Pub Date : 2026-02-01DOI: 10.1016/j.anpedi.2025.504129
Paz González-Rodríguez , María Aparicio-Rodrigo , Josep Vicent Balaguer-Martínez
{"title":"Integrar la mejor evidencia disponible: una hoja de ruta metodológica para el pediatra clínico","authors":"Paz González-Rodríguez , María Aparicio-Rodrigo , Josep Vicent Balaguer-Martínez","doi":"10.1016/j.anpedi.2025.504129","DOIUrl":"10.1016/j.anpedi.2025.504129","url":null,"abstract":"","PeriodicalId":7783,"journal":{"name":"Anales de pediatria","volume":"104 2","pages":"Article 504129"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.anpedi.2025.504058
Vicente Santa-María López , Ignacio Gutiérrez-Carrasco , Antonio Pérez-Martínez , Carmen Rodríguez-Vigil Iturrate , Susana García-Obregón , Mikael Lorite Reggiori , Thais Murciano Carrillo , Lorena Valero-Arrese , Montse Torrent , Itziar Astigarraga , en representación del Grupo de Histiocitosis de la Sociedad Española de Hematología y Oncología Pediátricas (SEHOP)
Langerhans cell histiocytosis (LCH) is a rare inflammatory myeloid neoplasm with heterogeneous organ and system involvement. Neurodegenerative LCH (ND-LDH) is an uncommon late manifestation with progressive clinical and radiological features, substantial morbidity and an unpredictable course. Historically it was considered a paraneoplastic sequela for which treatment was largely ineffective. Multisystemic disease, central diabetes and orbital and/or skull base bone lesions are risk factors associated with the development of ND-LCH. Early diagnosis, guided by clinical, radiological, electrophysiological and neurocognitive evaluations, may enable timely treatment to halt or slow its progression. Recent identification of activating mutations in the mitogen-activated protein kinase (MAPK) pathway and the development of murine models have redefined ND-LCH as an active neuroinflammatory and neurodegenerative form of LCH, changing our understanding of its etiopathogenesis and identifying novel risk factors and targets for therapy.
{"title":"Neurodegeneración en histiocitosis de células de Langerhans: más que una secuela","authors":"Vicente Santa-María López , Ignacio Gutiérrez-Carrasco , Antonio Pérez-Martínez , Carmen Rodríguez-Vigil Iturrate , Susana García-Obregón , Mikael Lorite Reggiori , Thais Murciano Carrillo , Lorena Valero-Arrese , Montse Torrent , Itziar Astigarraga , en representación del Grupo de Histiocitosis de la Sociedad Española de Hematología y Oncología Pediátricas (SEHOP)","doi":"10.1016/j.anpedi.2025.504058","DOIUrl":"10.1016/j.anpedi.2025.504058","url":null,"abstract":"<div><div>Langerhans cell histiocytosis (LCH) is a rare inflammatory myeloid neoplasm with heterogeneous organ and system involvement. Neurodegenerative LCH (ND-LDH) is an uncommon late manifestation with progressive clinical and radiological features, substantial morbidity and an unpredictable course. Historically it was considered a paraneoplastic sequela for which treatment was largely ineffective. Multisystemic disease, central diabetes and orbital and/or skull base bone lesions are risk factors associated with the development of ND-LCH. Early diagnosis, guided by clinical, radiological, electrophysiological and neurocognitive evaluations, may enable timely treatment to halt or slow its progression. Recent identification of activating mutations in the mitogen-activated protein kinase (MAPK) pathway and the development of murine models have redefined ND-LCH as an active neuroinflammatory and neurodegenerative form of LCH, changing our understanding of its etiopathogenesis and identifying novel risk factors and targets for therapy.</div></div>","PeriodicalId":7783,"journal":{"name":"Anales de pediatria","volume":"104 2","pages":"Article 504058"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To evaluate muscle strength based on grip strength in children and adolescents with obesity and comparing it with reference values. To analyse the association with body composition findings obtained by bioelectrical impedance analysis as well as clinical and biochemical variables.
Material and methods
Retrospective observational cohort study in pediatric patients with obesity (6-16 years) followed up in an outpatient clinic in a tertiary care hospital. We collected data on physical activity and anthropometric, biochemical, sonographic, bioimpedance and dynamometry parameters.
Results
The sample included 125 patients (mean age, 12.06 years; 50.4% female; body mass index [BMI] Z-score, 3.87 [SD, 1.46]). Male participants were less severely obese and had a healthier body composition. Prepubertal patients were less physically active and had a higher fat mass (FM) percentage. The prevalence of metabolic comorbidities, such as hyperuricemia and insulin resistance, increased with the degree of obesity. Children with obesity had a mean muscle strength Z-score of +0.71 in the dominant hand, with differences based on sex and stage of pubertal development. We found dynapenia in 4.8%, with a greater prevalence in prepubertal children. Muscle strength was positively correlated to physical activity, fat-free mass and phase angle and negatively correlated to FM percentage. Fat-free mass was the strongest predictor of muscle strength.
Conclusions
In this sample of children with obesity, muscle strength was not decreased compared to the healthy reference population. Fat-free mass is the strongest predictor of muscle strength. The findings highlight the positive influence of physical activity and the amount of lean mass on strength in children and adolescents with obesity.
{"title":"Estudio de la fuerza muscular mediante dinamometría de prensión manual en pacientes pediátricos con obesidad","authors":"Álvaro Martín Rivada , Mercedes Murray Hurtado , Elena Sánchez Camacho , Yolanda Ramallo Fariña","doi":"10.1016/j.anpedi.2025.504103","DOIUrl":"10.1016/j.anpedi.2025.504103","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate muscle strength based on grip strength in children and adolescents with obesity and comparing it with reference values. To analyse the association with body composition findings obtained by bioelectrical impedance analysis as well as clinical and biochemical variables.</div></div><div><h3>Material and methods</h3><div>Retrospective observational cohort study in pediatric patients with obesity (6-16 years) followed up in an outpatient clinic in a tertiary care hospital. We collected data on physical activity and anthropometric, biochemical, sonographic, bioimpedance and dynamometry parameters.</div></div><div><h3>Results</h3><div>The sample included 125 patients (mean age, 12.06 years; 50.4% female; body mass index [BMI] <em>Z-</em>score, 3.87 [SD, 1.46]). Male participants were less severely obese and had a healthier body composition. Prepubertal patients were less physically active and had a higher fat mass (FM) percentage. The prevalence of metabolic comorbidities, such as hyperuricemia and insulin resistance, increased with the degree of obesity. Children with obesity had a mean muscle strength <em>Z-</em>score of +0.71 in the dominant hand, with differences based on sex and stage of pubertal development. We found dynapenia in 4.8%, with a greater prevalence in prepubertal children. Muscle strength was positively correlated to physical activity, fat-free mass and phase angle and negatively correlated to FM percentage. Fat-free mass was the strongest predictor of muscle strength.</div></div><div><h3>Conclusions</h3><div>In this sample of children with obesity, muscle strength was not decreased compared to the healthy reference population. Fat-free mass is the strongest predictor of muscle strength. The findings highlight the positive influence of physical activity and the amount of lean mass on strength in children and adolescents with obesity.</div></div>","PeriodicalId":7783,"journal":{"name":"Anales de pediatria","volume":"104 2","pages":"Article 504103"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.anpedi.2025.504088
M. Ángeles Rivas Paterna , Carla Pérez Ingidua , Ana B. Rivas Paterna , David Ortega Martínez , Esther Aleo Luján , Emilio Vargas Castrillón
Introduction
In December 2021, Spain launched its COVID-19 vaccination campaign for children aged 5 to 11 years. Although the Comirnaty® vaccine exhibited a favorable safety profile in premarketing trials, its rapid deployment and novel mRNA technology raised concerns among the public, leading to parental hesitancy. Real-world postmarketing data are limited but crucial for guiding clinical and public health policy decisions.
Objective
To assess the incidence and nature of adverse drug reactions (ADRs) following pediatric COVID-19 vaccination.
Methods
Prospective, observational and descriptive study conducted at a tertiary care hospital in Spain. The sample consisted of a total of 2126 children aged 5 to 11 years. Data on ADRs were collected through telephone interviews, health record reviews and institutional registries. An expert committee evaluated each ADR using predefined criteria for causality and severity.
Results
Overall, 35.6% of participants reported at least one ADR, totaling 1437 reactions. Most were mild (99.5%) and resolved spontaneously. Only one case was classified as severe. The most common ADRs were injection site pain (57.1%), fever (11.1%) and headache (5.7%). There was no evidence of increased reactogenicity after the second dose. Of all ADRs, 65.1% were considered «definite» or «probable.»
Conclusions
The Comirnaty® vaccine maintains a favorable safety profile in children under real-world conditions, with predominantly mild, self-limiting reactions and minimal need for medical care.
{"title":"Reacciones adversas a la vacuna COVID-19 en población pediátrica en España","authors":"M. Ángeles Rivas Paterna , Carla Pérez Ingidua , Ana B. Rivas Paterna , David Ortega Martínez , Esther Aleo Luján , Emilio Vargas Castrillón","doi":"10.1016/j.anpedi.2025.504088","DOIUrl":"10.1016/j.anpedi.2025.504088","url":null,"abstract":"<div><h3>Introduction</h3><div>In December 2021, Spain launched its COVID-19 vaccination campaign for children aged 5 to 11<!--> <!-->years. Although the Comirnaty® vaccine exhibited a favorable safety profile in premarketing trials, its rapid deployment and novel mRNA technology raised concerns among the public, leading to parental hesitancy. Real-world postmarketing data are limited but crucial for guiding clinical and public health policy decisions.</div></div><div><h3>Objective</h3><div>To assess the incidence and nature of adverse drug reactions (ADRs) following pediatric COVID-19 vaccination.</div></div><div><h3>Methods</h3><div>Prospective, observational and descriptive study conducted at a tertiary care hospital in Spain. The sample consisted of a total of 2126 children aged 5 to 11<!--> <!-->years. Data on ADRs were collected through telephone interviews, health record reviews and institutional registries. An expert committee evaluated each ADR using predefined criteria for causality and severity.</div></div><div><h3>Results</h3><div>Overall, 35.6% of participants reported at least one ADR, totaling 1437 reactions. Most were mild (99.5%) and resolved spontaneously. Only one case was classified as severe. The most common ADRs were injection site pain (57.1%), fever (11.1%) and headache (5.7%). There was no evidence of increased reactogenicity after the second dose. Of all ADRs, 65.1% were considered «definite» or «probable.»</div></div><div><h3>Conclusions</h3><div>The Comirnaty® vaccine maintains a favorable safety profile in children under real-world conditions, with predominantly mild, self-limiting reactions and minimal need for medical care.</div></div>","PeriodicalId":7783,"journal":{"name":"Anales de pediatria","volume":"104 2","pages":"Article 504088"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.anpedi.2025.504109
Laia Brunet-Garcia , Flavio Zuccarino , Juan Manuel Carretero Bellon
{"title":"Una arteria, dos circulaciones: retos diagnósticos del origen anómalo de una rama de la arteria pulmonar desde la aorta en neonatos","authors":"Laia Brunet-Garcia , Flavio Zuccarino , Juan Manuel Carretero Bellon","doi":"10.1016/j.anpedi.2025.504109","DOIUrl":"10.1016/j.anpedi.2025.504109","url":null,"abstract":"","PeriodicalId":7783,"journal":{"name":"Anales de pediatria","volume":"104 2","pages":"Article 504109"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Hernia muscular en miembros inferiores en un adolescente","authors":"Lidia Jiménez García, Javier Vicente Hernández, Jorge Andrés López-Torrijos Florez, Gabriela Valentina Cattabriga León","doi":"10.1016/j.anpedi.2025.504062","DOIUrl":"10.1016/j.anpedi.2025.504062","url":null,"abstract":"","PeriodicalId":7783,"journal":{"name":"Anales de pediatria","volume":"104 2","pages":"Article 504062"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.anpedi.2025.504087
Andrés Rodríguez Galeano , Erika Ruge Joya , Diana Bravo Guerra , Juan Roa Giraldo
Introduction
Inflammatory immune-mediated diseases of the central nervous system, such as autoimmune encephalitis, acute disseminated encephalomyelitis or Guillain-Barré syndrome, pose diagnostic and therapeutic challenges in the pediatric population. Therapeutic plasma exchange has emerged as a useful option in these cases. This study evaluated the clinical response to therapeutic plasma exchange in children with these conditions.
Methods
We conducted a retrospective cohort study at Fundación Hospital Pediátrico La Misericordia in Bogotá (2018-2022), including 50 patients with a confirmed diagnosis of antibody-mediated inflammatory disease of the central nervous system who were managed with therapeutic plasma exchange. We collected data on clinical, therapeutic and outcome variables and performed descriptive, survival, and Cox regression analyses.
Results
The mean age was 10 years, with a uniform sex distribution. The most frequent conditions were autoimmune encephalitis (36%) and acute disseminated encephalomyelitis (14%). At discharge, 56% of patients had persistent neurologic symptoms and 46% had recovered their prior functional status. The mortality was 6%. The use of antiepileptic drugs was significantly associated with a lower risk of relapse (hazard ratio, 0.081; P = .024) and steroid use with increased survival, particularly in patients with autoimmune encephalitis, acute disseminated encephalomyelitis and myasthenia gravis (P < .05).
Conclusion
Therapeutic plasma exchange is a viable and safe treatment strategy for children with immune-mediated inflammatory diseases of the central nervous system. The concomitant use of antiepileptic drugs and steroids showed benefits in reducing relapse and mortality.
{"title":"Respuesta clínica a la terapia de recambio plasmático en pacientes con enfermedades inflamatorias del sistema nervioso central inmunomediadas","authors":"Andrés Rodríguez Galeano , Erika Ruge Joya , Diana Bravo Guerra , Juan Roa Giraldo","doi":"10.1016/j.anpedi.2025.504087","DOIUrl":"10.1016/j.anpedi.2025.504087","url":null,"abstract":"<div><h3>Introduction</h3><div>Inflammatory immune-mediated diseases of the central nervous system, such as autoimmune encephalitis, acute disseminated encephalomyelitis or Guillain-Barré syndrome, pose diagnostic and therapeutic challenges in the pediatric population. Therapeutic plasma exchange has emerged as a useful option in these cases. This study evaluated the clinical response to therapeutic plasma exchange in children with these conditions.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study at Fundación Hospital Pediátrico La Misericordia in Bogotá (2018-2022), including 50 patients with a confirmed diagnosis of antibody-mediated inflammatory disease of the central nervous system who were managed with therapeutic plasma exchange. We collected data on clinical, therapeutic and outcome variables and performed descriptive, survival, and Cox regression analyses.</div></div><div><h3>Results</h3><div>The mean age was 10 years, with a uniform sex distribution. The most frequent conditions were autoimmune encephalitis (36%) and acute disseminated encephalomyelitis (14%). At discharge, 56% of patients had persistent neurologic symptoms and 46% had recovered their prior functional status. The mortality was 6%. The use of antiepileptic drugs was significantly associated with a lower risk of relapse (hazard ratio, 0.081; <em>P</em> <!-->=<!--> <!-->.024) and steroid use with increased survival, particularly in patients with autoimmune encephalitis, acute disseminated encephalomyelitis and myasthenia gravis (<em>P</em> <<!--> <!-->.05).</div></div><div><h3>Conclusion</h3><div>Therapeutic plasma exchange is a viable and safe treatment strategy for children with immune-mediated inflammatory diseases of the central nervous system. The concomitant use of antiepileptic drugs and steroids showed benefits in reducing relapse and mortality.</div></div>","PeriodicalId":7783,"journal":{"name":"Anales de pediatria","volume":"104 2","pages":"Article 504087"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.anpedi.2025.504026
José Manuel Moreno Villares
{"title":"La investigación y la publicación científica en Pediatría en España","authors":"José Manuel Moreno Villares","doi":"10.1016/j.anpedi.2025.504026","DOIUrl":"10.1016/j.anpedi.2025.504026","url":null,"abstract":"","PeriodicalId":7783,"journal":{"name":"Anales de pediatria","volume":"104 2","pages":"Article 504026"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"La investigación y la publicación científica en Pediatría en España. La visión del comité editorial","authors":"Montserrat Antón-Gamero , Alejandro Avila-Alvarez , Josep Vicent Balaguer-Martínez , Mercedes Bueno Campaña , Rafael Galera-Martínez","doi":"10.1016/j.anpedi.2025.504126","DOIUrl":"10.1016/j.anpedi.2025.504126","url":null,"abstract":"","PeriodicalId":7783,"journal":{"name":"Anales de pediatria","volume":"104 2","pages":"Article 504126"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.anpedi.2025.504064
Gonzalo Pin Arboledas , Milagros Merino Andreu , Pedro Javier Rodríguez Hernández , Marta Furones García , Lucia Monfort Belenguer , Teresa de la Calle Cabrera , Guillermo Benito Ruiz , Óscar Sans Capdevila , Carlos Javier Egea Santaolalla
Introduction and objectives
The prevalence of sleep problems in people with ASD is high, affecting their quality of life and social skills. To date, there is no guideline for the treatment of insomnia in people with ASD at the national level in Spain or the European level. With the aim to guide the comprehensive management of insomnia, this consensus document was created under the leadership of the Spanish Association of Pediatrics (AEP) and the Spanish Sleep Society (SES).
Methods
Modified and adapted Delphi process.
Results and conclusions
The document describes diagnostic tools for use before treatment initiation and provides recommendations for comprehensive management. The treatment of insomnia begins with sleep hygiene measures and personalized cognitive-behavioral therapies. In maintenance insomnia, if these are not sufficient, pediatric prolonged-release melatonin (PedPRM) is recommended as the first-line drug, starting with a dose of 2 mg/day and adjusting it to up to 10 mg/day as needed. If the problems persist, alimemazine, risperidone or clonidine can be added, in that order, in a stepwise fashion. For early insomnia, immediate-release melatonin (IRM) is recommended, starting with a dose of 5 mg/day and reducing it to up to 2 mg/day if it is effective or increasing it to up to 7 mg/day otherwise, or else PedPRM. The dosage should be reevaluated periodically in regular follow-up visits using sleep diaries.
{"title":"Consenso sobre el tratamiento del insomnio en personas con trastorno del espectro autista menores de 18 años","authors":"Gonzalo Pin Arboledas , Milagros Merino Andreu , Pedro Javier Rodríguez Hernández , Marta Furones García , Lucia Monfort Belenguer , Teresa de la Calle Cabrera , Guillermo Benito Ruiz , Óscar Sans Capdevila , Carlos Javier Egea Santaolalla","doi":"10.1016/j.anpedi.2025.504064","DOIUrl":"10.1016/j.anpedi.2025.504064","url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>The prevalence of sleep problems in people with ASD is high, affecting their quality of life and social skills. To date, there is no guideline for the treatment of insomnia in people with ASD at the national level in Spain or the European level. With the aim to guide the comprehensive management of insomnia, this consensus document was created under the leadership of the Spanish Association of Pediatrics (AEP) and the Spanish Sleep Society (SES).</div></div><div><h3>Methods</h3><div>Modified and adapted Delphi process.</div></div><div><h3>Results and conclusions</h3><div>The document describes diagnostic tools for use before treatment initiation and provides recommendations for comprehensive management. The treatment of insomnia begins with sleep hygiene measures and personalized cognitive-behavioral therapies. In maintenance insomnia, if these are not sufficient, pediatric prolonged-release melatonin (PedPRM) is recommended as the first-line drug, starting with a dose of 2<!--> <!-->mg/day and adjusting it to up to 10<!--> <!-->mg/day as needed. If the problems persist, alimemazine, risperidone or clonidine can be added, in that order, in a stepwise fashion. For early insomnia, immediate-release melatonin (IRM) is recommended, starting with a dose of 5<!--> <!-->mg/day and reducing it to up to 2<!--> <!-->mg/day if it is effective or increasing it to up to 7<!--> <!-->mg/day otherwise, or else PedPRM. The dosage should be reevaluated periodically in regular follow-up visits using sleep diaries.</div></div>","PeriodicalId":7783,"journal":{"name":"Anales de pediatria","volume":"104 2","pages":"Article 504064"},"PeriodicalIF":2.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146090793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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