Children-Basel最新文献

Background: Children with emotional disturbance (ED) frequently display highly unpredictable behaviors compared to other children. The magnitude and unpredictability of childhood ED make finding effective management strategies difficult for parents. Prior research has examined parents' stress and the children's behaviors in schools, but we know very little about how parents manage at home.

Methods: This qualitative study used Naturalistic Inquiry to explore how parents respond to the challenges which arise at home due to childhood ED. Eight mothers raising 10 children with ED were recruited nationally. Data were gathered through semi-structured, individual interviews.

Results: Consequences-based parenting strategies were unsuccessful, but mothers achieved greater success with pre-planned, intentional responses and adapting the child's environment. Mothers learned their child's world view was very different than their own. This realization caused mothers' perspective toward their child to change. Mothers saw their child as struggling with a problem, instead of simply being defiant. The perception shift allowed mothers to approach situations with greater compassion and inner peace.

Conclusions: The findings provide suggestions for pediatric healthcare providers who work with such parents seeking assistance and advice.

Background/objectives: The objective of this study is to determine the extent to which obesity alters the diagnostic reliability of the clonidine stimulation test (CST) for growth hormone deficiency (GHD) and whether incorporating insulin-like growth factor 1 (IGF-1) and the annual growth velocity standard deviation score (GV SDS) improves diagnostic precision.

Methods: This retrospective study included 101 children evaluated for short stature using the clonidine stimulation test, with serum GH concentrations determined by a two-site, solid-phase, enzyme-labeled chemiluminescent immunometric assay (Immulite 2000 XPi, Siemens Healthcare Diagnostics, USA). Diagnostic performance was compared between overweight/obese (n = 47) and normal-weight (n = 54) groups. A two-step algorithm was evaluated: Step 1 applied a GH peak threshold of <5 ng/mL; Step 2 integrated IGF-1 SDS < -1.5 and annual GV SDS < -2.0 among children with subthreshold GH responses.

Results: The median GH peak was significantly lower in overweight/obese children (4.5 [IQR 2.0-7.4] vs. 8.2 [5.1-11.5] ng/mL; p = 0.043). Although sensitivity remained comparable (82.6% vs. 90.5%; p = 0.666), elevated BMI markedly reduced specificity (50.0% vs. 84.8%; p = 0.008) and overall accuracy (66.0% vs. 87.0%; p = 0.017). Overweight/obese children demonstrated a higher proportion of false-positive CST results than non-obese children (25.5% vs. 9.3%). Among obese children with a GH peak of <5 ng/mL (n = 31), Step 2, which integrates IGF-1 and GV, improved specificity from 50% to 75% and the positive predictive value from 61.3% to 84.2%, correctly reclassifying 9 of 12 children without GHD who would otherwise have been misdiagnosed based on CST alone.

Conclusions: Fixed GH cutoffs may lead to the misclassification of GHD in children with elevated BMI. Obesity significantly reduces the specificity and diagnostic accuracy of CST, increasing false-positive results. A two-step approach integrating IGF-1 and GV improves diagnostic precision and helps to differentiate true GHD from obesity-related GH suppression.

Objectives: Dysphagia is a major complication of acquired brain injury (ABI) in children; however, its trajectory and prognostic indicators remain insufficiently characterized. This study aimed to identify predictors of dysphagia and its recovery following pediatric ABI.

Methods: This retrospective study included all children admitted with ABI to tertiary pediatric rehabilitation center between 2014 and 2017. Data were collected from electronic medical records.

Results: One hundred children aged 2:00-17:11 years were included; 61% had dysphagia at admission. Participants with dysphagia received speech-language pathology (SLP) treatment, with a recovery rate of 78.68%. Treatment duration was significantly shorter among children who recovered (36 days) compared with those who did not (136 days; p < 0.001). Dysphagia at admission was associated with mechanical ventilation, duration of unconsciousness, duration of acute hospitalization, CNS tumor etiology, cranial nerve impairment (V, IX, X, XII), voice and speech impairments, and cognitive and behavioral impairments. Logistic regression showed that reduced consciousness, cranial nerve impairment, voice disorders, and CNS tumors explained 70.6% of dysphagia likelihood. Non-recovery was associated with unconsciousness, enteral feeding, hypoglossal injury, and dysphagia severity at admission. Level of consciousness at admission explained 33.7% of recovery likelihood.

Conclusions: Dysphagia was highly prevalent among children with ABI. Recovery rates following SLP treatment were high and were associated with level of consciousness at admission to rehabilitation.

Background/objectives: Physical and mental health symptoms commonly affecting children are often under-addressed given the limited availability of pediatric behavioral healthcare. Training school providers (e.g., nurses, mental health professionals) to address these concerns is a promising strategy to explore, considering the unique level of accessibility afforded by school settings. While our earlier work augmented school providers' pain management skills, providers desired more comprehensive training and youth support tools. Our team of interdisciplinary academic researchers and community partners will bridge this gap by developing the PURSUIT (Preventing Use of Substances for the Underserved with Innovative Technology) provider training program and companion online self-management platform for youth and caregivers. This protocol paper describes our planned approach to developing, implementing, and evaluating the PURSUIT program.

Methods: We will draw from evidence-based cognitive-behavioral, trauma-focused, and mindfulness protocols to develop a comprehensive provider training program and interactive online self-management platform for youth and caregivers. Content areas will include core cognitive-behavioral strategies and specific skills for pediatric pain management, trauma-focused care, and substance use prevention. Innovative technological approaches, such as live and animated videos, will be used to promote user engagement. Academic and community partners will have roles in material co-development. Outcomes of this project will include the PURSUIT training program and self-management platform feasibility and acceptability (e.g., completion/engagement rates, quantitative/qualitative reports), as well as the impact of the training program on provider knowledge and the impact of the self-management platform on youth/caregiver outcomes.

Conclusions: Interdisciplinary collaboration and community engagement will be critical to developing and evaluating a provider training program and youth/caregiver self-management platform.

Background/Objectives: Magnetic Resonance Imaging (MRI) is frequently used to evaluate back pain and other spinal indications in the pediatric population. However, the diagnostic value in the pediatric population remains unclear. This study aimed to determine the prevalence of spinal abnormalities detected by MRI in children and adolescents and to identify factors associated with MRI findings of added diagnostic value. Methods: A retrospective two-centre cohort study was conducted among 229 patients aged 0-16 years who underwent spinal MRI at two hospitals. MRI findings were classified into five categories: (1) no finding; (2) spinal incidental finding; (3) confirmed diagnosis with no additional information; (4) confirmed diagnosis/severity with additional information; and (5) new diagnosis. In categories 4 and 5, there was an added value of the MRI scan. Patients with and without added MRI findings were compared regarding age, gender, presence of night pain, exercise-dependent pain, sharp pain localization, trauma, neurological abnormalities, and symptom duration. Results: The prevalence of MRI abnormalities related to the patient's complaints was 19.2%. When the 'added value of MRI' group is compared to the 'no added value of MRI group', neurological abnormalities (p = 0.009) and shorter symptom duration (p = 0.002) were statistically associated with abnormal MRI findings. Stratified analysis showed that MRIs provided added diagnostic value more frequently in patients with clinical indications other than chronic back pain. Most abnormalities were located in the lumbar spine, with spondylolysis/spondylolisthesis and discopathy as the most common findings. Conclusions: Although spinal MRIs frequently detected abnormalities, only a small proportion of MRIs revealed findings that provided added diagnostic or therapeutic value. This highlights the importance of developing clear criteria for spinal MRI use in children and adolescents to minimize unnecessary imaging, limit patient burden, and optimize healthcare resources.

Background: Euthyroid sick syndrome (ESS) is a common finding in critically ill patients, including children with diabetic ketoacidosis (DKA). However, its prevalence, specific hormonal patterns, and recovery in the pediatric population remain inadequately characterized. This study aimed to determine the prevalence of ESS in pediatric DKA, characterize its hormonal subtypes, and identify factors associated with short-term thyroid function recovery. Methods: A retrospective cohort study was conducted involving 182 pediatric patients (0-18 years) with type 1 diabetes mellitus admitted for DKA between January 2023 and June 2025. Thyroid function tests (TSH, FT4, FT3) were measured at presentations and two weeks after DKA resolution. ESS was defined using age-specific reference ranges. Results: The prevalence of ESS at DKA presentation was 61.5% (112/182). Two distinct hormonal phenotypes were identified: isolated low FT3 (n = 40, 35.7%) and combined low FT4 and FT3 (n = 72, 64.3%). Patients with the isolated low FT3 pattern were significantly younger (median 9.5 [3.50, 11.00] vs. 12.0 [8.50, 14.00] years, p = 0.004) and had milder hormonal derangement than the combined group. Normalization of FT4 was significantly lower in children with severe DKA compared with those with mild/moderate disease (50.0% vs. 84.8%, p = 0.002). FT3 normalization was also reduced in the severe group (20.0% vs. 42.4%), although this difference did not reach statistical significance (p = 0.078). After 2 weeks, all ESS patients (100%) had achieved normal levels of at least one thyroid hormone, with 38.4% reaching normalization of FT3 and 36.6% achieving normalization of all measured thyroid parameters. Age (adjusted odds ratio [aOR] = 2.08, 95% confidence interval (CI): 1.57-3.06, p < 0.001) and baseline FT4 level (aOR = 2.14, 95% CI: 1.51-3.32, p < 0.001) were positive predictors for complete recovery. Conclusion: ESS is highly prevalent in pediatric DKA, with distinct phenotypic patterns associated with age and the severity of acute illness, particularly the degree of acidosis. While transient in nature, complete biochemical recovery within two weeks is not universal. These findings underscore that thyroid function tests during acute DKA should be interpreted with caution to avoid misdiagnosis of primary thyroid disease, and they support the critical practice of follow-up testing after metabolic stabilization instead of immediate hormone replacement.

Introduction: Intensive chemotherapy protocols and hematopoietic stem cell transplantation (HSCT) in children with cancer frequently lead to severe complications, such as mucositis and immune dysfunction. A growing body of evidence indicates that these complications are closely associated with the patient's nutritional status and the composition of the gut microbiome, which becomes profoundly destabilized as a result of cytotoxic therapy and antibiotic use.

Background: The aim of this review is to critically evaluate the current state of knowledge on the interplay between gut dysbiosis, metabolomic profiles-with particular emphasis on short-chain fatty acids (SCFAs)-and treatment-related toxicity in pediatric patients, as well as to delineate pathways toward personalized nutritional therapy.

Methods: A narrative review was conducted, including clinical and preclinical studies published between January 2015 and October 2025. PubMed/MEDLINE, Embase, Cochrane Library, and other databases were searched, focusing on changes in microbiome composition, correlations between gut-derived metabolites and the severity of complications (sepsis, graft-versus-host disease [GvHD], mucositis), and the effects of targeted nutritional interventions (probiotics, prebiotics, postbiotics, and fecal microbiota transplantation [FMT]) on microbiome modulation during anticancer therapy.

Results: The analysis demonstrates that pediatric oncologic treatment leads to a marked reduction in microbial diversity, including the loss of protective Clostridiales taxa (e.g., Faecalibacterium), accompanied by an overgrowth of Proteobacteria pathobionts. Metabolomic profiling indicates that low SCFA levels (e.g., butyrate < 20-50 µmol/g) are a strong predictor of severe mucositis, prolonged neutropenia, and an increased risk of sepsis. Interventions aimed at restoring eubiosis and enhancing SCFA production show potential in strengthening the intestinal barrier, modulating immune responses, and enabling maintenance of the planned relative dose intensity (RDI) of chemotherapy by reducing treatment-related toxicity.

Conclusions: Gut microbiome profiling and fecal metabolomics represent promising prognostic tools in pediatric oncology. There is an urgent need for further research employing "omics"-based approaches to develop precise, individually tailored nutritional protocols. Such strategies, including postbiotics and FMT, may minimize treatment-related adverse effects and improve long-term clinical outcomes in pediatric patients.

Cherubism is a rare fibro-osseous disorder of the jaws that typically presents in early childhood and is recognised as genetically heterogeneous. While the condition is well described in non-African populations, African data and molecular confirmation remain limited.

Background/objectives: This structured narrative review aimed to synthesize published African cases of cherubism by describing patterns of presentation, diagnosis, management, and genetic investigation.

Methods: A structured narrative literature review was conducted using PubMed, Scopus, Google Scholar, and African Journals Online. Peer-reviewed case reports and case series describing cherubism in African patients were included. Data extraction followed predefined criteria, capturing demographic features, age at onset and presentation, clinical, radiological and histological findings, management strategies, and the use of molecular genetic testing. Findings were synthesised descriptively.

Results: Fourteen studies reporting 20 individual cases from eight African countries were identified, with the majority originating from North Africa. Although symptom onset most commonly occurred in early childhood, the median age at presentation for management was 13.75 years, suggesting delayed access to care. Molecular genetic testing was reported in only two cases, while most diagnoses relied on clinical, radiological, and histopathological features. Surgical intervention was commonly described, with fewer cases managed conservatively.

Conclusions: Within the limitations of a structured narrative review based predominantly on published case reports and case series, and constrained by the scarcity of molecularly confirmed cases, the available African literature on cherubism remains limited in scope, geographically skewed, and characterised by incomplete genetic reporting. Recurring features include delayed presentation, reliance on clinical diagnosis, and limited use of molecular testing. These observations reflect gaps in reporting and genetic characterisation rather than population-level patterns, underscoring the need for improved molecular diagnostics, multidisciplinary care, and African registries.

Background/objective: Mobility Opportunities Via Education (MOVE) is a structured intervention to enhance independent mobility skills in individuals who are non-ambulatory. This study aims at identifying and mapping the literature related to the MOVE programme and to describe its content according to preselected categories, focusing on individuals with non-ambulatory cerebral palsy.

Methods: A scoping review was conducted, with thirteen databases searched in May 2024, complemented by reference search and private databases; the search was updated in August 2025. Publications after 1985 were included without restrictions on language, population, or context. Two reviewers independently screened records and extracted data using qualitative content analysis.

Results: From 6794 records, 228 publications in 15 languages were included, mainly from the United States and Europe. MOVE was developed in the 1980s during a shift towards age-appropriate, functional interventions for individuals with severe disabilities. It is an early task-specific, activity-based and family-centred approach with retrospectively proposed foundations in dynamic systems theory and motor learning. Implementation follows a structured six-step process, embedding mobility training into daily routines. MOVE has been implemented across populations, settings, and countries, particularly for non-ambulatory individuals with cerebral palsy.

Background: Extrahepatic portal vein obstruction (EHPVO) accounts for more than two thirds of pediatric portal hypertension. Rex shunt is the preferred surgical management, as it restores hepatopetal flow and minimizes or reverses liver dysfunction. Case Summary: We report surgical treatment of EHPVO in a 9-year-old girl using portal-Rex shunt with internal jugular vein (IJV) as a conduit and the intact proximal main portal vein instead of the superior mesenteric vein as a venous inlet. Improvement in thrombocytopenia and reduction in splenic size were achieved post-operatively. The portal-Rex shunt remains patent with good hepatopetal flow at one year post-operation. Conclusions: The success of a portal-Rex shunt to selectively bypass EHPVO rests upon careful selection of inlet and outlet veins, as well as a conduit with good patency, such as the IJV.