (p = 0.004), and early neonatal hypocalcemia was significantly higher in control neonates (42.75%) compared to neonates with FGR (4.35%) (p < 0.001). There was no statistical difference in acid base and blood gas analysis between FGR and control (p > 0.05). Logistic regression with the backward method showed that FGR reduces the probability of early neonatal hypocalcemia by 96.3% (t = 9.679, p = 0.001), and cesarean delivery increases it by 2.702 times (t = 6.963, p = 0.004). Conclusions: In this observational study, FGR was found to reduce and cesarean delivery was found to increase the probability of early neonatal hypocalcemia in moderate and late neonates. Clinicians should consider screening neonates born by cesarean delivery for early neonatal hypocalcemia. Three-tiered fetal heart rate categorization and acid base and blood gas analysis upon NICU admission cannot alert neonatologists to early neonatal hypocalcemia. Full article

(This article belongs to the Section Pediatric Neonatology)

19 pages, 1174 KB

Open AccessSystematic Review

Viral and Bacterial Etiology of Common Respiratory Infections in Children in Sub-Saharan Africa: A Systematic Review

by Jordy Exaucé Demboux Lyelet, Pembe Issamou Mayengue, Félix Koukouikila-Koussounda, Eric M. Leroy, Pierre Becquart and Fabien Roch Niama

Children 2025, 12(9), 1212; https://doi.org/10.3390/children12091212 - 10 Sep 2025

Viewed by 162

Abstract

Background/Objectives: Respiratory infections are a major global public health problem, with potentially serious consequences. Indeed, they remain one of the main causes of morbidity and mortality in children under 5 in developing countries. Etiological information on respiratory infections is crucial for prevention [...] Read more.

Background/Objectives: Respiratory infections are a major global public health problem, with potentially serious consequences. Indeed, they remain one of the main causes of morbidity and mortality in children under 5 in developing countries. Etiological information on respiratory infections is crucial for prevention and case management strategies. This review describes the etiology of respiratory infections reported in studies conducted in sub-Saharan African countries. Methods: PubMed, HINARI and Google Scholar search engines were used for bibliographic research, and only data from sub-Saharan Africa were considered. Articles published between 2010 and 2023, in English or French, were included in this review. Results: After a thorough search, 2175 documents were identified. Critical review and removal of duplicates identified 347 full-text studies, which underwent rigorous evaluation. A total of 50 articles were retained, with studies conducted in 24 sub-Saharan African countries, most of them in Cameroon (12%). Thirty-three (66%) were cross-sectional studies, and thirty-seven (74%) were hospital-based surveys. Respiratory syncytial virus was most frequently identified (0.6% to 59%), followed by rhinovirus (7.5% to 73%). The most frequent bacteria were Streptococcus pneumoniae (1–96%) and Haemophilus influenzae (2.5–54%). Conclusions: This study suggests that acute respiratory infections in sub-Saharan Africa, mainly in children, are primarily caused by viruses and a few bacteria. Full article

(This article belongs to the Section Pediatric Pulmonary and Sleep Medicine)

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9 pages, 216 KB

Open AccessArticle

Discussion of the Fetus in Fetal Cardiology Consultations: A Qualitative Study

by Samantha Syme, Kelsey Schweiberger, Judy C. Chang, Ann Kavanaugh-McHugh, Abdesalam Soudi, Justin T. Clapp, Nadine A. Kasparian, Robert M. Arnold and Kelly W. Harris

Children 2025, 12(9), 1211; https://doi.org/10.3390/children12091211 - 10 Sep 2025

Viewed by 105

Abstract

Background: While prenatal diagnosis of congenital heart disease is increasingly common, and communication is essential to minimizing familial stress, little is known about how the fetus is discussed in this setting. This study observed how clinicians and families refer to the fetus during [...] Read more.

Background: While prenatal diagnosis of congenital heart disease is increasingly common, and communication is essential to minimizing familial stress, little is known about how the fetus is discussed in this setting. This study observed how clinicians and families refer to the fetus during initial fetal cardiology consultations. Methods: Initial fetal cardiology consultations from one institution were recorded and transcribed verbatim. A codebook was developed and used to code the transcripts. Codes included any reference to the fetus and any attribution of agency or mental states to the fetus. Results: Nineteen consultations performed by five clinicians from one academic institution were included. Clinicians and families most frequently referred to the fetus using personal terminology (e.g., third-person pronouns, a given name, or “son” or “daughter”). Impersonal terminology (e.g., “baby”) was used less frequently, followed by medical terminology (e.g., “fetus”), which was only used in two consultations. In about half of the consultations, clinicians conferred agency or mental states on the fetus by attributing actions, emotions, or knowledge to the fetus. Conclusions: Fetal cardiology clinicians primarily use personal terminology when referring to the fetus during initial consultations. Familial preferences need to be evaluated to optimize communication and support. Full article

(This article belongs to the Section Pediatric Cardiology)

10 pages, 585 KB

Open AccessBrief Report

Epidemiological Trends in Pediatric Osteoarticular Infections—Results from a Single-Center Retrospective Study Covering 2015–2023

by Evelien B. van Kempen, Ayla Scholma, Nam Nam Cheung, Mirjam van Veen and Joost H. van Linge

Children 2025, 12(9), 1210; https://doi.org/10.3390/children12091210 - 10 Sep 2025

Viewed by 105

Abstract

Background: Pediatric infectious disease epidemiology has changed since the COVID-19 pandemic. To investigate possible changes in the epidemiology of pediatric osteoarticular infections (pOAIs), entailing osteomyelitis (OM), septic or infectious arthritis (AR), and osteomyelitis combined with arthritis (OA), we aimed to assess the number [...] Read more.

Background: Pediatric infectious disease epidemiology has changed since the COVID-19 pandemic. To investigate possible changes in the epidemiology of pediatric osteoarticular infections (pOAIs), entailing osteomyelitis (OM), septic or infectious arthritis (AR), and osteomyelitis combined with arthritis (OA), we aimed to assess the number of pOAI cases, pathogen distribution, and outcomes across the pre-, mid-, and post-pandemic periods. Methods: We conducted a single-center retrospective cohort study in the Dutch Juliana Children’s Hospital, including patients aged 0–18 years diagnosed with OM, AR, or OA between 2015 and 2023. Cases were grouped into three periods: pre-pandemic (P1: 2015–2019), mid-pandemic (P2: 2020–2021), and post-pandemic (P3: 2022–2023). Data on demographics, clinical course, imaging, microbiology, and outcomes were extracted from medical records. Results: A total of 118 pOAI cases (median age 2 years, IQR 1–8) were included. OM occurred in 50%, AR in 42%, and OA in 8% of cases. Annual case counts increased from an average of 10/year in P1 to 21/year in P3. Although the difference between P1 and P2 was not statistically significant (IRR 1.20; 95% CI 0.70–2.06), there was a significant increase in P3 compared to P1 (IRR 1.97; 95% CI 1.31–2.97). Pathogen detection was achieved in 50% of cases. Staphylococcus aureus remained the most frequently identified pathogen overall. From P1 to P2, proportions of Kingella kingae and GAS declined, while Staphylococcus aureus remained stable. In P3, Kingella kingae increased, Staphylococcus aureus decreased, and GAS remained relatively unchanged. However, none of these changes were statistically significant. No patients required PICU admission or experienced fatal outcomes. Conclusion: This study suggests an increase in pOAI after the COVID-19 pandemic. While patient characteristics and outcome remained similar over time, pathogen distribution seems to have changed throughout the periods. Full article

(This article belongs to the Section Pediatric Infectious Diseases)

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14 pages, 727 KB

Open AccessReview

Risk Factors for Transition of Care in Disorders of Gut–Brain Interaction: A Narrative Review and Expert Opinion

by Miguel Saps, Samantha Arrizabalo and Jose M. Garza

Children 2025, 12(9), 1209; https://doi.org/10.3390/children12091209 - 10 Sep 2025

Viewed by 178

Abstract

Background: Disorders of gut–brain interaction (DGBI) have a significant impact on the quality of life of children and families. Forty percent of children with recurrent abdominal pain continue to have symptoms into adulthood. Specialized programs for the transition of adolescents with DGBI to [...] Read more.

Background: Disorders of gut–brain interaction (DGBI) have a significant impact on the quality of life of children and families. Forty percent of children with recurrent abdominal pain continue to have symptoms into adulthood. Specialized programs for the transition of adolescents with DGBI to adult care are scarce. There are no widely accepted guidelines for transition of care. Identifying risk factors for persistence of symptoms into adulthood is key to identifying the optimal population that should be part of such programs and guidelines design. Methods: A narrative comprehensive review was conducted using predefined keywords to identify risk factors for persistent DGBI in children/adolescents. Results: Female sex, psychological distress, family history of DGBI, and certain comorbidities had stronger evidence for persistence, whereas other risk factors rely on limited data. Conclusions: It is suggested that transition programs should focus on adolescents presenting with multiple coexisting risk factors. The program should at least include pediatric and adult neurogastroenterologists, dieticians, psychologists, and social workers. Tertiary prevention through psychological support, school-based programs, and management of anxiety and sleep disturbances may reduce the persistence of symptoms. Prospective studies should refine risk stratification and guide transition strategies. Full article

(This article belongs to the Special Issue Innovations in Pediatric Disorders of the Gut-Brain Interaction: Bridging Science, Treatment, and Long-Term Outcomes)

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18 pages, 979 KB

Open AccessArticle

A School-Based Intervention Program to Reduce Weight Stigma in Adolescents

by Mariacarolina Vacca, Silvia Cerolini, Anna Zegretti, Andrea Zagaria, Edoardo Mocini and Caterina Lombardo

Children 2025, 12(9), 1208; https://doi.org/10.3390/children12091208 - 10 Sep 2025

Viewed by 206

Abstract

Background/Objectives: Weight-based stigma represents a pervasive psychosocial challenge affecting youth worldwide, with significant implications for mental and physical health. Although school-based interventions have been suggested as effective strategies to reduce weight bias, evidence regarding their content and efficacy in real-world educational contexts remains [...] Read more.

Background/Objectives: Weight-based stigma represents a pervasive psychosocial challenge affecting youth worldwide, with significant implications for mental and physical health. Although school-based interventions have been suggested as effective strategies to reduce weight bias, evidence regarding their content and efficacy in real-world educational contexts remains limited. The present study aimed to evaluate the effectiveness of a school-based intervention designed to reduce internalized weight stigma among Italian adolescents. Methods: A total of 539 secondary school students (Mage = 15.91 years; SD = 1.38; 51.5% males) from 10 schools in Italy were randomly assigned to either an intervention group (61.2%, n = 330) receiving the program or a minimal intervention control group (38.8%, n = 209). The intervention integrated psychoeducational modules and activities based on cognitive dissonance theory to address maladaptive weight-related attitudes and associated psychopathological outcomes. Pre- and post-intervention assessments evaluated internalized weight bias and body dissatisfaction in both groups. Results: A significant reduction in internalized weight bias was observed among students perceiving themselves as overweight following the intervention. Additionally, a marginally significant decrease in body dissatisfaction was reported in the intervention group from pre- to post-intervention. No comparable changes were found in the control group. Conclusions: These findings suggest that incorporating cognitive dissonance-based psychoeducational content within school-based programs may be a promising approach for reducing internalized weight stigma in adolescents. Further research is warranted to refine intervention strategies, explore the mechanisms underlying the observed effects, and assess the scalability and long-term impact of such initiatives in school settings. Full article

(This article belongs to the Special Issue Social-Emotional Skills, Resilience, and Behavioral Problems in Children)

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11 pages, 456 KB

Open AccessCase Report

Hereditary Spherocytosis: Review of Presentation at Birth

by Nadine-Stella Achenjang, Elizabeth Jadczak, Rita M. Ryan and Mary L. Nock

Children 2025, 12(9), 1207; https://doi.org/10.3390/children12091207 - 10 Sep 2025

Viewed by 118

Abstract

Background/Objectives: We wished to raise awareness of Hereditary Spherocytosis (HS) as a potential cause of early and significant hemolytic newborn jaundice. Methods: We utilized three recent cases from our experience to discuss hyperbilirubinemia etiologies to be considered when a baby has [...] Read more.

Background/Objectives: We wished to raise awareness of Hereditary Spherocytosis (HS) as a potential cause of early and significant hemolytic newborn jaundice. Methods: We utilized three recent cases from our experience to discuss hyperbilirubinemia etiologies to be considered when a baby has hemolytic hyperbilirubinemia, including HS, and presented a review of the literature about this disorder including presentation and evaluation in the neonate. Results: We found that ABO hemolytic disease of the newborn (HDN) is often considered as the etiology for presumed hemolytic hyperbilirubinemia even when the direct antiglobulin test (DAT) is negative. When there is a mother-baby ABO mismatch and baby’sDAT is negative, another etiology should be sought. HS should be considered in these cases as the prevalence of HS is as frequent as 1 in 2000 in certain populations, it is the third most common hemolytic disorder after ABO isoimmunization and G6PD deficiency, and it is the most common cause of non-immune hemolytic hyperbilirubinemia in neonates with kernicterus. The indices to look for in the complete blood count that are suggestive for HS are MCHC > 36.5–37 g/dL, an MCHC:MCV ratio (HS Index) > 0.36, and increased RDW. The lack of spherocytes on the newborn peripheral blood smear, family history, initial anemia, and reticulocytosis do not eliminate the diagnosis of HS. Conclusions: HS is common and should be included in the differential diagnosis for hemolytic hyperbilirubinemia. Red blood cell indices can suggest the diagnosis of HS, and eosin 5’ maleimide (EMA) testing can be used to make the diagnosis. If DAT-negative ABO HDN is the leading diagnosis for hyperbilirbinemia, a different etiology should urgently be sought. Full article

(This article belongs to the Special Issue Genetics and Precision Medicine with Hematologic Diseases in Children)

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10 pages, 402 KB

Open AccessArticle

Evaluation of Oral Health and Oral Health-Related Quality of Life in Children with Adenoid Hypertrophy

by Münevver Çoruh Kılıç, Kenan Cantekin, Emre Haylaz, Fahrettin Kalabalık, Korhan Kılıç, Hasan Basri Bircan and Mihriban Güner

Children 2025, 12(9), 1206; https://doi.org/10.3390/children12091206 - 10 Sep 2025

Viewed by 220

Abstract

Background/Objectives: Adenoid hypertrophy (AH), one of the most common pathologies in children, is a major cause of mouth breathing. Mouth breathing causes dry mouth, which removes the beneficial effects of saliva necessary for oral health. Therefore, an oral microflora favorable to caries [...] Read more.

Background/Objectives: Adenoid hypertrophy (AH), one of the most common pathologies in children, is a major cause of mouth breathing. Mouth breathing causes dry mouth, which removes the beneficial effects of saliva necessary for oral health. Therefore, an oral microflora favorable to caries is promoted. The primary objective of this study is to evaluate the oral health of children diagnosed with AH between the ages of 3 and 14 and to determine the early childhood oral health impact scale. Methods: This descriptive study was conducted between November 2019 and November 2020, involving 16 boys and 14 girls diagnosed with AH at the Department of Otorhinolaryngology, Faculty of Medicine, Atatürk University. These children, diagnosed with adenoid hypertrophy, were referred to the Department of Pedodontics, Faculty of Dentistry, Ataturk University, for the evaluation of their oral health prior to surgery. Oral examinations were performed on the pediatric participants under dental unit light by the same pedodontist, and their demographic data and DMFT/dmft scores were recorded. Data for the Early Childhood Oral Health Impact Scale (ECOHIS-T) were obtained from volunteers with communication skills and their parents. SPSS 21.0 software was used in the statistical evaluation of the data. A Chi-square test was used to assess differences between groups. Results: The mean age of the children was 5.9 ± 2.6 years. There was no statistically significant difference between AH grades 2, 3, and 4 in terms of dentition periods, gender, and occlusion (p = 0.177, p = 0.495). The scores of the first nine and last four questions of the ECOHIS-T were found to be higher in children with grade 4 AH (p = 0.011, p = 0.043). The DMFT index was also higher in children with grade 4 AH (p = 0.010). Conclusions: Tooth decay is more prevalent in children with severe adenoid hypertrophy. This condition was also observed to negatively affect their quality of life. Regular check-ups and preventive care are needed to improve the quality of life of these children. Full article

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

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13 pages, 3040 KB

Open AccessArticle

The Utility of Umbilical Cord Pulse Oximetry—A Translational Study with Four Minutes of Deferred Cord Clamping Using an Asphyxiated Preterm Ovine Model

by Justin Helman, Mausma Bawa, Sylvia Gugino, Nicole Bradley, Lori Nielsen, Arun Prasath, Clariss Blanco, Mary Divya Kasu, Hamza Abbasi, Munmun Rawat and Praveen Chandrasekharan

Children 2025, 12(9), 1205; https://doi.org/10.3390/children12091205 - 10 Sep 2025

Viewed by 195

Abstract

Background: Expert guidelines recommend using pulse oximetry (PO) in the delivery room to monitor oxygen saturation (SpO₂) and heart rate (HR). Umbilical cord pulse oximetry (UCP) is a novel concept that, despite being postductal, could provide accurate measurements of SpO₂ [...] Read more.

Background: Expert guidelines recommend using pulse oximetry (PO) in the delivery room to monitor oxygen saturation (SpO₂) and heart rate (HR). Umbilical cord pulse oximetry (UCP) is a novel concept that, despite being postductal, could provide accurate measurements of SpO₂ and HR, as it overcomes barriers associated with skin pigmentation. Methods: This pilot study used NONIN pulse oximetry on an intact umbilical cord that underwent deferred cord clamping (DCC) to evaluate umbilical cord SpO₂ in a preterm asphyxiated ovine model (N of 5) with an HR of <100 bpm. The UCP HR served as a surrogate marker for umbilical vessel flow. A receiver operator characteristic (ROC) curve was used to evaluate UCP parameters with arterial saturations (SaO₂) and carotid HR between 2 and 10 min. Results: Following asphyxia, five preterm lambs underwent DCC for 4 min. A significant relationship was noted between SaO₂ and umbilical SpO₂ (area under the curve (AUC) of 0.907, CI 0.857–0.968, p < 0.0001) along with carotid and umbilical HR (AUC) of 0.842 (CI 0.663–0.902, p < 0.0001). Conclusions: In a translational preterm model, UCP accurately predicted preductal SaO₂ and carotid HR (a surrogate for umbilical flow). Using UCP in the delivery room will help guide supplemental oxygen and determine the optimal duration of clamping the umbilical cord. These proof-of-concept studies/pilot findings require validation with larger animal cohorts and newborn infants. Full article

(This article belongs to the Special Issue Advances in Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment)

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11 pages, 692 KB

Open AccessArticle

High-Intensity Physical Activity During Late Adolescence Predicts Young Adult CT-Based Finite Element Bone Strength in Emerging Adulthood: Iowa Bone Development Study

by Soyang Kwon, Kathleen F. Janz, Indranil Guha, Alex V. Rowlands, Oscar Rysavy, Punam K. Saha, Chandler Pendleton, Euisung D. Shin and Steven M. Levy

Children 2025, 12(9), 1204; https://doi.org/10.3390/children12091204 - 9 Sep 2025

Viewed by 235

Abstract

Objective: This study investigated associations between physical activity (PA) during late adolescence and emerging adulthood and bone strength in emerging adulthood by utilizing advanced finite element analysis of computed tomography (CT/FEA) technology beyond the traditional dual-energy X-ray absorptiometry (DXA) method. Methods: This study [...] Read more.

Objective: This study investigated associations between physical activity (PA) during late adolescence and emerging adulthood and bone strength in emerging adulthood by utilizing advanced finite element analysis of computed tomography (CT/FEA) technology beyond the traditional dual-energy X-ray absorptiometry (DXA) method. Methods: This study included 266 participants (152 females) from the Iowa Bone Development Study. PA volume (average acceleration) and intensity (intensity gradient) metrics were calculated from ActiGraph accelerometer data collected at ages 17, 19, 21, and 23 years. Compressive modulus and compressive stiffness of the tibia were estimated at age 23 via CT/FEA of the tibia. Sex-specific linear regression models were used to evaluate associations between PA metrics and bone outcomes, adjusting for age, height, weight, musculoskeletal fitness, and calcium intake. Results: Intensity gradient averaged over 17–23 years of age was positively associated with compressive stiffness at age 23 years in both females and males (p < 0.01). Intensity gradient was positively associated with compressive modulus in females (p < 0.01), but not in males. No significant associations were found between average acceleration and either compressive stiffness or modulus in either sex (p > 0.05). Conclusions: Using a state-of-the-art CT/FEA method, this study suggests that high-intensity PA during late adolescence and emerging adulthood improves bone strength. Full article

(This article belongs to the Special Issue Physical Fitness and Health in Adolescents)

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20 pages, 713 KB

Open AccessArticle

Early Parenting Effects on Childhood Delay of Gratification and Adolescent Allostatic Load

by Heather Leonard, Atika Khurana and Derek Kosty

Children 2025, 12(9), 1203; https://doi.org/10.3390/children12091203 - 9 Sep 2025

Viewed by 215

Abstract

Background/Objectives: Early parenting can influence child self-regulatory skills, which are in turn linked to allostatic load (AL)—a predictor of future morbidity and mortality. However, this mechanistic pathway from early parenting to later AL has not been tested using longitudinal data. Methods: [...] Read more.

Background/Objectives: Early parenting can influence child self-regulatory skills, which are in turn linked to allostatic load (AL)—a predictor of future morbidity and mortality. However, this mechanistic pathway from early parenting to later AL has not been tested using longitudinal data. Methods: We analyzed longitudinal data (N = 1364) from the Study of Early Child Care and Youth Development to examine relationships between early childhood (ages 2–3) observed parenting behaviors (i.e., autonomy support, supportive presence and hostility) and a comprehensive index of adolescent (age 15) AL, and assessed delay of gratification (at 54 months) as a mediator and moderator of these associations. Results: Maternal supportive presence and hostility in early childhood were directly associated with adolescent AL. All three early childhood parenting behaviors were associated with delay of gratification at 54 months. There was no evidence of mediation or moderation. Conclusions: The findings suggest the important role of early parenting behaviors in predicting long-term AL outcomes. Full article

(This article belongs to the Section Global Pediatric Health)

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21 pages, 1337 KB

Open AccessReview

Clinical Impact of Patient-Specific 3D Models in Neonatal Surgery: A Case-Based Review of Applications and Future Directions

by Oscar Girón-Vallejo, Bernardo Garcia-Nuñez, Isidoro Narbona-Arias, Alexander Siles-Hinojosa, Francisco Javier Murcia-Pascual, Moutasem Azzubi, Ignacio Gorriti, Dario Garcia-Calderon, Antonio Piñero-Madrona and Lucas Krauel

Children 2025, 12(9), 1202; https://doi.org/10.3390/children12091202 - 9 Sep 2025

Viewed by 267

Abstract

Three-dimensional (3D) modeling and printing technologies are increasingly used in pediatric surgery, offering improved anatomical visualization, surgical planning, and personalized approaches to complex conditions. Compared to standard imaging, patient-specific 3D models—virtual or printed—provide a more intuitive spatial understanding of congenital anomalies, tumors, and [...] Read more.

Three-dimensional (3D) modeling and printing technologies are increasingly used in pediatric surgery, offering improved anatomical visualization, surgical planning, and personalized approaches to complex conditions. Compared to standard imaging, patient-specific 3D models—virtual or printed—provide a more intuitive spatial understanding of congenital anomalies, tumors, and vascular anomalies. This review compiles evidence from pediatric surgical fields including oncology, abdominal, and thoracic surgery, highlighting the clinical relevance of 3D applications. The technological workflow—from image segmentation to computer-aided design (CAD) modeling and multimaterial printing—is described, emphasizing accuracy, reproducibility, and integration into hospital systems. Several clinical cases are presented: neuroblastoma, cloacal malformation, conjoined twins, and two cases of congenital diaphragmatic hernia (one with congenital pulmonary airway malformation, CPAM). In each, 3D modeling enhanced anatomical clarity, increased surgeon confidence, and supported safer intraoperative decision-making. Models also improved communication with families and enabled effective multidisciplinary planning. Despite these advantages, challenges remain, such as production time, cost variability, and lack of standardization. Future directions include artificial intelligence-based automation, expanded use of virtual and mixed reality, and prospective validation studies in pediatric cohorts. Overall, 3D modeling represents a significant advance in pediatric precision surgery, with growing evidence supporting its safety, clinical utility, and educational value. Full article

(This article belongs to the Section Pediatric Surgery)

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12 pages, 747 KB

Open AccessArticle

Diagnostic Value of Leukocyte Count, C-Reactive Protein, and Procalcitonin in Pediatric Liver Transplant Patients During the First Week Postoperative: A Longitudinal Study from a Tertiary Center and a New Diagnostic Method for Predicting Systemic Infection

by Zerrin Onal, Elif Turkmen, Demet Demirkol, Ugur Can Leblebici, Ibrahim Kandemir, Tugce Goksu Yilmaz, Selda Hancerli Torun, Feza Ekiz, Ilgin Ozden and Ozlem Durmaz

Children 2025, 12(9), 1201; https://doi.org/10.3390/children12091201 - 9 Sep 2025

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Abstract

Background/Objectives: Infection is a major complication during the early postoperative period following pediatric liver transplantation (LT). Prompt diagnosis and treatment are essential to prevent death. We aimed to assess the diagnostic value of procalcitonin (PCT), white blood cell count (WBC), and C-reactive protein [...] Read more.

Background/Objectives: Infection is a major complication during the early postoperative period following pediatric liver transplantation (LT). Prompt diagnosis and treatment are essential to prevent death. We aimed to assess the diagnostic value of procalcitonin (PCT), white blood cell count (WBC), and C-reactive protein (CRP) levels for detecting bacterial infection and SIRS within the first week after LT. Methods: Demographic data, vital signs, laboratory results (PCT, CRP, WBC), and culture findings on the 1st, 4th, and 7th days between January 2010 and 2024 were collected retrospectively. Results: The study included 88 patients. Seventy-two percent had cirrhotic liver disease. SIRS was present in 17% (n = 15), and bacterial growth was detected in 20% (n = 18). Bacterial growth was found in 80% of patients with SIRS (n = 12/15) and in 8% of SIRS-negative patients (n = 6/73). PCT levels were significantly elevated on days 1, 4, and 7, and CRP levels on days 4 and 7 in patients with SIRS. PCT elevation was significant on days 1, 4, and 7, while WBC increase was noted on day 7 in patients with bacterial growth. Body temperature ≥ 37.1 °C and PCT ≥ 5.1 ng/dL on the first day together showed a sensitivity of 72.2% and specificity of 84.3% for bacterial growth. Similarly, body temperature ≥ 37.1 °C and PCT ≥ 9.2 ng/dL on the first day yielded 73% sensitivity and 95% specificity for diagnosing SIRS. Cirrhotic patients exhibited limited or no WBC response to bacterial growth. Conclusions: PCT, CRP, and WBC alone are insufficient for diagnosing infection. Combined assessment of body temperature changes and PCT elevation may serve as more accurate indicators. Nonetheless, close monitoring of culture results and clinical signs, with serial physical exams, can aid timely infection management or prevent unnecessary antibiotic adjustments. Full article

(This article belongs to the Special Issue Advances in Pediatric Gastroenterology (2nd Edition))

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14 pages, 549 KB

Open AccessArticle

Impact of a Strength Training Program on Physical Performance in U10 Soccer Players: A Quasi-Experimental Trial

by Adrián Torregrosa-Domínguez, Iván Moreno-Camacho, Eduardo José Fernández-Ozcorta and Rafael Ramos-Véliz

Children 2025, 12(9), 1200; https://doi.org/10.3390/children12091200 - 8 Sep 2025

Viewed by 259

Abstract

Background/Objectives: The integration of strength training in grassroots youth soccer remains limited, often due to persistent myths regarding its safety and utility. This study evaluated the effectiveness of a tailored, playful strength training program in young players and analyzed the influence of the [...] Read more.

Background/Objectives: The integration of strength training in grassroots youth soccer remains limited, often due to persistent myths regarding its safety and utility. This study evaluated the effectiveness of a tailored, playful strength training program in young players and analyzed the influence of the Relative Age Effect (RAE) on physical development and training response. Methods: A 14-week quasi-experimental pretest–posttest design was conducted with 27 federated male soccer players aged 9–10 years (experimental: n = 15; control: n = 12). The intervention consisted of twice-weekly, game-based strength training sessions integrated into the regular team routine. Outcomes included validated anthropometric (BMI) and functional (handgrip strength, standing long jump, Illinois agility test) indicators. RAE was analyzed according to birth quartile. Non-parametric statistical analyses and effect size (r) calculations were used. Results: The experimental group achieved significantly greater pre–post gains in handgrip strength than controls (right and left). Agility and standing long jump improved within the experimental group, but between-group differences were not significant. BMI decreased within the experimental group, yet the net between-group difference in BMI change was not significant in the context of a higher baseline BMI (p = 0.047). Although the Relative Age Effect (RAE) influenced baseline BMI, no moderating effect was detected on performance variables or training-induced changes in this sample. Conclusions: In U10 soccer players, a playful, context-integrated strength program produced superior gains in handgrip strength compared with usual practice. Improvements in agility and standing long jump were observed within the intervention group, but did not exceed those of the controls. BMI changes were not different between the groups and must be interpreted with caution, given baseline imbalances. In this sample, RAE did not moderate training response. Full article

(This article belongs to the Special Issue Physical Fitness and Health in Adolescents)

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Children, Volume 12, Issue 9 (September 2025) – 126 articles

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