Children

17 pages, 1615 KiB

Open AccessCase Report

Effectiveness of Intensive Linguistic Intervention in Autism Spectrum Disorder: A Case Study

by Esther Moraleda-Sepulveda, Noelia Pulido-García, Nadia Loro-Vicente and Noelia Santos-Muriel

Children 2025, 12(2), 182; https://doi.org/10.3390/children12020182 - 31 Jan 2025

Background: Autism Spectrum Disorder (ASD) is currently classified as a neurodevelopmental disorder with increasing prevalence year by year. One of the key characteristics of this population is the persistent and variable difficulty they present in the development of functional language. For this reason, [...] Read more.

Background: Autism Spectrum Disorder (ASD) is currently classified as a neurodevelopmental disorder with increasing prevalence year by year. One of the key characteristics of this population is the persistent and variable difficulty they present in the development of functional language. For this reason, most individuals with ASD are candidates for linguistic treatment, especially during the early stages of development. The aim of this study was to assess the effectiveness of an individualized and intensive oral language and communication intervention. Method: This research was conducted through a case study of a 5-year-old Spanish-speaking child diagnosed with ASD. The child’s family sought intensive speech therapy to address articulation difficulties that were affecting speech intelligibility. However, a linguistic intervention program was proposed that would cover work in all areas of language. A comprehensive assessment of the child’s language and communication skills was carried out by a team of five professionals. Following this, an individualized intervention was implemented for 27 h per week over a period of 4 weeks. After this period, the child’s linguistic skills were reassessed. Results: The results show that the proposed intervention not only improved articulation skills. Conclusion: It is important to conduct a detailed analysis of each case and design individualized interventions that directly impact the effectiveness of treatments. Full article

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

16 pages, 277 KiB

Open AccessArticle

Health Preferences in Transition: Differences from Pandemic to Post-Pandemic in Valuation of COVID-19 and RSV Illness in Children and Adults

by Kerra R. Mercon, Angela M. Rose, Christopher J. Cadham, Acham Gebremariam, Jamison Pike, Eve Wittenberg and Lisa A. Prosser

Children 2025, 12(2), 181; https://doi.org/10.3390/children12020181 - 31 Jan 2025

Abstract

Objective: This study aimed to measure changes in preferences regarding health-related quality of life associated with COVID-19 and RSV illness in children and adults from 2021 (during the COVID-19 pandemic) to 2023 (post-pandemic). Methods: A stated-preference survey elicited time trade-off (TTO) values from [...] Read more.

Objective: This study aimed to measure changes in preferences regarding health-related quality of life associated with COVID-19 and RSV illness in children and adults from 2021 (during the COVID-19 pandemic) to 2023 (post-pandemic). Methods: A stated-preference survey elicited time trade-off (TTO) values from US adults in spring 2021 (n = 1014) and summer 2023 (n = 1186). Respondents were asked to indicate how much time they would hypothetically be willing to trade from the end of their life to avoid the effects of varying severities of COVID-19 and RSV illness for: (1) children; (2) parents of an ill child (family spillover); and (3) adults. Attitudes relating to COVID-19 vaccination and data on experience with COVID-19 or RSV illness were also collected. The primary outcome measure was the loss in quality-adjusted life years (QALYs). Changes in preferences over the time period from 2021 to 2023 were evaluated using regression analysis. Results: QALY losses increased with disease severity and were highest for Long COVID. Across all COVID-19 and RSV health states, QALY losses associated with child health states were higher than family spillover or adult health states. In the regression analysis, QALY losses reported in the 2023 survey were significantly lower than 2021 QALY losses for COVID-19, but not RSV. Conclusions: Preferences may change over time in a pandemic context and therefore, economic analyses of pandemic interventions should consider the timeframe of health preference data collection to determine whether they are suitable to include in an economic evaluation. Even with the impacts on health-related quality of life attenuated over time, childhood illnesses still had a measurable impact on caregivers’ quality of life. Full article

(This article belongs to the Section Pediatric Infectious Diseases)

9 pages, 219 KiB

Open AccessArticle

Improved Sleep Quality and Sleep Duration After an 8-Week Exergaming Intervention for Exercise Training Among Elementary Schoolchildren in Taiwan

by Hsiao-Fang Kao, Chi-Fang Lin, I-Tung Lin, Yi-Chuan Hung, Ting-Wei Chang and Chien-Chang Ho

Children 2025, 12(2), 180; https://doi.org/10.3390/children12020180 - 31 Jan 2025

Abstract

Objectives: The present study aimed to investigate the effects of an 8-week exergaming intervention for exercise training on sleep quality and sleep duration among elementary schoolchildren in Taiwan. Methods: A randomized controlled trial design was employed, with 68 elementary schoolchildren (aged 10.76 ± [...] Read more.

Objectives: The present study aimed to investigate the effects of an 8-week exergaming intervention for exercise training on sleep quality and sleep duration among elementary schoolchildren in Taiwan. Methods: A randomized controlled trial design was employed, with 68 elementary schoolchildren (aged 10.76 ± 0.49 years) recruited and randomly assigned to either an experimental group (n = 35) or a control group (n = 33). The experimental group participated in an 8-week exergaming intervention for exercise training; this comprised three sessions per week consisting of three rounds per session, with each round lasting 1 min. The control group did not receive any training and maintained their regular daily routines. All participants provided information on their demographic characteristics and anthropometric measurements and completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire at both pre-test (baseline) and post-test (week 8) assessments. Results: After 8 weeks of exergaming intervention, the experimental group showed a significant reduction in the PSQI global score (6.17 ± 2.96 vs. 4.80 ± 1.97, p < 0.0001). The change in the PSQI global score in the experimental group was significantly greater than in the control group (−1.37 ± 1.97 vs. −0.27 ± 1.89, p = 0.022). Additionally, the experimental group demonstrated a significantly longer sleep duration at week 8 compared with the control group (505.15 ± 53.16 vs. 480.51 ± 54.13, p = 0.047). Conclusions: Overall, the findings of this study indicate a beneficial response of elementary schoolchildren to exergaming, with participants reporting improved sleep quality and sleep duration as a result of engaging in the exergaming intervention sessions three times per week for 8 weeks, with three one-minute rounds per session. Therefore, it appears that exergaming may be an effective method for improving certain aspects of sleep quality and sleep duration among children between 10 and 12 years of age. Full article

(This article belongs to the Topic Influence of Physical Activity, Nutrition, Educators and Parents on Children's Health Development)

12 pages, 945 KiB

Open AccessArticle

Behavioral Inhibition and Fear: The Moderating Role of Emotional Competence and Gender in Preadolescents

by Andrea Baroncelli, Stefania Righi, Carolina Facci and Enrica Ciucci

Children 2025, 12(2), 179; https://doi.org/10.3390/children12020179 - 31 Jan 2025

Abstract

Background: The behavioral inhibition system (BIS) is a key motivational system that shapes human emotions and behaviors; specifically, the BIS regulates avoidance behaviors, and it is linked to negative emotions such as fear and anxiety. Previous studies have demonstrated a link between high [...] Read more.

Background: The behavioral inhibition system (BIS) is a key motivational system that shapes human emotions and behaviors; specifically, the BIS regulates avoidance behaviors, and it is linked to negative emotions such as fear and anxiety. Previous studies have demonstrated a link between high BIS scores and attentional bias to threat in children, but literature is inconsistent. This may be due to differences in the individual awareness of emotions or in the accuracy of effectively detecting emotions. Moreover, the past literature has also found gender differences in BIS scores, which may suggest differential processes in boys and girls. Methods: The present study aims to investigate whether BIS scores were associated with an attentional facilitation index of fear in a sample of preadolescents (n = 264; 52.27% girls; M age = 12.98 years; SD = 0.89 years), considering the potential moderating role of (a) the awareness of others’ emotions as assessed by a self-report questionnaire, (b) emotion perception accuracy of fear as assessed by a laboratory task of emotion recognition, and (c) gender. Results: Our results showed that, only in males, higher scores of the BIS were associated with a lower attentional facilitation index of fear in the conditions of low levels of emotional competence (i.e., low levels of self-reported awareness of other emotions or low levels of accuracy recognition of fearful faces). Conclusions: Results were discussed in light of both theories of emotional development and practical clinical implications, with special attention to the emerged gender difference. Full article

(This article belongs to the Collection Emotional and Behavioral Problems in Children and Adolescents: Assessment and Intervention)

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31 pages, 524 KiB

Open AccessReview

Reduced Physical Activity and Increased Weight Status in Children and Adolescents During the COVID-19 Pandemic: A Systematic Review

by Luciana Zaccagni and Emanuela Gualdi-Russo

Children 2025, 12(2), 178; https://doi.org/10.3390/children12020178 - 30 Jan 2025

Abstract

Background/Objectives: The COVID-19 pandemic has impacted the lifestyles of children and adolescents because of the restrictions imposed to contain the infection. This systematic review examined the possible reduction in children’s and adolescents’ physical activity and changes in their BMI and weight status. Methods: [...] Read more.

Background/Objectives: The COVID-19 pandemic has impacted the lifestyles of children and adolescents because of the restrictions imposed to contain the infection. This systematic review examined the possible reduction in children’s and adolescents’ physical activity and changes in their BMI and weight status. Methods: A systematic review (PROSPERO: CRD42024589208) of English-language studies published up to 1 October 2024 in individuals with a mean age between 6 and 18 years that investigated physical activity data before and during or after the pandemic and focused on their BMI and weight status according to age, sex, and country making use of PubMed, Web of Science, and Scopus, identified 1040 possible articles. Results: Following the PRISMA statement, 26 articles with a whole set of 138,737 children and adolescents were enclosed in the review. The majority of included articles were of moderate quality, as determined by the Newcastle–Ottawa Scale adapted for observational studies. The studies found a decrease in PA, an increase in sedentary activities during/after the lockdown, and an increase in BMI and prevalence of overweight and obesity, especially in males and 8–11-year-olds. Conclusions: The interruption or restriction of outdoor physical activities and sports during the COVID-19 pandemic resulted in a more sedentary lifestyle among children and adolescents, contributing to an overall increase in BMI and obesity, with alarming implications for related health risks and other noncommunicable diseases. Therefore, the adverse effects of restrictive measures should be assessed when implementing public health strategies during pandemics. Full article

(This article belongs to the Special Issue Health Benefits of Physical Activity for Children and Adolescents: 2nd Edition)

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15 pages, 4593 KiB

Open AccessReview

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

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

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

Abstract

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

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

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

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11 pages, 653 KiB

Open AccessArticle

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

by Ahreen Allana, Sidra Bashir and Ivan Hand

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

Abstract

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

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

(This article belongs to the Section Pediatric Neonatology)

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16 pages, 685 KiB

Open AccessArticle

Mother and Child Emotion Regulation: A Moderated Mediation Model

by Maria Cenușă and Maria Nicoleta Turliuc

Children 2025, 12(2), 175; https://doi.org/10.3390/children12020175 - 30 Jan 2025

Abstract

The relationship between mother and child emotion regulation (ER) is widely researched, but fewer studies have investigated explanatory variables or those affecting the strength of this link. Background/Objectives: The present study focused on maternal play behavior, considered as an explanatory mechanism between mother [...] Read more.

The relationship between mother and child emotion regulation (ER) is widely researched, but fewer studies have investigated explanatory variables or those affecting the strength of this link. Background/Objectives: The present study focused on maternal play behavior, considered as an explanatory mechanism between mother and child ER. In addition, the study explored the moderating role of paternal empathy in the association between maternal emotion regulation (ER) and maternal play behavior. Methods: This present cross-sectional study involves 103 mothers and their husbands (the children’s fathers), with at least one child between the ages of 3 and 6 who is typically developed. Results: Our findings show that maternal play behavior mediates the relationship between maternal cognitive reappraisal (CR), expressive suppression (ES), and child ER. Regarding the moderating role of paternal empathy, lower levels moderate the association between ER and maternal play behavior. Conclusions: Our findings highlight the importance of maternal play behavior as an explanatory variable between maternal and child outcomes and, concomitantly, of paternal variables, such as empathy, in supporting maternal play behavior when it comes to achieving better child outcomes. Full article

(This article belongs to the Section Pediatric Mental Health)

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14 pages, 1097 KiB

Open AccessArticle

Writhing Movements and Hypoglycemia in Moderate–Late Preterm Infants: A Prospective Cohort Study

by Javier Merino-Andrés, Francisco Javier Fernández-Rego, Álvaro Hidalgo-Robles, María Cayeiro-Marín, Purificación López-Muñoz and Soraya Pérez-Nombela

Children 2025, 12(2), 174; https://doi.org/10.3390/children12020174 - 30 Jan 2025

Abstract

Introduction: This study aims to examine the relationship between hypoglycemia and general movement patterns during the early post-term-aged in moderate-to-late preterm infants and to assess the interobserver reliability of movement evaluation during this period. Compared with full-term infants, moderate-to-late preterm infants constitute the [...] Read more.

Introduction: This study aims to examine the relationship between hypoglycemia and general movement patterns during the early post-term-aged in moderate-to-late preterm infants and to assess the interobserver reliability of movement evaluation during this period. Compared with full-term infants, moderate-to-late preterm infants constitute the largest group of premature births globally and are at greater risk of developing neurodevelopmental disorders. Hypoglycemia is one of the most prevalent risk factors in this group. Methods: This prospective single-center explorative cohort study included moderate-to-late preterm infants during their admission in the neonatal intensive care unit. General movements were assessed via Prechtl’s General Movements Assessment, and blood glucose levels were monitored via the FreeStyle Optium™ Neo glucometer. Associations were analyzed via Fisher’s exact test, whereas interobserver reliability was evaluated via the intraclass correlation coefficient (ICC) and the kappa coefficient. Results: A total of 17 moderate-to-late preterm infants with hypoglycemia (<45 mg/dL) presented a relatively high percentage (58.8%) of poor repertoire and normal (35.2%) general movement patterns during the early post-term-aged. Interobserver reliability was good (ICC = 0.7), and the kappa coefficient indicated moderate reliability (0.4). Conclusions: Moderate-to-late preterm infants with transient hypoglycemia may frequently display poor repertoire movement patterns, highlighting the need for careful monitoring. Furthermore, the evaluation of general movements proves to be a reliable tool during the early post-term-aged. Full article

(This article belongs to the Section Pediatric Neonatology)

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16 pages, 922 KiB

Open AccessArticle

Effects of a Virtual Reality-Based Aggression Control Program on Children with Autism Spectrum Disorder: A Case Study

by Miran Jung and Jaewon Park

Children 2025, 12(2), 173; https://doi.org/10.3390/children12020173 - 29 Jan 2025

Abstract

Background/Objectives: Aggression is a major challenge for children with autism spectrum disorder (ASD), their family members, friends, and teachers because it can pose a threat or harm not only to the children with ASD but also to others. This study is a [...] Read more.

Background/Objectives: Aggression is a major challenge for children with autism spectrum disorder (ASD), their family members, friends, and teachers because it can pose a threat or harm not only to the children with ASD but also to others. This study is a case study aimed at verifying the effectiveness of a virtual reality-based aggression control program for children with ASD. Methods: The participants were two children (one was a 10-year-old boy and the other was a 6-year-old girl) who participated in the ACAA (Aggression Replacement Training for Children and Adolescents with ASD) Program for eight sessions over three weeks. Results: The frequency (C1: 48 → 3; C2: 32 → 3) and severity of aggressive behaviors in both participants decreased after the intervention compared to before. Additionally, overall problematic behaviors were also reduced after the intervention (C1: 85 → 70; C2: 87 → 64). Furthermore, both participants demonstrated a slight increase in their levels of adaptation (C1: 17 → 20; C2: 16 → 18). Conclusions: The effectiveness of the ACAA program has been demonstrated in reducing levels of aggression in children with ASD. Therefore, the ACAA program may contribute to helping aggressive children with ASD live in harmony with others in society and promote independence. Full article

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

14 pages, 2622 KiB

Open AccessArticle

Implementation of Parenteral Nutrition Formulations with Increased Calcium and Phosphate Concentrations and Its Impact on Metabolic Bone Disease in Preterm Infants: A Retrospective Single-Centre Study

by Sushma Sureshchandra, Rajesh Maheshwari, Tamara Nowland, James Elhindi, Lily Rundjan, Daphne D’Cruz, Melissa Luig, Dharmesh Shah, Gemma Lowe, Jane Baird and Pranav R. Jani

Children 2025, 12(2), 172; https://doi.org/10.3390/children12020172 - 29 Jan 2025

Abstract

Background: Metabolic Bone Disease of Prematurity (MBDP) is common in extremely preterm infants (≤28 weeks gestation). Parenteral nutrition (PN) with higher calcium (Ca) and phosphorus (P) concentration started soon after birth may improve bone health in preterm infants. We compared the effect of [...] Read more.

Background: Metabolic Bone Disease of Prematurity (MBDP) is common in extremely preterm infants (≤28 weeks gestation). Parenteral nutrition (PN) with higher calcium (Ca) and phosphorus (P) concentration started soon after birth may improve bone health in preterm infants. We compared the effect of two standard PN formulations on the incidence of MBDP and explored the predictive ability of biochemical markers for diagnosing MBDP. Methods: This retrospective study included eligible preterm infants ≤28 weeks gestation. Infants in group 1 (January 2016–December 2017) received PN 1 formulation with lower Ca (1.6 mmol/kg/day) and P concentration (1.4 mmol/kg/day). Infants in group 2 (June 2018–May 2020) received PN 2 formulation with higher Ca (2.3 mmol/kg/day) and P concentration (1.8 mmol/kg/day). We reviewed the biochemical and radiological investigations performed for diagnosing MBDP. Results: The incidence of MBDP reduced from 82.8% (77/93) in group 1 to 47.3% (27/57) in group 2. Grade 2–3 MBDP reduced significantly from 14% in group 1 to none in group 2 (p < 0.01). Serum phosphate <1.5 mmol/L had a sensitivity of 79% and specificity of 77%, and alkaline phosphatase >500 U/L showed a sensitivity of 72% and specificity of 71% for diagnosing radiological MBDP. There was no increase in hypercalcemia, hypophosphatemia or nephrocalcinosis from PN 2 formulation. Conclusions: A higher Ca and P concentration in PN reduced MBDP and eliminated grade 2–3 MBDP in our cohort without an increase in adverse events. Low serum phosphate and high serum alkaline phosphatase were the best predictors for diagnosing MBDP. Full article

(This article belongs to the Special Issue Care and Outcome of the Extreme Preterm Infant)

19 pages, 611 KiB

Open AccessSystematic Review

Children, Adolescents and Urine Hydration Indices—A Systematic Literature Review on Athletes and Non-Athletes

by Georgios Papaoikonomou, Kyriaki Apergi and Olga Malisova

Children 2025, 12(2), 171; https://doi.org/10.3390/children12020171 - 29 Jan 2025

Abstract

Background/Objectives: The importance of adequate hydration in children and adolescents has raised significant attention, both for its health benefits and for its role in supporting cognitive and physical performance. This is particularly important for young athletes who have increased dehydration risk due to [...] Read more.

Background/Objectives: The importance of adequate hydration in children and adolescents has raised significant attention, both for its health benefits and for its role in supporting cognitive and physical performance. This is particularly important for young athletes who have increased dehydration risk due to high sweat loss and often inadequate water intake. The aim of this review is to systematically assess the hydration status of children and adolescents, including athletes, and to identify notable differences in hydration levels between these groups. Methods: A systematic literature search was conducted following PRISMA guidelines. PubMed, Scopus, and Scholar were searched for articles published between 2004 and 2024 on hydration in children and adolescents, focusing on urinary biomarkers such as urine osmolality, urine specific gravity, and urine color. Two independent reviewers screened the studies, and clinical studies or those involving chronic diseases, disabilities, or missing data were excluded. Results: Fifty-one articles met the inclusion criteria and were categorized into competitive athletes (n = 26) and non-athletes (n = 25). The review revealed that both athletes and non-athletes were frequently dehydrated. Among athletes, 81% of studies reported dehydration, while 69% of studies observed dehydration in non-athlete children. Biomarkers consistently indicated failure to meet recommended hydration guidelines in both groups. Conclusions: Despite existing hydration guidelines, dehydration is prevalent among children and adolescents, irrespective of athletic involvement. This underscores the urgent need for targeted interventions to improve hydration education and practices in schools, homes, and extracurricular settings. Full article

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

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14 pages, 1613 KiB

Open AccessArticle

The Relationship Between Fatigue, Pain Interference, Pain-Related Distress, and Avoidance in Pediatric Hypermobile Ehlers–Danlos Syndrome

by Olivia E. Sokol, Emma E. Biggs, Ardin S. Berger, Laura E. Simons and Rashmi P. Bhandari

Children 2025, 12(2), 170; https://doi.org/10.3390/children12020170 - 29 Jan 2025

Abstract

Background/Objectives: Fatigue is a known predictor of disability and reduced quality of life in youth with hypermobility and chronic pain in general. Given the added relationship between chronic fatigue and connective tissue disorders, including hypermobile Ehlers–Danlos Syndrome (hEDS), this study aims to investigate [...] Read more.

Background/Objectives: Fatigue is a known predictor of disability and reduced quality of life in youth with hypermobility and chronic pain in general. Given the added relationship between chronic fatigue and connective tissue disorders, including hypermobile Ehlers–Danlos Syndrome (hEDS), this study aims to investigate the comparative role of fatigue on important predictors of outcomes for youth with and without hEDS who have chronic pain. Methods: In this retrospective study, pediatric patients with chronic pain diagnosed with hEDS (n = 100) were compared to an age- and sex-matched group of youth with chronic pain without diagnosed hypermobility (n = 100). Participants completed measures of pain-related distress (PCS-C), avoidance (FOPQ-A), and pediatric PROMIS measures for fatigue, anxiety, and pain interference. Data were analyzed using chi-square tests, t-tests, and ANCOVAs in RStudio. Results: Fatigue scores were higher and clinically elevated fatigue was more prevalent in those with hEDS than in matched chronic pain peers. Fatigue was significantly positively related to pain interference, avoidance, and pain-related distress in youth with and without hEDS. Conclusions: The current study supports the need for multidisciplinary treatment and rehabilitation for pediatric chronic pain and hypermobility and suggests that fatigue may be an important factor to consider when treating youth with hypermobility. Full article

(This article belongs to the Special Issue Management of Chronic Pain in Adolescents and Children: 2nd Edition)

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13 pages, 239 KiB

Open AccessArticle

Body Weight Perception and Other Factors Associated with Overweight and Obesity in U.S. Adolescents

by Gulzar Shah, Indira Karibayeva, Padmini Shankar, Semon Mason and J. Michael Griffin

Children 2025, 12(2), 169; https://doi.org/10.3390/children12020169 - 29 Jan 2025

Abstract

Background/Objectives: This study examines the factors associated with U.S. adolescents’ obesity and overweight status. Methods: Using a multivariable logistic regression, we analyzed the data from the 2021 Youth Risk Behavior Surveillance System (YRBSS), comprising 17,232 students. Results: The odds of being obese or [...] Read more.

Background/Objectives: This study examines the factors associated with U.S. adolescents’ obesity and overweight status. Methods: Using a multivariable logistic regression, we analyzed the data from the 2021 Youth Risk Behavior Surveillance System (YRBSS), comprising 17,232 students. Results: The odds of being obese or overweight were significantly higher (p ≤ 0.05) for the participants who perceived themselves as slightly overweight (AOR, 13.31; 95% CI [11.83, 14.97]) or very overweight (AOR, 39.29; 95% CI [30.12, 51.25]) compared to those who perceived their weight as about right. The participants with significantly higher odds included those aged 14 years (AOR, 2.53) compared to those aged 13 years or younger; male students (AOR, 1.63) compared to female students; and American Indian/Alaska Native and Native Hawaiian/Other Pacific Islander students (AOR, 2.11), Black or African American students (AOR, 2.63), Hispanic/Latino students (AOR, 1.54), and students of multiple races (AOR, 1.56), compared to White students. The odds were also significantly higher for the participants who did not eat breakfast on all seven days of a week (AOR, 1.21) and for the students who did not report their mental health status (AOR, 2.07) compared to those who reported their mental health as mostly or always not good. Conclusions: These findings suggest schools are uniquely positioned to implement strategies for healthier behaviors designed and implemented with a focus on health equity. Full article

(This article belongs to the Special Issue Adolescent Weight Management: Advances and Future Challenges)

12 pages, 188 KiB

Open AccessArticle

Blunt Trauma and Diaphragm Injury in Children: An Analysis of the National Trauma Data Bank

by Sammie Lai, Spencer Wilhelm, Robert Morden, Begum Akay, Nathan Novotny, Anthony Stallion and Pavan Brahmamdam

Children 2025, 12(2), 168; https://doi.org/10.3390/children12020168 - 29 Jan 2025

Abstract

Background/Objectives: Trauma is the leading cause of mortality and morbidity in children. Traumatic diaphragm rupture (TDR) is a rare but serious injury that can be difficult to identify. The current literature includes individual case reports and single-center case series only, which limits [...] Read more.

Background/Objectives: Trauma is the leading cause of mortality and morbidity in children. Traumatic diaphragm rupture (TDR) is a rare but serious injury that can be difficult to identify. The current literature includes individual case reports and single-center case series only, which limits our ability to generalize those findings. The purpose of this study is to use the National Trauma Data Bank (NTDB) in order to examine the clinical outcomes of blunt TDR in the pediatric population. Methods: We included patients from 0 to 18 years of age with blunt TDR using the NTDB from 2007 to 2017. Patient characteristics and demographics, mechanisms of injury, concomitant diagnoses, procedures, and clinical outcomes were extracted from the NTDB. Results: In this study, we identified a total of 88 pediatric patients with blunt TDR. The most common mechanism of injury was motor vehicle accidents (65%). The majority of these blunt TDR injuries were observed in males (73%) with a mean age of 12. Fractures of the spine and ribs (49%) and lacerations of the lungs (42%) were some of the most prevailing associated injuries. Seventy percent of patients were admitted to the ICU. In-hospital mortality was 6%. Conclusions: Overall, TDR is relatively unusual among the pediatric population, but is associated with significant morbidity and mortality. Any significant trauma to neighboring organs—the spine, ribs, and lungs—should heighten awareness of potential diaphragm injury. Full article

(This article belongs to the Section Pediatric Surgery)

18 pages, 1122 KiB

Open AccessReview

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

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

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

Abstract

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

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

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

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20 pages, 1683 KiB

Open AccessReview

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

by Samuel Bogdan Todor and Cristian Ichim

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

Abstract

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

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

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

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17 pages, 1741 KiB

Open AccessReview

Effectiveness of Non-Pharmacological Interventions in Reducing Dental Anxiety Among Children with Special Needs: A Scoping Review with Conceptual Map

by Zuhair Motlak Alkahtani

Children 2025, 12(2), 165; https://doi.org/10.3390/children12020165 - 29 Jan 2025

Abstract

Background: Children with special needs often need tailored approaches to oral healthcare to address their unique needs effectively. It is essential to analyze the effectiveness of non-pharmacological management in reducing dental anxiety among special needs children during dental treatment. Methods: Five electronic databases, [...] Read more.

Background: Children with special needs often need tailored approaches to oral healthcare to address their unique needs effectively. It is essential to analyze the effectiveness of non-pharmacological management in reducing dental anxiety among special needs children during dental treatment. Methods: Five electronic databases, PubMed, Scopus, Web of Science, Embase, and Google Scholar, were searched from 2007 to August 2024 for randomized control trials and observational studies comparing the effectiveness of non-pharmacological techniques in reducing dental anxiety during invasive and noninvasive dental treatment. The primary outcomes of the studied intervention were reduced dental anxiety and improved behavior during dental treatment. The conceptual map was created to understand the need for assessment and behavior management for special needs children (SN). Results: Nineteen articles qualified for the final analysis from 250 screened articles. Included studies evaluated the effect of strategies applied clinically, such as audio–visual distraction, sensory-adapted environment, and virtual reality. The included studies measured the trivial to large effect of measured interventions and supported non-pharmacological interventions in clinical settings. Conclusions: Most basic non-pharmacological interventions showed a trivial to large reduction in dental anxiety among SN patients. The conceptual map developed in this study supports the need for non-pharmacological interventions as they are cost-effective and create a positive environment in dental clinics. However, more studies need to focus on non-pharmacological behavior interventions in SN children to support the findings of this scoping review. Full article

(This article belongs to the Section Pediatric Dentistry & Oral Medicine)

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11 pages, 1533 KiB

Open AccessCase Report

Multidisciplinary Management of Acute Tetraparesis in an Infant with Achondroplasia, with a Focus on Anesthetic Strategies: A Case Report

by Barbora Nedomová, Robert Chrenko, Salome Jakešová, Petra Zahradníková, Martin Hanko and Ľubica Tichá

Children 2025, 12(2), 164; https://doi.org/10.3390/children12020164 - 29 Jan 2025

Abstract

Background/Objectives: This report details a rare instance of an infant with achondroplasia developing acute tetraparesis after a cervical whiplash injury, highlighting key multidisciplinary management considerations and specific anesthetic strategies to mitigate potential risks. Case presentation: A 1-year-old boy with achondroplasia presented with acute [...] Read more.

Background/Objectives: This report details a rare instance of an infant with achondroplasia developing acute tetraparesis after a cervical whiplash injury, highlighting key multidisciplinary management considerations and specific anesthetic strategies to mitigate potential risks. Case presentation: A 1-year-old boy with achondroplasia presented with acute tetraparesis after a whiplash injury. Initial craniocervical computed tomography demonstrated a reduced volume of the posterior fossa, foramen magnum stenosis, and ventriculomegaly, without any fractures or dislocations. Moreover, magnetic resonance imaging (MRI) revealed pathological signal changes in the medulla oblongata, cervical spinal cord in segments C1 and C2, and the posterior atlantoaxial ligament. After initial conservative therapy and head immobilization using a soft cervical collar, partial remission of the tetraparesis was achieved. Two weeks post-injury, microsurgical posterior fossa decompression extending to the foramen magnum and C1 laminectomy was performed under general anesthesia with intraoperative neuromonitoring. Following an unsuccessful intubation attempt using a fiberoptic bronchoscope, successful airway management was achieved using a combined technique incorporating video laryngoscopy. Venous access was secured under ultrasound guidance. The patient exhibited complete remission of neurological symptoms by the third postoperative month during follow-up. Conclusions: This case report underscores the crucial need for a multidisciplinary approach in managing children with achondroplasia, especially with foramen magnum stenosis and complex cervical spine injuries. Anesthetic management required meticulously planned airway strategies using advanced techniques like video laryngoscopy and fiberoptic bronchoscopy to reduce airway risks. It also highlights the importance of conservative therapy paired with timely neurosurgical intervention, resulting in the patient’s full recovery. Full article

(This article belongs to the Special Issue Advances in Pediatric Anesthesia, Pain Medicine and Intensive Care (2nd Edition))

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