Children

18 pages, 313 KB

Open AccessArticle

The Link Between Emotional Regulation and Impulsivity in Childhood Anxiety Disorder

by Duygu Karagöz, Ece Tezsezen and Nilfer Şahin

Children 2026, 13(3), 439; https://doi.org/10.3390/children13030439 - 23 Mar 2026

Viewed by 375

Background and Objectives: The aim of this study is to evaluate impulsivity in childhood anxiety disorders and to examine its relationship with anxiety sensitivity and emotion regulation. Materials and Methods: The study group consisted of a total of 60 children aged 8–12 years [...] Read more.

Background and Objectives: The aim of this study is to evaluate impulsivity in childhood anxiety disorders and to examine its relationship with anxiety sensitivity and emotion regulation. Materials and Methods: The study group consisted of a total of 60 children aged 8–12 years diagnosed with generalized anxiety disorder (GAD, n = 30) and other anxiety disorders (n = 30). The control group consisted of 40 healthy children of similar age without a psychiatric diagnosis. Data collection forms included the Barratt Impulsiveness Scale Short Form (BIS-S), the Children’s Anxiety Sensitivity Index (ASI-3), the Emotion Regulation Checklist (ERC), and The Screen for Child Anxiety Related Emotional Disorders (SCARED). Results: Our study found no significant differences in BIS-S scores between GAD, other anxiety disorders, and the control group. The total/physical and ERC subscales of the ASI-3 were higher in the generalized anxiety disorder and other anxiety disorder group than in the control group. However, there were no significant differences in the social dimension and cognitive dimension scores of the ASI-3. It has been determined that anxiety sensitivity does not significantly mediate the relationship between emotion regulation and impulsivity, and that emotional variability/negativity is directly and completely related to impulsivity. Conclusions: Our study suggests that children with anxiety disorders experience greater difficulties in regulating their emotions compared to healthy children, and that emotional variability is directly related to impulsivity. In this context, enhancing emotion regulation skills in anxiety disorders may prove to be a pivotal factor in the efficacy of treatment and the maintenance of behavioral control. Full article

(This article belongs to the Section Pediatric Mental Health)

15 pages, 394 KB

Open AccessArticle

Adult Rome IV Disorders of Gut–Brain Interaction in a Pediatric Population

by Natali González Rozo, Carlos Alberto Velasco-Benítez, Michelle Higuera Carrillo and Daniela Alejandra Velasco-Suárez

Children 2026, 13(3), 438; https://doi.org/10.3390/children13030438 - 23 Mar 2026

Viewed by 327

Abstract

Background: Disorders of the gut–brain interaction (DGBIs) constitute a group of functional conditions widely described in adults; however, some of these have not been included in pediatric Rome criteria, despite the fact that they may manifest during childhood. Early identification of these [...] Read more.

Background: Disorders of the gut–brain interaction (DGBIs) constitute a group of functional conditions widely described in adults; however, some of these have not been included in pediatric Rome criteria, despite the fact that they may manifest during childhood. Early identification of these conditions is relevant due to their clinical/psychosocial impact as well as their effect on quality of life. The aim was to determine the prevalence and associated factors of some DGBIs described in adults according to the Rome IV criteria in pediatric population. Methods: An observational/prospective/cross-sectional study was conducted in toddlers, school-aged children, and adolescents from three Colombian cities. The adapted Questionnaire for Pediatric Gastrointestinal Symptoms Rome IV (QPGS-IV) using adult criteria was applied, along with quality-of-life scales and PROMIS for anxiety/depression. Descriptive uni/bivariate analyses were performed as well as a multivariate logistic regression model. Results: A total of 704 participants were included (13.7 ± 2.8 years old). The prevalence of DGBIs described in adults according to QPGS-IV was 5.8%, with proctalgia fugax being the most frequent. In the bivariate analysis, race, school/social absenteeism, depressive traits, and impaired quality of life were significantly associated. In the multivariate model depressive traits (OR = 4.08; 95%CI = 1.82–9.12; p = 0.001), school (OR = 2.51; 95%CI = 1.06–5.98; p = 0.036), and social absenteeism (OR = 4.04; 95%CI = 1.70–9.62; p = 0.002) were the factors independently associated. Conclusions: These adult DGBIs, according to the QPGS-IV, can occur in pediatric populations and are closely related to psycho-emotional and functional factors. These are mainly associated with depression and school/social absenteeism, supporting the need for a biopsychosocial approach and a revision of the pediatric diagnostic criteria. Full article

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

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13 pages, 2335 KB

Open AccessArticle

Virtual Reality Versus Monitor-Based Distraction in Children with Mild Intellectual Disability: A Preliminary Comparative Observational Study

by Antonio Fallea, Simone Treccarichi, Simona L’Episcopo, Massimiliano Bartolone, Luigi Vetri, Mirella Vinci, Raffaele Ferri and Francesco Calì

Children 2026, 13(3), 437; https://doi.org/10.3390/children13030437 - 23 Mar 2026

Viewed by 292

Abstract

Background/Objectives: Dental anxiety represents a significant barrier to oral care in children with neurodevelopmental disorders (NDDs), whose sensory sensitivities and behavioral challenges often complicate clinical management and limit access to treatment. Virtual reality (VR) has emerged as a supportive tool to improve [...] Read more.

Background/Objectives: Dental anxiety represents a significant barrier to oral care in children with neurodevelopmental disorders (NDDs), whose sensory sensitivities and behavioral challenges often complicate clinical management and limit access to treatment. Virtual reality (VR) has emerged as a supportive tool to improve the feasibility of dental procedures in this vulnerable population. This study aims to evaluate whether a VR-based distraction approach could facilitate the completion of dental treatment in children with mild intellectual disability (ID). Methods: A prospective comparative observational study was conducted between February and September 2025 involving 56 children aged 11–15 years with mild ID and moderate dental anxiety (Corah Dental Anxiety Scale, DAS: 9–12). Participants were allocated to two groups of distraction approaches—VR distraction (n = 28) using the Oculus Quest 3^® headset or a monitor-based cartoon (n = 28)—according to device availability and to maintain balanced group sizes. The primary outcome was treatment success, defined as completion of the restorative dental procedure under local anesthesia within 50 min. Results: Treatment success was achieved in 78.6% of the VR group versus 46.4% of the monitor group (p = 0.026). The odds of successful treatment were more than four times higher with VR compared to monitor distraction (OR 4.12; 95% CI: 1.16–16.47), with a risk ratio of 2.50 (95% CI: 1.14–5.50). Stratified analysis suggested a stronger effect in females (OR 12.25; 95% CI: 1.27–118.36) than in males (OR 2.56; 95% CI: 0.53–12.43). Conclusions: VR-based distraction significantly improved dental treatment success in children with mild ID compared with conventional distraction. Although gender differences were observed, they should be interpreted with caution due to the small sample size. This work lays the foundation for developing both short- and long-term protocols to facilitate dental treatment management and cooperation in patients with NDDs. Full article

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11 pages, 658 KB

Open AccessReview

ATP6V1B1-Associated Inherited Distal Renal Tubular Acidosis in Children: Insights from a Literature Review

by Andreea Liana Bot (Rachisan), Marius Cosmin Colceriu, Diana Jecan-Toader, Bogdan Bulata, Dan Delean and Mihaela Sparchez

Children 2026, 13(3), 436; https://doi.org/10.3390/children13030436 - 23 Mar 2026

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Abstract

Inherited distal renal tubular acidosis (dRTA) is a rare but clinically significant disorder of renal acid–base regulation that frequently presents in infancy or early childhood. Among the genetic causes of autosomal recessive dRTA, mutations in the ATP6V1B1 gene are particularly important due to [...] Read more.

Inherited distal renal tubular acidosis (dRTA) is a rare but clinically significant disorder of renal acid–base regulation that frequently presents in infancy or early childhood. Among the genetic causes of autosomal recessive dRTA, mutations in the ATP6V1B1 gene are particularly important due to their association with early-onset disease and sensorineural hearing loss. Failure to recognize and treat this condition promptly can result in growth retardation, bone disease, nephrocalcinosis, chronic kidney disease, and permanent auditory impairment. This article presents a comprehensive review of the pediatric literature concerning dRTA. We focus on the pathophysiology, pediatric presentation, renal and audiological outcomes, genetic architecture, and management implications of ATP6V1B1-associated dRTA in children. We highlight evolving genotype–phenotype correlations, the emerging recognition of autosomal recessive disease mechanisms, and the importance of early diagnosis and long-term multidisciplinary follow-up. Full article

(This article belongs to the Special Issue Pediatric Kidney Disease: Prevalence, Risk, and Management Strategies)

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16 pages, 429 KB

Open AccessReview

Inequalities in Childhood Healthcare Access Among Racial and Ethnic Groups of Sub-Saharan Africa: A Narrative Review

by Syed Hanzila Azhar, Andrea Sárváry and Attila Sárváry

Children 2026, 13(3), 435; https://doi.org/10.3390/children13030435 - 23 Mar 2026

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Abstract

Background/Objective: Child health serves as a foundational part of human development. Inequities in access to key health services remain high in Sub-Saharan Africa (SSA), most notably among children from disadvantaged, racially, or ethnically marginalized groups. The objective of this structured narrative review is [...] Read more.

Background/Objective: Child health serves as a foundational part of human development. Inequities in access to key health services remain high in Sub-Saharan Africa (SSA), most notably among children from disadvantaged, racially, or ethnically marginalized groups. The objective of this structured narrative review is to evaluate and aggregate the available evidence on racial/ethnic disparities in childhood healthcare access in SSA. Methods: A comprehensive search on African Index Medicus (AIM), Web of Science and PubMed for studies published between 2010 and 2025 was executed using relevant MeSH terms and Boolean operators. Studies on healthcare access inequalities among racial or ethnic groups in SSA were included. This study was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Ten articles were included. Ethnicity was an independent contributor to inequities in childhood healthcare across four domains: vaccination coverage (lower for Hausa/Fulani in Nigeria and Somali/Luhya in Kenya compared to dominant groups), timeliness of vaccination, child mortality (higher in economically and ethnically marginalized groups), and nutritional status (elevated stunting and underweight odds in certain ethnic minorities). Conclusions: Racial and ethnic inequalities in child healthcare access across SSA are driven by multi-factor structural, geographical, and cultural barriers. Although socioeconomic improvement reduces some disparities, it does not eradicate them, highlighting that ethnic identity continues to shape health outcomes independently. Addressing these disparities requires strengthening culturally inclusive healthcare delivery, improving access in underserved regions, and integrating ethnicity-disaggregated monitoring into national health systems. Full article

(This article belongs to the Special Issue Social and Environmental Determinants of Health Care and Outcomes Among Children with Cancers)

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29 pages, 622 KB

Open AccessArticle

Mechanisms of Change in Mindfulness-Based Family Intervention (MYmind) Versus Methylphenidate for Childhood ADHD: A Randomized Controlled Trial

by Brett Kosterman Zoller, Susan M. Bögels, Renée Meppelink and Esther I. de Bruin

Children 2026, 13(3), 434; https://doi.org/10.3390/children13030434 - 23 Mar 2026

Viewed by 442

Abstract

Background/Objectives: Mindfulness-based interventions show promise for treating childhood ADHD, yet the mechanisms through which they produce effects remain unclear. This study provides the first direct comparison of treatment mechanisms between a mindfulness-based family intervention (MYmind) and methylphenidate. Methods: Data were drawn from [...] Read more.

Background/Objectives: Mindfulness-based interventions show promise for treating childhood ADHD, yet the mechanisms through which they produce effects remain unclear. This study provides the first direct comparison of treatment mechanisms between a mindfulness-based family intervention (MYmind) and methylphenidate. Methods: Data were drawn from a preregistered trial combining randomized and preference arms, comparing MYmind (2-month parallel parent–child mindfulness training) with 4-month methylphenidate in children aged 8–18 with ADHD (N = 120 children, 224 parents). Families were assessed at baseline, 2, 4 and 10 months. Multilevel mediation analyses tested whether treatment effects on ADHD symptoms were transmitted through 111 treatment-to-mediator-to-outcome pathways across three mechanism categories: child emotion regulation and coping (all children); adolescent self-regulation and mindfulness (ages 11+); and parent-level mechanisms, including mindful parenting, parental mindfulness, parenting style and self-compassion. Results: Direct treatment effects favored methylphenidate for ADHD symptom reduction at 4 months, with mindfulness catching up by 10 months. MYmind produced significantly greater improvements than methylphenidate in adolescent healthy self-regulation, parental self-compassion, mindful parenting and over-reactive parenting. Treatment did not differentially affect the remaining mechanisms. Across model sets, observed emotion regulation, maladaptive coping, parental self-compassion and mindful parenting each predicted ADHD outcomes. Across 111 pathways tested in 18 models, numerous significant individual pathways were consistent with theoretical predictions, yet no complete mediation chains reached statistical significance. Conclusions: MYmind engages distinct psychological and family-level processes compared to methylphenidate that are separately associated with ADHD symptom improvement. The absence of significant mediation effects likely reflects power limitations. These findings support mindfulness-based family intervention as a viable alternative to medication and highlight the need for larger-scale mechanism research. Full article

(This article belongs to the Section Pediatric Mental Health)

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12 pages, 3384 KB

Open AccessArticle

Pilonidal Sinus: Open Surgery or PEPSiT? Our Preliminary Experience in Adolescents

by Fabiola Cassaro, Salvatore Arena, Santi D’Antoni, Pietro Impellizzeri and Carmelo Romeo

Children 2026, 13(3), 433; https://doi.org/10.3390/children13030433 - 22 Mar 2026

Viewed by 224

Abstract

Background: Pilonidal sinus disease (PSD) is a chronic inflammatory condition commonly affecting the sacrococcygeal region, particularly in adolescents and young adults. Traditional open surgical approaches are associated with prolonged recovery, high complication rates, and recurrence. The advent of endoscopic techniques, such as Pediatric [...] Read more.

Background: Pilonidal sinus disease (PSD) is a chronic inflammatory condition commonly affecting the sacrococcygeal region, particularly in adolescents and young adults. Traditional open surgical approaches are associated with prolonged recovery, high complication rates, and recurrence. The advent of endoscopic techniques, such as Pediatric Endoscopic Pilonidal Sinus Treatment (PEPSiT), offers a promising alternative, reducing discomfort and potentially improving outcomes. The aims of the study were to compare the effectiveness and safety of PEPSiT versus traditional open excision in the treatment of PSD in the pediatric population. Methods: A retrospective, non-randomized study was conducted on patients aged 8–18 years who underwent surgery for PSD between 2019 and 2023 at our institution. Patients were divided into two groups: those undergoing traditional open excision (Group A) and those who received PEPSiT (Group B). Data were extracted from electronic medical records, including patient demographics, operative time, length of hospital stay, and post-operative complications such as recurrence and wound dehiscence. A minimum follow-up of 12 months was required. Statistical analysis was performed using the Chi-square test for categorical variables and Mann–Whitney U test for quantitative analysis. Results: A total of 61 patients were included in the study, with 40 undergoing Open surgery and 21 treated with PEPSiT. Mean operative time was shorter in the PEPSiT group (37.95 ± 10.86 min) compared with the Open group (47.85 ± 20.03 min), although this difference did not reach statistical significance (p = 0.052). Length of hospital stay was significantly reduced in the PEPSiT group (5.9 ± 8.73 h) compared with the Open group (15.40 ± 12.54 h) (p < 0.001). Post-operative complications were significantly less frequent following PEPSiT, with no cases of wound dehiscence observed compared with 27.5% in the Open group (p = 0.008). Recurrence rates were lower in the PEPSiT group (9.5%) than in the Open group (25%); however, this difference was not statistically significant (p = 0.149). Conclusions: PEPSiT is a feasible minimally invasive option for pediatric pilonidal sinus disease, associated with shorter hospital stay, faster wound healing, and fewer postoperative complications compared with open surgery, with comparable operative time. These results should nevertheless be interpreted with caution and warrant confirmation in prospective controlled studies. Full article

(This article belongs to the Section Pediatric Surgery)

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11 pages, 490 KB

Open AccessReview

The Nexø Method—Clinical Evidence for the Paradigm Shift in Caries Management for Children and Adolescents in Denmark Being Cost-Effective

by Kim Rud Ekstrand and Mauri Erik Christian Christiansen

Children 2026, 13(3), 432; https://doi.org/10.3390/children13030432 - 22 Mar 2026

Viewed by 231

Abstract

Introduction: In the period from the 1960s to the new millennium, dental care for children in Denmark focused mostly on drilling and filling lesions once they appeared. This often led to repeated operative treatments, not to mention the trauma related to the [...] Read more.

Introduction: In the period from the 1960s to the new millennium, dental care for children in Denmark focused mostly on drilling and filling lesions once they appeared. This often led to repeated operative treatments, not to mention the trauma related to the many anxiety-provoking dental treatments undergone by these children. Aim: It is cost-effective to document, by means of clinical data over a 25-year period, that the paradigm shift from operative management of caries to a more non-operative approach. Method: The name of the program is the Nexø method, which was developed in 1987 in the Municipality of Nexø (one of 275 municipalities) in Denmark. The method was operationalized into a structured approach based on three principles, dosed at individually assessed recalls according to diagnosis and risk assessment. The risk assessment was based on four risk criteria, each divided into a “good” (1 point) or “bad” (2 points) situation, which were eventually used to assess the length of the interval between visits to the clinic. Outcomes: National Danish oral health data (SCOR) and oral health data from the Nexø municipality from 1985 to 2005 were analyzed, descriptively as well as statistically (Welch’s t-test, 95%CI and Cohen’s d), to compare the caries experience on a national level with data from Nexø in terms of mean defs/DMFS and percentage of 5-, 15-, and 18-year-olds with a defs/DMFS = 0. Results: The mean defs/DMFS or percentage of children with a defs = 0/DMFS = 0 in Nexø was, prior to the implementation of the Nexø method (before 1987), at the national level or worse. The mean defs/DMFS dropped significantly (p-values < 0.0001) from 1990 onwards in Nexø in 5-, 15- and 18-year-olds compared to national data. The DMFS = 0 among 15-yr-olds in Nexø reached 80% in 2005 compared with 40% nationally in the same year. For 15-yr-olds in 2005, the effect size expressed by Cohen’s d = −0.43, indicating a moderate effect of the Nexø method. The mean number of sealed surfaces in 2003 was 3.1 (1SD = 1.6) in 39 reporting municipalities, and for Nexø the mean value was 2.8 surfaces. The cost (price/child/year) was under control over the years. Conclusions: The Nexø Method shows the clinical evidence that the paradigm shift to prevention of the disease process, rather than operative intervention, is cost effective, even with a rather limited use of sealants. A reduction in fear and anxiety-provoking dental treatments in Nexø compared to most other municipalities in Denmark is expected. Full article

(This article belongs to the Special Issue Pediatric Dental Restoration: Innovations in Treatment and Materials)

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28 pages, 477 KB

Open AccessArticle

Parent Learning Groups in Alternative Provision: A Mixed-Methods Study of Psychoeducation, Mentalization, and Peer Support for Parents of Children with Neurodevelopmental and Conduct Difficulties

by Gali Chelouche-Dwek and Peter Fonagy

Children 2026, 13(3), 431; https://doi.org/10.3390/children13030431 - 21 Mar 2026

Viewed by 339

Abstract

Background: Parents of school-age children with neurodevelopmental and conduct difficulties face elevated stress, reduced self-efficacy and relational strain, yet evidence for scalable, school-embedded support remains limited. Drawing on mentalization theory—which emphasises parents’ capacity to understand behaviour in terms of underlying mental states—this mixed-methods [...] Read more.

Background: Parents of school-age children with neurodevelopmental and conduct difficulties face elevated stress, reduced self-efficacy and relational strain, yet evidence for scalable, school-embedded support remains limited. Drawing on mentalization theory—which emphasises parents’ capacity to understand behaviour in terms of underlying mental states—this mixed-methods study evaluated a weekly parent learning group integrating psychoeducation, mentalization-based practice and peer support, delivered within an alternative provision school. Methods: A group of twelve parents who attended at least six sessions completed retrospective pretest–posttest questionnaires assessing parental reflective functioning (PRFQ) and parenting self-efficacy (PSOC). Semi-structured interviews explored parents’ subjective experiences and perceived changes in parent–child interactions and parent–school relationships. Quantitative outcomes were analysed using paired t-tests and effect sizes; qualitative data underwent reflexive thematic analysis. Results: Quantitative analyses revealed statistically significant improvements in parental reflective functioning and self-efficacy. Pre-mentalizing scores decreased substantially (d = 1.34), indicating reductions in non-mentalizing, while interest and curiosity about children’s mental states increased markedly (d = 1.83). Parenting self-efficacy improved significantly (d = 1.61). Although a reduction in excessive certainty about mental states approached significance (d = 0.63, p = 0.053), trends suggested greater epistemic balance. Qualitative analysis identified six themes elucidating mechanisms of change, including enhanced mentalizing capacity, reduced parental stress, transformed parent–child interactions and facilitation style as a critical active ingredient. Integration of findings suggests that psychoeducational content provided conceptual grounding for understanding behaviour, facilitator modelling scaffolded reflective practice, and relational safety within the group enabled authentic engagement with challenging experiences. Conclusions: These preliminary findings indicate that a school-based parent learning group combining psychoeducation, mentalization-based practice and peer support is feasible and associated with meaningful improvements in parental reflective functioning and self-efficacy. Parent narratives of transformed relational practices and shifts from reactive to reflective engagement echo broader literature demonstrating that group-delivered mentalization-oriented programmes can enhance reflective capacities and caregiving quality in diverse family contexts. The school setting may extend the reach of such interventions to families not engaged with clinical services and support collaborative parent–school partnerships. Future research should employ larger, controlled designs, incorporate observational and child outcome measures, and explore scalability across educational contexts. Full article

(This article belongs to the Section Pediatric Mental Health)

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19 pages, 773 KB

Open AccessArticle

Disability Community Perspectives on Participation in Research and Studying Positive Health

by Melissa M. Murphy, Judy L. Aschner, Paige S. Ryals, Ana Joselyn Barahona, Jennifer Lyman, Ashley Harris Whaley, Rachel Byrne and Nathalie L. Maitre

Children 2026, 13(3), 430; https://doi.org/10.3390/children13030430 - 20 Mar 2026

Viewed by 237

Abstract

Background/Objectives: Disability affects ~15.7 million children and ~67 million adults in the US, yet these individuals are typically under-represented in clinical research. Clinical research has increasingly broadened its focus on health outcomes to include “positive health,” which reflects the capacity of an individual [...] Read more.

Background/Objectives: Disability affects ~15.7 million children and ~67 million adults in the US, yet these individuals are typically under-represented in clinical research. Clinical research has increasingly broadened its focus on health outcomes to include “positive health,” which reflects the capacity of an individual to adapt to challenges and the absence of disease. Methods: A mixed-methods approach is used to investigate disability community perspectives on research inclusion and the use of positive health as an outcome in the context of childhood-onset disability. Results: Nationally, about one-fourth (1/4) of adults with disabilities and parents/caregivers reported participating in non-disability-specific research; overall, ~23% of adults and ~30% of parents/caregivers report exclusion because of disability, despite >80% endorsing health outcomes research. Disability stakeholders unanimously express the need to reframe positive health in a disability context, provide guidance on how to reframe it as a research outcome, and offer a roadmap for improving research inclusion. Conclusions: A paradigm shift in how positive health is framed may enhance its relevance to disabilities. An action plan for researchers is derived as a pragmatic approach to strengthen the relevance, generalizability and impact of their research. Full article

(This article belongs to the Section Global Pediatric Health)

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16 pages, 656 KB

Open AccessArticle

Perceived Social Support and Depressive Symptoms in AYA Cancer Patients: A Mediation Analysis of Hope Agency and Pathways

by Julie N. Germann, Colter D. Ray, Holly Rushing and Megan Rittenberg

Children 2026, 13(3), 429; https://doi.org/10.3390/children13030429 - 20 Mar 2026

Viewed by 364

Abstract

Background/Objectives: Adolescent/young adult (AYA) cancer patients experience a variety of challenges, including higher rates of depressive symptoms (D) than healthy controls. Although various forms of social support (SS) seem to be a protective factor against D, AYAs also experience significant disruptions to SS. [...] Read more.

Background/Objectives: Adolescent/young adult (AYA) cancer patients experience a variety of challenges, including higher rates of depressive symptoms (D) than healthy controls. Although various forms of social support (SS) seem to be a protective factor against D, AYAs also experience significant disruptions to SS. Snyder’s hope theory involves two interrelated components: agency (the belief in one’s ability to initiate or sustain action toward a desired goal) and pathways (the belief in one’s ability to produce workable routes to desired goals). Because hope, particularly the agency component, has been linked to both SS and D, it may mediate the relationship between the two. Methods: An online questionnaire was completed by AYA cancer patients (N = 205) in which they self-reported levels of perceived social support (PSS), hope, and D, among other scales and demographic variables. A parallel mediation model was conducted to determine if either or both agency and pathways explain the relationship between PSS and D. Results: Agency mediated the relationship between PSS and D in AYA women with cancer, but not men. Pathways did not mediate the relationship between PSS and D. Conclusions: Given the significantly higher prevalence of depression in women with cancer as compared to men, interventions to enhance agency are an important adjunct to methods to promote PSS in AYA women with cancer. Full article

(This article belongs to the Special Issue Psychological Support in Pediatric Oncology: Improving Clinical Outcomes and Quality of Life)

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13 pages, 564 KB

Open AccessArticle

Evaluation of the Effects of an Immune-Boosting Food Supplement on the Severity and Frequency of Pediatric Respiratory Tract Infections: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

by Fabrizio Calapai, Ilaria Ammendolia, Carmen Mannucci, Giorgia Bulferi, Lara Pauletto, Heide De Togni, Rita La Paglia, Floriana Raso, Mariaconcetta Currò and Gioacchino Calapai

Children 2026, 13(3), 428; https://doi.org/10.3390/children13030428 - 20 Mar 2026

Viewed by 351

Abstract

Background: Respiratory tract infections (RTIs) are common in children and represent one of the main reasons for pediatric consultations. Although generally benign, pediatric RTIs can lead to medical complications and significant socioeconomic burden. The objective of this trial was to evaluate the [...] Read more.

Background: Respiratory tract infections (RTIs) are common in children and represent one of the main reasons for pediatric consultations. Although generally benign, pediatric RTIs can lead to medical complications and significant socioeconomic burden. The objective of this trial was to evaluate the efficacy of a food supplement intended to support the immune system in reducing the rate and severity of pediatric RTIs. Methods: A randomized, double-blind, placebo-controlled, parallel-group clinical trial was conducted to assess the efficacy and safety of a food supplement based on vitamins, minerals, herbal extracts, and Lactobacillus rhamnosus CRL1505 (Pegaso^® Immuno Junior). A daily dose was administered for approximately 60 days within a three-month period to children aged 3–10 years with at least four RTI episodes in the previous year. RTI frequency, illness days, days with fever, cough, and rhinitis, and antipyretic and antibiotic use per episode were recorded over four months. Results: A total of 110 children completed the study. Compared with the placebo, the active supplement significantly reduced the mean number of RTI episodes per child (2.41 ± 0.84 vs. 4.13 ± 1.66; RR = 0.745, 95% CI 0.583–0.953) as well as the number of illness days, days with fever, cough, and rhinitis, and days with antipyretic or antibiotic use. The supplement was well-tolerated. Conclusions: The patented supplementation based on vitamins, minerals, herbal extracts, and Lactobacillus rhamnosus CRL1505 (Pegaso^® Immuno Junior), taken over a three-month period, may reduce the frequency and severity of RTIs in children aged 3–10 years. Full article

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12 pages, 251 KB

Open AccessArticle

A Prospective Observational Study: Are There Any Relationships Between Erythrocytosis, Renal Tubular–Glomerular Functions, and Systemic Hypertension in Adolescent Male Idiopathic Erythrocytosis Patients?

by Nesrin Tas, Demet Baltu, Emel Ozyurek and Bulent Alioglu

Children 2026, 13(3), 427; https://doi.org/10.3390/children13030427 - 20 Mar 2026

Viewed by 200

Abstract

Background: Childhood hypertension is an important predictor of adult cardiovascular disease. Idiopathic erythrocytosis in adolescent males is characterized by elevated hemoglobin and hematocrit levels, which may increase blood viscosity and potentially influence blood pressure (BP) regulation. However, the relationships between erythrocytosis, renal [...] Read more.

Background: Childhood hypertension is an important predictor of adult cardiovascular disease. Idiopathic erythrocytosis in adolescent males is characterized by elevated hemoglobin and hematocrit levels, which may increase blood viscosity and potentially influence blood pressure (BP) regulation. However, the relationships between erythrocytosis, renal tubular–glomerular function, and systemic hypertension in adolescents remain unclear. Methods: This prospective observational case–control study was conducted between October of 2023 and April of 2024, including 37 male adolescents with idiopathic erythrocytosis and 24 age-matched healthy male controls. Complete blood count parameters were confirmed using two samples obtained at separate time points. Biochemical, urinalysis, tubular phosphorus reabsorption, and fractional excretion of sodium tests were performed to assess renal tubular and glomerular function, and 24 h ambulatory blood pressure monitoring (ABPM) was performed in all participants and interpreted according to the 2022 American Heart Association recommendations. Results: The mean systolic and diastolic BP values measured via ABPM did not differ significantly between the groups. However, adolescents with idiopathic erythrocytosis demonstrated significantly higher systolic and diastolic BP load values during 24 h, daytime, and nighttime periods when compared with healthy controls (p < 0.05). Renal tubular and glomerular function parameters were similar between groups. Hematocrit levels showed significant correlations with multiple ABPM load parameters. In the multivariable linear regression analysis, hematocrit remained independently associated with 24 h systolic BP load after adjustment for age, BMI, and serum creatinine. Conclusions: Adolescent males with idiopathic erythrocytosis exhibited increased ambulatory BP load despite similar mean BP values to controls. Elevated hematocrit may contribute to early alterations in BP regulation in adolescents with idiopathic erythrocytosis. Full article

(This article belongs to the Section Pediatric Nephrology & Urology)

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13 pages, 538 KB

Open AccessArticle

Social and Experiential Drivers of Adolescent Alcohol Use: Evidence from an Exploratory Concept Mapping Study

by Sheila Ares-Maneiro, Albert Espelt, Lucía Antelo-Iglesias, Ester Teixidó-Compañó, Marina Bosque-Prous, Èlia Colomeda-Cortada, Lucía Moure-Rodríguez and Ainara Díaz-Geada

Children 2026, 13(3), 426; https://doi.org/10.3390/children13030426 - 20 Mar 2026

Viewed by 229

Abstract

Background/Objectives: To identify and prioritize adolescents’ motivations for alcohol consumption using a participatory qualitative approach. Methods: We conducted a concept mapping study with 39 adolescents aged 15–16 years from a public secondary school in Santiago de Compostela, Spain. Participants generated statements [...] Read more.

Background/Objectives: To identify and prioritize adolescents’ motivations for alcohol consumption using a participatory qualitative approach. Methods: We conducted a concept mapping study with 39 adolescents aged 15–16 years from a public secondary school in Santiago de Compostela, Spain. Participants generated statements in response to a focal question about reasons for drinking, grouped them into categories, and then rated each statement according to perceived frequency and importance using a five-point Likert scale. Results: A total of 41 statements were generated and organized into eight clusters: peer approval, influence, enjoyment, experimentation, fun, disinhibition, social pressure, and coping. Motivations related to fun, peer dynamics, and disinhibition received the highest ratings for both frequency and importance. In contrast, motivations linked to advertising, social media, and influencers were rated lowest. A strong positive association was observed between perceived importance and reported frequency across statements. Conclusions: Adolescents identified enjoyment and peer dynamics as the primary motivations for alcohol use, emphasising the significance of social influences in adolescent drinking behaviours. Despite the necessity for cautious interpretation of findings due to the context-specific nature of the sample, the results suggest that prevention efforts may benefit from the promotion of alcohol-free social environments, the strengthening of social-emotional skills, and the involvement of adolescents in preventive initiatives. Full article

(This article belongs to the Section Pediatric Mental Health)

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8 pages, 878 KB

Open AccessCase Report

PHOX2B Tyr14Ter Mutation Might Be Associated with Sustained Diurnal Hypertension: Case Report and Review of the Literature

by Fabio Antonelli, Simona Sottili, Maria Giovanna Paglietti, Alessandro Onofri, Renato Cutrera, Martina Mazzoni, Alessandro Rossi, Pierluigi Vuilleumier and Annalisa Allegorico

Children 2026, 13(3), 425; https://doi.org/10.3390/children13030425 - 19 Mar 2026

Viewed by 209

Abstract

Introduction: Congenital central hypoventilation syndrome (CCHS) is a rare disorder characterized by an impaired ventilatory response to hypercapnia and hypoxia, particularly during sleep, and frequently associated with autonomic dysfunction. It is caused by pathogenic variants in the PHOX2B gene. Although CCHS is typically [...] Read more.

Introduction: Congenital central hypoventilation syndrome (CCHS) is a rare disorder characterized by an impaired ventilatory response to hypercapnia and hypoxia, particularly during sleep, and frequently associated with autonomic dysfunction. It is caused by pathogenic variants in the PHOX2B gene. Although CCHS is typically diagnosed in the neonatal period, milder forms may present later in infancy or childhood, often triggered by respiratory infections. Case presentation: We report the case of 16-month-old male diagnosed with CCHS following an episode of hypoxemic–hypercapnic respiratory failure during respiratory syncytial virus (RSV) infection. His medical history included neonatal respiratory distress requiring oxygen therapy and recurrent wheezing. At 15 months, he developed acute respiratory distress with severe hypercapnia (PaCO₂ 70 mmHg), requiring admission to the Pediatric Intensive Care Unit and invasive mechanical ventilation. Persistent sleep-related hypercapnia and hypoxemia prompted evaluation for central hypoventilation, confirmed by means of transcutaneous capnography and nocturnal pulse oximetry. Genetic testing revealed a de novo nonsense mutation in exon 1 of PHOX2B (p.Tyr14Ter). Brain magnetic resonance imaging showed diffuse white matter changes suggestive of gliosis. Further investigations identified early-onset systemic hypertension, requiring antihypertensive therapy. The patient was discharged on nocturnal non-invasive ventilation and enrolled in a neurodevelopmental rehabilitation program. Conclusions: This case highlights the phenotypic variability of CCHS and the importance of considering this diagnosis in children presenting with unexplained hypercapnia and sleep-related hypoxemia. It underscores the need for comprehensive autonomic evaluation, including blood pressure monitoring. The p.Tyr14Ter variant may allow partial protein function, potentially accounting for the relatively mild phenotype. Full article

(This article belongs to the Special Issue Comprehensive Treatment and Multidisciplinary Management of Pediatric Chronic Lung Diseases)

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15 pages, 10329 KB

Open AccessReview

Anomalous Coronary Artery Origin from Pulmonary Artery and Coronary Fistulas: A Review About Coronary Steal Phenomenon

by Mario Giordano, Martina Evangelista, Enrico Piccinelli, Sara Moscatelli, Domenico Sirico, Giovanni Meliota, Maria Giovanna Russo, Gianfranco Butera, Biagio Castaldi, Massimo Chessa, Gabriele Rinelli and Silvia Favilli

Children 2026, 13(3), 424; https://doi.org/10.3390/children13030424 - 19 Mar 2026

Viewed by 244

Abstract

Anomalous coronary artery origin from pulmonary artery and coronary–pulmonary fistulas are the major causes of ischemic cardiopathy in children. Both anomalies are characterized by a connection between a higher and a lower pressure chamber causing coronary steal. However, several mechanisms and associated lesions [...] Read more.

Anomalous coronary artery origin from pulmonary artery and coronary–pulmonary fistulas are the major causes of ischemic cardiopathy in children. Both anomalies are characterized by a connection between a higher and a lower pressure chamber causing coronary steal. However, several mechanisms and associated lesions may be responsible of the different presentations of the “coronary steal phenomenon”. The aim of this review is to highlight the different embryology, anatomical features, clinical presentation, and the diagnostic and therapeutic strategy of these coronary anomalies, despite their similar pathophysiology. Full article

(This article belongs to the Section Pediatric Cardiology)

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17 pages, 282 KB

Open AccessArticle

Association of Sleep Quality, Sleep Disturbances, and Chronotype with Post-Traumatic Stress Disorder in Earthquake-Exposed Adolescents

by Gürkan Temelli and Yunus Emre Dönmez

Children 2026, 13(3), 423; https://doi.org/10.3390/children13030423 - 19 Mar 2026

Viewed by 265

Abstract

Background/Objectives: Post-traumatic stress disorder (PTSD) is a common psychiatric consequence of trauma, and adolescents may be particularly vulnerable after large-scale disasters. Sleep disturbances and circadian preference may play a role in PTSD symptomatology. This study aimed to investigate the associations between PTSD, sleep [...] Read more.

Background/Objectives: Post-traumatic stress disorder (PTSD) is a common psychiatric consequence of trauma, and adolescents may be particularly vulnerable after large-scale disasters. Sleep disturbances and circadian preference may play a role in PTSD symptomatology. This study aimed to investigate the associations between PTSD, sleep quality, sleep problems, and chronotype in adolescents exposed to an earthquake. Methods: This cross-sectional study included 201 adolescents aged 12–18 years: 92 diagnosed with PTSD and 109 earthquake-exposed controls without a DSM-5 psychiatric disorder. Participants completed the Children’s Posttraumatic Stress Reaction Index (CPTS-RI), Pittsburgh Sleep Quality Index (PSQI), Children’s Sleep Habits Questionnaire (CSHQ), and Children’s Chronotype Questionnaire (CCTQ). Group differences, correlation analyses, and binary logistic regression analyses were performed. Results: Adolescents with PTSD had significantly higher CPTS-RI, PSQI, CSHQ, and CCTQ scores compared with controls (all p < 0.001), indicating poorer sleep quality, more sleep problems, and a greater tendency toward eveningness. PTSD severity was positively correlated with sleep problems, impaired sleep quality, and eveningness. In logistic regression analysis, poor sleep quality (p < 0.001) and clinically significant sleep problems (p = 0.011) were independently associated with PTSD, whereas chronotype was not. Conclusions: Sleep disturbances are more strongly associated with PTSD than chronotype in earthquake-exposed adolescents. Assessment and treatment of sleep problems may represent an important therapeutic target following large-scale trauma. Full article

(This article belongs to the Section Pediatric Mental Health)

14 pages, 393 KB

Open AccessSystematic Review

Utilization Patterns and Clinical Indications of General Anesthesia in Pediatric Dentistry: A Systematic Review

by María Carmona-Santamaría, Davinia Pérez-Sánchez, Juan Ignacio Aura-Tormos, Clara Guinot-Barona, Laura Marqués-Martínez and Esther García Miralles

Children 2026, 13(3), 422; https://doi.org/10.3390/children13030422 - 19 Mar 2026

Viewed by 272

Abstract

Background: General anesthesia (GA) plays a key role in pediatric dentistry by enabling comprehensive dental treatment in children who cannot be adequately managed using conventional behavioral techniques, local anesthesia, or sedation. While previous reviews have primarily focused on safety outcomes and adverse events, [...] Read more.

Background: General anesthesia (GA) plays a key role in pediatric dentistry by enabling comprehensive dental treatment in children who cannot be adequately managed using conventional behavioral techniques, local anesthesia, or sedation. While previous reviews have primarily focused on safety outcomes and adverse events, less attention has been given to patterns of GA utilization and their broader clinical and public health implications. Objective: The objective was to synthesize and critically analyze contemporary evidence on utilization patterns, clinical indications, and treatment characteristics associated with GA in pediatric dentistry and to interpret variability in GA use as a clinical and health-system indicator. Methods: A systematic review with qualitative synthesis was conducted in accordance with PRISMA 2020 guidelines. Electronic searches were performed in EBSCOhost, Scopus, and the Cochrane Library to identify observational studies published between 2015 and 2025 reporting clinical data on pediatric dental treatment under GA. Results: Twenty-two observational studies met the inclusion criteria. Severe early childhood caries was the most frequently reported indication for GA, followed by behavioral management difficulties and treatment of children with special health care needs. Reported utilization rates varied widely across healthcare systems. Conclusions: GA remains an essential modality for managing complex pediatric dental cases; however, variability in utilization appears to reflect differences in preventive access, disease burden, and health-system organization. Interpreting GA use as a healthcare utilization indicator may support improved preventive strategies and policies aimed at reducing repeated GA exposure in vulnerable pediatric populations. Full article

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

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21 pages, 1534 KB

Open AccessArticle

A Study of the Relationship Between Breastfeeding, Attachment Style and Oral Health in Pubertal Children: A Network Analysis

by Jaime Alberto Toledo-Junco, Antonia Barranca-Enríquez, Tania Romo-González, Laura Leticia Salazar-Preciado, Clío Chávez-Palencia, Israel Huesca-Domínguez, Yolanda Campos-Uscanga and Socorro Herrera-Meza

Children 2026, 13(3), 421; https://doi.org/10.3390/children13030421 - 19 Mar 2026

Viewed by 905

Abstract

Background/Objectives: Although the benefits of breastfeeding on the development and health of the infant are well known, the relationship between breastfeeding, oral health and attachment style or emotional bonding is not fully known. This research sought to explore, from a comprehensive perspective, [...] Read more.

Background/Objectives: Although the benefits of breastfeeding on the development and health of the infant are well known, the relationship between breastfeeding, oral health and attachment style or emotional bonding is not fully known. This research sought to explore, from a comprehensive perspective, the associations between breastfeeding history and children’s attachment styles, as well as the relationships between breastfeeding history and oral health indicators within conceptual psychophysiological frameworks discussed in the literature. Methods: This was a cross-sectional (descriptive and analytical) and correlational study. In this work, the associations of breastfeeding with attachment and oral health were analyzed in 100 children between 9 and 11 years old at a primary school in the municipality of José Azueta, Veracruz, Mexico, from December 2023 to September 2024 by a clinical history, dental examinations (Oral Hygiene Index-Simulated (OHI-S), Dental Caries History (DEOPT) and Detection of Malocclusions (DAI)) and the Attachment and Interaction Styles Instrument. Results: Significant differences were found in the security and closeness attachment style, the oral-hygiene index, the caries index, and occlusion by type of breastfeeding, showing better values in boys and girls who were exclusively breastfed. Likewise, both in the correlation analysis and in the multiple regression model, associations were observed between having been exclusively breastfed and the attachment style and oral indices. Conclusions: Our data show the importance of breastfeeding in pubertal children, since it was associated with better attachment and oral health; however, these findings reflect patterns of co-occurrence and should not be interpreted as causal relationships. Full article

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

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17 pages, 643 KB

Open AccessReview

Mentalization and Emotion Regulation in Adolescent Attachment: A Scoping Review

by Varvara Salavou, Katerina Papanikolaou, Artemios Pehlivanidis and Georgios Giannakopoulos

Children 2026, 13(3), 420; https://doi.org/10.3390/children13030420 - 19 Mar 2026

Viewed by 372

Abstract

Background: Adolescence is a critical developmental period marked by reorganization of attachment relationships, heightened emotional reactivity, and ongoing maturation of reflective and regulatory capacities. Within this context, mentalization and emotion regulation have emerged as key concurrent associations linking attachment security to both [...] Read more.

Background: Adolescence is a critical developmental period marked by reorganization of attachment relationships, heightened emotional reactivity, and ongoing maturation of reflective and regulatory capacities. Within this context, mentalization and emotion regulation have emerged as key concurrent associations linking attachment security to both vulnerability and resilience. This scoping review examined how mentalization and emotion regulation are conceptualized and operationalized in adolescent attachment research and synthesized empirical evidence on their interaction across clinical and non-clinical samples. Methods: Following PRISMA-ScR guidelines, four electronic databases were searched for peer-reviewed studies published between 2015 and 2025. Twelve studies met the inclusion criteria, encompassing community, high-risk, and clinical samples and employing cross-sectional, psychometric, and prospective designs. Results: Across studies, attachment security was consistently associated with more adaptive emotion regulation and higher mentalization capacities, whereas emotion regulation difficulties were linked to internalizing and externalizing psychopathology. Mentalization was frequently reported as a mediator or correlate in the association between attachment security and emotional outcomes, while epistemic trust emerged as a promising interpersonal concurrent association with adaptive functioning. Conclusions: Findings highlight differentiated patterns of vulnerability and resilience and underscore the need for theoretically integrated, multimethod assessment frameworks to guide future research and prevention efforts in adolescence. Full article

(This article belongs to the Section Pediatric Mental Health)

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16 pages, 276 KB

Open AccessArticle

Relationship of Emotional Functioning in 9–12-Year-Old Schoolchildren with Key Lifestyles: Sleep Quality and Daily Physical Activity

by María del Carmen Carcelén-Fraile, Agustín Aibar-Almazán, Fidel Hita-Contreras and Yolanda Castellote-Caballero

Children 2026, 13(3), 419; https://doi.org/10.3390/children13030419 - 19 Mar 2026

Viewed by 247

Abstract

Background/Objectives: Sleep problems and physical activity are key lifestyle behaviors associated with children’s socioemotional development. However, their relative contribution to emotional regulation and emotional instability during middle childhood remains insufficiently clarified. This study aimed to examine the associations between sleep problems, habitual physical [...] Read more.

Background/Objectives: Sleep problems and physical activity are key lifestyle behaviors associated with children’s socioemotional development. However, their relative contribution to emotional regulation and emotional instability during middle childhood remains insufficiently clarified. This study aimed to examine the associations between sleep problems, habitual physical activity, and emotional regulation in elementary school children, while controlling for sociodemographic and lifestyle confounding variables. Methods: A cross-sectional study was conducted with 386 elementary school children (mean age = 11.15 ± 0.66 years; 45.6% boys) from southern Spain. Emotional regulation was assessed using the Emotion Regulation Checklist (ERC), sleep problems were measured with the Children’s Sleep Habits Questionnaire (CSHQ), and habitual physical activity was evaluated using the Physical Activity Questionnaire for Children (PAQ-C). Age, sex, socioeconomic status, and daily screen time were included as covariates. Pearson correlations and multiple linear regression analyses were performed. Results: Sleep problems were strongly associated with lower adaptive emotional regulation and higher emotional lability. In adjusted regression models, sleep problems emerged as the most robust independent predictor of both emotional regulation and lability. Although habitual physical activity was significantly associated with emotional outcomes at the bivariate level, its predictive strength decreased after adjustment for covariates and did not independently predict adaptive emotional regulation. Conclusions: Sleep problems appear to play a central role in children’s emotional functioning during middle childhood. Interventions aimed at promoting socioemotional well-being may benefit from prioritizing sleep health alongside physical activity within a comprehensive 24 h movement behavior framework. Full article

(This article belongs to the Special Issue Understanding the Correlates and Health Outcomes of Movement Behaviors in Childhood and Adolescence)

18 pages, 537 KB

Open AccessArticle

Quality of Life in Children with Developmental Language Disorder

by Mélanie van Barreveld, Iris Duinmeijer, Annette Scheper, Britt Hakvoort and Constance Vissers

Children 2026, 13(3), 418; https://doi.org/10.3390/children13030418 - 19 Mar 2026

Viewed by 808

Abstract

Background/Objectives: Developmental language disorder (DLD) has widespread and persistent consequences for children’s development, extending beyond language. Quality of life (QoL) can also be affected, potentially related to difficulties with cognition (e.g., language ability), behaviour (e.g., social–emotional functioning), and/or environmental factors (e.g., multilingualism). This [...] Read more.

Background/Objectives: Developmental language disorder (DLD) has widespread and persistent consequences for children’s development, extending beyond language. Quality of life (QoL) can also be affected, potentially related to difficulties with cognition (e.g., language ability), behaviour (e.g., social–emotional functioning), and/or environmental factors (e.g., multilingualism). This study set out to characterise changes in the QoL of children with DLD and to identify related factors. Methods: Data were collected at 4 and 9 years from children who had attended early language intervention groups before age 4. Parents completed online questionnaires, including the KINDL for QoL. The KINDL measures QoL on six domains: physical well-being, emotional well-being, self-esteem, family well-being, social well-being, and school functioning. Structural Equation Modelling (SEM) was used to assess the relationship between change in QoL and cognitive, behavioural, and environmental factors. Results: At both time points, the QoL of children with DLD was reduced compared to the normative group on all domains except self-esteem and family. Emotional well-being and self-esteem scores were significantly lower at 9 years compared to 4 years. Peer problems and multilingualism emerged as influential factors regarding changes in QoL over time. Conclusions: The QoL of children with DLD is vulnerable between age 4 and 9. Overall, QoL might deteriorate in this period, specifically emotional well-being. Early peer problems and multilingual status influence the changes observed in different aspects of QoL, although these effects should be interpreted with caution. Full article

(This article belongs to the Special Issue Clinical Advancements for Supporting Children with Developmental Language Disorder Across Global Contexts)

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12 pages, 1182 KB

Open AccessArticle

Effects of Boric Acid and Chlorhexidine as Cavity Disinfectants on Microleakage and Microshear Bond Strength in Primary Teeth

by Erdem Palaz, Ayşegül Ölmez and Zeliha Hatipoğlu Palaz

Children 2026, 13(3), 417; https://doi.org/10.3390/children13030417 - 18 Mar 2026

Viewed by 169

Abstract

Background: Cavity disinfection is commonly performed in pediatric restorative dentistry to reduce residual bacterial contamination. Although boric acid has been proposed as a potential antimicrobial agent, its effect on marginal integrity and adhesive performance in primary teeth remains unclear. This study evaluated the [...] Read more.

Background: Cavity disinfection is commonly performed in pediatric restorative dentistry to reduce residual bacterial contamination. Although boric acid has been proposed as a potential antimicrobial agent, its effect on marginal integrity and adhesive performance in primary teeth remains unclear. This study evaluated the effects of 3% and 5% boric acid, compared with 2% chlorhexidine (CHX), on microleakage and microshear bond strength of composite restorations in primary teeth bonded with a two-step self-etch adhesive system. Methods: Seventy-two extracted primary second molars were allocated to four groups (n = 18) for microleakage assessment: control, 2% CHX, 3% boric acid, and 5% boric acid. Standardized Class V cavities were prepared, disinfectants were applied for 60 s, and restorations were completed using Clearfil SE Bond and resin composite. Microleakage at occlusal and gingival margins was evaluated using dye penetration. For microshear bond strength testing, 60 primary molars (n = 15 per group) were treated similarly, and shear force was applied to bonded composite microcylinders. Data were analyzed at the p < 0.05 significance level. Results: Both boric acid groups showed significantly higher occlusal and gingival microleakage than the control and CHX groups (p < 0.05). Gingival microleakage was greater than occlusal microleakage in the boric acid groups (p < 0.05). Microshear bond strength was significantly reduced in the boric acid groups compared with the control (p < 0.05), whereas CHX had no significant effect. Failure modes did not differ significantly. Conclusions: While 2% CHX did not adversely affect adhesive performance, 3% and 5% boric acid increased microleakage and reduced bond strength. Caution is advised when using boric acid with self-etch adhesive systems in primary teeth. Full article

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

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25 pages, 571 KB

Open AccessReview

Clinical Aspects and Molecular Mechanisms of Cognitive Dysfunction in Children and Adolescents with Type 1 Diabetes

by Eleni Angelopoulou, Nicolas C. Nicolaides, Alexandros Gryparis, Tania Siahanidou, Panagiota Pervanidou and Christina Kanaka-Gantenbein

Children 2026, 13(3), 416; https://doi.org/10.3390/children13030416 - 18 Mar 2026

Viewed by 304

Abstract

Type 1 diabetes (T1D) constitutes a chronic metabolic disorder attributed to the autoimmune destruction of insulin-producing pancreatic β cells, which most frequently occurs in childhood. Long-term complications of T1D are expected to occur mainly in adult life, whereas cognitive dysfunction can also occur [...] Read more.

Type 1 diabetes (T1D) constitutes a chronic metabolic disorder attributed to the autoimmune destruction of insulin-producing pancreatic β cells, which most frequently occurs in childhood. Long-term complications of T1D are expected to occur mainly in adult life, whereas cognitive dysfunction can also occur in children and adolescents with T1D. Most studies demonstrate mild cognitive impairment, especially in the domains of memory, attention and executive functions, all of which affect academic performance, which may also negatively influence adherence to appropriate glucose monitoring and insulin treatment in children and adolescents with T1D. As a result, mild cognitive dysfunction can be an obstacle to both optimal glycemic control during childhood and adolescence and academic achievements for young individuals with T1D. The major metabolic changes occurring around the onset of diabetes, such as severe hyperglycemia and diabetic ketoacidosis, may have a negative impact on brain plasticity during this vulnerable period of neurodevelopment, especially in children diagnosed at a younger age. The pathophysiological mechanisms involved are closely related to increased oxidative stress and the accumulation of advanced glycation end products in the brain, thus leading to neuron cell damage and apoptosis. On the other hand, hypoglycemic episodes and glucose fluctuations may also impair neuronal integrity. The aim of the current narrative review is therefore to present the existing literature data on the clinical aspects, risk factors and molecular mechanisms associated with cognitive dysfunction in children and adolescents with T1D. Full article

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

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10 pages, 871 KB

Open AccessArticle

The Agreement Between Pulse Oximetry and Measured Arterial Oxygen Saturations in Postoperative Functionally Univentricular Patients

by Fabio Savorgnan, Sebastian Acosta, Joshua Prabhu, Pranathi Pilla, Vikram Shah, Saul Flores and Rohit S. Loomba

Children 2026, 13(3), 415; https://doi.org/10.3390/children13030415 - 18 Mar 2026

Viewed by 233

Abstract

Background: Pulse oximetry is widely used to estimate arterial oxygen saturation, yet accuracy may vary for a number of reasons. Data on children with functionally univentricular circulation are limited. The primary aim of this study was to evaluate the agreement between arterial [...] Read more.

Background: Pulse oximetry is widely used to estimate arterial oxygen saturation, yet accuracy may vary for a number of reasons. Data on children with functionally univentricular circulation are limited. The primary aim of this study was to evaluate the agreement between arterial oxygen saturation measured by blood gas and pulse oximetry in children with functionally univentricular circulations. Methods: A retrospective analysis was performed of paired arterial blood gas and pulse oximetry oxygen saturation measurements following Norwood, Glenn, or Fontan procedures. Signed difference was defined as arterial oxygen saturation by blood gas—arterial oxygen saturation by pulse oximetry. Bland–Altman analyses, multivariable regressions, and generalized additive modeling were performed. Results: Mean bias was −4.9 percentage points, indicating pulse oximetry overestimated arterial saturation. The 95% limits of agreement were wide, from −20.7 to 10.8. The agreement was similar in Black and White patients. Fontan physiology demonstrated reduced overestimation by pulse oximetry by multivariable regression. Nonlinear modeling demonstrated more bias in agreement at lower arterial oxygen saturation levels, with arterial oxygen saturation levels explaining 50% of the variance. Conclusions: In functionally univentricular patients, pulse oximetry using the Nellcor MAXN-NS pulse oximeter (Medtronic, Dublin, Ireland) systematically overestimates arterial saturation, particularly in the setting of hypoxemia. Saturation level, rather than race, was the dominant determinant of bias. Full article

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16 pages, 2667 KB

Open AccessArticle

Influence of Immobilization, Stretching, and Activity on the Morphological Properties of Spastic Gastrocnemius Muscles

by Andreas Habersack, Annika Kruse, Bernhard Guggenberger, Nina Mosser, Markus Tilp and Martin Svehlik

Children 2026, 13(3), 414; https://doi.org/10.3390/children13030414 - 18 Mar 2026

Viewed by 226

Abstract

Background/Objectives: Children with cerebral palsy (CP) often develop altered muscle architecture and calf muscle contractures. Orthotic immobilization aims to provide prolonged stretch to lengthen the muscle belly and muscle–tendon unit (MTU), but immobilization may also cause atrophy. This study investigated whether immobilization combined [...] Read more.

Background/Objectives: Children with cerebral palsy (CP) often develop altered muscle architecture and calf muscle contractures. Orthotic immobilization aims to provide prolonged stretch to lengthen the muscle belly and muscle–tendon unit (MTU), but immobilization may also cause atrophy. This study investigated whether immobilization combined with periods of daily muscle activation has a different effect on calf muscle properties than continuous immobilization alone. Methods: Fourteen children with CP and equinus deformity (mean age: 9.9 ± 3.0 years; GMFCS Level I: 10, II: 4) were enrolled in a 12-week randomized controlled trial. Participants were allocated to one of two groups: continuous immobilization (23 h per day) with a dynamic ankle–foot orthosis (AFO), or a combined regimen consisting of immobilization (14 h) and a daily activity phase (10 h). Gastrocnemius medialis (GM) MTU properties, including muscle belly and Achilles tendon (AT) length, fascicle length, and muscle volume, among others, were assessed four times using three-dimensional (3D) freehand ultrasound. Results: Significant within-group increases in MTU and AT lengths were observed over time at both a 90° ankle position (p < 0.01) and a more dorsiflexed ankle position (4 Nm applied torque, p < 0.01). However, no significant group × time interactions were observed for any parameter. Conclusions: Contrary to our hypothesis, combining activity and immobilization did not confer additional benefits. Nevertheless, shorter orthosis-wearing time had the same effect on the MTU and could lead to improved compliance with orthosis treatment in CP. Larger trials are needed to support our findings. Full article

(This article belongs to the Collection Advancements in the Management of Children with Cerebral Palsy)

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28 pages, 695 KB

Open AccessArticle

How Many Anxious Kids in Community Mental Health Would Be Eligible for an RCT? And Does It Matter? Insights from a Naturalistic Sample and a Non-Systematic Review

by Anya C. English, Megan Brady, Amanda L. Sanchez and Emily M. Becker-Haimes

Children 2026, 13(3), 413; https://doi.org/10.3390/children13030413 - 18 Mar 2026

Viewed by 322

Abstract

Background: Decades of randomized controlled trials (RCTs) support cognitive behavioral therapy (CBT) for pediatric anxiety, but exclusion criteria may limit generalizability to routine settings. We examined common exclusion criteria in recent CBT RCTs for pediatric anxiety, trends in these criteria over time, [...] Read more.

Background: Decades of randomized controlled trials (RCTs) support cognitive behavioral therapy (CBT) for pediatric anxiety, but exclusion criteria may limit generalizability to routine settings. We examined common exclusion criteria in recent CBT RCTs for pediatric anxiety, trends in these criteria over time, and whether meeting RCT exclusion criteria affects outcomes in a naturalistic sample. Methods: We reviewed 81 RCTs from the past 25 years assessing CBT for pediatric anxiety or related disorders to identify common exclusion criteria. We examined how often youth seeking exposure-based treatment for anxiety or OCD at an urban community health center met these exclusion criteria and whether this impacted treatment response, using three-year retrospective chart review data (n = 94). Results: Common exclusion criteria in identified RCTs included psychotropic medication use (66.7%), autism spectrum disorder (63.0%), and other psychiatric comorbidities. Suicidal ideation increased as an exclusion criterion over time (p < 0.05, Cramér’s V = 0.23). Based on these criteria, 53% of participants in our naturalistic sample would have been excluded from one or more RCTs. Excluded patients did not differ in baseline characteristics. Excluded youth required nearly twice as many treatment sessions and had more than double the rate of case management utilization (all ps < 0.01). Conclusions: Youth who would have been excluded from at least one RCT had poorer prognoses. Findings support continued emphasis on pragmatic trials to advance understanding of how to augment treatments to better meet the diverse needs of youth. Full article

(This article belongs to the Special Issue Advances in Mental Health and Well-Being in Children (Third Edition))

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9 pages, 219 KB

Open AccessArticle

Symptom and Gastritis Severity in Pediatric Duodenogastric Reflux: Interaction with Helicobacter pylori Infection

by Melike Arslan, Coşkun Fırat Özkeçeci and Meryem İlkay Eren Karanis

Children 2026, 13(3), 412; https://doi.org/10.3390/children13030412 - 18 Mar 2026

Viewed by 227

Abstract

Background: Duodenogastric reflux (DGR) is increasingly recognized in children with dyspeptic complaints; however, its association with symptom severity and histopathological gastritis remains unclear. This study aimed to evaluate the relationship between dyspeptic symptom severity and gastric histopathological findings in children with DGR and [...] Read more.

Background: Duodenogastric reflux (DGR) is increasingly recognized in children with dyspeptic complaints; however, its association with symptom severity and histopathological gastritis remains unclear. This study aimed to evaluate the relationship between dyspeptic symptom severity and gastric histopathological findings in children with DGR and to assess the contribution of concomitant Helicobacter pylori (H. pylori) infection. Methods: This multicenter observational cross-sectional study included children aged 5–18 years who underwent upper gastrointestinal endoscopy for dyspeptic symptoms. Symptom severity was assessed using a standardized Likert dyspepsia scale. Patients were classified into four groups based on the presence of DGR and H. pylori infection. Results: A total of 180 children were analyzed. Significant differences were observed among the study groups for all individual dyspeptic symptoms and total symptom severity scores (p ≤ 0.006). Post hoc pairwise comparisons demonstrated that children with DGR, either alone or in combination with H. pylori infection, had significantly higher symptom severity scores than the control group, with the highest scores observed in the H. pylori-positive/DGR-positive group. Histopathological gastritis severity and inflammatory activity were significantly associated with H. pylori infection (p < 0.001). In contrast, DGR was predominantly associated with mild histopathological gastritis despite a marked increase in dyspeptic symptom severity. Conclusions: DGR is independently associated with increased dyspeptic symptom severity in children, regardless of histopathological gastritis severity. While H. pylori infection is linked to more severe gastritis and a clinically relevant symptom burden, the coexistence of both conditions results in the greatest symptom severity. These findings highlight that symptom severity in pediatric dyspepsia cannot be explained solely by histopathological inflammation and underscore the clinical relevance of DGR. Full article

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

9 pages, 443 KB

Open AccessArticle

Febrile Seizures and Subsequent Autism Spectrum Disorder: A Nationwide Population-Based Cohort Study

by Ya-Hsuan Tsai, Go-Shine Huang and Mei-Hua Hu

Children 2026, 13(3), 411; https://doi.org/10.3390/children13030411 - 17 Mar 2026

Viewed by 356

Abstract

Objectives: To access the effects of febrile seizures from coexisting neurodevelopmental conditions that are commonly associated with autism spectrum disorder. We examined whether febrile seizures are independently associated with ASD after considering neurodevelopmental comorbidities and seizure-related clinical characteristics. Methods: We conducted a nationwide [...] Read more.

Objectives: To access the effects of febrile seizures from coexisting neurodevelopmental conditions that are commonly associated with autism spectrum disorder. We examined whether febrile seizures are independently associated with ASD after considering neurodevelopmental comorbidities and seizure-related clinical characteristics. Methods: We conducted a nationwide population-based matched cohort study using Taiwan’s National Health Insurance Research Database. The study included 948 children with FS and 3804 age- and sex-matched controls without FS. Participants were followed longitudinally for incident ASD. Associations were evaluated using Cox proportional hazards models with additional analyses restricted to the FS cohort. Neurodevelopmental comorbidities assessed included attention-deficit/hyperactivity disorder (ADHD), epilepsy, and Tourette syndrome/tic disorder. Results: Among 4752 children followed for more than 10 years, 43 (0.9%) developed ASD. FS were not independently associated with ASD in adjusted Cox regression models. In contrast, ADHD, epilepsy, and Tourette syndrome/tic disorder were strongly and consistently associated with ASD across analytic models. Conclusions: Febrile seizures were not independently associated with autism spectrum disorder. Instead, ASD risk was largely explained by coexisting neurodevelopmental comorbidities, consistent with a shared neurodevelopmental susceptibility framework. These findings suggest that developmental surveillance should prioritize children with neurodevelopmental disorders rather than those with febrile seizures alone. Full article

(This article belongs to the Special Issue Evaluating the Impact of Interventions on Developmental Outcomes in Children with Autism Spectrum Disorder (ASD))

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14 pages, 845 KB

Open AccessArticle

ABR Features in Ski-Slope Hearing Loss for Hearing Threshold Estimation: A Comparative Clinical Study of Click and CE-Chirp Stimuli

by Davide Brotto, Giuseppe Impalà, Elisa Lovato, Elena Mazzaro, Marco Maculan, Elisabetta Zanoletti, Nicole Galoforo and Patrizia Trevisi

Children 2026, 13(3), 410; https://doi.org/10.3390/children13030410 - 17 Mar 2026

Viewed by 335

Abstract

Background: Auditory brainstem responses (ABRs) are widely used for objective hearing threshold estimation in both adults and children. Click and CE-Chirp stimuli differ substantially in cochlear activation and neural synchrony, yet their relative performance in patients with ski-sloping hearing loss remains insufficiently characterized, [...] Read more.

Background: Auditory brainstem responses (ABRs) are widely used for objective hearing threshold estimation in both adults and children. Click and CE-Chirp stimuli differ substantially in cochlear activation and neural synchrony, yet their relative performance in patients with ski-sloping hearing loss remains insufficiently characterized, particularly with regard to pediatric diagnostic implications. Methods: This study compared ABRs elicited by click and CE-Chirp stimuli in adults with ski-sloping sensorineural hearing loss. The same comparison was also performed in a pediatric cohort including hearing-impaired and normal-hearing children. Adult subjects were further stratified according to audiometric configuration (DROP 1 kHz vs. DROP 2 kHz). ABR thresholds, wave V latency, amplitude, and detectability were analyzed across stimulus types and intensity levels. Associations between ABR thresholds and behavioral audiometric measures were also examined. Results: In adults with ski-sloping hearing loss, CE-Chirp stimulation yielded significantly lower ABR threshold estimates than click stimulation, particularly in the DROP 2 kHz subgroup, and showed stronger correlations with behavioral pure-tone averages across low-, mid-, and high-frequency ranges. Wave V latencies were consistently shorter with CE-Chirp stimulation, while wave V amplitudes did not differ significantly between stimuli at suprathreshold levels. In children, ABR thresholds obtained with CE-Chirp were generally equal to or lower than those obtained with clicks, although statistical significance was limited by sample size. CE-Chirp stimulation was associated with shorter wave V latencies in both hearing-impaired and normal-hearing children and produced larger wave V amplitudes at selected suprathreshold intensities in hearing-impaired children. Conclusions: Click and CE-Chirp stimuli provide complementary information in ABR assessment. While click stimulation remains essential for robust waveform identification, CE-Chirp stimulation appears to offer advantages in threshold estimation and neural synchrony, particularly in ski-sloping hearing loss and pediatric evaluations. Discrepancies between click- and CE-Chirp-derived ABR thresholds should not be attributed solely to maturational or synchrony-related factors but may warrant further frequency-specific audiological assessment to optimize diagnosis and rehabilitation strategies. Full article

(This article belongs to the Special Issue Diagnosis and Management of Pediatric Ear and Vestibular Disorders)

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Children, Volume 13, Issue 3 (March 2026) – 129 articles

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