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Children, Volume 10, Issue 11 (November 2023) – 110 articles

Cover Story (view full-size image): The brain is viewed as an immunologically privileged site and there are multiple resident immune cells that influence the CNS environment and are reactive to extra-CNS signaling. Microglia are an important component of this system, which influences early neurodevelopment in addition to modulating inflammation and regenerative responses to injury and infection. Microglia are influenced by gut microbiome-derived metabolites, both as part of their normal function and potentially in pathological patterns that may induce neurodevelopmental disabilities or behavioral changes. The mounting evidence indicates that not only is the gut–brain axis mediated by metabolites and microglia throughout an organism’s lifetime, but it is also influenced prenatally by the maternal microbiome and diet, which holds implications for both early neuropathology and neurodevelopment. View this paper
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12 pages, 2585 KiB  
Article
Use of the Subcutaneous Triptorelin Stimulation Test for Diagnosis of Central Precocious Puberty
Children 2023, 10(11), 1830; https://doi.org/10.3390/children10111830 - 20 Nov 2023
Viewed by 803
Abstract
Background: The gold standard gonadotropin-releasing hormone (GnRH) stimulation test uses the response to intravenously injected gonadorelin to diagnose central precocious puberty (CPP). However, gonadorelin is not always readily available. Objective: This study investigated the diagnostic efficacy of the subcutaneous triptorelin test and the [...] Read more.
Background: The gold standard gonadotropin-releasing hormone (GnRH) stimulation test uses the response to intravenously injected gonadorelin to diagnose central precocious puberty (CPP). However, gonadorelin is not always readily available. Objective: This study investigated the diagnostic efficacy of the subcutaneous triptorelin test and the optimal blood sampling time for diagnosis of CPP. Methods: This study retrospectively examined the medical records of 220 girls who had undergone either the triptorelin or gonadorelin test and compared their clinical characteristics. We retrospectively compared clinical parameters between girls diagnosed with CPP (n = 111) and idiopathic premature thelarche (IPT) (n = 109) using three different diagnostic methods: the gonadorelin, triptorelin 120 min, and triptorelin 180 min tests. The diagnostic ability of the stimulated luteinizing hormone (LH) concentration in the triptorelin test for CPP was evaluated using receiver operating characteristic (ROC) analysis. Results: The CPP group exhibited higher basal and peak gonadotropin levels, more advanced bone age, and a lower body mass index standard deviation score than the IPT group. In the gonadorelin test group, all girls with CPP exhibited a peak LH response 30–60 min after intravenous gonadorelin injection. In the triptorelin test group, most girls with CPP exhibited a peak LH response 60–180 min after subcutaneous triptorelin injection (n = 68). On the ROC curve, a peak LH concentration of ≥ 4.52 IU/L at 120 min had the highest CPP diagnostic accuracy, with sensitivity and specificity of 100% and 95.83%, respectively. Full article
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13 pages, 454 KiB  
Article
Prevalence and Determinants of Diarrhea, Fever, and Coexistence of Diarrhea and Fever in Children Under-Five in Bangladesh
Children 2023, 10(11), 1829; https://doi.org/10.3390/children10111829 - 20 Nov 2023
Viewed by 939
Abstract
Diarrhea and fever are prevalent childhood illnesses with potentially severe consequences, especially when they co-occur. This study investigates the prevalence and determinants of diarrhea, fever, and their coexistence among children under-five in Bangladesh. Data from the 2017–2018 Bangladesh Demography and Health Survey (BDHS) [...] Read more.
Diarrhea and fever are prevalent childhood illnesses with potentially severe consequences, especially when they co-occur. This study investigates the prevalence and determinants of diarrhea, fever, and their coexistence among children under-five in Bangladesh. Data from the 2017–2018 Bangladesh Demography and Health Survey (BDHS) were analyzed using multivariable stepwise logistic regression with backward selection. This study found that 5.0% for diarrhea, 34.0% for fever, and 3.0% for the coexistence of both illnesses. Common factors associated with childhood diarrhea and fever included the child’s age (12–23 months), and the mother’s education. Diarrhea was associated with households with improved water sources and children in the Barisal division, while fever was linked to underweight children and those from more affluent backgrounds. The coexistence of both was significantly linked to underweight children, higher birth orders, and children from the Rajshahi division. Notably, child illnesses were associated with parental education, higher socio-economic status, and access to improved drinking water sources. Diarrhea affects one in 20 children, fever affects one in three, and the coexistence of both conditions affects one in 35 children in Bangladesh. The findings need further research and policy reviews to develop effective interventions and improve child health in Bangladesh. Full article
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14 pages, 973 KiB  
Review
A Scoping Review of Studies on Assistive Technology Interventions and Their Impact on Individuals with Autism Spectrum Disorder in Arab Countries
Children 2023, 10(11), 1828; https://doi.org/10.3390/children10111828 - 20 Nov 2023
Viewed by 871
Abstract
The rising prevalence of autism spectrum disorder (ASD) in Arab countries necessitates evidence-based interventions. Assistive technology (AT) presents a promising approach. However, data on the pervasiveness of AT use and its effectiveness for individuals with ASD, specifically within Arab countries, remain scarce. Objective: [...] Read more.
The rising prevalence of autism spectrum disorder (ASD) in Arab countries necessitates evidence-based interventions. Assistive technology (AT) presents a promising approach. However, data on the pervasiveness of AT use and its effectiveness for individuals with ASD, specifically within Arab countries, remain scarce. Objective: To review the current literature on the AT interventions and outcomes reported for individuals with ASD in Arab countries. Methods: A scoping review adhering to PRISMA guidelines was undertaken to explore the utilization of AT, segmented into three categories: low-technology (low-tech), mid-technology (mid-tech), and high-technology (high-tech) devices. Results: Twelve studies had a pooled sample of 1547 participants, primarily male school-aged children with ASD. The AT applications evaluated ranged from low-tech visual schedules and support to high-tech virtual reality systems. Studies have reported the potential benefits of AT in improving communication, social, academic, adaptive, and functional abilities; however, comparative evidence between AT interventions is limited. The identified barriers to the adoption of AT included caregiver uncertainty about the use of AT and a lack of awareness of AT among professionals and the Arab community in general. Conclusion: Available studies suggest that the adoption of AT can enhance the skills of individuals with ASD in Arab countries. However, more rigorous studies across diverse demographic groups and Arab national regions are needed to strengthen the evidence base and provide appropriate recommendations. Full article
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12 pages, 515 KiB  
Hypothesis
Asymptomatic Infant Rib Fractures Are Primarily Non-abuse-Related and Should Not Be Used to Assess Physical Child Abuse
Children 2023, 10(11), 1827; https://doi.org/10.3390/children10111827 - 20 Nov 2023
Viewed by 1823
Abstract
Finding infant rib fractures was for many years an almost undisputed proof that physical child abuse took place. Yet, these rib fractures are virtually always occult and asymptomatic and are only identified when looked for, usually with X-rays, from physical child abuse accusations [...] Read more.
Finding infant rib fractures was for many years an almost undisputed proof that physical child abuse took place. Yet, these rib fractures are virtually always occult and asymptomatic and are only identified when looked for, usually with X-rays, from physical child abuse accusations related to, e.g., suspicion of the shaken baby syndrome. In a recent systematic literature review (searched in Cochran, Embase, PubMed and Sociological Abstracts), Güvensel questioned the diagnostic accuracy of rib fractures to be caused by abuse, due to lack of sufficient scientific evidence. Further, there is currently a world-wide disagreement between physicians considering themselves child abuse specialized, and physicians that explore non-abuse-related symptoms that may mimic physical abuse, which, it is hoped, will significantly reduce current unjustified child abuse diagnoses. In an attempt to help resolving this disagreement, we hypothesize that the probability of physical child abuse-related infant rib fractures is significantly lower than the probability of all other possible non-abuse-related causes of occult asymptomatic infant rib fractures, e.g., from birth trauma, prematurity, osteogenesis imperfecta, hypermobile Ehlers-Danlos Syndrome, severe chronic placental pathology (e.g., massive perivillous fibrin depositions and severe chronic histiocytic intervillositis), and vitamin-D deficiency. As method, we attempted to assess the incidence of these various causes of infant rib fractures, in the Netherlands and the USA. The results are that the estimated Dutch and USA physical abuse-related infant rib fracture incidences are at least about 250 and 45 times lower than the sum of all the non-abuse-related estimates. Because these latter rib fractures are occult and asymptomatic, it is likely that (many) more could be out there. In conclusion, occult asymptomatic rib fractures develop perinatally, virtually always as birth trauma, in infants with sufficiently weak bones due to vitamin D deficiency, transmitted by their vitamin D deficient pregnant mothers. This group also includes cortical rib cracks due to deformation forces, with an estimated 186/100,000 incidence. And, despite obvious uncertainties in all estimated incidences, we provided strong evidence that our hypothesis has relevance, implying that the abundant occult asymptomatic rib fractures, when found in infants, should not be used to assess potential physical child abuse. Full article
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18 pages, 360 KiB  
Article
The Effectiveness of an Intervention Programme for Reducing Peer Rejection in Early Childhood Education
Children 2023, 10(11), 1826; https://doi.org/10.3390/children10111826 - 19 Nov 2023
Viewed by 1012
Abstract
In the early years of schooling, peer groups are key to fostering students’ overall learning and development. Yet it has been found that around 10% of children suffer from peer rejection in the classroom, with this problem entailing negative consequences both in the [...] Read more.
In the early years of schooling, peer groups are key to fostering students’ overall learning and development. Yet it has been found that around 10% of children suffer from peer rejection in the classroom, with this problem entailing negative consequences both in the short and long term. The problem proves difficult for adults to detect, which usually leads to a delay in measures being taken to intervene and prevent it. This study applies an experimental design with pre-test and post-test measurements in two groups—experimental and control—in order to address the problem of rejection in the early years of schooling. It explores aspects such as sociometric type, degree of victimisation, social and antisocial behaviour, as well as problematic situations among 637 students at six schools. We then implement an intervention programme for socioemotional competence throughout a school year in an effort to improve students’ social skills and relationships, focusing specifically on preventing and reducing the rejection experienced by some of these children. The programme comprises 35 teaching activities and strategies that promote the development of competences for student inclusion (curbing aggression, encouraging teamwork, fostering self-esteem, etc.) and that seek to involve all students, teachers, and relatives by offering an array of complementary resources that enrich the initiatives applied (a programme calendar, assessment notebook, questionnaires, related website, material resources). After the intervention programme, it was found that the experimental group had reduced the percentage of students who suffered rejection from 9.9% to 7.3%, although the same was not true of the control group, which went from 9.5% of rejected students to 10.2%. The reduction in the percentage of rejected students in the experimental group after the application of the programme is an encouraging result that invites us to continue working on more comprehensive interventions to prevent and reduce this phenomenon. Full article
(This article belongs to the Special Issue Research on Socio-Emotional Development from Childhood to Adulthood)
15 pages, 973 KiB  
Article
Impact of Innovative Emotion Training in Preschool and Kindergarten Children Aged from 3 to 6 Years
Children 2023, 10(11), 1825; https://doi.org/10.3390/children10111825 - 17 Nov 2023
Cited by 1 | Viewed by 1340
Abstract
Children’s emotional abilities have been shown to be related to academic performance, peer acceptance, and in-school adjustment. The main objective of this study was to evaluate the effect of innovative emotion training designed to promote the emotional abilities of 316 preschool/kindergarten children aged [...] Read more.
Children’s emotional abilities have been shown to be related to academic performance, peer acceptance, and in-school adjustment. The main objective of this study was to evaluate the effect of innovative emotion training designed to promote the emotional abilities of 316 preschool/kindergarten children aged from 3 to 6 years old enrolled in public schools in the first three levels (L1, L2, and L3). Another objective was to examine the transfer effects on language comprehension and mathematics abilities. The emotion training (eight sessions) focused on the identification, comprehension, and expression of emotions and were co-constructed with teachers. Children were tested before and after the training on emotion, language, and mathematics skills. Results showed an improvement in emotional abilities in young children of L1 (3–4 years) and L2 (4–5 years) in the intervention group compared to those in the non-intervention group. Also, although children’s emotion basic abilities were correlated with their language comprehension and mathematics abilities, the nature of this link was not demonstrated to be causal. Findings are discussed in regard to the influence of the level and in regard to links with academic variables. Full article
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9 pages, 1094 KiB  
Article
Assessment of Oral Health in a Child Cohort of a Rural Zone of Ethiopia
Children 2023, 10(11), 1824; https://doi.org/10.3390/children10111824 - 17 Nov 2023
Viewed by 591
Abstract
Health conditions in a developing state such as Ethiopia are precarious; in addition to the extreme spread of infectious diseases such as AIDS, oral health is also affected by the scarce knowledge and possibility of treatment. This analysis considered 77 children aged 7 [...] Read more.
Health conditions in a developing state such as Ethiopia are precarious; in addition to the extreme spread of infectious diseases such as AIDS, oral health is also affected by the scarce knowledge and possibility of treatment. This analysis considered 77 children aged 7 to 11 from a primary school in Guraghe in Ethiopia. The presence of plaque, calculus, and caries was evaluated. For each caries, the affected tooth and the site of onset were considered. Plaque was detected in 39% of the children, calculus in 22%, and dental caries in 48% of the patients. The cavities were found to be equally distributed between the two arches, with a prevalence of location in the deciduous teeth and in the occlusal area. The implementation of home oral hygiene education and the training of health professionals who successfully promote oral health is necessary. Full article
(This article belongs to the Special Issue New Frontiers in Early Childhood Oral Health Care)
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10 pages, 1298 KiB  
Article
An Entangled Relationship between Bullying Perception and Psychosocial Dimensions in a Sample of Young Adolescents
Children 2023, 10(11), 1823; https://doi.org/10.3390/children10111823 - 17 Nov 2023
Viewed by 752
Abstract
Background: Bullying is a hostile behavior repeated over a time period, affecting children and adolescents in different social settings, mainly small and stable ones like school, with negative effects on mental and physical health. In this study, we aimed to provide the degree [...] Read more.
Background: Bullying is a hostile behavior repeated over a time period, affecting children and adolescents in different social settings, mainly small and stable ones like school, with negative effects on mental and physical health. In this study, we aimed to provide the degree of impairment of different variables related to health and well-being in bullying conditions, with attention to sex differences. Methods: Data were obtained from 5390 adolescents (mean age 13.08 ± 1.89; male 2729), and health-related quality of life (HRQoL) was assessed using the KIDSCREEN-52 questionnaire. Results: In all students, mood and emotion, self-perception, and parental relationships are the dimensions more compromised in bullying conditions, while lifestyle habit is the variable less involved. Bullied girls show a significant impairment of all HRQoL variables both with respect to the socially accepted counterpart and to the male population. Conclusions: Our study highlights the strict association between bullying and emotional and social dimensions, suggesting that enhancing them preventively could facilitate earlier detection of problems, thereby reducing health risks. Full article
(This article belongs to the Special Issue School Bullying during Childhood and Adolescence)
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11 pages, 534 KiB  
Article
Comprehensive Analysis of Risk Factors for Bronchopulmonary Dysplasia in Preterm Infants in Taiwan: A Four-Year Study
Children 2023, 10(11), 1822; https://doi.org/10.3390/children10111822 - 17 Nov 2023
Viewed by 736
Abstract
Bronchopulmonary dysplasia (BPD) is a major respiratory condition mainly affecting premature infants. Although its occurrence is global, risk factors may differ regionally. This study, involving 3111 infants with birth weight ≤ 1500 gm or gestational age (GA) < 30 weeks, aimed to identify [...] Read more.
Bronchopulmonary dysplasia (BPD) is a major respiratory condition mainly affecting premature infants. Although its occurrence is global, risk factors may differ regionally. This study, involving 3111 infants with birth weight ≤ 1500 gm or gestational age (GA) < 30 weeks, aimed to identify risk factors for BPD and BPD/mortality in Taiwan using data from the Taiwan Neonatal Network. The BPD criteria were based on the National Institute of Child Health and Human Development standards. Average GA was 27.5 weeks, with 23.7% classified as small for GA (SGA). Multivariate analysis highlighted low GA, low birth weight, and other perinatal factors as significant risk indicators for BPD. For moderate-to-severe BPD, additional risk factors included male gender and SGA, endotracheal intubation (ETT) or cardiopulmonary cerebral resuscitation (CPCR) in initial resuscitation. In the moderate-to-severe BPD/death group, SGA and ETT or CPCR in initial resuscitation remained the only additional risk factors. The study pinpoints male gender, SGA and ETT or CPCR as key risk factors for moderate-to-severe BPD/death in low-birth-weight infants in Taiwan, offering a basis for focused interventions and further research. Full article
(This article belongs to the Special Issue Advances in NICU Health Care)
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16 pages, 7451 KiB  
Review
Elastodontic Appliances for the Interception of Malocclusion in Children: A Systematic Narrative Hybrid Review
Children 2023, 10(11), 1821; https://doi.org/10.3390/children10111821 - 17 Nov 2023
Cited by 1 | Viewed by 879
Abstract
Background. Interceptive orthodontic treatment aims to eliminate factors that prevent the harmonious development of the maxillary and mandibular arches during childhood, and elastodontic appliances (EAs) represent a group of devices with an increasingly important role. This systematic narrative hybrid review (HR) aims to [...] Read more.
Background. Interceptive orthodontic treatment aims to eliminate factors that prevent the harmonious development of the maxillary and mandibular arches during childhood, and elastodontic appliances (EAs) represent a group of devices with an increasingly important role. This systematic narrative hybrid review (HR) aims to provide an overview of the clinical indications for the use of EAs according to the available evidence and to identify potential research areas for unexplored applications. Materials and methods. To assess the available literature on the subject, selective database searches were performed between July 2023 and September 2023. With the assistance of a health sciences librarian, a search strategy that utilized terms related to elastodontic therapy was developed. Embase, Scopus, PubMed, and Web of Science were the databases used. Results. The current literature addressing the usability of EAs is scarce and mostly limited to case reports and case series. After 2168 citations were found through the searches, 13 studies were ultimately included. In this regard, information about the clinical use and effectiveness of EAs are reported in a narrative form, defining specific domains of the application that are clinically oriented, including sagittal and transversal discrepancies, atypical swallowing, teeth malposition, two-phase orthodontics and a lack of teeth retention. Conclusions. Within the intrinsic quality limitation of the available literature, it seems that EAs may represent a promising treatment alternative for managing mild-to-moderate malocclusion in children as an adjuvant therapy to the interruption of spoiled habits. Full article
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3 pages, 173 KiB  
Editorial
Behavioral and Mental Health Problems in Children
Children 2023, 10(11), 1820; https://doi.org/10.3390/children10111820 - 17 Nov 2023
Viewed by 707
Abstract
The stimulus, stress, and behavioral and mental response (SSB) model proposes that various stimuli induce stress and behavioral responses, which may, in turn, lead to health problems [...] Full article
(This article belongs to the Special Issue Behavioral and Mental Health Problems in Children)
11 pages, 452 KiB  
Article
Early-Term Neonates Demonstrate a Higher Likelihood of Requiring Phototherapy Compared to Those Born Full-Term
Children 2023, 10(11), 1819; https://doi.org/10.3390/children10111819 - 16 Nov 2023
Viewed by 679
Abstract
Early-term neonates (with a gestational age (GA) of 37 and 0/7 weeks to 38 and 6/7 weeks) face higher morbidities, including respiratory and neurodevelopmental issues, than full-term (39 and 0/7 weeks to 40 and 6/7 weeks) infants. This study explores whether hyperbilirubinemia necessitating [...] Read more.
Early-term neonates (with a gestational age (GA) of 37 and 0/7 weeks to 38 and 6/7 weeks) face higher morbidities, including respiratory and neurodevelopmental issues, than full-term (39 and 0/7 weeks to 40 and 6/7 weeks) infants. This study explores whether hyperbilirubinemia necessitating phototherapy also differs between these groups. A retrospective study was conducted on neonates born from January 2021–June 2022, excluding those with specific conditions. Evaluated factors included GA, birth weight, bilirubin levels, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and feeding type, with phototherapy given as per AAP guidelines. Of 1085 neonates, 356 met the criteria. When stratifying the neonates based on the need for phototherapy, a higher proportion of early-term neonates required phototherapy compared to full-term (p < 0.05). After factoring in various risks (GA; birth weight; gender; feeding type; G6PD deficiency; transcutaneous bilirubin levels at 24 h and 24–48 h postpartum; maternal diabetes; and the presence of caput succedaneum or cephalohematoma), early-term neonates were more likely to need phototherapy than full-term babies (OR: 2.15, 95% CI: 1.21 to 3.80). The optimal cut-off for transcutaneous bilirubin levels 24–48 h postpartum that were used to predict phototherapy need was 9.85 mg/dl. In conclusion, early-term neonates are at a greater risk for developing jaundice and requiring phototherapy than full-term neonates. Monitoring bilirubin 24–48 h postpartum enhances early prediction and intervention. Full article
(This article belongs to the Section Pediatric Neonatology)
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6 pages, 3282 KiB  
Case Report
Fetal-Type Rhabdomyoma of the Cheek: A Conservative Management
Children 2023, 10(11), 1818; https://doi.org/10.3390/children10111818 - 16 Nov 2023
Viewed by 703
Abstract
Extracardiac rhabdomyomas are rare benign mesenchymal tumors diagnosed upon radiological and hystologic investigations and the treatment of choice is surgical exertion. There aren’t any similar cases managed conservatively reported in literature as in our case, to the best of our knowledge. We present [...] Read more.
Extracardiac rhabdomyomas are rare benign mesenchymal tumors diagnosed upon radiological and hystologic investigations and the treatment of choice is surgical exertion. There aren’t any similar cases managed conservatively reported in literature as in our case, to the best of our knowledge. We present a rare case of fetal cheek rhabdomyoma diagnosed in a healthy 2 months-old boy, with asymptomatic mass over the left masseter. The lesion could not be removed, due to the size and dimensions and the young age of the patient. However, the lesion did not show signs of spreading or progression over a 36 months follow-up. Fetal rhabdomyoma is a benign tumor, often located in the head and neck district, where surgery, especially in very young children, is associated with a high risk of complications and long-term sequelae. Our case report demonstrates the possibility to manage these lesions conservatively in the first years of life with close sonographic and clinical follow-up. Full article
(This article belongs to the Section Oncology and Hematology)
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7 pages, 416 KiB  
Case Report
Carrot-Induced Systemic Reaction: A Unique Presentation of Pollen-Food Allergy Syndrome in a Young Boy
Children 2023, 10(11), 1817; https://doi.org/10.3390/children10111817 - 15 Nov 2023
Viewed by 739
Abstract
Pollen-food allergy syndrome (PFAS) is a common IgE-mediated allergic condition resulting from cross-reactions between pollen and plant food allergens, primarily those in the PR-10 subfamily. Mostly symptoms are limited to the mouth and throat causing oral allergy syndrome (OAS). Systemic reactions are extremely [...] Read more.
Pollen-food allergy syndrome (PFAS) is a common IgE-mediated allergic condition resulting from cross-reactions between pollen and plant food allergens, primarily those in the PR-10 subfamily. Mostly symptoms are limited to the mouth and throat causing oral allergy syndrome (OAS). Systemic reactions are extremely rare. We report an 11-year-old boy who experienced a unique anaphylactic reaction after consuming raw carrot juice. The patient exhibited symptoms within one minute, including abdominal pain, facial and eyelid swelling, dyspnea, a macular rash, choking sensation and drowsiness. Desloratadine alleviated these symptoms, and as his overall condition improved rapidly, there was no need for adrenaline administration. Carrot-specific IgE levels in the patient’s serum were as follows: Dau c: 40.63 kUA/L and Dau c1: 31.5 kUA/L. He had previously been diagnosed with seasonal allergic rhinoconjunctivitis. The high degree of similarity among allergen components within the PR-10 subfamily contributed to cross-reactivity between birch pollen and carrots. It is important to remember that PFAS can manifest systemically, with symptoms ranging from mild skin itching to potentially fatal consequences. This highlights the need for healthcare professionals to be extra cautious and aware of this possibility, especially since carrots are commonly found in a wide range of dishes and snacks. Full article
(This article belongs to the Section Pediatric Allergy and Immunology)
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14 pages, 673 KiB  
Article
Risk Behaviors among Migrant Adolescents in Italy
Children 2023, 10(11), 1816; https://doi.org/10.3390/children10111816 - 15 Nov 2023
Viewed by 708
Abstract
Adolescence is a critical period for engaging in health risk behaviors. Migrant adolescents may face unique challenges due to acculturation stress. This study aims to monitor substance use and problem gambling among migrant adolescents living in Italy. Data from the 2017/18 Health Behavior [...] Read more.
Adolescence is a critical period for engaging in health risk behaviors. Migrant adolescents may face unique challenges due to acculturation stress. This study aims to monitor substance use and problem gambling among migrant adolescents living in Italy. Data from the 2017/18 Health Behavior in School-Aged Children survey in Italy were analyzed. The 18,794 participants included 15-year-olds, categorized as native or migrants, with ethnic backgrounds from Western, Eastern European, or non-Western/non-European countries. Girls had higher smoking rates, while boys exhibited higher prevalence of alcohol-related risk behaviors, cannabis use, and gambling. Boys from Eastern European countries displayed a greater risk of drunkenness (OR: 1.58, 95% CI: 1.06–2.37), particularly in the first generation, while those from Western countries showed a higher risk of multiple substance use (OR: 1.44, 95% CI: 1.05–1.96). Girls from Eastern European and non-Western/non-European countries had a lower risk of alcohol consumption (OR: 0.50, 95% CI: 0.29–0.85; OR: 0.55, 95% CI: 0.33–0.91, respectively). Finally, boys, especially those from Eastern European and non-Western/non-European countries, had a significantly higher risk of problem gambling (OR: 1.83, 95% CI: 1.04–3.22; OR: 2.10, 95% CI: 1.29–3.42, respectively). This disparity was more pronounced in the first generation, possibly due to acculturation challenges and socio-economic factors. Risk behaviors in adolescents are influenced by complex interplays of gender, cultural factors, and migration generation. Preventive strategies should consider these factors to effectively address substance use and gambling in this heterogeneous population. Full article
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21 pages, 1170 KiB  
Article
Indices of Narrative Language Associated with Disability
Children 2023, 10(11), 1815; https://doi.org/10.3390/children10111815 - 15 Nov 2023
Viewed by 724
Abstract
Narratives skills are associated with long-term academic and social benefits. While students with disabilities often struggle to produce complete and complex narratives, it remains unclear which aspects of narrative language are most indicative of disability. In this study, we examined the association between [...] Read more.
Narratives skills are associated with long-term academic and social benefits. While students with disabilities often struggle to produce complete and complex narratives, it remains unclear which aspects of narrative language are most indicative of disability. In this study, we examined the association between a variety of narrative contents and form indices and disability. Methodology involved drawing 50 K-3 students with Individual Education Programs (IEP) and reported language concerns from a large diverse sample (n = 1074). Fifty typically developing (TD) students were matched to the former group using propensity score matching based on their age, gender, grade, mother’s education, and ethnicity. Narrative retells and generated language samples were collected and scored for Narrative Discourse and Sentence Complexity using a narrative scoring rubric. In addition, the number of different words (NDW), subordination index (SI), and percentage of grammatical errors (%GE) were calculated using computer software. Results of the Mixed effect model revealed that only Narrative Discourse had a significant effect on disability, with no significant effect revealed for Sentence Complexity, %GE, SI, and NDW. Additionally, Narrative Discourse emerged as the sole significant predictor of disability. At each grade, there were performance gaps between groups in the Narrative Discourse, Language Complexity, and SI. Findings suggest that difficulty in Narrative Discourse is the most consistent predictor of disability. Full article
(This article belongs to the Special Issue Developmental Language Disorder in Children and Adolescents)
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15 pages, 414 KiB  
Article
The Effect of Saffron Kozanis (Crocus sativus L.) Supplementation on Weight Management, Glycemic Markers and Lipid Profile in Adolescents with Obesity: A Double-Blinded Randomized Placebo-Controlled Trial
Children 2023, 10(11), 1814; https://doi.org/10.3390/children10111814 - 15 Nov 2023
Viewed by 873
Abstract
Global rates of adolescent obesity have led the World Health Organization to consider the disease a pandemic that needs focus. In search of new anti-obesity agents, Crocus sativus, popularly known as saffron, is a nutraceutical agent, praised for its beneficial effects. The study [...] Read more.
Global rates of adolescent obesity have led the World Health Organization to consider the disease a pandemic that needs focus. In search of new anti-obesity agents, Crocus sativus, popularly known as saffron, is a nutraceutical agent, praised for its beneficial effects. The study aimed to investigate the possible effect of Kozanis saffron administration on weight management of obese prediabetic adolescents. Seventy-four obese prediabetic adolescents participated in a double-blind placebo-controlled trial of three arms, randomly assigned to receive either Kozanis saffron (n = 25, 60 mg/day), metformin (n = 25, 1000 mg/day) or a placebo (n = 24), for twelve weeks. Anthropometry, glycemic markers and lipid profiles were investigated at baseline and post-intervention. Saffron supplementation significantly reduced the weight z-score, BMI, BMI z-score and waist circumference (WC) of obese adolescents; however, this reduction was less significant compared to the effect of metformin. Metformin administration offered a significantly more profound improvement in anthropometry compared to saffron administration. Saffron administration also provided significant improvements in weight, weight z-scores, BMI values, BMI z-scores and WCs compared to the placebo. Saffron supplementation failed to change any glycemic marker, but provided a significant reduction in fasting triglyceride levels and also a significant increase in fasting HDL levels. Saffron Kozanis constitutes a promising nutraceutical option for adolescents and children with obesity and prediabetes in need of weight management. Full article
(This article belongs to the Special Issue Childhood and Adolescent Obesity and Weight Management: 3rd Edition)
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17 pages, 1725 KiB  
Article
Auditory Cortex Maturation and Language Development in Children with Hearing Loss and Additional Disabilities
Children 2023, 10(11), 1813; https://doi.org/10.3390/children10111813 - 15 Nov 2023
Viewed by 1483
Abstract
A significant portion of hearing-impaired children have additional disabilities, but data about the maturation of their auditory cortex are scarce. In these children, behavioral tests are often unreliable, and objective tests are needed for diagnostics and follow-up. This study aimed to explore auditory [...] Read more.
A significant portion of hearing-impaired children have additional disabilities, but data about the maturation of their auditory cortex are scarce. In these children, behavioral tests are often unreliable, and objective tests are needed for diagnostics and follow-up. This study aimed to explore auditory cortical maturation and language development, and the usability of an objective electroencephalogram-based biomarker in children with multiple disabilities. In 65 hearing aid and cochlear implant users (36 females; 36 with multiple disabilities; 44.3 ± 18.5 months of age, mean ± SD), auditory processing was examined using the P1 cortical auditory evoked response biomarker, and language development with the Preschool Language Scales 5th edition (PLS-5). During the study, all of the children received intensive extra language therapy for six months. No significant differences were found between the groups in P1 latency development, the proportion of abnormal P1 latencies, or the number of children whose P1 latencies changed from abnormal to normal during the study. The PLS-5 total language scores, auditory comprehension scores, or expressive communication scores did not differ between groups either. The P1 latencies showed meaningful negative correlations with the language scores. The results suggest that auditory cortex development is similar in hearing-impaired children with/without additional disabilities, and the P1 biomarker is a feasible tool to evaluate central auditory maturation in children with multiple disabilities. Full article
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11 pages, 1335 KiB  
Review
The Diverse Genomic Landscape of Diamond–Blackfan Anemia: Two Novel Variants and a Mini-Review
Children 2023, 10(11), 1812; https://doi.org/10.3390/children10111812 - 15 Nov 2023
Viewed by 1086
Abstract
Diamond–Blackfan anemia (DBA) is a ribosomopathy characterized by bone marrow erythroid hypoplasia, which typically presents with severe anemia within the first months of life. DBA is typically attributed to a heterozygous mutation in a ribosomal protein (RP) gene along with a defect in [...] Read more.
Diamond–Blackfan anemia (DBA) is a ribosomopathy characterized by bone marrow erythroid hypoplasia, which typically presents with severe anemia within the first months of life. DBA is typically attributed to a heterozygous mutation in a ribosomal protein (RP) gene along with a defect in the ribosomal RNA (rRNA) maturation or levels. Besides classic DBA, DBA-like disease has been described with variations in 16 genes (primarily in GATA1, followed by ADA2 alias CECR1, HEATR3, and TSR2). To date, more than a thousand variants have been reported in RP genes. Splice variants represent 6% of identifiable genetic defects in DBA, while their prevalence is 14.3% when focusing on pathogenic and likely pathogenic (P/LP) variants, thus highlighting the impact of such alterations in RP translation and, subsequently, in ribosome levels. We hereby present two cases with novel pathogenic splice variants in RPS17 and RPS26. Associations of DBA-related variants with specific phenotypic features and malignancies and the molecular consequences of pathogenic variations for each DBA-related gene are discussed. The determinants of the spontaneous remission, cancer development, variable expression of the same variants between families, and selectivity of RP defects towards the erythroid lineage remain to be elucidated. Full article
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2 pages, 149 KiB  
Editorial
Editorial for “Asthma and Its Impact in Adolescents” Special Issue
Children 2023, 10(11), 1811; https://doi.org/10.3390/children10111811 - 15 Nov 2023
Viewed by 545
Abstract
Bronchial asthma is a chronic disease related to the atopic condition in most cases but also to other factors (such as infectious diseases; social, economic, environmental, and occupational conditions; exposure to biological irritants; and/or chemical aggressions) [...] Full article
(This article belongs to the Special Issue Asthma and Its Impact in Adolescents)
18 pages, 738 KiB  
Article
Effects of Smartphone Activities on Postural Balance in Adolescents with Intellectual Disabilities
Children 2023, 10(11), 1810; https://doi.org/10.3390/children10111810 - 14 Nov 2023
Viewed by 873
Abstract
Considering the rising prevalence of smartphone usage among adolescents with intellectual disabilities and their frequent motor challenges, understanding its impact on their physical well-being is important. This study aims to investigate the impact of smartphone activities on postural balance in adolescents with intellectual [...] Read more.
Considering the rising prevalence of smartphone usage among adolescents with intellectual disabilities and their frequent motor challenges, understanding its impact on their physical well-being is important. This study aims to investigate the impact of smartphone activities on postural balance in adolescents with intellectual disabilities. Two groups of adolescents participated in the study: an intellectual disability group (IDG) (n = 16) and atypical development group (TDG) (n = 12). Static postural balance, using a stabilometric platform on firm and foam surfaces, and dynamic balance, using the Timed Up-and-Go Test (TUGT), were performed under various conditions, such as playing a game, watching videos, video calls, and listening to music. The center of pressure (CoP) values significantly increased (p < 0.05) during all smartphone activities (except listening to music) compared to the control condition in both groups, with the IDG demonstrated a more pronounced increase (p < 0.05) during playing video games and video calls on the firm surface. TUGT scores significantly increased (p < 0.05) during smartphone activities, with greater changes observed in the IDG (p < 0.05), and significantly decreased (p < 0.01) during listening to music in both groups. Our study suggests that adolescents with intellectual disabilities need special tools and guidance to ensure their safety and well-being when using smartphones. Full article
(This article belongs to the Section Global and Public Health)
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12 pages, 265 KiB  
Article
Diagnostic Accuracy of Multiplex Polymerase Chain Reaction in Early Onset Neonatal Sepsis
Children 2023, 10(11), 1809; https://doi.org/10.3390/children10111809 - 14 Nov 2023
Viewed by 694
Abstract
Early onset neonatal sepsis is a significant contributor to neonatal morbidity and mortality. Although blood cultures remain the diagnostic gold standard, they detect pathogens in only a minority of suspected cases. This study compared the accuracy of blood cultures with a rapid multiplex [...] Read more.
Early onset neonatal sepsis is a significant contributor to neonatal morbidity and mortality. Although blood cultures remain the diagnostic gold standard, they detect pathogens in only a minority of suspected cases. This study compared the accuracy of blood cultures with a rapid multiplex PCR test. Newborns at risk of neonatal sepsis were prospectively screened as recommended per national guidelines. Evaluations included laboratory parameters (CrP, IL6, differential blood count), blood culture, and a molecular multiplex PCR test (ROCHE LightCycler SeptiFast®) identifying 20 common microbial agents. Blood samples were taken simultaneously from umbilical cord or venous sources on the first day of life. Of 229 infants included, 69% were born preterm. Blood culture and multiplex PCR sensitivity were 7.4% and 14.8%, respectively. Specificity, negative and positive predictive values between methods showed no significant variance, although multiplex PCR had more false positives due to contamination. The limited sensitivity of blood cultures for early onset neonatal sepsis is concerning. Despite quicker results, multiplex PCR does not enhance diagnostic accuracy or antibiotic therapy guidance, thus it cannot be recommended for this indication. Full article
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10 pages, 434 KiB  
Review
Treatment of Ankyloglossia: A Review
Children 2023, 10(11), 1808; https://doi.org/10.3390/children10111808 - 14 Nov 2023
Viewed by 1006
Abstract
Aim: The aim of this narrative review is to analyze and compare the current scientific evidence regarding the diagnosis and treatment of hypertrophic lingual frenulum in preschool and school-age children. The treatments considered in this review are traditional surgical therapy, laser-assisted surgical therapy, [...] Read more.
Aim: The aim of this narrative review is to analyze and compare the current scientific evidence regarding the diagnosis and treatment of hypertrophic lingual frenulum in preschool and school-age children. The treatments considered in this review are traditional surgical therapy, laser-assisted surgical therapy, and functional rehabilitation therapy. Materials and methods: A comprehensive literature review was conducted using the PubMed and PubMed Central search engines, considering articles published in the English language between 1 January 2000 and 30 June 2022. The bibliographic search was performed using the following keywords as search strings: “lingual”, “frenulectomy”, “frenulotomy”, “frenulum”, “ankyloglossia”, and “laser.” Results: A total of 14 articles were included in this review, including four prospective observational studies, one case–control study, three cross-sectional studies, four retrospective studies, and one randomized controlled trial. The data extracted from each article are summarized in a table. Conclusions: In the literature, there are still limited studies regarding the treatment of hypertrophic frenulum. No common indications for the treatment of ankyloglossia and universally used classification for lingual frenulum were found. Currently, clinicians prefer the use of a diode laser for treatment. This method offers several advantages over the use of a scalpel blade. Many studies agree on the usefulness of providing patients with myofunctional rehabilitation to improve lingual mobility, both prior to surgical therapy and in the postoperative period. Full article
(This article belongs to the Special Issue New Frontiers in Early Childhood Oral Health Care)
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11 pages, 321 KiB  
Article
The Dark Side of Multimedia Devices: Negative Consequences for Socioemotional Development in Early Childhood
Children 2023, 10(11), 1807; https://doi.org/10.3390/children10111807 - 14 Nov 2023
Cited by 1 | Viewed by 972
Abstract
There is growing concern about the relationship between screen use by young children and negative effects on their development, as children with developmental and socioemotional impairments tend to have difficulties in their relationships and increased academic problems. The aim of our study was [...] Read more.
There is growing concern about the relationship between screen use by young children and negative effects on their development, as children with developmental and socioemotional impairments tend to have difficulties in their relationships and increased academic problems. The aim of our study was to analyse the relationship between the use of multimedia devices and paediatric symptoms in children below 5 years old. Data from 534 Portuguese parents of children aged from 18 to 57 months were collected via a self-report questionnaire. Children’s daily exposure to multimedia devices was nearly 2 h per day. Paediatric symptoms were positively associated with watching television and screen time and negatively associated with parents’ working hours. Touchscreen use was more frequent among girls and older children. Parents’ working hours comprised the most significant predictor of paediatric symptoms. Our findings reinforce past findings on the adverse links between the use of multimedia devices and paediatric symptoms and also highlight the influence of other variables like the child’s age and gender, as well as parental factors. The need to both create a more comprehensive framework regarding the long-term effects of multimedia device use and delineate effective strategies for prevention and intervention with parents and children is discussed. Full article
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14 pages, 333 KiB  
Article
First-Time Parents’ Bonding with Their Baby: A Longitudinal Study on Finnish Parents during the First Eight Months of Parenthood
Children 2023, 10(11), 1806; https://doi.org/10.3390/children10111806 - 14 Nov 2023
Viewed by 810
Abstract
Early positive bonding between parents and babies promotes the development of parenting skills and parents’ sensitivity to their infant’s needs. Positive bonding has been suggested to decrease the risk of maltreatment. There is less research into the differences between primiparae’s and their spouses’ [...] Read more.
Early positive bonding between parents and babies promotes the development of parenting skills and parents’ sensitivity to their infant’s needs. Positive bonding has been suggested to decrease the risk of maltreatment. There is less research into the differences between primiparae’s and their spouses’ bonding with their baby and changes in the parent-to-infant bonding during the first year of the baby’s life. The aim of this study was to describe bonding with one’s baby and related differences and changes within first-time parents. The data were collected from nine maternal health clinics in 2019–2021 in one city in Finland. The Mother-to-Infant Bonding Scale (MIBS) and the Edinburgh Postnatal Depression Scale (EPDS) were used. The data were collected during pregnancy (T1) and when the baby was aged 1–2 months (T2) and 6–8 months (T3). The questionnaire was completed separately by the primiparae (n = 81 at T1) and their spouses (n = 79 at T1). The findings demonstrated that both parents had positive feelings for their baby. The primiparae’s and their spouses’ MIBS scores were relatively low at T2 and T3. The change between time points or the difference in the parents’ bonding was not statistically significant when examining MIBS total scores. The present study identified a positive weak-to-moderate correlation between the MIBS and EPDS. This association was highlighted in the group of primiparae. The results of this study can be used to develop maternity and child health clinic services, and to promote parents’ equal growth in parenthood. Full article
(This article belongs to the Section Pediatric Nursing)
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11 pages, 554 KiB  
Article
Post-Acute Sequelae of COVID-19 (PASC) in Pediatrics: Factors That Impact Symptom Severity and Referral to Treatment
Children 2023, 10(11), 1805; https://doi.org/10.3390/children10111805 - 14 Nov 2023
Cited by 1 | Viewed by 927
Abstract
The post-acute sequelae of COVID-19 (PASC) is a complex condition. While there are emerging studies on its effects in adults, there is scarce research regarding the long-term effects of COVID-19 infection among youth. Several researchers have likened long-haul COVID-19 to chronic fatigue syndrome/myalgic [...] Read more.
The post-acute sequelae of COVID-19 (PASC) is a complex condition. While there are emerging studies on its effects in adults, there is scarce research regarding the long-term effects of COVID-19 infection among youth. Several researchers have likened long-haul COVID-19 to chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and postural orthostatic tachycardia syndrome (POTS). In adults, the prognosis for these diagnoses is less promising than that in youth; however, there is currently very little information available on the presentation of youth with PASC. A better understanding of the specific symptom presentation for youth diagnosed with PASC is necessary. Retrospective chart reviews were conducted collecting demographic data, COVID-19 symptoms and disease progression, and vaccination status. Additional data on referrals to a PASC treatment program and appointments attended were collected. Overall, data suggested that youth present with less severe PASC symptoms than adults, and the role of vaccination is unclear. These youth are often not referred to treatment programs. More exploration is necessary to continue to build an understanding of how best to aid youth diagnosed with PASC. Full article
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13 pages, 5185 KiB  
Article
Femoral Occlusion during Neonatal Cardiopulmonary Resuscitation Improves Outcomes in an Ovine Model of Perinatal Cardiac Arrest
Children 2023, 10(11), 1804; https://doi.org/10.3390/children10111804 - 13 Nov 2023
Viewed by 1376
Abstract
Background: The goal of chest compressions during neonatal resuscitation is to increase cerebral and coronary blood flow leading to the return of spontaneous circulation (ROSC). During chest compressions, bilateral femoral occlusion may increase afterload and promote carotid and coronary flow, an effect similar [...] Read more.
Background: The goal of chest compressions during neonatal resuscitation is to increase cerebral and coronary blood flow leading to the return of spontaneous circulation (ROSC). During chest compressions, bilateral femoral occlusion may increase afterload and promote carotid and coronary flow, an effect similar to epinephrine. Our objectives were to determine the impact of bilateral femoral occlusion during chest compressions on the incidence and timing of ROSC and hemodynamics. Methodology: In this randomized study, 19 term fetal lambs in cardiac arrest were resuscitated based on the Neonatal Resuscitation Program guidelines and randomized into two groups: femoral occlusion or controls. Bilateral femoral arteries were occluded by applying pressure using two fingers during chest compressions. Results: Seventy percent (7/10) of the lambs in the femoral occlusion group achieved ROSC in 5 ± 2 min and three lambs (30%) did not receive epinephrine. ROSC was achieved in 44% (4/9) of the controls in 13 ± 6 min and all lambs received epinephrine. The femoral occlusion group had higher diastolic blood pressures, carotid and coronary blood flow. Conclusion: Femoral occlusion resulted in faster and higher incidence of ROSC, most likely due to attaining increased diastolic pressures, coronary and carotid flow. This is a low-tech intervention that can be easily adapted in resource limited settings, with the potential to improve survival and neurodevelopmental outcomes. Full article
(This article belongs to the Section Pediatric Neonatology)
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3 pages, 178 KiB  
Reply
A Callout for International Collaboration. Reply to Giger, E.V.; Tilen, R. Comment on “Shaniv et al. Neonatal Drug Formularies—A Global Scope. Children 2023, 10, 848”
Children 2023, 10(11), 1803; https://doi.org/10.3390/children10111803 - 13 Nov 2023
Viewed by 560
Abstract
We are very grateful that the global-scope paper on neonatal drug formularies has received a relevant amount of interest from the readership of the journal [...] Full article
(This article belongs to the Special Issue Neonatal Clinical Pharmacology)
2 pages, 155 KiB  
Comment
Comment on Shaniv et al. Neonatal Drug Formularies—A Global Scope. Children 2023, 10, 848
Children 2023, 10(11), 1802; https://doi.org/10.3390/children10111802 - 13 Nov 2023
Cited by 1 | Viewed by 417
Abstract
We read the article by Shaniv D. et al. entitled “Neonatal Drug Formularies—A Global Scope” [...] Full article
(This article belongs to the Special Issue Neonatal Clinical Pharmacology)
18 pages, 521 KiB  
Review
What Is Helpful and What Is Challenging for the Caregivers of Young People Receiving Interventions to Prevent Suicide? Caregivers’ Perspectives—A Rapid Scoping Review
Children 2023, 10(11), 1801; https://doi.org/10.3390/children10111801 - 13 Nov 2023
Viewed by 741
Abstract
(1) Background: Suicide is a leading cause of death among young people. Preventing suicide in young people is a priority. Caregivers play a vital role in ensuring interventions for young people experiencing suicide ideation and/or attempts are implemented, and that they are maintained [...] Read more.
(1) Background: Suicide is a leading cause of death among young people. Preventing suicide in young people is a priority. Caregivers play a vital role in ensuring interventions for young people experiencing suicide ideation and/or attempts are implemented, and that they are maintained over time. Despite this, little is known about what caregivers find helpful and challenging in relation to suicide prevention interventions. This rapid scoping review is the first to address this gap. (2) Methods: Searches were completed on six electronic databases using keywords relating to ‘suicide prevention, ‘young people’, and ‘caregivers’. Ten studies—using both qualitative and quantitative methods, and involving >1400 carers from the United States and Europe—were selected for inclusion. (3) Results: The review shows that caregivers value interventions that are delivered by non-judgmental clinicians, that are suitable to the particular needs of their child, that are available when needed, and that support their confidence and communication. Caregivers experience difficulties with interventions that require their attendance at specific times, and that fail to recognize and/or address their own mental health needs. (4) Conclusions: The findings can be used to inform and improve the intervention design, with the aim of improving outcomes for caregivers and young people. Full article
(This article belongs to the Section Child and Adolescent Psychiatry)
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