Search Results (4,340)

Persistent microscopic hematuria in children is often considered benign, yet recent evidence shows that a substantial proportion of affected individuals have underlying glomerular disease, particularly collagen IV-related nephropathies. We report a case of autosomal dominant Alport syndrome (ADAS) diagnosed just before discontinuation of long-term follow-up in a young woman initially presumed to have benign familial hematuria. The proband had persistent microscopic hematuria from early childhood, with normal renal function and no extrarenal manifestations. Her mother also had microscopic hematuria without kidney impairment, and the absence of accessible family history reinforced the assumption of benign familial hematuria. At age 42, the mother developed sensorineural hearing loss, and around the same time, the family learned that the maternal grandfather was undergoing dialysis for end-stage renal disease of unknown etiology. These findings prompted genetic testing, which identified a heterozygous pathogenic COL4A4 frameshift variant (c.2317_2318del; p.Arg773GlyfsTer14) in both the mother and the proband, confirming ADAS. This case illustrates the phenotypic variability of ADAS within a single family and highlights the limitations of relying solely on clinical features or incomplete family history. In contemporary practice, persistent glomerular hematuria warrants long-term follow-up and a low threshold for molecular testing of COL4A3-COL4A5, even in the absence of overt clinical signs. Earlier genetic evaluation would likely have enabled a timelier diagnosis in this case. This report underscores the importance of reassessing presumed benign hematuria and integrating genetic testing into the diagnostic approach for children and young adults with persistent microscopic hematuria. Full article

Physical literacy is widely conceptualized as a holistic, multidimensional construct that encompasses the affective, physical, cognitive, and social domains. However, the assessment in early childhood education (ECE) contexts is conceptually fragmented and inconsistent in practice. This study aims to develop a practice-informed physical literacy assessment model based on practitioners’ perspectives and empirical patterns. A quantitative, cross-sectional survey was conducted with 324 practitioners working with children aged 1.5–7 years in various ECE contexts in Latvia. The questionnaire examined three dimensions of assessment practice: (1) physical literacy domains and components, (2) assessment processes (functions, methods, forms, and documentation), and (3) perceptions of assessment quality (validity, reliability, and usability). Descriptive statistics and nonparametric analyses were used to identify dominant patterns. The findings suggest that all four domains of physical literacy are included in assessments of early childhood educational contexts. However, the components of these domains are not consistently defined. More observable components are assessed more consistently, while less visible components are more frequently interpreted within specific pedagogical contexts. Assessment is predominantly formative, process-oriented, and embedded in play-based activities typical of early childhood education (ECE) contexts, with limited use of diagnostic approaches. Based on these findings, we propose a practice-informed assessment model. This model is conceptualized as a structured framework of content, assessment processes, and quality conditions applicable within early childhood education contexts. In this model, assessment criteria function as an interpretive filter that shapes the selection of methods and the interpretation of content. This positions assessment as a dynamic, context-dependent process mediated by the early childhood practitioners. These findings suggest the need to transition from standardized approaches to more context-sensitive and theoretically grounded assessment practices in early childhood education contexts. This framework has the potential to enhance the alignment between physical literacy conceptualizations and their subsequent implementation in practice. Full article

Introduction: Oral health in early childhood is essential. Parents, as the primary caregivers, must possess basic knowledge to achieve optimal oral health status. Objectives: The study aims to assess parents’ knowledge and perspectives on early childhood oral health and to evaluate how nationality and educational attainment influence their preventive habits and dental priorities within a nursery and primary school in the province of Huelva (Spain). Materials and Methods: The sample consisted of 129 parents of children aged 3, 4, and 5 years from the aforementioned educational center. A modified questionnaire, validated by experts in the field, was used as the assessment tool. Results: Nationality and education were key determinants of oral health literacy. Spanish-born guardians reported significantly higher dental attendance for their children compared to foreign-born guardians (97.7% vs. 84.2%; p = 0.030). A profound cultural gap was observed in caries etiology: 71.1% of foreign-born respondents attributed caries to “infections or heredity,” while 98.4% of Spanish-born respondents correctly identified behavioral factors (p < 0.001). Regarding educational attainment, 75% of the high-education group prioritized functional health (posterior sector) compared to only 26.3% in the low-education group (p < 0.001). Additionally, a non-linear gap was found in knowledge of primary tooth complications, with the medium-education group showing the lowest awareness (34.8%; p = 0.047). Full article

Background/Objectives: The frontal sinus exhibits individual morphological variability that may support human identification. Its development progresses through childhood and adolescence and stabilizes in early adulthood, with age-related changes potentially affecting radiological comparisons. This study presents a forensic case report and discusses it in light of the literature on frontal sinus development and forensic identification. Methods: A comparative radiological analysis was conducted using images obtained at two distinct stages of biological maturation (14 and 21 years of age). Manual delineation combined with semi-automated computational analysis was applied to assess morphological features of the frontal sinus, including contour configuration, lobulation, and dimensional parameters. Results: The intra vitam record was obtained at 14 years of age, during an active developmental phase, and the post mortem examination was obtained at 21 years, corresponding to early adulthood. Comparative analysis revealed significant morphological differences, including increased lobulation, contour complexity, and sinus expansion. These changes limited the reliability of frontal sinus morphology for identification in this case. Friction ridge examination independently established positive identification. Conclusions: This study highlights the limitations of frontal sinus analysis when applied across periods of active development and underscores the risk of misinterpretation if age-related changes are not adequately considered. Full article

Background/Objectives: AA amyloidosis is a serious complication of chronic inflammation, which may arise in the setting of inborn errors of immunity (IEIs) due to recurrent or persistent infections. Common variable immunodeficiency (CVID) is the most frequent symptomatic IEI in adults, yet its association with secondary AA amyloidosis remains rarely reported. Case presentation: We describe a 37-year-old male with a history of recurrent pneumonia, chronic sinusitis, and osteomyelitis with sepsis since childhood. At age 33, he developed bilateral pneumonia after COVID-19, followed by repeated lower respiratory tract infections. At age 36, nephrotic syndrome (proteinuria 10.69 g/day, hypoalbuminemia) led to kidney and gastric mucosa biopsies, which confirmed AA amyloidosis. Immunological workup revealed panhypogammaglobulinemia (IgG 0.1 g/L, IgA 0.01 g/L, IgM 0.28 g/L), markedly reduced switched memory B cells, and an inverted CD4⁺/CD8⁺ ratio. Chest CT showed bronchiectasis, bronchiolitis, and mediastinal lymphadenopathy. Whole-exome sequencing excluded known monogenic IEIs, autoinflammatory, or hereditary amyloidosis genes; a heterozygous likely pathogenic variant in ODAD2 (associated with primary ciliary dyskinesia) was considered incidental. A diagnosis of CVID with secondary AA amyloidosis was established. Conclusions: This case illustrates that CVID may remain undiagnosed for decades and present with secondary AA amyloidosis as the first major complication. In any patient with nephrotic syndrome and a history of recurrent or unusual infections, an IEI should be actively excluded. Early recognition of CVID and appropriate immunoglobulin replacement therapy can prevent infectious exacerbations and potentially halt amyloid progression. Full article

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. Full article

Background: Short sleep and formula feeding during infancy are associated with increased risk of childhood obesity. Feeding practices and sleep arrangements vary during infancy and may also be dynamic, yet their impact on infant night sleep duration remains unclear. Understanding these relationships is crucial for formulating recommendations to support breastfeeding and address sleep concerns. Objective: We examined the association between feeding mode and parent-reported infant night sleep duration during the first postnatal year, while additionally evaluating night-weaning and bedsharing as contextual sleep-related practices. Methods: Infants in the Phoenix Metropolitan Area (n = 193) were followed up at 3, 8, 13, 26, 39, and 52 weeks post-birth. Sleep and feeding questionnaires were answered at each visit. A multilevel growth model estimated infant night sleep duration trajectories by feeding mode (ordinal: exclusive formula, mixed, exclusive breastfeeding), night-weaning, and bedsharing as time-variant predictors. Maternal education and household income were covariates to account for differences in study attrition. Results: Infant night sleep duration followed a curvilinear trajectory, starting at 7.92 h (95% CI: 5.78, 10.06) and increasing by 0.40 h/month (95% CI: 0.21, 0.60), with a deceleration over time (0.02 h/month², p < 0.001). Each increase in levels of breast milk consumption was associated with an increase in infant night sleep duration (B = 0.87 h, p < 0.001), but the association weakened as the infant aged (B = −0.07 h/month, p < 0.001). Despite 59.7% of bedsharing infants being exclusively breastfed, bedsharing was not significantly associated with infant night sleep duration. Similarly, night-weaning was not significantly associated with infant night sleep duration. Conclusions: Breastfeeding is associated with longer infant night sleep duration, whereas bedsharing showed no association despite its correlation with breastfeeding. This research highlights the importance of breastfeeding in early life, not only for its developmental benefits but also for its relationship with infant night sleep duration, an essential component of healthy infant growth. Full article

Background/Objectives: Plant-based diets are increasingly adopted by families with young children, yet their potential effects on bone development and metabolic regulation during early childhood remain insufficiently understood. This study aimed to evaluate body composition, bone mineral density (BMD), biochemical markers of bone turnover, and adipokine profiles in healthy children aged 5–6 years adhering to lacto-ovo-vegetarian or omnivorous diets. Methods: A cross-sectional analysis was conducted in a well-characterized cohort of 90 healthy normal-weight children consuming either lacto-ovo-vegetarian or omnivorous diets. Body composition and bone mineral density were measured using dual-energy X-ray absorptiometry, and circulating markers of bone formation, resorption, and adipokines were determined using ELISA methods. Correlation analyses were performed to examine the relationships between anthropometric variables, bone parameters, and adipokines. Results: No significant differences were observed between vegetarian and omnivorous diets in anthropometric characteristics, bone mineral content (BMC), or BMD, indicating comparable skeletal status. However, vegetarian children exhibited significantly higher levels of bone turnover markers, including bone alkaline phosphatase (BALP) (p = 0.023) and C-terminal telopeptide of type I collagen (CTX-I) (p = 0.035), and a lower osteocalcin OC/CTX-I ratio (p = 0.027). These findings may suggest a subtle imbalance in bone remodeling dynamics in these children, although their clinical significance remains uncertain. Additionally, higher levels of carboxylated osteocalcin (Gla-OC) (p = 0.022) and an increased carboxylated to undercarboxylated OC (Gla-OC/Glu-OC) ratio (p = 0.005) were observed in vegetarian children. Among adipokines, vegetarian children showed lower HMW adiponectin levels (p = 0.05) and a lower HMW/total adiponectin ratio (p = 0.012). Correlation analyses revealed distinct metabolic patterns between groups. In vegetarian children, bone parameters were primarily associated with lean mass, indicating the predominant role of mechanical factors in skeletal development. In contrast, omnivorous children demonstrated a more integrated relationship between bone indices and adipokines. Conclusions: In conclusion, while a lacto-ovo-vegetarian balanced diet supports normal bone mass in early childhood, it may be associated with subtle alterations in bone metabolism and its regulatory pathways, including adipokine profiles. These findings highlight the importance of adequate dietary planning and underscore the need for longitudinal studies to determine long-term effects on bone status. Full article

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. This cross-sectional study examined the relationship between the appropriate use of screen time and family and child characteristics and aspects of social development through play in children aged 0–3 years. 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. Full article

In today’s digital age, child-rearing presents unique challenges that extend across generations, impacting both parenting and grandparenting. This study investigated patterns of grandparents’ attitudes toward their grandchildren’s technology use and identified key predictors of these patterns. Utilizing latent profile analysis (LPA) with a sample of 712 grandparents from Shanghai, China, the research identified four distinct attitudinal profiles: positively supportive, cautiously observant, low-involvement reserved, highly concerned and restrictive. Multinomial logistic regression analyses revealed that the age of the grandparent, sibling status, and the frequency of communication between grandparents and parents were significant predictors of profile membership. The findings indicate that grandparents’ attitudes toward their grandchildren’s technology use reflect a combination of acceptance and concern. This study underscores the need for further research and educational supports to help grandparents develop perspectives informed by an evidence base, thereby strengthening guidance strategies for young children’s digital engagement. Full article

Healthy, inclusive, and environmentally supportive educational settings are increasingly recognised as relevant to children’s development, well-being, and equity. However, evidence on the physical environment in early childhood education remains fragmented across outdoor spaces, indoor spatial organisation, indoor environmental quality, materials, and contaminant-related conditions. This systematic review aimed to synthesise current evidence on the relationship between the physical environment of early childhood educational settings and multidimensional indicators of child well-being. The protocol was registered in PROSPERO, and the review followed PRISMA 2020 guidelines. Searches were conducted in Web of Science Core Collection, Scopus, ERIC, and APA PsycInfo. Methodological quality and risk of bias were assessed using ROBINS-I and JBI critical appraisal tools. Eighteen studies were included. Of these, 10 focused on outdoor spaces and schoolyards, five on indoor spaces and spatial organisation, and three on indoor environmental quality, materials, or contaminants. The findings suggest four main interpretive patterns: (i) expanding opportunities for participation through functionally diverse areas and materials; (ii) shaping coexistence and interaction through access to and distribution of resources; (iii) supporting sensory regulation; and (iv) sustaining environmental health and habitability. Overall, more favourable settings were associated with better indicators of activity and play, interaction and coexistence, and involvement and regulation. For indoor environmental quality studies, however, the evidence was mainly indirect, referring to environmental-health, comfort, exposure, or habitability indicators rather than direct child-level well-being outcomes. The certainty of the evidence was moderate to low due to methodological limitations, particularly confounding and selection bias in non-randomised intervention studies and imprecision in the measurement of environmental exposure in several cross-sectional studies. The findings may inform cautious reflection on spatial design, educational practice, and policy, but stronger recommendations require more robust study designs, reproducible exposure metrics, clearer distinction between direct and indirect well-being-related indicators, and comparable outcome measures. Full article

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. Full article

The hypothesis that Group A beta-haemolytic Streptococcus (GAS) triggers an autoimmune cascade targeting basal ganglia dopaminergic circuits—producing obsessive–compulsive disorder (OCD), tic disorders, or chorea depending on the receptor subtype involved—is biologically compelling and supported by emerging molecular evidence. Yet PANDAS has remained a diagnostic conundrum since its original description in 1998, with ongoing uncertainty surrounding diagnostic criteria, the interpretation of streptococcal serology, and the distinction from primary neurodevelopmental disorders. This study aimed to review the diagnostic challenges of PANDAS, with focus on streptococcal serology interpretation, advances in dopamine receptor autoantibody biology, the genetic epidemiology of primary tic disorders, and the differential diagnosis of acute neuropsychiatric presentations in children. A structured narrative review was conducted using PubMed, MEDLINE, EMBASE, and the Cochrane Library for publications from 1998 to early 2025 addressing PANDAS, PANS, streptococcal antibodies, childhood movement disorders, autoimmune encephalitis, and the genetics of tic disorders. No currently available biomarker—including ASO, anti-DNase B, anti-basal-ganglia antibodies, or the Cunningham Panel—has demonstrated adequate individual-level diagnostic accuracy for PANDAS. Emerging molecular evidence identifies anti-D1R autoantibodies, acting via G protein-and beta-arrestin-mediated signalling, as candidate biomarkers for PANDAS/PANS neuropsychiatric phenotypes, and anti-D2R autoantibodies for Sydenham chorea movement phenotypes; independent replication in unselected populations is required. Primary tic disorders carry heritability estimates of 50–80% and first-degree familial risk ratios of approximately 18-fold in large population-based cohorts. Prospective blinded studies have not demonstrated a consistent population-level association between GAS infections and tic or OCD exacerbations: PANDAS and PANS remain diagnoses of exclusion. The high background prevalence of both GAS exposure and primary neurodevelopmental disorders in overlapping paediatric age ranges creates conditions for incidental temporal co-occurrence. In the absence of validated molecular biomarkers, diagnostic imprecision carries direct clinical consequences: children may be exposed to treatments with significant risk profiles—including IVIG, plasma exchange, and prolonged antibiotic prophylaxis—while evidence-based therapies are delayed. A stepwise diagnostic approach incorporating the full differential diagnosis is both an epistemological and a patient safety imperative. Full article

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. Full article

Background: Childhood cancer survival now approaches 80% in high-income countries, yet most survivors face lifelong toxicity. This review examines the interplay between treatment efficacy, relapse prevention, and therapy-related complications. Methods: Narrative synthesis of landmark pediatric oncology trials (2000–2026), including AALL1731 (blinatumomab), ELIANA/PLAT-02 (CAR T-cell), and GD2-CART01 (neuroblastoma), with comparative analysis of efficacy and toxicity. Results: In AALL1731, adding blinatumomab to chemotherapy improved 3-year disease-free survival from 87.9% to 96.0% (HR = 0.39, 95% CI: 0.27–0.56, p < 0.001), but increased sepsis from 5.1% to 14.8%. Comparison between AALL1731 (front-line blinatumomab) and ELIANA (CAR T-cell in relapsed disease) reveals that earlier immunotherapy deployment yields better outcomes: 96% DFS vs. 48% 3-year EFS, respectively. In GD2-CART01, early use (after 1–2 prior lines) achieved 89% 5-year survival vs. 43% with delayed use (HR = 0.31). Approximately 95% of survivors experience ≥1 late effect, with 60–90% carrying chronic conditions into adulthood. Conclusions: Immunotherapy transforms outcomes, but timing is critical, as earlier deployment dramatically improves survival. Toxicity remains pervasive, requiring systematic mitigation strategies. Full article