Children

17 pages, 3103 KiB

Open AccessArticle

Long-Term Performance of Feldspathic and Lithium Disilicate Restorations in Pediatric Anterior Dental Trauma

by Sorin Gheorghe Mihali, Șerban Talpoș, Dan Loloș, Bogdan Antonio Loloș, Andreea Raissa Hojda and Loredana Mitariu

Children 2025, 12(8), 1019; https://doi.org/10.3390/children12081019 (registering DOI) - 1 Aug 2025

Abstract

Background/Objectives: Anterior dental trauma in adolescents presents complex restorative challenges due to ongoing craniofacial development and high aesthetic expectations. This study evaluated the long-term clinical performance of feldspathic ceramic veneers and lithium disilicate crowns used in the anterior region following dental trauma [...] Read more.

Background/Objectives: Anterior dental trauma in adolescents presents complex restorative challenges due to ongoing craniofacial development and high aesthetic expectations. This study evaluated the long-term clinical performance of feldspathic ceramic veneers and lithium disilicate crowns used in the anterior region following dental trauma in adolescents. Methods: A total of 209 restorations were placed in 85 adolescents (50 females, 35 males), aged 11.1–17.9 years (mean age: 15.1 years). Of these, 144 were lithium disilicate crowns, and 65 were feldspathic ceramic veneers. All restorations were fabricated using minimally invasive protocols and followed up for periods ranging from 3 to 60 months. Outcomes were assessed based on standardized clinical criteria for success and failure. Results: Lithium disilicate crowns exhibited superior long-term performance, with the majority of failures occurring in feldspathic veneers (p < 0.001), primarily due to chipping or structural fracture. Age and gender had no statistically significant influence on failure rates. Conclusions: Both feldspathic and lithium disilicate ceramic restorations represent viable treatment options for anterior dental trauma in adolescents. However, lithium disilicate demonstrates greater mechanical reliability, particularly in teeth with significant hard tissue loss. These results support the use of durable ceramic materials in adolescent restorative protocols involving dental trauma. Full article

(This article belongs to the Collection Advance in Pediatric Dentistry)

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15 pages, 504 KiB

Open AccessArticle

Long-Term Impact of Neonatal Acute Kidney Injury on Renal Function in Children Born Preterm: A Follow-Up Study

by Tuğba Barsan Kaya, Özge Aydemir, Ozge Surmeli Onay, Evin Kocaturk, Çiğdem Öztunalı, Aslı Kavaz Tufan, Nuran Cetin, Özkan Alataş and Ayşe Neslihan Tekin

Children 2025, 12(8), 1018; https://doi.org/10.3390/children12081018 (registering DOI) - 1 Aug 2025

Abstract

Background and Objectives: The long-term renal and cardiovascular effects of neonatal acute kidney injury (AKI) in preterm infants remain unclear. This study investigated whether neonatal AKI leads to persistent subclinical kidney injury and blood pressure changes in school-aged children born preterm. Methods: In [...] Read more.

Background and Objectives: The long-term renal and cardiovascular effects of neonatal acute kidney injury (AKI) in preterm infants remain unclear. This study investigated whether neonatal AKI leads to persistent subclinical kidney injury and blood pressure changes in school-aged children born preterm. Methods: In this prospective cohort, preterm-born children (≤35 weeks’ gestation) with (n = 19) and without (n = 38) neonatal AKI were evaluated at 7–12 years. A term-born control group (n = 44) was included for biomarker comparison. Assessments included perinatal data, anthropometry, office and ambulatory blood pressure monitoring (ABPM), and renal ultrasonography. Kidney function was evaluated using serum creatinine (sCr), cystatin C, and estimated glomerular filtration rate (eGFR). Tubular injury was assessed using urinary kidney injury molecule-1/Cr (KIM-1/Cr), neutrophil gelatinase-associated lipocalin/Cr (NGAL/Cr), and trefoil factor 3/Cr (TFF3/Cr) ratios, as well as serum TFF3. Results: Conventional kidney function markers were similar among groups. However, the AKI group had higher serum cystatin C, lower cystatin C–based eGFR, and elevated urinary KIM-1/Cr and NGAL/Cr compared to no-AKI and term controls. Serum TFF3 was also higher in the AKI group. ABPM revealed higher nocturnal systolic blood pressure and blood pressure load in the AKI group. Kidney size did not differ between preterm subgroups. Conclusions: Neonatal AKI in preterm infants is associated with subtle alterations and potential renal stress or injury at school age, detectable only with sensitive biomarkers and ABPM. Further prospective studies are needed to validate these biomarkers and determine their role in predicting long-term outcomes in preterm infants with neonatal AKI. Full article

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

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11 pages, 398 KiB

Open AccessArticle

Perceived Physical Literacy Levels in Spanish Adolescents: Differences Between Sexes and Age Groups

by Raquel Albéniz-Pérez, Daniel Castillo, Pedro Duarte-Mendes and Javier Raya-González

Children 2025, 12(8), 1017; https://doi.org/10.3390/children12081017 - 1 Aug 2025

Abstract

Background/Objectives: Perceived physical literacy (PPL) appears to be a relevant strategy for combating the prevalent sedentary lifestyle among young people. Therefore, understanding their PPL levels will facilitate the implementation of appropriate strategies for this purpose. Therefore, this study aimed to analyze the [...] Read more.

Background/Objectives: Perceived physical literacy (PPL) appears to be a relevant strategy for combating the prevalent sedentary lifestyle among young people. Therefore, understanding their PPL levels will facilitate the implementation of appropriate strategies for this purpose. Therefore, this study aimed to analyze the differences in PPL considering the sex dimension (i.e., males and females) and the age-group (i.e., early compulsory secondary education, late compulsory secondary education and baccalaureate). Methods: Seven-hundred-and-four Spanish students (age = 14.3 ± 1.6 years old) belonging to three different Spanish secondary schools voluntarily participated in this study. To assess adolescents’ perceptions of their physical literacy, the Spanish Adolescents’ Perceived Physical Literacy Assessment (S-PPLI) was used. This instrument consists of nine items equally distributed across three categories: self-perception and self-confidence, self-expression and communication with others, and knowledge and understanding. Results: Males obtained higher scores in all the indicators of PPL, except for items 1, 8 and 9, compared to their female counterparts (p < 0.05), while the oldest age-group reported higher scores in the indicators of knowledge and understanding category compared to students in the early years of compulsory secondary education (p < 0.01). Conclusions: Programs based on increasing the PPL should be implemented specifically for females. Also, similar programs must be included into scholar curriculums from the beginning of secondary education, with the aim of promoting improvements in the health and physical condition of Spanish adolescents. Full article

(This article belongs to the Special Issue The Health Effects of Daily Physical Activity Behaviours in Children: Physical and Psychological Outcomes)

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9 pages, 999 KiB

Open AccessArticle

Assessment of Long-Term Knowledge Retention in Children with Type 1 Diabetes and Their Families: A Pilot Study

by Lior Carmon, Eli Hershkovitz, David Shaki, Tzila Gratzya Chechik, Inna Uritzki, Itamar Gothelf, Dganit Walker, Neta Loewenthal, Majd Nassar and Alon Haim

Children 2025, 12(8), 1016; https://doi.org/10.3390/children12081016 - 1 Aug 2025

Abstract

Background: The education process for newly diagnosed Type 1 diabetes mellitus (T1D) patients and their families, primarily led by diabetes specialist nurses, is essential for gaining knowledge about the disease and its management. However, few assessment tools have been employed to evaluate long-term [...] Read more.

Background: The education process for newly diagnosed Type 1 diabetes mellitus (T1D) patients and their families, primarily led by diabetes specialist nurses, is essential for gaining knowledge about the disease and its management. However, few assessment tools have been employed to evaluate long-term knowledge retention among T1D patients years after diagnosis. Methods: We developed a 20-question test to assess the knowledge of patients and their families at the conclusion of the initial education process and again 6–12 months later. Demographic and clinical data were also collected. Statistical analyses included comparisons between the first and second test results, as well as evaluation of potential contributing factors. The internal consistency and construct validity of the questionnaire were evaluated. Results: Forty-four patients completed both assessments, with a median interval of 11.5 months between them. The average score on the first test was 88.6, which declined to 82.7 on the second assessment (p < 0.001). In univariate analysis, factors positively associated with higher scores included Jewish ethnicity, lower HbA1c levels, and shorter hospitalization duration. Multivariate analysis revealed that parents had lower odds of experiencing a significant score decline compared to patients. Cronbach’s alpha was 0.69, and Principal Component Analysis (PCA) identified eight components accounting for 67.1% of the total variance. Conclusions: Healthcare providers should consider offering re-education to patients and their families approximately one year after diagnosis, with particular attention to high-risk populations during the initial education phase. Further studies are needed to examine this tool’s performance in larger cohorts. Full article

(This article belongs to the Special Issue Optimizing Glycemic Management in Pediatric Populations with Type 1 Diabetes: Challenges and Advances)

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13 pages, 272 KiB

Open AccessArticle

Effects of Cognitive Behavioral Therapy-Based Educational Intervention Addressing Fine Particulate Matter Exposure on the Mental Health of Elementary School Children

by Eun-Ju Bae, Seobaek Cha, Dong-Wook Lee, Hwan-Cheol Kim, Jiho Lee, Myung-Sook Park, Woo-Jin Kim, Sumi Chae, Jong-Hun Kim, Young Lim Lee and Myung Ho Lim

Children 2025, 12(8), 1015; https://doi.org/10.3390/children12081015 - 1 Aug 2025

Abstract

Objectives: This study assessed the effectiveness of a cognitive behavioral therapy (CBT)-based fine dust education program, grounded in the Health Belief Model (HBM), on elementary students’ fine dust knowledge, related behaviors, and mental health (depression, anxiety, stress, sleep quality). Methods: From [...] Read more.

Objectives: This study assessed the effectiveness of a cognitive behavioral therapy (CBT)-based fine dust education program, grounded in the Health Belief Model (HBM), on elementary students’ fine dust knowledge, related behaviors, and mental health (depression, anxiety, stress, sleep quality). Methods: From September to November 2024, 95 students (grades 4–6) living near a coal-fired power plant in midwestern South Korea were assigned to either an intervention group (n = 44) or a control group (n = 51). The intervention group completed a three-session CBT-based education program; the control group received stress management education. Assessments were conducted at weeks 1, 2, 4, and 8 using standardized mental health and behavior scales (PHQ: Patient Health Questionnaire, GAD: Generalized Anxiety Disorder Assessment, PSS: Perceived Stress Scale, ISI: Insomnia Severity Index). Results: A chi-square test was conducted to compare pre- and post-test changes in knowledge and behavior related to PM2.5. The intervention group showed significant improvements in seven fine dust-related knowledge and behavior items (e.g., PM2.5 awareness rose from 33.3% to 75.0%; p < 0.05). The control group showed limited gains. Regarding mental health, based on a mixed-design ANCOVA, anxiety scores significantly declined over time in the intervention group, with group and interaction effects also significant (p < 0.05). Depression scores showed time effects, but group and interaction effects were not significant. No significant changes were observed for stress, sleep, or group × PM2.5 interactions. Conclusions: The CBT-based education program effectively enhanced fine dust knowledge, health behaviors, and reduced anxiety among students. It presents a promising, evidence-based strategy to promote environmental and mental health in school-aged children. Full article

(This article belongs to the Special Issue Advances in Mental Health and Well-Being in Children (2nd Edition))

14 pages, 492 KiB

Open AccessArticle

Caries Rates in Different School Environments Among Older Adolescents: A Cross-Sectional Study in Northeast Germany

by Ahmad Al Masri, Christian H. Splieth, Christiane Pink, Shereen Younus, Mohammad Alkilzy, Annina Vielhauer, Maria Abdin, Roger Basner and Mhd Said Mourad

Children 2025, 12(8), 1014; https://doi.org/10.3390/children12081014 - 1 Aug 2025

Abstract

Background/Objectives: Educational background is an aspect of socio-economic status, that may be associated with higher caries risk. This study aimed to investigate differences in caries prevalence between different school types for older adolescents in Greifswald, Germany. Methods: Cross-sectional data were collected as part [...] Read more.

Background/Objectives: Educational background is an aspect of socio-economic status, that may be associated with higher caries risk. This study aimed to investigate differences in caries prevalence between different school types for older adolescents in Greifswald, Germany. Methods: Cross-sectional data were collected as part of compulsory dental school examinations between 2020 and 2023. Oral health status was assessed according to WHO criteria by six calibrated examiners and reported as mean D₃MFT (D₃: dentin caries, M: missing, F: filled, SD/±: standard deviation). To compare educational backgrounds, the adolescents were divided into two groups according to their age and type of school (11–15 and 16–18 years old). Results: The study included 5816 adolescents (48.7% females) with a mean D₃MFT of 0.65 (Q1–Q3: 0–1); 73.8% were clinically caries-free, having D₃MFT = 0, confirming the polarization in caries experience with 2.5 ± 2.13 SaC index. The logistic regression model showed a significantly increased Odds Ratio for having caries in relation to age, being male, having plaque or gingivitis (p < 0.005). There were significant differences in caries experience and prevalence between school types, where high schools had the lowest D₃MFT values in both age groups (0.39 ± 1.17 and 0.64 ± 1.49, respectively). The highest D₃MFT values were in schools for special educational needs in younger adolescents (1.12 ± 1.9) and in vocational schools in older adolescents (1.63 ± 2.55). Conclusions: In a low-caries-risk population, there were significant differences in caries experience and prevalence among adolescents in different school types. Prevention strategies should aim to reduce the polarization in caries across different educational backgrounds in late adolescence. Full article

(This article belongs to the Special Issue Oral Heath Disparities in Children and Adolescents: Determinants and Challenges)

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17 pages, 1893 KiB

Open AccessSystematic Review

Attention Deficit and Memory Function in Children with Bronchial Asthma: A Systematic Review and Meta-Analysis of 104,975 Patients with Trial Sequential Analysis

by Plamen Penchev, Daniela Milanova-Ilieva, Lyubomir Gaydarski, Petar-Preslav Petrov, Kostadin Ketev, Pavel Stanchev, Noor Husain and Nikolai Ramadanov

Children 2025, 12(8), 1013; https://doi.org/10.3390/children12081013 - 31 Jul 2025

Abstract

Introduction: Asthma is a chronic respiratory disease affecting approximately 5 million children in the US, but little is known about whether asthma alters children’s attention and memory functions. Most studies on this topic focus on psychiatric and QoL outcomes rather than cognitive functions, [...] Read more.

Introduction: Asthma is a chronic respiratory disease affecting approximately 5 million children in the US, but little is known about whether asthma alters children’s attention and memory functions. Most studies on this topic focus on psychiatric and QoL outcomes rather than cognitive functions, leaving a gap in the literature. We aimed to conduct a systematic review and meta-analysis to evaluate the attention deficit and memory function outcomes in children with bronchial asthma. Methods: A systematic search was conducted in PubMed, Web of Science, and Cochrane Library from inception to 28 February 2025 for studies evaluating attention deficit and memory function in children with bronchial asthma. Outcomes of interest included attention deficit and memory function. Statistical analysis was performed with R 4.3.1. Heterogeneity was accessed using the I² statistics and Cochrane Q test. The standardized mean difference (SMD) with restricted maximum-likelihood estimator random-effects method was computed for all outcomes. Results: A total of seven studies were included in the final meta-analysis, comprising 104,975 patients, of whom 10,200 (9.7%) had bronchial asthma (mean age ± 8.98 years, mean 45% females). In the pooled analysis, children with asthma had a worsened attention deficit compared to the healthy group (SMD 0.29; 95% CI [0.07; 0.51]; p = 0.01; I² = 92%). However, no statistically significant difference was found in memory function between groups (SMD −0.24; 95% CI [−1.81; 1.33]; p = 0.77; I² = 96%). Conclusions: Children with asthma showed significantly higher attention deficit scores compared to healthy children. No statistically significant differences were observed in memory function between the groups. These findings may have implications for early cognitive screening in pediatric asthma management. Full article

(This article belongs to the Special Issue Attention Deficit/Hyperactivity Disorder in Children and Adolescents)

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11 pages, 217 KiB

Open AccessArticle

Brain Injury Patterns and Short-TermOutcomes in Late Preterm Infants Treated with Hypothermia for Hypoxic Ischemic Encephalopathy

by Aslihan Kose Cetinkaya, Fatma Nur Sari, Avni Merter Keceli, Mustafa Senol Akin, Seyma Butun Turk, Omer Ertekin and Evrim Alyamac Dizdar

Children 2025, 12(8), 1012; https://doi.org/10.3390/children12081012 - 31 Jul 2025

Abstract

Background: Hypoxic–ischemic encephalopathy (HIE) is a leading cause of severe neurological impairments in childhood. Therapeutic hypothermia (TH) is both safe and effective in neonates born at ≥36 weeks gestation with moderate to severe HIE. We aimed to evaluate short-term outcomes—including brain injury detected [...] Read more.

Background: Hypoxic–ischemic encephalopathy (HIE) is a leading cause of severe neurological impairments in childhood. Therapeutic hypothermia (TH) is both safe and effective in neonates born at ≥36 weeks gestation with moderate to severe HIE. We aimed to evaluate short-term outcomes—including brain injury detected on magnetic resonance imaging (MRI)—in infants born at 34–35 weeks of gestation drawing on our clinical experience with neonates under 36 weeks of gestational age (GA). Methods: In this retrospective cohort study, 20 preterm infants with a GA of 34 to 35 weeks and a matched cohort of 80 infants with a GA of ≥36 weeks who were diagnosed with moderate to severe HIE and underwent TH were included. Infants were matched in a 1:4 ratio based on the worst base deficit in blood gas and sex. Maternal and neonatal characteristics, brain MRI findings and short term outcomes were compared. Results: Infants with a GA of 34–35 weeks had a lower birth weight and a higher rate of caesarean delivery (both p < 0.001). Apgar scores, sex, intubation rate in delivery room, blood gas pH, base deficit and lactate were comparable between the groups. Compared to infants born at ≥36 weeks of GA, preterm neonates were more likely to receive inotropes, had a longer time to achieve full enteral feeding, and experienced a longer hospital stay. The mortality rate was 10% in the 34–35 weeks GA group. Neuroimaging revealed injury in 66.7% of infants born at 34–35 weeks of gestation and in 58.8% of those born at ≥36 weeks (p = 0.56). Injury was observed across multiple brain regions, with white matter being the most frequently affected in the 34–35 weeks GA group. Thalamic and cerebellar abnormal signal intensity or diffusion restriction, punctate white matter lesions, and diffusion restriction in the corpus callosum and optic radiations were more frequently detected in infants born at 34–35 weeks of gestation. Conclusions: Our study contributes to the growing body of literature suggesting that TH may be feasible and tolerated in late preterm infants. Larger randomized controlled trials focused on this vulnerable population are necessary to establish clear guidelines regarding the safety and efficacy of TH in late preterm infants. Full article

(This article belongs to the Section Pediatric Neonatology)

23 pages, 480 KiB

Open AccessArticle

Executive Functions and Reading Skills in Low-Risk Preterm Children

by Miguel Pérez-Pereira, Constantino Arce and Anastasiia Ogneva

Children 2025, 12(8), 1011; https://doi.org/10.3390/children12081011 - 31 Jul 2025

Abstract

Background/Objectives. Previous research with extremely and very preterm children indicates that these children obtain significantly lower results in executive functions (EFs) and in reading skills than full-term (FT) children. The comparison results do not seem to be so clear when other PT children [...] Read more.

Background/Objectives. Previous research with extremely and very preterm children indicates that these children obtain significantly lower results in executive functions (EFs) and in reading skills than full-term (FT) children. The comparison results do not seem to be so clear when other PT children in lower-risk conditions are studied. Many studies with typically developing and preterm (PT) children indicate that reading ability is determined, in part, by EFs. Therefore, the study of EFs and reading and their relationships in low-risk PT children is pertinent. Methods. In the present study, 111 PT children, classified into three groups with different ranges of gestational age (GA), and one group of 34 FT children participated in a longitudinal study, carried out from 4 to 9 years of age. The results obtained from the four groups in different EFs measured at 4, 5, and 8 years of age, and in reading skills at 9 years of age were compared. The possible effects of EFs on reading skills were studied through multiple linear regression analyses. Results. The results obtained indicate that no significant difference was found between FT children and any of the GA groups of PT children, either in EFs or reading skills. The effect of EFs on reading skills was low to moderate. Verbal and non-verbal working memory had a positive significant effect on decoding skills (letter names, same–different, and word reading), but not on reading comprehension processes. Higher-order EFs (cognitive flexibility and planning), as well as inhibitory control, showed positive effects on reading comprehension skills. The effects of the different EFs varied depending on the reading process. Conclusions. In conclusion, low-risk PT children do not differ from FT children in their competence in EFs or reading skills. There are long-lasting effects of EFs, measured several years before, on reading skills measured at 9 years of age. Full article

(This article belongs to the Special Issue Advances in Neurodevelopmental Outcomes for Preterm Infants)

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20 pages, 576 KiB

Open AccessArticle

Effectiveness of a Physiotherapy Stress-Management Protocol on Cardiorespiratory, Metabolic and Psychological Indicators of Children and Adolescents with Morbid Obesity

by Pelagia Tsakona, Alexandra Hristara-Papadopoulou, Thomas Apostolou, Ourania Papadopoulou, Ioannis Kitsatis, Eleni G. Paschalidou, Christos Tzimos, Maria G. Grammatikopoulou and Kyriaki Tsiroukidou

Children 2025, 12(8), 1010; https://doi.org/10.3390/children12081010 - 31 Jul 2025

Abstract

Background: Chronic stress in childhood and adolescence leads to excessive cortisol secretion, adipokines production and obesity with all the negative mental and physical effects on the health of individuals and adulthood. Objectives: The aim of the present non-randomized controlled trial was to investigate [...] Read more.

Background: Chronic stress in childhood and adolescence leads to excessive cortisol secretion, adipokines production and obesity with all the negative mental and physical effects on the health of individuals and adulthood. Objectives: The aim of the present non-randomized controlled trial was to investigate the effect of a stress management protocol with diaphragmatic breathing (DB) and physiotherapy exercise on stress, body composition, cardiorespiratory and metabolic markers of children and adolescents with morbid obesity. Methods: The study included 31 children and adolescents (5–18 years old) with morbid obesity (22 in the intervention arm and 9 controls). All participants completed anxiety questionnaires and a self-perception scale. Forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), blood pressure (BP) and SpO₂ were measured. Fasting glucose, uric acid, triglycerides, HbA1c, (AST/SGOT), (ALT/SGPT), HDL, LDL, insulin, ACTH, cortisol, HOMA-IR, 17-OH, S-DHEA, SHBG were assessed, and anthropometric measurements were also performed. Results: In the intervention group, 4 months after the treatment, an improvement was noted in the BMI, BMI z-score, waist-to-height ratio, FEV1, SpO₂, pulse and systolic BP. HDL increased, ALT/SGPT and insulin resistance improved. Positive changes were observed in temporary and permanent stress and self-esteem of children in the intervention group, including anxiety, self-perception, physical appearance, etc. Conclusions: A combined exercise and DB protocol has a positive effect on stress, by improving body composition, reducing insulin resistance, and ameliorating physical and mental health and quality of life of pediatric patients with morbid obesity. Full article

(This article belongs to the Special Issue Childhood Obesity: Prevention, Intervention and Treatment)

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12 pages, 1639 KiB

Open AccessArticle

Neuroanatomical Reflections of Childhood Obesity: Volumetric Analysis of the Pituitary Gland and Olfactory Bulb

by Emel Hatun Aytaç Kaplan, Elif Bulut, Nazlı Gülsüm Akyel, Zümrüt Kocabey Sütçü and Şeyda Doğantan

Children 2025, 12(8), 1009; https://doi.org/10.3390/children12081009 - 31 Jul 2025

Abstract

Introduction: Obesity is a rapidly increasing condition that leads to serious health issues. The sense of smell, one of the oldest senses related to energy metabolism, has been increasingly studied in relation to obesity. Objective: This study investigates the impact of childhood obesity [...] Read more.

Introduction: Obesity is a rapidly increasing condition that leads to serious health issues. The sense of smell, one of the oldest senses related to energy metabolism, has been increasingly studied in relation to obesity. Objective: This study investigates the impact of childhood obesity on the volumes of the olfactory bulb and pituitary gland, exploring the relationship between body mass index and these brain structures. Method: This study included 146 participants aged 6–18 years with different body mass indices between 2021 and 2024 at Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey. Participants were classified into normal weight, obese, and morbidly obese groups, and olfactory bulb and pituitary gland volumes were retrospectively analyzed. MRI scans were performed to exclude intracranial pathologies due to headache complaints, and patients with cranial pathologies were excluded from the study. Results: This study examined the olfactory bulb and pituitary gland volumes among normal weight, obese, and morbidly obese groups aged 6–18 years. In the morbidly obese group, right olfactory bulb area and right olfactory bulb volume were significantly higher compared to the other groups, while left olfactory bulb area was higher in both the obese and morbidly obese groups. Additionally, in the morbidly obese group, pituitary height was significantly lower than the other groups, and pituitary volume was also found to be reduced in morbid obesity. Conclusions: This study demonstrated that childhood obesity is linked to significant changes in the volumes of the olfactory bulb and pituitary gland. In morbidly obese children, an increase in pituitary volume and alterations in olfactory bulb volume suggest possible neuroanatomical adaptations. Full article

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

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27 pages, 1164 KiB

Open AccessReview

Physical Literacy as a Pedagogical Model in Physical Education

by Víctor Manuel Valle-Muñoz, María Mendoza-Muñoz and Emilio Villa-González

Children 2025, 12(8), 1008; https://doi.org/10.3390/children12081008 - 31 Jul 2025

Abstract

Background/Objectives: Legislative changes in educational systems have influenced how student learning is understood and promoted. In physical education (PE), there has been a shift from behaviorist models to more holistic approaches. In this context, physical literacy (PL) is presented as an emerging [...] Read more.

Background/Objectives: Legislative changes in educational systems have influenced how student learning is understood and promoted. In physical education (PE), there has been a shift from behaviorist models to more holistic approaches. In this context, physical literacy (PL) is presented as an emerging pedagogical model in school PE, aimed at fostering students’ motor competence in a safe, efficient, and meaningful way. The aim of this study is to analyze the origins, foundations, methodological elements, and educational value of PL, highlighting its potential to promote holistic and inclusive learning as the basis for an emerging PL model. Methods: A narrative review was conducted through a literature search in the Web of Science, PubMed, Scopus, and SportDiscus databases up to June 2025, focusing on scientific literature related to PL and PE. The analysis included its historical background, philosophical and theoretical foundations, and the key methodological elements and interventions that support its use as a pedagogical model. Results/Discussion: The findings indicate that the PL model can be grounded in key principles, such as student autonomy, teacher training, connection with the environment, inclusion, and collaboration. Additionally, motivation, enjoyment, creativity, and continuous assessment are identified as essential components for effective implementation. Moreover, this model not only guides and supports teachers in the field of PL but also promotes comprehensive benefits for students at the physical, cognitive, affective, and social levels, while encouraging increased levels of physical activity (PA). Conclusions: PL is understood as a dynamic and lifelong process that should be cultivated from early childhood to encourage sustained and active participation in PA. As a pedagogical model, PL represents an effective tool to enhance student learning and well-being in PE classes. Full article

(This article belongs to the Section Global Pediatric Health)

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12 pages, 697 KiB

Open AccessArticle

Together TO-CARE: A Novel Tool for Measuring Caregiver Involvement and Parental Relational Engagement

by Anna Insalaco, Natascia Bertoncelli, Luca Bedetti, Anna Cinzia Cosimo, Alessandra Boncompagni, Federica Cipolli, Alberto Berardi and Licia Lugli

Children 2025, 12(8), 1007; https://doi.org/10.3390/children12081007 - 31 Jul 2025

Abstract

Background: Preterm infants and their families face a challenging experience during their stay in the neonatal intensive care unit (NICU). Family-centered care emphasizes the importance of welcoming parents, involving them in their baby’s daily care, and supporting the development of parenting skills. NICU [...] Read more.

Background: Preterm infants and their families face a challenging experience during their stay in the neonatal intensive care unit (NICU). Family-centered care emphasizes the importance of welcoming parents, involving them in their baby’s daily care, and supporting the development of parenting skills. NICU staff should support parents in understanding their baby’s needs and in strengthening the parent–infant bond. Although many tools outline what parents should learn, there is a limited structured framework to monitor their involvement in the infant’s care. Tracking parental participation in daily caregiving activities could support professionals in effectively guiding families, ensuring a smoother transition to discharge. Aims: The aim of this study was to evaluate the adherence to and effectiveness of a structured tool for parental involvement in the NICU. This tool serves several key purposes: to track the progression and timing of parents’ autonomy in caring for their baby, to support parents in building caregiving competencies before discharge, and to standardize the approach of NICU professionals in promoting both infant care and family engagement. Methods: A structured template form for documenting parental involvement (“together TO-CARE template”, TTCT) was integrated into the computerized chart adopted in the NICU of Modena. Nurses were asked to complete the TTCT at each shift. The template included the following assessment items: parental presence; type of contact with the baby (touch; voice; skin-to-skin); parental involvement in care activities (diaper changing; gavage feeding; bottle feeding; breast feeding); and level of autonomy in care (observer; supported by nurse; autonomous). We evaluated TTCT uploaded data for very low birth weight (VLBW) preterm infants admitted in the Modena NICU between 1 January 2023 and 31 December 2024. Staff compliance in filling out the TTCT was assessed. The timing at which parents achieved autonomy in different care tasks was also measured. Results: The TTCT was completed with an average of one entry per day, during the NICU stay. Parents reached full autonomy in diaper changing at a mean of 21.1 ± 15.3 days and in bottle feeding at a mean of 48.0 ± 22.4 days after admission. The mean length of hospitalization was 53 ± 38 days. Conclusions: The adoption of the TTCT in the NICU is feasible and should become a central component of care for preterm infants. It promotes family-centered care by addressing the needs of both the baby and the family. Encouraging early and progressive parental involvement enhances parenting skills, builds confidence, and may help reduce post-discharge complications and readmissions. Furthermore, the use of a standardized template aims to foster consistency among NICU staff, reduce disparities in care delivery, and strengthen the support provided to families of preterm infants. Full article

(This article belongs to the Section Pediatric Neonatology)

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15 pages, 495 KiB

Open AccessArticle

Perceptions of Infant Cry Sounds Among Tobacco and Cannabis Using Mothers and Their Association with Tobacco and Cannabis Cravings

by Pamela Schuetze, Madison R. Kelm, Olivia Bell and Rina D. Eiden

Children 2025, 12(8), 1006; https://doi.org/10.3390/children12081006 - 31 Jul 2025

Abstract

Background/Objectives: We examined maternal perceptions of infant cries as a mediator between maternal tobacco/cannabis use, psychological distress (depression/anger/hostility) and reported cravings for cigarettes and/or cannabis across two time points. Methods: A total of 96 substance-using mothers (35 tobacco-only and 61 tobacco/cannabis) [...] Read more.

Background/Objectives: We examined maternal perceptions of infant cries as a mediator between maternal tobacco/cannabis use, psychological distress (depression/anger/hostility) and reported cravings for cigarettes and/or cannabis across two time points. Methods: A total of 96 substance-using mothers (35 tobacco-only and 61 tobacco/cannabis) were recruited in pregnancy. Maternal substance use and psychological distress were measured when their children were school age (5–6 years, T1). At the middle childhood assessment (9–12 years, T2), mothers listened to a standardized set of newborn cries and, afterwards, rated their aversiveness, impact on negative affect, and their tobacco/cannabis cravings. Results: Higher levels of maternal depressive symptoms at T1 were associated with perceptions of cries as being more aversive at T2, which, in turn, were associated with increased cannabis cravings at T2. At T1, higher depressive symptoms predicted increased tobacco cravings and higher maternal anger/hostility predicted increased cannabis cravings. Conclusions: Results highlight the role that infant cries and psychological distress play in cravings among tobacco/cannabis-using mothers. Full article

(This article belongs to the Special Issue Prenatal Substance Exposure: Historical Perspective, Current Research and Future Challenges)

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9 pages, 703 KiB

Open AccessArticle

Development of the Visual Analysis of Form and Contour

by Clay Mash, Lauren M. Henry and Marc H. Bornstein

Children 2025, 12(8), 1005; https://doi.org/10.3390/children12081005 - 30 Jul 2025

Abstract

Background/Objectives: A common approach to investigating visual form processing is through studying responses to visual stimuli that comprise illusory contours. Such stimuli induce contours where none exist physically and thus reveal the constructive nature of visual perception and the conditions that engender it. [...] Read more.

Background/Objectives: A common approach to investigating visual form processing is through studying responses to visual stimuli that comprise illusory contours. Such stimuli induce contours where none exist physically and thus reveal the constructive nature of visual perception and the conditions that engender it. The present work used IC stimuli to study the development of visual form detection and extraction in infants and adults. Methods: Infant and adult participants viewed square stimulus forms with either real or illusory contours, while their looking behavior was measured with an eye tracker. Fixations of the stimuli were coded by region, distinguishing between the contours of the forms and within the forms themselves. Fixations were summed by region, and fixations on forms were interpreted to index the detection of coherent, whole forms. Fixations on contours (real and illusory) were interpreted to index the extraction of form edges. Results: Total form fixations differed by age. For real contours, fixations by infants exceeded those by adults; when contours were illusory, adult fixations were greater than those of infants. Contour fixations were similar between ages. Infants and adults both looked more at contours when illusory than when real. Conclusions: Together, the results provide new conclusions about change and continuity in the visual analysis of form and contour. The results suggest that the visual detection and binding of simple form structure appears to develop between infancy and adulthood. However, the exploration of contours that support the extraction of form contours from backgrounds appears to change little between infancy and adulthood. Full article

(This article belongs to the Section Pediatric Ophthalmology)

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12 pages, 451 KiB

Open AccessArticle

Medical Post-Traumatic Stress Disorder Symptoms in Children and Adolescents with Chronic Inflammatory Arthritis: Prevalence and Associated Factors

by Leah Medrano, Brenda Bursch, Jennifer E. Weiss, Nicholas Jackson, Deborah McCurdy and Alice Hoftman

Children 2025, 12(8), 1004; https://doi.org/10.3390/children12081004 - 30 Jul 2025

Abstract

Background: Youth with chronic rheumatologic diseases undergo medical experiences that can lead to post-traumatic stress disorder (PTSD). Understudied in pediatric rheumatology, medical PTSD can be significantly distressing and impairing. Objective: This study explored the prevalence of medical PTSD symptoms in youth with chronic [...] Read more.

Background: Youth with chronic rheumatologic diseases undergo medical experiences that can lead to post-traumatic stress disorder (PTSD). Understudied in pediatric rheumatology, medical PTSD can be significantly distressing and impairing. Objective: This study explored the prevalence of medical PTSD symptoms in youth with chronic inflammatory arthritis and associated factors, including pain, disease activity, mental health history, and anxiety sensitivity. Methods: A cross-sectional study of 50 youth (ages 8–18) with juvenile idiopathic arthritis (JIA) and childhood-onset systemic lupus erythematous (cSLE) was conducted at a pediatric rheumatology clinic. Participants completed self-report measures assessing post-traumatic stress symptoms (CPSS-V), pain, anxiety sensitivity (CASI), pain-related self-efficacy (CSES), adverse childhood experiences (ACEs), and fibromyalgia symptoms (PSAT). Clinical data included diagnoses, disease activity, treatment history, and demographics. Results: Forty percent had trauma symptoms in the moderate or more severe range. The 14% likely meeting criteria for probable medical PTSD were older (median 17 vs. 15 years, p = 0.005), had higher pain scores (median 4 vs. 3, p = 0.008), more ACEs (median 3 vs. 1, p = 0.005), higher anxiety sensitivity scores (median 39 vs. 29, p = 0.008), and higher JIA disease activity scores (median cJADAS-10 11.5 vs. 7.5, p = 0.032). They were also more likely to report a history of depression (71 vs. 23%, p = 0.020). No associations were found with hospitalization or injected/IV medication use. Conclusions: Medical trauma symptoms are prevalent in youth with chronic inflammatory arthritis. Probable PTSD was associated with pain and psychological distress. These findings support the need for trauma-informed care in pediatric rheumatology. Full article

(This article belongs to the Special Issue Advances in Pediatric Rheumatology: Focus on Juvenile Idiopathic Arthritis)

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18 pages, 1287 KiB

Open AccessArticle

A Multidimensional and Integrated Rehabilitation Approach (A.M.I.R.A.) for Infants at Risk of Cerebral Palsy and Other Neurodevelopmental Disabilities

by Angela Maria Setaro, Erika Loi, Serena Micheletti, Anna Alessandrini, Nicole D’Adda, Andrea Rossi, Jessica Galli, AMIRA Group and Elisa Fazzi

Children 2025, 12(8), 1003; https://doi.org/10.3390/children12081003 - 30 Jul 2025

Abstract

Background/Objectives: Early experiences can significantly influence brain development, particularly when they occur during specific time windows known as sensitive or critical periods. Therefore, the early promotion of neurodevelopmental functions is crucial in children at risk for neurodevelopmental disabilities, such as those with cerebral [...] Read more.

Background/Objectives: Early experiences can significantly influence brain development, particularly when they occur during specific time windows known as sensitive or critical periods. Therefore, the early promotion of neurodevelopmental functions is crucial in children at risk for neurodevelopmental disabilities, such as those with cerebral palsy. This article introduces AMIRA (A Multidimensional and Integrated Rehabilitation Approach), a rehabilitative framework designed for infants at risk of neurodevelopmental disabilities. Methods: AMIRA is intended to guide clinical–rehabilitation reasoning rather than prescribe a rigid sequence of predetermined activities for the child. The theoretical foundation and structure of AMIRA are presented by formalizing its criteria, objectives, tools, and intervention procedures. The framework comprises four distinct sections, each supported by adaptive strategies to facilitate access to materials and to promote play-based interactions among the child, their environment, and communication partners. Particular attention is given to optimizing both micro- and macro-environments for children with, or at risk of, co-occurring visual impairment. Each rehabilitative section includes three progressive phases: an initial observation phase, a facilitation phase to support the child’s engagement, and an active experimentation phase that gradually introduces more challenging tasks. Results: The intervention pathways in AMIRA are organized according to six core developmental domains: behavioral–emotional self-regulation, visual function, postural–motor skills, praxis, interaction and communication, and cognitive function. These are outlined in structured charts that serve as flexible guidelines rather than prescriptive protocols. Each chart presents activities of increasing complexity aligned with typical developmental milestones up to 24 months of age. For each specific ability, the corresponding habilitation goals, contextual recommendations (including environmental setup, objects, and tools), and suggested activities are provided. Conclusions: This study presents a detailed intervention approach, offering both a practical framework and a structured set of activities for use in rehabilitative settings. Further studies will explore the efficacy of the proposed standardized approach. Full article

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

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10 pages, 714 KiB

Open AccessArticle

Use of Mid-Upper Arm Circumference Band in Wasting Detection in Children with Cerebral Palsy in Türkiye

by Uğur Topçu, Çiğdem Lazoğlu, Caner Aslan, Abdurrahman Zarif Güney, Zübeyr Kavcar and Orhan Coşkun

Children 2025, 12(8), 1002; https://doi.org/10.3390/children12081002 - 30 Jul 2025

Abstract

Background/Objectives: Malnutrition is a common problem in children with cerebral palsy (CP). The aim of this study was to investigate the suitability and diagnostic performance of mid-upper arm circumference (MUAC) z-score in diagnosing wasting in children with CP, and its impact on [...] Read more.

Background/Objectives: Malnutrition is a common problem in children with cerebral palsy (CP). The aim of this study was to investigate the suitability and diagnostic performance of mid-upper arm circumference (MUAC) z-score in diagnosing wasting in children with CP, and its impact on diagnostic accuracy when evaluated concomitantly with additional clinical factors (birth weight, history of phototherapy). Methods: This single-center, cross-sectional study included 83 children with CP, aged 6 months–17 years, followed-up in our clinic. Anthropometric measurements (MUAC, Body Mass Index (BMI)) and clinical data (birth weight, history of phototherapy, Gross Motor Function Classification System (GMFCS)) were prospectively collected. Wasting was defined according to the BMI z-score ≤ −2 criteria. The diagnostic performance of MUAC z-score was evaluated by Receiver Operating Characteristic (ROC) analysis. The contribution of additional covariates was examined using logistic regression analysis and the backward elimination method. Results: MUAC z-score alone demonstrated good discrimination in diagnosing wasting with an Area Under the Curve (AUC) value between 0.805 and 0.821, but its sensitivity was limited (67.0%). No statistically significant difference was found in diagnostic performance between MUAC measurements of the right arm, left arm, and the unaffected arm (p > 0.050). In logistic regression analysis, MUAC z-score (p = 0.001), birth weight (p = 0.014), and a history of phototherapy (p = 0.046) were found to be significantly associated with wasting malnutrition. The simplified model including these variables yielded an AUC value of 0.876. Conclusions: MUAC z-score is a usable tool for wasting malnutrition screening in children with CP. Although its sensitivity is limited when used alone, its diagnostic accuracy increases when evaluated concomitantly with additional clinical factors such as birth weight and a history of phototherapy. This combined approach may offer clinicians a more robust tool for the early diagnosis and management of wasting malnutrition in children with CP. Full article

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

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14 pages, 2017 KiB

Open AccessArticle

Prevalence of Depression and Anxiety Symptoms Among Parents of Hospitalized Children in 14 Countries

by Linda S. Franck, Renée Mehra, Christine R. Hodgson, Caryl Gay, Jennifer Rienks, Amy Jo Lisanti, Michelle Pavlik, Sufiya Manju, Nitya Turaga, Michael Clay and Thomas J. Hoffmann

Children 2025, 12(8), 1001; https://doi.org/10.3390/children12081001 - 30 Jul 2025

Abstract

Background/Objectives: Despite the importance of parent mental health for child health, there are no global prevalence data on parental mental health symptoms when children are hospitalized. We aimed to describe depression and anxiety symptom prevalence and associated factors among parents of hospitalized [...] Read more.

Background/Objectives: Despite the importance of parent mental health for child health, there are no global prevalence data on parental mental health symptoms when children are hospitalized. We aimed to describe depression and anxiety symptom prevalence and associated factors among parents of hospitalized children. Methods: We conducted this 14-country prospective cohort survey with parents/primary caregivers staying at a nearby Ronald McDonald House^® during their child’s hospital treatment. We used the Hospital Anxiety and Depression Scale to measure depression and anxiety symptoms and validated scales and theory-based questions to measure parent, family, and child covariates. We calculated the prevalence of clinically significant or concerning symptoms of depression and anxiety, and used multivariable regression analyses to examine associations between covariates and outcomes. Results: Among 3350 participants, 1789 (49.7%) reported depression symptoms and 2286 (69.0%) reported anxiety symptoms. Worry about housing and poorer ratings of their child’s health were associated with increased risk of depression symptoms. Poorer rating of the child’s health, living with a partner, and discrimination in daily life were associated with increased risk of anxiety symptoms. Higher levels of self-care, hospital family-centered care, and social support were associated with reduced risk of depression symptoms. Higher levels of self-care and social support were associated with reduced risk of anxiety symptoms. Conclusions: Clinically significant or concerning depression and anxiety symptoms are common among parents of hospitalized children globally. Hospitals should consider offering routine mental health symptom screening and preventative mental health and support services to all parents. Full article

(This article belongs to the Section Pediatric Mental Health)

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