Children

21 pages, 498 KB

Open AccessEditor’s ChoiceReview

Precision Therapeutics in Lennox–Gastaut Syndrome: Targeting Molecular Pathophysiology in a Developmental and Epileptic Encephalopathy

by Debopam Samanta

Children 2025, 12(4), 481; https://doi.org/10.3390/children12040481 - 8 Apr 2025

Cited by 5 | Viewed by 2744

Abstract

Lennox–Gastaut syndrome (LGS) is a severe childhood-onset developmental and epileptic encephalopathy characterized by multiple drug-resistant seizure types, cognitive impairment, and distinctive electroencephalographic patterns. Current treatments primarily focus on symptom management through antiseizure medications (ASMs), dietary therapy, epilepsy surgery, and neuromodulation, but often fail [...] Read more.

Lennox–Gastaut syndrome (LGS) is a severe childhood-onset developmental and epileptic encephalopathy characterized by multiple drug-resistant seizure types, cognitive impairment, and distinctive electroencephalographic patterns. Current treatments primarily focus on symptom management through antiseizure medications (ASMs), dietary therapy, epilepsy surgery, and neuromodulation, but often fail to address the underlying pathophysiology or improve cognitive outcomes. As genetic causes are identified in 30–40% of LGS cases, precision therapeutics targeting specific molecular mechanisms are emerging as promising disease-modifying approaches. This narrative review explores precision therapeutic strategies for LGS based on molecular pathophysiology, including channelopathies (SCN2A, SCN8A, KCNQ2, KCNA2, KCNT1, CACNA1A), receptor and ligand dysfunction (GABA/glutamate systems), cell signaling abnormalities (mTOR pathway), synaptopathies (STXBP1, IQSEC2, DNM1), epigenetic dysregulation (CHD2), and CDKL5 deficiency disorder. Treatment modalities discussed include traditional ASMs, dietary therapy, targeted pharmacotherapy, antisense oligonucleotides, gene therapy, and the repurposing of existing medications with mechanism-specific effects. Early intervention with precision therapeutics may not only improve seizure control but could also potentially prevent progression to LGS in susceptible populations. Future directions include developing computable phenotypes for accurate diagnosis, refining molecular subgrouping, enhancing drug development, advancing gene-based therapies, personalizing neuromodulation, implementing adaptive clinical trial designs, and ensuring equitable access to precision therapeutic approaches. While significant challenges remain, integrating biological insights with innovative clinical strategies offers new hope for transforming LGS treatment from symptomatic management to targeted disease modification. Full article

(This article belongs to the Special Issue Childhood Epilepsy: Clinical Advances and Perspectives)

15 pages, 244 KB

Open AccessEditor’s ChoiceArticle

Early-Onset Inherited Metabolic Diseases: When Clinical Symptoms Precede Newborn Screening—Insights from Emilia-Romagna (Italy)

by Giulia Montanari, Egidio Candela, Federico Baronio, Vittorio Ferrari, Giacomo Biasucci, Marcello Lanari and Rita Ortolano

Children 2025, 12(4), 464; https://doi.org/10.3390/children12040464 - 4 Apr 2025

Cited by 4 | Viewed by 1845

Abstract

Background: Expanded Newborn Screening (ENS) allows the early identification of many inherited metabolic diseases (IMDs) for which timely treatment can modify the natural history. For most IMDs, diagnosis by ENS is pre-clinical. However, clinical symptoms may emerge for certain conditions before screening results [...] Read more.

Background: Expanded Newborn Screening (ENS) allows the early identification of many inherited metabolic diseases (IMDs) for which timely treatment can modify the natural history. For most IMDs, diagnosis by ENS is pre-clinical. However, clinical symptoms may emerge for certain conditions before screening results become available. Methods: We describe six cases of patients with early-onset IMDs born between 2013 and 2023, who were admitted or transferred to Sant’Orsola University Hospital in Bologna (Italy). Results: Over the study period, 379,013 newborns underwent ENS in the Italian region of Emilia-Romagna. Excluding cases of congenital hypothyroidism, pre-clinical diagnoses from ENS were 410. In addition, six cases of IMD presented with early-onset clinical symptomatology, an antecedent to the outcome of newborn screening (incidence over 11 years of 1.58 cases per 100,000 infants). Among these patients, three were diagnosed with Urea Cycle Disorders (UCDs)—two with Citrullinemia type I (CIT1) and one with Argininosuccinic Acidemia (ASA); two were diagnosed with Methylmalonic Acidemia (MMA); and one was found to have Medium-Chain Acyl-CoA Dehydrogenase Deficiency (MCADD). Conclusions: Our 11-year experience with ENS has shown that clinical onset can occur between the second and fourth day of life, though rare. Even if dried blood spot (DBS) collection was performed 24–48 h after birth, the time required for sample transportation and processing would still delay result availability, making early intervention unlikely. Therefore, our experience supports performing ENS at 48–72 h, as currently implemented in Italy, while also highlighting the advantages and limitations of earlier screening. Full article

(This article belongs to the Section Pediatric Neonatology)

13 pages, 745 KB

Open AccessEditor’s ChoiceReview

Efficacy and Safety of Growth Hormone (GH) Therapy in Patients with SHOX Gene Variants

by Giorgio Sodero, Federica Arzilli, Elena Malavolta, Marilea Lezzi, Fabio Comes, Antonietta Villirillo, Donato Rigante and Clelia Cipolla

Children 2025, 12(3), 325; https://doi.org/10.3390/children12030325 - 4 Mar 2025

Cited by 6 | Viewed by 2611

Abstract

Background: Among the potential indications for growth hormone (GH) therapy is the presence of mutations in the SHOX (short stature homeobox-containing) gene, located in the telomeric pseudotautosomal region (PAR1) on the short arm of both sex chromosomes. Despite general recommendations supporting GH therapy [...] Read more.

Background: Among the potential indications for growth hormone (GH) therapy is the presence of mutations in the SHOX (short stature homeobox-containing) gene, located in the telomeric pseudotautosomal region (PAR1) on the short arm of both sex chromosomes. Despite general recommendations supporting GH therapy in these cases, there is a lack of comprehensive evidence specifically evaluating its efficacy and safety in this subgroup of pediatric patients. Aim: The objective of this scoping review was to evaluate the efficacy and safety of growth hormone therapy in patients with SHOX gene variants, providing a narrative synthesis of the included studies. Materials and Methods: This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. We summarized information extracted from 22 articles identified by our search strategy. Currently, only one randomized clinical trial has analyzed the efficacy profile of GH in patients with SHOX mutations. Results: Growth hormone is a valuable therapeutic aid for these patients. However, its prescription in children with SHOX gene mutations should consider the specific characteristics of each patient, similar to the approach taken for patients with idiopathic growth hormone deficiency (GHD). Conclusion: Growth hormone therapy in patients with SHOX gene alterations appears to be both safe and effective. However, longitudinal prospective studies and targeted clinical trials are necessary to confirm these findings. Despite this, GH remains one of the preferred hormonal therapies for patients with short stature and confirmed SHOX gene mutations. Full article

(This article belongs to the Special Issue Pediatric Growth and Skeletal Disorders)

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28 pages, 792 KB

Open AccessEditor’s ChoiceReview

The Impact of Parental Behaviors on Children’s Lifestyle, Dietary Habits, Screen Time, Sleep Patterns, Mental Health, and BMI: A Scoping Review

by Cátia Maia, Diogo Braz, Helder Miguel Fernandes, Hugo Sarmento and Aristides M. Machado-Rodrigues

Children 2025, 12(2), 203; https://doi.org/10.3390/children12020203 - 8 Feb 2025

Cited by 9 | Viewed by 7400

Abstract

Background and Objectives: Childhood obesity and being overweight are influenced by the family environment, diet, sleep, and mental health, with parents playing a key role in shaping behaviors through routines and practices. Healthy parental habits can encourage positive outcomes, while poor routines and [...] Read more.

Background and Objectives: Childhood obesity and being overweight are influenced by the family environment, diet, sleep, and mental health, with parents playing a key role in shaping behaviors through routines and practices. Healthy parental habits can encourage positive outcomes, while poor routines and stress often lead to unhealthy weight gain. This study analyzed the impact of parental behaviors on children’s lifestyles and habits, as well as the trend and intensity of the effect of these behaviors on different age groups. Methods: A systematic review of 1504 articles from Web of Science, PubMed, Scopus, and APA PsycNet (as of 22 July 2024) included studies on parents and children aged 4–18 years, focusing on physical activity, sleep, screen time, nutrition, and mental health. Twenty-six studies were analyzed, including 19 cross-sectional and 7 longitudinal studies. The outcomes included physical activity, sedentary behaviors, eating and sleeping habits, mental health, and BMI. Bias was assessed using JBI tools according to the GRADE framework and Newcastle-Ottawa Quality Assessment. Results: The studies involved 89,545 youths and 13,856 parents. The key findings revealed associations between parental physical activity, sleep, dietary habits, mental health, screen time, and their children’s BMIs. Parenting styles significantly influence children’s behaviors. This review highlights the crucial influence of parenting styles and behaviors on children’s physical activity, diet, sleep, and mental health, emphasizing the link between family dynamics and childhood obesity. The findings stress the importance of targeting parental habits in interventions focused on healthy routines and stress management. Longitudinal studies are needed to determine causality, while research involving diverse populations is essential to enhance the applicability of these findings. Full article

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

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15 pages, 4593 KB

Open AccessEditor’s ChoiceReview

Comparative Analysis of Early Class III Malocclusion Treatments—A Systematic Review and Meta-Analysis

by Andrei Otel, José María Montiel-Company and Álvaro Zubizarreta-Macho

Children 2025, 12(2), 177; https://doi.org/10.3390/children12020177 - 30 Jan 2025

Cited by 2 | Viewed by 2874

Abstract

Several therapeutic methods have been proposed for early class III malocclusion treatment; however, the existing literature does not provide evidence on the most recommended techniques or materials. The aim of the present systematic review and meta-analysis was to summarize the clinical evidence on [...] Read more.

Several therapeutic methods have been proposed for early class III malocclusion treatment; however, the existing literature does not provide evidence on the most recommended techniques or materials. The aim of the present systematic review and meta-analysis was to summarize the clinical evidence on the efficacy of each method. The PRISMA recommendations were followed. Four databases were searched for articles published up to February 2024. Controlled trials, randomized or non-randomized clinical trials, and prospective or retrospective studies with a control group and a minimum follow-up of 6 months were included. The risk of bias was assessed using the Cochrane collaboration tool. Inconsistency was assessed using the Q test, with a significance level of p < 0.05 and a forest plot. A total of 61 articles were identified, and eight were included in the meta-analysis, which examined three parameters: Sella-Nasion-A (SNA), Sella-Nasion-B (SNB), and A Point-Nasion-B (ANB) values. The meta-analysis was carried out using the random effects model and the inverse variance method. The effect size was determined as the difference between the means of the SNA, SNB, and ANB values in the initial and final intervention groups or between the intervention group and control group. Statistical significance was assessed using the z-test and was declared when p-value < 0.05. The heterogeneity of the meta-analysis was analyzed using the Q test and the I² statistical index. Publication bias was analyzed using the trim-and-fill method to adjust the skewness of the funnel plot. The risk of bias in the selected studies was assessed using the Cochrane collaboration tool to analyze the methodological quality assessment of the clinical trials. There were statistically significant differences between traditional maxillary disjunction and traction and the different types of Alt-RAMEC protocols, with the latter allowing greater skeletal corrections. Full article

(This article belongs to the Special Issue Oral Hygiene and Periodontal Status of Children: Progress and Prospects)

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11 pages, 505 KB

Open AccessEditor’s ChoiceArticle

Quality Improvement Project to Improve Adherence to Best Practices to Decrease Incidence of Necrotizing Enterocolitis in Preterm Infants

by Ahreen Allana, Sidra Bashir and Ivan Hand

Children 2025, 12(2), 176; https://doi.org/10.3390/children12020176 - 30 Jan 2025

Cited by 3 | Viewed by 2063

Abstract

Background/Objectives: Necrotizing enterocolitis (NEC) is one of the most devastating gastrointestinal emergencies in preterm infants. This quality improvement (QI) project aimed to increase the utilization of accepted evidence-based practices in our neonatal intensive care unit (NICU) to ultimately decrease the incidence of NEC [...] Read more.

Background/Objectives: Necrotizing enterocolitis (NEC) is one of the most devastating gastrointestinal emergencies in preterm infants. This quality improvement (QI) project aimed to increase the utilization of accepted evidence-based practices in our neonatal intensive care unit (NICU) to ultimately decrease the incidence of NEC in our level III NICU. Methods: Our QI team implemented a bundle of nine of these evidenced-based practices for NEC prevention and disseminated information among the NICU team. Items in the bundle included delayed cord clamping, parental education on the importance of breast milk, obtaining early consent for donor breast milk, adherence to the unit’s feeding protocol, avoiding routine gastric residual checks, the discontinuation of antibiotics at 48 h once blood cultures were negative, restricting the use of antacids, nasogastric tube (NGT) replacement every 72 h and the removal of central lines once a feeding volume of 100 mL/kg/day was attained. The baseline incidence of clinically proven NEC was found to be 7% at the start of the intervention. We conducted two Plan-Do-Study-Act (PDSA) cycles over a 2-year period from 1 January 2021 to 31 December 2022. Results: There were 74 infants who met the inclusion criteria of being <1500 g and/or at <32 weeks of gestation. The adherence to our process measures improved over the course of our two PDSA cycles from 78% adherence to 91.6%, p < 0.05. The incidence of NEC decreased from 7% to 5.3% following the first PDSA cycle, a 24% reduction. Following the second PDSA cycle, the incidence decreased even further from 5.3% to 2.8%, a 60% reduction from baseline, although this was not statistically significant due to the small sample size. Conclusions: In this QI initiative, we achieved improved adherence to several evidence-based interventions over a two-year period with the aim of reducing the incidence of NEC at our institution. Full article

(This article belongs to the Section Pediatric Neonatology)

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18 pages, 1122 KB

Open AccessEditor’s ChoiceReview

Severe Asthma in School-Age Children: An Updated Appraisal on Biological Options and Challenges in This Age Group

by Cristiana Indolfi, Angela Klain, Maria Cristina Capuano, Simone Colosimo, Renata Rapillo and Michele Miraglia del Giudice

Children 2025, 12(2), 167; https://doi.org/10.3390/children12020167 - 29 Jan 2025

Cited by 4 | Viewed by 2747

Abstract

This review examines the growing role of biological therapies in managing severe asthma in children aged 6–11 years. Severe asthma, characterized by persistent symptoms and frequent exacerbations, presents significant challenges in pediatric care. Biologic treatments, including mepolizumab, omalizumab, and dupilumab, provide targeted interventions [...] Read more.

This review examines the growing role of biological therapies in managing severe asthma in children aged 6–11 years. Severe asthma, characterized by persistent symptoms and frequent exacerbations, presents significant challenges in pediatric care. Biologic treatments, including mepolizumab, omalizumab, and dupilumab, provide targeted interventions for patients with high eosinophilic inflammation or allergic asthma (T2-high asthma). Alongside their therapeutic benefits, the review evaluates the safety profiles of these biologics, highlighting potential side effects and the necessity for monitoring during long-term use. Cost considerations and treatment adherence also emerge as important challenges that need to be addressed in clinical practice. Additionally, the review emphasizes the need for identifying patients who would derive the most benefit from biologic therapies, advocating for the development of biomarkers to aid in treatment decisions. Emerging biologics, such as tezepelumab, are introduced as promising alternatives with the potential to target upstream inflammatory pathways, offering hope for treating T2-low asthma forms, which currently lack effective treatment options in children. Full article

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

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20 pages, 1683 KB

Open AccessEditor’s ChoiceReview

Microbiome Modulation in Pediatric Leukemia: Impact on Graft-Versus-Host Disease and Treatment Outcomes: A Narrative Review

by Samuel Bogdan Todor and Cristian Ichim

Children 2025, 12(2), 166; https://doi.org/10.3390/children12020166 - 29 Jan 2025

Cited by 9 | Viewed by 2148

Abstract

The gut microbiome significantly influences the outcomes of pediatric leukemia, particularly in patients undergoing hematopoietic stem cell transplantation (HSCT). Dysbiosis, caused by chemotherapy, antibiotics, and immune system changes, contributes to complications such as graft-versus-host disease (GVHD), gastrointestinal issues, and infections. Various microbiome-related interventions, [...] Read more.

The gut microbiome significantly influences the outcomes of pediatric leukemia, particularly in patients undergoing hematopoietic stem cell transplantation (HSCT). Dysbiosis, caused by chemotherapy, antibiotics, and immune system changes, contributes to complications such as graft-versus-host disease (GVHD), gastrointestinal issues, and infections. Various microbiome-related interventions, including prebiotics, probiotics, postbiotics, and fecal microbiota transplantation (FMT), have shown potential in mitigating these complications. Specific microbial signatures have been linked to GVHD risk, and interventions like inulin, Lactobacillus, and SCFAs (short-chain fatty acids), particularly butyrate, may help modulate the immune system and improve outcomes. FMT, while showing promising results in restoring microbial balance and alleviating GVHD, still requires careful monitoring due to potential risks in immunocompromised patients. Despite positive findings, more research is needed to optimize microbiome-based therapies and ensure their safety and efficacy in pediatric leukemia care. Full article

(This article belongs to the Special Issue Children with Leukemia and Lymphoma: Diagnosis and Management)

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16 pages, 241 KB

Open AccessEditor’s ChoiceArticle

Developmental Patterns in Autism and Other Neurodevelopmental Disorders in Preschool Children

by Maria Eugenia Martelli, Federica Gigliotti, Federica Giovannone, Giuliana Lentini, Filippo Manti and Carla Sogos

Children 2025, 12(2), 125; https://doi.org/10.3390/children12020125 - 24 Jan 2025

Cited by 4 | Viewed by 3794

Abstract

Background: Neurodevelopmental disorders (NDDs) encompass an inclusive group of conditions that appear during the developmental period but continue to persist in adulthood, ranging from particular difficulties to a global impairment of social, cognitive, and emotional functioning. The developmental trajectories associated with these conditions [...] Read more.

Background: Neurodevelopmental disorders (NDDs) encompass an inclusive group of conditions that appear during the developmental period but continue to persist in adulthood, ranging from particular difficulties to a global impairment of social, cognitive, and emotional functioning. The developmental trajectories associated with these conditions are highly heterogeneous. This study aimed to analyze and compare developmental and adaptive profiles of preschool-aged children with different NDDs to better characterize their developmental trajectories. Methods: We analyzed data from the initial global evaluation of 196 children with NDDs (aged 20 to 71 months), enrolled in three subgroups: 108 with autism spectrum disorder (ASD), 52 with language disorder (LD), and 36 with mixed specific developmental disorder (MSDD). A comprehensive neuropsychiatric evaluation was performed using standardized tools (Griffiths-III, ADOS-2, VABS-II, and ADI-R), and the parents completed the DP-3 and the CBCL 1½-5. Results: Our results showed that all NDDs exhibited poor psychomotor skills, with children with ASD being the most impaired, although their profiles were comparable to those of MSDD in communication and motor areas. CBCL’s pervasive developmental problem scale has been shown to provide relevant information for distinguishing children with ASD. Furthermore, DP-3 and VABS-II measure highly differentiated developmental profiles of each diagnostic group. Conclusions: Our results highlighted the importance of including parents’/caregivers’ perspectives in defining children’s functioning and the possibility of using DP-3 as a screening tool for different neurodevelopmental disorders. Full article

(This article belongs to the Special Issue Children and Adolescents with Neurodevelopmental Disabilities: Ecological Assessment Tools and Cognitive Analysis)

14 pages, 1417 KB

Open AccessEditor’s ChoiceArticle

Polypharmacy in Pediatric Palliative Care: Exploring Discrepancies Between Physicians and Pharmacists

by Daniele Mengato, Anna Zanin, Fernando Baratiri, Lisa Pivato, Laura Camuffo, Franca Benini and Francesca Venturini

Children 2025, 12(2), 124; https://doi.org/10.3390/children12020124 - 24 Jan 2025

Cited by 4 | Viewed by 1288

Abstract

Background/Objectives: Off-label drug use is prevalent in pediatric care, particularly in pediatric palliative care (PPC), due to the scarcity of pediatric-specific formulations and clinical trials. Differences in perception between healthcare professionals regarding off-label prescriptions underscore the complexity of this practice and highlight [...] Read more.

Background/Objectives: Off-label drug use is prevalent in pediatric care, particularly in pediatric palliative care (PPC), due to the scarcity of pediatric-specific formulations and clinical trials. Differences in perception between healthcare professionals regarding off-label prescriptions underscore the complexity of this practice and highlight the need for improved collaboration to optimize therapeutic outcomes. Methods: A cross-sectional observational study was conducted from August to October 2021 at the PPC center of the University Hospital of Padova, Italy. Data were collected from medical records of 169 patients. Off-label prescriptions were independently assessed by two physicians and two clinical pharmacists using respective reference sources. Discrepancies were resolved through consensus. Statistical analyses included the χ²-test for categorical variables and t-tests for continuous data. Results: Among the 993 drug prescriptions analyzed, the pharmacists reported a higher proportion of off-label uses (32.9%) compared to the physicians (18.4%; p < 0.05). After a consensus, 26.5% of the prescriptions were identified as off-label, with 67.9% due to indications, 49.6% due to dosage, and 44.4% due to age discrepancies. Conclusions: This study suggests a high prevalence of off-label prescribing in pediatric palliative care (PPC) and highlights differing professional perspectives, underscoring the potential benefits of exploring standardized protocols and enhanced interdisciplinary collaboration. Enhanced communication between healthcare providers, alongside the development of registries and clinical trials, is essential for improving the safety and efficacy of off-label drug use in pediatric populations. A flexible regulatory framework and customized galenic formulations could further support these goals. Full article

(This article belongs to the Special Issue Advances of Polypharmacy Issues in Pediatrics)

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13 pages, 221 KB

Open AccessEditor’s ChoiceArticle

The Impact of Physical Activity and Screen Time on Motor Creativity in Kindergarteners

by Rafat Ghanamah

Children 2025, 12(2), 116; https://doi.org/10.3390/children12020116 - 22 Jan 2025

Cited by 6 | Viewed by 3816

Abstract

Background/Objectives: Motor creativity and physical activity are essential to early childhood development, impacting physical, cognitive, and socio-emotional development. This study investigates the relationships among motor creativity, motor working memory (MSTM), screen time, and physical activity (PA) in kindergarten children, focusing on the mediating [...] Read more.

Background/Objectives: Motor creativity and physical activity are essential to early childhood development, impacting physical, cognitive, and socio-emotional development. This study investigates the relationships among motor creativity, motor working memory (MSTM), screen time, and physical activity (PA) in kindergarten children, focusing on the mediating roles of cognitive functions and screen time. Methods: Data were collected from 124 Arab Israeli kindergarten children through assessments of Thinking Creatively in Action and Movement (TCAM) for motor creativity and the Hand Movement Test for MSTM. Parents reported the children’s screen time and days engaged in moderate-to-vigorous physical activity (MVPA). Results: The results show significant positive associations between motor creativity and both MSTM and PA, underscoring the role of cognitive processes in creative motor expression. Linear regression and mediation analyses showed that MSTM significantly mediates the relationship between PA and motor creativity. Conversely, screen time negatively correlates with PA and motor creativity, serving as a significant mediator that restricts opportunities for physical and creative activities. Conclusions: This study emphasizes the bidirectional relationship between PA and motor creativity, wherein diverse physical activities stimulate creativity, and creative movements encourage active participation. The combined mediating effects of MSTM and screen time highlight the complexity of these relationships, suggesting the need for integrated interventions. The findings inform early childhood education by advocating for strategies that promote physical activity, enhance cognitive functions, and limit excessive screen time, fostering holistic development in young children. Full article

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

18 pages, 953 KB

Open AccessEditor’s ChoiceReview

Severe Diabetic Ketoacidosis in Children with Type 1 Diabetes: Ongoing Challenges in Care

by Simone Foti Randazzese, Mariarosaria La Rocca, Bruno Bombaci, Alessandra Di Pisa, Elèna Giliberto, Teresa Inturri, Daniel Militi, Fortunato Lombardo, Eloisa Gitto, Giuseppina Salzano and Stefano Passanisi

Children 2025, 12(1), 110; https://doi.org/10.3390/children12010110 - 19 Jan 2025

Cited by 6 | Viewed by 8875

Abstract

Diabetic ketoacidosis is the most common acute complication in children and adolescents with type 1 diabetes, and contributes significantly to morbidity, mortality, and healthcare burden. This review aims to explore the multifaceted aspects of severe diabetic ketoacidosis in pediatric age, including its epidemiology, [...] Read more.

Diabetic ketoacidosis is the most common acute complication in children and adolescents with type 1 diabetes, and contributes significantly to morbidity, mortality, and healthcare burden. This review aims to explore the multifaceted aspects of severe diabetic ketoacidosis in pediatric age, including its epidemiology, pathogenesis, risk factors, complications and emphasizing advances in prevention strategies. Incidence rates vary due to influences from geographic, socioeconomic, cultural and demographic factors. Pathogenesis is linked to insulin deficiency and an excess of counter-regulatory hormones, which disrupt glucose, protein, and lipid metabolism, causing hyperglycemia, ketosis, acidosis, dehydration, and electrolyte imbalances. According to the International Society for Pediatric and Adolescent Diabetes guidelines, severe diabetic ketoacidosis is characterized by a pH < 7.1 or bicarbonate < 5 mmol/L. This condition can lead to a wide range of life-threatening complications, including cerebral edema that represents the leading cause of death. Several prevention strategies, including awareness campaigns, early diagnosis of diabetes, regular monitoring and management, effective insulin therapy, education, access to healthcare and technological assistance, may contribute to reduce the risk of severe diabetic ketoacidosis episodes in children and adolescents. Full article

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

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11 pages, 235 KB

Open AccessEditor’s ChoiceArticle

Deciphering the Link Between Diagnosis-Related Group Weight and Nursing Care Complexity in Hospitalized Children: An Observational Study

by Manuele Cesare, Fabio D’Agostino, Emanuele Sebastiani, Nursing and Public Health Group, Gianfranco Damiani and Antonello Cocchieri

Children 2025, 12(1), 103; https://doi.org/10.3390/children12010103 - 17 Jan 2025

Cited by 6 | Viewed by 1411

Abstract

Background/Objectives: The increasing medical and nursing care complexity in hospitalized children represents a significant challenge for healthcare systems. However, the link between these two dimensions remains partially explored. This study aims to decipher the relationship between Diagnosis-Related Group (DRG) weight and nursing care [...] Read more.

Background/Objectives: The increasing medical and nursing care complexity in hospitalized children represents a significant challenge for healthcare systems. However, the link between these two dimensions remains partially explored. This study aims to decipher the relationship between Diagnosis-Related Group (DRG) weight and nursing care complexity in hospitalized children and to identify the determinants of medical complexity. Methods: This retrospective study, conducted in an Italian university hospital, included children aged 2 to 11 years admitted to the hospital in 2022 with a minimum hospital stay of 2 days. Data were gathered from the Neonatal Pediatric Professional Assessment Instrument and the Hospital Discharge Register. DRG weight was used as an indicator of medical complexity, while the number of nursing diagnoses (NDs) documented in the first 24 h from hospital admission and the nursing actions (NAs) recorded during the patient’s hospital stay were used to measure nursing care complexity. Correlation analyses were conducted to explore the associations between DRG weight, NDs, and NAs. Stepwise regression was run to identify the key determinants of medical complexity across sociodemographic, clinical, organizational, and nursing variables. Results: Among 914 patients (mean age of 6.11 ± 2.90 years), the median DRG weight was 0.6982 (IQR: 0.5522). Patients had an average of 3.89 ± 2.83 NDs and a median of 17 NAs (IQR: 8). Significant correlations were found between NDs and NAs (r_s = 0.507; p < 0.001), as well as between DRG weight and the frequency of NDs (r_s = 0.232; p < 0.001) and NAs (r_s = 0.184; p < 0.001). Stepwise regression indicated that the number of NAs, surgical DRG, scheduled admissions, and ND frequency were significant determinants of DRG weight (R² = 0.311; adjusted R² = 0.308; p < 0.001). Conclusions: In children, DRG weight is also influenced by nursing care complexity, alongside clinical and organizational factors. An integrated approach is essential to enhance pediatric care and patient outcomes. Full article

(This article belongs to the Section Pediatric Nursing)

20 pages, 264 KB

Open AccessEditor’s ChoiceReview

Thematic Review of Endocrine Disruptors and Their Role in Shaping Pubertal Timing

by And Demir, Adem Aydin and Atilla Büyükgebiz

Children 2025, 12(1), 93; https://doi.org/10.3390/children12010093 - 16 Jan 2025

Cited by 4 | Viewed by 4919

Abstract

This review examines the inconsistent effects of endocrine-disrupting chemicals (EDCs) and pollutants on pubertal timing, emphasizing the methodological challenges contributing to variability in findings. Data from nine key studies reveal that chemicals such as BPA, phthalates, and PFAS impact pubertal onset differently based [...] Read more.

This review examines the inconsistent effects of endocrine-disrupting chemicals (EDCs) and pollutants on pubertal timing, emphasizing the methodological challenges contributing to variability in findings. Data from nine key studies reveal that chemicals such as BPA, phthalates, and PFAS impact pubertal onset differently based on exposure timing, dosage, and sex. For instance, BPA is linked to earlier puberty in girls but delayed onset in boys, while other EDCs show mixed effects across populations. These discrepancies often arise from challenges in study design, such as the difficulty in establishing reliable control groups, accurately measuring exposures, and accounting for confounding factors like socioeconomic status, diet, and obesity. Sex-specific differences and environmental shifts during the COVID-19 pandemic, including increased indoor exposure and stress, further complicate the picture. These factors highlight the urgent need for more robust research methodologies, including standardized exposure assessments and longitudinal studies, to clarify the mechanisms driving these effects. Despite these challenges, the findings stress the importance of public health interventions, such as stricter EDC regulations, improved pollutant monitoring, and minimizing exposures during sensitive developmental windows. Addressing methodological gaps is crucial for producing reliable, actionable insights to protect adolescent development from the adverse effects of EDCs. Full article

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

14 pages, 1798 KB

Open AccessEditor’s ChoiceArticle

Dietary Habits and Nutritional Status of Youths Living in Rural and Semi-Urban Albania in the Ongoing Nutrition Transition: Preliminary Results

by Ruden Cakoni, Stefania Moramarco, Argjend Kosiqi, Angela Andreoli and Ersilia Buonomo

Children 2025, 12(1), 98; https://doi.org/10.3390/children12010098 - 16 Jan 2025

Cited by 4 | Viewed by 2886

Abstract

Background: Albania is undergoing a demographic, epidemiological, and nutrition transition leading to an increased prevalence of overweight and obesity among new generations. Comprehensive studies on the nutritional status and dietary patterns of youths in the country are still lacking. Methods: A cross-sectional study [...] Read more.

Background: Albania is undergoing a demographic, epidemiological, and nutrition transition leading to an increased prevalence of overweight and obesity among new generations. Comprehensive studies on the nutritional status and dietary patterns of youths in the country are still lacking. Methods: A cross-sectional study was conducted on a convenience sample of students (10–18 years) attending secondary schools in rural and semi-urban areas (October–November 2024). Information collected included socio-demographic data, anthropometric measurements (weight, height), and adherence to the Mediterranean Diet (MD) (KIDMED). Factors influencing dietary patterns were investigated, with a multivariate logistic regression performed to identify key drivers for poor MD adherence (AOR 95% CI). Results: In total, 426 children (47.2% females) were interviewed. Over 20% of the sample was overweight or obese, with the prevalence of these diseases decreasing with age regardless of gender. The KIDMED score highlighted suboptimal MD adherence (4.6 ± 2.5 SD), with significant differences between females and males (4.1 ± 2.4 SD vs. 5.1 ± 2.4 SD, p < 0.001), especially in rural areas (3.9 ± 2.4 SD vs. 4.9 ± 2.5 SD, p = 0.003). Dietary quality tended to decline with age. Female gender was the strongest predictor of poor MD adherence (AOR 2.08 CI: 1.34–3.22; p = 0.001). Conclusions: The MD is a cornerstone for ensuring the Albanian population’s long-term health and well-being. This study holds significant public health relevance in a country with high mortality rates due to cardiovascular diseases. Future nutrition interventions focused on the poor MD adherence of new generations should take into consideration geographic, cultural, and social dimensions, including gender equality. 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)

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14 pages, 882 KB

Open AccessEditor’s ChoiceArticle

Physical Literacy, According to the World Health Organization (WHO), in an Italian Preschool and Education for a Daily Movement Routine

by Gaetano Raiola

Children 2025, 12(1), 66; https://doi.org/10.3390/children12010066 - 7 Jan 2025

Cited by 5 | Viewed by 1436

Abstract

Background and Objectives: The preschool context produces excessive sedentary behavior in children. The systematic fulfillment of structured physical activities during school time, namely a daily movement routine (DMR), can contribute to increasing the quantity of physical activity (PA) and to improving physical literacy [...] Read more.

Background and Objectives: The preschool context produces excessive sedentary behavior in children. The systematic fulfillment of structured physical activities during school time, namely a daily movement routine (DMR), can contribute to increasing the quantity of physical activity (PA) and to improving physical literacy (PL), reaching the WHO’s recommendations. Aim: The present study aims to quantify the sedentary time spent by 4- and 5-year-old preschool children and to verify the effects that a DMR could have on sedentary habits in preschool children. Method: An experimental observational study was carried out. Ad hoc questionnaires were administered to parents, teachers, and children, and an observation checklist was used to quantify the time spent in sedentary activities at school. Descriptive statistics and t-tests were applied for data analysis. Results: Thirty-two children attending Italian preschool participated in this study. The implementation of a DMR significantly reduced the sedentary time in preschool, decreasing the time spent sitting by 45.69% and increasing the time spent standing by 185%. Conclusions: This study confirms the hypothesis that children move for less time than recommended by the WHO and highlights the importance of making the experiences of the DMR structural, as this could be an opportunity for educational processes to enhance active lifestyles in promoting the development of physical literacy. Full article

(This article belongs to the Special Issue Physical Education and Exercise Promotion and Intervention in Children and Adolescents for Health and Wellbeing)

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10 pages, 6304 KB

Open AccessEditor’s ChoiceArticle

Foreign Bodies in Lower Airway in Children: Brief Review and Clinical Experience

by Stoyan Markov, Petya Markova, Ivanka Karavelikova and Hristina Halacheva

Children 2025, 12(1), 67; https://doi.org/10.3390/children12010067 - 7 Jan 2025

Cited by 2 | Viewed by 2071

Abstract

Background: Foreign body aspiration is a preventable occurrence that carries a high risk of mortality in the pediatric population. Clinically, foreign body aspiration manifests as cough, followed by choking, which might not be given any consideration by the caregivers of the child. An [...] Read more.

Background: Foreign body aspiration is a preventable occurrence that carries a high risk of mortality in the pediatric population. Clinically, foreign body aspiration manifests as cough, followed by choking, which might not be given any consideration by the caregivers of the child. An episode of sudden wheezing can also raise the suspicion of a foreign body in the lower respiratory tract. The clinical findings depend on the type, size, and localization of the foreign body and include persistent cough, localized airway resistance, localized or diffuse wheezing, and difficulty breathing. A bronchoscopy is the procedure of choice for the removal of foreign bodies. Flexible bronchoscopy is increasingly being used as the initial diagnostic procedure in children with an uncertain history of choking, in the absence of physical and radiological lung changes, and in chronic complaints requiring the exclusion of a foreign body in the airways. Thus, the aim of this study was to describe our clinical experience with lower respiratory tract foreign body extraction in children over a period of five years. Materials and Methods: Over a 5-year period, 154 patients under the age of 18 underwent a bronchoscopy due to a suspected foreign body in the lower respiratory tract. Of these patients, 92% had an incident leading to acute respiratory distress, and 8% had no definite data on such an event in the anamnesis. Results: A foreign body in the respiratory tract was found in and extracted from 50 patients, and foreign bodies were absent in 104 of the cases. Conclusions: If a foreign body enters the lower respiratory tract, immediate and adequate actions are required to solve the problem. A bronchoscopy should be conducted in every suspected case of foreign body aspiration. Full article

(This article belongs to the Special Issue Addressing Challenges in Pediatric Critical Care Medicine)

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15 pages, 791 KB

Open AccessEditor’s ChoiceArticle

The Effects of a Web-Based Need-Supportive Intervention for Physical Education Teachers on Students’ Physical Activity and Related Outcomes: A Randomized Controlled Trial

by Hasso Paap, Andre Koka, Pille-Riin Meerits and Henri Tilga

Children 2025, 12(1), 56; https://doi.org/10.3390/children12010056 - 3 Jan 2025

Cited by 7 | Viewed by 1801

Abstract

Background/Objectives: Globally, adolescents are insufficiently active, highlighting the need for effective strategies to enhance their activity levels. This study evaluated a web-based intervention program designed for physical education (PE) teachers, aimed at fostering students’ basic psychological needs—autonomy, competence, and relatedness—in PE settings. Methods: [...] Read more.

Background/Objectives: Globally, adolescents are insufficiently active, highlighting the need for effective strategies to enhance their activity levels. This study evaluated a web-based intervention program designed for physical education (PE) teachers, aimed at fostering students’ basic psychological needs—autonomy, competence, and relatedness—in PE settings. Methods: Secondary school PE teachers and their students were randomly assigned into either an experimental (teachers n = 36; students n = 463, Mage = 13.94, SD = 0.88) or a control group (teachers n = 49; students n = 820, Mage = 13.93, SD = 0.87). Teachers in the experimental group underwent a 4-week web-based intervention program focused on autonomy-, competence-, and relatedness-supportive motivational techniques. Students completed questionnaires assessing psychological measures and self-reported physical activity (PA) before and after the teachers’ training. Results: Results indicated that students in the experimental group perceived significantly higher autonomy, competence, and relatedness support compared to their control group counterparts at post-test. Conclusions: Consequently, the web-based need-supportive intervention was effective in promoting need-supportive teacher behavior. As the developed training for PE teachers increased students’ perceptions of need support from their PE teachers, it holds promise for future PE teacher education. Furthermore, the web-based format offers scalability for broader implementation. Full article

(This article belongs to the Special Issue Physical Activity and Sedentary Behaviors in Children and Adolescents)

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17 pages, 277 KB

Open AccessEditor’s ChoiceReview

Body Composition in Preterm Infants: Current Insights and Emerging Perspectives

by Sreekanth Viswanathan, Melissa Thoene, Zaineh Alja’nini, Pradeep Alur and Kera McNelis

Children 2025, 12(1), 53; https://doi.org/10.3390/children12010053 - 2 Jan 2025

Cited by 5 | Viewed by 3202

Abstract

In recent years, significant advancements in respiratory and nutritional care have markedly improved the survival rates of preterm infants and enhanced long-term health outcomes. Despite these improvements, emerging research highlights the lasting impacts of early growth patterns on an individual’s health trajectory. Adults [...] Read more.

In recent years, significant advancements in respiratory and nutritional care have markedly improved the survival rates of preterm infants and enhanced long-term health outcomes. Despite these improvements, emerging research highlights the lasting impacts of early growth patterns on an individual’s health trajectory. Adults born prematurely face a higher incidence of health issues related to their early birth. The American Academy of Pediatrics recommends that preterm infants should achieve growth rates similar to those of fetuses, with clinicians emphasizing nutrition delivery to help these infants reach their expected weight for gestational age. However, this approach often results in altered body composition, characterized by increased fat mass and decreased fat-free mass compared to full-term infants. Air displacement plethysmography stands out as a highly reliable method for measuring preterm body composition, while DEXA scans, despite their reliability, tend to overestimate body fat. Other methods include bioelectric impedance, isotope dilution, MRI, ultrasound, and skinfold thickness, each with its own strengths and limitations. In this paper, we aim to raise awareness among neonatal clinicians about the importance of achieving acceptable neonatal body composition. We discuss the pros and cons of different body composition measurement methods, the impact of nutrition and other factors on body composition in preterm infants, long-term follow-up data, and the potential use of body composition data to tailor nutritional interventions in NICU and post-discharge settings. This comprehensive approach is designed to optimize health outcomes for preterm newborns by focusing on their body composition from an early stage. Full article

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

14 pages, 895 KB

Open AccessEditor’s ChoiceReview

Role of Human Milk Microbiota in Infant Neurodevelopment: Mechanisms and Clinical Implications

by Valentina Biagioli, Vincenzo Sortino, Raffaele Falsaperla and Pasquale Striano

Children 2024, 11(12), 1476; https://doi.org/10.3390/children11121476 - 30 Nov 2024

Cited by 7 | Viewed by 2962

Abstract

Background: Human milk (HM) is recognized as an ideal source of nutrition for newborns; as a result, its multiple bioactive molecules can support the growth of healthy newborns and reduce the risk of mortality and diseases such as asthma, respiratory infections, diabetes (type [...] Read more.

Background: Human milk (HM) is recognized as an ideal source of nutrition for newborns; as a result, its multiple bioactive molecules can support the growth of healthy newborns and reduce the risk of mortality and diseases such as asthma, respiratory infections, diabetes (type 1 and 2), and gastrointestinal disorders such as ulcerative colitis and Crohn’s disease. Furthermore, it can reduce the severity of necrotizing enterocolitis (NEC) in preterm infants. Moreover, human milk oligosaccharides (HMOs) present in breast milk show an immunomodulatory, prebiotic, and neurodevelopmental effect that supports the microbiota–gut–brain axis. Material and methods: This study examined the state-of-the-art research, using keywords such as “breastfeeding”, “human milk oligosaccharides”, “microbiota–gut–brain axis”, “infants”, and “malnutrition”. The literature review was conducted by selecting articles between 2013 and 2024, as the most recent ones. The databases used were Web Science, PubMed, and Scopus. Results: We found multiple studies examining the composition of HM and infant formula (IF). However, further longitudinal studies and randomized control trials (RCTs) are needed to better understand the clinical outcomes that bioactive components exert on healthy and hospitalized children and how, in conditions of malnutrition, it is necessary to support the growth of the newborn. Conclusions: In this review, we affirm the importance of human milk and, through it, the modulation of the microbiota and the neuroprotective role in newborns, determining the health of the following years of life. Full article

(This article belongs to the Special Issue Promoting Breastfeeding and Human Milk in Infants)

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16 pages, 302 KB

Open AccessEditor’s ChoiceReview

Affective Touch in Preterm Infant Development: Neurobiological Mechanisms and Implications for Child–Caregiver Attachment and Neonatal Care

by Valentina Lucia La Rosa, Alessandra Geraci, Alice Iacono and Elena Commodari

Children 2024, 11(11), 1407; https://doi.org/10.3390/children11111407 - 20 Nov 2024

Cited by 18 | Viewed by 8192

Abstract

Background/Objectives: Affective touch is crucial in infant development, particularly in regulating emotional, cognitive, and physiological processes. Preterm infants are often deprived of essential tactile stimulation owing to their early exposure to the external environment, which may affect long-term developmental outcomes. This review aimed [...] Read more.

Background/Objectives: Affective touch is crucial in infant development, particularly in regulating emotional, cognitive, and physiological processes. Preterm infants are often deprived of essential tactile stimulation owing to their early exposure to the external environment, which may affect long-term developmental outcomes. This review aimed to examine the neurobiological mechanisms of affective touch and highlight effective interventions, such as skin-to-skin contact (SSC) and kangaroo care (KC), to promote development in preterm infants. Methods: This review summarizes recent studies in the literature on affective touch, the role of C-tactile fibers, and the effects of tactile interventions in neonatal care. Studies were selected based on their relevance to the care and development of preterm infants, with a focus on physiological and neurodevelopmental outcomes. Key interventions, including SSC and massage therapy, are discussed in relation to their effectiveness in the neonatal intensive care unit (NICU). Results: The results suggest that affective touch, mainly through activation of tactile C-fibers, improves caregiver–infant bonding, reduces stress responses, and supports neurodevelopment in preterm infants. Interventions such as SSC and KC have also been shown to improve physiological regulation in these infants, including heart rate, breathing, and temperature control while promoting emotional regulation and cognitive development. Conclusions: Affective touch is a key component of early development, particularly in preterm infants admitted to the NICU. Integrating tactile interventions such as SSC and KC into neonatal care practices may significantly improve long-term developmental outcomes. Future research should explore the epigenetic mechanisms underlying affective touch and further refine tactile interventions to optimize neonatal care. Full article

(This article belongs to the Special Issue Children with Specific Neurodevelopmental Disorders: Assessment and Intervention)

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27 pages, 1316 KB

Open AccessEditor’s ChoiceReview

Digital Device Usage and Childhood Cognitive Development: Exploring Effects on Cognitive Abilities

by Vicente Javier Clemente-Suárez, Ana Isabel Beltrán-Velasco, Silvia Herrero-Roldán, Stephanie Rodriguez-Besteiro, Ismael Martínez-Guardado, Alexandra Martín-Rodríguez and Jose Francisco Tornero-Aguilera

Children 2024, 11(11), 1299; https://doi.org/10.3390/children11111299 - 27 Oct 2024

Cited by 25 | Viewed by 33520

Abstract

The increasing ubiquity of digital devices in childhood had outpaced the understanding of their effects on cognitive development, creating a significant research gap regarding their long-term impact. Objective: The present narrative overview explored the complex relationship between digital device usage and cognitive development [...] Read more.

The increasing ubiquity of digital devices in childhood had outpaced the understanding of their effects on cognitive development, creating a significant research gap regarding their long-term impact. Objective: The present narrative overview explored the complex relationship between digital device usage and cognitive development in childhood. Methods: We conducted a comprehensive literature search across multiple databases, including PubMed, Embase, Scopus, and Web of Science, to critically assess cognitive domains such as attention, memory, executive functions, problem-solving skills, and social cognition. Incorporating over 157 peer-reviewed studies published between 2001 and 2024, we used strict inclusion and exclusion criteria to ensure scientific rigor. Results: The review integrated empirical findings with established theoretical frameworks, particularly from cognitive development and media psychology, to highlight both the advantages and risks of early, frequent exposure to technology. The potential for digital devices to enhance cognitive skills, such as multitasking and information processing, was weighed against risks such as cognitive overload, diminished attention spans, and impaired social skills. We also examined psychological and behavioral outcomes, including identity formation, emotional regulation, and maladaptive behaviors associated with excessive screen time. Additionally, we identified strategies to mitigate negative effects, emphasizing structured digital engagement and parental involvement to support healthy cognitive and psychological growth. Our findings provided actionable recommendations for parents, educators, and policymakers, promoting optimal digital practices that enhanced cognitive development while safeguarding against potential harms. Conclusions: The review offered essential insights for stakeholders in child development, education, and policy-making, highlighting the need for balanced integration of digital tools in childhood learning environments. Full article

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

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14 pages, 1077 KB

Open AccessEditor’s ChoiceArticle

Prevalence of Anxiety and Depression among Parents of Children with Cancer—A Preliminary Study

by Anna Lewandowska, Tomasz Lewandowski, Anna Bartosiewicz, Katalin Papp, Dana Zrubcová, Mária Šupínová, Aleksandra Stryjkowska-Góra, Barbara Laskowska, Gabriela Joniec and Serap Ejder Apay

Children 2024, 11(10), 1227; https://doi.org/10.3390/children11101227 - 10 Oct 2024

Cited by 5 | Viewed by 3739

Abstract

Background: A child’s cancer is a highly stressful experience for the entire family. Childhood cancer disrupts family functioning and is one of the most stressful and challenging events parents face, often beyond their control. Parents play a crucial role in providing emotional support [...] Read more.

Background: A child’s cancer is a highly stressful experience for the entire family. Childhood cancer disrupts family functioning and is one of the most stressful and challenging events parents face, often beyond their control. Parents play a crucial role in providing emotional support to children throughout their illness, and their ability to cope can help reduce the child’s negative emotions. The aim of this study was to assess the prevalence of anxiety and depression among parents of children with cancer. Methods: This cross-sectional study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines and included parents of children undergoing cancer treatment. Convenience sampling was used. The Beck Depression Inventory and the Hospital Anxiety and Depression Scale were utilized to assess the parents. Results: This study included 270 participants (73% women, 27% men) with children at an average age of 8.75 ± 4.82 years. Diagnoses included leukemia (53%), lymphoma (29%), and other cancers. On the Beck Depression Inventory, 33% of parents were mildly depressed, 12% moderately depressed, and 32% severely depressed, with an average score of 20.63 ± 12.39 points. The HADS-M scale indicated anxiety at 48.43 ± 20.78%, depression at 45.01 ± 22.8%, and aggression at 54.72 ± 28.71%. Conclusions: Most parents of children with cancer have symptoms of depression and anxiety, which are influenced by the duration of the child’s illness. A strong correlation was observed between the level of anxiety and the tendency for depression. Full article

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

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15 pages, 2422 KB

Open AccessEditor’s ChoiceArticle

Pediatric Dentists’ Practice Patterns in the Screening, Diagnosis, and Management of Temporomandibular Disorders

by Caroline M. Sawicki and Linda Sangalli

Children 2024, 11(10), 1168; https://doi.org/10.3390/children11101168 - 26 Sep 2024

Cited by 6 | Viewed by 1523

Abstract

Background/Objectives: Pain associated with temporomandibular disorders (TMDs) is the main non-odontogenic cause of orofacial pain among youth. Pediatric dentists are often the first healthcare practitioners to perform a comprehensive oral examination in children, which should include evaluation of the temporomandibular joint, masticatory muscles, [...] Read more.

Background/Objectives: Pain associated with temporomandibular disorders (TMDs) is the main non-odontogenic cause of orofacial pain among youth. Pediatric dentists are often the first healthcare practitioners to perform a comprehensive oral examination in children, which should include evaluation of the temporomandibular joint, masticatory muscles, and surrounding structures for signs and/or symptoms of TMD. This study assessed pediatric dentists’ practice patterns in the screening, diagnosis, and management of TMD. Methods: A 19-item online survey was used to assess pediatric dentists’ clinical practice patterns and perceived knowledge and comfort levels in the screening, diagnosis, and management of TMD. The survey was distributed in July 2024, with a one-month window open for the study. Confidence levels and perceived knowledge were compared according to years from graduation and frequency of TMD screening assessment with ANOVA or independent t-test, as appropriate. Open-ended items were analyzed thematically. Results: A total of 206 pediatric dentists and pediatric dentistry residents participated in this study. A share of 72.8% of respondents reported that up to 25% of their patients per week present with signs and symptoms of TMD. About one-fifth of pediatric dental providers never complete a screening history for TMD (22.1%) or a clinical assessment of TMD-related structures (21.6%). There was overall low self-perceived knowledge and confidence among pediatric dentists regarding the diagnosis, screening, and management of TMD in children and adolescents, regardless of the number of years from graduation. Respondents who reported seeing up to 50% of TMD patients reported significantly more knowledge and confidence in diagnosing pediatric TMD than those who encountered fewer TMD patients. An overwhelming majority (81.6%) indicated a need for continuing education courses and training focused on the management of TMD in pediatric patients. Conclusions: Providers reported low confidence and self-perceived knowledge about TMD in pediatric populations, a high rate of referral of patients with TMD, and a particular interest for professional development opportunities focused on management of TMD. Full article

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

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14 pages, 958 KB

Open AccessEditor’s ChoiceArticle

The Effects of Exergames on Physical Fitness, Body Composition and Enjoyment in Children: A Six-Month Intervention Study

by Santo Marsigliante, Giulia My, Gianmarco Mazzotta and Antonella Muscella

Children 2024, 11(10), 1172; https://doi.org/10.3390/children11101172 - 26 Sep 2024

Cited by 8 | Viewed by 4652

Abstract

Background/Objectives: Physical inactivity in children can lead to decreased physical fitness and reduced enjoyment of physical activity. This study aimed to evaluate the impact of exergaming on physical fitness, body composition and perceived enjoyment in elementary school children. Methods: Sixty-four male students (mean [...] Read more.

Background/Objectives: Physical inactivity in children can lead to decreased physical fitness and reduced enjoyment of physical activity. This study aimed to evaluate the impact of exergaming on physical fitness, body composition and perceived enjoyment in elementary school children. Methods: Sixty-four male students (mean age 9.5 years) were randomly assigned to an exergaming group (EG, n = 32), engaging in Kinect Adventures three times a week for six months, or a control group (CG, n = 32), which continued standard physical education. Assessments were conducted pre- and post-intervention, including anthropometric measures, physical fitness tests (standing long jump, countermovement jump, sit-and-reach, 20-m sprint), aerobic fitness (20-m shuttle run), and perceived enjoyment measured with the PACES scale. Results: The EG demonstrated significant reductions in body weight, BMI, and relative fat mass compared to the CG (p < 0.01). Improvements in physical fitness were evident in EG, with increases in standing long jump distance (+12.8%; p < 0.0001), countermovement jump height (+65%, p < 0.0001), and flexibility (+75%; p < 0.0001). Aerobic fitness improved significantly in EG (+87.8m) compared to CG. Perceived enjoyment was notably higher in EG, especially at week three, compared to CG (69.3 ± 5.8 vs. 44.2 ± 11.6; p < 0.0001). Conclusions: Exergaming offers benefits for physical fitness and body composition in children, while also enhancing enjoyment. Incorporating exergames into physical education programs could be an effective strategy for addressing childhood obesity, improving physical skills, and increasing student enjoyment, encouraging long-term physical activity adherence. Full article

(This article belongs to the Special Issue Movement Behaviors and Health-Related Physical Fitness in Pediatric Population)

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19 pages, 742 KB

Open AccessEditor’s ChoiceArticle

Retinopathy of Prematurity in Eight Portuguese Neonatal Intensive Care Units: Incidence, Risk Factors, and Progression—A Prospective Multicenter Study

by Mariza Fevereiro-Martins, Ana Carolina Santos, Carlos Marques-Neves, Manuel Bicho, Hercília Guimarães and on behalf of the GenE-ROP Study Group

Children 2024, 11(10), 1154; https://doi.org/10.3390/children11101154 - 24 Sep 2024

Cited by 4 | Viewed by 1903

Abstract

Background/Objectives: Retinopathy of prematurity (ROP) is a retinal neovascular disease affecting preterm infants. Identifying risk factors for its development and progression is critical for effective screening and prevention. This study aimed to analyze the incidence of ROP and identify key risk factors for [...] Read more.

Background/Objectives: Retinopathy of prematurity (ROP) is a retinal neovascular disease affecting preterm infants. Identifying risk factors for its development and progression is critical for effective screening and prevention. This study aimed to analyze the incidence of ROP and identify key risk factors for its development and progression. Methods: We conducted a prospective, observational cohort study on 455 neonates (gestational age [GA] < 32 weeks or birth weight < 1500 g) across eight Portuguese NICUs. Results: ROP incidence was 37.8%, with 4.6% requiring treatment. Multivariate analysis identified low GA and the number of red blood cell (RBC) transfusions as significant factors for ROP development and progression. After adjusting for these variables, platelet transfusions, high maximum fraction of inspired oxygen (FiO₂) in the second week, and surfactant use remained significantly associated with ROP development, while early and late sepsis, maternal chronic hypertension, and delayed enteral nutrition were associated with progression to ROP requiring treatment. Conclusions: These findings underscore the importance of addressing low GAs and adult RBC transfusions in ROP risk management and suggest that maximum FiO₂, platelet transfusions, and sepsis also play crucial roles. Larger studies are needed to validate these results and explore preventive interventions, particularly regarding the impact of multiple adult RBC transfusions on fetal hemoglobin percentages. Full article

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14 pages, 268 KB

Open AccessEditor’s ChoiceArticle

BMI, Dental Caries, and Risk Factors among Elementary School Children: A Cross-Sectional Study

by Deema J. Farsi

Children 2024, 11(9), 1145; https://doi.org/10.3390/children11091145 - 21 Sep 2024

Cited by 3 | Viewed by 1762

Abstract

Background/Objectives: Obesity and dental caries are multifactorial diseases with high prevalence amongst Saudi children. The aim of the study was to determine their association with common risk factors. Methods: This cross-sectional study examined 300 children attending elementary schools. After taking their height and [...] Read more.

Background/Objectives: Obesity and dental caries are multifactorial diseases with high prevalence amongst Saudi children. The aim of the study was to determine their association with common risk factors. Methods: This cross-sectional study examined 300 children attending elementary schools. After taking their height and weight, their body mass indices (BMIs) were calculated. Oral examination was performed to record the decayed, missed, and filled scores (dmft/DMFT). A thorough questionnaire was compiled and validated to gather information on diet and physical activity (PA). The KIDMED score was calculated from a 16-item questionnaire to assess diet. Junk food and PA scores were also calculated based on relevant questions. Nonparametric tests were used to assess the associations between the scores and health outcomes (dmft/DMFT and BMI). Results: Fifty-eight of the children had poor diets, which was associated with higher dmft/DMFT (p = 0.012). PA levels were very low, and the average PA score was 2.12 ± 0.61. No association was found between BMI percentiles and PA level, nor between BMI percentiles and diet quality. Older children had lower BMI percentiles compared with younger children (coefficient = −9.35, 95% CI: −17.05, −1.65), and a borderline significant negative association was observed between dmft/DMFT and BMI percentile. Conclusions: Poor diets and chips consumption were related to dental caries. Obesity was not related to diet quality nor PA level. Full article

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19 pages, 716 KB

Open AccessEditor’s ChoiceArticle

Parental Knowledge, Attitudes, and Practices Regarding Early Childhood Caries in Bihor, Romania: A Cross-Sectional Study

by Abel Emanuel Moca, Raluca Iulia Juncar, Rahela Tabita Moca, Mihai Juncar, Rebeca Daniela Marton and Luminița Ligia Vaida

Children 2024, 11(9), 1131; https://doi.org/10.3390/children11091131 - 18 Sep 2024

Cited by 7 | Viewed by 2157

Abstract

Background/Objectives: Early childhood caries (ECC) is a significant global health issue, particularly affecting deciduous teeth in young children. ECC is prevalent in Romania, where nearly half of children experience dental caries. This study aimed to assess the influence of gender, age, and living [...] Read more.

Background/Objectives: Early childhood caries (ECC) is a significant global health issue, particularly affecting deciduous teeth in young children. ECC is prevalent in Romania, where nearly half of children experience dental caries. This study aimed to assess the influence of gender, age, and living environment on parents’ knowledge, attitudes, and practices (KAP) regarding ECC in Bihor County, Romania, using a KAP-type questionnaire. Methods: A cross-sectional study was conducted between March and September 2024, utilizing an online KAP questionnaire distributed via social networks. The sample comprised 419 parents of children under six years old. Respondents provided socio-demographic data and answered questions regarding their knowledge, attitudes, and practices concerning ECC prevention, treatment, and oral health. Statistical analysis was conducted using Chi-square tests to assess associations between demographic factors and parental KAP. A p-value of less than 0.05 was considered statistically significant. Results: Of the 419 respondents, 83.1% were female, and 62.5% were between the ages of 31 and 40. Significant gender-based differences were found in knowledge about pain from caries (93.7% of female participants vs. 81.7% of male participants, p = 0.004) and the importance of brushing twice daily (93.7% of female respondents vs. 80.3% of male respondents, p = 0.010). Younger parents (aged 18–30) were more likely to affirm the effectiveness of fluoride (65.4%) compared to those aged 31–40 (53.1%, p = 0.02). Urban parents were more likely to correctly identify the timing of tooth eruption (59.1% vs. 52.6% of rural parents, p = 0.021). Conclusions: The study highlights gender, age, and urban–rural disparities in parental knowledge and attitudes towards ECC. These findings underscore the need for targeted educational interventions to improve oral health outcomes and reduce ECC prevalence in the Bihor region. Tailored public health strategies addressing demographic factors could enhance preventive oral health behaviors and reduce the healthcare burden associated with untreated dental caries. Full article

(This article belongs to the Special Issue Public Health and Preventive Medicine for Children)

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32 pages, 850 KB

Open AccessEditor’s ChoiceReview

Associations between Meal Patterns and Risk of Overweight/Obesity in Children and Adolescents in Western Countries: A Systematic Review of Longitudinal Studies and Randomised Controlled Trials

by Georgios Saltaouras, Athanasia Kyrkili, Eirini Bathrellou, Michael Georgoulis, Mary Yannakoulia, Vasiliki Bountziouka, Urška Smrke, George Dimitrakopoulos and Meropi D. Kontogianni

Children 2024, 11(9), 1100; https://doi.org/10.3390/children11091100 - 7 Sep 2024

Cited by 7 | Viewed by 4087

Abstract

Childhood overweight/obesity (OV/OB) is a major public health problem in Western countries, often accompanied with comorbidities (e.g., hypertension and insulin resistance) (i.e., metabolically unhealthy obesity—MUO). Among diet-related risk factors of OV/OB risk and MUO, meal patterns remain limitedly studied. The aim of this [...] Read more.

Childhood overweight/obesity (OV/OB) is a major public health problem in Western countries, often accompanied with comorbidities (e.g., hypertension and insulin resistance) (i.e., metabolically unhealthy obesity—MUO). Among diet-related risk factors of OV/OB risk and MUO, meal patterns remain limitedly studied. The aim of this systematic review was to explore associations between meal patterns and the risk of childhood OV/OB and MUO in children/adolescents aged 2–19 years. Longitudinal studies and randomised controlled trials from PUBMED and Scopus published between January 2013 and April 2024 were retrieved. Twenty-eight studies were included, all of which reported on OV/OB risk, with none on MUO risk. Regular consumption of breakfast (n = 3) and family meals (n = 4) and avoiding dining while watching TV (n = 4) may be protective factors against childhood OV/OB, whereas meal skipping (primarily breakfast; n = 4) may be a detrimental factor. Mixed effects of meal frequency on OV/OB risk were observed; no effects of frequency of lunch or of fast-food consumption and of meals served at school were found. There was insufficient evidence to support the role of other patterns (meal timing, eating in other social contexts). Meals were mainly participant-identified, leading to increased heterogeneity. Research focusing on childhood MUO and the use of harmonised definitions regarding the assessment of meal patterns are highly warranted. 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)

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11 pages, 575 KB

Open AccessEditor’s ChoiceReview

Psychological and Clinical Challenges in the Management of Type 1 Diabetes during Adolescence: A Narrative Review

by Bruno Bombaci, Arianna Torre, Alessandro Longo, Maria Pecoraro, Mattia Papa, Lacrima Sorrenti, Mariarosaria La Rocca, Fortunato Lombardo and Giuseppina Salzano

Children 2024, 11(9), 1085; https://doi.org/10.3390/children11091085 - 4 Sep 2024

Cited by 22 | Viewed by 9086

Abstract

Adolescence, a critical period of physical and psychological development, presents unique challenges in type 1 diabetes (T1D) management due to endocrinological changes, reduced therapeutic adherence, and elevated susceptibility to psychological issues such as depression, anxiety, and eating disorders. This narrative review explores the [...] Read more.

Adolescence, a critical period of physical and psychological development, presents unique challenges in type 1 diabetes (T1D) management due to endocrinological changes, reduced therapeutic adherence, and elevated susceptibility to psychological issues such as depression, anxiety, and eating disorders. This narrative review explores the impact of psychological and behavioral factors on glycemic control in adolescents with T1D. We examine the prevalence and influence of mental health disorders, lifestyle factors, harmful behaviors, and social dynamics on diabetes management and glycemic outcomes. Strategies for improving metabolic control are also reviewed, including cognitive behavioral therapy, technological devices, and educational interventions. The importance of tailored psychological support, family involvement, and targeted interventions to improve adherence to treatment and glycemic control in adolescents with T1D should be emphasized. Full article

(This article belongs to the Special Issue Glycemic Control in Children and Adolescents with Type 1 Diabetes)

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12 pages, 235 KB

Open AccessEditor’s ChoiceArticle

Vitamin D Deficiency—A Public Health Issue in Children

by Alexandru Herdea, Harun Marie, Adelina Ionescu, Diana-Mihaela Sandu, Sara-Teodora Pribeagu and Alexandru Ulici

Children 2024, 11(9), 1061; https://doi.org/10.3390/children11091061 - 30 Aug 2024

Cited by 12 | Viewed by 2858

Abstract

Background: 25-hydroxyvitamin D [25(OH)D] deficiency is a global health concern, particularly in pediatric populations, with implications for musculoskeletal health and overall well-being. This study aimed to evaluate serum 25(OH)D levels in a pediatric population and assess the prevalence of deficiency and insufficiency. Methods: [...] Read more.

Background: 25-hydroxyvitamin D [25(OH)D] deficiency is a global health concern, particularly in pediatric populations, with implications for musculoskeletal health and overall well-being. This study aimed to evaluate serum 25(OH)D levels in a pediatric population and assess the prevalence of deficiency and insufficiency. Methods: A retrospective analysis was conducted on data from 741 pediatric patients (2–17 years old) who visited an urban hospital for children for acute respiratory and gastrointestinal conditions in the span of 2 years. Serum 25(OH)D levels were measured using chemiluminescent microparticle immunoassay. Statistical analyses were performed to assess the prevalence of deficiency and insufficiency, seasonal variations, and correlations with age and daylight exposure. Results: Of the 739 pediatric patients analyzed, a substantial proportion exhibited insufficient (31.80%) or deficient (36.54%) serum 25(OH)D levels. While younger age groups generally had higher mean 25(OH)D levels, a negative correlation was observed between 25(OH)D levels and age. Sunlight exposure variations did not significantly impact serum 25(OH)D levels. Despite diverse daylight exposure patterns, there were no significant differences between longer and shorter daylight periods. Conclusions: This study highlights the high prevalence of 25(OH)D deficiency and insufficiency in the pediatric population, emphasizing the need for public health monitoring and targeted supplementation strategies. Findings underscore the importance of regular consultations with healthcare providers to ensure optimal 25(OH)D levels in children, with potential implications for revising current sufficiency thresholds. Addressing 25(OH)D deficiency is crucial for promoting musculoskeletal health and overall well-being in children. Full article

(This article belongs to the Section Global Pediatric Health)

14 pages, 623 KB

Open AccessEditor’s ChoiceReview

Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS): Immunological Features Underpinning Controversial Entities

by Lucia Leonardi, Camilla Perna, Irene Bernabei, Marco Fiore, Meiqian Ma, Jennifer Frankovich, Luigi Tarani and Alberto Spalice

Children 2024, 11(9), 1043; https://doi.org/10.3390/children11091043 - 27 Aug 2024

Cited by 7 | Viewed by 8291

Abstract

Pediatric acute-onset neuropsychiatric syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS), represent an overlapping group of disorders which is characterized by acute-onset obsessive compulsive disorders, eating restriction, tics, cognitive and behavioral deterioration which typically follows a relapsing-remitting course but [...] Read more.

Pediatric acute-onset neuropsychiatric syndrome (PANS) and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS), represent an overlapping group of disorders which is characterized by acute-onset obsessive compulsive disorders, eating restriction, tics, cognitive and behavioral deterioration which typically follows a relapsing-remitting course but some patients have a primary or secondary persistent progress. This condition is likely caused by heterogeneous inflammatory mechanisms (autoantibodies, complement activation, pro-inflammatory cytokine production) involving the basal ganglia as evidenced by imaging studies (patients vs. controls), sleep studies that found movements and/or atonia during REM sleep, and neurological soft signs that go along with basal ganglia dysfunction. The condition causes significant psychiatric and behavioral symptoms, caregiver burden and sleep abnormalities. Autoantibodies resulting from molecular mimicry of infectious agents (namely group A Streptococcus) and neuronal autoantigens that map to the basal ganglia play also a subtle role. This narrative review aims to describe the key immunological features documented thus far and that likely play a role in the pathogenesis and clinical manifestations of this disorder. Full article

(This article belongs to the Special Issue Neurodevelopmental Disorders in Pediatrics)

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14 pages, 297 KB

Open AccessEditor’s ChoiceArticle

Relationship of Social–Emotional Learning, Resilience, Psychological Well-Being, and Depressive Symptoms with Physical Activity in School-Aged Children

by Evan Belaire, Fawzi Mualla, Lucas Ball, Iris Ma, Debra Berkey and Weiyun Chen

Children 2024, 11(8), 1032; https://doi.org/10.3390/children11081032 - 22 Aug 2024

Cited by 8 | Viewed by 3203

Abstract

Background: This study investigated the association of psychological well-being (PWB), resilience, depressive symptoms, and social–emotional learning (SEL) with physical activity (PA) in school-aged children. The objective was to understand how these psychosocial factors influence PA levels and identify gender-specific differences in these relationships. [...] Read more.

Background: This study investigated the association of psychological well-being (PWB), resilience, depressive symptoms, and social–emotional learning (SEL) with physical activity (PA) in school-aged children. The objective was to understand how these psychosocial factors influence PA levels and identify gender-specific differences in these relationships. Methods: This cross-sectional study involved 534 fourth grade and sixth grade students from eight schools in the Midwest region of the United States, with data collected through a Qualtrics survey. Multiple linear regression models were used to analyze the data, with gender-specific analyses conducted to identify differences between boys and girls. Results: The models indicated that all psychosocial factors taken together are significantly associated with PA (F = 26.937, p < 0.001). Of the factors, PWB and resilience were associated with higher PA individually for the total sample (β = 0.383, p = 0.001; β = 0.146, p = 0.005). A gender-specific analysis revealed that all factors collectively were significantly associated with PA in boys and girls (F = 15.846, p < 0.001; F = 6.869, p < 0.001). Individually, PWB and resilience were significantly associated with PA in boys (β = 0.358, p = 0.001; β = 0.171, p = 0.013), while only PWB was significantly associated with PA in girls (β = −0.355, p = 0.001). Conclusions: This study highlights the necessity of promoting resilience and psychological well-being through structured physical activities, aiming to reduce the risk of obesity and improve mental health among children. Future research should consider longitudinal designs and objective measures to further elucidate these relationships and inform effective educational strategies. Full article

(This article belongs to the Special Issue Promoting Physical Activity in the School Setting)

12 pages, 280 KB

Open AccessEditor’s ChoiceArticle

Socioeconomic Status and Rate of Poverty in Overweight and Obesity among Spanish Children and Adolescents

by Alejandra Gallego, Jorge Olivares-Arancibia, Rodrigo Yáñez-Sepúlveda, Héctor Gutiérrez-Espinoza and José Francisco López-Gil

Children 2024, 11(8), 1020; https://doi.org/10.3390/children11081020 - 21 Aug 2024

Cited by 6 | Viewed by 2577

Abstract

Background: This study aimed to analyze the relationship between socioeconomic status (SES), poverty rate, and the prevalence of overweight/obesity or obesity in children and adolescents aged 2–14. Methods: Parents or guardians reported the weight and height of participants, used to calculate body mass [...] Read more.

Background: This study aimed to analyze the relationship between socioeconomic status (SES), poverty rate, and the prevalence of overweight/obesity or obesity in children and adolescents aged 2–14. Methods: Parents or guardians reported the weight and height of participants, used to calculate body mass index (BMI) and BMI z-scores according to the International Obesity Task Force standards. Participants were categorized into “overweight/obesity” and “no overweight/obesity” and further into “obesity” and “no obesity”. The rate of poverty rate was determined using data from the National Statistics Institute of Spain, defining it as the percentage of people with income below 60% of the national median. SES was based on the head of household’s occupation and categorized into low, medium, and high levels. Results: Adjusted multilevel models showed participants with medium or high SES had lower odds of overweight/obesity compared to those with low SES (medium SES: odds ratio [OR]: 0.63, 95% confidence interval [CI]: 0.54–0.73; high SES: OR: 0.59, 95% CI: 0.49–0.70). Participants in the high-poverty group had higher odds of having overweight/obesity (OR: 1.40, 95% CI: 1.13–1.74) compared to the low-poverty group. Conclusions: The study highlights significant socioeconomic disparities in childhood overweight/obesity, emphasizing the potential impact of SES and poverty on health outcomes in Spanish children and adolescents. Full article

(This article belongs to the Special Issue Dietary Habits, Social Determinants of Health and Obesity Risk in Children and Adolescents)

16 pages, 867 KB

Open AccessEditor’s ChoiceReview

The Transition from Childhood to Adolescence: Between Health and Vulnerability

by Francesca Mastorci, Maria Francesca Lodovica Lazzeri, Cristina Vassalle and Alessandro Pingitore

Children 2024, 11(8), 989; https://doi.org/10.3390/children11080989 - 14 Aug 2024

Cited by 23 | Viewed by 14686

Abstract

Transitioning from childhood into adolescence is an extraordinary time of life, associated with major physical, emotional, cognitive, and social changes and characterized by dynamic development in which interaction with the environment modulates the individual resources responsible for well-being and health. This sensitive period [...] Read more.

Transitioning from childhood into adolescence is an extraordinary time of life, associated with major physical, emotional, cognitive, and social changes and characterized by dynamic development in which interaction with the environment modulates the individual resources responsible for well-being and health. This sensitive period is the time when, in addition to hormonal, metabolic, and neural changes, certain behavioral strategies begin to take shape that will shortly go on to define the emotional, social, and cultural identity of the individual. This narrative review aimed to uncover the crucial processes underlying the transition by identifying processes that are responsible for cognitive, psychosocial, and emotional development, in the absence of disease. For this aim, we highlight (1) the physical, psychological, and social determinants during the transition from childhood to adolescence; (2) the role of health-related variables in resilience or vulnerability mechanisms; and (3) recent school-based strategies to promote health and well-being. Recognizing that health and well-being are the result of the interaction of many biological, psychological, social, cultural, and physical factors will lead to comprehensive health promotion involving all actors joining the growth process, from health professionals and the educational community to parents and community. Furthermore, it is important that psychosocial dimensions are strengthened already during childhood to prevent the onset of frailty and illness in adolescence. Full article

(This article belongs to the Section Global Pediatric Health)

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8 pages, 470 KB

Open AccessEditor’s ChoiceArticle

Feasibility and Acceptability of a Newborn Screening Program Using Targeted Next-Generation Sequencing in One Maternity Hospital in Southern Belgium

by Tamara Dangouloff, Kristine Hovhannesyan, Davood Mashhadizadeh, Frederic Minner, Myriam Mni, Laura Helou, Flavia Piazzon, Leonor Palmeira, François Boemer and Laurent Servais

Children 2024, 11(8), 926; https://doi.org/10.3390/children11080926 - 30 Jul 2024

Cited by 5 | Viewed by 2615

Abstract

Purpose: Genomic newborn screening programs are emerging worldwide. With the support of the local pediatric team of Liege, Belgium, we developed a panel of 405 genes that are associated with 165 early-onset, treatable diseases with the goal of creating a newborn screening test [...] Read more.

Purpose: Genomic newborn screening programs are emerging worldwide. With the support of the local pediatric team of Liege, Belgium, we developed a panel of 405 genes that are associated with 165 early-onset, treatable diseases with the goal of creating a newborn screening test using targeted next-generation sequencing for all early-onset, treatable, and serious conditions. Methods: A process was developed that informed the future parents about the project and collected their consent during a face-to-face discussion with a trained investigator. The first baby was screened on 1 September 2022. The main objective of the study was to test the feasibility and the acceptability of targeted sequencing at birth as a first-tier newborn screening approach to detect treatable genetic conditions or genetic conditions for which a pre-symptomatic or early symptomatic clinical trial is available. Results: As of 20 June 2024, the parents of 4425 children had been offered the test; 4005 accepted (90.5%) and 420 refused (9.5%). The main reasons for refusal were the research nature of the project and the misunderstanding of what constitutes genetic conditions. Conclusions: These data demonstrate the high acceptability of genomic newborn screening in a properly informed population. Full article

(This article belongs to the Section Pediatric Neonatology)

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11 pages, 645 KB

Open AccessEditor’s ChoiceReview

Exploring the Continuous Glucose Monitoring in Pediatric Diabetes: Current Practices, Innovative Metrics, and Future Implications

by Agata Chobot, Claudia Piona, Bruno Bombaci, Olga Kamińska-Jackowiak, Valentina Mancioppi and Stefano Passanisi

Children 2024, 11(8), 907; https://doi.org/10.3390/children11080907 - 27 Jul 2024

Cited by 8 | Viewed by 4559

Abstract

Continuous glucose monitoring (CGM) systems, including real-time CGM and intermittently scanned CGM, have revolutionized diabetes management, particularly in children and adolescents with type 1 diabetes (T1D). These systems provide detailed insights into glucose variability and detect asymptomatic and nocturnal hypoglycemia, addressing limitations of [...] Read more.

Continuous glucose monitoring (CGM) systems, including real-time CGM and intermittently scanned CGM, have revolutionized diabetes management, particularly in children and adolescents with type 1 diabetes (T1D). These systems provide detailed insights into glucose variability and detect asymptomatic and nocturnal hypoglycemia, addressing limitations of traditional self-monitoring blood glucose methods. CGM devices measure interstitial glucose concentrations constantly, enabling proactive therapeutic decisions and optimization of glycemic control through stored data analysis. CGM metrics such as time in range, time below range, and coefficient of variation are crucial for managing T1D, with emerging metrics like time in tight range and glycemia risk index showing potential for enhanced glycemic assessment. Recent advancements suggest the utility of CGM systems in monitoring the early stages of T1D and individuals with obesity complicated by pre-diabetes, highlighting its therapeutic versatility. This review discusses the current CGM systems for T1D during the pediatric age, established and emerging metrics, and future applications, emphasizing the critical role of CGM devices in improving glycemic control and clinical outcomes in children and adolescents with diabetes. Full article

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

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19 pages, 611 KB

Open AccessEditor’s ChoiceReview

Efficacy and Safety of Vagus Nerve Stimulation in Lennox–Gastaut Syndrome: A Scoping Review

by Debopam Samanta

Children 2024, 11(8), 905; https://doi.org/10.3390/children11080905 - 27 Jul 2024

Cited by 10 | Viewed by 2820

Abstract

Lennox–Gastaut syndrome (LGS) is a severe developmental and epileptic encephalopathy characterized by drug-resistant seizures, cognitive impairments, and abnormal electroencephalographic patterns. Vagus nerve stimulation (VNS) is a widely used neuromodulation therapy for LGS, but its effects on seizure outcomes, different seizure types, non-seizure outcomes, [...] Read more.

Lennox–Gastaut syndrome (LGS) is a severe developmental and epileptic encephalopathy characterized by drug-resistant seizures, cognitive impairments, and abnormal electroencephalographic patterns. Vagus nerve stimulation (VNS) is a widely used neuromodulation therapy for LGS, but its effects on seizure outcomes, different seizure types, non-seizure outcomes, and adverse events in this population have not been comprehensively reviewed. To conduct a scoping review on the use of VNS in LGS, a literature search was performed in PubMed, OVID, Web of Science, and Embase from inception to 9 June 2024, using relevant keywords and without restrictions on study design. The search yielded forty eligible studies (twenty-four retrospective cohorts, fourteen prospective cohorts, and two registry analyses) comprising 1400 LGS patients treated with VNS. No randomized controlled trials were identified. Across studies, the median seizure reduction ranged from 20.6% to 65%, with 0% to 100% of patients achieving a ≥50% seizure reduction. No consistent preoperative biomarker of VNS responsiveness was identified in LGS. Although inconsistent among different studies, tonic, atonic, and tonic–clonic seizures responded best, while focal seizures responded worst. Improvements in seizure severity, alertness, and quality of life were reported in some studies, but cognitive and adaptive functioning generally remained unchanged. Adverse events were mostly mild and transient, including hoarseness, cough, and paresthesia. Device-related complications and infections were uncommon. In conclusion, further research is needed to better understand VNS’s position in the evolving LGS treatment landscape and its cost effectiveness. Full article

(This article belongs to the Special Issue Diagnosis and Treatment in Childhood Epilepsy)

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12 pages, 594 KB

Open AccessEditor’s ChoiceArticle

Evaluating Malnutrition Practices and Mother’s Education on Children Failure to Thrive Symptoms Using Entropy-Weight and TOPSIS Method

by Maria Tzitiridou-Chatzopoulou, Georgia Zournatzidou, Eirini Orovou, Maria Lithoxopoulou, Eftychia Drogouti, George Sklavos, Evangelia Antoniou and Christos Tsakalidis

Children 2024, 11(8), 903; https://doi.org/10.3390/children11080903 - 26 Jul 2024

Cited by 9 | Viewed by 1711

Abstract

Background/Objectives: Failure to thrive (FTT) is mostly caused by insufficient consumption of nutrient-rich food, recurrent infections like diarrhea and intestinal worms, substandard caregiving practices, and limited availability of health and other vital services. Furthermore, there was a correlation between the educational level of [...] Read more.

Background/Objectives: Failure to thrive (FTT) is mostly caused by insufficient consumption of nutrient-rich food, recurrent infections like diarrhea and intestinal worms, substandard caregiving practices, and limited availability of health and other vital services. Furthermore, there was a correlation between the educational level of mothers and the occurrence of FTT in children aged 6–12 months. Thus, the objective of the current research is twofold: (i) to investigate other factors related to FTT and (ii) to evaluate the impact of them on FTT in Sub-Saharan African countries and their urban areas. Methods: We used weight entropy and TOPSIS methods to approach the research question. In particular, the entropy-weight method is effective for precisely evaluating the relative significance of the selected criteria for TOPSIS computation. Thus, data were retrieved from the database of UNICEF for the year 2019 for nine Sub-Saharan countries, and based on the methods used, five criteria have been selected for consideration. Those of mothers in higher education were identified as having a higher weight, which means that this can affect positively the ability of mothers to mitigate the situation of FTT and protect their children. Results: The findings of the study highlight the factors of maternal education at a higher level and unhealthy habits as those with the greatest weight and impact on the FTT. Moreover, the results indicate that the association between maternal education, and especially higher education, and FTT is stronger in Ethiopia. Despite the limited amount of research on the specified relationship in Sub-Saharan countries, this study is among the initial ones to examine it. Conclusions: The current study can aid policymakers in devising appropriate policies and implementing effective measures to tackle FTT in Sub-Saharan Africa, like enhancing the number of mothers in these countries to be integrated into the educational system to help both themselves and their children mitigate or avoid the symptoms of FTT. Full article

(This article belongs to the Special Issue Infant Feeding: Advances and Future Challenges: 2nd Edition)

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13 pages, 264 KB

Open AccessEditor’s ChoiceArticle

Mepolizumab in Severe Pediatric Asthma: Certainties and Doubts through a Single-Center Experience and Review of the Literature

by Marco Maglione, Melissa Borrelli, Alessandro Dorato, Chiara Cimbalo, Luigi Antonio del Giudice and Francesca Santamaria

Children 2024, 11(8), 895; https://doi.org/10.3390/children11080895 - 25 Jul 2024

Cited by 3 | Viewed by 2506

Abstract

Background: Although, in most children with asthma, good symptom control is achieved with a low to moderate dose of inhaled corticosteroids, a small group of patients still experiences frequent symptoms, and even severe exacerbations, impairment of lung function, and reduced quality of life. [...] Read more.

Background: Although, in most children with asthma, good symptom control is achieved with a low to moderate dose of inhaled corticosteroids, a small group of patients still experiences frequent symptoms, and even severe exacerbations, impairment of lung function, and reduced quality of life. Some of these subjects with severe asthma require biologic drugs as add-on therapy. In the past decade, numerous monoclonal antibodies have been approved for children or adolescents with severe asthma, in addition to their increasing use in adult asthma. However, the available evidence on how to select the most appropriate biologic based on a single patient’s clinical, functional, and laboratory characteristics is still scant, and is insufficient to guide clinicians in the decision-making process of a personalized treatment. Materials and Methods: We report a case series of four patients with severe eosinophilic asthma treated with mepolizumab, an anti-interleukin-5 monoclonal antibody, and review the existing literature on this treatment in children and adolescents. Results: Our patients, all with blood eosinophilia and elevated fractional exhaled nitric oxide levels, developed poor symptom control despite prolonged treatment with high-dose inhaled corticosteroids plus a second controller, addressing the addition of a biologic drug. In all of them, a 12-month treatment with subcutaneous mepolizumab showed a reduction in the blood eosinophil count and in asthma exacerbations, as well as an improvement on the Asthma Control Test. The results of the literature search focused on the strengths and limitations of the pediatric use of mepolizumab and highlighted the areas worthy of further research. Conclusions: Mepolizumab has proven effective in improving symptom control in pediatric patients with severe asthma. Additional well-powered clinical trials will be helpful in developing evidence-based guidelines regarding biologic drugs in the pediatric population. Full article

(This article belongs to the Special Issue Molecular and Pathophysiological Mechanisms Underlying Asthma and Allergy in Children)

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21 pages, 323 KB

Open AccessEditor’s ChoiceArticle

Atypical Sensory Processing in Neurodevelopmental Disorders: Clinical Phenotypes in Preschool-Aged Children

by Federica Gigliotti, Federica Giovannone, Arianna Belli and Carla Sogos

Children 2024, 11(7), 875; https://doi.org/10.3390/children11070875 - 19 Jul 2024

Cited by 9 | Viewed by 6712

Abstract

Background: Sensory processing issues are frequent in neurodevelopmental disorders (NDDs), with very variable prevalence rates ranging from 20% to 95%. This study aimed to investigate sensory processing in preschool-aged children with NDDs, to clarify the epidemiology, and to identify associated or correlated clinical [...] Read more.

Background: Sensory processing issues are frequent in neurodevelopmental disorders (NDDs), with very variable prevalence rates ranging from 20% to 95%. This study aimed to investigate sensory processing in preschool-aged children with NDDs, to clarify the epidemiology, and to identify associated or correlated clinical and psychometric variables. Methods: A total of 141 NDD children (age range 2–5 years old) were included and enrolled in two subgroups: 72 with ASD and 69 with other NDDs. A standardized neuropsychological evaluation was assessed (Griffiths III/WPPSI-III/Leiter-R, ADOS-2) and the parents completed the CBCL ½–5, the SPM-P, and the ADI-R. Results: Atypical sensory processing was reported in 39.7% of the total sample, more frequently in ASD (44.4%) than in other NDDs (34.8%). No statistically significant differences were found regarding gender and developmental level. A positive correlation was found between sensory processing abnormalities and behavioral problems (p < 0.01). Conclusions: Compared to other NDDs, ASDs more frequently have atypical sensory processing and appear to present a specific vulnerability in the processing of proprioceptive and vestibular inputs. Our results suggest that sensory processing difficulties should be considered regardless of developmental level and in children with behavioral problems. Full article

15 pages, 459 KB

Open AccessEditor’s ChoiceArticle

Assessment of Adolescents in Child-to-Parent Violence: Invariance, Prevalence, and Reasons

by Luis Burgos-Benavides, M. Carmen Cano-Lozano, Andrés Ramírez, Samuel P. León, Venus Medina-Maldonado and Francisco Javier Rodríguez-Díaz

Children 2024, 11(7), 845; https://doi.org/10.3390/children11070845 - 12 Jul 2024

Cited by 8 | Viewed by 2664

Abstract

Child-to-parent violence is a form of family violence where the children are the aggressors. Objective: This study first aimed to analyze the psychometric validity of the Child-to-Parent Violence Questionnaire (CPV-Q) among Ecuadorian adolescents. Second, the measurement invariance across the children’s sex was examined. [...] Read more.

Child-to-parent violence is a form of family violence where the children are the aggressors. Objective: This study first aimed to analyze the psychometric validity of the Child-to-Parent Violence Questionnaire (CPV-Q) among Ecuadorian adolescents. Second, the measurement invariance across the children’s sex was examined. Finally, the prevalence of child-to-parent violence (CPV) was also determined. Methods: A total of 2084 adolescents aged 12 to 18 years participated in this study. The participants were residents of two provinces in southern Ecuador. A higher percentage of participants were women. They lived mostly with their father and mother. The married marital status of the parents was the most frequently reported. Most of the fathers and mothers of the participants completed primary education. The sampling design was probabilistic, with proportional allocation by age and quotas according to the number of inhabitants per province. The sample size was determined by using a finite population formula. All the participants were randomly selected. The CPV-Q was used to assess child-to-parent violence. The items were adapted linguistically and tailored to the Ecuadorian context. Results: The questionnaire demonstrated excellent model fit and adequate reliability. Full measurement invariance was held for all scales except for the reasons subscale pertaining to fathers. Statistically significant differences were observed with respect to the sex of the aggressor, with control/domain behaviors toward both parents and psychological violence toward the mother being more frequent among daughters than sons. Similarly, reactive reasons were more frequent among daughters than sons. Conclusion: This study provides significant psychometric evidence on the CPV-Q in Ecuadorian adolescents along with data on the prevalence of violence against parents. Full article

(This article belongs to the Special Issue Children and Adolescent Mental Health Problems and Prevention)

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11 pages, 251 KB

Open AccessEditor’s ChoiceArticle

Assessment and Rehabilitation Intervention of Feeding and Swallowing Skills in Children with Down Syndrome Using the Global Intensive Feeding Therapy (GIFT)

by Silvia Franceschetti, Marco Tofani, Serena Mazzafoglia, Francesca Pizza, Eleonora Capuano, Massimiliano Raponi, Gessica Della Bella and Antonella Cerchiari

Children 2024, 11(7), 847; https://doi.org/10.3390/children11070847 - 12 Jul 2024

Cited by 5 | Viewed by 4662

Abstract

Background: Children with Down syndrome (DS) experience more difficulties with oral motor skills, including chewing, drinking, and swallowing. The present study attempts to measure the preliminary effectiveness of Global Intensive Feeding Therapy (GIFT) in DS. GIFT is a new rehabilitation program addressing the [...] Read more.

Background: Children with Down syndrome (DS) experience more difficulties with oral motor skills, including chewing, drinking, and swallowing. The present study attempts to measure the preliminary effectiveness of Global Intensive Feeding Therapy (GIFT) in DS. GIFT is a new rehabilitation program addressing the specific difficulties and needs of each child, focusing on sensory and motor oral abilities. It follows an intensive schedule comprising 15 sessions over 5 consecutive days, with 3 sessions per day. The principles of GIFT are applied with specific objectives for DS. Methods: GIFT was preliminarily implemented among 20 children diagnosed with DS. To measure the efficacy of GIFT, the Karaduman Chewing Performance Scale (KCPS), the International Dysphagia Diet Standardization Initiative (IDDSI), and the Pediatric Screening–Priority Evaluation Dysphagia (PS–PED) were used. Data were analyzed using the Wilcoxon signed-rank test before (T0) and after intervention (T1) and at one-month follow-up (T2). The effect size was also measured for specific outcomes, using Kendall’s W. Results: Our findings revealed that children with DS showed no risk of dysphagia according to the PS–PED (mean score 2.80). Furthermore, statistically significant improvements in chewing performance were observed, as measured by the KCPS (p < 0.01), as well as in texture acceptance and modification, as measured by the IDDSI post-intervention (p < 0.01). For both the KCPS and IDDSI, a large effect size was found (Kendall’s W value > 0.8). Parents/caregivers continued using GIFT at home, and this allowed for a positive outcome at the one-month follow-up. Conclusions: GIFT proved to be effective in the rehabilitation of feeding and swallowing disorders in children with DS, as well as for food acceptance. Full article

(This article belongs to the Special Issue Children with Specific Neurodevelopmental Disorders: Assessment and Intervention)

9 pages, 3016 KB

Open AccessEditor’s ChoiceReview

Identifying Language Development in Children with ADHD: Differential Challenges, Interventions, and Collaborative Strategies

by Dimitra V. Katsarou, Efthymia Efthymiou, Georgios A. Kougioumtzis, Maria Sofologi and Maria Theodoratou

Children 2024, 11(7), 841; https://doi.org/10.3390/children11070841 - 10 Jul 2024

Cited by 7 | Viewed by 11679

Abstract

Attention Deficit Hyperactivity Disorder (ADHD) significantly influences children’s language acquisition and usage. This theoretical study explores the multifaceted impact of ADHD on language development, specifically focusing on reading and writing challenges. Existing research reveals that approximately 30% of children with ADHD show significant [...] Read more.

Attention Deficit Hyperactivity Disorder (ADHD) significantly influences children’s language acquisition and usage. This theoretical study explores the multifaceted impact of ADHD on language development, specifically focusing on reading and writing challenges. Existing research reveals that approximately 30% of children with ADHD show significant delays in reading proficiency. Additionally, about 40% of these children struggle with phonological processing, which directly impacts their reading and writing skills. Interventions targeting executive function training combined with phonics-based instruction have been shown to significantly improve language outcomes. This study introduces a comprehensive framework connecting these challenges to specific interventions and collaborative strategies, emphasizing the importance of a multi-disciplinary approach. This work provides perspectives on the specific connections between ADHD symptoms and language difficulties, offering detailed potential solutions based on empirical data. Moreover, it features the necessity of adopting integrated intervention strategies to advance academic outcomes and communicative competencies for children with ADHD, providing new understandings into effective educational practices. Full article

(This article belongs to the Special Issue Language Acquisition and Language Impairment in Children with and without Neurodevelopmental Disorders)

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12 pages, 264 KB

Open AccessEditor’s ChoiceArticle

The Effects of a School-Based Physical Activity Program on Physical Fitness in Egyptian Children: A Pilot Study from the DELICIOUS Project

by Osama Abdelkarim, Noha El-Gyar, Amira M. Shalaby and Mohamed Aly

Children 2024, 11(7), 842; https://doi.org/10.3390/children11070842 - 10 Jul 2024

Cited by 6 | Viewed by 2115

Abstract

Background: Ensuring the physical fitness of Egyptian children is of paramount importance to their overall well-being, given the unique socio-cultural and educational barriers they face that may hinder their active participation. As part of the DELICIOUS project, the “Be Fit Program” aims to [...] Read more.

Background: Ensuring the physical fitness of Egyptian children is of paramount importance to their overall well-being, given the unique socio-cultural and educational barriers they face that may hinder their active participation. As part of the DELICIOUS project, the “Be Fit Program” aims to increase the level of physical fitness among Egyptian school-aged children. This study explores the effectiveness of a structured, six-week physical activity (PA) program in improving various facets of physical fitness in children, including body composition, speed, coordination, muscular strength, and cardiovascular endurance. With the increasing prevalence of sedentary lifestyles, such efforts are imperative to improve overall health outcomes. Methods: A cohort of 125 children, aged 8.50 to 12.25 y (mean age 10.19 ± 1.03 y), participated in the study. Their body composition, speed, coordination, strength, and aerobic fitness were assessed before and after the Be Fit Program using the revised International Physical Performance Test Profile. Paired t-tests were used to detect changes between the pre- and post-tests. Results: Following the six-week intervention, statistical analyses revealed significant improvements in coordination and lower body strength (p < 0.01). Aerobic endurance showed marginal improvements, approaching statistical significance (p = 0.06). Conversely, there were no statistically significant changes in body composition, speed, or upper body strength (p > 0.05). Conclusions: The study confirms that tailored, non-competitive physical activities can positively influence specific fitness components in Egyptian children. However, achieving holistic improvements across all targeted fitness domains may require further strategic adjustments or a longer program duration. This pilot study underscores the importance of culturally tailored, school-based PA programs and highlights the continued need for research and program refinement to comprehensively improve children’s fitness in the Egyptian context. Full article

(This article belongs to the Special Issue Childhood Physical Activity and Health)

17 pages, 300 KB

Open AccessEditor’s ChoiceArticle

Nasal High-Frequency Oscillatory Ventilation Use in Romanian Neonatal Intensive Care Units—The Results of a Recent Survey

by Maria Livia Ognean, Anca Bivoleanu, Manuela Cucerea, Radu Galiș, Ioana Roșca, Monica Surdu, Silvia-Maria Stoicescu and Rangasamy Ramanathan

Children 2024, 11(7), 836; https://doi.org/10.3390/children11070836 - 9 Jul 2024

Cited by 2 | Viewed by 2392

Abstract

Background: Nasal high-frequency oscillatory ventilation (nHFOV) has emerged as an effective initial and rescue noninvasive respiratory support mode for preterm infants with respiratory distress syndrome (RDS); however, little is known about nHFOV use in Romanian neonatal intensive care units (NICUs). Objectives: We aimed [...] Read more.

Background: Nasal high-frequency oscillatory ventilation (nHFOV) has emerged as an effective initial and rescue noninvasive respiratory support mode for preterm infants with respiratory distress syndrome (RDS); however, little is known about nHFOV use in Romanian neonatal intensive care units (NICUs). Objectives: We aimed to identify the usage extent and clinical application of nHFOV in Romania. Methods: A structured web-based questionnaire was designed to find the rate of nHFOV use and knowledge of this new method of noninvasive respiratory support in Romanian level III NICUs. Using multiple-choice, open-ended, and yes/no questions, we collected information on the NICU’s size, noninvasive respiratory support modes used, nHFOV use, indications, settings, nasal interfaces, secondary effects, and equipment used. Descriptive statistics and comparisons were performed using IBM SPSS Statistics 26.0. Results: A total of 21/23 (91.3%) leaders from level III NICUs (median [IQR] number of beds of 10 [10–17.5]) responded to the survey. The most frequently used noninvasive ventilation modes were CPAP mode on mechanical ventilators (76.2%), followed by NIPPV (76.2%); heated, humidified high-flow nasal cannula (HHHFNC) (61.9%); and nHFOV (11/21 units; 52.4%). A total of 5/11 units reported frequent nHFOV use (in two or more newborns/month) in both term and preterm infants. The main indications reported for nHFOV use were CPAP failure (90.9%), hypercapnia (81.8%), and bronchopulmonary dysplasia (72.7%). Face/nasal masks and short binasal prongs are the most commonly used nasal interfaces (90.9% and 72.7%, respectively). Air leaks at the interface level (90.9%), thick secretions (81.8%), and airway obstruction (63.6%) were the most frequently mentioned adverse effects of nHFOV. Only three of the NICUs had a written protocol for nHFOV use. Most units not yet using nHFOV cited lack of equipment, experience, training, or insufficient information and evidence for the clinical use and outcome of nHFOV use in neonates as the main reasons for not implementing this noninvasive respiratory mode. Conclusions: Our survey showed that nHFOV is already used in more than half of the Romanian level III NICUs to support term and preterm infants with respiratory distress despite a lack of consensus regarding indications and settings during nHFOV. Full article

(This article belongs to the Special Issue Diagnosis and Management of Newborn Respiratory Distress Syndrome)

9 pages, 230 KB

Open AccessEditor’s ChoiceArticle

Different Eating Habits Are Observed in Overweight and Obese Children Than in Normal-Weight Peers

by Żaneta Malczyk, Agnieszka Pasztak-Opiłka and Agnieszka Zachurzok

Children 2024, 11(7), 834; https://doi.org/10.3390/children11070834 - 9 Jul 2024

Cited by 4 | Viewed by 2212

Abstract

Background: Obesity is diagnosed in 13.6% of early primary school children in Poland. Its presence at this age increases the risk of obesity occurrence in adulthood. Therefore, it is important to properly shape eating behaviors at the stage of childhood and identify incorrect [...] Read more.

Background: Obesity is diagnosed in 13.6% of early primary school children in Poland. Its presence at this age increases the risk of obesity occurrence in adulthood. Therefore, it is important to properly shape eating behaviors at the stage of childhood and identify incorrect eating styles. Methods: This study aimed to investigate whether overweight and obese children differ significantly from children with normal body weights in terms of their eating styles. For the materials and methods, 43 mothers of overweight or obese children aged 3–10 years and 88 mothers of normal-weight children aged 3–10 years completed a questionnaire related to sociodemographic factors and the Children’s Eating Behaviour Questionnaire. Results: The overweight and obese children, compared with normal-weight children, scored higher on the food responsiveness (p = 0.009) and emotional overeating (p = 0.013) scales and lower on the satiety responsiveness (p = 0.025) and slowness in eating scales (p < 0.0001). No significant difference was found for other subscales between the studied groups. In the group of overweight and obese children, the child’s age correlated negatively with enjoyment of food, as did the mother’s BMI with slowness in eating. Conclusions: The results indicate the presence of significant differences in eating styles between normal-weight children and overweight or obese children. Identifying families at high risk of inappropriate eating behaviors and educating them appropriately can reduce the risk of children becoming overweight or obese. Full article

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

10 pages, 820 KB

Open AccessEditor’s ChoiceArticle

Incidence and Characteristics of Pediatric Patients with Acute Otitis Hospitalized in a Romanian Infectious Diseases Hospital

by Vlad Ștefan Pleșca, Anca Streinu-Cercel, Oana Săndulescu, Anca Cristina Drăgănescu, Răzvan Hainăroșie and Anca Doina Pleșca

Children 2024, 11(7), 832; https://doi.org/10.3390/children11070832 - 8 Jul 2024

Cited by 2 | Viewed by 1957

Abstract

Background: Otic involvement is common in children during acute infectious diseases, and is an important cause of morbidity and health service utilization. Methods: We performed a retrospective analysis of pediatric cases hospitalized in the largest infectious disease hospital in Romania between 2018 and [...] Read more.

Background: Otic involvement is common in children during acute infectious diseases, and is an important cause of morbidity and health service utilization. Methods: We performed a retrospective analysis of pediatric cases hospitalized in the largest infectious disease hospital in Romania between 2018 and 2023, with the aim of quantifying the incidence and impact of acute otitis (AO) according to pediatric age subgroups. Results: A total of 1118 cases diagnosed with AO were eligible and included in the analysis. Acute congestive otitis media was the most common subtype, identified in 53.3% of cases, followed by acute purulent otitis media (APOM) in 26.7% of children. The majority of AO cases (69.9%) were diagnosed in the pre-pandemic period (2018–2019), and infants (10.6%), toddlers (49.4%), and preschoolers (29.2%) were the most affected age groups. A viral infection associated with the AO episode was documented in 49.6% of cases. Influenza viruses were most commonly reported (20.5%), followed by SARS-CoV-2 (5.8%), and adenovirus (4.9%). A total of 38 cases of AO were identified in children with measles. In 15.9% of APOM cases, Streptococcus pneumoniae was isolated by culture from otic secretions. The duration of hospitalization was longer in children with APOM and acute otitis externa compared to the other subtypes of AO (p < 0.001). Conclusions: Our study highlights the importance of ENT (ear, nose, and throat) monitoring in children hospitalized for acute infectious diseases, as the majority of AO cases occur in the context of a viral infection. These findings emphasize the necessity for tailored assessment and intervention in suspected cases of AO, especially in young children under 5 years of age. Full article

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

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11 pages, 2460 KB

Open AccessEditor’s ChoiceArticle

Do Gender and BMI Affect the Motor Skills of Five-Year-Old Preschoolers Differently?

by Marcos Mecías-Calvo, Fernando Carregal-San Emeterio and Rubén Navarro-Patón

Children 2024, 11(7), 829; https://doi.org/10.3390/children11070829 - 7 Jul 2024

Cited by 1 | Viewed by 1556

Abstract

Background/Objective: Weight gain is associated with numerous health complications and constitutes a serious public health problem. Motor competence (MC) can be a protective factor since children’s participation and practice in physical activities can improve their health. The objective of this study was to [...] Read more.

Background/Objective: Weight gain is associated with numerous health complications and constitutes a serious public health problem. Motor competence (MC) can be a protective factor since children’s participation and practice in physical activities can improve their health. The objective of this study was to investigate the impact of gender and BMI on MC [i.e., manual dexterity (MD), aiming and catching (A&C), balance (Bal), and total MC percentile (TP)] depending on gender (boy/girl) and BMI (normal weight, overweight or obesity). Methods: The MABC-2 battery was applied in a sample of 368 preschool children (5.69 ± 0.28 years of age; 54.9% girls). Results: Boys and girls showed statistically significant differences in MC components: boys had higher scores in A&C (p = 0.002), while girls excelled in MD (p < 0.001), Bal (p = 0.035); TP (p < 0.001), and BMI [Bal (p = 0.009); TP (p = 0.050)], with a higher percentile in those children with overweight in both cases. Statistically significant differences were also found in the interactions between gender*BMI [MD (p < 0.001) and TP (p < 0.001)]. Conclusions: The findings showed that there were notable variations in total percentile, balance, and manual dexterity between boys and girls. In addition, girls outperformed boys in all categories save aiming and catching. However, males who were overweight or obese earned greater percentiles in both balance and the MABC-2 battery’s total percentile. Full article

(This article belongs to the Special Issue Motor Competence and Physical Activity in School Children)

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19 pages, 3304 KB

Open AccessEditor’s ChoiceArticle

The Accuracy of Digital Impressions versus Conventional Impressions in Neonates with Cleft Lip and/or Palate: A Laboratory-Based Study

by Jyotsna Unnikrishnan, Mahmoud Bakr, Robert Love and Ghassan Idris

Children 2024, 11(7), 827; https://doi.org/10.3390/children11070827 - 6 Jul 2024

Cited by 5 | Viewed by 2294

Abstract

Cleft lip and palate (CL/P) are a common congenital craniofacial anomaly requiring precise impressions for effective treatment. Conventional impressions (CIs) pose challenges in neonates with CL/P due to their delicate oral anatomy. While digital impressions (DIs) are increasingly recognised for their potential benefits [...] Read more.

Cleft lip and palate (CL/P) are a common congenital craniofacial anomaly requiring precise impressions for effective treatment. Conventional impressions (CIs) pose challenges in neonates with CL/P due to their delicate oral anatomy. While digital impressions (DIs) are increasingly recognised for their potential benefits over conventional methods in dentistry, their accuracy and application in neonates with cleft lip and palate (CL/P) remain underexplored. This study aimed to assess the accuracy of DIs compared to CIs in neonates with CL/P, using alginate and putty materials as references. A laboratory-based case–control study was conducted, utilising soft acrylic models resembling neonatal mouths with CL/P. Alginate and putty impressions were obtained conventionally, while digital impressions were captured using an intraoral scanner (IOS). A total of 42 models were analysed, divided evenly into three groups, with each group comprising 14 models. Superimposition and surface discrepancy analyses were performed to evaluate impression accuracy. The results revealed no statistically significant differences between the digital and conventional impressions in their intra-arch measurements and surface discrepancies. The mean measurement values did not significantly differ among groups, with p values indicating no significant variations (p > 0.05), confirmed by an analysis of variance. High intra-examiner reliability with Intra Class Coefficient (ICC) values close to 1 indicated consistent measurements over time. The current study demonstrates that DIs are equally accurate as conventional alginate and putty impressions in neonates with cleft lip and palate, offering a viable and less invasive alternative for clinical practise. This advancement holds promise for improving the treatment planning process and enhancing patient comfort, particularly in vulnerable neonatal populations. Further research is warranted to explore the clinical implications and factors affecting DI accuracy in this population. Full article

(This article belongs to the Special Issue Congenital Cleft Lip and Palate: Diagnosis, Treatment and Management)

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