Children

11 pages, 4452 KiB

Open AccessArticle

The Frequency and Risk Factors of Acute Kidney Injury in Children with Oncological Diseases: A Single-Center Study in Bulgaria

by Petya Markova, Antoniya Yaneva, Stoyan Markov, Mariya Spasova and Neofit Spasov

Children 2025, 12(5), 540; https://doi.org/10.3390/children12050540 - 23 Apr 2025

Abstract

Background: Progress in the treatment of childhood oncological diseases has led to the prolonged survival of patients with this severe diagnosis. On the other hand, the prolonged chemotherapy courses that achieve this outcome also bring a number of complications, with acute kidney injury [...] Read more.

Background: Progress in the treatment of childhood oncological diseases has led to the prolonged survival of patients with this severe diagnosis. On the other hand, the prolonged chemotherapy courses that achieve this outcome also bring a number of complications, with acute kidney injury being one of them. Its occurrence in patients not only affects their quality of life but also prolongs and increases the cost of hospitalization, burdens the body with additional treatment, and impacts the ability to manage the underlying disease. Aim: The aim of this study is to determine the frequency of acute kidney injury among children hospitalized in the Pediatric Oncohematology Unit in Plovdiv during the period 2016–2020, as well as to identify the risk factors for its occurrence, its severity, and its dependence on tumor type, gender, and age. Patients and Methods: During the five-year period under review, a total of 213 newly diagnosed children with hematological diseases were admitted to our Pediatric Oncohematology Unit—122 boys and 91 girls. Results: Acute kidney injury was identified in 94 (44.1%) of the children—54 with solid tumors and 40 with malignant hemopathies. The main cause of acute kidney injury diagnosed was drug-induced nephrotoxicity, especially due to nephrotoxic chemotherapeutic agents. No statistically significant association was found between the type of tumor and the occurrence of acute kidney injury. Of the children with documented episodes of AKI, 11 were found to have CKD according to the KDIGO criteria. Conclusions: Acute kidney injury is a common complication that occurs during the medical treatment of children with malignant diseases. Full article

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

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3 pages, 144 KiB

Open AccessEditorial

Introduction to the Special Issue “Nutritional Status and Eating Patterns in Children and Adolescents: Prevalence, Screening and Prevention of Metabolic Disorders”

by Stefania Moramarco and Ersilia Buonomo

Children 2025, 12(5), 539; https://doi.org/10.3390/children12050539 - 23 Apr 2025

Abstract

Nutrition plays a fundamental role in shaping the current and future health of children and adolescents [...] Full article

(This article belongs to the Special Issue Nutritional Status and Eating Patterns in Children and Adolescents: Prevalence, Screening and Prevention of Metabolic Disorders)

13 pages, 385 KiB

Open AccessArticle

Impact of the COVID-19 Pandemic on the Dutch Screening Program for Developmental Dysplasia of the Hip—Delayed Screening and One-Year Outcomes

by Jan H. Hinloopen, Demi J. Donker, Joost H. van Linge, Christiaan J. A. van Bergen, Florens Q. M. P. van Douveren, Margret Foreman-van Drongelen, Frederike E. C. M. Mulder, Jaap J. Tolk and Pieter Bas de Witte

Children 2025, 12(5), 538; https://doi.org/10.3390/children12050538 - 23 Apr 2025

Abstract

Background/Objectives: In the Netherlands, selective ultrasound (US) screening for developmental dysplasia of the hip (DDH) typically occurs at 3 months of age. During the COVID-19 pandemic, US screening was temporarily halted in Dutch hospitals, with consequent delay in DDH screening and possibly inferior [...] Read more.

Background/Objectives: In the Netherlands, selective ultrasound (US) screening for developmental dysplasia of the hip (DDH) typically occurs at 3 months of age. During the COVID-19 pandemic, US screening was temporarily halted in Dutch hospitals, with consequent delay in DDH screening and possibly inferior outcomes in DDH patients. Methods: We analyzed 1849 infants screened for DDH during the COVID-19 pandemic (March–August 2020) and 1663 infants screened before the pandemic (March–August 2019). We compared mean age and timing of screening (standard vs. delayed (delayed defined as ≥15 weeks)). For secondary outcomes, we compared DDH patients with delayed screening to standard screening, assessing severity at diagnosis, treatment method and duration, and outcomes at the age of one year, including acetabular index (AI) on radiographs. Results: Mean age at screening was 17.3 weeks during the COVID-19 crisis (2020) vs. 15.8 weeks in the 2019 cohort (mean difference 1.5, 95% CI 1.1–1.8, p < 0.001). Delayed screening occurred in 57.6% of infants in 2020 vs. 36.7% in 2019 (p < 0.001). Patients with DDH with delayed screening (n = 284), compared to standard screening (n = 284), did not differ in mean alpha angle at diagnosis (55.0° vs. 54.4°, mean difference 0.6, 95% CI −0.06–1.25, p = 0.08) and AI at one year (24.0° vs. 24.5°, mean difference −0.5, 95% CI −1.05–0.14, p = 0.13). Conclusions: This study revealed that disruption of healthcare caused by the COVID-19 pandemic resulted in a delay in the Dutch DDH-screening program. However, in this study, delayed screening was not associated with inferior outcomes at the age of one year. Full article

(This article belongs to the Special Issue Research in Paediatric Orthopaedic Surgery (2nd Edition))

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13 pages, 1136 KiB

Open AccessArticle

Associations of Prenatal Socioeconomic Status and Childhood Working Memory: A Structural Equation Modeling Approach

by Shelley H. Liu, David Bellinger, Kristen Dams-O’Connor, Jeanne A. Teresi, Ivan Pantic, Sandra Martínez-Medina, John Chelonis, Martha M. Téllez-Rojo and Robert O. Wright

Children 2025, 12(5), 537; https://doi.org/10.3390/children12050537 - 23 Apr 2025

Abstract

Objective: To determine if prenatal socioeconomic status (SES) is associated with childhood working memory (WM), we constructed a more precise, integrative measure of WM using variables from multiple tasks that may provide a more representative measure of WM. Study Design: We used data [...] Read more.

Objective: To determine if prenatal socioeconomic status (SES) is associated with childhood working memory (WM), we constructed a more precise, integrative measure of WM using variables from multiple tasks that may provide a more representative measure of WM. Study Design: We used data from a prospective birth cohort study in Mexico City, Mexico, with N = 515 children aged 6–9 years. Prenatal SES was measured using the Mexican Association of Marketing Research and Public Opinion Agencies (AMAI) index. We created a latent variable for nonverbal working memory using multiple tasks (Cambridge Neuropsychological Test Automated Battery spatial working memory, operant chamber Delayed Match to Sample and Incremental Repeated Acquisition). Structural equation models were used to assess associations between prenatal SES and nonverbal working memory, adjusting for child demographics (e.g., age and sex), prenatal exposures (e.g., exposures to lead, arsenic, and secondhand smoke), and family (current SES, maternal IQ) variables. Results: Children had a mean age of 6.6 years [SD 0.6], and 50.5% were boys. Using confirmatory factor analysis, we constructed a latent variable of nonverbal working memory, which was measurement invariant across child sex. Prenatal SES was associated with childhood nonverbal working memory (standardized factor loading = 0.17; p = 0.004). These associations were modified by child sex. Higher prenatal SES was significantly associated with higher childhood WM in females (standardized factor loading = 0.26; p = 0.002), but not in males. Conclusions: Prenatal socioeconomic status is a predictor of childhood working memory, but it may be a stronger predictor for girls compared with for boys. Full article

(This article belongs to the Section Pediatric Mental Health)

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13 pages, 221 KiB

Open AccessArticle

Genetic Variants in Early-Onset Inflammatory Bowel Disease: Monogenic Causes and Clinical Implications

by Duygu Demirtas Guner, Hacer Neslihan Bildik, Hulya Demir, Deniz Cagdas, Inci Nur Saltik Temizel, Riza Koksal Ozgul, Hayriye Hizarcioglu Gulsen, Cagman Tan, Begum Cicek, Hasan Ozen, Aysel Yuce and Ilhan Tezcan

Children 2025, 12(5), 536; https://doi.org/10.3390/children12050536 - 23 Apr 2025

Abstract

Background/Objectives: This study aims to identify genetic variants associated with early-onset inflammatory bowel disease (IBD) and to improve diagnostic and therapeutic approaches. In selected monogenic IBD cases, treatment included colchicine, interleukin-1 inhibitors, and hematopoietic stem cell transplantation. Methods: This study included patients with [...] Read more.

Background/Objectives: This study aims to identify genetic variants associated with early-onset inflammatory bowel disease (IBD) and to improve diagnostic and therapeutic approaches. In selected monogenic IBD cases, treatment included colchicine, interleukin-1 inhibitors, and hematopoietic stem cell transplantation. Methods: This study included patients with early-onset IBD, defined as IBD diagnosed before the age of 10, who were under follow-up at the Department of Pediatric Gastroenterology, Hacettepe University, and agreed to participate between December 2018 and April 2021. Whole-exome sequencing (WES) was performed prospectively in patients without a prior diagnosis of monogenic disease, while clinical and laboratory data were reviewed retrospectively. Identified variants were evaluated for pathogenicity using standard bioinformatics tools. Results: A total of 47 patients were enrolled, including 33 boys (70.2%) and 14 girls (29.8%). The median age at symptom onset was 36 months (IQR: 10–72), and the median age at diagnosis was 3.7 years (IQR: 1.5–7.6). Crohn’s disease was diagnosed in 53.2% (n = 25), ulcerative colitis in 38.3% (n = 18), and unclassified IBD in 8.5% (n = 4). Monogenic IBD was identified in 36.2% (n = 17) of patients, including nine with Familial Mediterranean Fever and others with glycogen storage disease type 1b (n = 2), XIAP deficiency, chronic granulomatous disease, DOCK8 deficiency, IL10 receptor alpha defect, LRBA deficiency, and NFKB2 deficiency (n = 1 each). A novel SLC29A3 gene variant (c.480_481delTGinsCA, p.V161I) (transcript ID: ENST00000479577.2) was identified in 76.6% (n = 36) of patients. Conclusions: This study underscores the importance of genetic variants in early-onset IBD, particularly MEFV and the novel NFKB2. The frequent detection of the SLC29A3 variant may suggest its potential involvement in the pathogenesis of the disease. Full article

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

23 pages, 767 KiB

Open AccessArticle

Are Children’s Externalizing and Internalizing Behaviours at 5 Years Predicted by Maternal Perinatal Depression Trajectory Profiles?

by Stefan Kurbatfinski, Henry Ntanda, Jackson Mullin, Deborah Dewey, Brenda M. Y. Leung and Nicole Letourneau

Children 2025, 12(5), 535; https://doi.org/10.3390/children12050535 - 23 Apr 2025

Abstract

Background/Objectives: Mothers’ depressive symptoms are associated with their children’s internalizing and externalizing behavioural problems. Because mothers’ depressive symptoms can vary across the prenatal and postnatal periods, considering their trajectories is important when predicting children’s behavioural problems. The purposes of this study were to: [...] Read more.

Background/Objectives: Mothers’ depressive symptoms are associated with their children’s internalizing and externalizing behavioural problems. Because mothers’ depressive symptoms can vary across the prenatal and postnatal periods, considering their trajectories is important when predicting children’s behavioural problems. The purposes of this study were to: (1) identify profiles of mothers characterized by their prenatal and postnatal (up to 3 years postpartum) depressive symptom trajectories and (2) examine the associations between maternal depressive symptom profile trajectories and preschool children’s internalizing and externalizing behavioural problems at 5 years of age. Methods: This study used data derived from the APrON Study. The Edinburgh Postnatal Depression Scale measured mothers’ depressive symptoms in early (<27 weeks) and late (≥27 weeks) pregnancy and at 3, 6, 12, 24, and 36 months postpartum. The Behavioural Assessment Scales for Children, 2nd Edition, quantified children’s internalizing and externalizing problems at approximately 60 months of age. Non-growth latent profile analysis determined the most suitable and parsimonious number of maternal depressive symptom profiles, and linear regression analysis quantified their associations with their 5-year-old-children’s behavioural problems. Results: A three-profile structure characterized maternal depressive symptom trajectories: minimal, subclinical, and high. Unadjusted (n = 704) and adjusted (n = 621) analyses showed that: 1) mothers’ subclinical and high depressive symptom profiles (p < 0.01) predicted children’s internalizing problems and 2) mothers’ subclinical depressive symptom profiles (p < 0.01) predicted externalizing problems. Conclusions: Maternal subclinical depressive symptoms were equally, if not more, important compared to high depressive symptoms in predicting children’s behavioural problems. Overlooking mothers with subclinical depressive symptoms could have implications for their children’s behavioural/mental health. Full article

(This article belongs to the Collection Emotional and Behavioral Problems in Children and Adolescents: Assessment and Intervention)

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9 pages, 201 KiB

Open AccessArticle

Association of Physical Activity Intensity and Light/Deep Sleep in Young People from Southern Spain

by Pablo Ramírez-Espejo, José Luis Solas-Martínez, Manuel J. de la Torre-Cruz and Alberto Ruiz-Ariza

Children 2025, 12(5), 534; https://doi.org/10.3390/children12050534 - 22 Apr 2025

Abstract

Background: Previous research has examined the relationship between physical activity (PA) and sleep quality in young people. However, studies exploring how different intensities of PA relate to light and deep sleep, using objective measurement tools, remain scarce. Therefore, the aim of the [...] Read more.

Background: Previous research has examined the relationship between physical activity (PA) and sleep quality in young people. However, studies exploring how different intensities of PA relate to light and deep sleep, using objective measurement tools, remain scarce. Therefore, the aim of the present study was to analyze the potential associations between PA intensity and sleep stages and to determine the most effective intensity of PA for positively influencing sleep during adolescence. Methods: The sample consisted of 1072 Spanish pre-adolescents and adolescents (53% girls and 47% boys) aged 13.03 ± 1.79 years. Sleep and intensity of PA were measured using the Xiaomi Mi Band 4 smartband. Sleep was categorized as light or deep, while PA intensity was determined by heart rate (HR) and classified as light (resting to 50% of maximum HR), moderate (50–70% of max HR), and vigorous (70–85% of max HR). Results: Analyses revealed that greater daily time spent in light-intensity PA was associated with less light sleep and more deep sleep. Additionally, vigorous-intensity PA was positively associated with increased deep sleep. No negative associations were observed between moderate-intensity PA and sleep quality. In conclusion, this study suggests that promoting prolonged light-intensity activities (e.g., walking) or short bursts of vigorous activity (e.g., sports participation) may enhance sleep quality during pre-adolescence and adolescence. Full article

(This article belongs to the Special Issue Physical Activity and Lifestyle Habits in Children and Adolescents: 2nd Edition)

11 pages, 4471 KiB

Open AccessArticle

Tibial Tubercle Avulsion Fracture in Young Athletes Surgically Treated: Mid-Long Term Result and Comparison

by Lorenzo Moretti, Carlo Amati, Alessandro Geronimo, Andrea Michele Abbaticchio, Maria Paola Miolla, Daniela Dibello and Giuseppe Solarino

Children 2025, 12(5), 533; https://doi.org/10.3390/children12050533 - 22 Apr 2025

Abstract

Objectives: Tibial apophysis avulsion fracture is an unusual injury in young pediatric athletes. The mechanism of injury is often related to sports (i.e football and basketball). Fifteen patients who had this kind of fracture underwent surgical Open Reduction and Internal Fixation (ORIF) [...] Read more.

Objectives: Tibial apophysis avulsion fracture is an unusual injury in young pediatric athletes. The mechanism of injury is often related to sports (i.e football and basketball). Fifteen patients who had this kind of fracture underwent surgical Open Reduction and Internal Fixation (ORIF) with two or three cannulated screws and tendon stripping. In this kind of injury and treatment, one of the most important concerns is the recovery of the extensor apparatus strength of the lower limb. Materials and Methods: We followed up the patients for 12 months, performing biomechanical tests and a kinetic analysis to evaluate the activation of the leg muscles such as rectus femoris, vastus medialis, vastus lateralis, and semitendinosus muscle fibers and compared them with the contralateral healthy limb. Results: The results showed that there was an almost complete recovery of muscle strength activation without any statistically significant differences compared to the healthy limb. Conclusions: This surgical treatment appears to be safe and effective in the treatment of tibial apophysis fractures in young athletes, since this type of surgical treatment does not compromise the recovery of the extensor apparatus strength and/or return to sport of the lower limb in case of tibial apophysis fractures in young athletes. Full article

(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)

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14 pages, 506 KiB

Open AccessArticle

Epidemiology and Outcomes of Late-Onset Neonatal Sepsis in Preterm Infants in a Tertiary Hospital

by Katerina Kaffe, George A. Syrogiannopoulos, Efthimia Petinaki, Maria Goudesidou, Anna Kalaitzi, Antonios Gounaris and Ioanna N. Grivea

Children 2025, 12(5), 532; https://doi.org/10.3390/children12050532 - 22 Apr 2025

Abstract

Background/Objective: Late-onset sepsis (LOS), a systemic infection occurring after 72 h of life, is a significant issue of morbidity and mortality in preterm neonates. Nevertheless, in this population, cultures frequently remain negative, even in the presence of typical clinical signs of sepsis. Materials [...] Read more.

Background/Objective: Late-onset sepsis (LOS), a systemic infection occurring after 72 h of life, is a significant issue of morbidity and mortality in preterm neonates. Nevertheless, in this population, cultures frequently remain negative, even in the presence of typical clinical signs of sepsis. Materials and Methods: This single-center, retrospective study included preterm infants with a birth weight (BW) < 1500 g and/or a gestational age (GA) ≤ 32 weeks, diagnosed with culture-negative LOS (CNLOS) and culture-proven LOS (CPLOS). The study aimed to determine the incidence of these conditions, describe the frequency of isolated pathogens, and compare clinical profiles, antibiotic usage, morbidity, and mortality between these two groups as well as a no-sepsis group. Results: Among 277 infants, 30 (10.8%) had CPLOS, 83 (30%) had CNLOS, and 164 (59.2%) had no sepsis. Significant differences were found between the groups regarding BW, GA, hospitalization duration, morbidity, and mortality (p < 0.001). CNLOS and CPLOS did not differ in terms of mechanical ventilation or central line use. However, CPLOS infants had a higher rate of thrombocytopenia (p < 0.001), inotrope use (p = 0.006), and mortality (p < 0.001) compared to CNLOS infants. The duration of antibiotic treatment was similar between groups [median DOT (IQR): 20 (14–33) vs. 20 (14–35), p = 0.935]. In the CPLOS group, Gram-negative pathogens were isolated in 42.4% of infants, with Klebsiella oxytoca being the most common; Gram-positive organisms in 36.3%; and fungi in 21.2%. Conclusions: LOS, whether culture-proven or not, was associated with neonatal morbidity and mortality. CPLOS was linked to a worse prognosis, while CNLOS was also frequently diagnosed and associated with increased antibiotic use in Neonatal Intensive Care Units (NICUs). Full article

(This article belongs to the Section Pediatric Neonatology)

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18 pages, 4895 KiB

Open AccessCase Report

Oral Implications of Herbst Device Modification: A Case Report

by Monica Macrì, Mariastella Di Carmine, Antonio Scarano and Felice Festa

Children 2025, 12(5), 531; https://doi.org/10.3390/children12050531 - 22 Apr 2025

Abstract

Background: Many studies analyse the effectiveness of the Herbst device in the treatment of dentoskeletal Class II malocclusion due to mandibular retrusion. This fixed device was devised by Emil Herbst for Class II treatment using a bite jumping, i.e., a device that holds [...] Read more.

Background: Many studies analyse the effectiveness of the Herbst device in the treatment of dentoskeletal Class II malocclusion due to mandibular retrusion. This fixed device was devised by Emil Herbst for Class II treatment using a bite jumping, i.e., a device that holds the jaw in a forced anterior position. Comparison of the results obtained in numerous studies is difficult because they are often not comparable and not congruent due to a number of variables that prevent standardization. Methods: The purpose of the present study is to report some clinical-level considerations that may be important in order to obtain more predictable therapeutic outcomes. The simplified design of the Herbst device offers better patient comfort and easier cleanability but may show some disadvantages, such as less anchorage. Results: The device was evaluated in conjunction with the multi-bracket phase that preceded Herbst therapy and concluded after the device was removed. The therapy was performed in the absence of skeletal anchorage. Conclusions: In our opinion, standardization of therapy according to precise protocols may positively affect the therapeutic outcomes by achieving faster occlusal stabilization, more proper neuro-muscular balance, less stress on anchor units, and shorter treatment time. Full article

(This article belongs to the Special Issue New Research Progress of Clinical Pediatric Dentistry: 2nd Edition)

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20 pages, 271 KiB

Open AccessArticle

The Strategies of Picture Books as a Mode of Health Communication for Young Children with Coeliac Disease

by Lydia McKeon, Jessica Gildersleeve and Amy B. Mullens

Children 2025, 12(5), 530; https://doi.org/10.3390/children12050530 - 22 Apr 2025

Abstract

Background/Objectives: Coeliac disease, a chronic and lifelong health condition, is one of the most common autoimmune diseases. However, it is also one of the most under-recognised conditions, and emotionally and cognitively appropriate materials are especially lacking for young children and their families who [...] Read more.

Background/Objectives: Coeliac disease, a chronic and lifelong health condition, is one of the most common autoimmune diseases. However, it is also one of the most under-recognised conditions, and emotionally and cognitively appropriate materials are especially lacking for young children and their families who are coping with this disease. Effective health communication is essential for educating and supporting children living with coeliac disease as well as their families and communities. Picture books can serve as useful and accessible educational and health promotion tools, promoting adaptive coping strategies for dealing with a potentially traumatic condition. Methods: This study aimed to fill a critical gap in the literature by examining a range of picture books (n = 9) aimed at children three to eight years of age diagnosed with coeliac disease. Reflective thematic and structural narrative analyses were applied to explore strategies and themes used in these books and how they align with the current literature on developing coping through children’s narratives. Results: Four themes were developed and measured against an existing model of coping narratives to find a more specific model that recognises the specific concerns of coeliac disease. The four themes found were Information Provision; Promotion of CD Management; Anxiety and Hypervigilance Reduction, with two subthemes of Validating Feelings and Reducing Concerns; and Community and Connection. Conclusions: The findings have likely implications for the following applications: incorporation into clinician training (as a therapeutic and health promotion intervention), support within schools, authors of similar books for children coping with chronic illness, and coping approaches for individuals/families to promote health literacy/support regarding living with coeliac disease. Full article

(This article belongs to the Special Issue New Insights in Pediatric Mental Healthcare)

29 pages, 4317 KiB

Open AccessArticle

Are the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents as Effective for OCD as for Anxiety and Depression?

by Lauren Milgram, Madison E. Bigler, Elizabeth R. Halliday, Kiara R. Timpano and Jill Ehrenreich-May

Children 2025, 12(4), 529; https://doi.org/10.3390/children12040529 - 21 Apr 2025

Abstract

Background: Obsessive–compulsive disorder (OCD) in youth commonly co-occurs with other affective disorders (e.g., anxiety, depression). Exposure and response prevention (ERP) is the front-line treatment for OCD but may require significant adaptation to treat co-occurring symptoms or complex comorbidity patterns. Preliminary evidence suggests [...] Read more.

Background: Obsessive–compulsive disorder (OCD) in youth commonly co-occurs with other affective disorders (e.g., anxiety, depression). Exposure and response prevention (ERP) is the front-line treatment for OCD but may require significant adaptation to treat co-occurring symptoms or complex comorbidity patterns. Preliminary evidence suggests that the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A) are effective in reducing OCD symptoms. Still, it is not yet known if the UP-C/A are comparably effective to treat OCD as they are for anxiety and depression, the disorders for which there is the most robust empirical support. Methods: This study compared trajectories of OCD, anxiety, and depression symptom change among 388 youth who received UP-C/A treatment (M = 15 sessions) at a university-based research clinic. We also examined whether youth with (n = 60) and without (n = 328) an OCD diagnosis demonstrated comparable improvements in anxiety, depression, and transdiagnostic treatment targets (i.e., anxiety sensitivity, cognitive flexibility, and distress tolerance). Results: OCD symptoms improved at a slower rate than anxiety and depression symptoms during the first half of UP-C/A treatment but at a comparable rate to anxiety and depression symptoms during the second half of treatment. Youth with and without OCD exhibited comparable improvements in anxiety, depression, anxiety sensitivity, cognitive flexibility, and distress tolerance across the treatment course. Conclusions: Findings support the efficacy of UP-C/A treatment for co-occurring OCD and affective disorders but suggest that initiating exposure earlier in the treatment course may confer additional benefits. Full article

(This article belongs to the Special Issue Advances in Obsessive–Compulsive Disorders in Children: Epidemiology, Diagnosis and Treatment)

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14 pages, 476 KiB

Open AccessReview

From Doubt to Direction: Untangling Pediatric Scrupulosity

by Rachel E. Mathews and Shivali Sarawgi

Children 2025, 12(4), 528; https://doi.org/10.3390/children12040528 - 21 Apr 2025

Abstract

Background: Up to 33% of individuals with obsessive-compulsive disorder (OCD) have scrupulosity symptoms, although less is known regarding the prevalence rates in youth, specifically. Scrupulosity translates to “fearing sin where there is none” and describes pathological guilt and distress related to religion [...] Read more.

Background: Up to 33% of individuals with obsessive-compulsive disorder (OCD) have scrupulosity symptoms, although less is known regarding the prevalence rates in youth, specifically. Scrupulosity translates to “fearing sin where there is none” and describes pathological guilt and distress related to religion and morality. Disentangling scrupulosity from true religious beliefs and actions may be difficult in youth for a number of reasons, including the nature of youth as a time of developing independent identities and values, expected ritualistic behavior (e.g., confession, ritualistic cleansing), scrupulosity being reinforced in some religious communities, and the discomfort or inexperience of clinicians with both these symptoms and various belief systems. The literature suggests limited knowledge of scrupulosity among mental health providers, including pediatric clinicians, and apprehension to discuss or target scrupulous beliefs and behaviors. Apprehension may be enhanced for providers working with youth populations, particularly given broader misconceptions about the efficacy and safety of gold-standard interventions. Objectives: This narrative review with practice guidelines examines the existing literature related to pediatric scrupulosity and its challenges and describes evidence-based treatments for scrupulosity in pediatric populations. Recommendations for clinical practice and research are discussed. Full article

(This article belongs to the Special Issue Advances in Obsessive–Compulsive Disorders in Children: Epidemiology, Diagnosis and Treatment)

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14 pages, 984 KiB

Open AccessArticle

Association Between the Oral Health Status and Sociodemographic Factors Among 5–15-Year-Old Schoolchildren from Mallorca, Spain—A Cross-Sectional Study

by Daniela Vallejos, Irene Coll and Nora López-Safont

Children 2025, 12(4), 527; https://doi.org/10.3390/children12040527 - 20 Apr 2025

Abstract

Background: Oral health is a key indicator of general health, well-being, and quality of life. Sociodemographic factors can affect children’s oral health status. The aim of this study was to analyze the sociodemographic factors that influence the oral health of schoolchildren in Mallorca. [...] Read more.

Background: Oral health is a key indicator of general health, well-being, and quality of life. Sociodemographic factors can affect children’s oral health status. The aim of this study was to analyze the sociodemographic factors that influence the oral health of schoolchildren in Mallorca. Materials and methods: We conducted a cross-sectional observational epidemiological study in Mallorca, analyzing different indicators of oral health, such as the DMFT/dmft index and the Community Periodontal Index (CPI), and sociodemographic variables among 718 schoolchildren aged 5–6, 12 and 15 years. Results: The DMFT (Decayed, Missing, and Filled Permanent Teeth) caries index was higher in public (Pub) schools than in private/charter (P/C) schools for children in the sixth grade of elementary school (Pub, 0.6918 ± 1.272; P/C, 0.323 ± 0.824; p < 0.05) and in the fourth year of secondary school (Pub, 1.178 ± 1.724; P/C, 0.627 ± 1.195; p < 0.05), as determined using a t-test. First-grade elementary students with more highly educated mothers/guardians had a lower rate of DMFT (Decayed, Missing, and Filled Primary Teeth) caries than those whose mothers obtained only elementary-level education (higher, 0.800 ± 1.616; elementary, 3.333 ± 3.393; p < 0.05). Regarding periodontal health, we observed that sixth-grade elementary schoolchildren with more highly educated mothers/guardians had more healthy sextants (higher, 3.987 ± 1.977; elementary, 1.333 ± 2.461; p < 0.001). Conclusions: The sociodemographic and parental factors analyzed, such as the type of school and parents’ education levels, significantly affected the oral health of the schoolchildren in this study. Full article

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

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16 pages, 2316 KiB

Open AccessSystematic Review

Practice of Routine Monitoring of Gastric Residual in Preterm Infants: A Meta-Analysis Article

by Hassan Al-shehri

Children 2025, 12(4), 526; https://doi.org/10.3390/children12040526 - 20 Apr 2025

Abstract

Background: Controversy exists about the usefulness of gastric residual (GR) evaluation in preterm infants, and different results have been obtained in studies addressing this practice. Therefore, this meta-analysis aimed to evaluate the efficacy and safety of the practice of routine monitoring of GR [...] Read more.

Background: Controversy exists about the usefulness of gastric residual (GR) evaluation in preterm infants, and different results have been obtained in studies addressing this practice. Therefore, this meta-analysis aimed to evaluate the efficacy and safety of the practice of routine monitoring of GR compared to avoiding routine aspiration or alternative interventions. Methods: An online database search was conducted for relevant randomized trials from 2017 to 2023. The efficacy of the intervention was assessed from the incidence of necrotizing enterocolitis (NEC) and the time taken for full enteral feeds. The safety was assessed from the duration of hospitalization, incidence of late-onset sepsis, and days of total parenteral nutrition. Results: Only six studies were deemed eligible, fit the inclusion criteria, and were included in the quantitative synthesis. There was no significant difference between the groups in the incidence of NEC, with a mean difference of 0.95 (95% CI: 0.52, 1.75), while the intervention practice showed the early achievement of full enteral feeds (−2.21; 95% CI: −2.58, −1.84), a shorter duration of hospitalization (−0.65; 95% CI: −1.33, 0.02), a lower incidence of late-onset sepsis (0.70; 95% CI: 0.45, 1.09), and less days of total parenteral nutrition −1.65 (95% CI: −1.90, −1.40). Conclusions: For preterm infants with no signs of feeling intolerance, the results from this study stress the omission of the practice of routine gastric residual aspiration. Full article

(This article belongs to the Section Pediatric Neonatology)

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18 pages, 1396 KiB

Open AccessArticle

From Local to International Approach: Prognostic Factors and Treatment Outcomes in Neuroblastoma—A 30-Year Single-Center Retrospective Analysis

by Joanna Stankiewicz, Monika Pogorzała, Piotr Księżniakiewicz and Jan Styczyński

Children 2025, 12(4), 525; https://doi.org/10.3390/children12040525 - 19 Apr 2025

Abstract

Background/Objectives: Over the past three decades, significant progress has been made in understanding the biology of neuroblastoma. The integration of prognostic factors has facilitated risk stratification and the development of targeted treatment approaches. This study aims to analyze the outcomes of pediatric [...] Read more.

Background/Objectives: Over the past three decades, significant progress has been made in understanding the biology of neuroblastoma. The integration of prognostic factors has facilitated risk stratification and the development of targeted treatment approaches. This study aims to analyze the outcomes of pediatric patients with neuroblastoma treated at a single oncology center over a 30-year period. Methods: This retrospective study analyzed data from patients aged 0–18 years with neuroblastoma, treated at the Department of Pediatric Hematology and Oncology in Bydgoszcz, Poland, between 1993 and 2023. The study endpoints included the 5-year probability of overall survival (pOS), event-free survival (pEFS), and relapse-free survival (pRFS), analyzed separately for low/intermediate- and high-risk groups. Results: Seventy-five patients met the inclusion criteria. Thirty-two children were categorized as high-risk patients and forty-three as low/intermediate risk. During the study period, outcomes in the low/intermediate-risk group improved significantly (the 5-year pOS 85.7% vs. 100.0%, p = 0.019; the 5-year pRFS 85.7% vs. 100.0%, p = 0.662; the 5-year pEFS 83.3% vs. 100.0%, p = 0.038). In the high-risk group, outcomes improved but did not reach statistical significance (the 5-year pOS 0.0% vs. 41.1%, p = 0.342; the 5-year pRFS 0.0% vs. 32.5%, p = 0.180; and the 5-year pEFS 0.0% vs. 21.5%, p = 0.537). Sixteen patients experienced relapse, of whom only three survived; stem cell transplantation at relapse significantly improved survival (OS 0.0% vs. 50.0%, p = 0.001). In the multivariable analysis, stage at diagnosis was a prognostic factor for pOS (HR 6.0; 95%CI 0.7–49.6, p = 0.096), while pelvic localization was a risk factor for pRFS (HR 3.0; 95%CI 0.8–10.5; p = 0.084). Conclusions: This analysis highlights significant advancements in the diagnosis and treatment of neuroblastoma. Nevertheless, outcomes for high-risk patients and those who experience relapse remain poor, underscoring the need for further therapeutic improvements. Full article

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

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13 pages, 1063 KiB

Open AccessArticle

Social Affiliation and Attention to Angry Faces in Children: Evidence for the Contributing Role of Parental Sensory Processing Sensitivity

by Antonios I. Christou, Kostas Fanti, Ioannis Mavrommatis, Georgia Soursou, Pantelis Pergantis and Athanasios Drigas

Children 2025, 12(4), 524; https://doi.org/10.3390/children12040524 - 18 Apr 2025

Abstract

Low social affiliation has been described as a phenotypic marker of antisocial behaviors by disrupting children’s initiation and enjoyment of positive physical and emotional connections with others. Laboratory studies have shown that, in early childhood, low social affiliation rates are preceded by lower [...] Read more.

Low social affiliation has been described as a phenotypic marker of antisocial behaviors by disrupting children’s initiation and enjoyment of positive physical and emotional connections with others. Laboratory studies have shown that, in early childhood, low social affiliation rates are preceded by lower attention to faces. In addition, while low social affiliation has also been associated with behavioral outcomes when accounting for parenting influences, the effect that parental environmental sensitivity may have on contributing to the link between emotional processing early in life and later behavioral manifestations associated with antisocial behavior is currently unknown. Objectives: The present eye-tracking study aims to delineate the potential contribution of parental Sensory Processing Sensitivity (SPS) to the link between children’s rates of social affiliation and their attentional patterns in response to emotional faces. Methods: For the needs of this study, children performed a lab-based, computerized facial processing task (N = 153; Mage = 9.97; SDage = 1.28; 48.8% females). In addition, one of the children’s parents completed questionnaires for their children’s and their own behavior (N = 153; Mage = 40.9; SDage = 4.85; 87.7% females). Results: The results underline the contributing role of parental SPS on the associations between social affiliation and visual scanning when viewing angry emotional faces. In particular, children with low rates of social affiliation spent significantly more time fixating on the mouth regions of angry faces only when their parents had higher SPS. Conclusions: This study unveils the possibility for the contextual influence of parental environmental sensitivity on the early emotional processing mechanisms in children with low rates of social affiliation. These findings suggest that interventions aimed at improving emotional processing in children at risk for antisocial behavior should consider parental SPS as a contributing factor. Tailoring parent-based interventions to address how highly sensitive parents interpret and respond to emotional challenges may reduce children’s attentional biases to threats and support healthier socioemotional development. Full article

(This article belongs to the Topic Risk and Protective Factors in Social Interactions: Behavioral and Neural Evidence)

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12 pages, 1284 KiB

Open AccessCase Report

Mesenchymal Stem Cell Therapy for Hutchinson–Gilford Progeria: Improvements in Arterial Stiffness and Bone Mineral Density in a Single Case

by Eun-Young Joo, Ji-Sun Park, Hyun-Tae Shin, Myungji Yoo, Su-Jin Kim, Ji-Eun Lee and Gwang-Seong Choi

Children 2025, 12(4), 523; https://doi.org/10.3390/children12040523 - 18 Apr 2025

Abstract

Background/Objectives: Hutchinson–Gilford progeria syndrome (HGPS) is a rare genetic disorder that cause premature aging due to LMNA mutations and progerin accumulation. Although lonafarnib, an FDA-approved farnesyltransferase inhibitor, offers modest extension of life, the disease remains progressive. As progeria is associated with stem cell [...] Read more.

Background/Objectives: Hutchinson–Gilford progeria syndrome (HGPS) is a rare genetic disorder that cause premature aging due to LMNA mutations and progerin accumulation. Although lonafarnib, an FDA-approved farnesyltransferase inhibitor, offers modest extension of life, the disease remains progressive. As progeria is associated with stem cell depletion and mesenchymal stem cell (MSC) therapy has shown efficacy in treating atherosclerosis, we aimed to evaluate its efficacy and safety in HGPS. Methods: A 7-year-old male with classic HGPS and preexisting severe cerebrovascular disease received four intravenous infusion of bone marrow-derived MSCs (2.5 × 10⁵ cells/kg) over 8 months. Growth, metabolic, cardiovascular, musculoskeletal, auditory, and inflammatory cytokines were monitored throughout the study. Prophylactic enoxaparin was administered to prevent vascular complications. Results: MSC therapy was associated with improved lean body mass (11.5%), bone mineral density (L-spine z-score: 0.55 → 2.03), reduced arterial stiffness (9.98% reductionin pulse wave velocity), joint range of motion, dentition, and decreased sICAM-1 levels. However, Cardiovascular deterioration continued, and the patient passed away 10 months after the fourth dose, likely due to progression of the underlying vascular disease. No severe adverse effects were attributed to MSC therapy. Conclusions: MSC therapy may offer short-term benefits in arterial stiffness, bone health and inflammation in HGPS without notable safety concerns. Further studies are warranted to validate these findings, explore earlier intervention, and determine long-term efficacy and optimal dosing strategies. Full article

(This article belongs to the Section Translational Pediatrics)

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22 pages, 10717 KiB

Open AccessArticle

ChildWeCare: An Innovative System for the Surveillance and Care of Early Childhood Development Disorders in Thailand

by Duangkamol Tangviriyapaiboon, Chayut Owatsakul, Patrinee Traisathit, Salinee Thumronglaohapun and Pimwarat Srikummoon

Children 2025, 12(4), 522; https://doi.org/10.3390/children12040522 - 18 Apr 2025

Abstract

Background: A structure survey conducted by the Department of Health on early childhood development in Thailand indicates that 27.20–32.50% of preschool children have developmental delays. These children require appropriate care and constant stimulation to help them develop normally. Methods: The ChildWeCare innovation system [...] Read more.

Background: A structure survey conducted by the Department of Health on early childhood development in Thailand indicates that 27.20–32.50% of preschool children have developmental delays. These children require appropriate care and constant stimulation to help them develop normally. Methods: The ChildWeCare innovation system for monitoring children and providing appropriate care for those with developmental delays from birth to 5 years of age has been developed. This is accompanied by qualified personnel providing assistance to parents for their child’s development. Enrollment of participants and provision of services via the system were implemented. Appropriate intervention from the ChildWeCare system will be provided for each specific child, and each parent will be assigned homework for training their children. Results: The database of the ChildWeCare system was developed using MySQL, which can store information about the child, parent, homework, and log usage system, as well as data on each parent’s homework assignments. Our pilot testing shows that parents were satisfied with the ChildWeCare system. Conclusions: The ChildWeCare system could provide guidance on suitable stimulation techniques and strategies for each child’s specific needs. These preliminary results could indicate the advantages of further plans for the system’s implementation in other settings in Health Region 1 or nationwide. Full article

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

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