Children doi: 10.3390/children13060792

Authors: Margarita Panova Maria Spasova Snezhana Stoencheva Teodora Dimcheva Iglika Sotkova-Ivanova Pamela Boykova

Background: The use of low-molecular-weight heparins (LMWH) for the treatment and prevention of thromboembolic diseases in pediatric patients is increasing, although optimal dosing and monitoring strategies remain insufficiently defined. Methods: This study was conducted at the Clinic of Pediatrics, University Hospital “St. George”, and included 26 hospitalized patients aged 0–18 years with confirmed arterial or venous thrombosis receiving treatment or prophylaxis with enoxaparin. A total of 42 samples were analyzed. Anti-factor Xa activity was measured using an LMWH-calibrated anti-FXa assay (Innovance Heparin, Siemens Healthineers) on a Sysmex CS-2500 analyzer. Therapeutic and prophylactic dosing followed CHEST 2012 guidelines. The study evaluated age- and weight-based dosing, the number of dose adjustments required to achieve target Anti-Xa levels, and the relationship between Anti-Xa levels and anticoagulant response. Results: The mean baseline Anti-Xa level achieved with the initial weight-based dose (1.0 mg/kg/12 h) was significantly lower in children aged 1–2 years compared with older age groups. Older children, as well as patients with oncological and nephrological diseases, achieved higher anticoagulant levels with standard prophylactic dosing. Age under 1 year, oncological disease, and baseline Anti-Xa level < 0.3 IU/mL were identified as independent predictors of the need for more frequent dose adjustments to achieve a therapeutic response. Conclusions: Monitoring of Anti-factor Xa levels is essential in pediatric patients receiving LMWH for both treatment and prophylaxis. Standard dosing regimens may be insufficient in younger children and specific clinical subgroups, supporting the need for individualized dosing strategies.

Children doi: 10.3390/children13060791

Authors: Joungmin Kim

Background/Objectives: Children’s mental health and positive development are shaped by family, environmental, and individual factors. Although neurodevelopmental disabilities (NDDs) are well-established correlates of poorer mental health outcomes, few national-scale studies have simultaneously modeled positive (flourishing) and negative (anxiety, depression) outcomes within a unified ecological framework. This study examined how parent mental health, peer victimization, neighborhood and school context, and four NDD diagnoses (autism spectrum disorder [ASD], attention-deficit/hyperactivity disorder [ADHD], developmental delay, and learning disability) are associated with flourishing, current anxiety, and current depression in a national sample of U.S. children aged 6–17 years. Methods: Cross-sectional data from the 2023–2024 National Survey of Children’s Health (NSCH; N = 71,172) restricted to ages 6–17 with complete data (unweighted n = 64,263; weighted population estimate ≈ 44.6 million children) were analyzed using Complex Sample logistic regression (SPSS 30), accounting for stratified design (state × stratum), household clustering, and sampling weights. Three hierarchical models were estimated for each outcome. NDD-stratified subgroup analyses (n = 13,971; weighted ≈ 8.6 million) triangulated moderation findings. Multiple imputation (m = 5) sensitivity analyses confirmed robustness. Results: Weighted prevalence was 60.7% for flourishing, 13.2% for current anxiety, and 5.1% for current depression. In Block 2 models, poorer parent mental health and more frequent bullying victimization were robustly associated with all outcomes (flourishing OR = 0.62 and 0.65; anxiety OR = 1.64 and 1.63; depression OR = 1.95 and 1.75; all p < 0.001). Supportive neighborhood (flourishing OR = 1.40, depression OR = 0.80) and safe school (flourishing OR = 1.20, anxiety OR = 0.87) were protective. ADHD was the strongest disability-specific correlate (flourishing OR = 0.29; anxiety OR = 4.69; depression OR = 4.27). Three of the twelve interaction terms were significant, all involving ADHD. Relative to children without any NDD, subgroup analyses suggested attenuated associations of parent mental health and bullying with anxiety and depression among children with any NDD (e.g., bullying on anxiety: no-NDD aOR = 1.73 vs. Any-NDD 1.52); however, formal interaction tests identified ADHD as the only significant moderator of these associations. On the absolute-risk scale, however, the increase in internalizing problems with more frequent bullying was larger in children with ADHD. Conclusions: Family mental health support and bullying prevention are universally relevant levers for improving children’s mental health and flourishing. Although attenuation of the odds-ratio associations was observed primarily in ADHD-related analyses, specifically for the internalizing outcomes (anxiety and depression), universal anti-bullying and parent mental health interventions remain relevant for children with NDDs, supporting integration into pediatric clinical and public-health programs alongside disability-specific support pathways.

Children doi: 10.3390/children13060790

Authors: Vilma Ivanauskienė Aušrelė Kudrevičienė Vaida Aleksejūnė Renata Dzikienė Ilona Aldakauskienė Rasa Tamelienė

Preterm birth remains a major global health concern, affecting approximately one in ten neonates, with an estimated 15 million infants born prematurely each year. Prematurity and clinical factors such as antibiotics, cesarean delivery, and limited access to mother’s own milk disrupt microbiota development in VLBW infants; although human milk supplies nutrients and a microbial community, its composition and clinical role are not yet well understood. However, the composition and clinical significance of the human milk microbiota (HMM) in VLBW infants remain insufficiently characterized. Background: This review aims to summarize recent evidence (2021–2025) on the microbiome of MOM in mothers of VLBW (<1500 g) preterm infants and to evaluate its potential role in neonatal health. Methods: The study used a systematic literature review, searching PubMed and Google Scholar with predefined criteria and keywords. Results and Conclusions: MOM microbiota of VLBW in infants is dominated by Staphylococcus, Enterococcus, Streptococcus, Enterobacteriaceae, and Acinetobacter, with lower levels of Veillonella, Clostridium sensu stricto, Pseudomonas, Haemophilus, and Bifidobacterium; its diversity increases over lactation, and feeding type influences infant gut colonization and immune development, though links to necrotising enterocolitis (NEC) remain limited. Further research using multi-omic approaches is needed to clarify these mechanisms and their clinical implications.

Children doi: 10.3390/children13060789

Authors: Camille Schunder Agnès Gras-Vincendon François Brezin

Introduction: Medical care for transgender minors is understudied, largely because these forms of care are relatively recent. The primary objective of this work was to describe the cohort of transgender adolescents who initiated follow-up at the Strasbourg University Hospital before the age of 18, whether or not they began hormone therapy prior to reaching adulthood. Method: This was an observational, retrospective, single-center, descriptive study conducted among adolescents who had attended at least one consultation in our center before the age of 18 between January 2017 and March 2024. Results: Our population consisted of 115 patients predominantly made up of transmasculine (AFAB) adolescents (68%). Compared with the general population, we observed significantly higher rates of psychiatric co-occurrences, autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD). Only 46.1% initiated gender-affirming hormone therapy (GAHT) in our cohort, and just 34.8% before age 18. A total of 6% of adolescents received puberty blockers as monotherapy. The mean age at GAHT initiation was 16.99 years. Transition pathways appear to differ according to the adolescent’s type of schooling. The rate of retransition/treatment interruption in our sample ranged from 0% to 6.1%, depending on the criteria applied. We did not identify any adolescent who retransitioned to their sex assigned at birth after starting GAHT by the end of the data collection. Discussion: The high prevalence of psychiatric co-occurrences raises important questions regarding how to improve care for these adolescents. The predominance of AFAB adolescents similarly prompts reflection on the barriers that transfeminine adolescents may face when seeking to transition before adulthood. In addition, the substantial number of adolescents presenting with ASD or ADHD underscores the need for particular vigilance regarding their specific needs and overall well-being. Finally, the variability in retransition rates depending on the criteria applied highlights the absence of a consensual definition, which limits the comparability and validity of existing studies. Conclusions: Long-term prospective studies are needed to objectively demonstrate the effectiveness of current transition pathways. Academic research in this field should be strengthened, along with the development of larger prospective datasets, to improve the overall health of this population.

Children doi: 10.3390/children13060788

Authors: Agata Maria Kawalec-Rutkowska Anna Kawalec Katarzyna Kiliś-Pstruśińska

Abnormalities of the urachus detected in infancy and early childhood are often interpreted as persistent congenital abnormalities requiring surgical correction. However, growing clinical experience suggests that a proportion of these findings may reflect ontogenetic immaturity of the urachus rather than fixed pathological conditions. As a transient embryological structure, the urachus undergoes postnatal remodeling and involution, which may explain the spontaneous regression of urachal anomalies observed during follow-up. This paper proposes ontogenetic immaturity of the urachus as a biological substrate for the natural resolution of selected urachal changes, including cystic dilatation and incomplete obliteration. We discuss the developmental background of urachal maturation and emphasize the importance of distinguishing delayed involution from true structural pathology. The clinical implications of this concept are highlighted, with particular focus on the role of careful observation and longitudinal monitoring as an alternative to early surgical intervention in asymptomatic or mildly symptomatic patients. Recognizing ontogenetic immaturity as a reversible developmental state may help reduce overtreatment and support more individualized, developmentally informed management strategies. Integrating principles of developmental biology into clinical decision-making reinforces the value of conservative approaches in selected urachal conditions and under-scores the broader relevance of ontogeny in kidney and urinary tract disease.

Children doi: 10.3390/children13060787

Authors: Indrani Bhattacharjee Catalina Le Cacheux Eric B. Ortigoza Jonathan Dillman Sherwin S. Chan Alain Cuna

Necrotizing enterocolitis (NEC) remains one of the most serious gastrointestinal emergencies in preterm infants, and imaging plays a central role in diagnosis and clinical management. Historically, evaluation has relied primarily on abdominal radiography, which remains widely available and embedded in established diagnostic frameworks. However, the hallmark radiographic signs of NEC (i.e., pneumatosis intestinalis, portal venous gas, and free air) reflect relatively advanced manifestations of intestinal injury that indicate established mucosal disruption or transmural necrosis. Bowel ultrasound has increasingly complemented radiography by enabling real-time assessment of bowel wall integrity, perfusion, motility, and intra-abdominal fluid, providing physiologic information that may refine clinical interpretation and monitoring of disease progression. Expanding use of neonatologist-performed bowel ultrasound may further improve access to bedside intestinal imaging and facilitate more timely evaluation in neonatal intensive care settings. In parallel, emerging imaging technologies seek to extend the capabilities of conventional imaging by interrogating biologic processes that underlie intestinal injury. Modalities such as contrast-enhanced ultrasound, ultra-high-frequency ultrasound, and photoacoustic imaging offer the potential to characterize bowel microvascular perfusion, tissue oxygenation, and microstructural changes that may precede overt radiographic abnormalities. Complementary physiologic monitoring approaches are also being explored to identify infants at risk before clinical disease develops. Techniques including superior mesenteric artery Doppler, near-infrared spectroscopy, bowel acoustic monitoring, and electrogastrography aim to detect early alterations in intestinal perfusion, oxygenation, and motility. In addition, artificial intelligence applied to imaging and physiologic data may enhance pattern recognition, risk stratification, and clinical decision support. Together, these advances suggest that NEC evaluation is evolving from a paradigm focused on detecting late structural injury toward integrated approaches capable of identifying intestinal vulnerability earlier and monitoring disease more precisely.

Children doi: 10.3390/children13060786

Authors: Jakub S. Gąsior

Fundamental movement skills (FMSs), typically categorized into locomotor, object control, and stability skills, constitute the essential building blocks for more complex physical activities and are essential for participation in everyday tasks, sports, and physical activities [...]

Children doi: 10.3390/children13060785

Authors: Taufiq Hidayat Irwanto Irwanto Ali Rohman Shabrina Nur Imanina Ayurveda Zaynabila Heriqbaldi Bagas Triambodo Afrizal Alif Azzam Muhyiddin Achmad Ari Pratama Mahrus A. Rahman I Ketut Alit Utamayasa Nur Syamsiatul Fajar Mochamad Amin

Background/Objectives: Ventricular septal defect (VSD) is the most common congenital heart disease in children and is often associated with growth impairment and malnutrition. Increased metabolic demand, feeding difficulties, and recurrent infections contribute to poor nutritional status. Insulin-like growth factor-1 (IGF-1), a key mediator of growth hormone activity, reflects nutritional and metabolic conditions. Previous studies have evaluated endocrine and growth abnormalities in heterogeneous congenital heart disease populations. However, data specifically examining the relationship between serum IGF-1 levels and nutritional status in isolated pediatric ventricular septal defect remain limited, particularly in Southeast Asian populations. Methods: The single centre observational case–control study was conducted at Dr. Soetomo Hospital, Surabaya, involving 110 children (55 VSD patients and 55 healthy controls). VSD diagnosis was confirmed by echocardiography. Nutritional status was assessed using WHO anthropometric criteria. Serum IGF-1 levels were measured using ELISA. Statistical analyses compared IGF-1 levels between groups and across nutritional categories. Results: Moderate and severe wasting were more common in the VSD group. Median IGF-1 levels were significantly lower in VSD patients compared to controls (5.18 vs. 21.4 ng/mL; p < 0.001). A positive association between IGF-1 levels and nutritional status was observed. Conclusions: Children with VSD have poorer nutritional status and significantly lower IGF-1 levels compared to healthy controls. This association may be explained by the dysregulation of the growth hormone–IGF-1 axis. IGF-1 may complement nutritional assessment for identifying and monitoring growth impairment and guiding early nutritional interventions in pediatric VSD.

Children doi: 10.3390/children13060784

Authors: Adina Mihaela Frenti Florin Filip Elena Tătăranu Vlad Dima Roxana Axinte Alina Sânzâiana Melinte Mirabela Dima Iulia Ciubotariu Petronela Vicoveanu Smaranda-Ileana Jurchis-Irimie Smaranda Diaconescu

Background and Objectives: Lung ultrasound (LUS) has fundamentally transformed neonatal respiratory diagnostics, offering a radiation-free, bedside-applicable modality capable of guiding surfactant therapy, characterizing pulmonary pathology, and monitoring treatment response in real time. While surfactant replacement therapy is firmly established for neonatal respiratory distress syndrome (RDS), its role in acute complications—specifically pulmonary hemorrhage (PH) and pneumothorax (PTX)—remains uncertain and heterogeneous in clinical practice. This review examines how LUS-based phenotyping can improve the diagnostic precision and therapeutic sequencing of surfactant administration in these high-risk scenarios, and how comorbidities such as hemodynamically significant patent ductus arteriosus, persistent pulmonary hypertension, sepsis, and coagulopathy modulate clinical outcomes. Materials and Methods: We conducted a structured narrative review of studies published from 2020 onward, sourced from PubMed, Web of Science, Semantic Scholar, and Mendeley, using PRISMA-inspired selection principles. The search combined terms including “lung ultrasound,” “neonatal POCUS,” “surfactant therapy,” “pulmonary hemorrhage,” “neonatal pneumothorax,” and “LUS score.” Studies focusing on neonatal populations, clinical LUS applications, and surfactant use in PH and PTX were prioritized. Results: Quantitative LUS scoring systems (range 0–18) predict surfactant need and re-dosing with AUC values of 0.85–0.87, outperforming clinical estimates alone. In PH, LUS reveals dense consolidation with alveolar flooding patterns, guiding the timing of rescue surfactant after hemodynamic stabilization; response monitoring via serial LUS is feasible and informative. In PTX, hallmark signs—absent lung sliding, loss of B-lines, and the pathognomonic lung point—allow diagnosis within seconds, guiding immediate thoracentesis and subsequent surfactant administration if underlying RDS is confirmed. Nationally implemented LUS protocols in neonatal intensive care units have demonstrated significant reductions in radiation exposure without compromising diagnostic accuracy. Conclusions: LUS-guided decision algorithms—integrating ultrasonographic phenotyping, quantitative scoring, and hemodynamic assessment—represent the current best framework for individualizing surfactant therapy in neonatal PH and PTX. Standardization of POCUS training and protocol implementation in neonatal units is essential. Prospective multicenter trials are urgently needed to define optimal indications, timing, and dosing in these vulnerable populations.

Children doi: 10.3390/children13060783

Authors: Onur Bağcı Aybüke Yazıcı Ayşe Ören Gaffari Tunc Ipek Guney Varal

Objective: Delaying postpartum cord clamping may contribute to neonatal circulation by allowing continued placental transfusion. The timing of cord clamping is still debated and is called delayed cord clamping (DCC) if performed more than 30 s after birth. This study evaluated the effect of DCC on the clinical outcomes of preterm infants. Methods: Preterm infants (gestational age < 30 weeks) admitted to our Level 4 neonatal intensive care unit in 2023–2024 were evaluated retrospectively. Delayed cord clamping at postnatal 60 s was practiced when infants were considered stable. The demographic characteristics and morbidities of infants who did and did not have DCC were compared. Results: A total of 156 infants were included in the study. Of these, 70 infants were in the DCC group, and 86 infants were in the non-DCC group. Median gestational age was 28 weeks (interquartile range [IQR]: 26–30 weeks) and 26 weeks (IQR: 25–28 weeks), and median birth weight was 1000 g (IQR: 780–1300 g) and 850 g (IQR: 685–1095 g), respectively (p < 0.001 for both). The DCC group had a higher rate of antenatal steroid (ANS) use (p < 0.001), higher APGAR scores (p < 0.001), and lower rates of intraventricular hemorrhage (IVH) (p < 0.001), respiratory distress syndrome (RDS) (p < 0.001), bronchopulmonary dysplasia (BPD) (p = 0.013), feeding intolerance (p = 0.01), and mortality (p = 0.016) compared to the non-DCC group. Grade 3 IVH was not observed in the DCC group. In logistic regression analysis, not performing DCC was associated with significantly greater odds of IVH (odds ratio [OR]: 2.92, 95% CI: 1.48–5.77, p < 0.01), BPD (OR: 2.25, 95% CI: 1.18–4.29, p = 0.01), RDS (OR: 3.97, 95% CI: 1.86–8.48, p < 0.001), and mortality (OR: 3.44, 95% CI: 1.21–9.81, p < 0.01). However, these differences were not statistically significant after correcting for birth week, birth weight, Apgar score, and ANS. Conclusions: When applied in preterm infants under 30 weeks of gestational age, DCC can promote hemodynamic stability and reduce morbidities such as IVH and RDS. Also, implementing DCC with unstable infants will provide more conclusive information about its effectiveness.

Children doi: 10.3390/children13060782

Authors: Luciana Margara Inés Piñas-Bonilla Pablo Abián Alfredo Bravo-Sánchez David Ortiz-Sánchez María Ramírez-delaCruz Paula Esteban-García Javier Portillo Carlos Ramírez Javier Abián-Vicén

Background/objectives: Obesity is a multifactorial condition influenced by interactions between genetic susceptibility and environmental factors. The fat mass and obesity-associated (FTO) gene has been widely linked to obesity risk, particularly the rs9939609 polymorphism, which is associated with higher body mass index (BMI) and adiposity. However, evidence in adolescents remains inconsistent, and lifestyle factors such as physical activity and diet may modify genetic risk. The objectives of this study were: (i) to examine the influence of environmental, genetic, physical activity, and dietary factors on the BMI and overweight-related variables of adolescents, and (ii) to assess the impact of the rs9939609 polymorphism in the FTO gene on these variables. Methods: A cross-sectional study was conducted involving 206 adolescents aged 12 to 16 years. Body mass index (BMI), physical fitness, physical activity levels, adherence to the Mediterranean diet, mobile phone usage, and FTO rs9939609 genotyping from buccal swabs were collected. Results: No significant associations were found between the FTO genotype and BMI, or with physical activity, mobile phone usage and dietary habits. Boys showed higher physical fitness and physical activity levels than girls (p < 0.05). The only factor significantly associated with BMI was regular breakfast consumption: adolescents who habitually ate breakfast had a lower prevalence of overweight (χ2 = 7.98, p = 0.005). Conclusions: The rs9939609 polymorphism in the FTO gene was not associated with overweight in this adolescent cohort. The findings underscore the relevance of healthy behaviours, particularly regular breakfast consumption and physical activity, especially among boys, as factors potentially associated with lower prevalence of overweight during adolescence.

Children doi: 10.3390/children13060781

Authors: Velisha Thompson Joyce Shirinde Masilu D. Masekameni Thokozani P. Mbonane

Background/Objectives: Allergic rhinitis (AR) is increasingly recognized in early childhood; however, its prevalence and environmental determinants within urban informal settlements remain under-researched. This study investigated the prevalence and risk factors associated with allergic rhinitis among children under five years old attending preschools in Alexandra Township, Johannesburg. Methods: A cross-sectional study was conducted involving 3265 children. Data were collected through self-reported surveys with caregivers, designed to assess demographic, clinical, and environmental variables. Multivariate logistic regression analysis was employed to determine adjusted odds ratios (AORs) and p-values for potential environmental and clinical risk factors. Results: The findings show a prevalence of 37.3% (n = 1214) for allergic rhinitis, 47.3% (n = 1544) for rhinitis, and 42.7% (n = 1394) for rhinoconjunctivitis. Exposure to open sewerage pipelines was associated with the highest risk (AOR: 4.85, p < 0.001), followed by prolonged residence in the township (greater than 24 months; AOR: 2.74, p < 0.001) and proximity to local waterways (AOR: 1.89, p < 0.001). Additional significant factors included frequent paracetamol consumption and walking to school, while asthma and eczema exhibited an association with the presence of AR. Conclusions: The elevated prevalence of allergic symptoms within this cohort is linked to localized macro-environmental hazards, suggesting that infrastructural challenges in informal urban settings may influence early respiratory health outcomes. Protecting pediatric respiratory health may necessitate multisectoral interventions, with a specific emphasis on ensuring safe sanitation and clean household energy, to complement traditional clinical management in these vulnerable communities.

Children doi: 10.3390/children13060780

Authors: Maddalena Comune Irene Furnari Erika Silvestro Simone Spolaore Federica Percivati Silvia Nurisso Silvia Garazzino Marco Denina

Background: Staphylococcus aureus neonatal osteomyelitis (SA-NOm) is a rare condition with the potential for lifelong skeletal morbidity. Available evidence remains scarce and inconsistent, with notable differences in clinical presentation, therapeutic regimens, and reported outcomes, underscoring the need for a systematic evaluation combining clinical experience with existing literature. Methods: We retrospectively reviewed data from all neonates admitted to Regina Margherita Children’s Hospital, Turin, Italy, between 2017 and 2024 with a diagnosis of SA-NOm. A structured narrative review of the pertinent literature published over the past 25 years was conducted to identify additional cases and compare management approaches. Results: Four neonates with SA-NOm were identified at our center (institutional cohort) while a literature review retrieved 38 additional cases (literature cohort) to establish a combined cohort (n = 42). Of these, 78% were born at term, with a male-to-female ratio of 1.6:1 (26 males, 16 females). Approximately half of the combined cohort presented identifiable risk factors for SA-NOm, including neonatal intensive care unit admission, prematurity, sepsis, or maternal complications. Across the combined cohort, the mean age at presentation was 19 days. The most common presenting signs were local swelling and reduced mobility of the affected limb, although systemic symptoms often complicated early recognition. Long bones were most frequently involved—particularly the femur, humerus, and tibia—with equal distribution between upper and lower extremities. The mean intravenous antibiotic duration for the combined cohort was 31.6 days, followed by two to three weeks of oral therapy. Empiric regimens varied, including glycopeptides alone or combined with second- or third-generation cephalosporins, anti-staphylococcal penicillins, or carbapenems. Sequelae rates were rarely reported in the literature, likely due to limited follow-up, whereas extended surveillance in our cohort revealed substantial long-term morbidity, including restricted joint mobility, limb length discrepancy, and persistent radiographic abnormalities. Conclusions: SA-NOm, due to its rarity and potential for long-term skeletal sequelae, requires early diagnosis and timely empiric antibiotic therapy based on local resistance data. Prospective multicenter studies are needed to define standardized diagnostic and therapeutic protocols.

Children doi: 10.3390/children13060779

Authors: Seung Hwan Baek Young Mi Park Teahyen Cha So Jin Yoon Jung Ho Han Jeong Eun Shin Ho Seon Eun Min Soo Park Joohee Lim Soon Min Lee

Background: Neonatal morbidities are major determinants of clinical outcomes and healthcare utilization in preterm infants. However, population-level evidence quantifying the cumulative contribution of neonatal morbidities to neonatal intensive care unit (NICU) length of stay (LOS) and medical costs remains limited. Methods: We conducted a nationwide retrospective cohort study using the Korean Health Insurance Review and Assessment Service database. Preterm infants admitted to NICUs between 2020 and 2023 were identified. After exclusions, 30,034 infants with complete birth weight data and 31,240 with complete gestational age data were included. Major neonatal morbidities—including bronchopulmonary dysplasia (BPD), patent ductus arteriosus (PDA), sepsis, intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), and periventricular leukomalacia (PVL)—were identified using ICD-10 odes. Associations of individual morbidities and cumulative morbidity burden with NICU LOS and medical costs were evaluated using multivariable regression and generalized linear mixed models. Results: Mean NICU LOS was 26.5 days, and mean total medical cost was 41.9 million KRW. All major morbidities were associated with prolonged LOS and increased costs. BPD showed the strongest association with LOS, whereas NEC and sepsis were associated with the highest costs. NICU LOS and medical costs increased in a stepwise manner with increasing numbers of morbidities; each additional morbidity was associated with an 8.0-day increase in LOS and a 32.5 million KRW increase in medical costs (both p < 0.001). Conclusions: Greater cumulative morbidity burden was associated with prolonged hospitalization and increased healthcare costs in preterm infants.

Children doi: 10.3390/children13060778

Authors: Gabriela Telman-Kołodziejczyk Adrian Guźniczak Patrycja Sosnowska-Sienkiewicz Danuta Januszkiewicz-Lewandowska

Importance: A comprehensive analysis of childhood cancer and cancer predisposition syndromes (CPSs) incidence can provide insights that lead to improvements and modifications in treatment protocols through personalized therapy, thereby reducing toxicity. Purpose: This study aimed to analyze age-specific hospital-based childhood cancer rates and the distribution of CPSs in a 20-year pediatric cohort from the region. Materials: A total of 2190 patients, aged from birth to 17 years, diagnosed with any type of neoplasm classified by ICD-10 codes at Karol Jonscher’s Clinical Hospital of Poznan University of Medical Sciences (KJCH PUMS) between 1 January 2000, and 31 December 2019, were included, with 193 (8.8%) having an underlying CPS. Results: The pediatric population of the Greater Poland Region has declined over the past two decades. The most common diagnoses can be grouped into three main categories: (1) leukemias, involving 704 patients (32.1%); (2) central nervous system (CNS) tumors, represented by 382 children (17.4%); and (3) lymphomas, including 279 patients (12.7%), together accounting for 1353 cases (61.8%). The age-specific hospital-based case rate for childhood cancer (all types combined) peaked in the 0–28 days age group at 71.8 per 100,000 person-years (95% CI: 52.2–96.4), with a trend to decrease with age and a slight increase among adolescents aged 16–17 years (13.6 per 100,000, 95% CI: 12.0–15.4). The age-specific incidence of CPS-positive cancers declined from 18.0 (95% CI: 8.2–29.4) per 100,000 person-years in the first month of life to 0.7 (95% CI: 0.3–1.2) in 16–17-year-olds. CPS-positive children were diagnosed at significantly younger ages for four cancer types: liver and intrahepatic bile duct tumors (C22: A = 0.097, adjusted p < 0.001), myeloid leukemia (C92: A = 0.179, adjusted p < 0.001), lymphoid leukemia (C91: A = 0.309, adjusted p = 0.007), and renal tumors (C64: A = 0.335, adjusted p = 0.013). Conclusions: CPSs likely play a significant and underestimated role in pediatric cancers, especially during early childhood. Improving access to genetic testing could greatly enhance risk assessment, personalized treatment, and long-term outcomes in pediatric oncology.

Children doi: 10.3390/children13060777

Authors: Paul Schwanitz von Keitz Kira Henriette Liebau Wolfram Mittelmeier Susanne Froehlich

Background: Developmental dysplasia of the hip (DDH) is the most common congenital musculoskeletal disorder in newborns. Flexion–abduction orthoses are widely used in early treatment; however, in vivo data on their biomechanical load characteristics remain limited. This study aimed to evaluate axial force transmission in a hip flexion–abduction orthosis and to compare load patterns between healthy newborns and infants with DDH. Methods: In this exploratory observational study, 36 newborns (19 healthy, 17 with unilateral DDH) were examined within the first week of life. Axial forces transmitted through a Mittelmeier–Graf hip flexion–abduction orthosis (MGO) were measured using integrated force sensors under symmetrical and asymmetrical adjustment configurations. Intergroup comparisons were performed using non-parametric statistical tests. Results: Mean axial forces were significantly higher in healthy infants than in those with DDH under both symmetrical (4.02 N vs. 2.51 N; p = 0.019) and asymmetrical (3.67 N vs. 1.83 N; p = 0.001) conditions. Relative load corresponded to approximately 11–12% of body weight in healthy infants and 5–7% in the DDH group. No significant intra-individual differences were observed between dysplastic and contralateral hips. Orthosis configuration (symmetrical vs. asymmetrical) did not significantly affect load distribution. Conclusions: This exploratory in vivo study demonstrates that axial load transmission in a hip flexion–abduction orthosis is low and influenced by underlying hip pathology. Infants with DDH generate lower forces than healthy newborns, potentially reflecting altered biomechanics. As no significant differences were observed between orthosis configurations, symmetrical adjustment may be favored in clinical practice due to better usability and compliance. Further studies with larger cohorts are needed to confirm these findings.

Children doi: 10.3390/children13060776

Authors: Yumeng Liu Jinpeng Hu Shuo Zhang Qingqi Chong Jinxia Wang Xiaohui Gong Zhibao Lv Qingfeng Sheng

Background: Determining surgical assessment in infants with necrotizing enterocolitis (NEC) without radiographic pneumoperitoneum remains challenging. This study aimed to describe clinical factors associated with surgical intervention and to retrospectively assess an eight-parameter indicator in this setting. Methods: A retrospective study was conducted on infants with Bell stage II–III NEC treated between July 2014 and June 2023. Patients without radiographic pneumoperitoneum were classified into the conservative management group (CON) and surgical intervention group (SUR). Variables considered clinically relevant and suitable for bedside assessment were evaluated for the construction of an exploratory composite indicator. For selected parameters, each item was coded as present or absent, and the total number of positive parameters was calculated for each infant. Clinical characteristics, parameter frequencies, and the distribution of the composite indicator were compared between groups. Receiver operating characteristic (ROC) curve analysis was used descriptively to summarize the apparent discrimination of the composite indicator for observed surgical intervention. Results: A total of 115 infants were included; 70 received conservative management and 45 underwent surgical intervention. Eight bedside parameters were selected: endotracheal intubation history, hypotension, peritonitis, radiographic abnormalities, leukopenia, thrombocytopenia, acidosis, and hyponatremia. The SUR group had a higher frequency of several bedside abnormalities and a higher composite indicator score than the CON group. The exploratory composite indicator showed an area under the ROC curve of 0.842 for distinguishing infants who underwent surgical intervention from those managed conservatively. Conclusions: Infants with NEC who underwent surgical intervention showed a higher burden of bedside clinical, radiographic, and laboratory abnormalities. This exploratory eight-parameter indicator may provide a practical descriptive summary of disease severity and surgical concern in this challenging clinical setting.

Children doi: 10.3390/children13060774

Authors: Dhawal Sanjay Bandrey Christie S. Vieux Haley M. Laughlin Cara Price Susan Landry Johanna R. Bick Dana M. DeMaster

Background/Objectives: Children born very preterm (VPT; <33 weeks gestation) are at increased risk for atypical neurodevelopment and deficits in self-regulation, including executive function (EF) and emotion regulation (ER). Responsive parenting interventions, such as Play and Learning Strategies (PALS), improve caregiver behavior; however, their effects on neurodevelopmental outcomes in VPT populations remain limited. This study describes a randomized controlled trial evaluating a digital adaptation of PALS (ePALS). Methods: Families of toddlers aged 15–28 months born very preterm were randomized to either the ePALS intervention or an active control condition. Assessments were conducted at pre-test and post-test to evaluate caregiver responsiveness, child EF and ER, and neural development using behavioral tasks, EEG, and MRI. Results: To date, 84 families have been randomized (43 ePALS, 41 control). Preliminary findings indicate that parents in the ePALS condition demonstrate greater improvements in responsiveness compared to the control group. Intervention adherence rates are reported. Conclusions: These findings support the feasibility and preliminary efficacy of a digitally delivered parenting intervention for improving caregiver responsiveness in families of VPT toddlers. Ongoing analyses will evaluate long-term behavioral and neurodevelopmental outcomes.

Children doi: 10.3390/children13060775

Authors: Thyde Dumont-Mathieu Marianne Barton Rosalie Chuckta Natalia Suarez Martinez Deborah Fein

Background: The American Academy of Pediatrics recommends autism-specific screening at the 18- and 24-month well-child-care visits. Early identification facilitates early intervention (EI), which improves developmental outcomes. Historically, Non-Hispanic Black and Hispanic/Latino children in the United States receive autism diagnoses and autism-specific services later than Non-Hispanic White children. Variability in pediatric screening rates may indicate that systemic factors impede screening and referral; enhanced screening across community settings may support autism identification and connection to services. Methods: A feasibility study was conducted with one early learning program (ELP) to determine if screening for autism in ELPs is feasible. ELP teachers and staff received one 90 min training session on screening with the Modified Checklist for Autism in Toddlers—Revised (M-CHAT-R). They were then tasked with independently screening ELP-enrolled children between 16 and 30 months old. Results: Eighty children were eligible for screening and 79 screenings were completed; 14 screens were positive and 65 were negative. Of the 14 positive screens, eight referrals were made to EI. All eight families completed EI evaluations and were eligible for EI services. One family declined an evaluation. Five positive autism screens were for children already receiving general EI services. Those five screening results were communicated to the child’s EI team and an autism-specific evaluation was completed; four of the five children subsequently received autism diagnoses. Conclusions: Our data supports the feasibility of completing autism-specific screenings within an ELP setting.

Children doi: 10.3390/children13060773

Authors: Giulia Stanca Maria Sframeli Camilla Verdilio Beatrice Berti Lavinia Fanelli Natalia Longoni Marisa Maniaci Giorgia Coratti Chiara Cutrì Roberta Onesimo Concetta Palermo Daniela Leone Anna Falco Giulia Norcia Valentina Giorgio Carolina Ausili Cefaro Antonella Cerchiari Sonia Messina Marika Pane Eugenio Mercuri

Background/Objectives: The advent of disease modifying therapies (DMTs) for Spinal Muscular Atrophy (SMA) has highlighted the need for reliable tools to assess bulbar function in type I individuals. The Oral and Swallowing Abilities Tool (OrSAT) was originally developed to evaluate swallowing and feeding abilities in infants with SMA type I during the first two years of life. This study aimed to assess the applicability of the OrSAT in a cohort of children with SMA type I older than 2 years. Methods: Fifty-two children with genetically confirmed SMA type I, aged 2 to 12.6 years, were included. All participants had received at least one DMT, administered either soon after diagnosis or when treatment became available. Bulbar and feeding abilities were assessed using the OrSAT and results were grouped according to clinical subtype and feeding modality. Given the small sample size of the subgroups and the ordinal nature of OrSAT scores, comparisons between groups were performed using the non-parametric Kruskal–Wallis test. Results: At follow-up, 27 children were orally fed, 19 were exclusively tube-fed, and 6 were tube-fed but were also able to eat some food by mouth. The OrSAT scores reflect a wide spectrum of bulbar function from severe to no impairment. Most children who required exclusive tube-feeding at follow-up had already been tube-fed at treatment initiation, while a small number showed improvement in swallowing abilities and the partial recovery of oral feeding during follow-up. Conclusions: Our results suggest that the OrSAT, previously used only in the first two years of life, may also be applicable in older children to describe bulbar involvement and monitor changes over time. However, further studies are needed to refine the tool for this age group and to formally validate its use in older children with SMA type I. Its use may contribute to the longitudinal assessment of swallowing abilities and support rehabilitative management.

Children doi: 10.3390/children13060772

Authors: Carter James Kornak White Xue-Cheng Liu Scott E. Van Valin

Background: Slipped capital femoral epiphysis (SCFE) is a common adolescent hip disorder occurring during the pubertal growth spurt, and prior studies have demonstrated regional seasonal variation in presentation volume. The relationship between seasonality, socioeconomic deprivation, and disease severity remains incompletely characterized. This study investigated whether SCFE presentation volume demonstrates seasonal variation and whether seasonality is associated with socioeconomic deprivation, body mass index (BMI), and radiographic severity. Methods: We retrospectively reviewed children newly diagnosed with SCFE at a single institution in Wisconsin (USA) between January 2012 and March 2024. Variables included age, sex, race, Area Deprivation Index (ADI), BMI, month of symptom onset, Southwick slip angle, stability, chronicity, and symptom duration. Presentation volume was analyzed using 3-month rolling averages and sinusoidal regression with 12-month periodicity. Associations among ADI, BMI, and slip angle were assessed using linear regression and Spearman’s correlation. Results: In total, 122 of 160 patients met the inclusion criteria. SCFE presentation volume demonstrated significant seasonality (p < 0.05). Lower-volume months were associated with higher neighborhood deprivation and greater radiographic severity (p < 0.05). ADI correlated with slip angle (r = 0.29, p < 0.05) and BMI (r = 0.33, p < 0.05), whereas BMI was not significantly associated with slip angle. Chronic slips demonstrated greater slip angles than acute presentations (p < 0.05). Conclusions: SCFE presentation volume in Wisconsin follows a significant seasonal pattern, and social determinants of health may influence the timing of presentation and disease severity.

Children doi: 10.3390/children13060771

Authors: Barbara Sgobbi Lorenzo Antichi Maria Elena Bolis Laura Morlacchi Daniele Donati Ilia Bresesti Massimo Agosti

Objective: This pilot study aimed to explore how a receptive music intervention, based on musical genres reflecting maternal listening preferences during pregnancy, affects distress levels in Italian preterm infants. Specifically, it investigated the effects of soft pop/rock music, compared with classical music, on infants’ LF/HF ratio (derived from heart rate variability [HRV]) and peripheral oxygen saturation (SpO2), which were used as physiological markers of distress. Method: This retrospective observational pilot study analyzed clinical data routinely collected between May 2014 and January 2015 from 27 preterm infants (gestational age 23–32 weeks; birth weight < 1500 g) who received receptive music therapy as part of standard family-centered care in the NICU. Maternal listening preferences during pregnancy were assessed in 30 mothers via an ad hoc questionnaire; a content analysis identified, at the group level, the three most frequently reported artists (i.e., Jovanotti, Vasco Rossi, and W. A. Mozart), which were used to create three standardized playlists. According to the internal clinical procedure, each infant underwent four sessions on consecutive days: a no-music condition on Day 1, followed by the three music conditions on Days 2–4 in randomized order. The LF/HF ratio and SpO2 were measured at five time points per session (one pre-test, three intra-session time points, and one post-test). Wilcoxon signed-rank tests were used to compare conditions and time points, with effect sizes and a Benjamini–Hochberg (FDR) correction for multiple comparisons. Results: The LF/HF ratio did not differ significantly across music conditions or relative to the no-music condition. SpO2 was higher during the Mozart condition than during the no-music condition at three of the five time points; this association remained significant after FDR correction, with medium-to-large effect sizes. No effect was observed for the soft pop/rock conditions on physiological indexes. Conclusions: Receptive music therapy based on maternal listening during pregnancy was not associated with changes in the LF/HF ratio. The Mozart condition was associated with higher SpO2 than the no-music condition. Given the small sample, the single-center setting, and the retrospective observational design, these findings are preliminary and require confirmation in larger, adequately powered prospective trials. Future studies should also examine the specific musical features (e.g., tempo, harmonic structure, voice timbre) that may drive these physiological responses.

Children doi: 10.3390/children13060770

Authors: Chiara Tirone Simona Fattore Nicoletta Menzella Davide De Tomaso Martina Giaimo Stefano Cecere Alessandro Perri Irene Messana Tiziana Cabras Barbara Manconi Alessandra Olianas Cristina Contini Giulia Guadalupi Gavino Faa Massimo Castagnola Federica Iavarone Giovanni Vento

Background: Oxidative stress plays a key role in the pathogenesis of complications in preterm infants, including bronchopulmonary dysplasia (BPD). Thymosin β4 (Tβ4) and thymosin β10 (Tβ10) are proteins involved in tissue repair and responses to oxidative stress, but their role in extremely preterm neonates remains poorly understood. Methods: A total of 149 saliva samples from 18 infants with gestational age < 30 weeks were analyzed. Salivary proteins and their proteoforms were characterized using an integrated proteomic platform based on nano-HPLC-ESI-MS. Relative quantification was performed using extracted ion current (XIC) peak areas. Associations with postmenstrual age, oxygen requirement, and BPD development were assessed, including longitudinal analysis using generalized estimating equation (GEE) models. Results: Significant correlations were found between postmenstrual age and total Tβ4 (p = 0.001), oxidized Tβ4 percentage (p = 0.025), and total Tβ10 (p = 0.043). Higher oxygen requirement was associated with lower levels and percentages of oxidized Tβ10 (p = 0.005; p < 0.001). No significant differences were observed during the first week of life between neonates who later developed BPD and those who did not. However, longitudinal analysis showed that in neonates without BPD, total and oxidized Tβ10 and total Tβ4 increased over time, whereas in neonates with BPD, these biomarkers remained stable or decreased. The increase in oxidized Tβ10 percentage was slower in infants with BPD. Conclusions: Although no early differences were detected, longitudinal trajectories of Tβ4 and Tβ10 differed between infants with and without BPD. Postnatal changes in these proteins may be associated with differences in clinical course and exposure to postnatal oxidative stress.

Children doi: 10.3390/children13060769

Authors: Cristiano Becker Juliana Barbosa Goulardins Juliana Cristina Fernandes Bilhar Marques Ramon Jeronimo Cuevas Gajardo

Despite its increasing use in pediatric neurorehabilitation, Cuevas Medek Exercise (CME) remains rooted in clinical tradition, with limited theoretical articulation in relation to contemporary models of motor development, control, and learning. While clinical observations and reports from practice suggest possible functional benefits in children with motor delays, the absence of a conceptual framework limits its integration into evidence-informed physical therapy practice and education. This perspective proposes a conceptual model for CME that aligns its core principles with current theoretical constructs in motor behavior and developmental neuroscience. By examining key elements of CME—such as distal initiation, postural challenge, and task variability—through the lens of affordances, self-organization, and experience-dependent plasticity, the article presents CME not merely as a technique, but as a conceptual developmental approach informed by embodied action. We argue that such reframing may support more rigorous clinical reasoning, contribute to interdisciplinary dialogue, and inform a theoretical basis for future research exploring the proposed mechanisms and potential effects of CME. More broadly, this perspective contributes to ongoing discussions on how clinically derived interventions can be conceptually integrated within contemporary rehabilitation science. While the present article does not provide empirical validation, it offers a theoretical framework intended to inform future investigation and critical reflection in pediatric physical therapy.

Children doi: 10.3390/children13060768

Authors: Yeşim Yiğit Özge Yılmaz Ece Onur Yurda Şimşek Arzu Oran Esra Toprak Kanık Hasan Yüksel

Background: Acute bronchiolitis is one of the most common lower respiratory tract infections in early childhood and is frequently associated with recurrent wheezing and later development of asthma. Identifying biomarkers related to airway epithelial injury and disease severity may improve risk stratification. Materials and Methods: A total of 155 children aged 1–36 months who presented with their first episode of wheezing were enrolled. Clinical data and bronchiolitis symptom scores were recorded at admission. Serum levels of CC16, surfactant protein-D (SP-D), YKL-40, and isoprostane were measured. Patients were followed for one year to assess recurrence of wheezing. Results: According to symptom scores, 81 patients had mild and 74 had moderate bronchiolitis; no severe cases were observed. The distribution of bronchiolitis severity differed significantly between recurrent and non-recurrent wheezing groups. Serum YKL-40 levels were significantly correlated with disease severity (p < 0.05), and the effect size analysis indicated a moderate effect. SP-D levels showed a non-significant trend with severity (p = 0.17). No significant associations were observed for CC16 or isoprostane. Conclusions: Serum YKL-40 may be a potential biomarker reflecting disease severity in children with acute bronchiolitis. Further longitudinal studies are needed to evaluate the prognostic value of epithelial injury markers for recurrent wheezing and asthma development.

Children doi: 10.3390/children13060767

Authors: Yuri Nurdiantami Hilda Meriyandah Tokie Anme

Background/Objectives: Household poverty is a known risk factor for early childhood development. However, the extent to which caregiver education may moderate income-related developmental disadvantages remains underexplored in Southeast Asian contexts. This study investigated whether caregiver educational attainment buffers the association between household income, child-rearing environments, and early developmental outcomes in Indonesia. Methods: This study utilized cross-sectional data from Indonesian caregivers. To maximize statistical power, analyses of the home environment using the Index of Child Care Environment included the full sample (N = 933). Analyses of developmental outcomes using the Early Childhood Development Index were restricted to 3- and 4-year-old children (N = 355). General Linear Models (GLMs) were conducted, controlling for child age and sex. Results: For the home environment, both household income (p = 0.042) and caregiver education (p = 0.021) were independent, significant predictors, with no significant interaction. However, for developmental outcomes, the Income × Caregiver Education interaction was statistically significant (p < 0.001). Conclusions: Income and caregiver education were independently associated with the home environment, while their interaction was associated with developmental outcomes among children aged 3 to 4 years. These findings are consistent with an educational buffering hypothesis and warrant further longitudinal research.

Children doi: 10.3390/children13060766

Authors: Valentin Stroe Lacramioara Eliza Chiperi Horatiu Suciu Marius Harpa David Emanuel Anitei Liliana Gozar

Background/Objectives: Early thrombosis of systemic-to-pulmonary artery shunts (SPS) remains a major cause of morbidity and mortality in neonates with duct-dependent pulmonary circulation. Despite advances in surgical technique, no universally accepted perioperative thrombosis-prevention protocol exists. We evaluated the early outcomes of a standardized perioperative thrombosis-prevention protocol applied in neonates undergoing SPS placement. Methods: This single-center case series included nine consecutive neonates undergoing primary modified Blalock–Taussig shunt placement between January 2024 and July 2025. A predefined and standardized perioperative thrombosis-prevention protocol was uniformly applied, incorporating preoperative aspirin when feasible, intraoperative systemic heparinization targeting activated clotting time (ACT) > 300 s, meticulous shunt flushing and de-airing, preferential distal anastomosis to the main pulmonary artery when anatomically suitable, and early postoperative continuous heparin infusion followed by enteral aspirin. The primary endpoint was early shunt thrombosis within 30 days. Results: Median age at surgery was 28 days (range 14–35), and median operative weight was 3.2 kg (range 2.8–3.6). Cardiopulmonary bypass was required in 33.3% of patients. Delayed sternal closure was performed in 22.2%. Despite recognized prothrombotic risk factors—including complex anatomy, hypoplastic pulmonary arteries, and low cardiac output syndrome (33.3%)—no early shunt thrombosis occurred (0/9). There were no reinterventions, no early mortality, and no major bleeding or intracranial hemorrhage. Conclusions: In this single-center neonatal series, implementation of a standardized perioperative thrombosis-prevention protocol was associated with preserved early shunt patency without increased bleeding risk. Although limited by a small sample size, these findings support the feasibility and short-term safety of a standardized perioperative management strategy in neonatal systemic-to-pulmonary shunt surgery. These findings should be considered hypothesis-generating and not evidence of definitive effectiveness.

Children doi: 10.3390/children13060765

Authors: Selma Cakmakci Harun Demirci Gonca Altinisik Inan Servet Guresci Suheyla Aytac Arslan Arzu Yazal Erdem Derya Ozyoruk Ibrahim Qaddoumi Inci Ergurhan Ilhan Neriman Sari

Purpose: We aim to review our experience in treating children with ependymoma, the third most common malignant central nervous system tumor in children, at Ankara Bilkent City Hospital. Methods: We reviewed medical records of children <18 years old at diagnosis with ependymoma followed up between 2006 and 2024. Clinical, pathological, radiological, treatment, and outcome data were evaluated. Results: Thirty-two patients (56% males) were included. Median age at diagnosis was 6.8 years (range: 0.6–17 years). Sixteen tumors (50%) were Grade 2 histology. Resection extent was gross total resection (GTR, n = 16), subtotal resection (STR, n = 15), or biopsy (n = 1). Radiotherapy was given to 10 patients; chemotherapy to 3; and both to 11. Eight patients underwent surgery only. In univariate analysis, resection extent significantly impacted both event-free survival (EFS) (3-year EFS 79.0% in GTR vs. 38.9% in STR, p = 0.009) and overall survival (3-year OS 100% in GTR vs. 79.4% in STR, p = 0.035). Four patients (12.5%) died. Six patients remained alive with active disease; three were lost to follow-up. Conclusions: The best outcomes occurred in patients who underwent GTR. The EFS/OS rates were comparable to those in the literature. Our findings suggest that chemotherapy and radiotherapy in relapsed ependymoma may prolong survival.

Children doi: 10.3390/children13060764

Authors: Mustafa Dogan Metin Tan Emre Tepeli Ozlem Gul Dolunay Gurses Guven Yenmis Mehmet Dokur

Background/Objectives: In individuals with a genetic predisposition, acute rheumatic fever (ARF) can manifest as arthritis, carditis, chorea, subcutaneous nodules, and erythema marginatum. It occurs after a latent period of 1–3 weeks of untreated upper respiratory tract infections caused by group A beta-hemolytic streptococci. The presence and severity of carditis determine the prognosis for ARF. Carditis manifests as pancarditis, and although all patients have pericarditis, not all experience a pericardial effusion. Patients with severe carditis exhibit pericardial effusion more frequently. The physiopathology of ARF remains unclear, specifically which patients will experience carditis, arthritis, or chorea. However, the Turkish population has fully clarified the physiopathology and clinical features of Familial Mediterranean fever (FMF), a common rheumatic disease. In the Turkish population, the heterozygous positivity rate for the FMF gene mutation is 15–35%. For these reasons, we examined the presence of FMF gene mutations in our patients to determine whether there is a correlation between the clinical course of ARF and the FMF gene mutation. Methods: The study included 60 patients with arthritis (n = 11), carditis (n = 26), or both (n = 23), as well as 60 healthy controls. These pediatric patients underwent screening for mutations in exons 2 and 10 of the MEFV gene. Results: There was no statistically significant difference between the patient and control groups in terms of the incidence of MEFV gene mutations in exon 10. However, in patients with ARF, the exon 2 E148Q variant was significantly more common than in the control group. Conclusions: This study suggests a relationship between certain clinical manifestations of ARF and MEFV gene mutations in children.

Children doi: 10.3390/children13060763

Authors: Despoina Ourda Maria Karatzioti Marianthi Koutsokosta Athanasios Gregoriadis Vassilis Barkoukis

Background/Objectives: This study examined the association between parental physical activity and preschool children’s physical activity and social behavior. Methods: Participants were 151 preschool children (70 girls, 81 boys; Mage = 52.51 months, SD = 3.38) attending public and private kindergartens in Thessaloniki (Greece) and Nicosia (Cyprus). Children’s psychosocial development was assessed by kindergarten teachers using the Strengths and Difficulties Questionnaire, while parents reported their own and their children’s physical activity through the Preschool-age Children’s Physical Activity Questionnaire (home version). Descriptive statistics and Pearson correlations were computed, and the main hypotheses were tested using multiple linear regression analyses. Results: Results indicated a consistent positive association between parental physical activity and children’s physical activity across intensity levels. Parental physical activity frequency and duration during both weekdays and weekends was significantly associated with children’s low-, moderate-, and vigorous-intensity physical activity, while parental beliefs about physical activity were negatively associated with children’s sedentary behavior. In contrast, parental physical activity showed no significant association with all indicators of social behavior at school, including emotional symptoms, conduct problems, hyperactivity/inattention, and prosocial behavior. Conclusions: Overall, the findings support the role of parental physical activity as an important correlate of preschool children’s physical activity behavior, while its direct association with broader psychosocial development appears small. These results highlight the importance of parental role modeling and attitudes toward physical activity, particularly in shaping children’s movement behaviors.

Children doi: 10.3390/children13060762

Authors: Laura Beccani Monica Valle Sara Damilano Francesco Venturelli Massimo Vicentini Olivia Vecchi Silvia Faccioli

Background/Objectives: Early motor intervention is increasingly recognized as a critical component in the management of infants with, or at high risk of, cerebral palsy (CP). This systematic review aimed to synthesize recent evidence on early motor interventions in infants aged 0–2 years and to identify current gaps in knowledge. Methods: We performed a systematic literature review across PubMed, Embase, CINAHL, and Scopus. Studies published between 1 January 2020 and 5 October 2024 were included. Eligible studies were Randomized Controlled Trials (RCTs), non-randomized trials, and cohort studies that involved infants aged 0–2 years diagnosed with CP or classified as at high risk of CP who received early motor interventions targeting motor outcomes. Study selection and data extraction were executed by two independent reviewers following standardized protocols. The Rob2 Checklist was used to assess the risk of bias. This systematic review protocol was registered on PROSPERO with the ID 506784. Results: Six articles representing four RCTs were included. Although intervention protocols varied, shared therapeutic principles emerged across studies. Most participants were approximately 12 months old; only one study included infants younger than 3 months, highlighting limited evidence in the earliest detectable risk period. No consistent superiority of experimental interventions over standard care was observed; however, notable within-group improvements in motor and developmental domains were reported across both study arms. Major limitations included heterogeneity of outcome measures, limited use of CP-specific standardized tools, and insufficient assessment of functional and goal-based outcomes. Conclusions: Current evidence indicates a shift toward meaningful, family-centered early motor interventions, emphasizing active participation and parental involvement. Five core principles were identified: early initiation, task specificity, active experience, guided support, and engagement of both the child and caregivers. Future research should focus on earlier intervention timing, standardized outcome measures, and caregiver-related outcomes to optimize early intervention strategies during critical developmental windows.

Children doi: 10.3390/children13060761

Authors: Norma Olvera Molly R. Matthews-Ewald Tamal J. Roy Rhonda Scherer Luz M. Garcini Consuelo Arbona

Background/Objectives: Binge eating behavior has been deemed a significant factor associated with adolescent obesity. Understanding the underlying factors contributing to binge eating is critical, particularly among youth at risk of obesity. Hispanic and African American/Black children and adolescents experience disproportionately higher rates of obesity compared to their White peers. This study investigated the associations among anxiety, sleep quality, and binge eating among 315 Hispanic and African American/Black boys and girls, while controlling for demographic and adiposity covariates. Methods: Participants completed self-report surveys and underwent objective assessments of height, weight, and body fat percentage. Results: Descriptive analyses indicated a mean age of 10.71 years for boys and 10.92 years for girls. Most participants (71.9%) were classified as overweight or obese, and 94.1% were U.S.-born. Hierarchical regression analyses showed that both anxiety (β = 0.24, p < 0.001) and sleep quality (β = 0.23, p < 0.001) were significantly linked with higher levels of reported binge eating, after controlling for age, ethnicity, gender, and body fat percentage. The full model accounted for 15.4% of the variance in binge eating. Conclusions: These findings highlight the importance of targeting anxiety and sleep quality in interventions aimed at reducing binge eating among Hispanic and African American/Black early adolescents.

Children doi: 10.3390/children13060760

Authors: Yoon Lee Minsoo Shin Jahye Jung Ah-Ram Sul Yong Hee Hong

Background/Objectives: Pediatric obesity poses significant public health challenges and is associated with an increased risk of adult obesity. Healthcare professionals play an important role in providing patient-centered care; however, barriers to effective pediatric obesity management remain insufficiently explored in South Korea. Methods: Eleven healthcare professionals managing pediatric obesity participated in focus group interviews. Audio-recorded interviews were transcribed verbatim and analyzed using thematic content analysis. Four main themes emerged: (1) the current status of pediatric obesity management, (2) clinical experiences and outcomes, (3) awareness of governmental policies, and (4) areas needing improvement. Results: Participants described multiple barriers to pediatric obesity management, including limited clinical resources, time constraints, low awareness among patients and families, and perceived inadequacies in reimbursement policies. Participants also reported low treatment adherence and frequent dropout during follow-up care. Many participants reported limited awareness of governmental initiatives related to pediatric obesity management but expressed willingness to utilize such programs if they became more accessible and better integrated into clinical practice. Conclusion: The findings suggest that pediatric obesity management in South Korea may be influenced by structural, financial, and sociocultural barriers. Participants emphasized the need for improved multidisciplinary collaboration, greater institutional support, and increased accessibility of obesity-related programs and resources. Further comparative and context-specific studies may help inform tailored approaches to pediatric obesity management.

Children doi: 10.3390/children13060759

Authors: Aleksandra Moluszys Łukasz Mański Mirella Kozakiewicz Marek Niedoszytko Eliza Wasilewska

Background/Objectives: Breathing is increasingly recognized as an integral component of the motor system, interacting with postural control and movement. Despite this, clinical assessment of respiratory function in children remains largely limited to physiological parameters, with relatively few tools available to evaluate breathing as an organized motor pattern. The aim of this study was to develop and preliminarily validate the Breath Motor Pattern Index (BMPI), an observational tool designed to assess the organization of respiratory motor patterns in children. Methods: A scoping review was conducted to identify key components of respiratory motor pattern organization. Based on these findings, the BMPI was developed and evaluated in a cohort of 210 children aged 0–72 months, divided into three groups: healthy controls, children with neurological conditions, and children with respiratory disorders. Inter-rater and test–retest reliability was assessed using intraclass correlation coefficients (ICC). Measurement error was quantified using the standard error of measurement (SEM) and minimal detectable change (MDC95). Construct-related validity was examined through correlations with the Gross Motor Function Measure (GMFM-88) and comparisons between clinical groups. Results: The BMPI showed high inter-rater reliability (ICC = 0.998) and test–retest reliability (ICC = 0.999), with low measurement error (SEM = 0.55; MDC95 = 1.53). A weak but statistically significant correlation with GMFM-88 was observed (rho = 0.23, p < 0.001). BMPI scores differed significantly between groups (p < 0.001), with lower values observed in the neurological group and higher values in the pulmonary group. Conclusions: The BMPI appears to be a promising observational tool with potential clinical applicability for assessing respiratory motor pattern organization in children. The findings support the conceptualization of breathing as an integrated component of the motor system while highlighting the need for further psychometric and longitudinal validation studies. Future research should further investigate the responsiveness of the BMPI as well as its potential utility in clinical decision-making and therapeutic monitoring.

Children doi: 10.3390/children13060758

Authors: Usha Devi Jörn-Hendrik Weitkamp Jeffrey S. Shenberger Parvesh Mohan Garg

Necrotizing enterocolitis (NEC) remains one of the most devastating gastrointestinal emergencies in neonates and also presents major diagnostic challenges. Despite extensive research, NEC still lacks a practical definition and relies on a set of nonspecific clinical, laboratory, and radiological findings rather than a single pathognomonic presentation or test. The modified Bell staging system remains the most widely used framework in clinical practice and research, but it was originally developed to guide treatment decisions rather than aid diagnosis and has important limitations when applied as a diagnostic aid. Clinical and radiological criteria used for early stages of NEC are nonspecific, disease progression is not always linear, radiographic signs are inconsistently present, and histopathological confirmation is unavailable in most of the cases as surgery is not undertaken in all the cases. These limitations have led to the opinion that even the modified Bell staging is “broken” when it is used to define the disease itself. At the same time, increased understanding about gut immunity and microbiome progression, and neonatal hemodynamics make it increasingly clear that NEC is not a single uniform disease. It is now regarded as a heterogeneous syndrome comprising multiple phenotypes that share a final common pathway of intestinal injury and necrosis differing in timing, predisposing factors, mechanism, and clinical course. These presentations overlap with several neonatal conditions including spontaneous intestinal perforation, septic ileus, cow’s milk protein allergy, congenital heart disease-related intestinal hypoperfusion, viral enterocolitis, malrotation with volvulus, and intussusception. This review discusses controversies in the definition and staging of NEC, consolidates alternative diagnostic criteria beyond Bell’s system, and elaborates on a phenotype-based framework for clinical distinction. Also, the review sheds light on the clinical mimickers, practical bedside diagnosis using serial clinical assessment and imaging, consequences of NEC, and emerging precision medicine approaches. A shift from stage-based labeling toward a practical, phenotype-informed framework may improve diagnostic precision, reduce misclassification, and enhance both clinical care and research.

Children doi: 10.3390/children13060756

Authors: Dafni Moriki Dimosthenis Maris Aspasia Mavronasou Panagiotis Dalamarinis Despoina Koumpagioti Maria Tsouprou Vasilis Grammeniatis Michalis Kalogiannis Angeliki Galani Eleni A. Kortianou Konstantinos Douros

Background: Preschool wheezing is common, but distinguishing transient wheezing from early persistent asthma remains difficult. Oscillometric techniques, including impulse oscillometry (IOS), may provide objective prognostic information. Objective: To systematically review longitudinal studies assessing whether oscillometric measurements obtained at preschool age are associated with later asthma-related outcomes or lung function impairment. Methods: PubMed, Scopus, and MEDLINE (via EBSCOhost) were searched from inception to 28 February 2026. Eligible studies included preschool-aged children or closely related early-childhood populations assessed with IOS or forced oscillation technique (FOT), longitudinal follow-up, and later asthma-related or spirometric outcomes. Two reviewers independently screened studies, extracted data, and assessed risk of bias with QUIPS. Owing to substantial heterogeneity, findings were synthesized qualitatively. Results: Seven longitudinal cohort studies, encompassing 1077 children, met the eligibility criteria; baseline oscillometry was performed between ages 2 and 7 years, and follow-up ranged from 1 to 10 years. Short-term classification and longer-term prognostic studies were interpreted separately. Resistance-based indices, particularly R5, showed the most consistent associations with later asthma-related outcomes and lower subsequent spirometric indices, including FEV1 and FEV1/FVC. Most studies were at moderate risk of bias, and some reports came from related cohorts. Conclusions: Preschool oscillometry may provide complementary physiological information to assess asthma risk in symptomatic or high-risk preschool-aged children, particularly through resistance-based measures. However, evidence remains limited, heterogeneous, and insufficient to support a single validated cutoff, routine screening of apparently healthy children, or routine stand-alone prognostic use.

Children doi: 10.3390/children13060757

Authors: Federica Pauciulo Marco Tofani Giulia Stella Alessandra Lacopo Susanna Summa Giulia Tullo Caterina Delia Antonella Cerchiari Gessica Della Bella

Background/Objectives: Drooling is a common and clinically relevant issue in children with neurodevelopmental conditions, with important consequences for daily functioning, social participation, and caregiver burden. The lack of validated tools in Italian makes it difficult to quantify the impact of drooling on daily life, support appropriate care pathways, and evaluate the effectiveness of interventions. The aim of this study was to translate, culturally adapt, and evaluate the psychometric properties of the Italian version of the Drooling Impact Scale (DIS) in a pediatric population. Methods: The DIS is a 10-item caregiver-reported outcome measure, with each item rated on an ordinal 0–10 scale, designed to assess the functional and psychosocial impact of drooling. It was translated using a standard forward–backward procedure, followed by expert review and cognitive debriefing with caregivers. Caregivers of children aged ≥2 years with heterogeneous neurodevelopmental conditions and feeding/swallowing impairments were consecutively recruited from a tertiary pediatric hospital. Psychometric properties were assessed in line with COSMIN recommendations, including internal consistency (Cronbach’s α), structural validity through exploratory factor analysis, inter-rater and test–retest reliability (intraclass correlation coefficients, ICC), measurement error (standard error of measurement, SEM; smallest detectable change, SDC), and construct validity through correlation with the Pediatric Quality of Life Inventory (PedsQL). Results: The Italian DIS was completed by caregivers of 126 children. It showed excellent internal consistency (Cronbach’s α = 0.92). Factor analysis indicated a clear dominant factor, explaining 56.5% of the variance, while additional factors contributed only marginally. Agreement between caregivers was excellent (ICC = 0.94), and test–retest reliability was good (ICC = 0.85). Measurement error analysis yielded SEM = 8.66, SDC_individual = 24.00, and SDC_group = 2.14. As expected, DIS scores were associated with health-related quality of life. Conclusions: The Italian version of the DIS appears to be a reliable and structurally sound instrument for assessing the impact of drooling in children with neurodevelopmental conditions. It may be useful in both clinical practice and research, although further studies are needed to explore its responsiveness and confirm these findings in different settings.

Children doi: 10.3390/children13060755

Authors: David Guevorkian Eric Cavatorta Yoann Marechal

Background/Objective: Surfactant replacement therapy remains a life-saving intervention in the management of neonatal respiratory distress syndrome (RDS). In 2022, we presented a novel minimally invasive method of surfactant delivery with a flexible endoscope: Fiberscope-Assisted Surfactant Therapy (FAST). This new study describes the clinical course of neonatal RDS in neonates treated with FAST, comparing them to those treated with INSURE (Intubation–Surfactant–Extubation). Method: In this single-center cohort study, we retrospectively analyzed data from neonates with RDS admitted to our unit between 2021 and 2024. Following surfactant therapy, short- and medium-term respiratory and hemodynamic effects were compared between the two cohorts. Results: Data from 21 neonates born at 27 to 35 weeks of gestation (birth weights 890–2685 g) treated with FAST and 37 neonates born at 27 to 35 weeks (birth weights 920–2910 g) treated with INSURE were analyzed. The two groups were comparable in gestational age and antenatal steroid exposure. In the FAST group, the procedure was successfully completed in all cases without sedation and analgesia, with a consistent trend toward reduced FiO2 and pCO2, as well as increased pH. Comparing FAST with INSURE, no significant differences were observed in respiratory outcomes, with a significant difference in the need for blood volume expansion after surfactant delivery (1 infant in FAST vs. 17 infants in INSURE; p < 0.001). Conclusions: FAST demonstrated comparable respiratory efficacy to INSURE, with greater hemodynamic stability without sedation and analgesia or laryngoscopy, making it an even less invasive option for surfactant therapy.

Children doi: 10.3390/children13060754

Authors: Jenneke J. E. H. Saat Elke Naumann Merle Borremans Willem J. J. Assendelft Koos van der Velden Gerdine A. J. Fransen

Background: Community-based combined lifestyle interventions (CLIs) are used to help children with overweight or obesity achieve a healthier lifestyle. CLIs utilize the combined knowledge and expertise of professionals from a variety of disciplines. Here, we describe the composition of teams of professionals and their approach to collaboration in four community-based CLIs designed for children with overweight or obesity (focusing on children 4–12 years of age) living in the Netherlands. Methods: A descriptive cross-case comparison was conducted in which four community-based CLIs implemented in ten communities were conceptualized as “cases”. Quantitative data regarding the frequency of contact within the teams, topics addressed in meetings of the CLI teams, the perceived importance of other relevant disciplines in the team, and perceived satisfaction with the collaboration between professionals within the team were collected via questionnaires answered by the professionals (n = 82 respondents). Descriptive analyses including frequencies, percentages, and cross-case comparisons of team characteristics and collaboration were also conducted. Results: The CLI teams differed in composition, size, and background disciplines. The frequency of contact was higher in small teams (<6 professionals) compared to large teams. Larger teams appeared to report a lower perceived satisfaction regarding collaboration. Moreover, the role of coordinator or central healthcare provider was perceived as more important in the large teams than in the small teams. Conclusions: Variation was observed in professional expertise and collaboration within CLI teams. Moreover, professionals in a team should collaborate based on the local possibilities. In large teams (>6 professionals) in particular, a coordinator or trained central healthcare provider can help facilitate collaboration.

Children doi: 10.3390/children13060753

Authors: Rut González-Jiménez José Ramón Trillo Ricardo Bernárdez-Vilaboa Juan E. Cedrún-Sánchez Carla Otero-Currás Francisco Javier Povedano-Montero

Background/Objectives: Efficient visual processing is relevant for reading, writing, and sustained attention in schoolchildren. However, the relative discriminative value of different visual domains for identifying teacher-reported academic difficulties remains unclear. This study evaluated five visual system alteration domains for identifying teacher-reported academic difficulties using machine learning models. Methods: An observational analytical study was conducted in 581 primary schoolchildren. After complete-case analysis, 506 participants were included in the machine-learning analyses. Academic functioning was rated by teachers using a 1–5 ordinal scale and dichotomized as a pragmatic school-based indicator of teacher-reported academic difficulties. Five predictor groups were analyzed: DIVE-based oculomotor function, clinical oculomotor assessment, accommodative system, vergence system, and axial length. Five classifiers were evaluated using stratified 5-fold cross-validation combined with model-complexity penalization through hyperparameter optimization. Results: The accommodative system showed the highest cross-validated performance (XGBoost: accuracy 0.952 ± 0.021; macro-F1 0.919 ± 0.028), followed by clinically assessed and instrumentally assessed oculomotor predictors. Oculomotor alterations also showed strong performance, whereas vergence alterations showed high specificity but very low sensitivity, and abnormal axial length showed limited discriminative performance. Conclusions: Functional visual domains, particularly accommodation and oculomotor control, showed stronger cross-validated classification performance than vergence or axial-length variables. These findings are exploratory and require external validation cohorts, standardized academic outcomes, and future combined-domain modeling before clinical or educational implementation.

Children doi: 10.3390/children13060752

Authors: Anna Zisi Charilaos Kostoulas Athanasia Sesse Chrysoula Kosmeri Anastasios Serbis Hane Lee Ioannis Georgiou Ekaterini Siomou

Background: Congenital anomalies of the kidney and urinary tract (CAKUT) comprise a broad spectrum of malformations and constitute the leading cause of end-stage kidney disease (ESKD) in childhood. Despite extensive research, a monogenic cause is identified in only ~10% of cases, while variable penetrance and expressivity suggest a more complex disease mechanism. Epigenetic and environmental factors have also been implicated, further complicating efforts to elucidate the etiology of these anomalies. Methods: Whole exome sequencing (WES) was performed in 47 individuals with isolated, non-syndromic congenital renal parenchymal anomalies. Results: Variants in four genes (BBS1, PKHD1, XPNPEP3, and KCTD1) were identified, each of which has an established role in nephrogenesis and is implicated in syndromic disorders in which CAKUT can occur as part of the clinical spectrum. In addition, a variant in GREB1L was detected, a gene previously associated with CAKUT. The WES analysis identified candidate variants in 10.6% of patients, consistent with diagnostic yields reported in comparable CAKUT studies. The genes harboring variants are involved in key biological processes, including signaling pathways, ciliary function, and mitochondrial biology, supporting their relevance for further investigation. Conclusions: Our findings support WES as a valuable tool for identifying clinically relevant variants and expanding the genetic landscape of CAKUT.

Children doi: 10.3390/children13060751

Authors: Stavros Hatzopoulos Ludovica Cardinali Piotr Henryk Skarzynski Giovanna Zimatore

Background: China and India represent a large proportion of the Asian birth cohort and have produced extensive but heterogeneous evidence on neonatal hearing screening. This scoping review summarizes studies published between 2005 and 2025 on otoacoustic-emission-based neonatal hearing screening programs in these countries, with emphasis on program implementation, screening coverage, the prevalence of congenital and bilateral hearing loss, follow-up, and intervention pathways. Methods: Searches were conducted in PubMed, Scopus, and Google Scholar using predefined keywords. Studies reporting screening protocols, coverage, prevalence, or follow-up outcomes were included. The standard English language filter was used. A total of 19 papers were considered for this review. Results: The data from the two assessed Asian states show two clearly different screening implementation profiles. In China, universal hearing screening has evolved into a large-scale and increasingly standardized system, supported by technical specifications and regional or municipal databases. The reported screening coverage was 85.8% in early rural programs, 93.6% in Shanghai, and 97.9% in Liuzhou. National institutional surveys indicate that UNHS has now been substantially implemented in many regions. Reported hearing loss prevalence estimates generally ranged from 1.66 to 3.43 per 1000 newborns, although follow-up and regional equity remain problematic, especially in rural settings. In India, the evidence is dominated by tertiary-hospital feasibility studies rather than a uniformly implemented national program. Reported hearing loss prevalence estimates varied more widely, from 0.29 to 5.60 per 1000 screened newborns, largely reflecting differences in study design, screening timing, referral completion, and population risk profile. Across both countries, OAE-based two-stage or sequential OAE + AABR protocols reduced referral rates and improved case identification, but loss to follow-up remained a recurrent limitation. Conclusions: China and India provide complementary models of neonatal hearing screening expansion. China demonstrates the effects of system-level scale-up, whereas India highlights the feasibility and constraints of hospital-based implementation in a highly diverse healthcare environment. Future priorities include stronger follow-up systems, harmonized reporting standards, and broader dissemination of outcome data through peer-reviewed publications.

Children doi: 10.3390/children13060749

Authors: Min-Jung Bang Wontae Kim Sungjoo Park Sanghoon Lee Jeong-Meen Seo

Background: Laparoscopic duodenoduodenostomy is an established approach for duodenal atresia, yet its applicability in neonates with concurrent situs anomalies remains poorly defined. This study evaluated the feasibility and perioperative outcomes of laparoscopic duodenoduodenostomy in this population. Methods: A retrospective review was conducted of all neonates who underwent laparoscopic repair for duodenal atresia by a single surgeon at Samsung Medical Center between January 2017 and December 2023. Thirteen patients were divided into situs anomaly (n = 3) and situs solitus (n = 10) groups. Anatomical features, operative details, and perioperative outcomes were reviewed and descriptively summarized according to situs status. Results: All three neonates in the situs anomaly group had situs ambiguus—left isomerism with polysplenia (n = 2) or right isomerism with asplenia (n = 1). Interrupted inferior vena cava with azygos continuation and intestinal malrotation were present in all three patients; however, only two required a concurrent Ladd procedure. Laparoscopic repair was completed in all 13 patients without open conversion. Operative time, feeding milestones, and hospital stay were descriptively similar between groups. No anastomotic complications, reoperations, or mortality occurred. Conclusion: In this small case series, laparoscopic duodenoduodenostomy was completed without conversion or perioperative anastomotic complications in neonates with duodenal atresia and concurrent situs anomalies. Situs anomaly alone may not preclude minimally invasive repair in experienced hands.

Children doi: 10.3390/children13060750

Authors: Dimitra V. Katsarou Eleni E. Kyvrakidou

Background and Objectives: Williams syndrome (WS) is a rare neurodevelopmental genetic condition traditionally described as being associated with a highly sociable behavioral profile. However, growing evidence indicates that this characterization may oversimplify the socio-cognitive phenotype, as some individuals with WS exhibit socio-communicative and pragmatic difficulties that may overlap with ASD-related features, although these difficulties should not be interpreted as autism-specific. The present systematic review aimed to investigate the presence of autistic traits in WS, to synthesize evidence on pragmatic and socio-communicative difficulties, and to explore their association with adaptive functioning and, indirectly, adaptive and functional outcomes. Materials and Methods: This study follows a systematic search and selection process in accordance with PRISMA 2020 guidelines and employs a systematic review with structured narrative synthesis. A systematic search of PubMed, Scopus, and Web of Science was performed up to December 2022, supplemented by grey literature sources. Nine studies met the predefined inclusion criteria. Due to substantial methodological heterogeneity, findings were synthesized using a structured narrative approach. Study quality was evaluated using adapted criteria addressing research design, sample characteristics, measurement tools, and risk of bias. Results: The findings suggest that autistic traits may constitute a potentially clinically relevant, though not universal, aspect of the WS phenotype. Pragmatic language difficulties were consistently reported, particularly in relation to conversational management, social reciprocity, and context-appropriate language use. These difficulties appear to function as a key mechanism linking socio-cognitive characteristics with functional outcomes. Patterns of adaptive functioning showed both distinctions from and overlaps with autism spectrum disorder (ASD), especially in communication domains. Available genetic and molecular evidence points to a possible contribution of additional modifying factors for phenotypic variability, with possible phenotypic overlap between WS and ASD, particularly in pragmatic language and adaptive communication. Conclusions: The evidence supports a multidimensional and spectrum-based conceptualization of socio-communicative functioning in Williams syndrome. Despite strong social motivation, individuals with WS may experience meaningful pragmatic and adaptive challenges, with implications for assessment and intervention. These findings highlight the importance of multidimensional and individualized clinical approaches.

Children doi: 10.3390/children13060748

Authors: Andrei-Ioan Munteanu Delia-Maria Nicoară Iulius Jugănaru Raluca Asproniu Otilia Mărginean

Pachydermodactyly (PDD) is a benign, non-inflammatory, non-erosive digital fibromatosis characterized by progressive, asymptomatic, periarticular soft tissue thickening predominantly affecting the proximal interphalangeal (PIP) joints. Additional localizations, including the palm and the distal interphalangeal (DIP) or metacarpophalangeal (MCP) joints, have also been reported. The etiology of PDD is multifactorial, encompassing idiopathic, trauma-induced, genetic, and behavioral factors. Objective: The aim of this report is to describe the clinical, imaging, and laboratory features of pachydermodactyly in two male adolescents initially referred to a pediatric rheumatology service for suspected juvenile idiopathic arthritis (JIA), highlighting the diagnostic pitfalls and differentiation criteria from inflammatory arthritis. In addition, a narrative review of cases published from 1975 to 2025 is presented to contextualize our findings within the broader literature. Results: Two male adolescents (aged 13 years and 5 months and 16 years) presented with progressive, painless periarticular soft tissue swelling of the PIP joints, initially raising suspicion for JIA. Comprehensive evaluation identified characteristic features of PDD in both patients, with complete absence of inflammatory markers, synovitis, or osseous changes. Case 1 was classified as mono-PDD and Case 2 as classic, trauma-associated PDD with atypical perilesional hypopigmentation, requiring MRI for definitive exclusion of infiltrative pathology. A narrative review of 15 representative published cases from 2014 to 2025 is presented, demonstrating persistent underdiagnosis and consistent misclassification as JIA across multiple clinical settings and geographic regions. Conclusions: PDD should be considered in the differential diagnosis of any adolescent presenting with painless digital swelling. Its recognition as a benign, non-inflammatory entity is essential to prevent unnecessary diagnostic procedures and immunosuppressive therapy. Clinical awareness and multidisciplinary assessment remain the cornerstones of accurate diagnosis and appropriate management.

Children doi: 10.3390/children13060747

Authors: Regina R. Tukhvatullina Nune V. Matinyan Vasiliy A. Akimov Raisa V. Milutis Tatiana S. Belysheva Lana R. Turkia Ekaterina V. Chufistova Guzel M. Muftakhova Julietta A. Karmanova Anatoly P. Kazantsev Vera V. Reshetnikova Timur T. Valiev Kirill I. Kirgizov Tatiana V. Gorbunova Svetlana R. Varfolomeeva Irina Zh. Shubina Mikhail V. Kiselevskiy

Background: An infantile hemangioma (IH) is a benign lesion that develops as a result of pathologically dysregulated proliferation of the endothelial cells of the capillaries, typically appearing within the first three years of life. The disease is found mostly on the skin and—less often—in the internal organs. Although IH generally has a good prognosis and may sometimes undergo spontaneous regression, certain types of IH with a specific form, localization, and size may lead to life-threatening conditions including impairment of vital functions. This determines the need for precise diagnostics and treatment. Case presentation: The paper presents a clinical observation of an infant in the first months of life with IH presenting as diffuse hepatic hemangiomatosis and a hemangioma of the left eyebrow area. The IH was associated with life-threatening conditions. However, effective treatment with the non-selective β-adrenoblocker propranolol led to a positive outcome and the resolution of complications. Conclusions: This case demonstrates the critical importance of timely diagnosis and treatment for lesions that, while benign, can lead to fatal complications if not addressed promptly.

Children doi: 10.3390/children13060746

Authors: Manuele Cesare Gianfranco Damiani Gloria Anderson Jessica Preziosi Rosemary Frasso Leonardo Villani Nursing and Public Health Group Nursing and Public Health Group Vittorio Maio Antonello Cocchieri

Background/Objectives: Rural–urban disparities are well documented in pediatric healthcare, influencing access, service organization, and outcomes. However, whether these differences extend to the domain of nursing care remains unclear. This study examined the association between degree of urbanization and nursing complexity among children admitted to a single tertiary-care pediatric hospital, comparing clinical, organizational, and nursing characteristics across geographic groups. Methods: Routinely collected electronic nursing documentation and hospital administrative records were retrospectively examined in a tertiary-care pediatric hospital in Rome, Italy. Children aged 2 to <18 years were consecutively included. Degree of urbanization was defined using the ISTAT-derived DEGURBA classification. The study outcome for nursing complexity corresponded to the number of nursing diagnoses documented at hospital admission. Descriptive analyses and a multivariable negative binomial regression model assessed the association between urbanization and nursing complexity, adjusting for age, sex, DRG weight, number of medical diagnoses, and chronic conditions. Results: Among 1652 pediatric hospitalizations, those from rural areas showed a higher clinical burden, with significantly higher DRG weight and more chronic conditions, but nursing complexity did not differ significantly across geographic groups. In the multivariable model, degree of urbanization was not independently associated with nursing complexity for admissions from towns and suburbs (IRR = 0.93, 95% CI 0.82–1.04, p = 0.211) or rural areas (IRR = 1.00, 95% CI 0.84–1.20, p = 0.966), compared with those from cities. Higher DRG weight (IRR = 1.11, 95% CI 1.05–1.17) and a greater number of medical diagnoses (IRR = 1.17, 95% CI 1.11–1.25) were positively associated with nursing complexity, whereas the number of chronic conditions showed an inverse association (IRR = 0.90, 95% CI 0.84–0.96). Conclusions: In this single-center sample, rural–urban differences in clinical burden are not accompanied by statistically detectable differences in nursing complexity at hospital admission. Despite a higher clinical burden among children admitted from less urbanized areas, nursing complexity does not appear to differ significantly across geographic groups. Standardized nursing data enhance the ability to compare admission-level care needs across geographic contexts, enabling more precise and stratified population and public health analyses.

Children doi: 10.3390/children13060745

Authors: Jole Rechichi Domenico Umberto De Rose Flaminia Pugnaloni Andrea Diociaiuti Elisa Pisaneschi Andrea Dotta Annabella Braguglia May El Hachem

Background: Inherited Epidermolysis Bullosa (EB) is a wide group of rare genetic disorders characterized by mucocutaneous fragility and blister formation. In neonates with EB, pain control is particularly complex because painful skin lesions coexist with developmental vulnerability, repeated handling, and the need for frequent wound care. Traditional opioid use carries a risk of adverse effects such as respiratory depression. Tramadol, a centrally acting weak opioid with a dual mechanism of action, may offer a safer alternative. Methods: This retrospective observational study analyzed neonates with different EB subtypes admitted to our tertiary neonatal care center between January 2020 and October 2022. Genetic diagnosis was confirmed via next-generation sequencing. Pain was assessed using the Neonatal Infant Pain Scale (NIPS). Tramadol was administered intravenously (1–2 mg/kg bolus or 0.1–0.2 mg/kg/h infusion) before daily wound dressings, then transitioned to oral dosing when appropriate. Pain scores before and after tramadol administration were compared. Results: Six neonates with various EB subtypes were included. All patients received tramadol for procedural pain control. No significant differences in NIPS scores were observed before and after tramadol administration (p = 0.997), indicating adequate pain control, although baseline pain scores were low, limiting interpretation of analgesic efficacy. No immediate adverse events were observed during hospitalization or reported during follow-up. Conclusions: Scheduled tramadol administration appears to be a safe and effective option for pain management in neonates with EB, with no observed hemodynamic or respiratory complications. Given the scarcity of data in this population, our findings highlight the need for multicenter studies to establish standardized analgesia protocols for EB neonates.

Children doi: 10.3390/children13060744

Authors: Cătălina Mărgineanu Lia-Oxana Usatiuc Maria Lucia Sur Mara Similie Alexandru Cristian Bolunduț Csilla-Enikő Szabo Dana-Teodora Anton-Păduraru Gabriela Roman

Background/Objectives: The rising prevalence of childhood obesity has coincided with increasing incidence of type 1 diabetes mellitus (T1DM), raising questions regarding their potential bidirectional interaction. This systematic review evaluated the association between obesity and T1DM risk, as well as post-diagnostic weight trajectories and metabolic outcomes in pediatric populations. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. PubMed, Embase, and Scopus were searched for studies published between January 2010 and January 2026. Eligible studies included observational and interventional research in children and adolescents addressing T1DM and obesity; reviews, case reports, and non-English studies were excluded. Risk of bias was assessed using Joanna Briggs Institute tools. Due to heterogeneity, results were synthesized narratively. Results: Sixty-seven studies were included. Population-based data showed a positive association between higher BMI and incident T1DM, with obesity associated with a twofold increased risk (HR 2.05, 95% CI 1.58–2.66) and a 25% increase per 1-SD BMI increment. Insulin resistance (IR) indices correlated with BMI and predicted faster progression to clinical T1DM in autoantibody-positive individuals. At diagnosis, 20–30% of children were overweight or obese, increasing to 30–40% during follow-up. Excess adiposity was associated with higher insulin requirements and increased prevalence of hypertension and dyslipidemia. Longitudinal data indicate that BMI standard deviation scores rise with age, diabetes duration, and pubertal stage, with higher insulin doses and intensive insulin therapy contributing to weight gain. Conversely, some large cohort studies report no linear association between BMI and incident T1DM, indicating heterogeneity across populations. The limitations of this review include the predominance of observational studies, heterogeneous methodologies, and limited generalizability beyond predominantly European and North American pediatric populations. Conclusions: Overall, the evidence supports a bidirectional relationship: obesity may increase T1DM risk and accelerate disease progression, while T1DM-related factors promote weight gain after diagnosis. These findings highlight the importance of integrating weight management strategies into routine pediatric T1DM care.

Children doi: 10.3390/children13060743

Authors: Hannah Rogan Jenny John Kevin Zhao Scott Holmes Alyssa A. Lebel

Pediatric new daily persistent headache (NDPH) is a clinically defined headache subtype that remains controversial due to a lack of unique and objective mechanistic features. For many headache subtypes, different, and sometimes unique, patterns of structural and functional changes can be observed in the brain, supporting a unique role for neuroimaging in identifying the presence and type of headache experienced. To date, there has been little research into pediatric NDPH and how it may have a unique mechanism relative to other headache subtypes. We review published research that addressed structural and functional neuroimaging in persons with NDPH. We found that research to date supports differences in both brain structure and function in persons with NDPH relative to healthy controls. Such differences reflect both cortical and sub-cortical regions of the brain. No studies to date have evaluated brain data between persons with NDPH and other headache subtypes. We discuss application of machine learning and artificial intelligence to validate NDPH as a unique headache diagnosis. We believe that future work pursuing both neuroimaging alongside machine learning can help inform the classification and differential diagnosis of pediatric patients with NDPH from other chronic headache conditions.

Children doi: 10.3390/children13060742

Authors: Salvatore Angileri Rosario Caruso Serena Francesca Flocco Irene Baroni Gaia Spaziani Silvia Favilli Iacopo Olivotto Daniele Ciofi Ilaria Milani Giulia Maga Cristina Arrigoni Arianna Magon Maddalena De Maria

Background/Objectives: Structured transition care models for adolescents with congenital heart disease (CHD) are increasingly advocated, but methodological evidence to support the design of adequately powered randomized trials remains limited. This pilot randomized study was designed primarily to assess the feasibility of repeated patient-reported outcome (PRO) collection and to generate empirical parameters for planning a future confirmatory trial, rather than to formally evaluate intervention efficacy. Methods: This was a single-center, parallel-group, pilot randomized controlled trial conducted at Meyer Children’s Hospital, Florence, Italy, within the TELEMACO project (NCT05713591). Twenty-three adolescents with CHD were randomized 1:1 to a structured transition care intervention (n = 11) or usual care (n = 12). PROs, including the SF-12 Physical (PCS12) and Mental (MCS12) Component Summaries, health engagement, life satisfaction, and healthcare needs, were collected at baseline and at 3, 6, 9, and 12 months. Pre-specified exploratory analyses addressed retention, missingness, linear mixed-effects models, intraclass correlation coefficients (ICCs), and sample size scenarios. Results: Retention at 12 months was 63.6% (intervention) and 58.3% (control), with substantially lower completion rates at intermediate assessments (T2–T3: 27–50%), directly affecting the reliability of longitudinal estimates at those time points. Mixed-effects models showed no significant time-by-group interaction for PCS12 (p = 0.13) or MCS12 (p = 0.39); unadjusted contrasts suggested nominally higher PCS12 values in the intervention group at selected assessments. ICCs were approximately 0 for PCS12 and 0.56 for MCS12, indicating fundamentally different variance structures. Conclusions: Repeated PRO collection was feasible, though retention across intermediate assessments was inconsistent. The pilot generated empirically grounded estimates for the design of a future confirmatory trial. Sample-size scenarios were highly sensitive to uncertainty in the PCS12 variability estimate, ranging from approximately 25 to 115 analyzable participants per group, depending on the true standard deviation. Within this pilot dataset, PCS12 at 12 months, analyzed cross-sectionally with baseline adjustment, emerged as a provisional endpoint option requiring further evaluation in an adequately powered confirmatory trial.

Children doi: 10.3390/children13060741

Authors: Gregory Michael Taylor Guilcher

Sickle cell disease is the most common monogenetic disease worldwide and affects millions of children and adults. While supportive care practices have improved life expectancy, particularly in high income countries, sickle cell disease typically has adverse impact on quality of life and reduced life expectancy. As a result, patients and providers are increasingly seeking information regarding curative and transformative therapies and advocating for improved global access. This review will describe allogeneic hematopoietic cell transplantation eligibility, approaches to transplant, short and long-term outcomes and key supportive care considerations for providers who care for patients with sickle cell disease.

Children doi: 10.3390/children13060740

Authors: Margarita Bakracheva Elena Ivanova Kaloyan Damyanov Rositsa Racheva Milen Zamfirov

Background: Autism spectrum disorder (ASD) or psychiatric conditions, special education needs and addictions exert substantial demands on families, yet parental psychological functioning remains insufficiently integrated into prevention and family-based support. An in-depth understanding of parental experiences constitutes a cornerstone of family-centered care, given that parental well-being and resourceful functioning exert a direct and enduring influence on both intervention effectiveness and the broader trajectory of child development. This study aimed at identifying latent parental profiles across clinical and typical developmental contexts. Methods: A total of 281 parents of children with psychiatric diagnoses (primarily ASD), special educational needs, addiction, and typical development were assessed for positive and negative functioning. Latent Profile Analysis (LPA) identified psychological subgroups, followed by Welch’s ANOVA to determine discriminating variables and multinomial logistic regression to examine sociodemographic and contextual predictors. Results: A three-profile solution emerged: Low well-being, high co-dependency and low resource functioning (50%); High well-being, low co-dependency and high resource functioning (26%); and Moderate well-being, moderate co-dependency and moderately resourceful functioning (24%). Parents of children with psychiatric diagnoses were significantly less likely to belong to the High well-being, low co-dependency and high resource functioning profile, underscoring the heightened psychological vulnerability characteristic of this group. Parents of typically developing children tend to belong to Moderate well-being, moderate co-dependency and moderately resourceful functioning. Conclusions: Parental psychological functioning exhibits heterogeneity across developmental contexts. Although parents of children with psychiatric diagnoses revealed the highest vulnerability, the profiles also revealed substantial psychological strain among parents of typically developing children. These findings highlight the need to shift from child-focused to family-centered prevention and support.

Children doi: 10.3390/children13060739

Authors: Suhyeon Ha Dae Yeon Kim Yu Jeong Cho So Hyun Nam Eunyoung Jung Min Jeong Cho Ju Yeon Lee

Background/Objectives: Abdominal lymphatic malformations (ALM) in children are rare vascular anomalies with heterogeneous presentation and challenging operative anatomy. Existing classification systems are largely descriptive and provide limited guidance for predicting resectability. We developed the LIE scoring system, an imaging-based classification incorporating Location, Intestinal involvement, and Extent, to enable structured preoperative risk stratification. Materials and Methods: We performed a retrospective, multicenter cohort study of pediatric patients with ALM treated at eight tertiary referral centers between 2010 and 2024. Lesions were assigned LIE scores based on preoperative imaging. Scores ranged from 0 to 5, with greater weight assigned to diffuse disease. Patients were categorized as resectable (0–2), limited resectable (3), or high risk (≥4). We performed multivariable logistic regression and receiver operating characteristic (ROC) analyses. Results: Fifty-nine patients were included. Complete resection rates decreased with increasing score (85.7%, 66.7%, and 25%; p for trend = 0.003). Higher scores were associated with increased risk of incomplete excision (OR 5.75, 95% CI 1.04–33.13). Multivariable analysis revealed consistent associations of extent and intestinal involvement with incomplete excision. ROC analysis demonstrated modest discriminative ability (AUC 0.62). Adjunctive therapies were more frequently used in higher-score groups. Conclusions: The LIE scoring system provides a clinically applicable framework for preoperative risk stratification in pediatric ALM. Despite modest predictive performance, it reflects operative complexity and may support surgical planning and patient counseling.

Children doi: 10.3390/children13060738

Authors: Vlad-Laurentiu David Maria-Corina Stanciulescu Emil-Radu Iacob Calin-Marius Popoiu

Background: Robotic-assisted surgery has increasingly been adopted in pediatric surgical practice; however, data from early implementation stages remain limited. Materials and methods: We conducted a prospective audit of the first 71 pediatric robotic-assisted procedures performed over a 24-month period using the da Vinci Xi platform in a tertiary pediatric center. Patient characteristics, surgical indications, perioperative parameters, and postoperative outcomes were analyzed. Results: A total of 71 procedures were performed in 71 patients (39 girls, 32 boys; mean age 4.46 years). The most frequent procedures were cholecystectomy (n = 19), ovarian tumor excision (n = 14), and pyeloplasty (n = 13). Mean operative time was 90 ± 65.30 min. Intraoperative complications occurred in 9.9% of cases, conversion to open surgery in 2.8%, and postoperative complications in 2.8%. Trocar insertion time and docking time improved significantly during the second year (p < 0.05). No mortality or long-term complications were recorded. Conclusions: Robotic-assisted pediatric surgery is feasible and safe, with acceptable complication rates and favorable early outcomes. Progressive improvement in operative setup parameters reflects a measurable learning curve.

Children doi: 10.3390/children13060737

Authors: Manuel E. Soto-Martinez Wojciech Feleszko Alexander Moeller

Background/Objectives: Respiratory tract infections (RTIs) are a leading cause of morbidity in children under five, with over 75% experiencing recurrent episodes and an increased risk of asthma by school age, particularly following respiratory syncytial virus (RSV) and rhinovirus (RV) infections. While current therapies primarily address acute symptoms, effective preventive strategies remain limited. Bacterial-derived immunomodulators have emerged as promising interventions, but their mechanisms and pediatric clinical evidence remain incompletely characterized. This narrative review examines preclinical mechanisms and clinical findings for four such agents, contextualizing current evidence and identifying key gaps. Methods: A targeted narrative review of PubMed-indexed literature (inception to September 2025) was conducted. Mechanistic studies, pediatric (0–18 years) clinical trials, and meta-analyses evaluating OM-85, polyvalent mechanical bacterial lysates (PMBL/Ismigen), MV130, and Lactobacillus rhamnosus CRL1505 were included. Outcomes of interest comprised immunological mechanisms, RTI incidence, wheezing, and asthma-related outcomes. Results: All four agents share convergent immunomodulatory mechanisms involving epithelial barrier reinforcement, innate immune activation, and adaptive immune modulation. OM-85 has the most extensive preclinical evidence. PMBL enhances epithelial repair via the IL-23/IL-22 axis, MV130 induces trained immunity, and CRL1505 acts through the gut–lung axis. Clinical evidence varies markedly, with OM-85 showing the most comprehensive data (18 RCTs and 7 meta-analyses), followed by PMBL and MV130, while evidence for CRL1505 remains predominantly preclinical. Conclusions: Despite variable evidence maturity, these agents share a coherent mechanistic rationale and favorable safety profiles, with ongoing studies expected to clarify their clinical role in early-life respiratory prevention.

Children doi: 10.3390/children13060736

Authors: Maria Catone Vincenza Sansone Giorgia Della Polla

Background/Objectives: Cyberchondria is the compulsive and repetitive search for health-related information online. Adolescents may be vulnerable to cyberchondria due to extensive Internet use and developing health literacy skills; however, evidence from Italy remains limited. The aim of this study is to examine knowledge, attitudes, and behaviors related to cyberchondria among Italian adolescents aged 10–19 years and identify the associated factors. Methods: This cross-sectional investigation was conducted from January to March 2025 among adolescents in Naples, southern Italy. Data collection relied on a self-administered structured questionnaire, including the Cyberchondria Severity Scale-12 (CSS-12). Two multivariate logistic regression models identified independent predictors of online health information-seeking and high cyberchondria (CSS-12 ≥ 32 points). Results: Among 793 participants (mean age 15.8 ± 2.2 years; 50% female), 59.7% used the Internet to seek health information, and this behavior was independently associated with older age, female gender, lower self-perceived health, chronic conditions, and increasing CSS-12 values. The mean CSS-12 score reached 31.2 ± 8.3, and 53.4% of participants scored ≥ 32 points. Higher cyberchondria was associated with believing that the Internet is useful for health decision-making, needing more information about cyberchondria, needing more information about a health topic, perceiving the Internet as important for health resources, having a father with a high school diploma or less, and having parents without underlying chronic medical conditions. Conclusions: Italian adolescents commonly use the Internet to seek health information, and they present non-negligible cyberchondria levels. This study’s findings emphasize the need for targeted educational interventions promoting safe and critical online health information-seeking behaviors.

Children doi: 10.3390/children13060735

Authors: Şeyma Şimşirgil Kara Kübra Gümüş Çetin Çoban Huriye Demet Cabar

Objective: This study examined the relationships between the developmental stages of children aged 6–72 months and their parents’ psychological resilience and psychological well-being. Method: The study was designed as a descriptive and correlational survey. The sample included a total of 184 children aged 6–72 months, as well as their parents, who visited Sinop Atatürk State Hospital. Data were collected face-to-face using the Personal Information Form, the Early Developmental Stages Inventory (EGE), the Psychological Well-being Scale (PWBS), and the Psychological Resilience Scale for Adults (PRS). The data were analyzed using the independent samples t-test, Pearson correlation coefficient, and simple and multiple linear regression analyses. Results: According to the study’s results, most children (92.4%) were found to be at a normal level in terms of overall development; importantly, personal-social skills had the highest rate of developmental delay (19.0%). Comparative analyses showed that the psychological resilience and psychological well-being scores of parents of children with typical development were higher than those of parents of children with developmental delays. Correlation analysis revealed a moderate positive relationship (r = 0.330, p < 0.001) between the Early Developmental Stages Inventory score and the Psychological Well-being Scale, and a weak positive relationship (r = 0.154, p < 0.05) between the Psychological Resilience Scale and the Early Developmental Stages Inventory score. Regression analyses suggest that psychological well-being and resilience are associated with child development outcomes. Discussion and Conclusions: The findings of this study indicate that there are meaningful associations between parents’ psychological well-being and resilience levels and children’s early developmental outcomes. Children whose parents reported higher psychological well-being and resilience tended to demonstrate more favorable developmental profiles in several developmental domains. These results suggest that parental psychological characteristics may be relevant factors associated with early childhood developmental outcomes and should be interpreted within broader ecological and contextual frameworks.

Children doi: 10.3390/children13060734

Authors: Benigno Linares Segovia Rocío Stephanie Bermúdez Pérez Rebeca Monroy-Torres Octavio Alejandro Jiménez Garza Norma Amador Licona Juan M. Guízar-Mendoza Rodrigo Francisco del Río Hidalgo Juan Antonio Ortega García Luz Claudio

Background: During the firing stage of artisanal brick production, particulate matter and other pollutants are released into the air, to which children are particularly vulnerable. Objective: To compare the frequency of allergic diseases and impaired lung function among children exposed and unexposed to artisanal brick production. Methods: A cross-sectional comparative study was conducted among 386 children aged 6 to 14 years, recruited from a primary and a secondary school in Guanajuato, Mexico. Participants were classified as exposed (n = 193) or unexposed (n = 193) to artisanal brick production. Once parents and children voluntarily consented to participate, study procedures were initiated. Forced spirometry and anthropometric measurements were performed, and the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was administered. We assessed the frequency of respiratory symptoms, allergic diseases, and lung function abnormalities. We measured the frequency of respiratory symptoms, allergic diseases, and lung function abnormalities. Results: The mean age of the 386 children was 9.7 ± 1.7 years. Each group consisted of 103 girls and 90 boys. The most important risk factors for impaired lung function were living in the brickyard (OR = 6.9, 95% CI: 4.3–11.1; p = 0.001) and being male (OR = 3.6, 95% CI: 2.3–5.7; p = 0.001). The prevalence of impaired lung function was 13.5% in exposed and 4.1% in unexposed children (OR = 3.6, 95% CI: 1.5–8.1; p = 0.001). Most of the respiratory symptoms observed were obstructive and we found no difference in the frequency of allergic diseases, but respiratory symptoms were more frequent in exposed children. Conclusions: Respiratory symptoms and obstructive abnormalities in pulmonary function are more prevalent among children living in brickyards. Male sex and residence in the brickyard were the principal risk factors for impaired lung function.

Children doi: 10.3390/children13060731

Authors: Tamer M. El-Saeed Mohammed F. Elbanna Ahmed M. Aboeleneen Afnan M. Alkhateeb Afnan S. Gmmash Ohud A. Sabir Abeer S. Jamal Marwa M. I. Ismaeel

Background: Upper extremity deficits in unilateral cerebral palsy (UCP) severely restrict daily autonomy. Although movement-based priming is known to stimulate neuroplasticity, the distal transfer of lower extremity (LE) training to augment paretic upper limb (UL) function remains largely uninvestigated. This randomized controlled trial evaluated whether a 6-week LE cross-training (CT) priming regimen enhances UL functional restoration in pediatric UCP. Methods: Thirty-six children (6–8 years) were randomized to a conventional physical therapy cohort (n = 18) or an experimental CT cohort (n = 18). The CT group performed high-resistance contractions utilizing the non-paretic LE immediately preceding standard therapy. Blinded evaluations quantified Handgrip Strength (HGS) via dynamometry, grasping proficiency via the Peabody Developmental Motor Scales (PDMS-2), and gross dexterity via the Box and Block Test (BBT) pre and post intervention. Results: Analysis indicated a robust, near-significant between-group effect (Wilks’ Λ = 0.775, p = 0.057). While both cohorts achieved substantial internal improvements, the CT participants displayed superior developmental trajectories across all domains, notably in grasping age equivalence (34.28 ± 6.33 vs. 25.78 ± 3.26 months) and HGS (3.89 ± 0.79 vs. 3.03 ± 0.53 kg). Conclusions: LE cross-training priming may be a feasible adjunct, but it did not demonstrate statistically significant additional UL benefit versus standard rehabilitation in this sample. Therefore, these results should be interpreted as exploratory and hypothesis-generating. This potential cross-segmental transfer may theoretically operate via interhemispheric facilitation, warranting further investigation in larger, adequately powered trials.

Children doi: 10.3390/children13060733

Authors: Roshni Cheema Mihaela Visoiu

Background: Thoracic paravertebral catheters are increasingly used in neonates to avoid neuraxial techniques during thoracoscopic tracheoesophageal fistula (TEF) repair. Catheter fracture and retention are exceedingly rare in this population, and optimal management remains undefined. Learning Objectives: Recognize this complication risk in neonatal paravertebral placement; identify appropriate imaging when retention is suspected; discuss conservative and surgical approaches; and understand the importance of early transparent communication with caregivers. Case: A 2-day-old term neonate weighing 2.90 kg underwent thoracoscopic repair of type C tracheoesophageal fistula with intraoperative placement of an ultrasound-guided right paravertebral catheter for continuous analgesia. The catheter was placed at the T5 vertebral level using a 20 G, 2-inch Tuohy needle with an in-plane lateral-to-medial approach. Saline hydrodissection was used to confirm entry into the paravertebral space. A 24 G radiopaque Perifix One catheter was initially inserted but proved difficult to advance. During attempted removal, some resistance was encountered, and both the needle and catheter were withdrawn together. Subsequent inspection suggested possible catheter shortening, raising concern for a retained fragment. A second catheter of size 20 G advanced via an 18 G needle was then successfully placed at the same level and was removed without complications on postoperative day 3. Comparison with an intact reference catheter revealed that the first-placed 24 G catheter was approximately 1.5 cm shorter, although the tip appeared intact. The pain physician promptly notified both the clinical teams and the family. One month later, during routine imaging for respiratory distress, a curvilinear opacity was noted at the T9 vertebral level. Dedicated thoracic spine films confirmed a 7 mm retained paravertebral catheter fragment. Multidisciplinary consensus (pain team, anesthesia, NICU, and surgery) determined that the fragment was small, non-metallic, and remote from critical structures. Conservative management with long-term follow-up was chosen. The family was informed early during initial suspicion and again upon confirmation. At 17-month follow-up, the child remained asymptomatic. Discussion: Retained catheter fragments are rare in pediatric regional anesthesia and may be radiographically occult early. In neonates, re-operation for a tiny, inert foreign body may cause more morbidity than observation. Prevention depends on appropriate equipment selection, catheter integrity checks pre- and post-placement, careful technique, and attention to resistance or difficulty during advancement or removal. Clear and timely communication with caregivers preserves trust when complications or iatrogenic uncertainty arise. Conclusions: In this neonate, a small retained paravertebral catheter fragment was identified incidentally and was safely managed with conservative observation. When such fragments are non-metallic, stable, and located away from critical structures, non-operative management with close follow-up may be an appropriate and safe approach.

Children doi: 10.3390/children13060732

Authors: Ayse Nur Durmus Havva Akpınar

Background: Adolescents with type 1 diabetes (T1D) face considerable psychosocial demands that may increase vulnerability to diabetes-specific disordered eating behaviors. This study investigated the relationships among diabetes-specific disordered eating behaviors, social anxiety, social appearance anxiety, and psychological resilience in adolescents with T1D. Methods: This cross-sectional and correlational study included 176 adolescents diagnosed with T1D. Data were obtained using the Diabetes Eating Problem Survey-Revised (DEPS-R), the Social Anxiety Scale for Adolescents (SAS-A), the Social Appearance Anxiety Scale (SAAS), and the Child and Youth Resilience Measure (CYRM-12). Results: The mean age was 14.16 ± 2.73 years; 51.1% were male, and 63.1% had a disease duration of ≥3 years. Elevated levels of diabetes-specific disordered eating behaviors were observed in 85.8% of participants. Mean scores were 36.06 ± 15.26 (DEPS-R), 58.86 ± 12.90 (SAS-A), 48.82 ± 12.09 (SAAS), and 35.17 ± 10.61 (CYRM-12). Disordered eating behaviors showed positive correlations with social anxiety and social appearance anxiety and negative correlations with psychological resilience (all p < 0.001). Regression analyses indicated that social anxiety remained independently associated with disordered eating behaviors, whereas social appearance anxiety and psychological resilience did not. Psychological resilience was inversely related to both anxiety measures. Conclusions: Diabetes-specific disordered eating behaviors are common in adolescents with T1D and are closely linked to social anxiety-related factors. Social anxiety appears to be a key associated variable. Although psychological resilience was not independently related to disordered eating behaviors, it showed inverse associations with social anxiety. These findings support integrating routine psychosocial screening and targeted interventions into multidisciplinary diabetes care.

Children doi: 10.3390/children13060730

Authors: Ayşegül Cebe Tok Oya Sayın

Objectives: To evaluate serum zonulin and CHI3L1 as indicators of intestinal permeability and disease activity in pediatric celiac disease and to explore their associations with histopathological findings and nutritional status. Methods: This prospective cross-sectional study included 131 pediatric patients with CD (aged 2–18 years) and 42 healthy controls. Patients were classified as newly diagnosed, gluten-free diet (GFD)-adherent, or GFD-nonadherent. Body mass index was calculated, and serum levels of micronutrients, zonulin, and CHI3L1 were measured using a sandwich enzyme-linked immunosorbent assay. Associations with histopathological findings, serological markers, and nutritional parameters were analyzed. Results: Age and sex distributions were similar across groups (mean age: 10.9 ± 4.27 years). Serum zonulin and CHI3L1 levels were moderately positively correlated (r = 0.525, p < 0.001). Both biomarkers showed significant positive correlations with Marsh scores and tissue transglutaminase IgA levels. Zonulin was inversely correlated with hemoglobin, serum iron, and ferritin, whereas CHI3L1 showed negative correlations with hemoglobin and folate. Parathyroid hormone levels were positively correlated with both biomarkers. Receiver operating characteristic analysis demonstrated acceptable discriminatory performance for distinguishing CD from controls (AUC: 0.713 for zonulin and 0.709 for CHI3L1). Conclusions: Serum zonulin and CHI3L1 levels are associated with disease activity and mucosal injury in pediatric CD but do not directly reflect micronutrient status. These biomarkers may complement conventional monitoring parameters by providing additional information on intestinal permeability and inflammatory activity during follow-up.

Children doi: 10.3390/children13060729

Authors: Antonio Ibáñez-Camacho Belén Pastor-Villaescusa Jose Manuel Jurado-Castro Mercedes Gil-Campos Francisco Jesus Llorente-Cantarero

Survival rates in pediatric cancer have increased substantially over recent decades. However, children and survivors frequently experience treatment-related alterations in physical function, body composition, bone health, and metabolic regulation. Chemotherapy, glucocorticoid exposure, physical inactivity, nutritional imbalance, and inflammatory and neuroendocrine disturbances may contribute to reduced lean mass, decreased bone mineral density, sarcopenic obesity, and long-term cardiometabolic risk. This narrative review critically summarizes current evidence on multimodal exercise and nutritional interventions in pediatric oncology, with particular attention to their effects on physical function, body composition, nutritional status, and metabolic health. Literature searches were conducted in PubMed, Scopus, and Web of Science up to April 2026, combining contextual evidence with studies evaluating combined exercise and nutritional strategies. Current evidence suggests that structured and supervised exercise, particularly resistance and combined aerobic–resistance training, is feasible and safe, and may improve cardiorespiratory fitness, muscle strength, functional capacity, and body composition. Nutritional care should be individualized, prioritizing adequate protein intake, micronutrient status, periodic reassessment of energy requirements, and body composition rather than relying on BMI alone. Nevertheless, available findings remain limited by small sample sizes, heterogeneous protocols, variable supervision, inconsistent outcome assessment, and limited long-term follow-up. Integrating exercise, nutrition, and regular monitoring into pediatric oncology care may help mitigate treatment-related functional and metabolic complications. Future studies should prioritize adequately powered randomized trials, standardized intervention protocols, objective monitoring of exercise intensity, harmonized body composition and functional outcomes, and longer follow-up to define clinically applicable multimodal care models.

Children doi: 10.3390/children13060728

Authors: Maciej Szyduczyński Johannes Korneliussen Adrianna Jażdżewska Daria Sosińska Ewelina Wojciechowska Stefan Anzelewicz Andrzej Gołębiewski

Background: Ureteropelvic junction obstruction (UPJO) represents a common congenital anomaly in infants and young children. While minimally invasive approaches, including laparoscopic pyeloplasty (LP) and robot-assisted laparoscopic pyeloplasty (RALP), have gained acceptance, comparative outcomes in children younger than 3 years have still not been well-established. This study aimed to evaluate the safety and efficacy of RALP versus LP in infants and children younger than 3 years or weighing < 15 kg. Methods: A systematic literature search of PubMed, Web of Science, and Embase was conducted through May 2025. Five retrospective cohort studies comprising 272 patients met inclusion criteria (age younger than 3 years or weighing < 15 kg). Meta-analysis was performed using random-effects models. Results: Hospital stay was significantly shorter in the RALP group compared with LP (mean difference = −1.69 days; 95% CI: −2.71 to −0.67). No statistically significant differences were observed in operative time, complication rates, or success rates between approaches. Conclusions: RALP is associated with significantly reduced hospitalization time compared with LP in infants and young children, while maintaining comparable safety and efficacy profiles. These findings support RALP as a valuable minimally invasive option in this challenging patient population, though larger prospective studies are warranted.

Children doi: 10.3390/children13060727

Authors: Esteban López-Garrido Alejandra Luna-Huerta Ana Patricia Ortega-González Hadassa Yuef Martínez-Padrón

Background: Late-onset neonatal sepsis (LONS) remains a major cause of morbidity in preterm neonates admitted to the neonatal intensive care unit (NICU), yet the contribution of vitamin D status to neonatal infectious susceptibility remains uncertain. Objective: To evaluate clinical and demographic variables and serum vitamin D levels assessed at birth in preterm neonates with and without LONS. Methods: A retrospective observational cohort study was conducted in a tertiary NICU in northeastern Mexico between May 2023 and October 2024. Preterm neonates (<37 weeks of gestation) with serum 25(OH)D measured within the first hour of life were included. Vitamin D status was classified as sufficient (≥30 ng/mL), insufficient (20–29 ng/mL), or deficient (<20 ng/mL). LONS was defined as sepsis occurring after 72 h of life. Comparisons between neonates with and without LONS were performed using Fisher’s exact test for categorical variables and Student’s t-test or Mann–Whitney U test for continuous variables, as appropriate. Results: Twenty-nine preterm neonates were included (mean gestational age: 32.0 ± 2.6 weeks; mean birth weight: 1748 ± 545 g). The mean serum 25(OH)D level at birth was 35.5 ± 13.0 ng/mL. LONS occurred in 31% (9/29) of neonates, of which 55% were microbiologically confirmed. No significant differences were observed in vitamin D levels between neonates with and without LONS (35.0 ± 12.0 vs. 35.7 ± 13.7 ng/mL; p = 0.899). Vitamin D deficiency was not associated with LONS (OR 1.13, 95% CI 0.09–14.28). The prevalence of vitamin D deficiency was low (10%) in this cohort. Conclusions: A clear association between serum 25(OH)D levels at birth and the development of LONS could not be demonstrated in this small exploratory cohort. Given the limited sample size and low prevalence of vitamin D deficiency, further multicenter prospective studies are required to better understand the potential relationship between vitamin D status and neonatal infectious outcomes.

Children doi: 10.3390/children13060725

Authors: Han Gao Sergey Kiselev Ningkun Xiao

Research on sex-related differences in child and adolescent neurocognitive development has often been framed around whether boys and girls differ and which group performs better. This framing is increasingly inadequate because it treats developmental timing, observable phenotypes, and clinical recognition as interchangeable forms of evidence. Drawing on developmental neuroscience, cognitive development, research on gendered experience, and clinical studies of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), this integrative narrative review proposes a developmental-visibility framework. The framework interprets sex-related differences across three analytically distinct layers: developmental timing, phenotypic expression, and clinical recognition. Developmental timing refers to age-related trajectories, pubertal coupling, maturation tempo, and variability. Phenotypic expression refers to how developmental differences may appear in language, executive function, emotion, and social cognition under specific task and measurement conditions. Clinical recognition refers to how informants, referral thresholds, compensatory or camouflaging behavior, and diagnostic tools influence which difficulties are identified. ASD and ADHD illustrate the clinical-recognition layer because less externally disruptive or more compensated presentations may remain underrecognized despite meaningful developmental burden. The framework helps explain why modest average effects, inconsistent behavioral findings, and unequal clinical recognition can coexist. It shifts the field from asking whether sex-related differences exist to asking when, how, and under what social and clinical conditions they become visible.

Children doi: 10.3390/children13060726

Authors: Eglė Jauniškytė Giedrė Žulpaitė Jolanta Labanauskienė

Background/Objectives: Distal femoral physeal fractures are rare and particularly uncommon in very young patients, as they typically require a significant amount of kinetic energy. They carry a high risk of premature physeal closure and later growth disturbance. We aimed to describe the management and long-term outcome of an open distal femoral physeal fracture in a 6-year-old child. Methods: We report a previously healthy 6-year-old child sustained an open distal femoral physeal fracture in an electric scooter–motor vehicle collision. Emergency treatment included trauma assessment, resuscitation, intravenous cefazolin, urgent irrigation and debridement, open reduction, crossed smooth Kirschner-wire fixation, and immobilization. Long-term follow-up included growth prediction using the multiplier method. Results: The injury was classified intraoperatively as a Salter–Harris type I distal femoral physeal fracture. Despite timely surgical treatment, progressive limb-length discrepancy developed, increasing from 1.3 cm at 10 months to 6.5 cm over 5 years. Growth prediction estimated a final discrepancy of 7.32 cm at skeletal maturity, and contralateral distal femoral epiphysiodesis was performed. The literature confirms that displaced high-energy distal femoral physeal injuries in younger children carry a substantial risk of premature physeal closure and later corrective surgery. Conclusions: Open high-energy distal femoral physeal fractures in young children are limb-growth-threatening injuries. This case demonstrates that satisfactory initial fracture management does not eliminate the risk of later premature physeal closure, and that clinically important discrepancy evolves gradually over several years. Long-term follow-up and growth prediction are essential to guide timely corrective treatment to minimize the leg-length discrepancy in bone maturity.

Children doi: 10.3390/children13060724

Authors: Andreea Maria Sticea Bogdan Constantin Ungurean Bogdan Constantin Rață Adrian Cojocariu

Background/Objectives: The phenomenon of bullying represents a major issue in school settings worldwide, despite extensive research on the topic. This study aimed to investigate the associations between bullying perpetration, victimization, and assertive behavior among primary school students. Methods: The sample consisted of 352 fourth-grade students (174 boys and 178 girls; aged 10–11 years) from 7 schools in Iași, Romania. Bullying perpetration and victimization were assessed using the Adolescent Peer Relations Instrument–Bully/Target (APRI-BT), while assertive behavior was assessed using the Children’s Assertive Behavior Scale (CABS). Statistical analyses were performed using IBM SPSS Statistics version 20. Results: Positive correlations ranging from weak to strong were identified between bullying perpetration and victimization in both boys and girls. Bullying perpetration and victimization were also associated with assertive behavior and nonassertive behaviors, although most correlations were weak in magnitude. Conclusions: The findings highlight the complexity of bullying-related interpersonal dynamics during late childhood and may have implications for school-based social and emotional learning and bullying prevention interventions during this developmental stage.

Children doi: 10.3390/children13060723

Authors: Osnat Atun-Einy Maninderjit Kaur

Background/Objectives: Physically active play (PA-play) offers natural, self-directed, and varied opportunities for physical activity and motor skill development in children. It is often viewed as a rich context for learning, yet how PA-play systematically supports the core concepts and elements of motor learning (ML) requires a closer examination in typically developing (TD) children and those with neurodevelopmental disorders such as Developmental Coordination Disorder (DCD). Methods: A two-part integrative conceptual synthesis was conducted to explore how core ML concepts are reflected in children’s PA-play. Part 1 involved a synthesis of the play literature, analyzed through an ML lens in TD children. Part 2 involved synthesizing the literature on ML elements and characteristics of PA-play in children with DCD. Results: In Part 1, the conceptual synthesis highlighted that PA-play in TD children enables conditions supportive of ML, including both implicit and explicit learning, high-volume practice, task variability, progressive challenge, and feedback through verbal and non-verbal cues. In Part 2, the synthesis highlighted ML difficulties in children with DCD, such as slow, effortful learning with reduced adaptability and greater performance variability. Additionally, the synthesis highlighted limited DCD evidence using PA-play as an ecological context for ML. Conclusions: Overall, PA-play could offer environments consistent with ML elements in TD children, yet evidence for its effectiveness in children with DCD remains limited. Future research should explore how PA-play can be leveraged to address the specific ML challenges faced by children with DCD.

Children doi: 10.3390/children13060722

Authors: Lucía Cascobelo-Águeda Miguel Garrido-Bueno María Rodríguez-García Pastora Tirado-Hernández Elena Andrade-Gómez Javier Fagundo-Rivera Pablo Fernández-León

Background/Objectives: Celiac disease is a chronic autoimmune disorder triggered by gluten ingestion in genetically predisposed individuals. In children and adolescents, it presents heterogeneously and may negatively affect physical, psychological, and social well-being. Although a strict gluten-free diet is the only effective treatment, it may also impose important dietary, social, and economic burdens. This systematic review aimed to evaluate the impact of celiac disease on the quality of life of affected children and adolescents and their families. Methods: This systematic review was conducted according to PRISMA, AMSTAR 2, and Cochrane Handbook recommendations. Searches were performed in PubMed, Scopus, CINAHL, Web of Science, and PsycINFO for studies published between 2019 and 2026 in English or Spanish. Quantitative, qualitative, and mixed-methods studies on pediatric celiac disease and quality of life were included. Two reviewers independently conducted study selection, data extraction, and risk-of-bias assessment. Due to study heterogeneity, a narrative synthesis was performed. Results: Thirteen studies were included. Children and adolescents with celiac disease generally reported lower quality of life, particularly in emotional, social, and school-related domains. Adherence to a gluten-free diet was an important factor associated with quality of life. Although it improved symptoms, it was also linked to social restrictions, nutritional imbalances, and financial burden. Families also reported stress, lifestyle changes, and reduced well-being. Findings should be interpreted cautiously due to heterogeneity and variability in methodological quality across studies. Conclusions: Current evidence suggests that celiac disease may have a multidimensional impact on the quality of life of pediatric patients and their families. These findings support the need for a comprehensive multidisciplinary approach addressing dietary, psychosocial, and family-related factors.

Children doi: 10.3390/children13060721

Authors: Barbara Jelić Dario Vučenović Jelena Flego

Objectives: The aim of this study was to analyze current trends in screen exposure and to provide a deeper understanding of the relationships between temperament, screen exposure, and psychological adjustment in preschoolers. Methods: The study was conducted in kindergartens and one health center in the city of Zagreb, using a convenience sample of 115 mothers who assessed their preschool children’s screen exposure, temperament, and psychological adjustment. Results: Descriptive data analysis indicated that children’s screen time generally fell within the American Academy of Child and Adolescent Psychiatry’s recommended guidelines. Correlation analysis indicated that externalizing problems were significantly positively correlated with impulsivity, activity, emotionality, and weekend screen time. Conversely, prosocial behavior was negatively correlated with impulsivity and weekend screen exposure. Moderation analyses revealed that weekend screen time significantly altered the associations between temperament and externalizing problems. Specifically, longer weekend screen exposure weakened the relationships between Impulsivity and externalizing problem and between Activity and externalizing problems, suggesting that screen time may buffer the impact of high-risk temperament profiles on behavioral difficulties. Weekend screen time did not moderate the relationship between Emotionality and externalizing problems. Similarly, longer screen exposure weakened the negative association between Impulsivity and prosocial behavior, indicating that screen time may reduce the extent to which impulsive temperament undermines prosocial functioning in preschool children. Conclusions: These findings provide deeper insight into the role of temperament and screen time exposure in predicting both maladaptive and prosocial behaviors among preschool-aged children.

Children doi: 10.3390/children13060720

Authors: Anna Cecilia McWhirter Samuel W. Rueter Jessica N. Tveit Arin M. Connell Elizabeth A. Stormshak

Background/Objectives: Parenting interventions are an effective way to support child development, and brief screening tools can support equitable implementation of parenting interventions by reducing program costs, increasing accessibility, and engaging populations who have traditionally been underserved. However, brief assessments are frequently overlooked and underutilized. The Family Check-Up (FCU) Online is a digital parenting intervention that integrates a brief FCU Online Assessment, feedback, and parenting skills via an app along with optional provider support. To date, no prior work has validated the FCU Online Assessment. Method: The current study combined two samples of parents participating in FCU Online studies and assessed: (1) reliability, (2) construct validity, (3) convergent validity by comparing FCU Online Assessment subscales to similar parenting and child behavior measures, and (4) predictive validity by using FCU Online Assessment at pretest to predict posttest scores as well as parenting and child behaviors at time 2 and time 3. Results: Strong reliability was found among all five subscales, including Low Conflict (7 items, α = .81), Positive Parenting Practices (11 items, α = .80), Positive School Behaviors (5 items, α = .83), Consistent Rules and Routines (11 items, α = .81), and Child Mental Health (5 items, α = .80). The FCU Online Assessment demonstrated construct and convergent validity, as well as predictive validity in that the FCU Online Assessment at pretest predicted posttest scores. Conclusions: The FCU Online Assessment is a brief, reliable, and valid measure of parenting and child wellbeing. It can be used by parents and providers alike to evaluate parenting skills and child mental health, develop targeted goals and intervention approaches, and assess family wellbeing over time.

Children doi: 10.3390/children13060719

Authors: Mitsuki Ikeda Haruhiko Hoshino Yujiro Matsuishi Misaki Kotani Shunsuke Kobayashi Takahiro Kido Yuki Enomoto Nobutake Shimojo Yoshiaki Inoue

Background: Pain assessment in critically ill, mechanically ventilated pediatric patients is highly complex owing to communication barriers and the frequent use of sedation. A standardized, rapid, and objective tool such as the Behavioral Pain Scale (BPS) is urgently needed in Japanese pediatric intensive care units (PICUs), particularly in mixed adult–pediatric settings, to ensure consistent, multidisciplinary assessment. This study aimed to evaluate the clinical applicability, validity, and reliability of the Japanese version of the BPS in critically ill mechanically ventilated pediatric patients. Methods: This single-center, prospective cross-sectional observational study was conducted between October 2021 and March 2023. The final analysis included 70 observations from 37 pediatric patients who needed mechanical ventilation (MV). Concurrent and convergent validity were assessed using Spearman’s rank correlation coefficients (ρ) between the BPS; the Face, Legs, Activity, Cry, Consolability (FLACC) scale; and the COMFORT-Behavior (COMFORT-B) scale. Interrater reliability was evaluated using intraclass correlation coefficients (ICCs) and weighted kappa values among the three independent observers. The sample size (52 observations) was calculated based on the kappa coefficient estimation. The impact of sedation depth (assessed using the Richmond Agitation–Sedation Scale [RASS]) and the observers’ prior clinical experience with the evaluations were also analyzed. Results: Concurrent and convergent validity were high, showing strong correlations with the FLACC (ρ = 0.49–0.91) and COMFORT-B (ρ = 0.69–0.87) scales. The total BPS score showed moderate interrater reliability (ICC = 0.66, 95% CI = 0.55–0.76; weighted κ = 0.63–0.71). However, deep sedation (defined as a median RASS score ≤ −4 across observers), present in 68.6% of the observations, caused a pronounced floor effect that suppressed behavioral responses, even during painful procedures. Consequently, the reliability of fine motor subscales like “upper limb movement” (κ = 0.08) was slight and for “facial expression” (κ = 0.38), it was fair. Furthermore, the correlation strength with the FLACC scale varied significantly with observer experience, with the strongest correlation (ρ = 0.91) achieved by the observer with extensive adult ICU experience. Conclusions: As an initial validation, the Japanese version of the BPS has demonstrated acceptable validity and moderate reliability in mechanically ventilated pediatric patients. However, its clinical application requires careful interpretation because of the pronounced floor effect under deep sedation. Furthermore, accurate assessment depends heavily on specific training and familiarity with the adult-derived scale. With adequate training, the BPS has the potential to serve as an alternative tool and a valuable common multidisciplinary language in mixed intensive care settings. Future research should investigate whether implementing this tool improves multidisciplinary communication and clinical outcomes.

Children doi: 10.3390/children13060718

Authors: Donatella Di Corrado Maria Chiara Parisi Matteo Pacifico Mancini Patrizia Tortella

Background: Promoting physical activity in early childhood is essential for supporting motor, cognitive, and socio-emotional development. Outdoor environments rich in natural stimuli may further enhance these benefits. Recent approaches suggest that integrating movement with narrative contexts may provide additional developmental opportunities by engaging cognitive and affective processes. This study examined the associations between three outdoor motor activity approaches—Storytelling in Motion, Free Play, and Traditional Motor Instruction—and motor competence and inhibitory control in preschool children. Methods: Eighty-seven preschool children (M_age = 5.32 ± 0.60 years) participated in a quasi-experimental pretest–posttest study conducted in outdoor educational settings in Northern Italy, including a natural environment, a structured playground, and a school courtyard. Participants were assigned at the class level to three groups of unequal size (Storytelling in Motion n = 36, Free Play n = 22, Traditional Motor Instruction n = 29). All groups completed ten weekly sessions lasting approximately 60 min. Motor competence was assessed using selected tasks derived from the Test of Motor Competence and the Movement Assessment Battery for Children-2, while inhibitory control was evaluated using the Day/Night Test. Results: Significant Time × Group interactions were observed for several outcomes. The Storytelling in Motion group showed numerically greater improvements at a descriptive level in dynamic balance (Heel-to-Toe Walking: p < 0.001, η2p = 0.229) and fine motor control (Bicycle Trail: p < 0.001, η2p = 0.194) compared to the other groups. The Free Play group showed greater improvements in coordination-related tasks and upper-body strength. No significant differences between groups were observed for inhibitory control. These differences remained significant after adjustment but should be interpreted cautiously due to the non-randomized design. Accordingly, these findings should be considered preliminary and hypothesis-generating (ANCOVA, p < 0.05). Conclusions: Narrative-based outdoor motor activities may represent a potentially relevant approach; however, no firm conclusions can be drawn from the present design. Given the quasi-experimental nature of the study and the contextual differences between intervention settings, the findings should be interpreted with caution. Future research using randomized controlled designs and standardized environments is needed to clarify the independent and combined effects of instructional and environmental factors.

Children doi: 10.3390/children13060717

Authors: Simona Fattore Chiara Tirone Alessandro Perri Francesca Paola Fusco Simonetta Frezza Milena Tana Donato Rigante Davide De Tomaso Nicoletta Menzella Alessandra Lio Francesca Serrao Stefano Nobile Andrea Piras Silvia Baroni Simonetta Costa Giovanni Vento

Bronchopulmonary dysplasia (BPD) remains a major complication of extreme prematurity, driven in part by persistent inflammation. Interleukin (IL)-1–mediated signaling plays a central role in sustaining lung injury, making IL-1 blockade a potential therapeutic target. Evidence on the use of anakinra, a recombinant IL-1 receptor antagonist, in neonatal BPD is still limited. We report the case of a female preterm infant (28+2 weeks’ gestation, birth weight 800 g, −1.41 zs) affected by BPD requiring prolonged respiratory support. Due to persistent respiratory failure despite standard therapies, off-label treatment with subcutaneous anakinra (5 mg/kg twice daily) was initiated at 150 days of life. Clinical respiratory parameters and exploratory salivary inflammatory biomarkers (IL-6 and soluble urokinase plasminogen activator receptor, suPAR) were longitudinally monitored. Following anakinra initiation, the patient showed a gradual improvement in respiratory parameters, with reduction in oxygen requirement, mean airway pressure, and improved gas exchange. Respiratory support was gradually de-escalated from nasal intermittent positive pressure ventilation to continuous positive airway pressure and subsequently to high-flow nasal cannula. Salivary suPAR levels demonstrated a decreasing trend, while IL-6 showed transient fluctuations, partly associated with intercurrent infections. Treatment was generally well tolerated during the observation period. The infant was discharged on minimal respiratory support, with continued improvement during follow-up. This case suggests a possible role of IL-1 blockade in the modulation of persistent inflammation in BPD with a refractory clinical course, although the observed clinical course may also reflect the natural evolution of the disease. Longitudinal salivary biomarkers may represent a feasible, exploratory, non-invasive approach to describe inflammatory dynamics over time. Larger prospective studies are needed to evaluate the efficacy, safety, and optimal treatment protocols of anakinra.

Children doi: 10.3390/children13060716

Authors: Niccolò Butti Eleonora Mascheroni Vittoria Maucci Roberta Nossa Lucia Scaccia Francesca Masserano Emilia Biffi Rosario Montirosso

Background/Objectives: This study explored parents’ perspectives regarding digital media use in children and adolescents with neurodevelopmental disorders (NDs) and examined how these views vary according to family and clinical characteristics. Methods: Data were collected from an Italian survey involving 352 families. Items assessed the perceived effects of digital devices on child development and parenting, awareness of screen time guidelines, and use of time- and content-limiting tools. Quantitative analyses were complemented by a reflexive thematic analysis of open-ended responses describing how digital media influenced parenting. Results: Parents expressed divergent attitudes towards digital media, with broadly similar proportions reporting positive, neutral, and negative views regarding both child development and parenting. More favourable views were associated with greater perceived benefits for children and were more frequent among parents of children with more severe functional disabilities. About half had discussed screen use with health professionals, and most were aware of existing guidelines. Thematic analysis identified six themes related to digital parenting: educational means (digital devices as tools for communication, learning, and socialisation), entertainment (screens as a source of leisure or behavioural management), reward (digital media used as reinforcement), screen time as a “necessity” (technology as an integral and sometimes rehabilitative part of daily life), negative effects on the child (concerns about detachment, reduced social interaction, and mood dysregulation), and parental behaviour and attitudes (reflecting the emotional burden of regulation and broader beliefs about digital media). Conclusions: Parents of children with NDs navigate digital media use through a complex balance of perceived risks and benefits. Findings highlight the need for family-centred guidance and assistive technology approaches that promote digital inclusion while addressing parental stress and regulatory challenges.

Children doi: 10.3390/children13060715

Authors: Maria Cândida de Carvalho Furtado Waldemar Brandão Neto Maria Regina Pontes Luz Riccioppo Isadora Fiacadori Gomes Paula Saud De Bortoli Edmara Bazoni Soares Maia Débora Falleiros Mello

Background/Objectives: Excessive screen time has become increasingly common among children worldwide. The current study investigated the relationship between adherence to recommended screen time guidelines and family and child characteristics and social development through play. Methods: This cross-sectional study included 278 mothers from all five Brazilian geographic regions who answered two self-administered online questionnaires assessing sociodemographic characteristics, family characteristics, child development, and screen use in children aged 0–3 years. Analyses included descriptive statistics, chi-square tests, and logistic regression to identify factors associated with adherence to recommended screen time guidelines. Results: Male sex (OR = 3.306, 95% CI: 1.759–6.213), family characteristics (living with both parents, OR = 4.102, 95% CI: 1.134–14.836) and aspects of social development (playing with another child (OR = 2.410, 95% CI: 1.024–5.650); body-based exploratory play (OR = 2.941, 95% CI: 1.225–7.042); and playing with homemade toys (OR = 1.931, 95% CI: 1.032–3.623)) were associated with adherence to recommended screen time guidelines. Conclusions: Appropriate screen time use was associated with male sex, living with both parents, playing with peers, engaging in body-based exploratory play, and using homemade toys. Routine child health consultations must explore family characteristics and evaluate aspects of children’s social development to identify healthy screen use behaviors.

Children doi: 10.3390/children13050713

Authors: Ruimeng Ma Jingrong Song Yu Fu Rui Li Tienan Feng Zonglang Yu Mengting Zhang Shuping Jin Xiaoying Zhang

Background/Objectives: Small airway dysfunction (SAD) may occur early in children with Mycoplasma pneumoniae pneumonia (MPP), but pulmonary function testing is often deferred until clinical stabilization and may be limited by poor cooperation. Early risk stratification may therefore help identify children who warrant further testing. We aimed to identify early predictors of subsequent spirometry-defined SAD and to develop an internally validated risk-stratification model in hospitalized children with MPP. Methods: In this single-center retrospective cohort study conducted between July 2022 and July 2024, 172 hospitalized children with confirmed MPP were included. Clinical characteristics, immune-inflammatory indices, and chest computed tomography (CT) findings were collected during early hospitalization. Pulmonary function testing was performed after clinical stabilization, and SAD was defined as at least two of forced expiratory flow at 25%, 50%, and 75% of forced vital capacity being <65% of predicted values. Multiple imputation, LASSO selection, and multivariable logistic regression were used for model development and bootstrap internal validation. Results: SAD was identified in 76/172 children (44.2%). Wheezing, CT evidence of small airway involvement, and higher soluble interleukin-2 receptor levels were more common in children with SAD; wheezing remained independently associated with SAD. A model based on routine clinical and chest CT variables showed good discrimination (AUC, 0.885; optimism-corrected AUC, 0.869). Adding interleukin-17 provided limited incremental value. Conclusions: SAD was common in hospitalized children with MPP. An internally validated model based on readily available clinical and chest CT variables may help prioritize children for pulmonary function testing after clinical stabilization, whereas interleukin-17 added limited predictive value. External validation is required before broader clinical application.

Children doi: 10.3390/children13050714

Authors: Erika Roncarati Dorina Lauritano Saverio Ceraulo Luigi Baggi Roberta Calcaterra Roberto Gatto Silvia Caruso Stefano Cianetti Guido Lombardo Gianmaria Fabrizio Ferrazzano Francesco Carinci

Background: Dental caries remain a major public health issue among Italian children, with prevalence exceeding 60% in specific subgroups and marked socioeconomic gradients. Objectives: This multicenter study aimed to describe baseline caries experience, malocclusions, and oral hygiene status in pediatric populations residing in three Italian regions and to develop and preliminarily evaluate the feasibility of an integrated care pathway for the prevention and management of caries and malocclusions. Materials and Methods: Within the CCM 2024 program (ID 10), a cross-sectional baseline assessment was conducted on 795 children aged 6–11 years, examined in school settings and via mobile dental units. Caries experience was assessed using the dmft/DMFT indices and International Caries Detection and Assessment System (ICDAS) criteria. Malocclusions were evaluated using the Index of Orthodontic Treatment Need (IOTN). Oral hygiene was assessed through standardized clinical indices. The proposed care pathway comprises three tiers: (1) universal, school-based oral health education; (2) targeted clinical preventive and interceptive interventions; and (3) telemedicine/AI-supported follow-up for high-risk children. Descriptive and multivariable statistical analyses were performed. Results: At baseline, overall caries burden was low. No statistically significant differences in dmft/DMFT were observed between males and females. A non-significant trend toward higher caries indices was found among children with a positive breastfeeding history. By contrast, oral hygiene level was strongly associated with caries indices: children with insufficient hygiene had the highest dmft/DMFT, those with moderate hygiene showed intermediate values, and those with optimal hygiene presented the lowest caries experience. In multivariable models, oral hygiene emerged as the main independent predictor of dmft/DMFT. Conclusions: In this low-caries cohort, oral hygiene was confirmed as the principal modifiable determinant of caries risk. A tiered, school- and community-based care pathway focused on hygiene promotion, early screening, and minimally invasive clinical interventions appears feasible at baseline and may be scalable, with the aim of reducing the burden of caries and malocclusions and improving equity in pediatric oral health.

Children doi: 10.3390/children13050712

Authors: Andrei-Ioan Munteanu Delia-Maria Nicoară Iulius Jugănaru Raluca Asproniu Raluca Vasilescu Lucian-Ioan Cristun Otilia Mărginean

Background: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) represents a group of rare systemic autoimmune disorders marked by inflammation and damage to small- and medium-sized blood vessels. The clinical presentation of AAV is highly variable, ranging from isolated organ involvement to severe, life-threatening multisystem disease, posing significant challenges in diagnosis, treatment, and prognosis. Objective: To demonstrate the clinical heterogeneity and different outcomes in three pediatric cases of ANCA-positive disease and emphasize the importance of integrating clinical findings with laboratory and imaging investigations for accurate diagnosis. Methods: We present three pediatric patients (ages 12–15 years) with ANCA-positive results but distinct clinical presentations, evaluated at the Children’s Emergency Hospital “Louis Turcanu”, Timisoara, between 2020 and 2024. All cases were investigated according to EULAR/PRINTO/PReS criteria for pediatric vasculitis. Results: Case 1 (PR3-ANCA positive) developed severe multi-organ involvement, including granulomatosis with polyangiitis (GPA) with pulmonary hemorrhage, pericarditis, thrombotic events, and renal impairment, requiring intensive immunosuppression with cyclophosphamide, rituximab, and mycophenolate mofetil, ultimately developing chronic kidney disease stage 3a. Case 2 (BPI-ANCA positive) presented with purpuric lesions and painless joint swelling, responding favorably to corticosteroid therapy with subsequent remission. Case 3 (MPO-ANCA) manifested as polyarticular arthritis without other organ involvement and was ultimately diagnosed as seronegative juvenile idiopathic arthritis (JIA), achieving complete remission with adalimumab therapy. Conclusions: This case series highlights the diverse clinical and biological features of ANCA-positive conditions in children, emphasizing that ANCA positivity requires careful clinical correlation as it may indicate true vasculitis requiring aggressive treatment or alternative diagnoses such as JIA with incidental ANCA positivity. Tailored therapeutic strategies based on clinical presentation and continued research are essential to improve patient outcomes.

Children doi: 10.3390/children13050711

Authors: Višnja Tokić Pivac Sanja Kolaček Iva Hojsak Zrinjka Mišak Oleg Jadrešin Ivan Pavić

Objectives: We aimed to assess fractional exhaled nitric oxide (FeNO) and spirometry in pediatric patients with inflammatory bowel disease (IBD) and relate these parameters to disease activity, duration, and current treatment. Methods: This prospective case–control study included 161 subjects: children with newly diagnosed, active IBD (N = 55), children in clinical remission (N = 53), and healthy controls (N = 53). FeNO was measured using a chemiluminescent analyzer, and pulmonary function was assessed by spirometry. Results: FeNO was higher in patients with IBD than in controls (p = 0.025) and positively correlated with CRP (ρ = 0.22; p = 0.027). Respiratory function measured by spirometry in children with IBD was preserved. No association was found between respiratory parameters, disease activity, and duration. The correlation between FeNO and aminosalicylate treatment was of borderline significance (ρ = 0.28; p = 0.052). Conclusions: Children with IBD, although having normal pulmonary function measured by spirometry, do have increased FeNO, which is positively correlated with CRP. FeNO reflects systemic inflammation, but its role as a clinical marker of disease activity or relapse remains uncertain.

Children doi: 10.3390/children13050710

Authors: Amal H. Aljohani Hamdi Ahmed Alsufiani Abeer Musaibieh AlSaadi Nora Abdulrahman Alem Mamoun AliAbusunoon Amnah Ibrahim Madkhali

Background: Severe asthma exacerbations remain a major cause of pediatric intensive care unit (PICU) admissions, particularly in early childhood. Objective: To describe the demographic characteristics, clinical features, management strategies, and short-term outcomes of children admitted to the PICU with severe acute asthma exacerbations. Methods: A retrospective descriptive study was conducted of pediatric patients aged 1–14 years with severe acute asthma requiring PICU admission at King Salman Medical City, Madinah, Saudi Arabia (January 2023–October 2024). A total of 73 patients were included. Data included demographics, risk factors, medical history, clinical presentation, management, and outcomes. Results: The mean patient age was 4.6 years, with most (57.5%) aged 1–5 years. Males comprised 56.2% of cases. WHO BMI-for-age z-score assessment revealed a bimodal nutritional distribution: 27.9% of patients were underweight, including 20.6% with severe underweight, while 29.4% were overweight or obese; 42.6% had normal nutritional status. Severe undernutrition was concentrated in the 1–5-year age group, whereas obesity predominated in the 6–10-year age group. A family history of asthma was noted in 54.8% of patients; 16.4% had prior COVID-19 infection. Early symptom onset and delayed diagnosis were common. Poor asthma control was documented in 60.3%, with low medication adherence (9.6%) and limited aerochamber use (13.7%). The most frequent presenting symptoms were dyspnea, cough, and wheezing. Management followed evidence-based protocols: systemic corticosteroids and bronchodilators were first-line therapies. The mean PICU stay was 3.1 days and the mean hospital stay was 8.1 days. No mortality or major complications occurred; 93.2% of patients were discharged in good health. Conclusions: Severe pediatric asthma requiring PICU admission is associated with early symptom onset, a bimodal pattern of nutritional risk encompassing both undernutrition and overweight/obesity, family history of asthma, and inadequate outpatient management. These descriptive findings highlight the need for age-adjusted nutritional screening, enhanced medication adherence support, and targeted outpatient education to reduce avoidable PICU admissions.

Children doi: 10.3390/children13050709

Authors: Takahiro Nishimura Hideaki Watanabe Naoya Taki Ichiro Kikkawa

Background/Objectives: The prevalence of developmental dysplasia of the hip (DDH) in adolescent idiopathic scoliosis (AIS) remains unclear, partly because of differences in diagnostic criteria and measurement accuracy. Additionally, spinopelvic alignment and skeletal maturation may affect radiographic assessment of acetabular morphology in patients with AIS. This study aimed to clarify the prevalence of DDH in Japanese patients with AIS using standardized radiographic assessment and to compare conventional and age-adjusted diagnostic criteria for DDH. Methods: This cross-sectional study included 602 Japanese patients aged 10–18 years with AIS. Patients with inadequate radiographs, including those with pelvic rotation and lateral inclination, were excluded to improve measurement accuracy. DDH was defined using two criteria: (1) conventional (lateral center-edge angle <20°) and (2) age-adjusted thresholds (<15° for <15 years and <18° for ≥15 years). Radiographic parameters were compared between patients with and without DDH. A multivariate logistic regression analysis was performed to identify factors independently associated with DDH. Results: The prevalence of DDH in AIS was 5.6% (34/602) using the conventional criterion and 1.5% (9/602) using the age-adjusted criteria. Patients with DDH showed significantly lower acetabular coverage, with a lower lateral center-edge angle and acetabular head index and higher Sharp and Tönnis angles than those without DDH (all p < 0.01). No significant difference in the main curve Cobb angle was observed between the groups. A younger age was independently associated with DDH, whereas sex and the main curve Cobb angle were not. Conclusions: The prevalence of DDH in Japanese patients with AIS varies substantially depending on the diagnostic criteria. Standardized radiographic evaluation with exclusion of pelvic rotation provides a reliable estimate. These findings highlight the importance of evaluating acetabular morphology on standing whole-spine radiographs in patients with AIS while considering skeletal maturation and spinopelvic alignment.

Children doi: 10.3390/children13050708

Authors: Ayah Khodor Ahmad Tarabaih Mohammad Alkilzy

Objectives: The aim of the study was to assess the prevalence, severity and treatment needs of molar incisor hypomineralization (MIH) among a cohort of children in Lebanon. Methods: A cross-sectional study was performed in Akkar district in northern Lebanon on 1237 school children between 10 and 12 years old (mean age 11.11 ± 0.80 years) who were recruited from eight private schools. Clinical evaluations were performed after teeth cleaning and drying using sterile gauze. Examiners assessed all teeth present in the oral cavity using the MIH index of the EAPD. If MIH was diagnosed, a further grading was made according to the MIH-TNI index. Results: In total, 212 children (17.14% [95% CI:15.0, 19.2]) were diagnosed with MIH. Of these, 200 children with completed documentation were included in the further statistical analysis. Out of the affected cases, mild lesions were the most common at 41% (n = 82). Although males exhibited higher cumulative numbers of affected teeth (52.5%, n = 267), with notably greater proportions in moderate (17.7%) and severe (16.7%) cases, the difference between genders was not statistically significant (p = 0.069). Treatment needs increased with severity, in which mild lesions primarily required preventive care (41.0%), while moderate lesions required restorative treatments (34.0%); in contrast, severe lesions (25.0%) often necessitated extensive interventions, such as crowns, pulp therapies or even extractions. Although descriptive patterns suggested an increase in more complex treatment needs in older age groups, the association was not statistically significant (p = 0.26). Conclusions: The prevalence of MIH observed in this cohort study aligns with internationally reported values. Early detection, preventive management, and timely restorative interventions are essential to minimize the long-term impact of MIH.

Children doi: 10.3390/children13050707

Authors: Giuliana C. Antolovich Ingrid Sutherland Zoe McCallum Monica S. Cooper

Background/Objectives: Advances in paediatric care have increased the survival of children with severe neurological impairment, often accompanied by complex disability, multimorbidity, and a substantial treatment burden. Determining whether interventions provide meaningful benefit to the child is ethically challenging, particularly when decision-making is shared between parents and clinicians, while the child has limited capacity to participate directly in decision-making. This paper examines the guiding question “what’s in it for the kid?” as a means of strengthening child-centred ethical deliberation alongside established frameworks. Methods: We undertook a conceptual bioethical analysis informed by clinical experience in an inner city tertiary public hospital. The analysis focuses on children with severe neurological impairment and medical complexity. The paper critically examines how the guiding question aligns with and extends key ethical constructs, including shared decision-making, the Zone of Parental Discretion, the Best Interests Standard, and care ethics. Clinical scenarios are used illustratively to demonstrate application in practice. Results: Existing ethical frameworks form an important foundational structure for complex decision-making. The question “what’s in it for the kid” translates ethical principles into a practical moral prompt that centres the child as the subject of decision-making. It facilitates clearer consideration of risks, benefits meaningful to the child and lived experience and helps to distinguish the child’s interests from those of parents and clinicians. Its simplicity enhances accessibility and supports consistent use in complex, high-stakes decisions. Conclusions: “What’s in it for the kid?” is a pragmatic and accessible ethical prompt that complements established frameworks by translating them into clinically usable practice. It promotes explicit, child-focused deliberation and supports a more transparent and child-centred evaluation of benefit and burden, particularly in contexts of uncertainty and medical complexity.

Children doi: 10.3390/children13050706

Authors: Massimo Verdicchio Cristina Bucci Sara Isoldi Laura Aurino Maria Giovanna Puoti Serena Marulo Federica Riccitiello Rossella Turco Francesco Cirillo Giovanni Di Nardo Paolo Quitadamo

Background/Objectives: Congenital esophageal stenosis (CES) is a rare condition that may present with feeding difficulties in infancy, often becoming evident during weaning. We report a case of CES presenting with progressive dysphagia during the introduction of solid foods. Methods: Clinical evaluation, contrast esophagography, endoscopy, and magnetic resonance imaging were performed to characterize the stenosis and guide management. Results: Imaging revealed a fixed narrowing of the mid-distal esophagus with minimal passage of contrast and proximal dilatation. Endoscopy confirmed a non-traversable intrinsic stenosis with macroscopically normal mucosa. The patient underwent three endoscopic dilation sessions under general anesthesia using Savary-Gilliard bougies with progressive diameters (3–5 mm, 3–7 mm, and 7–11 mm). No major procedural complications occurred. At 2-month follow-up after the last dilation, feeding was appropriate for age, dysphagia had improved, and growth was regular. Conclusions: CES should be suspected in infants with feeding difficulties that worsen during weaning, particularly when symptoms are resistant to anti-reflux therapy. Endoscopic dilation can improve feeding tolerance, although repeated and staged sessions may be required. The role of adjunctive therapies such as topical budesonide remains uncertain.

Children doi: 10.3390/children13050705

Authors: Batuhan Yeke Mustafa Senol Akin Seyma Butun Turk Sarkhan Elbayiyev Burak Ceran Ozdemir Ozdemir Ufuk Cakir

Objective: In addition to hyperoxia, inflammation and infection contribute to the pathogenesis of retinopathy of prematurity (ROP). However, the differential effects of specific bacterial pathogens on ROP development remain unclear. This study aimed to evaluate the association between sepsis due to Gram-positive and Gram-negative bacteria and the development and severity of ROP. Materials and Methods: Infants at risk for ROP, defined as those with birth weight ≤1500 g or gestational age ≤32 weeks, or those with birth weight >1500 g or gestational age >32 weeks who required cardiorespiratory support, were included in this retrospective study. Patients were categorised into no-ROP and any-stage ROP groups, as well as treatment-requiring and non-treatment-requiring ROP groups. The clinical characteristics, laboratory findings, and microbiological data were compared between the groups. Results: Among the 319 enrolled infants, 193 (60.6%) did not develop ROP, whereas 126 (39.4%) developed any-stage ROP. Clinical early-onset sepsis, clinical and proven late-onset sepsis, and increased frequency of late-onset sepsis episodes were significantly associated with any-stage and treatment-requiring ROP (p < 0.05). In multivariate analysis, both Gram-positive (OR 2.36, 95% CI 1.2–4.6, p = 0.012) and Gram-negative bacterial sepsis (OR 3.56, 95% CI 1.5–8.3, p = 0.004) were independently associated with any-stage ROP. In addition, Gram-positive bacterial sepsis (OR 4.4, 95% CI 1.1–16.9, p = 0.031) was independently associated with treatment-requiring ROP. Conclusions: Gram-positive bacterial sepsis was associated with both any-stage ROP and treatment-requiring ROP, whereas Gram-negative bacterial sepsis was associated with any-stage ROP only. These findings support the potential role of pathogen-specific inflammatory processes in ROP development and progression. Further prospective studies incorporating detailed inflammatory and oxygenation parameters are required to clarify these relationships.

Children doi: 10.3390/children13050704

Authors: Yasin Selcuk Yardibi Begum Baris Cetinkaya Zeynep Tobcu Sevim Orum Dondu Ulker Ustebay Sefer Ustebay

Background/Objectives: Asthma, one of the most common chronic diseases in childhood, and acute bronchiolitis, a leading cause of hospitalization in early childhood, remain significant contributors to morbidity and mortality. Methods: This retrospective cohort study evaluated the efficacy and safety of intravenous magnesium sulfate (IV MgSO4) as a secondary treatment in pediatric patients with acute asthma exacerbation unresponsive to first-line therapy and in patients with acute bronchiolitis unresponsive to supportive care. A total of 450 patients aged 6 months to 18 years, including 252 with acute asthma exacerbation and 198 with acute bronchiolitis, were included. Results: Significant improvements in peripheral capillary oxygen saturation were observed after IV MgSO4 administration in both groups (p < 0.001). In the acute asthma exacerbation group, IV MgSO4 also significantly reduced tachypnea compared to the acute bronchiolitis group (p < 0.001). No adverse effects related to IV MgSO4 were observed. Conclusions: These findings suggest that IV MgSO4 may be both beneficial and safe as an early secondary treatment in acute asthma exacerbations.

Children doi: 10.3390/children13050703

Authors: Rok Košiček Vanja Erčulj Lilijana Kornhauser Cerar Lev Bregant Miroslav Petrovec Marko Pokorn Ana Spirovska Tina Uršič Urška Rahne Potokar Stefan Grosek

Background/Objectives: The impact of postnatal CMV infection in extremely premature newborns is poorly characterized. We aimed to determine the impact and outcomes of postnatal CMV infection in a population of extremely premature newborns of gestational age of less than 29 weeks hospitalized in the Department of Perinatology, Division of Gynecology, University Medical Center Ljubljana. Methods: We included all extremely premature newborns of gestational age of less than 29 weeks treated in the Department of Perinatology between December 2022 and December 2024. Newborns were screened for CMV infection at set timepoints and congenital infection was excluded with PCR testing. Additional PCR testing for CMV was performed if newborns developed clinical features suspect for postnatal CMV infection. Clinical characteristics and treatment outcomes of newborns were noted. Mothers of infected newborns had their CMV serostatus determined. Results: In total, 63 extremely premature newborns were included, and 14 newborns had confirmed postnatal CMV infection. Postnatal CMV infection was associated with hepatosplenomegaly and lower platelet and leukocyte counts compared to controls. We found no association between postnatal CMV infection and other neonatal comorbidities. Conclusions: In our study, postnatal CMV infection was associated with a more severe and prolonged clinical course of extremely premature newborns compared to uninfected controls; however, in multivariable analysis, the association with a prolonged length of stay was no longer statistically significant. The results suggest that preventing postnatal CMV infection in this population is important.

Children doi: 10.3390/children13050702

Authors: Elif Kandemir Ülker Seçil Çalışkan

Background/Objectives: This study aims to compare the oral health-related quality of life (OHRQoL) of children with molar incisor hypomineralisation (MIH) and their parents with that of an age- and caries-matched control group, and to evaluate the long-term impact of dental rehabilitation on OHRQoL. Methods: A total of 30 children aged 8–12 years were included, with 15 participants in the MIH group and 15 in the control group. OHRQoL was assessed using the Pediatric Oral Health-Related Quality of Life (POQL) scale. Data were obtained at baseline and at 3, 6, and 12 months after treatment. Statistical analyses included a chi-square test, independent samples t-test, Mann–Whitney U test and Friedman test, according to data distribution. Results: Baseline POQL scores were significantly higher in the MIH group compared with the control group for both children and parents (p = 0.020 and p = 0.036, respectively). Among subscales, emotional functioning scores in children and role and physical functioning scores in parents were significantly higher in the MIH group (p = 0.027 and p = 0.032, respectively). Following dental rehabilitation, POQL scores significantly decreased in both groups (p < 0.001), and this improvement was maintained throughout the 12-month follow-up period. Conclusions: MIH has a negative impact on the OHRQoL of both children and parents, regardless of caries experience. Comprehensive dental rehabilitation results in significant and sustained improvements in OHRQoL, indicating the importance of early and comprehensive management in children with MIH.

Children doi: 10.3390/children13050700

Authors: Yasar Gokhan Gul Sümeyye Yildiz Hande Güngör Burak Omur Pelin Karaaslan Bahadir Ciftci

Background/Objectives: Postoperative agitation (PA) and postoperative pain in pediatric patients following sevoflurane anesthesia are challenging clinical scenarios. This study aimed to evaluate the effects of intraoperative dexmedetomidine infusion compared to fentanyl infusion on the prevention of postoperative agitation and analgesic efficacy in children undergoing tonsillectomy and/or adenoidectomy. Methods: After ethical committee approval, a total of 85 pediatric patients (age range: 2–13 years) in the ASA I-II group were included in the study. Patients were randomized into two groups: the dexmedetomidine group (Group D, n = 40) and the fentanyl group (Group F, n = 45). Postoperative pain was monitored in the recovery unit (PACU) using the FLACC (face, legs, activity, cry, consolability) scale, and agitation was monitored using the PAED (pediatric anesthesia emergence delirium) scale. FLACC and PAED were monitored at 5, 10, 15, 30 min, and 2 and 4 h postoperatively. Results: Demographic data and surgical durations were similar between groups (p > 0.05). The dexmedetomidine group had lower FLACC pain scores at 10 and 15 min (uncorrected trends), but only the difference at 30 min remained statistically significant after Bonferroni correction (p = 0.0001; Cohen’s d = 0.85). Although PAED scores were numerically lower in Group D, no statistically significant difference was found. While an observational trend toward lower agitation was noted, it did not reach statistical significance. Extubation times and hemodynamic parameters were similar in both groups. Conclusions: The intraoperative use of dexmedetomidine in tonsillectomy and adenoidectomy procedures provides superior analgesia compared to fentanyl, particularly in the first 30 min postoperatively, without prolonging recovery time.

Children doi: 10.3390/children13050701

Authors: Tatsuya Akitomo Satoru Kusaka Ryota Nomura

Background/Aim: While improvements in oral health can sometimes lead to improvements in systemic diseases, certain systemic diseases such as heart disease require consideration during dental treatment. In clinical pediatric dentistry, dental professionals may encounter the pediatric patient with systemic diseases, and should consult with physicians regarding the overall health status of their patients with systemic diseases before dental procedures. Materials and Methods: We reviewed the responses to letters of inquiry made to external medical institutions regarding the overall physical condition of patients during a 5-year period (2021–2025). The survey items were the gender, age, aim of letter, systemic disease, and physician responses and instructions. Result: A total of 48 letters of inquiry were found, of which 34 were initial confirmations and 14 were reconfirmations. In children aged ≤5 years, the common aim was oral management or caries treatment, and the proportion of surgical procedures increased with age. Among the systemic diseases involved, the diseases of the circulatory system such as congenital heart disease were the most common, with 70% of initial confirmations leading to premedication with antibiotics prior to invasive dental procedures. Although many responses remained unchanged upon reconfirmation, the responses for some patients changed. Conclusions: This study shows the importance of dental professionals consulting with physicians regarding the health condition of patients with systemic diseases before oral management. Furthermore, a single confirmation is insufficient, and the information must be regularly updated.

Children doi: 10.3390/children13050699

Authors: Johanna Krämer Nieke Ueding Christian Ott Angelika Seitz Malte Ottenhausen Sandro M. Krieg Ahmed El Damaty Mohammed Issa

Objective: Rapid-sequence magnetic resonance imaging (rMRI) has emerged as a radiation-free alternative to computed tomography (CT) in pediatric neuroimaging. This study aimed to evaluate the diagnostic utility, clinical consequences, and subgroup-specific differences in pediatric patients undergoing rMRI for emergency neurosurgical indications. Methods: We conducted a retrospective, single-center study of 158 rMRIs in 73 pediatric patients who underwent rMRI between January 2017 and December 2023 due to suspected complications of hydrocephalus and brain tumors. A short MRI protocol (195 s) including FLAIR BLADE and T2 HATSE sequences was employed. Patients were categorized into tumor non-related and tumor-related hydrocephalus groups. Results: A total of 158 rMRIs in 73 pediatric patients were included. The mean age was 7.09 ± 4.63 years, with 69.6% male patients. Ventricular size monitoring was the most common rMRI indication (96.2%). Clinical consequences followed in 52.5% of cases, including surgical interventions (21.5%) and shunt valve adjustments (37.3%). Sedation was required in only 5.1% of patients. Only 1.9% required follow-up CT. Statistically significant intergroup differences were found in drainage type (p < 0.001), diagnosis (p < 0.001), and need for follow-up MRI (17.4% in the tumor-related hydrocephalus group vs. 4.5% in the tumor non-related hydrocephalus group; p = 0.014). Conclusions: rMRI is a safe, efficient, and effective alternative to CT for emergency neuroimaging in pediatric patients with hydrocephalus, tumors, or shunts. It facilitates timely clinical decision-making while avoiding radiation exposure. Our findings support broader implementation of rMRI protocols, particularly for patients requiring ongoing tumor surveillance.

Children doi: 10.3390/children13050698

Authors: Francesca D’Elia Rosario Ceruso Giuseppe Giardullo Angelica Delfina Picone Vera Simoes Tiziana D’Isanto Giovanni Esposito

Background/Objectives: Musculoskeletal pain represents a frequent and increasingly recognized health issue during adolescence. During this developmental phase, daily habits such as prolonged sitting, sedentary behaviors and the adoption of non-neutral postures may contribute to spinal overload and pain symptoms. This study contributes to the existing literature by focusing on concrete postural behaviors in real-life daily situations, an aspect that is still underexplored despite its relevance for musculoskeletal health. The aim of this study was to investigate the associations between daily habits, postural behaviors and the presence of back and neck pain. Methods: A cross-sectional study was conducted on a sample of 70 adolescents aged 10–20 years. Data were collected using the Back Pain and Body Posture Evaluation Instrument for Children and Adolescents (BackPEI-CA), administered online. Descriptive statistics and chi-square tests with effect sizes (Cramer’s V) were used to examine associations between postural behaviors, lifestyle factors, and pain outcomes, providing an inferential assessment beyond simple descriptive analysis. Results: Significant associations were found between gender and back pain, sitting posture during daily activities (writing at the desk and talking with friends) and back pain, with flexed or asymmetrical postures more frequently reported among participants with pain, and between back and neck pain (p < 0.05). Conclusions: The findings highlight the relevance of gender and daily postural behaviors as factors associated with musculoskeletal pain in adolescents. By identifying posture-specific behaviors linked to pain, this study provides preliminary evidence that can inform targeted preventive strategies and guide future research on modifiable daily habits in youth.

Children doi: 10.3390/children13050697

Authors: Andrea Bianchino Andrea Migliorelli Marianna Manuelli Chiara Bianchini Francesco Stomeo Stefano Pelucchi Andrea Ciorba Luca Sacchetto Silvia Palma Daniele Monzani

Background/Objectives: Auditory processing disorders (APDs), defined as impaired neural processing of acoustic stimuli despite normal peripheral hearing, often co-occur with neurodevelopmental disorders (NDDs) and may contribute to language, attentional, and learning difficulties. Emerging evidence suggests that shared neurotransmitter systems may represent a common neurobiological substrate underlying these conditions. The aim of this study is to integrate current evidence on glutamatergic, GABAergic, and monoaminergic systems in neurodevelopmental and auditory processing disorders in children and adolescents, and to evaluate the hypothesis that shared neurotransmitter dysregulation may underlie their clinical overlap. Methods: A narrative review of the literature was conducted through electronic searches in PubMed and Embase up to 31 December 2025, using keywords related to neurotransmitters, NDDs and APDs. Results: Available evidence indicates that an imbalance between excitatory glutamatergic and inhibitory GABAergic neurotransmission has been proposed as a central mechanism in NDDs and may also contribute to auditory processing difficulties through altered neural synchrony, sensory gating and temporal auditory coding. Findings collectively suggest the hypothesis of shared neurotransmitter dysregulation across NDDs and APDs. Conclusions: Auditory processing difficulties may represent sensory-level expressions of shared neurochemical vulnerability across neurodevelopmental conditions. Future longitudinal and multimodal studies are needed to clarify causal relationships and to identify clinically useful biomarkers.

Children doi: 10.3390/children13050696

Authors: Zuhal Karali Yasin Karali Zeynep Senocak Sara Sebnem Kilic

Background and aims: Atopic dermatitis (AD) is the most common chronic inflammatory skin disease among children. Our study aimed to evaluate the prevalence of hypogammaglobulinemia among pediatric patients with AD and to characterize the clinical and laboratory findings of patients diagnosed with AD and hypogammaglobulinemia. Method: The electronic files of 1850 patients aged 0–18 years diagnosed with AD between 2020 and 2022 in the Pediatric Immunology and Allergy Clinic of Bursa Medical Faculty City Hospital were retrospectively analyzed. During this period, all patients newly diagnosed with atopic dermatitis at our clinic were systematically screened for their serum immunoglobulin (Ig) levels (IgG, IgA, and IgM) at the time of initial presentation. We included 200 AD patients with hypogammaglobulinemia. Disease severity was classified using the Scoring Atopic Dermatitis (SCORAD) index. Multivariate logistic and linear regression analyses were performed to identify independent determinants of disease severity, considering age, sex, eosinophil counts, total IgE, food allergies, and baseline immunoglobulin levels. Results: The prevalence of hypogammaglobulinemia among the 1850 screened children with AD was 10.8% (200/1850). Of the 200 patients included in this study, 128 (64%) were male, and 72 (36%) were female. The median age at first clinic presentation was 8 months (interquartile range (IQR) 25–75%: 5–16). According to the Scoring Atopic Dermatitis (SCORAD) index, AD severity was mild in 150 (75%) patients and moderate-to-severe in 50 (25%). Food allergy sensitization was present in 72 (36%) patients. Patients with moderate-to-severe AD had significantly lower IgG (300 vs. 374 mg/dL; p < 0.001; r = −0.346), IgA (10 vs. 14 mg/dL; p = 0.004), and IgM (38 vs. 51 mg/dL; p = 0.001) levels when compared with those with mild disease. Multivariate logistic regression confirmed that lower IgG was the only immunoglobulin independently associated with moderate-to-severe AD (OR = 1.97 per 100 mg/dL decrease; 95% CI: 1.15–3.39; p = 0.013), while food allergy was the strongest independent predictor of the SCORAD index (β = +11.97; p < 0.001). None of the patients received intravenous immunoglobulin (IVIG) treatment. Of the 142 patients who underwent serial serum immunoglobulin measurements, 56 (39%) achieved age-appropriate normal IgG levels, while hypogammaglobulinemia persisted in 86 (61%). Conclusions: We found a higher frequency of hypogammaglobulinemia in patients with AD in our study, as compared with previously reported rates of THI in children from the general pediatric population. Although our study showed an increase in IgG levels during the follow-up period in many patients, it emphasizes the need for long-term immunological monitoring, especially in patients with moderate-to-severe AD.

Children doi: 10.3390/children13050695

Authors: Carmen Rodríguez-Barrios Natalia Jiménez-Luque Yolanda Marín Almagro Irene Gutierrez-Rosa Manuel Lubián-Gutiérrez Bahram Jafrasteh Isabel Benavente-Fernández Simón Pedro Lubián-López

Background/Objectives: Children born very preterm (VP) are at increased risk of later emotional and cognitive difficulties, including anxiety symptoms during childhood. Altered early brain development, particularly within subcortical circuits involved in emotional regulation, may contribute to this vulnerability. This study aimed to assess anxiety symptoms in preschool-aged children born VP, examine their relationship with cognitive performance, and determine whether neonatal brain volumes at term-equivalent age (TEA) were associated with later anxiety symptoms. We also explored whether cognition mediated the association between neonatal striatal volumes and anxiety. Methods: We conducted a longitudinal cohort study of infants born at ≤32 weeks of gestation and/or with a birth weight ≤1500 g admitted to a tertiary neonatal intensive care unit between 2018 and 2021. At 4–6 years of age, anxiety symptoms were assessed using the Child Behavior Checklist (CBCL) Anxiety Problems subscale, and cognitive performance was evaluated with the Wechsler Preschool and Primary Scale of Intelligence-IV (WPPSI-IV). Neonatal magnetic resonance imaging performed at TEA was used to obtain regional brain volumetric measures. Associations were analyzed using adjusted linear regression, interaction-based volumetric modeling, path analysis, and receiver operating characteristic analysis. Results: Ninety-five children were included, and 24 (25.3%) showed clinically relevant anxiety symptoms according to the CBCL Anxiety Problems subscale. Higher WPPSI-IV scores were associated with lower anxiety scores (β = −0.183; p = 0.042). The best-fitting MRI model included caudate volume, putamen volume, and their interaction, with a significant association between the putamen–caudate interaction and anxiety symptoms (β = −17.807; p < 0.001). In the path model, both cognition and the putamen–caudate interaction were directly associated with anxiety, whereas the indirect effect through cognition was not significant. The final MRI model showed acceptable discrimination for clinically relevant anxiety (AUC = 0.796). Conclusions: Anxiety symptoms were frequent in preschool-aged children born VP and were associated with lower cognitive performance. Neonatal striatal volumetric organization, particularly the interaction between the putamen and caudate volumes, was independently associated with later anxiety symptoms, suggesting that cognitive and early neural factors may contribute to anxiety risk through parallel rather than mediated pathways.

Children doi: 10.3390/children13050694

Authors: Yan Sun Qingyou Zhang Yaqian Huang Xueqin Liu

Background: Pulmonary arterial hypertension is a rare but life-threatening condition in children, with hereditary forms often being linked to mutations in genes such as bone morphogenetic protein receptor type 2 (BMPR2), caveolin 1 (CAV1), and potassium channel subfamily K member 3 (KCNK3). Among these, CAV1 mutations are associated with severe disease phenotypes, though cases resulting from de novo heterozygous CAV1 mutations with multi-system involvement remain rarely reported. The CAV1 mutation (c.424C > T, p.Q142X) disrupts caveolin-1 function, leading to dysregulated pulmonary vascular remodeling and multi-system abnormalities. Methods: This was a retrospective case study of a pediatric patient with hereditary PAH. The patient was followed at our hospital from initial presentation until death. Clinical data were collected from medical records, including physical examinations, laboratory tests, echocardiography, chest X-ray, computed tomography pulmonary angiography (CTPA), and genetic analysis. The patient was treated sequentially with various PAH-targeted medications. This report also includes a review of the relevant literature on CAV1-associated PAH. Results: A female aged 3 years and 11 months was diagnosed with hereditary PAH associated with a de novo heterozygous CAV1 mutation (c.424C > T, p.Q142X). Both parents underwent genetic testing and were negative for the mutation, confirming its de novo origin. Clinical manifestations included special facial features, congenital telangiectasia, cutis marmorata (marbled skin), congenital cataract, hereditary lipodystrophy, and severe PAH. The patient presented with progressive exercise intolerance, syncope, and worsening dyspnea over nine years. Echocardiography revealed pulmonary hypertension with an estimated pulmonary artery systolic pressure of 69–105 mmHg, right heart enlargement, right ventricular hypertrophy, and moderate tricuspid regurgitation. Blood and urine metabolic screenings were normal. A chest X-ray showed progressive enlargement of the cardiac silhouette and bulging of the pulmonary artery segment. CTPA demonstrated pulmonary hypertension, secondary right heart dysfunction, decompensated right ventricular function, and mosaic perfusion in both lungs, suggestive of small arterial branch occlusion. Right heart catheterization was declined by the parents. Thus, the diagnosis of PAH was established based on clinical, echocardiographic, CTPA, and genetic findings. The patient was hospitalized four times and lost to follow-up from 2017 to 2023. She received sequential treatment with digoxin, hydrochlorothiazide, tadalafil, ambrisentan, selexipag, and treprostinil. Despite these therapies, pulmonary artery pressure continued to rise with progressive clinical deterioration. The patient ultimately died at 13 years of age due to a pulmonary hypertensive crisis and multiple organ failure following a severe episode of gastroenteritis. Conclusions: Despite aggressive treatment with multiple targeted reduced pulmonary artery pressure drug therapies, managing hereditary PAH caused by CAV1 mutations in children remains a significant challenge, with a high mortality rate. Early genetic diagnosis, regular follow-up, and individualized treatment are crucial. It requires the joint efforts of patients, parents, and healthcare providers.

Children doi: 10.3390/children13050692

Authors: Chien-Lin Lin Pei-Jung Wang

Background/Objectives: Child temperament and mastery motivation are key factors for future child competencies. Therefore, two purposes of this study were: (1) to compare temperament characteristics in children with global developmental delay (GDD) and typical development (TD); (2) to explore the relations among child temperament and mastery motivation in GDD and TD groups. This study design was cross-sectional. Methods: Participants included 26 children with GDD (ages 2–5) recruited from clinical settings in Central Taichung. A comparison group of 26 TD children, matched for sex and mental age, was subsequently enrolled through community advertisements and local early childhood centers. The participants were invited to our laboratory in order to conduct child development assessment using the Comprehensive Developmental Inventory for Infants and Toddlers, and their mothers were asked to fill in questionnaires, including the revised Dimension of Mastery Questionnaire (DMQ 18) with preschool version to assess mastery motivation and the Child Behavior Questionnaire—Short Form to obtain three dimensions of child temperament (surgency/extraversion, negative affect, effortful control). Correlations and hierarchical regressions were used to examine associations (p < 0.05, two-tailed). Results: Children with GDD exhibited higher extraversion and lower effortful control than children with TD, whereas no group difference was observed in negative affect. Domain-specific relationships between child temperament and mastery motivation were found in both the GDD and TD groups. Conclusions: These findings suggest that early childhood practitioners should consider children’s temperamental and mastery motivation characteristics, identify individual strengths and weaknesses, and design strength-based intervention strategies to promote engagement in daily activities within natural settings.