Children-Basel最新文献

Background: Early childhood caries (ECC) compromise the nutrition, growth, and quality of life in young children, and their relationship with breastfeeding practices remains disputed.

Aim: To determine if prolonged breastfeeding increases the risk of dental caries in children aged under 71 months.

Material and methods: A systematic review of PubMed, Multidisciplinary Digital Publishing Institute, and Evidence-Based Dentistry, was conducted through August 2025, including observational studies, randomized trials, narrative reviews, and meta-analyses on breastfeeding and ECC.

Results: Thirty-one studies involving 28,000 children were included. Exclusive breastfeeding for under six months halves ECC probability (OR 0.53-0.58), whereas breastfeeding beyond 12 months and nocturnal feeds increase probability by 60-86% (OR 2.35-7.14). Parental factors-high plaque levels, feeding-to-sleep, and skipped post-feed cleaning-strongly predict ECC (OR 8.51-75.6). Interventions combining feeding counseling with home visits or visual aids reduce ECC incidence by 22-32% (RR 0.68-0.78).

Conclusions: Exclusive breastfeeding through six months is protective against ECC, but prolonged or nocturnal feeding heightens risk. Integrating structured oral health education into breastfeeding promotion is recommended.

Background/Objectives: Pediatric cancer survivors frequently experience neuromuscular sequelae related to chemotherapy-induced neurotoxicity. Agents such as vincristine, methotrexate, and platinum compounds can lead to persistent gait alterations and sensorimotor deficits that impair mobility and quality of life. This study aimed to objectively assess gait in pediatric cancer survivors after the completion of oncological pharmacological treatment to identify specific spatiotemporal, kinematic, and kinetic alterations and characterize neuromechanical patterns associated with neurotoxic exposure. Methods: A cross-sectional observational study was conducted including pediatric cancer survivors (6-18 years) who had completed chemotherapy and age- and sex-matched healthy controls. Gait was analyzed using a Vicon^®3D motion capture system, with reflective markers placed on standardized anatomical landmarks. Spatiotemporal, kinematic, and kinetic variables were compared between groups using parametric tests and statistical parametric mapping (SPM) with Holm-Bonferroni correction (α = 0.05). Results: Pediatric cancer survivors showed slower gait velocity (Mean Difference (MD) = 0.17, p = 0.018, Confidence Interval CI95% = 0.04; 0.4), shorter step (MD = 0.1, p = 0.015, CI95% = 0.01; 0.19) and stride length (MD = 0.17, p = 0.018, CI95% = 0.03; 0.31), as well as reduced single support time (MD = 0.1, p = 0.043, CI95% = 0.01; 0.19), along with significant alterations in pelvic, hip, knee, and ankle kinematics compared with controls. Increased pelvic elevation (MD = 0.92, p = 0.018, CI95% = 0.25; 1.58), reduced hip extension during stance (MD = -2.99, p = 0.039, CI95% = -5.19; -0.74), knee hyperextension in mid-stance (MD = -3.84, p < 0.001, CI95% = -6.18; -0.72), and limited ankle dorsiflexion (MAS MD = -4.04, p < 0.001, CI95% = -6.79; -0.86, LAS MD = -3.16, p < 0.001) and plantarflexor moments in terminal stance (MAS MD = -149.65, p = 0.018, CI95% = -259.35; -48.25, LAS MD = -191.81, p = 0.008, CI95% = -323.81; -57.31) were observed. Ground reaction force peaks during loading response (MAS MD = -16.86, p < 0.001, CI95% = -26.12; -0.72 LAS MD = -11.74, p = 0.001, CI95% = -19.68; -3.94) and foot-off (MAS MD = 10.38, p = 0.015, CI95% = 0.41; 20.53, LAS MD = 11.88, p = 0.01, CI95% = 3.15; 22.38) were also reduced. Conclusions: Children who have completed chemotherapy present measurable gait deviations reflecting persistent neuromechanical impairment, likely linked to chemotherapy-induced neurotoxicity and deconditioning. Instrumented gait analysis allows early detection of these alterations and may support the design of targeted rehabilitation strategies to optimize functional recovery and long-term quality of life in pediatric cancer survivors.

Background/Objectives: Cluttering in childhood and adolescence is characterised by unstable speech timing, excessive coarticulation, irregular rate and reduced intelligibility, yet the developmental mechanisms underpinning these behaviours remain partially understood. This review synthesises empirical and conceptual evidence to examine cluttering through the lenses of speech motor development, neurocognitive mechanisms, task demands and allied-health practice. Four research questions guided the review, focusing on motor characteristics, developmental and neurocognitive mechanisms, task dependence and clinical implications. Methods: Following the PRISMA guidelines, a comprehensive search across seven databases identified studies examining cluttering in children and adolescents. Screening and full-text review were conducted in Covidence by two reviewers, with disagreements resolved by the first author. Twelve studies met the inclusion criteria. Data were extracted into a structured evidence table, and findings were synthesised. Results: Across studies, cluttering emerged as a developmental motor-cognitive integration disorder. Speech motor systems, linguistic formulation and executive control showed difficulty aligning under real-world communicative demands, leading to timing instability, articulatory blurring and reduced intelligibility. Symptoms were strongly influenced by task complexity, with spontaneous and extended discourse eliciting the most pronounced breakdowns. Conclusions: Cluttering reflects a developmental vulnerability in coordinating speech motor, linguistic and executive processes. Understanding cluttering in this way challenges narrow rate-based definitions and supports more nuanced approaches to assessment and intervention. Significant evidence gaps remain, particularly in longitudinal, mechanistic, multilingual and ecologically valid research. This developmental motor-cognitive framework strengthens the conceptual foundations of cluttering and clarifies its relevance to children's motor development.

Background/Objectives: Neurodevelopmental disorders (NDDs) require contextual approaches emphasizing family roles. Parents of children with NDDs face a complex socio-emotional reality. They may experience high levels of stress, fatigue, depression, and feelings of guilt and uncertainty, and they are often left feeling isolated and unsupported. All of these factors increase their socio-emotional vulnerability and affect their children's wellbeing. A significant part of the available evidence has focused on parents of typically developing children or on a single construct. For these reasons, and considering the impact of the COVID-19 pandemic, the aim of this study was to review interventions targeting the improvement of the socio-emotional wellbeing of parents of children with NDDs, in order to characterise recent research, the specific constructs addressed, and the effectiveness of interventions. Methods: No prior protocol/registration. ERIC and Web of Science databases (selected for their broad multidisciplinary coverage in psychology and social sciences) were searched from 2020-2025 (last search: 7 September 2025), limited to English/Spanish publications. Inclusion criteria encompassed parents/primary family caregivers of children with NDDs receiving socio-emotional programs. Two independent reviewers screened the titles/abstracts and full texts, resolving disagreements through discussion. Following PRISMA 2020 guidelines, this systematic review employed narrative synthesis without risk-of-bias assessment and included 16 studies (approximately, 1100 participants). Results: The analysis indicated a scarce but growing scientific output, with a complex methodological landscape showing promising preliminary convergence in intervention outcomes. Interventions effects appeared mediated by cultural suitability, accessibility, and contextual alignment. Conclusions: Future work should pursue multisystemic approaches engaging diverse societal contexts and agents to optimize child and family wellbeing.

Background/Objectives: Conservative management of pediatric forearm fractures remains challenging due to the high incidence of secondary displacement. Given the remarkable remodeling potential of children's bones, clinicians must decide whether to rely on natural healing or intervene. This study evaluated whether accepted secondary displacements affect long-term outcomes and sought to identify predictors of functional impairment. Methods: This retrospective cohort study assessed the long-term outcomes of a cohort of 410 consecutive children who presented with 212 distal metaphyseal and 198 diaphyseal both-bone forearm fractures between 2006-2010. In all patients, closed reduction was recommended for ≥50% displacement, ≥15° angulation (<10 years), or ≥10° angulation (10-16 years). Secondary displacements were frequently accepted, anticipating remodeling. We included 316 children (<16 years) with both-bone forearm fractures (147 diaphyseal, 169 distal metaphyseal), representing 77% of the original cohort, for long-term follow-up (mean 7.2 years, minimum 4 years). Functional and radiographic outcomes were compared between accepted secondary displacements and maintained alignments, stratified by fracture location. Multivariate logistic regression identified predictors of long-term functional impairment, defined as ≥15° loss of pro-supination or QuickDASH ≥ 20. Results: In the distal metaphyseal group there were 50 secondary displacements out of 212 fractures, of which 31 were accepted. In the diaphyseal group there were 60 secondary displacements, of which 49 were accepted. At long-term follow-up, patients with accepted secondary displacements had no clinically relevant differences in functional or radiographic outcomes compared with those with maintained alignments across both diaphyseal and distal metaphyseal fracture groups. For distal fractures, complete initial radial displacements, re-fractures, and bicortical ulnar fractures predicted pro-supination loss ≥ 15° or QuickDASH ≥ 20. For diaphyseal fractures, older age at trauma predicted increased risk of pro-supination limitation. Conclusions: Accepted secondary displacements did not worsen long-term outcomes, supporting reconsideration of strict reduction criteria. The substantial remodeling capacity of pediatric bone-especially in distal metaphyseal fractures in skeletally immature children-should be emphasized when making treatment decisions to avoid unnecessary surgical interventions.

Background/Objectives: Pediatric trauma systems require accurate metrics for evaluating triage decisions. Undertriage occurs when an injured child requires pediatric trauma center resources but is treated at a center lacking those resources. Current undertriage definitions utilize mortality-based scores, including the Injury Severity Score (ISS) > 15 or the International Classification of Disease (ICD) Injury Severity Score (ICISS). However, resource-based metrics like the ICD Critical Care Severity Score (ICASS) may be preferable in children. This study evaluated the relationship of ISS, ICISS and ICASS to the need for pediatric trauma resources (NFPTCR) to derive a more empiric definition of undertriage. Methods: The American College of Surgeons Trauma Quality Improvement Program database was queried for patients aged ≤ 15 years old. NFPTCR was defined as blood product transfusion within 4 h, invasive procedure for cardiopulmonary stabilization/contamination/bleeding within 72 h, initial admission to intensive care unit (ICU) or ICU stay ≥ 3 days, intubation, mechanical ventilation and general anesthesia ≤ 5 years old, or physical child abuse. ICASS and ICISS were derived from 2014 to 2018 datasets and applied to the 2019 dataset. The ability of ISS, ICISS and ICASS to distinguish NFPTCR patients was assessed using multivariable logistic regression and receiver-operator characteristic (ROC) analysis. Results: Out of 97,773 children, 15,985 (16%) were NFPTCR+. ISS, ICISS and ICASS had areas under the curve of 0.760, 0.701 and 0.812 for NFPTCR+, respectively (all p < 0.001). ISS had 36% sensitivity at 15; whereas ICASS had 95%, 93% and 89% sensitivity at 5, 10 and 15, respectively. Conclusions: ICASS was superior to ISS and ICISS for identifying NFPTCR. Consideration should be given to redefining pediatric trauma undertriage based on resource-based metrics, like ICASS.

Late bedtimes and insufficient sleep duration among children and adolescents have been consistently associated with daytime sleepiness, irritability, and poorer academic performance. To mitigate these adverse consequences of insufficient sleep, it is essential to provide children, students, teachers, and parents with not only knowledge about sleep improvement but also practical tools that facilitate behavioral change. This review synthesizes existing evidence from studies that have addressed this issue by evaluating students' individual sleep behaviors using checklists of sleep-promoting practices. Drawing on practical examples from school-based interventions, the review highlights the effectiveness of sleep education programs for children and adolescents. These programs aim to bridge the gap between sleep-related knowledge and actual behavioral change by targeting daily sleep habits. Typically, such programs consist of a single 50 min educational session focusing on the importance of sleep and strategies for improvement, followed by a two-week self-help period during which students actively practice and monitor specific target behaviors. Overall, the findings indicate that sleep education programs incorporating self-help components not only enhance sleep-related knowledge but also promote healthier sleep behaviors and improve sleep patterns. Moreover, these programs effectively reduce daytime sleepiness and irritability among children and adolescents, thereby contributing to a healthier and more adaptive school life.

Background/Objectives: Asthma, type 1 diabetes mellitus (T1DM), and epilepsy are prevalent chronic diseases among school-aged children, affecting safety, attendance, and academic performance. This systematic review evaluated school teachers' knowledge, attitudes, and preparedness regarding these conditions and identified gaps that hinder effective management and inclusion. Methods: Following PRISMA guidelines, PubMed, Cochrane Library, Scopus, and Google Scholar were searched between 20 September and 9 October 2025. Forty-nine quantitative cross-sectional studies assessing teachers' knowledge, attitudes, or preparedness toward asthma, T1DM, or epilepsy were included. The AXIS tool assessed methodological quality, focusing on clarity of objectives, sample justification, ethical transparency, and instrument validation. Results: Teachers' knowledge was generally moderate and varied by region. Studies on epilepsy (n = 21) highlighted misconceptions and limited understanding of seizure first aid. Diabetes studies (n = 9) indicated moderate awareness but insufficient preparedness for hypoglycemia and insulin management. Asthma studies (n = 19) revealed inconsistent knowledge, particularly regarding symptom recognition and emergency response. AXIS assessment identified recurring limitations, including unjustified sample sizes, limited instrument validation, and poor reporting of non-responders. Conclusions: These findings emphasize the need to enhance school preparedness through targeted, evidence-based teacher training, clear health policies and emergency protocols, awareness and inclusion initiatives, improved collaboration among teachers, parents, and healthcare providers, and strengthened school health infrastructure. Addressing these areas is critical to ensure safe, inclusive, and supportive learning environments for children with chronic illnesses.

Background/Objectives: The Rett Syndrome Behavior Questionnaire (RSBQ) is a widely used caregiver-reported instrument for assessing behavioral and neurological features of Rett syndrome (RTT). However, a validated Korean version has not been available. This study aimed to translate the RSBQ into Korean (K-RSBQ) and to evaluate its psychometric properties in a Korean RTT population. Methods: The RSBQ was translated and back-translated using standardized procedures and refined through a Delphi process. Primary caregivers of individuals with clinically diagnosed RTT completed an online survey including the K-RSBQ and the Childhood Autism Rating Scale (CARS). Test-retest reliability was assessed in a subset of caregivers who completed the questionnaire twice within one week, and inter-rater reliability was evaluated when an additional caregiver was available. Results: Sixty-six primary caregivers participated. The K-RSBQ demonstrated high internal consistency for the total score (Cronbach's α = 0.912) and moderate-to-high consistency across most subscales. Test-retest reliability for the total score was moderate (weighted κ = 0.594), while inter-rater reliability between primary and secondary caregivers was generally low. The hand behavior subscale showed low and non-significant test-retest reliability. The K-RSBQ total score exhibited a low-to-moderate correlation with the CARS total score, and the general mood subscale showed a moderate correlation with the CARS emotional response item. Caregivers reported minimal difficulty in understanding the questionnaire items. Conclusions: The K-RSBQ demonstrates acceptable internal consistency and test-retest reliability when administered to primary caregivers, with preliminary evidence supporting its construct validity. Although limitations exist regarding criterion validation and inter-rater agreement, the K-RSBQ represents a feasible and culturally adapted tool for assessing RTT-related behavioral features in Korean clinical and research settings.

Background/objective: Despite the fact that almost 87% of children with Autism Spectrum Disorder (ASD) have physical coordination issues, motor skills are not the primary concern when ASD is diagnosed. An aquatic environment can provide multisensory stimuli that might assist these children; however, studies related to hydrotherapy with children with ASD have not yet examined whether this environment has an effect on balance and coordination.

Methods: A control vs. research group examined the effect of a weekly, three-month hydrotherapy program on the balance and coordination abilities of male children and adolescents diagnosed with high-functioning ASD. Children (N = 22) between the ages of 6 and 17 years (mean: 8.4 ± 2.4), participated in this study. Each participant's coordination and balance abilities were evaluated using the Movement Assessment Battery for Children-Second Edition (M-ABC-II). The initial evaluation (test one) was repeated (test two) after two months to establish improvement prior to intervention. The final evaluation (test three) was conducted at intervention termination. Individual functional goals were set for each patient using the Goal Attainment Scale (GAS).

Results: No improvement was noted within the pre-intervention period (between tests one and two), yet there was a statistically significant improvement in the M-ABC-II Total Test score (p = 0.0133), in Manual Dexterity (p = 0.0181), and balance (p = 0.0053) post-intervention, between tests two and three. The mean GAS score for this study was 52.1, suggesting the achievement of prespecified functional goals.

Conclusions: This study demonstrated a positive impact of a 12-week hydrotherapy program on balance and coordination and manual dexterity among children with ASD. A positive impact was also noted in patients' individual functional abilities.