Pediatric Reports

Background: Adolescence is characterized by physical and psychosocial changes. This implies modifying or implementing correct nutritional habits at an early age, which would have an impact on a healthy adult life. Objectives: The FFQ of dietary patterns has not been estimated in the population of adolescents. Therefore, conducting a pilot, cross-sectional, comparative, and correlational study, we sought to identify frequently consumed foods in an adolescent population. Methods: As part of the methodology, a Food Frequency Questionnaire (FFQ) was given to a non-probability convenience sample of 178 subjects aged 14 to 19 years to evaluate the most frequently consumed foods. Results: This study showed that the diet of Mexican adolescents was characterized with little variability in the foods consumed: 28.20% of the population had a good consumption of milk (1 to 5 serving/day), 16.50% of sugars, and 16% of cereals, while only less than 15% had a good consumption of source animal foods, fruits and vegetables, oils, and fat. Conclusions: Mexican adolescents have demonstrated that their diet is poorly varied. Adolescence is an important period in life that can define habitual dietary intake, and therefore, it is crucial to promote healthy eating at this age. Further research and appropriate public policies are needed. Full article

Objective: Gut dysbiosis has been implicated in the pathology of inflammatory bowel disease (IBD). There is some evidence to suggest that the use of antibiotic treatment can incite an early clinical response or remission when used in conjunction with standard-of-care (SOC) therapy to treat IBD-related flares. Furthermore, antibiotics have been historically investigated for use as a bridge when initiating biologic therapy while waiting for peak biologic treatment effect to occur. This study investigated and compared the time to clinical response when treated with combination antibiotics, metronidazole monotherapy, or SOC therapy in pediatric patients with an active IBD flare. Methods: This study was a retrospective, Institution Review Board-approved, single-centered cohort study which included patients who were less than 18 years of age with a confirmed diagnosis of IBD who received conventional treatment alone or with either combination antibiotic therapy or metronidazole monotherapy to treat an active IBD flare between March 2013 and January 2024. Patients were excluded if they received antibiotic therapy to treat an active infection, had positive stool cultures or enteric pathogen polymerase chain reaction panel, or had colonic disease limited to the rectum. Results: Fifty-nine patients were included and divided into metronidazole monotherapy (n = 18), SOC therapy (n = 20), and combination antibiotics (n = 21). The primary outcome of days to clinical response was not significantly different across all groups; however, patients who received combination antibiotics achieved the fastest time to clinical response (median (IRQ))—4 days (1, 65), compared to 7.5 days (1, 119) for the SOC group and 9 days (2, 217) for the metronidazole group. Secondary outcomes of achievement of clinical response, remission, or failure were determined to be non-significant between all groups. Conclusions: There is no significant difference in time to clinical response, attaining clinical response or remission, or treatment failure rate for patients treated with combination antibiotics, metronidazole monotherapy, or SOC. However, results of this study suggest that the use of combination antibiotics plus SOC may lead to a faster time to clinical response and remission compared to SOC therapy alone. Further studies are warranted to elucidate the role of antimicrobial therapy in management of pediatric IBD. Full article

Background/Objectives: Parenting stress, the emotional strain resulting from the demands of child-rearing, can profoundly affect both parental well-being and children’s emotional and behavioral development. This study examined the impact of maternal parenting stress during early childhood on the longitudinal progression of children’s internalizing, externalizing, and attention deficit hyperactivity disorder (ADHD) symptoms, from early childhood through adolescence. Methods: The study included 406 mother–child pairs from the Rhea mother–child cohort in Crete, Greece. Maternal parenting stress was assessed at age 4 using the Parental Stress Scale (PSS). Children’s symptoms were evaluated at ages 4 (Strengths and Difficulties Questionnaire, ADHD Test), 6, 11, and 15 years (Child Behavior Checklist, Conners’ Parent Rating Scale) through maternal reports. Multivariate mixed regression models, incorporating a random intercept for each child and a random slope for age at follow-up, were used to analyze the trajectories of symptoms from ages 4 to 15. Group-based trajectory modeling was applied to identify trajectory groups from 4 to 15 years, and multinomial logistic regression models were implemented to examine the associations between parental stress and group trajectories. Results: The results revealed that higher parental stress at age 4 was significantly associated with increased internalizing (b = 0.94, 95% CI: 0.68, 1.21), externalizing (b = 1.03, 95% CI: 0.75, 1.30), and ADHD symptoms (b = 0.86, 95% CI: 0.58, 1.14) over the study period. Notably, the impact of parenting stress on behavioral problems decreased with age (interaction with age, p = 0.032). Additionally, higher parenting stress at age 4 was linked to a greater likelihood of belonging to adverse symptom trajectories, including high decreasing, low increasing, and stable high trajectories for both internalizing and externalizing problems. Conclusions: These findings underscore the importance of early maternal parenting stress as a predictor of long-term emotional and behavioral difficulties in children, emphasizing the need for early intervention programs that support maternal mental health and children’s emotional development. Full article

Cannabinoid hyperemesis syndrome (CHS) is characterized by a pattern of cyclic vomiting and abdominal pain despite an absence of an organic cause, occurring in regular cannabis users. This syndrome was first described in 2004. Initially considered rare, with the increased use and legalization of cannabis, a growing incidence of diagnoses has been observed. Data on the pediatric population are still scant despite the high rate of cannabis consumption in young people. In this narrative review, we aim to synthesize the growing knowledge about CHS and its epidemiology, pathophysiology, diagnosis, and management in the pediatric population. Findings in this review highlight the diagnostic challenges in pediatric patients, the limited efficacy of standard anti-emetic therapies, and the central role of cannabis cessation in treatment. This review underscores the need for increased awareness of CHS in pediatric practice to ensure timely diagnosis and avoid unnecessary investigations and interventions. Full article

Background: This study examined treatment outcomes for cannabis use disorder (CUD) among adolescents (12–17 years old) in the United States. Methods: Data from the 2018–2021 Treatment Episode Data Set-Discharges (TEDS-D) included 40,054 adolescents diagnosed with CUD. Descriptive statistics, Chi-square tests, and multivariable logistic regression assessed treatment outcomes and factors associated with treatment completion. Results: Only 36.8% of adolescents completed treatment. The most common reasons for not completing treatment were dropping out (28.4%) and transferring to another facility/program (17.0%). Males and Black non-Hispanic adolescents had lower odds of completing treatment (OR = 0.79, 95%CI: 0.75–0.84), while Hispanic (OR = 1.13, 95%CI: 1.08–1.18), Asian (OR = 1.56, 95%CI: 1.3–1.86) and Native Hawaiian/Pacific Islander adolescents (OR = 2.31, 95%CI: 2.04–2.61) had higher odds of completion compared to their White counterparts. Independent living arrangements, homelessness, arrests in the past 30 days and younger age (<15 years old) decreased the likelihood of treatment completion. Adolescents with co-occurring mental health and substance use disorders also had lower completion rates (OR = 0.79, 95%CI: 0.77–0.86). Referral from schools/employers and treatment settings were associated with a higher success, particularly with stays of 4–6 months and 7–12 months. Conclusion: This study highlights the need for targeted CUD treatment programs that support at-risk adolescents, especially those experiencing homelessness or facing legal issues. High dropout and transition rates suggest a need for continuity of care and program integration between facilities. Strengthening coordination among public health officials, community organizations, and stakeholders is essential to developing culturally responsive treatment interventions that address social determinants of health, substance use, and mental health in this vulnerable population. Full article

Objectives/Background: Aarskog–Scott syndrome (AAS), also known as faciogenital dysplasia, is a rare X-linked genetic disorder primarily characterized by its diverse physical manifestations. Previous evidence suggests a potential association between AAS and neurodevelopmental disorders, including autism spectrum disorder (ASD). Methods: This case study presents a male adolescent with ASD and a novel genetic variant in FGD1 underlying AAS. We conducted comprehensive clinical, genetic, and behavioral assessments to characterize the neurodevelopmental presentation. Moreover, we examined the existing literature on AAS and comorbid neurodevelopmental disorders. Results: The patient demonstrated features consistent with both AAS and ASD, presenting with characteristic physical features of AAS and meeting diagnostic criteria for ASD on both ADI-R and ADOS-2. Cognitive assessment revealed above-average nonverbal IQ (Leiter-3, NVIQ = 115), while adaptive functioning was notably impaired (Vineland composite score = 65). Executive function deficits were identified through several assessments, though ADHD diagnostic criteria were not met. The literature review considered 64 studies, including 151 individuals with AAS. ASD was observed in 4.0%, Attention Deficit/Hyperactivity Disorder (ADHD) in 10.6%, and Intellectual Disability (ID) in 14.2% of cases. Conclusions: The combination of ASD with preserved nonverbal intelligence but impaired adaptive functioning in this AAS case demonstrates the complex neurodevelopmental manifestations possible in this rare genetic condition. The prevalence of neurodevelopmental disorders among people with AAS may be higher than their prevalence in the general population. However, a comprehensive assessment of developmental progress was rarely performed in previous studies, which may lead to systematic underestimation of co-occurring neurodevelopmental difficulties in AAS. Full article

Purpose: Suicide is a leading cause of death among children and adolescents worldwide. This study examined the prevalence and characteristics of suicides among children and adolescents (aged ≤ 19 years) over a 13-year period in the broader area of Athens, Greece. Key aspects analyzed included victim demographics, circumstances surrounding the incidents, and methods employed. Methods: A retrospective analysis was conducted on autopsy cases performed at the Department of Forensic Medicine and Toxicology, National and Kapodistrian University of Athens, from 1 January 2011, to 31 December 2023. Results: Out of 5819 autopsies conducted between 2011 and 2023, 371 were classified as suicides. Among these, 12 cases (representing 3.2% of suicides) involved children and adolescents aged ≤ 19 years and met the study’s inclusion criteria for detailed forensic analysis. The average age of the victims was 17.7 ± 2.1 years (range: 14–19), with males representing 58.3% of cases. Hanging was the most common method of suicide (9 cases, 75.0%), followed by firearm use, falls from height, and hydrogen sulfide inhalation (one case each). Death occurred in the home in 10 cases (83.3%), with 6 specifically taking place in the bedroom. Scars indicative of prior self-harming behavior were present in two cases (16.7%), while suicide notes were found in three cases (25.0%). Toxicological analysis revealed alcohol and cannabis use in one case, cannabis alone in one case, and alcohol alone in two cases. Four victims (33.3%) had a documented psychiatric diagnosis, with two of them under antidepressant treatment at the time of death. Conclusions: This study highlights the forensic value of autopsy-based investigations in unveiling hidden patterns of adolescent suicidality and informs targeted prevention strategies. Integrating medico-legal findings into public health responses may enhance early identification and intervention in vulnerable youth populations. Full article

Objectives: To assess the safety and efficacy of adenotonsillectomy (AT) for treating uncomplicated pediatric obstructive sleep apnea (OSA) in children of different ages. Methods: A systematic search was conducted in four electronic databases, and 71 studies with a total of 9087 participants were included in the analysis. The studies were all before-and-after studies, cohort studies, and randomized controlled trials. Surgical results were analyzed according to age, disease severity, and follow-up duration. Results: Children younger than 7 years at the time of AT had a significantly greater decrease in disease severity, a greater decrease in hypoxemic burden, improved sleep quality, and improved cardiovascular function than children older than 7 years. Both cognitive and behavioral performance improved postoperatively, although these changes were more significantly associated with the duration of follow-up than with age at surgery. Notably, the rate of surgical complications was much greater in children under the age of 3. Conclusions: The current evidence indicates that AT is performed optimally between the ages of 3 and 7 years, offering the greatest chance of disease resolution and remission of associated conditions, balanced with a reduction in surgical risk. We highly recommend conducting high-quality randomized controlled trials to further inform the clinical guidelines for pediatric AT. Full article

Background: Antenatal ultrasonography measurements of the estimated fetal weight (EFW) are a critical point in the decision-making process of obstetric planning and management to preserve the safety of both the newborn and the mother. This study aims to investigate the accuracy of ultrasonography to measure the EFW in comparison with the actual birth weight (BW) measured immediately after delivery. Methods: In this retrospective study, electronic records of 270 newborns who fulfilled the inclusion criteria were retrieved. A structured data sheet was used to collect the EFW, calculated by the Hadlock A formula using real-time ultrasound imaging on the day of delivery or the day before, and the actual BW immediately after delivery. Results: Out of 270 fetuses, 53.7% (145) were female, and 46.3% (125) were male. The mean BW was 2918.1 ± 652.81 g (range: 880 to 5100). The mean EFW was 3271.55 ± 691.47 g (range: 951 to 4942). The mean gestational age was 38 ± 2.48 weeks (range: 29 to 42). Spearman’s rho correlation test revealed strong compatibility between EFW and BW (r = 0.82, p < 0.001). Linear regression analysis showed a strong correlation between EFW and BW (R = 0.875, R² = 0.766, and p < 0.001). The cross-tabulation test showed 86.8%, 78.4%, and 26.9% compatibility between measurements of EFW and the true BW in group-1 (<2500 g), group-2 (2500–4000 g), and group-3 (>4000 g) fetuses (p< 0.001). Conclusions: EFW using ultrasonography yields high compatibility with the actual BW. Despite the slight overestimation, ultrasonography provides high clinical value in obstetric assessment and subsequent management. Full article

Background/Objectives: In research on the relationship between pubertal timing and adolescent health, more attention is typically given to early rather than late maturation, as well as the associated risk of engaging in health-compromising behaviors. The aim of this study was to assess changes in HRQL (health-related quality of life) depending on subjectively perceived pubertal timing, measured in five categories. Methods: A cross-sectional online survey was conducted in spring 2024 in a western region of Poland (N = 9411; mean age 15.15 ± 1.56 years). Mean KIDSCREEN-27 index scores were compared according to self-reported pubertal timing, and five relevant general linear models were estimated, adjusting analyses for respondents’ age, sex, and the remaining four HRQL scores. Results: In the study group, 49.0% of students assessed their pubertal timing as typical, 28.5% as earlier, and 22.5% as later compared to peers of the same sex. For all five KIDSCREEN-27 dimensions, adolescents who matured at a pace perceived as typical achieved the highest quality-of-life index scores. Significantly earlier or significantly later pubertal timing was associated with a notable decrease in these indices. Some significant interactions were identified between sex or age and pubertal timing as predictors of HRQL. The strongest association with pubertal timing was observed for the Psychological Well-being dimension, where differences unfavorable to older age groups were additionally linked to delayed pubertal timing. Conclusions: Greater awareness of the relationship between perceived pubertal timing and adolescents’ well-being is warranted among preventive care physicians, parents, and school psychologists and educators. Full article

Background/Objectives: Increased burdens on caregivers of infants and toddlers significantly affect caregivers’ quality of life and health. Although adequate care during infancy contributes to child development and special health care needs affect caregiver burden, the risk factors for and protective factors against increased caregiver burden remain unclear. We aimed to evaluate children’s health care needs and required caregiving time and identify factors associated with increased caregiver burden. Methods: We conducted an online survey of 287 Japanese caregivers who were randomly selected from a web panel and were raising children aged <4 years. The survey comprised a sociodemographic data form, Children with Special Health Care Needs (CSHCN) Screener, caregiving time survey form, and questions on increased burden. Needs and caregiving time were evaluated by dividing the participants into CSHCN and non-CSHCN groups. Related factors were analyzed using increased burden as the dependent variable. The chi-square test, Mann–Whitney U test, and modified Poisson regression were used for data analysis. Results: Among the children of the 287 participating caregivers, 16.4% were identified as CSHCN, while 96.9% had no specific diagnosis. Overall, 38.3% of the CSHCN group met only one of the five CSHCN Screener items. The CSHCN group spent significantly more time providing and arranging/coordinating health care. The non-CSHCN group spent significantly more time providing daily care. After adjusting for covariates, increased caregiver burden was significantly associated with a younger age of the child, more caregiving time required 6 months prior to the survey, and providing care for CSHCN. Conclusions: To help reduce the burden of childcare on caregivers of infants and young children, children’s needs should be identified and generous childcare provided from an early age. Early identification of CSHCN and appropriate support for families may help reduce caregiver burden during early childhood. Full article

Background: The maternal microbiota serve as a key regulator of neonatal immune development and early-life health outcomes. This systematic review aims to find out how the makeup of the maternal microbiota affects newborn immunity and the risk of allergies, identify which microbes are linked to a higher or lower chance of allergies, and assess treatments that could improve newborn immune health. Methods: We conducted a systematic search in PubMed, MEDLINE, and Web of Science, adhering to the PRISMA guidelines. We included randomized controlled trials (RCTs), cohort studies, and observational studies that looked at how the makeup of the maternal microbiota affects newborn immune responses or allergic outcomes in early life. We conducted a systematic search, and the quality of the studies was evaluated using the GRADE system and tools to check for bias (RoB 2, Newcastle–Ottawa Scale, MINORS). Results: We included a total of 74 studies. The main findings showed that having a cesarean delivery and using certain antibiotics during pregnancy increased the risk of allergies, while breastfeeding, taking probiotics, and changing the mother’s diet helped to protect against allergies. Maternal stress had a negative association with the microbiota composition (OR = 1.9–2.4) and neonatal immune regulation. Moreover, the study noted significant geographic variation in the microbiota’s influence, underscoring the importance of contextualized interventions. Conclusions: The composition of the maternal microbiota has a major impact on neonatal immunity and the risk of early-life allergy. Adverse factors include cesarean birth, antibiotic exposure, and maternal stress, all of which have been associated with alterations in neonatal immunity. More studies are required to validate promising microbiota-targeted strategies and develop evidence-based guidelines to improve maternal and neonatal immune health. Full article

Background/Objectives: Emotional eating has been recognized as the tendency to eat in response to emotions, being recognized as a crucial risk factor for recurrent weight gain. Emotional eating has been interrelated with obesity/overweight, depression, anxiety, stress, and specific dietary habits at any stage of human life, negatively affecting human quality of life. The present study aims to summarize and explore the effects of emotional eating on children and how these effects may, in turn, influence their mental and physical health at the next stages of their lives. Methods: This is a narrative review of the presently existing clinical evidence concerning the impact of emotional eating in children. A comprehensive search of the most reliable online databases, e.g., PubMed, Scopus, Web of Science, and Google Scholar, was performed utilizing relevant keywords. Several inclusion and exclusion criteria were used to collect only cross-sectional, longitudinal, descriptive, and case–control surveys in children’s populations. Results: The current clinical evidence suggests that parental behavior may increase the risk of emotional eating in children. Several pieces of evidence also implied potential associations of emotional eating with overweight/obesity and mental disorders in children. Children’s dietary habits may also affect their risk of developing emotional eating. Conclusions: The prevalence of emotional eating is gradually increasing in the general population, and especially in children. Public strategies should be performed to educate parents to recognize potential emotional eating behaviors in their children and to adopt more healthy dietary habits for their children, even in the first months of their life. Educational programs should be organized in school communities to directly educate children on the benefits of healthy dietary patterns. Full article

Neuroimaging has emerged as an innovative and essential tool for understanding the intricate relationship between brain development, emotions, and behavior. Investigating the neurobiological mechanisms underlying this interaction during the critical phase of brain maturation is crucial for promoting individual psychological well-being and mitigating the profound impact of mood disorders during childhood. This narrative scoping review synthesizes current pediatric neuroimaging evidence, filling a gap in the literature by integrating structural, functional, and emerging modalities, to provide clear translational pathways for clinical and behavioral observations. The contribution of major neuroimaging techniques, including fMRI, PET, DTI, and sMRI, is analyzed, emphasizing their ability to detect structural and functional alterations associated with mood disorders, enabling early diagnosis and personalized therapeutic strategies. Furthermore, the potential of these technologies to monitor the effects of psychotherapy is explored, demonstrating how such interventions can modulate neural circuits and enhance emotional processing. Despite significant advancements and growing interest, challenges remain, including the complexity of data interpretation, technological limitations, and ethical considerations related to the use of these interventions in pediatric populations. This review synthesizes the most recent scientific evidence, underscoring the potential of neuroimaging to improve diagnostic accuracy and therapeutic outcomes, while outlining future research directions aimed at enhancing interventions for children and adolescents with mood disorders. Full article

To evaluate and compare the awareness and implementation of children’s rights in pediatric hospital settings from the perspectives of parents and children, this study emphasizes ethical considerations in healthcare, focusing on communication practices, privacy, and participation rights. Methods: A cross-sectional study was conducted in the largest pediatric hospital in Greece between February and April 2023. A total of 250 parents and 150 children participated. Data were collected using a structured questionnaire assessing six domains of children’s rights: access to information, participation, privacy, non-discrimination, play and recreation, and parental support. Statistical analysis included chi-square tests for categorical variables, with significance set at p < 0.05. Results: Significant discrepancies were identified between parents and children in their awareness of children’s rights. Only 2.9% of children were aware of printed lists of rights, and 46.3% of parents reported not knowing of their existence (p = 0.005). Children evaluated communication practices, such as the use of child-friendly language, more positively than parents (p = 0.02). Parents reported higher satisfaction with explanations of health conditions, treatments, and medication side effects (p < 0.001). Regarding privacy, children rated room allocation and privacy practices during examinations less positively than parents (p = 0.02). Conclusions: The study highlights critical gaps in the communication and implementation of children’s rights within pediatric hospitals. Tailored interventions, including staff training, development of child-friendly materials, and policy adjustments, are necessary to bridge these gaps and ensure an ethically sound healthcare environment that prioritizes the rights and well-being of both children and their families. Full article

Aberrant salience, defined as the inappropriate attribution of significance to neutral stimuli, is increasingly recognized as a critical mechanism in the onset of psychotic disorders. In young individuals at ultra-high risk (UHR) for psychosis, abnormal salience processing may serve as a precursor to full-blown psychotic symptoms, contributing to distorted perceptions and the onset of psychotic ideation. This review examines current literature on aberrant salience among UHR youth, exploring its neurobiological, psychological, and behavioral dimensions. Through a comprehensive analysis of studies involving neuroimaging, cognitive assessments, and symptomatology, we assess the consistency of findings across diverse methodologies. Additionally, we evaluate factors contributing to aberrant salience, including neurochemical imbalances, dysregulation in dopamine pathways, and environmental stressors, which may jointly increase psychosis vulnerability. Identifying aberrant salience as a measurable trait in UHR populations could facilitate earlier identification and targeted interventions. Implications for clinical practice are discussed, highlighting the need for specialized therapeutic approaches that address cognitive and emotional dysregulation in salience attribution. Recent research underscores the importance of aberrant salience in early psychosis research and advocates for further studies on intervention strategies to mitigate progression to psychosis among UHR individuals. Full article

Over the past decade, the field of childhood histiocytosis, particularly Langerhans cell histiocytosis (LCH), has undergone transformative changes. The integration of molecular genetics, targeted therapies, and refined diagnostic methodologies has revolutionized patient management and redefined disease classification. This editorial provides a comprehensive overview of the pivotal developments from 2015 to 2025, highlights ongoing challenges, and explores future directions in research and clinical care. Full article

Objectives: Feeding and eating disorders (FED) represent a major public health issue and are the second leading cause of death among psychiatric conditions in children and adolescents. Psychopathological comorbidities play a significant role in the onset and persistence of FED, yet research on their underlying structure remains limited. This study explores the psychiatric comorbidities associated with FED, focusing on common etiopathogenetic factors and their clinical implications. Methods: Data were retrospectively collected from the Italian Regional Center for FED in the Emilia-Romagna Region between June 2023 and April 2024. Diagnoses were assigned following DSM-5 criteria using the Italian version of the semi-structured K-SADS-PL diagnostic interview. Principal component analysis (PCA) was performed to identify latent psychological dimensions underlying FED psychopathology, retaining five components based on the scree plot. Additionally, an analysis of covariance (ANCOVA) was conducted to examine differences in factor scores across FED subtypes, while adjusting for potential confounders. Results: Seventy-two participants were included (mean age: 14.6 years; mean BMI: 18.3 kg/m²; male-to-female ratio: 1:8). Diagnoses were distributed as follows: 63.9% anorexia nervosa (AN), 13.9% other specified feeding and eating disorder (OSFED), 6.9% avoidant restrictive food intake disorder (ARFID), 4.2% binge eating disorder (BED), 4.2% unspecified feeding and eating disorder (UFED), and 2.7% bulimia nervosa (BN). All participants met the criteria for at least one psychiatric comorbidity. Identified psychopathological clusters include the following: (1) mood disorders (66.5%); (2) anxiety disorders (87.5%); (3) obsessive–compulsive and related disorders (47.2%); (4) neurodevelopmental disorders, i.e., attention-deficit/hyperactivity disorder (ADHD) (30.5%); (5) disruptive and impulse-control disorders (13.9%); and (6) psychotic symptoms (40.3%). No instances of tic or elimination disorders were detected. Conduct disorder was more prevalent among UFED, BED, and BN patients compared to other FED (p = 0.005), and moderate/severe ADHD was associated with higher body mass index (BMI) (p = 0.035). PCA revealed distinct psychological dimensions underlying FED, while ANCOVA indicated significant differences in factor scores across FED subtypes, supporting the presence of shared transdiagnostic mechanisms. Conclusions: This study highlights the complex interplay between FED and psychiatric comorbidities, emphasizing the need for early intervention and personalized treatment approaches. The dimensional structure identified through PCA suggests that common psychopathological factors may drive FED development, and ANCOVA findings support their differential expression across FED types. Future research should further investigate these transdiagnostic mechanisms to optimize clinical care. Full article

Munchausen Syndrome by Proxy (MSBP) is recognized as a form of child abuse in which a caregiver induces or fabricates illnesses in their child to gain medical and social attention. MSBP represents one of the most complex and insidious forms of child abuse, characterized by an ambiguous clinical presentation that poses significant challenges for physicians, psychiatrists, and social workers. However, this condition raises critical questions regarding its diagnosis, management, and forensic implications. Traditionally, MSBP has been framed as an individual pathological manifestation of the mother, overlooking the role of the healthcare and legal systems in its identification and management. In this article, we propose a critical reflection on MSBP, emphasizing how the issue is not merely a “parental failure” but rather a systemic failure of healthcare, social, and judicial institutions in recognizing, preventing, and effectively managing such cases. Full article