Introduction Children of military families face unique stressors, including frequent relocations and parental deployments, which can disrupt stability and influence behavioral development. These experiences may also contribute to conduct problems and challenges in social interactions, including bullying victimization and perpetration. However, limited research exists specifically examining behavioral risks in military-connected children. Objective To assess whether children with at least one parent with current or prior military service have increased behavioral problems or a history of being bullied. Methodology We performed secondary data analysis of U.S. children aged 0-17 years who participated in the National Survey of Children's Health (NSCH) from 2017 to 2021. The independent variable was parental military-duty status categorized as at least one parent with (1) current or (2) prior active-duty service in the U.S. Armed Forces, Reserves, or the National Guard, and (3) parents never in military duty (reference group). Outcomes assessed included (1) history of child behavioral or conduct problems and (2) history of being bullied. Outcomes were assessed independently. Confounding variables included demographic factors, family poverty ratio, deployment status, child's general health, and a history of physical abuse and of living with mentally ill relatives. Logistic regression was used to estimate crude and adjusted associations. Results We analyzed data from 140,542 children: 4,919 (3.5%) had parents in active service, and 13,914 (9.9%) had parents with prior military service. A total of 10,681 (7.6%) reported a history of behavioral problems. Among those with information available regarding bullying (n = 81,382), 35,808 (44%) reported having ever been bullied. Children of currently active-duty parents were not associated with increased odds of behavioral problems (adjusted OR 0.89, 95% confidence interval (CI) 0.73-1.10, P = 0.289) but had higher odds of reporting being bullied (adjusted OR 1.30, 95% CI 1.07-1.58, P = 0.008), even after adjustment for selected covariates. Lastly, children of parents with prior military service had increased odds of both behavioral problems (adjusted OR 1.36, 95% CI 1.19-1.57) and being bullied (adjusted OR 1.19, 95% CI 1.08-1.31). Conclusions Parental military service was associated with increased risks of behavioral problems and risk of being bullied in U.S. children. Although we are unable to determine causation from this analysis, our findings support current literature highlighting the need for further research aimed at understanding the mechanisms and potential long-term health impacts of military service on child behavior. Behavioral health screening and early intervention programs could help to address emerging psychological and emotional challenges in this vulnerable population.
Tailored oral-health education programs based on an individual's learning style can improve knowledge and oral health outcomes. This study aims to assess the effectiveness of tailored oral-health education modes on oral health-related knowledge in children aged 10-12 years. One hundred and fifty-two children were categorized into visual, auditory, and tactile learners based on the University of California Learning Style Questionnaire (2006). Twenty children were randomly selected from each group. Tailored oral health education was delivered using: visual mode for dental trauma, auditory mode for dental caries, and tactile mode for tooth brushing. Oral health-related knowledge scores were assessed at baseline, immediately after intervention, and 1-week after intervention. The Kruskal-Wallis test was used for comparison of knowledge scores, followed by post hoc analysis using the Wilcoxon signed-rank test with significance at P ≤ 0.05. Out of 152 children, 61 (40.1%) were identified as visual learners, 37 (24.3%) as auditory learners, and 28 (18.4%) as tactile learners. Visual learners exhibited a significant increase in knowledge scores in visual mode ( P < 0.001) and auditory mode ( P = 0.050). Auditory learners showed a statistically significant increase in scores in all three modes (auditory P < 0.001; visual P = 0.009; tactile P = 0.015). Tactile learners demonstrated a significant increase in scores in visual mode ( P = 0.029) and auditory mode ( P = 0.042). Visual was the most common learning style, followed by auditory and tactile. Visual learners performed best in visual methods, while auditory learners showed significant improvement in all modes. Understanding an individual's learning style helps in delivering tailor-made education strategies, making learning more engaging and effective.
Early childhood caries (ECC) is a multifactorial disease, in which socioeconomic factors, parental knowledge, and oral health-related behaviors play critical roles in determining disease severity. The aim of the study was to evaluate the determinants of severity of ECC among preschool children diagnosed with ECC and to explore the direct and indirect pathways influencing caries severity. This descriptive cross-sectional analytical study included 770 preschool children with ECC aged 36-72 months. Sociodemographic details, parental oral health knowledge, and oral health behaviors were assessed using a structured questionnaire. The severity of caries was recorded using the decayed, missing, and filled teeth (dmft) index according to the World Health Organization criteria. Descriptive statistics, Chi-squared tests, Pearson's correlation, multiple linear regression, and multiple logistic regression were used. Structural equation modeling was employed to assess the mediation pathways. Statistical significance was set at P < 0.05. Higher dmft scores were significantly associated with increasing age, lower socioeconomic status (SES), lower maternal education, poor parental knowledge, infrequent tooth brushing, absence of dental visits, and higher sugar exposure ( P < 0.001). Multiple linear regression analysis showed that maternal education and SES were the strongest predictors of dmft scores. Logistic regression revealed that children from lower socioeconomic strata had more than threefold higher odds of severe ECC. Mediation analysis demonstrated that approximately 30% of the socioeconomic effect on caries severity was indirectly mediated by parental knowledge and oral health behaviors. ECC severity is strongly influenced by socioeconomic disadvantages, with parental knowledge and behaviors acting as important modifiable mediators.
Children with medical complexity often require complicated home care regimens, yet health care safety issues in community settings have been rarely described. Systems-level approaches to addressing patient safety in pediatric home health care (HHC) also remain nascent. Quantifying and categorizing HHC staff incidents is a first step toward preventing the occurrence of safety events in this population. To identify the rates and types of patient safety events within a US national pediatric population receiving HHC. This was a retrospective cohort study (September 1, 2022, to August 31, 2023) that used staff incident reports from a pediatric HHC agency with sites in 11 US states. Participants were patients aged younger than 21 years receiving HHC within the study year, excluding psychiatric HHC. Days of HHC receipt. Rate and type of staff-reported patient safety events per 1000 HHC-days, reviewed by 3 trained clinician reviewers, and classified using the National Coordinating Council for Medication Error Reporting and Prevention Index. This study identified 2901 children (males, 1710 [59.0%]) who received a median of 98.0 (IQR, 14.0-312.0) days of HHC. The mean (SD) age was 8.7 (5.3) years. A total of 678 incident reports were filed for 348 children (11.9%). Of these, 307 (45.3%) were patient safety events, including 168 harmful errors (54.7%), 110 nonharmful errors (35.8%), and 22 hazards (7.2%). This equated to a mean (SD) of 0.68 (4.40) patient safety events per 1000 HHC-days. Errors most frequently involved medications (108 [38.8%]) and implanted devices (91 [32.7%]). Harmful errors were most frequently related to non-pressure-related skin injuries (45 [26.8%]) and falls (30 [17.9%]). Approximately half of all errors required additional monitoring (133 [47.8%]) and 45 (16.2%) required emergency care. Patient safety events were more likely in children with invasive home ventilation compared with other types of implanted medical technology. In this cohort study of children receiving HHC, more than 1 in 10 had a reported incident, of which approximately half were patient safety related. This work provides new data about pediatric HHC safety. Further work should explore factors contributing to and preventing health care-related harms to children at home and include parent perspectives.
While the gastrointestinal symptoms of ulcerative colitis (UC) are well-defined, its impact on motor development in children remains poorly understood. We aimed to assess motor proficiency, handgrip strength, and physical activity levels in children with UC and to investigate associations with disease activity. In this cross-sectional study, 49 children with UC aged 8-17 years and 41 age‑ and sex-matched healthy controls were enrolled. Disease activity was assessed using the Pediatric Ulcerative Colitis Activity Index, and laboratory markers including C-reactive protein and erythrocyte sedimentation rate were measured. Motor proficiency was evaluated using the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition. Handgrip strength was measured with a dynamometer, and physical activity was assessed via the Physical Activity Questionnaire (PAQ). Group comparisons were adjusted for age, sex, socioeconomic status, and body mass index, with False Discovery Rate correction for multiple testing. Children with UC scored significantly lower on the Total Motor Composite than controls (37.4 vs. 45.1, p < 0.001). Adjusted analyses revealed a specific pattern: fine motor skills were preserved, but significant deficits were found in gross motor domains, including bilateral coordination and strength and agility (all p < 0.001). Handgrip strength differences lost significance after adjustment for body mass index, and no difference was observed in physical activity. Within the UC group, a higher erythrocyte sedimentation rate correlated with lower non-dominant handgrip strength (ρ =  - 0.533, p < 0.001) and poorer agility (ρ =  - 0.414, p = 0.003).  Children with UC exhibit significant gross motor deficits, even during clinical remission. These cross-sectional findings indicate that clinically well children may still have impaired motor proficiency compared to healthy peers. However, longitudinal studies are needed to determine whether these deficits predate diagnosis, emerge during active disease, or persist despite remission. • The primary treatment goal in ulcerative colitis with children is the resolution of symptoms and intestinal inflammation. • The potential effects of ulcerative colitis on a child's motor function are not routinely assessed in clinical practice. • Children with ulcerative colitis have significantly lower overall motor proficiency scores compared to their healthy peers. • Children in clinical remission may still have impaired motor skills, indicating a potential need for comprehensive functional assessment during follow-up.
Trans and gender diverse (trans) young people experience higher rates of physical and mental ill-health due to chronic exposure to gender minority stress. Consequently, trans young people report higher health and mental healthcare service utilisation. Disconcertingly, negative experiences of healthcare services are prevalent among trans young people, especially those with additional marginalised identities and backgrounds who experience multiple forms of marginalisation. Patient-reported experience measures (PREM) are auseful tool for improving patients' healthcare experiences however existing PREMs are not relevant, appropriate, nor inclusive of the unique healthcare experiences of trans young people, especially those facing additional forms of marginalisation. This study will co-develop and validate a PREM for trans young people aged 12 to 25 years attending health and mental healthcare services. This PREM will capture how healthcare experiences should affirm all aspects of trans young people's identities in health and mental health services, including but not limited to their gender. Underpinned by a 'co-production' framework, the proposed study comprises four stages informed by a Lived Experience Advisory Group (LEAG) made up of eight trans young people from across Australia. Stage 1 is a scoping review of qualitative studies exploring the experiences of marginalised young people using healthcare services. Stage 2 is semi-structured, one-to-one interviews with multiply marginalised trans young people aged 12 to 25 years in Australia (n = 30) and healthcare professionals of trans young people in Australia (n = 30). Candidate PREM items generated from Stages 1-2 will be appraised in a multi-stakeholder modified e-Delphi Consensus Survey (N = 90; Stage 3) comprising multiply marginalised trans young people (n = 30), healthcare professionals (n = 30), and parents/caregivers of trans young people (n = 30). Lastly, in Stage 4, PREM items will be reviewed by trans young people in two cognitive debriefing focus groups (N = 14) to improve clarity, understandability, and interpretation. This study will co-produce and validate a PREM to effectively measure the quality of trans young peoples' experiences utilising health and mental healthcare services. The PREM will subsequently be implemented into integrated youth health services as part of a multi-staged quality improvement project evaluating an integrated gender service model of care operating in Victoria, Australia. The Whole of Self Affirming Care Lived Experience Advisory Group together with trans members of the research team in designated peer and non-peer research roles have contributed to the design of the present study protocol and corresponding manuscript. These individuals will also contribute to analysis, interpretation, and write-up of all subsequent data and outputs.
Given the known link between maternal and child mental health, it is likely that children whose mothers experienced more distress because of the COVID-19 pandemic were at greater risk for increased behavior problems. Yet research to date has not tested this hypothesis among families who were hit hardest by the pandemic-those with low incomes and from Black and Hispanic backgrounds. Research is also needed that focuses on young children and uses a longitudinal design. We harmonized data from 4 cohorts originally designed to study pediatric parenting interventions with underresourced families in 2 US cities. We examined, first, whether maternal distress because of the pandemic was associated with change over the next 1 to 2 years in preschool-aged children's anxiety/depression and aggression, and second, whether such associations were moderated by maternal depression. Maternal pandemic-related distress predicted a small increase in child aggression but no change in anxiety/depression. There was no moderation by maternal depression. Among families at risk of the most severe health and financial hardships because of the pandemic, maternal pandemic-related distress was associated with increases in child aggression 1 to 2 years later. Maternal mental health must be made a priority in the future disasters not only in its own right but also because of possible spillover effects on young children.
Early childhood caries (ECC) results from a complex interplay of genetic and environmental factors. Polymorphisms of enamel formation genes may alter the susceptibility to ECC. The primary objective of this study is to analyze the association between rs12640848 of the ENAM gene, rs1376729959 of the TUFT1 gene, and rs1784418 of the MMP20 gene with ECC. This case-control study included 124 children aged 3-6 years in each group. A questionnaire was administered to collect the demographic information, socioeconomic status, oral hygiene and feeding practices, 24-h diet diary, and caries status by International Caries Detection and Assessment System II criteria. DNA was isolated from peripheral venous blood, followed by Polymerase Chain Reaction, and analysis of the genotypes under dominant and recessive models. Logistic regression was performed to understand the effect of covariates. The frequency of Allele A of rs12640848 was greater in children with caries as compared to children without caries. The AG and AA genotypes of rs12640848, with odds ratios of 2.03 (1.17-3.54) and 3.20 (1.24-8.25), respectively, were significantly more frequent in children with caries. The computed tomography (CT) genotype of rs1784418 was significantly more prevalent in cases than in controls, with an odds ratio of 1.82 (1.04-3.18). The CC genotype of rs1784418 was significantly more common in children without caries, with an odds ratio of 1.79 (1.06-3.01). AA, AG genotypes of rs12640848, and the CT genotype of rs1784418 were more prevalent in children with caries. Polymorphism rs1376729959 did not reveal an association with ECC.
Childhood obesity is a growing global health problem with significant biomechanical and psychosocial consequences. While many studies have examined these domains separately, few integrate postural abnormalities, psychophysical functioning, and lifestyle factors within a single framework. This narrative review synthesises the literature published between 2005 and 2025 to summarise current evidence and identify research gaps. The findings indicate that overweight and obesity increase the risk of musculoskeletal deviations such as genu valgum, flat feet, and increased lumbar lordosis, as well as altered gait biomechanics and reduced motor competence. Excess body weight is also associated with lower self-esteem, negative body image, depressive symptoms, and reduced health-related quality of life in children and adolescents. These outcomes appear to be influenced by modifiable lifestyle factors, including parental health behaviours, sleep patterns, and screen time, although reported associations remain inconsistent. Notably, few studies address biomechanical, psychological, and environmental factors simultaneously, which limits the understanding of their interactions. To address this gap, a prospective observational study of 250-300 children aged 7-17 years is proposed. The study will combine objective postural assessments, validated psychometric tools, and lifestyle analyses at baseline and after a 12-14-month follow-up. This integrated approach aims to identify postural compensation patterns, psychosocial risk trajectories, and modifiable behavioural predictors associated with childhood obesity, supporting the development of early preventive and interdisciplinary interventions.
Early childhood caries (ECC) is a prevalent, multifactorial disease influenced by microbial factors and host immune factors. Saliva serves as a noninvasive diagnostic medium with the potential to detect immune biomarkers such as human leukocyte antigen-DR (HLA-DR), a key class II molecule of the major histocompatibility complex involved in antigen presentation and the activation of adaptive immune responses. To evaluate and compare salivary HLA-DR levels in preschool children with and without ECC and assess the relationship between HLA-DR levels and deft scores. This cross-sectional study was conducted among preschool children aged 3-6 years attending school dental screening camps. Forty children aged 3-6 years were included and divided into ECC ( n = 20) and caries-free ( n = 20) groups. Caries status was assessed using World Health Organization criteria and the Deft Index. Unstimulated saliva samples were collected and analyzed for HLA-DR concentrations using a commercially available sandwich enzyme-linked immunosorbent assay. Intergroup comparisons were performed using the Mann-Whitney U -test, and associations were evaluated using Spearman's correlation. Children with ECC showed significantly higher salivary HLA-DR levels (median 10.31 pg/mL, interquartile range [IQR]: 7.65-17.98) than caries-free controls (median 6.28 pg/mL, IQR: 3.14-9.32) ( P = 0.023). A weak positive but nonsignificant correlation was found between HLA-DR levels and deft scores (ρ =0.236, P = 0.317). Elevated salivary HLA-DR levels in ECC suggest enhanced local immune activation and may serve as a noninvasive biomarker for ECC presence, although not a direct indicator of lesion severity.
ObjectiveTo map the evidence on the exposure to screens as a determining risk factor for impaired child development up to the age of 6.IntroductionScreens of all kinds fill family life and shape many children's routines from ever younger ages. Exposure to screens has potential negative effects, and it is important to map that evidence to update the nursing diagnosis.Inclusion CriteriaScoping review based on JBI framework (2024). The Population was children aged 6 or younger; the Concept was the negative effects of screen exposure; and the Context was any type of screen exposure across all environments where children live. Included all full-text primary, secondary, and grey literature in English, Portuguese, or Spanish from the past decade.MethodsA search was carried out in March 2025 across five databases, yielding 309 articles, with the main results reported in Web of Science, CINAHL, and PubMed. After selection by two independent reviewers, data were extracted from 26 articles.ResultsAll 26 articles were in English and drawn from diverse countries and contexts, with most using cross-sectional or longitudinal observational designs. They reported various developmental issues, organized into five categories: cognitive and language development; motor skills, physical activity and well-being; sleep patterns; socio-emotional skills; and behavioral development.ConclusionsExcessive screen time is linked to deficits in cognition, language, sleep, behavior, and socio-emotional development. Research gaps were identified, including the scarcity of longitudinal studies and limited insight into parental mediation and content type. These results emphasize the need for strategies promoting mindful technology use in early childhood.
Early identification of developmental delay and autism in young children improves outcomes, but screening rates in young children are low, particularly for some patient groups. To examine patient- and system-level characteristics associated with screening return rates and timelines and evaluate the association of an electronic health record (EHR)-based dashboard with these outcomes. This retrospective cohort study using EHR data from a large integrated health care system analyzed screening questionnaire return rates and time to return among children aged 6 to 66 months referred to a secondary screening program. A cross-sectional analysis (September 1, 2022, to September 1, 2023) used adjusted modified Poisson regression and restricted mean survival time (RMST). Changes in return rates, as well as time to return and time to case completion, were assessed before (November 2, 2022, to March 31, 2023) and after (November 2, 2023, to March 31, 2024) implementation of an EHR-embedded monitoring dashboard. Data were analyzed from December 5, 2023, to February 20, 2026. Patient and organizational characteristics based on EHR data and indicators for dashboard implementation. Return rates of screening questionnaires, time to return questionnaires in days, and time to case completion in days (review questionnaire, recommendations to families, and place relevant referrals). A total of 17 303 screening referral orders (11 351 [65.6%] among males; mean [SD] age, 27.73 [12.79] months; 15 853 [91.6%] aged 16-66 months) for 16 038 unique patients were included in this study. Questionnaires were returned for 7500 referrals (43.3%). Lower return rates were associated with older age (adjusted relative risk [ARR], 0.71 [95% CI, 0.68-0.75]), non-English language preference (ARR range, 0.65 [95% CI, 0.47-0.89] to 0.73 [95% CI, 0.65-0.83]), Black race (ARR, 0.79 [95% CI, 0.72-0.86]) or Hispanic ethnicity (ARR, 0.85 [95% CI, 0.81-0.89]), highest neighborhood deprivation quintile (ARR, 0.92 [95% CI, 0.86-0.98]), and Medicaid insurance (ARR, 0.85 [95% CI, 0.81-0.89]). Online portal account access was linked to higher return rates (ARR, 1.99 [95% CI, 1.75-2.26]) and faster return times (adjusted RMST difference, -6.42 days [95% CI, -7.26 to -5.59 days]). Older age was associated with longer return times (adjusted RMST difference, 6.82 days [95% CI, 5.90-7.75 days]). After dashboard implementation, return rates increased from 41.2% (2823 of 6854) to 54.7% (3883 of 7097) (ARR, 1.34 [95% CI, 1.29-1.38]), while decreases were observed for time to return (adjusted RMST difference, -6.62 days [95% CI, -7.18 to -6.07 days]) and completion (adjusted RMST difference, -37.07 days [95% CI, -38.47 to -35.67] days). The findings of this cohort study suggest that completion of recommended developmental screening can be challenging for certain patient populations. EHR-based tools may be useful to improve return rates and reduce return and case completion times.
Optimal management of first-time traumatic patellar dislocation (FTPD) in pediatric patients remains disputed. Nonoperative treatment avoids surgical risks and may be optimal for select patients, whereas operative medial patellofemoral ligament (MPFL) repair aims to prevent recurrent instability and reduce redislocation in the short term. To compare the redislocation rate, subsequent surgical intervention, and subjective knee function between pediatric patients initially treated with a knee brace (KB) and those who underwent operative MPFL repair. Cohort study; Level of evidence, 2. This 10-year follow-up study of 74 participants from a previously conducted randomized controlled trial included 46 patients (62%) available for reassessment (KB, n = 25; MPFL repair, n = 21). The primary outcomes, redislocation and subsequent knee surgery, were collected from questionnaires and medical records. Subjective knee function was measured using the Knee injury and Osteoarthritis Outcome Score for children (KOOS-Child), Kujala Anterior Knee Pain Scale, and Tegner Activity Score. Key anatomic risk factors were taken from magnetic resonance imaging scans at baseline. Group comparisons were performed at 10-year follow-up. The KB group demonstrated a higher overall redislocation rate (80%) compared with the MPFL repair group (62%), although the difference was not statistically significant (P = .175). Early redislocations (≤2 years) were more frequent in the KB group (52% vs 29%; P = .108), whereas rates for late (>2 years) redislocations (28% vs 33%) were similar. Among patients with redislocation, 45% (KB) and 54% (MPFL repair) underwent subsequent knee surgery. Surgery occurred earlier in the KB group (a mean of 25 vs 62 months). Long-term functional scores were similar between groups. However, patients who sustained any redislocation reported significantly lower KOOS-Pain, KOOS-Quality of Life, and Kujala scores than those who remained stable. Anatomic patellar instability factors were common in both groups. The long-term redislocation rate in FTPD for patients with MPFL repair was nearly as high as for patients treated nonoperatively. Subjective knee function was comparable between the 2 treatments. Given the high rate of recurring instability in children, the authors do not support routine MPFL repair for FTPD, nor do they support nonoperative treatment as the gold standard for every child. However, when nonoperative treatment is used, a structured follow-up should be mandatory.
While pediatric liver transplantation has markedly improved long-term survival, adult outcomes remain insufficiently explored beyond graft function, particularly regarding mental health and disease understanding-key dimensions of meaningful survival. To this aim, we evaluated psychosocial, behavioral, and lifestyle outcomes of adults who received a liver transplant during childhood, using validated tools. Fifty adult patients transplanted before 18 years of age at Cliniques Universitaires Saint-Luc completed an anonymous online questionnaire including measures of anxiety (STAI-Trait), depression (BDI-SF), and alcohol use (AUDIT), as well as questions on lifestyle, treatment adherence, and disease knowledge. The results showed that clinically relevant anxiety and depressive symptoms were reported in 49% and 33% of respondents, respectively. Problematic alcohol use was found in 8% of participants, and 24% reported never receiving medical counseling about alcohol risks. Only 31% could correctly explain the pathophysiology of their liver disease, and 36% were unaware of its transmissible genetic nature. Despite these challenges, 76% were professionally or academically active. These findings highlight the persistence of high psychological distress and limited disease understanding into adulthood, supporting the integration of mental health screening and patient education into long-term post-transplant care.
Background and Objectives: Childhood obesity is associated with alterations in body composition that may impair muscular strength and functional capacity. While higher body mass is often accompanied by greater absolute strength, the independent effect of adiposity on muscle strength after accounting for lean mass remains insufficiently understood. This study aimed to evaluate the associations between adiposity and muscle strength in children and adolescents, while accounting for growth and maturation, and to examine differences according to weight status. Materials and Methods: This retrospective cross-sectional study included 84 children and adolescents aged 5-18 years. Anthropometric measurements were used to calculate body mass index (BMI), waist-to-hip ratio, and waist-to-height ratio, with weight status classified according to CDC BMI-for-age percentiles. Body composition was assessed using bioelectrical impedance analysis (Tanita). Pubertal stage was evaluated using Tanner classification. Muscle strength was assessed using dominant handgrip strength. Associations between adiposity-related parameters and muscle strength were analyzed using correlation and multivariable linear regression models adjusted for age, sex, pubertal stage, physical activity, and body composition. Results: Body mass index was positively correlated with absolute handgrip strength (r = 0.561, p < 0.001). Body fat percentage was negatively associated with relative handgrip strength (r = -0.381, p < 0.001). In multivariable regression analyses, body fat percentage remained an independent negative predictor of handgrip strength (β = -0.203, p = 0.0046), whereas fat-free mass and fat-free mass index were positive predictors in respective models (p < 0.001). Conclusions: Increased adiposity is associated with reduced muscle strength in children and adolescents when strength is evaluated relative to body size or adjusted for lean mass. These findings support the concept of impaired muscle performance in pediatric populations with excess adiposity and highlight the importance of integrating body composition and functional assessments in clinical evaluation.
Post-appendectomy intra-abdominal abscess (PAA) is a common and problematic complication in children with perforated appendicitis, contributing to prolonged hospitalization, readmissions, and increased healthcare costs. Despite advances in surgical and antimicrobial management, substantial heterogeneity persists in definitions, risk stratification, and treatment strategies. This narrative review aims to synthesize current evidence regarding the pathophysiology, risk factors, diagnostic pathways, clinical impact, and therapeutic approaches to PAA in the pediatric population. PAA occurs predominantly after perforated appendicitis and reflects persistent contamination and fibrin-driven loculation within the peritoneal cavity. Established predictors include fecalith presence, higher perforation severity, and elevated inflammatory markers. Diagnosis is typically established during the second postoperative week using ultrasound as first-line imaging. Management strategies vary widely, ranging from antibiotics alone to percutaneous or surgical drainage. PAA significantly increases length of stay, need for invasive procedures, and healthcare expenditure. In conclusion, PAA remains a clinically significant complication in pediatric perforated appendicitis. Standardized definitions, validated predictive tools, and high-quality trials are urgently needed to harmonize management, optimize outcomes, and reduce variability in care.
The prevalence of children affected by life-limiting or life-threatening conditions has consistently increased over the last decade. Communicating to parents that their baby is affected by such conditions is always difficult. The aim of this study was to investigate the management of these infants among healthcare providers (HCPs) in Italy. This is a descriptive study involving HCPs working in neonatal departments. Participants were asked to. complete a questionnaire specifically created. 180 HCPs responded to the questionnaire. Overall, 62% of professionals believe they are not adequately trained in communicating with parents, and 53% believe their ethical and spiritual values ​​influence their work. Significant differences were found in the availability and involvement of pediatric palliative care services during the perinatal period across Northern, Central, and Southern Italy. This study highlighted the need to invest in training professionals, palliative care, and integrated care networks to ensure equitable and respectful care. • The prevalence of children affected by life-limiting or life-threatening conditions has consistently increased over the last decade. • Communication is a key aspect of care while dealing with parents in the perinatal setting. • A great number of physicians and nurses do not feel prepared enough in managing communication with parentsof newborns affected by life-limiting or life-threatening conditions. • Perinatal management and the availability of perinatal palliative care services and ethical consults are extremelyheterogeneous across Italy, with Northern regions offering greater care opportunities.
Background and Objectives: Sleep-related breathing disorders (SRBDs) are common but often underdiagnosed in children. Early identification is essential, as untreated pediatric SRBDs can lead to cognitive, metabolic, and cardiovascular complications. This study aimed to estimate the prevalence of children at risk for SRBDs, defined as those screening positive based on Pediatric Sleep Questionnaire (PSQ) scores, and to analyze the association with potential risk factors in the general pediatric population of Lithuania. Materials and Methods: This cross-sectional study included 1929 children aged 2-17 years. Parents completed a questionnaire covering demographics, health status, and the PSQ. A validated Lithuanian version of the PSQ was used, with ≥8 (40%) positive responses indicating suspected SRBDs. Results: Overall, 14.9% of children were suspected of having SRBDs, with the highest prevalence among those aged 7-11 years (17.5%), followed by 2-6 years (14.9%) and ≥12 years (12.6%) (p = 0.032). In preschoolers (2-6 years), the strongest predictors were attention deficit hyperactivity disorder (ADHD; p < 0.001, OR 4.456, 95% CI 1.992-9.968) and allergic rhinitis (p < 0.001, OR 2.268, 95% CI 1.433-3.591). In children aged 7-11 years, endocrine diseases showed the strongest association (p < 0.001, OR 13.366, 95% CI 2.914-61.313), followed by ADHD (p = 0.001, OR 5.693, 95% CI 1.981-16.363) and adenotonsillar hypertrophy (p < 0.001, OR 3.079, 95% CI 1.839-5.156). In adolescents (≥12 years), SRBDs were primarily associated with ADHD (p < 0.001, OR 17.513, 95% CI 9.597-31.961) and endocrine diseases (p < 0.001, OR 6.214, 95% CI 2.965-13.020), while obesity remained significant (p < 0.001, OR 3.400, 95% CI 2.106-5.489). Conclusions: Approximately 15% of Lithuanian children were at risk for SRBDs. Risk factors differed by age: adenotonsillar hypertrophy in school-aged children, allergic rhinitis in preschoolers, and obesity in adolescents, whereas ADHD was associated across age groups.
Gastroesophageal reflux disease (GERD) is a common condition in children requiring surgical intervention when medical therapy fails. Nissen (total) and Toupet (partial) fundoplications are the most frequently performed antireflux procedures; however, their comparative effectiveness and safety in the pediatric population remain uncertain. A systematic literature search was conducted in PubMed, Embase, and Cochrane CENTRAL from database inception to 2025. Eligible studies included randomized controlled trials and observational studies comparing total and partial fundoplication in patients younger than 18 years with GERD. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using random-effects models in R software. Eighteen studies including 2,633 children were analyzed. Total fundoplication was associated with a significantly higher risk of postoperative dysphagia compared with partial fundoplication (RR 1.69; 95% CI 1.07-2.68; p = 0.024; I²=12%; n = 1,154), corresponding to an absolute risk increase of 5.7% and a number needed to harm (NNH) of 17. No significant difference was observed in reflux recurrence (RR 0.72; 95% CI 0.21-2.42; p = 0.59; I²=71% n = 834), although event rates were numerically lower after total fundoplication (6.8% vs. 13.7%), corresponding to an absolute risk reduction of 6.9% (NNT = 15). Intraoperative complications (RR 1.11; p = 0.84), postoperative complications (RR 1.49; p = 0.12), reoperation rates (RR 0.95; p = 0.88), and mortality (RR 1.09; p = 0.74) were comparable between procedures. Total and partial fundoplication demonstrate similar effectiveness for reflux control and overall safety in pediatric GERD. However, total fundoplication is associated with a higher risk of postoperative dysphagia, suggesting that partial fundoplication may offer functional advantages in selected patients.
Early childhood caries (ECC) remains a major public health concern in India, with feeding-at-sleep behaviors recognized as important behavioral risk factors. The feeding at sleep time (FeAST) scale was developed to quantify such behaviors, but its applicability across diverse Indian sociocultural settings remains uncertain. To evaluate the external validity of the FeAST scale in identifying ECC risk among 12-36-month-old toddlers in Bhubaneswar, Odisha, and to examine the association between socioeconomic status and ECC. A hospital-based cross-sectional study conducted in a tertiary care teaching hospital in Bhubaneswar, Eastern India. A total of 387 toddlers aged 12-36 months and their caregivers were recruited. Feeding behaviors were assessed using the original FeAST questionnaire, generating scores for combined breastfeeding (CBR), combined bottle-feeding (CBO), and other feeding constructs (OFC). ECC status was determined through oral examination. SES was classified using the updated B. G. Prasad Scale (2025). Receiver operating characteristic analysis with a minimal cutoff score was used to determine diagnostic accuracy. Chi-square test assessed associations between ECC and SES. Statistical significance was set at P < 0.05. ECC prevalence was 32.9%. CBR (AUC = 0.446) and CBO (AUC = 0.481) demonstrated poor discriminatory ability, while OFC showed modest performance (AUC = 0.577). No significant association was found between ECC and SES ( P = 0.511). The FeAST scale demonstrated limited diagnostic validity in this Eastern Indian cohort, indicating the need for regional recalibration incorporating contextual feeding and oral hygiene behaviors.