Children

18 pages, 953 KiB

Open AccessReview

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

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

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

Viewed by 731

Abstract

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

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

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

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14 pages, 825 KiB

Open AccessArticle

Phenotypic Presentation of Children with Joint Hypermobility: Preclinical Signs

by Mateus Marino Lamari, Neuseli Marino Lamari, Michael Peres de Medeiros, Gerardo Maria de Araújo Filho, Adriana Barbosa Santos, Matheus Gomes Giacomini, Vitor Roberto Pugliesi Marques, Eny Maria Goloni-Bertollo and Érika Cristina Pavarino

Children 2025, 12(1), 109; https://doi.org/10.3390/children12010109 - 18 Jan 2025

Viewed by 559

Abstract

Introduction: Joint hypermobility (JH) is mobility beyond the normal range of motion. JH can be an isolated finding or a characteristic of a syndrome. Characteristics related to the sitting position with atypical body positions, such as sitting in splits (S), with the foot [...] Read more.

Introduction: Joint hypermobility (JH) is mobility beyond the normal range of motion. JH can be an isolated finding or a characteristic of a syndrome. Characteristics related to the sitting position with atypical body positions, such as sitting in splits (S), with the foot on the head (F), in W (W), in a concave shape (C), episodes of dislocations, and subluxations, suggest impacts on body mechanics since childhood, with damage to the conformation of the joints. Objectives: Identify preclinical signs of JH, in addition to Beighton Score (BS), through signs that are easily recognized early by pediatricians and family members to avoid possible joint deformities in the future. Methods: The medical records of 124 children (59.7% girls) between one and nine years old were analyzed. JH was assessed using the BS, a history of luxations/subluxations, and the concave (C), “W”, “splits” (S), and foot (F) on head sitting positions. Results: The concave sitting position was the most common, followed by W, F, and S in decreasing order. A total of 52.4% of the children had BS > 6, with a higher prevalence among girls (60.8%) compared to boys (40.0%); a difference statistically significant (p = 0.024, Fisher’s exact test). Thirty-two patients (27.4%) had luxations/subluxations with the higher scores. Conclusions: Sitting in S, F, W, and C positions are preclinical phenotypic characteristics of JH, easily identified by pediatricians and family members to prevent possible joint deformities. BS ≥ 6 is more frequently observed in all positions. The majority of the total sample has BS > 6, with a significant female gender influence. Among those with a history of occasional joint dislocations and subluxations, half of them have the highest BS scores. Full article

(This article belongs to the Section Pediatric Mental Health)

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23 pages, 3617 KiB

Open AccessSystematic Review

MTHFR Gene Polymorphisms and Cancer Risk in Children and Adolescents: A Systematic Review and Meta-Analysis

by Savvas Kolanis, Eleni P. Kotanidou, Vasiliki Rengina Tsinopoulou, Elisavet Georgiou, Emmanuel Hatzipantelis, Liana Fidani and Assimina Galli-Tsinopoulou

Children 2025, 12(1), 108; https://doi.org/10.3390/children12010108 - 17 Jan 2025

Viewed by 484

Abstract

Background/Objectives: MTHFR gene polymorphisms (677C>T and 1298A>C) correlate with various types of cancer across all age groups; however, a small number of studies have included solely children and adolescents. The aim of this systematic review and meta-analysis was to present and synthesize [...] Read more.

Background/Objectives: MTHFR gene polymorphisms (677C>T and 1298A>C) correlate with various types of cancer across all age groups; however, a small number of studies have included solely children and adolescents. The aim of this systematic review and meta-analysis was to present and synthesize all the available evidence on the association between MTHFR gene polymorphisms and the incidence of all types of cancer in children and adolescences. Methods: After a systematic search of all of the available data, original case–control studies involving children or adolescents with a confirmed diagnosis of any type of cancer and a molecular genetic test of MTHFR gene polymorphisms were included. Results: A total of 53 original studies in children and adolescents with cancer were included in the systematic review. Among these, 40 studies reviewed children and adolescents with Acute Lymphoblastic Leukemia (ALL), 4 those with Acute Myeloblastic Leukemia (AML), 8 those with central nervous system (CNS) tumors and 3 those with other types of cancer. Children and adolescents with ALL had less frequent T allele sequences (CT and TT variations) of the 677C>T polymorphism compared to a healthy population (OR: 0.85; CI: 0.80–0.91; p < 0.00001). Concerning the 1298A>C polymorphism, the C allele sequences (AC and CC) did not present a statistically significant difference in frequency compared to a healthy population (OR: 1.01; CI: 0.95–1.08; p = 0.69). Conclusions: Children and adolescents with ALL appeared to have the T allele sequences of the 677C>T polymorphism of the MTHFR gene less frequently compared to a healthy population. Full article

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

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17 pages, 571 KiB

Open AccessReview

Stressful but Not Unhappy: A Review of the Positive Aspects of Parenting a Child with Autism Spectrum Disorder

by Kenneth Curley, Robert Hughes and Yasuhiro Kotera

Children 2025, 12(1), 107; https://doi.org/10.3390/children12010107 - 17 Jan 2025

Viewed by 688

Abstract

This review aimed to identify and synthesise the evidence for the positive aspects of parenting a child with autism spectrum disorder (ASD). To date, ASD parental research has predominantly focused on the negative aspects; parents and carers are left uninformed of how to [...] Read more.

This review aimed to identify and synthesise the evidence for the positive aspects of parenting a child with autism spectrum disorder (ASD). To date, ASD parental research has predominantly focused on the negative aspects; parents and carers are left uninformed of how to strengthen their positive mental wellbeing. Three electronic databases—PubMed, Scopus, and Web of Science —were searched for literature reporting positive aspects of parenting a child with ASD, published between January 2013 and December 2023. The PRISMA 2020 checklist was used for reporting. Two hundred and fifty-four articles were retrieved from the databases. After title/abstract screening (n = 213) and full-text reviews (n = 32), six papers were included (n = 6). Sixteen positive aspects of parenting a child with ASD were identified and grouped into three themes: joyful moments, journey to resilience, and social connection. These three themes are eudaimonic wellbeing constructs and often under-represented in ASD parental studies. Focusing on joyful moments, building resilience through the parenting journey, and finding support and connection with others in similar situations can support the mental wellbeing of parents and carers of children with ASD. Future research is needed to further evaluate the positive aspects of parenting a child with ASD. Full article

(This article belongs to the Special Issue Depression, Anxiety and Stress in Children and Adolescents: 2nd Edition)

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12 pages, 489 KiB

Open AccessArticle

Attitudes of Adolescents Toward Addictive Substances: Hope and Self-Control as Protective Factors

by Serkan Cengiz, Mehmet Emin Turan and Eyüp Çelik

Children 2025, 12(1), 106; https://doi.org/10.3390/children12010106 - 17 Jan 2025

Viewed by 487

Abstract

Background: Experiences of ostracism may be related to attitudes toward substance abuse. However, the protective factors underlying this relationship are still unclear. Therefore, based on the Need-threat and Self-control theory, we aimed to test a model in which self-control and hope mediate [...] Read more.

Background: Experiences of ostracism may be related to attitudes toward substance abuse. However, the protective factors underlying this relationship are still unclear. Therefore, based on the Need-threat and Self-control theory, we aimed to test a model in which self-control and hope mediate the relationship between ostracism and attitudes toward addictive substances. Methods: In this model, we highlighted risk factors (ostracism) and protective factors (self-control and hope). This study was a cross-sectional data analysis of 787 students (52.50% boys, 47.50% girls; M_age = 15.69, SD = 1.12). Results: The results revealed that ostracism was positively associated with attitudes toward addictive substances, and evidence was provided that this relationship was mediated by hope and self-control. Ultimately, the research highlights the link between ostracism and attitudes toward addictive substances, identifying hope and self-control as mediators. Conclusions: This study highlights individual risk and protective factors related to attitudes toward addictive substances and offers new perspectives on ways to prevent and reduce adolescents’ positive attitudes toward substance use. School counselors and educators should help students strengthen skills such as hope and self-control to prevent them from developing positive attitudes toward substance use in the future. Full article

(This article belongs to the Special Issue Children’s Well-Being and Mental Health in an Educational Context)

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13 pages, 527 KiB

Open AccessArticle

A Survey of Parents’ Perspective of Receiving a Developmental Diagnosis for Their Child

by Stacey D. Miller, Maria Juricic, Jaimy Coates, Jeffrey N. Bone, Ash Sandhu, Kishore Mulpuri and Maureen O’Donnell

Children 2025, 12(1), 105; https://doi.org/10.3390/children12010105 - 17 Jan 2025

Viewed by 415

Abstract

Receiving a diagnosis, such as cerebral palsy (CP), can have lasting impacts on caregivers and families. Previous literature has described that caregivers wish to receive a diagnosis together, without delay, in a private, direct, honest, and sympathetic way. This study aimed to understand [...] Read more.

Receiving a diagnosis, such as cerebral palsy (CP), can have lasting impacts on caregivers and families. Previous literature has described that caregivers wish to receive a diagnosis together, without delay, in a private, direct, honest, and sympathetic way. This study aimed to understand the experience of caregivers of children with cerebral palsy (CP) or similar conditions when receiving a diagnosis for their child.: Caregivers of children and youth aged 0–18 years with CP or a similar physical condition completed a survey investigating who first provided a diagnosis, and the way it was provided. Questions were based on the pediatric SPIKES framework. Caregivers were asked how receiving a diagnosis could have been improved. Thematic analysis of qualitative data were performed.: A total of 180 surveys were completed. Mean age at diagnosis was 19.0 (SD 25.7) months. Most caregivers reported the healthcare provider was sympathetic and understanding (75%) and clear and direct (69%). Only 25% of caregivers recalled being directed to where to find information; only 37% reported being told what their child does well or is expected to do well. Thematic analysis revealed three themes: (1) less waiting, (2) more compassionate communication, and, (3) information and support to move forward: Caregivers wanted the diagnosis to be timely and provided with compassion. Requests for greater information on the diagnosis, available support, and their child’s future, suggest that greater care to support families in the aftermath of receiving a diagnosis is also needed. Full article

(This article belongs to the Special Issue Cerebral Palsy: Pediatric Patient- and Family-Centered Care and Clinical Research)

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12 pages, 1328 KiB

Open AccessArticle

Neonatal Thyroid-Stimulating Hormone Reference Intervals in Multi-Ethnics Population

by Hery Priyanto, Fauqa Arinil Aulia, Hartono Kahar, Muhammad Faizi, Ferdy Royland Marpaung and Aryati Aryati

Children 2025, 12(1), 104; https://doi.org/10.3390/children12010104 - 17 Jan 2025

Viewed by 544

Abstract

(1) Background: This study is designed to establish thyroid-stimulating hormone (TSH) reference intervals tailored to different neonatal age groups and Indonesian local populations. (2) Methods: Dried blood spot neonatal TSH values, from 1 January 2022 to 31 December 2023, were used to establish [...] Read more.

(1) Background: This study is designed to establish thyroid-stimulating hormone (TSH) reference intervals tailored to different neonatal age groups and Indonesian local populations. (2) Methods: Dried blood spot neonatal TSH values, from 1 January 2022 to 31 December 2023, were used to establish the neonatal TSH reference intervals partitioned by sex, gestational age, and ethnic group at different neonatal ages. (3) Results: A significant difference in the reference intervals value was observed in sex, gestational ages, and parental ethnicity groups in different neonatal age subgroups (p < 0.05). Male reference intervals were significantly higher than those of females at all neonatal ages. Late and post-term gestational age categories reference intervals were higher than early and full-term. Among the ethnic groups, Madurese had a higher upper limit TSH reference interval. (4) Conclusions: Our neonatal TSH reference intervals were needed to provide a reference adapted to the local population of Indonesia. Full article

(This article belongs to the Section Pediatric Neonatology)

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11 pages, 235 KiB

Open AccessArticle

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

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

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

Viewed by 497

Abstract

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

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

(This article belongs to the Section Pediatric Nursing)

24 pages, 544 KiB

Open AccessArticle

Evaluating Tech Neck: A Pilot Study Using a Self-Developed Questionnaire on Symptoms, Posture, and Preventive Measures

by Brigitte Osser, Csongor Toth, Carmen Delia Nistor-Cseppento, Gyongyi Osser, Caius Calin Miuța, Iosif Ilia, Diana Carina Iovanovici, Cristina Aur and Laura Ioana Bondar

Children 2025, 12(1), 102; https://doi.org/10.3390/children12010102 - 17 Jan 2025

Viewed by 493

Abstract

Background/Objectives: Musculoskeletal symptoms, such as neck pain, back pain, and eye strain, are prevalent in modern work environments, particularly among individuals engaged in prolonged sitting and repetitive tasks. This study aimed to explore the prevalence of these symptoms and the impact of ergonomic [...] Read more.

Background/Objectives: Musculoskeletal symptoms, such as neck pain, back pain, and eye strain, are prevalent in modern work environments, particularly among individuals engaged in prolonged sitting and repetitive tasks. This study aimed to explore the prevalence of these symptoms and the impact of ergonomic tool usage, break frequency, posture awareness, and proactive measures on symptom intensity and daily functioning. Methods: This cross-sectional pilot study used a self-developed questionnaire to assess the prevalence and intensity of musculoskeletal symptoms among participants aged 6–18 years. The survey collected data on ergonomic tool usage, break frequency, posture awareness, and proactive measures (such as taking breaks and seeking professional help). Symptom intensity was assessed across common musculoskeletal issues. Internal consistency was assessed using Cronbach’s Alpha. Statistical analyses, including descriptive statistics, Chi-squared tests, ANOVA, and Spearman’s correlation, were used to identify significant correlations and associations between variables. Results: A significant proportion of participants reported moderate to severe symptoms, including neck pain, back pain, and eye strain. Participants who used ergonomic tools reported significantly lower symptom intensity (<0.001). A positive correlation was found between fewer breaks and higher symptom intensity (r = 0.908, p < 0.001). Those with higher posture awareness reported lower symptom intensity (p < 0.001). Proactive measures, including regular breaks and ergonomic interventions, were perceived as effective strategies for managing symptoms. Increased symptom intensity was associated with reduced ability to perform daily activities (p < 0.001). Conclusions: The study highlights the significant role of ergonomic tools, posture awareness, and regular breaks in mitigating musculoskeletal symptoms. Proactive measures, including structured interventions, can effectively reduce symptom intensity and improve daily functioning. These findings suggest that workplace health strategies focusing on ergonomics and posture education are crucial for reducing the impact of musculoskeletal discomfort on employee well-being and productivity. Full article

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Graphical abstract

9 pages, 911 KiB

Open AccessArticle

The Development of the Radial Bow in Children: Normative Values

by Samara F. Kass, Julia L. Conroy, Alisa Forsberg, Rebecca S. Li, Catherine C. May, Natasha S. McKibben, Julio J. Jauregui, Raymond W. Lui and Joshua M. Abzug

Children 2025, 12(1), 101; https://doi.org/10.3390/children12010101 - 17 Jan 2025

Viewed by 411

Abstract

Background: Radial bowing is necessary for forearm rotation. Fractures or deformities of the forearm that affect the radial bow may disrupt normal forearm rotation. Objective: The purpose of this study was to evaluate the development and establish normative values for the pediatric and [...] Read more.

Background: Radial bowing is necessary for forearm rotation. Fractures or deformities of the forearm that affect the radial bow may disrupt normal forearm rotation. Objective: The purpose of this study was to evaluate the development and establish normative values for the pediatric and adolescent radial bow. Methods: A retrospective review of radiographs from children aged 0–17 years with no previous history of an upper extremity fracture or condition was performed. Patient demographics, maximal radial bow location, and depth were recorded in millimeters and as percentages of the total radial length. The proximal, middle, and distal third radial bows were measured. Means and standard deviations were utilized to establish average measurements by age group. Pearson correlation coefficients assessed the relationship between radial bowing and age. Results: A total of 505 forearm radiographs were measured. The average age of the patients was 10.0 years (SD: 5.2). The maximal radial bow location remained consistent with age, with a mean value of 61.7%. The maximal radial bow depth marginally decreased with age, with a mean value of 7.7%. The proximal, middle, and distal third maximal radial bows (measured in millimeters) increased with age. Conclusions: The maximal radial bow depth marginally decreases with increasing age, while the location of the maximal radial bow remains consistent as age increases. These measurements may be used to assess fracture reduction to ensure proper restoration of the radial bow during fracture and congenital condition treatment. Furthermore, they can aid in the detection of subtle fractures of the radius, including plastic deformations and greenstick fractures. Full article

(This article belongs to the Special Issue Pediatric Upper Extremity Pathology)

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12 pages, 448 KiB

Open AccessArticle

The Relationship Between Self-Control and Non-Suicidal Self-Injury in Adolescent Psychiatric Outpatients: Exploring the Role of Self-Control

by Zhenhua Chen, Jie Xu, Ronghua Zhang, Yuxuan Wang and Ziwei Shang

Children 2025, 12(1), 99; https://doi.org/10.3390/children12010099 - 16 Jan 2025

Viewed by 504

Abstract

Background: Non-suicidal self-injury (NSSI) is a significant public health concern that threatens the physical and mental health of adolescents. Given its high prevalence among adolescents, understanding the characteristics and contributing factors of NSSI is crucial. This study aimed to characterize NSSI and examine [...] Read more.

Background: Non-suicidal self-injury (NSSI) is a significant public health concern that threatens the physical and mental health of adolescents. Given its high prevalence among adolescents, understanding the characteristics and contributing factors of NSSI is crucial. This study aimed to characterize NSSI and examine the relationship between self-control and NSSI among adolescent psychiatric outpatients. Method: This study was conducted in a psychiatric department of a hospital in Hubei Province, China, involving 206 adolescent psychiatric outpatients (135 females, 12–18 years old). Assessments included the Ottawa Self-Injury Inventory (OSI), the Self-Control Scale (SCS), and a self-designed sociodemographic questionnaire. Result: In this sample, 77.18% reported a history of NSSI. The prevalence of NSSI was significantly higher in females than in males (χ² = 19.059, p < 0.01). The NSSI group had significantly lower self-control scores compared to the non-NSSI group (F = 27.458, p < 0.01). In the NSSI group (n = 156), self-control was negatively associated with NSSI frequency and fully mediated by NSSI function. Conclusions: These findings highlight the complete mediating role of NSSI function between self-control and NSSI frequency, offering insights for future prevention and intervention efforts. Full article

(This article belongs to the Special Issue Stress and Stress Resilience in Children and Adolescents)

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14 pages, 1798 KiB

Open AccessArticle

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

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

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

Viewed by 905

Abstract

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

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

(This article belongs to the Special Issue Nutritional Status and Eating Patterns in Children and Adolescents: Prevalence, Screening and Prevention of Metabolic Disorders)

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11 pages, 965 KiB

Open AccessArticle

Body Composition Changes and Associations in Infants and Mothers During the First Year: Insights from a Pilot Study of the Baby-bod Project

by Manoja P. Herath, Kiran D. K. Ahuja, Jeffrey M. Beckett, Sisitha Jayasinghe, Nuala M. Byrne and Andrew P. Hills

Children 2025, 12(1), 97; https://doi.org/10.3390/children12010097 - 16 Jan 2025

Viewed by 512

Abstract

Background: The period following childbirth is marked by dynamic changes in maternal physiology and the growth trajectory of the newborn. We aimed to elucidate the changes and associations in body composition of infants and their mothers during the first year postpartum. Methods: This [...] Read more.

Background: The period following childbirth is marked by dynamic changes in maternal physiology and the growth trajectory of the newborn. We aimed to elucidate the changes and associations in body composition of infants and their mothers during the first year postpartum. Methods: This pilot study assessed infant body composition using the PEA POD air displacement plethysmography (ADP) system (birth–6 months) and deuterium dilution (9–12 months). Maternal body composition was assessed using the BOD POD ADP system at 12 months postpartum. Mothers were grouped by prepregnancy body mass index (BMI) <25 kg/m² (lean) or ≥25 kg/m² (overweight/obese: OW/OB), and data were analysed using linear regression. Results: Twenty-nine infant–mother pairs were assessed. Infant percent fat mass (%FM) increased from birth to 6 months (9.3% vs. 24.2%; p < 0.001) and then gradually declined. At birth and 3 months, %FM was significantly higher in infants born to OW/OB mothers compared to their lean counterparts. A significant positive association (β = 0.3; p = 0.040) was observed between maternal %FM and infant %FM at 1 year post-delivery after controlling for the mother’s prepregnancy BMI. Conclusions: Infants born to OW/OB mothers have increased %FM at birth and 3 months, which may have consequences for their health throughout childhood and into adulthood. Moreover, maternal prepregnancy BMI is a significant predictor of maternal postpartum weight status and body composition and impacts the relationship between maternal and infant body composition at 12 months postpartum. While the findings of our pilot study underscore the importance of encouraging women of childbearing age to maintain a healthy BMI before conception, further research is needed to substantiate these results. Full article

(This article belongs to the Section Pediatric Neonatology)

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15 pages, 739 KiB

Open AccessArticle

Stress and Traditional Support: The Role of Orphans’ and Vulnerable Children’s Primary Caregivers in Rural Ethiopia

by Aweke Tadesse, Kenan Li and Jesse Helton

Children 2025, 12(1), 96; https://doi.org/10.3390/children12010096 - 16 Jan 2025

Viewed by 560

Abstract

Background/Objectives: Orphans’ and Vulnerable Children’s (OVC) primary caregivers (PCGs) in Ethiopia live with multiple social and emotional problems stemming from extreme poverty, war, environmental disasters, and the HIV pandemic. Family and community supports are strained, leaving OVC’s PCGs dependent on inconsistent humanitarian aid. [...] Read more.

Background/Objectives: Orphans’ and Vulnerable Children’s (OVC) primary caregivers (PCGs) in Ethiopia live with multiple social and emotional problems stemming from extreme poverty, war, environmental disasters, and the HIV pandemic. Family and community supports are strained, leaving OVC’s PCGs dependent on inconsistent humanitarian aid. This aid is typically focused on OVCs and does not address PCG well-being. This study aimed to assess PCG well-being and explore their perceived stress and the traditional family and community coping mechanisms. Method: Participants from the Oromia region of Ethiopia were recruited, and a mixed-methods design was employed. Six cases were included using a criterion sampling technique. An explanatory data analysis technique was used, and data were triangulated from interviews, focus group discussions, archival information, and surveys. A 36-item Well-being Measuring Tool (WMT) Likert scale was employed to measure well-being domains. Result: The results indicated that none of the PCGs reported the desirable and average summative well-being domain mean scores [25 and 23]. Among the ten well-being domains, only “spirituality” and “community cohesion” were above the average score [2.3]. The “economy” domain had the lowest score, indicating a critical deficiency [1.3]. A lack of community support could exasperate perceived stress, and well-being deficiencies were linked. Conclusions: Lack of family and community support could exacerbate feeling overlooked, unwelcome, and lonely. A policy that promotes a supportive community environment and safeguards the most vulnerable OVCs and their PCGs should be in place. This study recommends further rigorous research examining the well-being determinants of OVCs’ PCGs in Ethiopia and the role of traditional support systems in rural settings. Full article

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12 pages, 2338 KiB

Open AccessReview

Updates in Biliary Atresia: Aetiology, Diagnosis and Surgery

by Mark Davenport

Children 2025, 12(1), 95; https://doi.org/10.3390/children12010095 - 16 Jan 2025

Viewed by 605

Abstract

Biliary atresia (BA) is an obliterative disease of the bile ducts affecting between 1 in 10,000–20,000 infants with a predominance in Asian countries. It is clinically heterogeneous with a number of distinct variants (e.g., isolated, Biliary Atresia Splenic Malformation syndrome, Cat-eye syndrome, cystic [...] Read more.

Biliary atresia (BA) is an obliterative disease of the bile ducts affecting between 1 in 10,000–20,000 infants with a predominance in Asian countries. It is clinically heterogeneous with a number of distinct variants (e.g., isolated, Biliary Atresia Splenic Malformation syndrome, Cat-eye syndrome, cystic BA, and CMV-associated BA). Facts about its aetiology are hard to encounter but might include genetic, developmental, exposure to an environmental toxin, or perinatal virus infection. However, the cholestatic injury triggers an intrahepatic fibrotic process beginning at birth and culminating in cirrhosis some months later. Affected infants present with a triad of conjugated jaundice, pale stools, and dark urine and may have hepatosplenomegaly upon examination, with later ascites coincident with the onset of progressive liver disease. Rapid, efficient, and expeditious diagnosis is essential with the initial treatment being surgical, typically with an attempt to restore the bile flow (Kasai portoenterostomy (KPE)) or primary liver transplantation (<5%) if considered futile. Failure to restore bile drainage or the onset of complications such as recurrent cholangitis, treatment-resistant varices, ascites, hepatopulmonary syndrome, and occasionally malignant change are usually managed by secondary liver transplantation. This issue summarises recent advances in the disease and points a way to future improvements in its treatment. Full article

(This article belongs to the Special Issue Pediatric Digestive Tract Disease: Surgical Aspects)

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15 pages, 534 KiB

Open AccessArticle

Prenatally Diagnosed Cardiac Tumors and Tuberous Sclerosis Complex: A Single-Center Experience

by Matija Bakoš, Dora Jelinek, Ana Ćorić Ljoka, Nada Sindičić Dessardo, Dalibor Šarić and Ruža Grizelj

Children 2025, 12(1), 94; https://doi.org/10.3390/children12010094 - 16 Jan 2025

Viewed by 515

Abstract

Background/Objectives: Cardiac rhabdomyoma (CR), the most frequently occurring fetal cardiac tumor, is often an early marker of tuberous sclerosis complex (TSC). This study evaluates outcomes of fetuses with prenatally diagnosed cardiac tumors managed at a single tertiary center. Methods: Medical records of fetuses [...] Read more.

Background/Objectives: Cardiac rhabdomyoma (CR), the most frequently occurring fetal cardiac tumor, is often an early marker of tuberous sclerosis complex (TSC). This study evaluates outcomes of fetuses with prenatally diagnosed cardiac tumors managed at a single tertiary center. Methods: Medical records of fetuses diagnosed with cardiac tumors between 2009 and 2024 were retrospectively reviewed. Results: Sixteen cases were identified, with a median follow-up of 6.7 years. TSC was confirmed in 14 cases (88%). Multiple tumors were observed in 13 cases (81%), while 3 cases (19%) had solitary tumors. Both non-TSC cases involved solitary tumors. Cardiac complications (arrhythmias, conduction disorders, and hemodynamic abnormalities) occurred in 38% of cases prenatally and 69% postnatally, with larger tumor diameters significantly associated with complications (p = 0.02). No fetal hydrops or mortality occurred; however, one child died at age five due to a seizure. Postnatal tumor regression occurred in 56% of cases and complete regression in 38% by a median age of 2.3 years (range: 0.6–4.4). One tumor remained stable. Brain MRI revealed TSC-related changes in all TSC-affected patients except one, who had a developmental brain anomaly. Most TSC patients experienced epilepsy (71%) and developmental delays. Conclusion: While CRs are typically benign and regress spontaneously, their strong association with TSC highlights the importance of early diagnosis and family counseling. TSC-related epilepsy and psychomotor delays significantly impair the quality of life. Early mTOR inhibitor therapy offers promise in mitigating TSC-related complications and improving outcomes. Full article

(This article belongs to the Special Issue Advances in Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment)

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20 pages, 264 KiB

Open AccessReview

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

by And Demir, Adem Aydin and Atilla Büyükgebiz

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

Viewed by 608

Abstract

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

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

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

31 pages, 348 KiB

Open AccessArticle

Design, Content and Ecological Validity and Reliability of the Physical Activity and Sport Habits Questionnaire for Children Aged 8–12 Years in the Province of Gipuzkoa (Spain)

by Aduna Badiola-Lekue, Irantzu Ibañez, Maite Fuentes, Javier Yanci, Oidui Usabiaga and Aitor Iturricastillo

Children 2025, 12(1), 100; https://doi.org/10.3390/children12010100 - 16 Jan 2025

Viewed by 589

Abstract

Background/Objectives: This study aimed to develop a questionnaire to describe and diagnose the physical activity and sport (PAS) habits of 8–12-year-old schoolchildren, assessing its content, ecological validity and reliability, from a multidimensional perspective aligned with Global Matrix 4.0 indicators. Methods: The questionnaire design [...] Read more.

Background/Objectives: This study aimed to develop a questionnaire to describe and diagnose the physical activity and sport (PAS) habits of 8–12-year-old schoolchildren, assessing its content, ecological validity and reliability, from a multidimensional perspective aligned with Global Matrix 4.0 indicators. Methods: The questionnaire design phase involved seven individuals from the university sector and sport managers from the Gipuzkoa Provincial Council. Seventeen experts later evaluated the questionnaire’s content and ecological validity. For reliability testing, 276 schoolchildren aged 8 to 12 completed the questionnaire twice, with a time interval of two weeks to two months. Statistical analyses included the Wilcoxon test to compare expert ratings, effect size and percentage change calculations for magnitude assessment, and McNemar, McN-Bowker or Wilcoxon tests to compare differences between initial and repeat responses. Cohen’s Kappa was used to assess agreement. Results: The initial battery of items, submitted to the validation process, comprised 31 items across 10 dimensions, derived from validated questionnaires and published works. Following content and ecological validity evaluations, modifications were made and nine items were removed due to improved wording, clarification of concepts, redundancy or lack of relevance. Expert quantitative analyses indicated improved overall questionnaire values. Reliability analysis revealed significant differences in five of the twenty-two items, though substantial agreement (from slight to almost perfect) was observed in twenty items. Conclusions: The study confirmed the questionnaire’s validity and reliability as a suitable tool for assessing PAS practices among 8–12-year-old schoolchildren in Gipuzkoa, Spain, in both Basque and Spanish languages. Full article

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

18 pages, 513 KiB

Open AccessArticle

Parental Evaluation of a Responsive Parenting Program for Infants with Hearing Loss

by Reinhild Glanemann, Karen Reichmuth, Stephanie Brinkheetker, Antoinette am Zehnhoff-Dinnesen and Katrin Neumann

Children 2025, 12(1), 92; https://doi.org/10.3390/children12010092 - 15 Jan 2025

Viewed by 492

Abstract

Background: Parental satisfaction is an important factor in the evaluation of early intervention programs but is rarely investigated. The Muenster Parental Program (MPP) is a short, evidence-based early intervention program that focuses on parental responsiveness. It is a family-centered intervention for parents of [...] Read more.

Background: Parental satisfaction is an important factor in the evaluation of early intervention programs but is rarely investigated. The Muenster Parental Program (MPP) is a short, evidence-based early intervention program that focuses on parental responsiveness. It is a family-centered intervention for parents of infants aged 3–18 months who have recently been diagnosed with hearing loss and fitted with hearing devices, including prior to or following cochlear implant surgery. Objective: We aim to receive feedback from parents regarding the process and outcomes of their participation in the MPP. Method: Following their participation, all participants of the MPP were asked to complete an evaluation questionnaire. This article reports feedback from the first 52 participants (44 mothers, 7 fathers, and 1 godmother). Their infants (N = 45) had moderate to complete hearing loss, they were aged 2–20 months, and 40% of them had an additional disease, disorder, and/or developmental delay. Results: Parents reported high levels of satisfaction with the content, didactics, setting, and individual benefits of the intervention, and a high recommendation rate (92%). The aspects most appreciated were meeting other affected parents and the concrete individual support of parent–child communication, including video feedback. Almost all parents (96%) reported a change in their communication style with their child. This confirms the results of a previous controlled intervention study on the enhancement of parental responsiveness via the MPP. Conclusions: This evaluation of the MPP from a parental point of view has revealed equally high satisfaction with the content, setting, and didactics amongst all parents regardless of any potentially influential parent or child variables. The MPP is well suited to a wide range of close caregivers’ needs despite the known diversity of children with hearing loss and their parents or families. Full article

(This article belongs to the Section Pediatric Otolaryngology)

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11 pages, 2045 KiB

Open AccessArticle

Radiographic and Clinical Results of Combined Bone and Soft-Tissue Tailored Surgeries for Hip Dislocation and Subluxation in Cerebral Palsy

by Giulia Beltrame, Artemisia Panou, Andrea Peccati, Haridimos Tsibidakis, Francesco Pelillo and Nicola Marcello Portinaro

Children 2025, 12(1), 91; https://doi.org/10.3390/children12010091 - 15 Jan 2025

Viewed by 446

Abstract

Background/Objectives: The aim of the study is to present middle-term results of tailored bone and soft-tissue surgeries in subluxated and dislocated hips in children affected by cerebral palsy. Methods: A total of 87 medical records belonging to 73 children affected by CP, treated [...] Read more.

Background/Objectives: The aim of the study is to present middle-term results of tailored bone and soft-tissue surgeries in subluxated and dislocated hips in children affected by cerebral palsy. Methods: A total of 87 medical records belonging to 73 children affected by CP, treated with combined soft-tissue releases, VDO, and pelvic osteotomy, were reviewed retrospectively. Radiological measurements of AI, RI, and NSA were obtained before surgery, postoperatively, at 12 and 24 months after surgery. Results were assessed globally and by GMFCS, age, and Robin score. Results: Postoperative results are not statistically influenced by age and GMFCS levels at surgery. All three radiographic parameters showed persistent statistically significant improvement after surgery and at follow-up, respectively. Conclusions: Obtaining the best possible concentric reduction of the femoral head in the acetabulum, with simultaneous multilevel soft-tissue rebalancing, creates the best mechanical and biological environment to allow the reshaping of both articular surfaces, obtaining physiological internal joint pressure. The anatomical best congruency is protective from recurrence. Full article

(This article belongs to the Section Pediatric Orthopedics & Sports Medicine)

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14 pages, 1393 KiB

Open AccessArticle

Kinetics and Kinematics of Shape Tracing in Children with Probable Developmental Coordination Disorder (pDCD)

by Michal Hochhauser, Yfat Ben Refael, Esther Adi-Japha and Rachel Bartov

Children 2025, 12(1), 90; https://doi.org/10.3390/children12010090 - 15 Jan 2025

Viewed by 887

Abstract

Background: Children with developmental coordination disorder (DCD) exhibit visual–motor deficits affecting handwriting. Shape tracing, a key prerequisite for handwriting, supports motor and cognitive development but remains underexplored in research, particularly in objectively studying its role in children with DCD. Objectives: To compare the [...] Read more.

Background: Children with developmental coordination disorder (DCD) exhibit visual–motor deficits affecting handwriting. Shape tracing, a key prerequisite for handwriting, supports motor and cognitive development but remains underexplored in research, particularly in objectively studying its role in children with DCD. Objectives: To compare the kinetics (pressure applied to the writing surface) and kinematics (spatial and temporal aspects) of shape tracing in children with pDCD to those of typically developing (TD) peers utilizing a digitized tablet. Methods: A total of 27 children with pDCD aged 7 to 12 years and 27 TD children matched by age and gender traced five unique shapes resembling print letters onto a digitized tablet. Participants’ performance measurements included precision, time, smoothness, velocity, and pressure. Results: The findings revealed lower precision, longer duration, more smoothness but less consistency, lower velocity, and less pressure application in the pDCD group. Conclusions: This research underlies the mechanisms of shape-tracing difficulties in children with DCD. Insights into early shape-tracing processes beyond product outcomes are essential for therapeutic and educational interventions, with digitized tablets offering a novel tool for assessing graphomotor skills in children with DCD. Full article

(This article belongs to the Special Issue Movement Disorders in Children: Challenges and Opportunities)

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12 pages, 636 KiB

Open AccessArticle

Cross-Sectional Analysis of IL-6, TNF-α, Adiponectin, Leptin, and Klotho Serum Levels in Relation to BMI Among Overweight and Obese Children Aged 10–14 in La Rioja, Spain

by Beatriz Fernández-Vallejo, Francisco Jiménez Monteagudo, Lourdes Romero, Maria Isabel López Aznárez, María del Carmen Romero Cobas and Laura Pérez-Martínez

Children 2025, 12(1), 89; https://doi.org/10.3390/children12010089 - 14 Jan 2025

Viewed by 774

Abstract

Background: Childhood obesity is a major public health concern, being linked to an increased risk of metabolic disorders and cardiovascular disease. Even in childhood, obesity is associated with systemic low-grade inflammation, which is a critical factor in the development of atherosclerosis and a [...] Read more.

Background: Childhood obesity is a major public health concern, being linked to an increased risk of metabolic disorders and cardiovascular disease. Even in childhood, obesity is associated with systemic low-grade inflammation, which is a critical factor in the development of atherosclerosis and a predictor of cardiovascular morbidity and mortality. Objectives: To describe the prevalence of obesity and examine the relationship between IL-6, TNF-α, adiponectin, leptin, the leptin/adiponectin (L/A) ratio, and Klotho levels with BMI in children. Methods: This cross-sectional study included children aged 10–14 years from La Rioja, Spain. Participants were selected based on BMI criteria for overweight (85th–95th percentiles) and obesity (>95th percentile). Socio-demographic and anthropometric data and blood samples were collected and analyzed for IL-6, TNF-α, adiponectin, leptin, and Klotho. Results: A total of 340 participants were included, with 276 (81.2%) classified as normal weight and 64 (18.8%) as overweight or obese. Mean age was similar between groups (p = 0.40). Obesity was more prevalent in males (59.4%, p = 0.048). Obese participants had higher mean birth weight (p = 0.003), current height (p = 0.04), BMI (p < 0.0001), and abdominal circumference (p < 0.0001). BMI correlated positively with leptin (r = 0.54, p = 0.0008) and the L/A ratio (r = 0.40, p = 0.025), showing sex-specific differences. Conclusions: This study underscores leptin and the L/A ratio as potential biomarkers of metabolic dysregulation in childhood obesity, particularly in females. Longitudinal studies are needed to confirm these findings and assess the clinical utility of these biomarkers in pediatric obesity management. Full article

(This article belongs to the Special Issue Timing of Puberty: Associations with Obesity and Impact on Growth)

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14 pages, 514 KiB

Open AccessArticle

Is the Family Health Center Professionals’ Knowledge Level About Child Abuse and Neglect Sufficent? A Comprehensive Field Study

by Serdar Deniz, Muhammet Bayraktar, Tufan Nayir, Elçin Balcı and Feyza İnceoğlu

Children 2025, 12(1), 88; https://doi.org/10.3390/children12010088 - 14 Jan 2025

Viewed by 420

Abstract

Background: Child abuse and neglect bring lots of undesirable consequences for the future of children and societies with it. It is expected that health service providers have sufficient knowledge about that subject in order to determine abuse and neglect. Materials and methods: In [...] Read more.

Background: Child abuse and neglect bring lots of undesirable consequences for the future of children and societies with it. It is expected that health service providers have sufficient knowledge about that subject in order to determine abuse and neglect. Materials and methods: In this study, a 67-item scale with a Cronbach’s alpha value of 0.92 was used. A score of more than 3 on the scale meant that the score was at a sufficient level. The universe of this descriptive study is health professionals working in 512 family health units in Mersin, Türkiye. Interviews were conducted with 97.26% (n = 249) of family physicians and 98.04% (n = 251) of family health workers working in the 256 units included in the sample. Results: Since the overall scale score of the study group was above 3, it (3.77 ± 0.36) was determined that the average score of the participants was sufficient. 46.2% (n = 231) of the group did not receive training on child neglect and abuse during their education, and 45.2% (n = 226) during their work. 95.8% stated that they paid attention to signs of abuse and neglect in children brought for examination and follow-up, while 83.4% stated that they had not encountered any cases in the last year. 42% (n = 210) of the group thought that the relevant authorities would not take the necessary action even if they observed signs of child neglect and abuse, while 37.4% (n = 187) stated that they did not know when and how to report. Conclusions: Although the findings of the study suggest that the group’s level of knowledge is sufficient, it is of great importance to increase their knowledge about reporting processes and to encourage them in this regard. Full article

(This article belongs to the Section Pediatric Mental Health)

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14 pages, 1532 KiB

Open AccessArticle

The Impact of a Music- and Movement-Based Intervention on Motor Competence, Social Engagement, and Behavior in Children with Autism Spectrum Disorder

by Chayma Kanzari, Aymen Hawani, Karim Ben Ayed, Maher Mrayeh, Santo Marsigliante and Antonella Muscella

Children 2025, 12(1), 87; https://doi.org/10.3390/children12010087 - 14 Jan 2025

Viewed by 665

Abstract

Background/Objectives: The main objective of this manuscript is to evaluate the effects of training, music, and movement intervention on motor functions, social engagement, and behaviors in autistic children. Methods: Twenty-one children with a diagnosis of mild autism spectrum disorder (ASD), with an age [...] Read more.

Background/Objectives: The main objective of this manuscript is to evaluate the effects of training, music, and movement intervention on motor functions, social engagement, and behaviors in autistic children. Methods: Twenty-one children with a diagnosis of mild autism spectrum disorder (ASD), with an age range of 5-to-13 years, were divided into two groups: the experimental group (n = 10) and the control group (n = 11). All participants were examined before (T0) and after the intervention (T1) to evaluate their motor functions (Bruininks–Oseretsky Motor Performance Test (BOT-2)), maladaptive behavior (RCS (Response to Challenge Scale)), and enjoyment and engagement (PACES (Physical Activity Enjoyment Scale)). Results: Statistical analysis showed that music and movement intervention significantly improved motor functions such as balance and bilateral coordination (p < 0.0001), social engagement (p = 0.002), and adaptive behaviors (p = 0.005) in children with ASD. Our research supports the feasibility of music and movement intervention and documents the interest in participating in children with ASD. Conclusions: This study demonstrates the benefits of movement and music interventions and can be considered a useful way to manage autism spectrum disorders in the future. Full article

(This article belongs to the Special Issue Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder: Advances in Social-Cognitive and Educational Processes)

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6 pages, 846 KiB

Open AccessBrief Report

Scaphoid Fat Stripe Sign: Is It a Reliable Radiological Sign of Scaphoid Fracture in Children?

by Pavle Manic, Stéphanie Schizas, Pierre-Yves Zambelli and Eleftheria Samara

Children 2025, 12(1), 86; https://doi.org/10.3390/children12010086 - 13 Jan 2025

Viewed by 541

Abstract

Objectives: The scaphoid fat pad stripe (SFS) is a radiological sign first described in 1975 as a line of relative lucency lying parallel to the lateral border of the scaphoid, with slight convexity toward it, and it is optimally demonstrated on postero-anterior and [...] Read more.

Objectives: The scaphoid fat pad stripe (SFS) is a radiological sign first described in 1975 as a line of relative lucency lying parallel to the lateral border of the scaphoid, with slight convexity toward it, and it is optimally demonstrated on postero-anterior and oblique views with ulnar deviation of the carpus. The obliteration or displacement of this line is commonly present in acute fractures of the scaphoid, radial styloid process, and proximal first metacarpus. The aim of this observational study is to investigate the supportive value of the fat stripe sign (SFS) in the diagnosis of scaphoid fractures in the pediatric population. Methods: This is a monocentric, retrospective study of all patients referred to the Pediatric Traumatology Unit of a tertiary hospital from the Emergency Department with clinical suspicion of scaphoid fracture without visible fracture in the initial X-ray. Radiological reports for CT and MRIs were recorded, and the initial X-rays were blindly reviewed by a pediatric orthopedic fellowship-accredited surgeon for the presence of an abnormal scaphoid fat pad stripe sign and the presence of a fracture line in the initial X-rays. Results: The results of the blind interpretation of the initial X-rays for the fat stripe sign showed 86% sensitivity and 58% specificity, with the negative predictive value reaching 92%. Conclusions: The scaphoid fat stripe sign can be used as an adjacent in the diagnosis of an occult scaphoid fracture in children or adolescents. Its high negative predictive value, if confirmed in larger studies, can be an element used to exclude scaphoid fracture and consequently avoid unnecessary immobilizations and health costs. Full article

(This article belongs to the Section Pediatric Radiology)

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15 pages, 687 KiB

Open AccessArticle

A Survey on the Organization and Operation of Level II/III Neonatal Intensive Care Units in Greece: A Comparison Between 2004 and 2022

by Kosmas Sarafidis, Nicoletta Iacovidou, Eleftheria Hatzidaki, Ilias Chatziioannidis and Gabriel Dimitriou

Children 2025, 12(1), 85; https://doi.org/10.3390/children12010085 - 13 Jan 2025

Viewed by 469

Abstract

Background/Objectives: Limited data exist on the organization and operation of Level II/III Neonatal Intensive Care Units (NICUs) in Greece; this retrospective cross-sectional survey explored their structure and functioning in 2004 and 2022. Methods: A structured questionnaire was utilized, along with demographic and perinatal [...] Read more.

Background/Objectives: Limited data exist on the organization and operation of Level II/III Neonatal Intensive Care Units (NICUs) in Greece; this retrospective cross-sectional survey explored their structure and functioning in 2004 and 2022. Methods: A structured questionnaire was utilized, along with demographic and perinatal data obtained from the Hellenic Statistical Authority. Results: Between 2004 and 2022, live births decreased by 28%, while the prematurity rate rose from 6.96% to 11.87% (p < 0.001). Significant regional differences were observed in the number of NICUs (p = 0.033), live births (p < 0.001), and NICUs per 10,000 live births (p = 0.025). In this survey, data from 20 Level III NICUs in 2004 and 22 NICUs (one Level II) in 2022 were analyzed. NICU admissions increased by 16.1% (p = 0.389), while the rate of admitted neonates/1000 live births increased from 13.5 to 21.8 (p < 0.001). In 2022, premature infants constituted 40.2% of NICU admissions. The number of board-certified neonatologists increased by 21.8% between 2004 and 2022 (p = 0.795), along with a rise in the ratio of neonatologists per 10,000 live births (from 14.8 to 25, respectively, p < 0.001). Conversely, there was a significant 17.2% reduction in the nursing staff by 2022 (p = 0.034). The number of available NICU beds also increased during the study period. The ratio of ventilators to intensive care beds significantly improved (p < 0.001). In 2022, new treatment modalities, like therapeutic hypothermia, were introduced, and most NICUs reported offering long-term follow-up programs. Conclusions: This survey highlights significant advancements in Level II/III NICU infrastructure and care capabilities, while emphasizing demographic changes and a critical shortage of neonatal nursing staff. These factors should be carefully considered by health authorities in the development of future neonatal care strategic planning in the country. Full article

(This article belongs to the Special Issue Neonatal Morbidity: Current Advances, New Perspectives and Future Challenges)

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10 pages, 223 KiB

Open AccessArticle

The Self-Compassion Scale Short Form for Children Aged 8–12: Validation of the Italian Version

by Valentina Levantini, Iacopo Bertacchi, Antonella Magno, Gianluca Domenico Privitera, Alessia Rinaldi, Nicoletta Zara and Pietro Muratori

Children 2025, 12(1), 84; https://doi.org/10.3390/children12010084 - 13 Jan 2025

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Abstract

Background: Although self-compassion has been consistently linked to positive outcomes in adults and adolescents, only a few studies have explored self-compassion in children and early adolescents due to a lack of measures specifically designed for younger populations. Methods: The current study explored the [...] Read more.

Background: Although self-compassion has been consistently linked to positive outcomes in adults and adolescents, only a few studies have explored self-compassion in children and early adolescents due to a lack of measures specifically designed for younger populations. Methods: The current study explored the psychometric properties of the Italian translation of the Self-Compassion Scale for Children (SCS-C) in a sample of 230 children (mean age = 10.52, SD = 1.33). Results: The results revealed a two-factor solution for our data, with a positive self-compassion factor and a negative self-compassion factor, which were shown to be internally consistent. The SCS-C scores correlated with the children’s mindfulness, self-esteem, and narcissistic traits in the assumed directions. Conclusions: Overall, our study preliminarily supports the reliability and validity of the Italian version of the SCS-C. Full article

(This article belongs to the Section Pediatric Mental Health)

27 pages, 1886 KiB

Open AccessReview

Thrombocytopenia in Critically Ill Children: A Review for Practicing Clinicians

by Balagangadhar R. Totapally, Abhinav Totapally and Paul A. Martinez

Children 2025, 12(1), 83; https://doi.org/10.3390/children12010083 - 12 Jan 2025

Viewed by 783

Abstract

Thrombocytopenia frequently occurs in patients before, during, and after admission to Pediatric Intensive Care Units (PICUs). In critically ill children, it is often due to multifactorial causes and can be a sign of significant organ dysfunction. This review summarizes the potential causes/mechanisms of [...] Read more.

Thrombocytopenia frequently occurs in patients before, during, and after admission to Pediatric Intensive Care Units (PICUs). In critically ill children, it is often due to multifactorial causes and can be a sign of significant organ dysfunction. This review summarizes the potential causes/mechanisms of thrombocytopenia in acutely ill children, their identification, and treatments, with special attention paid to septic patients. The mechanisms of thrombocytopenia include decreased production and sequestration, but the most common reason is increased destruction or consumption. This review specifically reviews and compares the presentation, pathogenesis, and treatment of disseminated intravascular coagulation (DIC) and the thrombotic microangiopathic spectrum (TMA), including thrombocytopenia-associated multiorgan failure (TAMOF), hemolytic uremic syndrome, and other diagnoses. The other etiologies discussed include HLH/MAS, immune thrombocytopenia, and dilutional thrombocytopenia. Finally, this review analyzes platelet transfusions, the various thresholds, and complications. Full article

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

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14 pages, 6048 KiB

Open AccessArticle

Leptomeningeal Dissemination in Choroid Plexus Tumors: Magnetic Resonance Imaging Appearance and Risk Factors

by Daniel Nunes do Espirito Santo, Monika Warmuth-Metz, Camelia-Maria Monoranu, Martin Hasselblatt, Christian Thomas, Torsten Pietsch, Jürgen Krauß, Tilmann Schweitzer, Brigitte Bison, Matthias Eyrich, Uwe Kordes, Denise Obrecht-Sturm, Mirko Pham and Annika Quenzer

Children 2025, 12(1), 82; https://doi.org/10.3390/children12010082 - 11 Jan 2025

Viewed by 461

Abstract

Background: Intracranial choroid plexus tumors (CPT) are rare and primarily affect young children. Leptomeningeal dissemination (LMD) has been reported not only in high-grade choroid plexus carcinoma (CPC) but also in lower histological grades; however, a systematic evaluation of CPT-specific imaging characteristics remains lacking. [...] Read more.

Background: Intracranial choroid plexus tumors (CPT) are rare and primarily affect young children. Leptomeningeal dissemination (LMD) has been reported not only in high-grade choroid plexus carcinoma (CPC) but also in lower histological grades; however, a systematic evaluation of CPT-specific imaging characteristics remains lacking. Methods: We analyzed the imaging characteristics of LMD in a single-center pediatric cohort of 22 CPT patients (thirteen choroid plexus papilloma (CPP), six atypical choroid plexus papilloma (aCPP), three CPC), comparing LMD features with those of the primary tumor. Additionally, we examined the correlation between resection status and LMD development during follow-up. Results: At diagnosis, we observed true LMD in three (two CPCs, one CPP) and pseudo-LMD in one case (CPP). During follow-up, two CPP patients developed cystic LMD, and one aCPP patient developed a solid metastasis. LMD had characteristics of the primary tumor in 3/4 cases. Incomplete resection was associated with a higher risk of LMD (p = 0.025). Conclusions: LMD can occur in both high- and lower-grade CPT, presenting at diagnosis as well as in relapsed lower-grade cases. Notable MR-imaging features include pseudo-LMD at diagnosis and cystic LMD in relapsed CPP cases. Incomplete tumor resection may increase the risk of LMD, although further validation is needed. Full article

(This article belongs to the Section Pediatric Radiology)

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25 pages, 1087 KiB

Open AccessArticle

Risk Factors and Clinical Predictors of Suicidal Behaviors and Non-Suicidal Self-Injury Among Pediatric Psychiatry Emergency Admissions Pre- and Post-Pandemic: A Retrospective Cohort Study

by Roxana Șipoș, Tudor Văidean and Elena Predescu

Children 2025, 12(1), 81; https://doi.org/10.3390/children12010081 - 11 Jan 2025

Viewed by 585

Abstract

Background: Suicidal behavior (SB) and non-suicidal self-injury (NSSI) are significant public health concerns among adolescents. The COVID-19 pandemic may have exacerbated these issues. Methods: This retrospective cohort study analyzed data from 341 adolescents (aged 6–18 years) presenting to a Romanian pediatric psychiatry emergency [...] Read more.

Background: Suicidal behavior (SB) and non-suicidal self-injury (NSSI) are significant public health concerns among adolescents. The COVID-19 pandemic may have exacerbated these issues. Methods: This retrospective cohort study analyzed data from 341 adolescents (aged 6–18 years) presenting to a Romanian pediatric psychiatry emergency department during the years 2019 (pre-pandemic) and 2022 (post-pandemic). All participants underwent a thorough psychiatric assessment, and, together with their caregivers, were questioned on a wide range of potentially relevant issues, such as family, social, school, and life history factors. Logistic regression and random forest models were used to identify predictors of SB and NSSI. Results: SB was significantly predicted in regression models based on a prior suicidal ideation (OR = 68.410; p < 0.001), having a parent living abroad (OR = 11.438; p = 0.020), depression (OR = 6.803; p < 0.001), and conflicts with peers (OR = 0.325, p = 0.042), teachers (OR = 0.119, p = 0.024), or both (OR = 0.166, p = 0.012). The random forest model featured a slightly different order of the main predictors and highlighted the importance of additional predictors, such as prior suicide attempts, gender, and past non-suicidal self-injury. NSSI was mainly predicted by a history of self-harm (OR = 52.437; p < 0.001), the number of comorbid psychiatric disorders (OR = 1.709; p = 0.003), and conduct disorder (OR = 0.184; p < 0.001), to which are added, according to random forest models, new predictors, such as borderline personality disorder, suicidal ideation, and school performance. Post-pandemic increases were observed in depression, suicidal ideation, and possible psycho-traumatic negative life event exposure. Conclusions: This study underscores the complex interplay of individual, familial, and societal factors influencing adolescent self-harm. Comprehensive interventions are needed, with early intervention crucial for those with a history of self-harm. Further research using prospective designs is recommended. Full article

(This article belongs to the Special Issue Addressing Challenges in Child Mental Health: Research and Strategies for Comprehensive Development)

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