bims-cliped 2026-03-29 papers

bims-cliped

Biomed News

on Clinical pediatrics

Issue of 2026–03–29
28 papers selected by
Alyssa M. Portwood, Akron’s Children

Extraneural metastases of pediatric brain tumors: a systematic review.
Major Adverse Events of Cardiac Catheterization in Pediatric Cardiomyopathy: Insights From the IMPACT Registry.
Prevalence of Hip Joint Effusion in Children Diagnosed With Transient Synovitis in the Pediatric Emergency Department.
Management strategies of pediatric coccydynia: a narrative review.
Safety of excipients in pediatric medications: Impact on child health.
Adult Rome IV Disorders of Gut-Brain Interaction in a Pediatric Population.
Effect of ondansetron on QTc interval prolongation in healthy pediatric patients: a systematic review and meta-analysis.
Redefining Fatherhood: A Qualitative Exploration of Fathering Practice in Pediatric Cancer Families in China.
Clonidine-assisted EEG in children: A three year retrospective review of effectiveness and safety.
Parent Perspectives on the Diagnosis, Management, and Family Impact of Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis Syndrome.
Adherence to Pediatric Asthma Guidelines in Children with Asthma Exacerbation at the Emergency Department.
Chill out: Hypothermia treatment in the pediatric patient population.
Public Insurance Is Associated with Delays to Surgery in Pediatric Patients with a First-Time Patellar Dislocation Involving a Loose Body.
Current Evidence on the Role of Pediatric Dentists in the Multidisciplinary Management of Pediatric Obstructive Sleep Apnea.
Outcomes in the Management of Pediatric Retrograde Cricopharyngeal Dysfunction.
The Impact of Follow-Up on Etiological Classification of Pediatric Vertigo.
An Epidemiologic Review of Vascular Complications in Pediatric Posterior Sternoclavicular Dislocations: Implications for "Cardiothoracic Standby".
Reducing extravasation and infiltration in the pediatric population: a best practice implementation project.
Safety and Tolerability of Bilastine 0.6% Ophthalmic Solution in Children and Adolescents: An 8-Week Phase 3 Study.
Children with enuresis - are they more constipated than others?
Updates in pediatric kidney transplantation.
Digital Tools' Effectiveness on Physical Activity Outcomes in Children and Adolescents: Umbrella Review.
ADHD in Children, Adolescents, and Adults: Incidence, Prevalence, and Treatment. An Analysis of Routine Health Insurance Data.
Seasonal allergic rhinitis in children: diagnostic markers of extreme allergic phenotype formation.
Mixed-Method Follow-Up of Toddler-Aged Children with Spastic Cerebral Palsy After an Intense Physical/Occupational Therapy Intervention.
Buprenorphine for Children and Adolescents with Sickle Cell Disease: A Scoping Review.
Pediatric Evans Syndrome as a Multisystem Immune Disorder: A 13-Year Longitudinal Experience from a Single Academic Center.
Evaluating Study Techniques for Australian Medical Students During Clinical Placement: A Scoping Review.

J Neurosurg Pediatr. 2026 Mar 20. 1-10

Extraneural metastases of pediatric brain tumors: a systematic review.

Maria Cristina Roccavilla, Eric Vigneul, Edward Fomekong.

   OBJECTIVE: Brain tumors are the most common solid neoplasm in children, accounting for 25% of pediatric cancer cases, with an incidence rate of 6.23 per 100,000. In addition, up to 2% of these patients will develop extraneural metastases associated with a significantly poorer prognosis. The aim of this study was to investigate the incidence, presentation patterns, and neurosurgical considerations associated with extraneural metastases of primary pediatric brain tumors.
METHODS: Using PRISMA guidelines, a search was conducted in the PubMed database to identify all full-text articles published in the English language up to May 2024 that described extraneural metastases in the pediatric population. The included studies comprised retrospective case reports and case series detailing the occurrence of extraneural metastasis following diagnosis of a primary brain tumor. Statistical differences between groups were assessed using the Mann-Whitney U-test for continuous variables and the chi-square test for categorical variables.
RESULTS: Of 3811 articles reviewed, 124 articles that included 399 patients (male-to-female ratio of 1.46) with extraneural metastases were identified and analyzed. The mean age at diagnosis of the primary tumor was 8.78 (SD 4.92) years. Latency (the time from diagnosis of the primary tumor to appearance of extraneural metastases) increased with age, with a mean of 19.31 (SD 22.75) months. Medulloblastomas were the most frequent tumors leading to extraneural metastases. Surgical interventions, particularly tumor resection and shunt placement, played a crucial role in the management of the disease, with 79% of children undergoing surgery. Among these patients, placement of a ventriculoperitoneal shunt was associated with a significantly higher occurrence of abdominal metastases (p < 0.00001), whereas lymph node and lung metastases were more frequent in patients without shunts.
CONCLUSIONS: As nearly all pediatric brain tumors carry a risk of extraneural metastases, these findings provide insights into the metastatic behavior of various tumors and highlight that surgery can influence the pattern of metastastic dissemination. This confirms the need for personalized follow-up and clinical management strategies based on tumor type, age, and surgical approach.

Keywords:  brain tumor; extraneural metastasis; medulloblastoma; oncology; pediatric; ventriculoperitoneal shunt

DOI:  https://doi.org/10.3171/2025.10.PEDS25394
J Am Heart Assoc. 2026 Mar 25. e047780

Major Adverse Events of Cardiac Catheterization in Pediatric Cardiomyopathy: Insights From the IMPACT Registry.

Khalifah A Aldawsari, Kevin F Kennedy, Alejandro Martinez Herrada.

   BACKGROUND: Despite the role of cardiac catheterization for hemodynamic assessment and endomyocardial biopsy in children with cardiomyopathy, data on procedure-related major adverse events (MAE) in this population are lacking. We aim to describe the rate of MAE in children with cardiomyopathy undergoing cardiac catheterization. Our secondary objective is to compare the rate of MAE among patient subsets within this population.
METHODS: We included patients with cardiomyopathy from the National Cardiovascular Data Registry IMPACT (Improving Pediatric and Adult Congenital Treatment) who were 18 years old or younger and underwent cardiac catheterization between April 2016 and December 2024. Data collected included demographic, preprocedural, procedural, and outcome-related variables. We performed univariate and multivariate analyses to identify variables independently associated with MAE.
RESULTS: A total of 4932 procedures were evaluated, with a median age of 10 years. Dilated cardiomyopathy was the most prevalent cardiomyopathy in 53.4%. The rate of MAE was 3.17%. The most common MAE was arrhythmia, representing 42.3% of all MAE. The multivariate analysis also revealed that age <1 year, hypertrophic cardiomyopathy compared with dilated cardiomyopathy, preprocedural inotropic support, left femoral venous access, and systemic heparinization were associated with an increased rate of MAE. In contrast, procedures performed electively were associated with a lower risk of MAE.
CONCLUSIONS: Cardiac catheterization in pediatric patients with cardiomyopathy was associated with low incidence of MAE as compared with the general pediatric population. Factors associated with an increased rate of MAE include age <1 year, hypertrophic cardiomyopathy, inotropic support, left femoral venous access, and systemic heparinization.

Keywords:  adverse events; cardiac catheterization; cardiomyopathy; endomyocardial biopsy

DOI:  https://doi.org/10.1161/JAHA.125.047780
Pediatr Emerg Care. 2026 Mar 25.

Prevalence of Hip Joint Effusion in Children Diagnosed With Transient Synovitis in the Pediatric Emergency Department.

Ayelet Shles, Husam Tibi, Nir Friedman.

   BACKGROUND: Transient synovitis (TS) is a benign condition characterized by acute hip pain and is a common cause of limping in children. Ultrasonography (US) examination frequently reveals hip joint effusion. However, accurate documentation of its prevalence among children with a diagnosis of TS is scarcely documented in the literature.
OBJECTIVES: The main objective of our study was to evaluate the prevalence of hip joint effusion among children diagnosed with TS in the pediatric emergency department (PED).
METHODS: A Retrospective chart review of children diagnosed with TS in the PED between 2017 and 2021 who underwent an US examination as part of their evaluation.
RESULTS: Overall, 392 children with a mean age of 5 years were included in the study group, of whom hip effusion was demonstrated in 302 (77%) patients. Most participants underwent point-of-care ultrasound (POCUS) performed by the PED physician as part of their evaluation (328, 83%). Children with hip joint effusion had higher pain levels, hip joint tenderness, and higher CRP values compared with children without an effusion.
CONCLUSIONS: In our study, the prevalence of hip joint effusion among children presenting to the PED with a final clinical diagnosis of TS was 77%. Higher pain levels and hip joint tenderness were associated with the presence of hip effusion in TS.

Keywords:  hip joint effusion; pediatric emergency department (PED); point of care ultrasound (POCUS); transient synovitis (TS); ultrasound (US)

DOI:  https://doi.org/10.1097/PEC.0000000000003597
Front Pediatr. 2026 ;14 1750781

Management strategies of pediatric coccydynia: a narrative review.

Jinchao Cao, Kaixuan Tian.

  Pediatric coccydynia is a challenging, uncommon clinical entity that warrants management distinct from adult protocols, primarily due to the anatomical specificity of the developing coccyx. Despite its morbidity, current therapeutic decision-making is severely constrained by a critical lack of high-level evidence in the pediatric and adolescent population. This narrative review aims to address this knowledge gap by synthesizing the latest available literature on pediatric coccydynia to establish a contemporary, evidence-informed foundation for clinical practice. We performed a comprehensive search of in PubMed, Embase spanning from inception to the present, focusing on studies discussing the etiology, diagnosis, and management outcomes specifically in children and adolescents. The review structurally summarizes the distinguishing anatomy, diverse etiologies, and refined diagnostic approach relevant to pediatric coccydynia. The review outlines a potential stepwise treatment progression, beginning with non-operative strategies (including ergonomic adjustments, pharmacotherapy, and targeted nerve blocks) to coccygectomy as a reported surgical solution for refractory cases. This comprehensive synthesis offers a vital, evidence-informed framework for clinicians navigating the management of coccydynia in pediatric patients.

Keywords:  children; coccydynia; conservative treatment; etiology; pain management; surgical procedures

DOI:  https://doi.org/10.3389/fped.2026.1750781
Farm Hosp. 2026 Mar 23. pii: S1130-6343(26)00024-3. [Epub ahead of print]

Safety of excipients in pediatric medications: Impact on child health.

Leonel Silva-Chocoteco, Monserratt Abud-González, Cesar Ricardo Cortez-Álvarez, Nicte Selene Fajardo-Robledo.

   OBJECTIVE: Excipients, the inactive components of medications, are essential in pharmaceutical formulations, but their safety in the pediatric population is not always guaranteed. Children, due to their physiological and metabolic immaturity, are more susceptible to the adverse effects of these additives. This study aimed to review the safety of the most common excipients in pediatric medicines, highlighting their risks and documented mechanisms of toxicity.
METHOD: A systematic review was conducted following the guidelines for systematic reviews and meta-analyses, including studies published between 2014 and 2025. Searches were performed in PubMed, Web of Science, and ScienceDirect, along with regulations from key international and national regulatory agencies.
RESULTS: Fifty-four excipients with potential toxicity in children were identified and classified into four functional groups. Notable adverse effects include hepatic, renal, and neurological toxicity, as well as hypersensitivity reactions. A significant limitation is the lack of specific data for the pediatric population.
CONCLUSION: exposure to excipients in children is an underestimated clinical problem, exacerbated by the frequent use of formulations adapted from adults. The discussion addresses regulatory disparities, the critical need to develop medicines specifically designed for children, and the importance of collaborative initiatives to build pediatric safety databases. The pharmacist plays a key role in the informed selection of excipients. The findings indicate that a considerable proportion of excipients used in pediatric formulations carry documented toxicological risks, especially in younger age groups. This review underscores the urgent need for more rigorous safety evaluation, the development of age-specific formulations, and greater transparency in information for healthcare professionals.

Keywords:  Drug compounding; Drug toxicity; Drug-related side effects and adverse reactions; Efectos colaterales y reacciones adversas relacionados con medicamentos; Excipientes; Excipients; Formulación de medicamentos; Pediatrics; Pediatría; Pharmaceutical preparations; Preparaciones farmacéuticas; Toxicidad de medicamentos

DOI:  https://doi.org/10.1016/j.farma.2026.02.012
Children (Basel). 2026 Mar 23. pii: 438. [Epub ahead of print]13(3):

Adult Rome IV Disorders of Gut-Brain Interaction in a Pediatric Population.

Natali González Rozo, Carlos Alberto Velasco-Benítez, Michelle Higuera Carrillo, Daniela Alejandra Velasco-Suárez.

  Background: Disorders of the gut-brain interaction (DGBIs) constitute a group of functional conditions widely described in adults; however, some of these have not been included in pediatric Rome criteria, despite the fact that they may manifest during childhood. Early identification of these conditions is relevant due to their clinical/psychosocial impact as well as their effect on quality of life. The aim was to determine the prevalence and associated factors of some DGBIs described in adults according to the Rome IV criteria in pediatric population. Methods: An observational/prospective/cross-sectional study was conducted in toddlers, school-aged children, and adolescents from three Colombian cities. The adapted Questionnaire for Pediatric Gastrointestinal Symptoms Rome IV (QPGS-IV) using adult criteria was applied, along with quality-of-life scales and PROMIS for anxiety/depression. Descriptive uni/bivariate analyses were performed as well as a multivariate logistic regression model. Results: A total of 704 participants were included (13.7 ± 2.8 years old). The prevalence of DGBIs described in adults according to QPGS-IV was 5.8%, with proctalgia fugax being the most frequent. In the bivariate analysis, race, school/social absenteeism, depressive traits, and impaired quality of life were significantly associated. In the multivariate model depressive traits (OR = 4.08; 95%CI = 1.82-9.12; p = 0.001), school (OR = 2.51; 95%CI = 1.06-5.98; p = 0.036), and social absenteeism (OR = 4.04; 95%CI = 1.70-9.62; p = 0.002) were the factors independently associated. Conclusions: These adult DGBIs, according to the QPGS-IV, can occur in pediatric populations and are closely related to psycho-emotional and functional factors. These are mainly associated with depression and school/social absenteeism, supporting the need for a biopsychosocial approach and a revision of the pediatric diagnostic criteria.

Keywords:  Rome criteria; disorders of gut–brain interaction; proctalgia fugax; quality of life

DOI:  https://doi.org/10.3390/children13030438
Rev Paul Pediatr. 2026 ;pii: S0103-05822026000101401. [Epub ahead of print]44 e2025134

Effect of ondansetron on QTc interval prolongation in healthy pediatric patients: a systematic review and meta-analysis.

Isabela Maurício Costa Carneiro, Paulo Eduardo Souza Castelo Branco, Adriane Helena Silva Franco, Amanda Prates de Oliveira, Agatha Marcela Andrade de Aguiar.

OBJECTIVE: The aim of this study was to describe electrocardiographic changes in healthy pediatric patients receiving low-dose ondansetron and to determine whether these changes are associated with the occurrence of cardiac dysrhythmias.
DATA SOURCE: The search was conducted in PubMed, EMBASE, LILACS, SciELO, and the Cochrane databases, selecting articles published until September 2024. The primary outcome was the mean change in the corrected QT interval (QTc) interval. The mean variation of the Tp-e interval and the incidence of significant QTc prolongation were assessed as secondary outcomes.
DATA SYNTHESIS: Four studies were included in this review, including 231 healthy pediatric patients who received ondansetron (IV or oral). Most were male, aged 0.6-18 years. The mean IV ondansetron dose ranged from 0.1 to 0.2 mg/kg, while the mean oral dose was 0.18 mg/kg, with a maximum dose of 8 mg. The mean change in the QTc interval was 4.7 ms (95% confidence interval [CI] 1.48.1), and in the Tp-e interval was 7.7 ms (95%CI 2.0-13.5). The risk of a significant QTc prolongation was 2.5% (95%CI -0.009-0.059). No dysrhythmia was observed in the studies.
CONCLUSIONS: There was a statistically significant increase in QTc and Tp-e intervals following ondansetron administration in healthy pediatric patients. However, it is highly unlikely that these changes result in cardiac dysrhythmia, suggesting no relationship between low-dose ondansetron use and an increased risk of dysrhythmia in healthy pediatric patients.

DOI: https://doi.org/10.1590/1984-0462/2026/44/2025134
J Pediatr Health Care. 2026 Mar 25. pii: S0891-5245(25)00335-9. [Epub ahead of print]

Redefining Fatherhood: A Qualitative Exploration of Fathering Practice in Pediatric Cancer Families in China.

Hui Hou, Tian-Ming Zhang, Xue-Song He.

   INTRODUCTION: Few studies have examined the unique roles of fathers in the context of pediatric cancer. This study explores the distinct characteristics of the roles of fathers of children with cancer, emphasizing how fatherhood experiences in the context of illness differ from traditional fatherhood roles.
METHOD: In this study, an Interpretative Phenomenological Analysis was adopted to guide the research design. Semi-structured interviews were conducted with fathers of children with cancer (n = 12) at a children's hospital in Shanghai. Themes were extracted through the phenomenological analysis, focusing on identity adaptation and the shift in parenting perspectives.
RESULTS: Three main themes were extracted: (1) fatherhood dilemmas, (2) adjusting fatherhood, and (3) rebuilding fatherhood. These findings suggest that the practice of fatherhood is deeply influenced by social contexts and is constantly being reshaped through individual reflection and adaptation.
DISCUSSION: This study highlights fatherhood in the context of pediatric cancer as a process of adjustment and identity reconstruction and recommends a supportive environment to enhance fathers' parenting experiences.

Keywords:  Fatherhood; children with cancer; qualitative study; transformative experience

DOI:  https://doi.org/10.1016/j.pedhc.2025.10.009
Eur J Paediatr Neurol. 2026 Mar 24. pii: S1090-3798(26)00025-5. [Epub ahead of print]61 54-57

Clonidine-assisted EEG in children: A three year retrospective review of effectiveness and safety.

Arie Fisher, Aisling Devitt, Niamh McSweeney, Eimer Maloney.

   OBJECTIVE: To evaluate the effectiveness and safety of clonidine sedation for paediatric electroencephalography (EEG) in children unlikely to tolerate non-sedated recording.
METHODS: We conducted a retrospective review of all clonidine-sedated EEGs performed between September 2022 and September 2025 at our department. For each study, referral details and EEG reports were examined to record patient demographics, prior EEG history, sleep capture, study outcome, and any adverse events. EEGs were classified as successful if recording was completed and interpretable. Sleep was recorded as obtained or not. Descriptive statistics and Mann-Whitney U tests were used.
RESULTS: Seventy-five clonidine-sedated EEGs were included. The mean age was eight years (range 2-17), and 75% were male. Almost all children had a neurodevelopmental or behavioural diagnosis, and most (69%) had previously undergone a non-sedated EEG. Overall, 82% of clonidine EEGs were successfully completed, including 76% of children who had previously failed a non-sedated study. Sleep was obtained in 68% of recordings, and 78% of those who had not achieved sleep previously, did so with clonidine. Median recording duration was 74 min (IQR 53-91). EEG abnormalities were identified in 60% of successful studies. No unplanned admissions or abandoned procedures occurred.
CONCLUSIONS: Clonidine sedation is a safe and effective method for facilitating EEG acquisition and sleep capture in children with developmental or behavioural challenges who are unable to tolerate standard or sleep-deprived recordings. Use of clonidine in this population may reduce failed EEG attempts and support detection of EEG abnormalities in selected patients.

Keywords:  ASD; Behavioral; Children; Clonidine; EEG; Sedation

DOI:  https://doi.org/10.1016/j.ejpn.2026.03.008
Mil Med. 2026 Mar 27. pii: usag138. [Epub ahead of print]

Parent Perspectives on the Diagnosis, Management, and Family Impact of Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis Syndrome.

Laura Londono, Katherine J Bell, David R Stagliano, Daniel J Adams.

INTRODUCTION: Periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome (PFAPA) is a rare, self-resolving, under-recognized autoinflammatory condition impacting young children. There is limited management and outcome data on PFAPA. Our study aims to describe the diagnostic and treatment approach, family impact, and outcomes of children with PFAPA from the perspective of their parents.
MATERIALS AND METHODS: We performed a survey-based case series study targeted toward parents of children diagnosed with PFAPA. Department of Defense beneficiaries diagnosed with PFAPA between ages 0 and 18 years and cared for by a Military Pediatric Infectious Disease physician at Naval Medical Center Portsmouth or Walter Reed National Capital Consortium between 2012 and 2023 were included. Parents of these patients were contacted via telephone and invited to participate in the online anonymous survey covering PFAPA diagnostic timeline, management strategies, clinical outcomes, and the impact on the patient's family. Quantitative data from the survey was analyzed using descriptive statistics, and qualitative data from free text responses underwent manual thematic analysis.
RESULTS: Twenty-two children were identified with PFAPA, and 17 parents were successfully contacted and invited to participate. Of these, 10 parents completed the survey. For eight (80%) patients, a PFAPA diagnosis required more than four healthcare visits and took greater than a year from symptom onset. Seven parents reported use of abortive corticosteroids for PFAPA treatment, and four (40%) underwent tonsillectomy, resulting in immediate cessation of fever episodes for three of the four patients. At the time of the survey, 70% of children with PFAPA had experienced resolution of their fever episodes. Nearly every parent stated that PFAPA led to missed school and workdays. Half of respondents stated that PFAPA negatively impacted their child's mental health and/or family well-being. More than half (60%) of respondents expressed feeling dismissed in their concerns and wished more providers were knowledgeable about PFAPA.
CONCLUSIONS: For most children with PFAPA, diagnosis requires more than four healthcare visits and over a year of time. PFAPA is a self-limited condition but poorly impacts families through missed school, missed workdays, and other family life disruptions. Parents of children with PFAPA want to be heard when they express concerns about frequent fever episodes and want providers to be better informed about PFAPA and available treatment options.

DOI: https://doi.org/10.1093/milmed/usag138
Open Access Emerg Med. 2026 ;18 567362

Adherence to Pediatric Asthma Guidelines in Children with Asthma Exacerbation at the Emergency Department.

Teeranai Sakulchit, Wichapa Sathapornpunya.

   Purpose: Pediatric asthma exacerbation guidelines were implemented in the emergency department (ED) of the Songklanagarind Hospital in March 2021. The primary outcome was physician adherence to the guideline. Secondary outcomes included comparisons of selected ED quality indicators.
Patients and Methods: This single-center retrospective before-after study included children aged <15 years who presented with asthma exacerbation at the ED. Data were collected before guideline implementation (January 1, 2020, to February 28, 2021) and after implementation (March 1, 2021, to December 31, 2022). Guideline adherence was described as proportions. Between-period comparisons were analyzed using multivariable logistic regression to estimate odds ratios with 95% confidence intervals (CI).
Results: A total of 313 pediatric patients met the inclusion criteria with 135 and 178 patients in the pre-and post-guideline groups, respectively. Overall adherence to the guidelines was approximately 42.1%. After implementation, patients were more likely to have scheduled outpatient follow-up on the next calendar business day (adjusted OR 4.82, 95% CI 2.33-10.38) and less likely to be admitted to the hospital (adjusted OR 0.30, 95% CI 0.11-0.76).
Conclusion: Following the introduction of the guidelines in the ED, physician adherence was partial and was associated with significant improvements in some aspects of care quality. Ongoing review, feedback, education, and monitoring of time-sensitive care processes may help sustain and further improve the care of children with asthma exacerbations.

Keywords:  asthma; children; emergency; exacerbation; guideline adherence

DOI:  https://doi.org/10.2147/OAEM.S567362
J Natl Med Assoc. 2026 Mar 23. pii: S0027-9684(26)00046-5. [Epub ahead of print]

Chill out: Hypothermia treatment in the pediatric patient population.

Kenneth F Potter, Jacqueline Szilagyi, Laura Lahaye.

  Perioperative hypothermia is a significant concern in pediatric patients, contributing to various complications such as coagulopathy, neurologic dysfunction, infection, and prolonged recovery times. This article reviews the definition, measurement, and impact of hypothermia in children, with emphasis on the unique vulnerabilities of pediatric patients, including their immature thermoregulatory systems and differing age-related risks. We examine the challenges in temperature monitoring, highlighting the discrepancies between peripheral and central temperature measurements, as well as the consequences of temperature mismanagement. Strategies to prevent hypothermia, including prewarming, intraoperative warming, and continuous temperature monitoring are discussed, along with the associated challenges of equipment availability and patient-specific factors unique to the pediatric population. Further, this article addresses healthcare disparities as they pertain to the prevention and management of perioperative hypothermia. We advocate for the implementation of standardized protocols and further research to reduce disparities and improve outcomes. Ultimately, with proper resources and diligence, the effects of hypothermia can be effectively mitigated, ensuring safer perioperative care for all pediatric patients.

Keywords:  Coagulopathy; Delayed emergence; Nonshivering thermogenesis; Perioperative hypothermia; Pre-warming; Temperature monitoring

DOI:  https://doi.org/10.1016/j.jnma.2026.03.001
J Pediatr Soc North Am. 2026 May;15 100327

Public Insurance Is Associated with Delays to Surgery in Pediatric Patients with a First-Time Patellar Dislocation Involving a Loose Body.

Alexandra Dejneka, Amin M Alayleh, David Kell, Casey Kuka, Kevin J Orellana, Brendan A Williams, John Todd R Lawrence, Neeraj M Patel.

   Background: First-time patellar dislocations with a loose body require prompt operative treatment to prevent further intra-articular damage. Social determinants and demographic characteristics have been associated with delays in pediatric orthopaedic injuries requiring less urgent interventions. The purpose of this study was to examine the impact of demographic factors on surgical timing for children with first-time patellar dislocations involving a loose body.
Methods: This is a retrospective comparative study of patients <19 years of age undergoing surgery for a first-time patellar dislocation with a loose body or unstable osteochondral fracture at two urban tertiary children's hospitals between 2007 and 2021. Patients with an underlying genetic syndrome, neuromuscular condition, or recurrent instability were excluded. Demographic data included age, sex, race, ethnicity, and insurance. Clinical data were also collected, with attention to the timing between injury and surgery. Univariable analysis was followed by multivariate regression. Odds ratios are reported with 95% confidence intervals (CIs).
Results: A total of 163 patients met study inclusion criteria (mean age 14.7 ± 2.4 years, 55.3% girls). The median time between injury and surgery for patients with public insurance was 55 days (interquartile range, IQR, 204 days) compared to 38.5 days (IQR 55 days) for those with private insurance (P = .005). Compared to privately insured children, a higher proportion of those with public insurance had surgery beyond 30 days after injury (80.4% vs 63.7%, P = .04). Patients who underwent fixation of their loose body had surgery a median of 33 days after injury (IQR 30 days), while those who underwent removal had surgery 48.5 days after injury (IQR 69 days, P = .04). In regression analysis, children with public insurance had 2.3 times higher odds of undergoing surgery later than 30 days after injury (95% CI: 1.1-5.2, P = .04). Each year of increasing age was associated 1.2 times higher odds of surgery beyond 30 days postinjury (95% CI: 1.0, 1.4, P = .02).
Conclusions: Time to surgical intervention in pediatric patients with first-time patellar dislocations involving a loose body was significantly delayed in older children and those with public insurance. Delayed surgery is associated with a lower likelihood of osteochondral fixation. Identifying the underlying mechanisms of these disparities can facilitate more equitable care for pediatric patients with patellar instability.
Key Concepts: (1)Public insurance is associated with longer delays to surgery for pediatric patients with a first-time patellar dislocation involving a loose body.(2)Older age is independently associated with delayed surgical intervention in this patient population.(3)Delayed treatment for these injuries lowers the likelihood of osteochondral fixation.(4)Identifying and addressing disparities is necessary to promote equitable pediatric orthopaedic care.
Level of Evidence: Level III.

Keywords:  Disparities; Insurance; Loose body; Patellar dislocation

DOI:  https://doi.org/10.1016/j.jposna.2026.100327
Diagnostics (Basel). 2026 Mar 12. pii: 843. [Epub ahead of print]16(6):

Current Evidence on the Role of Pediatric Dentists in the Multidisciplinary Management of Pediatric Obstructive Sleep Apnea.

Antonino Lo Giudice, Alessia Malgioglio, Antonino Maniaci, Ignazio La Mantia, Alberto Bianchi, Salvatore Cocuzza.

  Pediatric obstructive sleep apnea (OSA) is a prevalent and underdiagnosed condition associated with significant neurocognitive, behavioral, and systemic consequences. Sleep-related breathing disorders (SRBDs) in children range from primary snoring to OSA, with even mild forms increasingly linked to adverse outcomes. Given their frequent contact with pediatric patients, pediatric dentists and orthodontists are uniquely positioned to contribute to early identification and management within a multidisciplinary framework. Objectives: This narrative review aimed to summarize and critically appraise current evidence to clarify the clinical role, scope of practice, and responsibilities of pediatric dentists and orthodontists within the multidisciplinary management of pediatric obstructive sleep apnea. A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and EMBASE up to 1 November 2025. Review articles addressing the involvement of pediatric dentists and orthodontists in pediatric OSA were included. No restriction was applied to language or publication year. Two authors independently performed study selection and data extraction. The methodological quality and data extraction of the studies were structured according to the SANRA scale. Ten studies were deemed suitable for inclusion in the current review. After examination of the full texts, the available evidence was filtered into specific clinical domains aimed at clarifying the role of the pediatric dentist and orthodontist in the management of pediatric obstructive sleep apnea (OSA). Qualitative thematic analysis of the included studies identified three main areas in which pediatric dentists and orthodontists contribute to the management of pediatric OSA. The first area involves screening through recognition of clinical signs and symptoms, use of validated questionnaires, and identification of craniofacial and occlusal features associated with increased airway risk. The second area concerns participation in the diagnostic-therapeutic pathway and multidisciplinary care, including timely referral, clinical documentation, and collaboration with pediatricians, otolaryngologists, and sleep specialists. The third area relates to orthodontic treatments such as rapid maxillary expansion and mandibular advancement appliances, which may provide adjunctive benefits in selected patients, although current evidence is limited by heterogeneity and growth-related confounding factors. Pediatric dentists and orthodontists play a pivotal yet complementary role in the management of pediatric OSA. In particular, all the involved specialists are encouraged to actively participate in the screening process, interdisciplinary communication, and diagnostic and therapeutic decision-making processes.

Keywords:  OSAS; children; orthodontics; pediatric dentistry

DOI:  https://doi.org/10.3390/diagnostics16060843
Laryngoscope. 2026 Mar 23.

Outcomes in the Management of Pediatric Retrograde Cricopharyngeal Dysfunction.

Aidan P Wright, Vivian Jin, Nathaniel B Hunter, Andrew G Tritter.

   OBJECTIVE: To review the presentation and treatment outcomes of pediatric patients with retrograde cricopharyngeal dysfunction (RCPD).
METHODS: A retrospective chart review was performed on pediatric patients diagnosed with retrograde cricopharyngeal dysfunction (RCPD) and treated with cricopharyngeal botulinum toxin injection (CPBTI). Patient-specific demographic, clinical, and treatment data were collected with a focus on outcomes and complications.
RESULTS: Twenty-five patients were identified (mean ± SD age, 14.4 ± 3.91; range 4-17). Eighteen (72%) patients were female. Common presenting symptoms included inability to belch (100%), bloating (96%), excessive flatulence (92%), and gurgling sounds from the throat (88%). Patients under 5 years of age were noted by parents to have visible abdominal distention and food aversion. Eleven patients (46%) had social anxiety related to their symptoms prior to intervention. Seven (28%) had alternate diagnoses prior to initial consultation. The average duration of follow-up was 247 days. All patients (100%) experienced symptomatic improvement, with 88% noting complete symptom resolution and 12% noting reduced symptoms. Only one patient required a second injection to maintain their treatment response.
CONCLUSION: RCPD presents similarly in both pediatric and adult patients, though the ability to verbally express symptoms may limit recognition in younger patients. Pediatric patients appear to better tolerate expected side effects of treatment and demonstrate a higher overall long-term success rate when compared to adult outcomes in the literature. Increased recognition and treatment of RCPD in children may help minimize long term sequelae of the condition while also affording decreased treatment morbidity.
LEVEL OF EVIDENCE: 4:

Keywords:  RCPD; R‐CPD; abelchia; botulinum toxin; children; cricopharyngeus muscle; inability to belch; pediatrics; retrograde cricopharyngeal dysfunction; retrograde cricopharyngeus muscle dysfunction

DOI:  https://doi.org/10.1002/lary.70509
Children (Basel). 2026 Mar 06. pii: 376. [Epub ahead of print]13(3):

The Impact of Follow-Up on Etiological Classification of Pediatric Vertigo.

Nina Božanić Urbančič, Dejan Mladenov, Saba Battelino.

  Background: Vertigo and dizziness in children represent diagnostically challenging conditions with heterogeneous etiologies. At initial presentation, a substantial proportion of pediatric patients remain without a definitive etiological diagnosis. Evidence on the impact of longitudinal follow-up on etiological classification in pediatric vertigo is limited. Methods: This observational cohort study uses prospectively collected clinical data. Children aged 1-17 years who presented to a tertiary ENT clinic with vertigo and/or dizziness between 2015 and 2020 were systematically enrolled and followed. The present study represents a retrospective revision of a previously published cohort of 257 children. In 2025, extended follow-up data were reviewed to reassess etiological classification using the same diagnostic categories as in the original analysis. Descriptive statistics were applied to compare etiological distributions at initial evaluation and after follow-up revision. Results: After data revision, the proportion of children with unclassified etiology decreased from 44% to 10%. Central etiologies accounted for 35% of cases, peripheral vestibular disorders for 18%, hemodynamic causes for 16%, psychogenic etiologies for 10%, and other specific causes for 7%. Follow-up duration ranged from 0 to 132 months (mean 17.6 months; median 4.5 months). Diagnostic investigations were frequently performed; however, the etiological yield of certain tests, particularly cranial computed tomography, was low. Conclusions: Extended follow-up significantly improves etiological classification in children with vertigo and dizziness, demonstrating that diagnostic uncertainty at initial presentation often reflects evolving clinical phenotypes rather than the absence of an underlying disorder. A longitudinal, clinically guided, and multidisciplinary approach is essential to enhance diagnostic accuracy and optimize the use of diagnostic investigations in pediatric vertigo.

Keywords:  dizziness; etiology; follow-up; migraine; pediatric vertigo; vestibular disorders

DOI:  https://doi.org/10.3390/children13030376
J Pediatr Soc North Am. 2026 May;15 100311

An Epidemiologic Review of Vascular Complications in Pediatric Posterior Sternoclavicular Dislocations: Implications for "Cardiothoracic Standby".

Ryan Lebens, Yoli Meydan, Christian Leonardo, Rigel Hall, Steven Liu, James Barsi.

   Background: Posterior sternoclavicular dislocation (P-SCD) is a rare injury of the shoulder girdle often occurring after falls, motor vehicle accidents, or sports injuries. Given the proximity of the sternoclavicular joint to major mediastinal vessels, current guidelines recommend a cardiothoracic (CT) surgeon to be on standby during operative treatment. However, the true incidence of vascular complications following P-SCD, particularly in pediatric populations, remains poorly defined. The purpose of this study is to quantify the incidence of vascular injury associated with pediatric P-SCD using a large, multi-institutional database to help better characterize the need for a CT surgeon to be on standby.
Methods: A retrospective cohort study was conducted using the TriNetX Research Network, which identified patients aged ≤21 years with P-SCD (ICD-10-CM S43.22∗) between 2015 and 2025. The primary outcome was thoracic vascular injury, identified by ICD-10-CM codes S25.X during the index encounter. Patients were classified as having isolated P-SCD or polytrauma based on co-coded injuries during the index encounter. Demographics and injury characteristics were summarized descriptively, and comparisons between patients with and without vascular injury were assessed using t-tests and χ2 tests (P < .05).
Results: A total of 432 patients were identified, with a mean age of 15.9 years. Vascular injury occurred in 1.2% of the cohort (n = 5), all of whom presented with polytrauma. No vascular injuries were observed among patients with isolated P-SCD. Patients with vascular injury had significantly more injury regions (mean 6.8 vs 0.94; P < .01) and longer hospital stays (mean 11.4 vs 2.3 days; P < .01). Patients with vascular injury were also older on average compared to patients without vascular injury (19.20 vs. 15.82 years , P < .01).
Conclusions: Vascular injury following pediatric P-SCD is rare and was observed only in patients with polytrauma. These results suggest that routine CT surgery to be on standby may require reevaluation as the standard practice. While not intended to change clinical guidelines, this study provides critical epidemiological data and highlights the need for further prospective research to inform surgical protocols.
Key Concepts: (1)Posterior sternoclavicular dislocation (P-SCD) is an uncommon shoulder girdle injury with potential for serious mediastinal complications.(2)Current surgical guidelines recommend cardiothoracic (CT) surgeon to be on standby during operative management of P-SCD due to possible vascular injury.(3)In this large, multi-institutional pediatric cohort, vascular injury following P-SCD was observed in only 1.2% of cases.(4)All vascular injuries occurred exclusively in patients presenting with polytrauma, and none occurred in isolated P-SCD.(5)These findings suggest that a CT surgeon on standby may warrant reevaluation in isolated pediatric P-SCD and that further prospective research is needed to refine risk stratification.
Level of Evidence: Level IV, Retrospective Cohort Study.

Keywords:  Epidemiology; Pediatric trauma; Posterior sternoclavicular dislocation; Vascular injury

DOI:  https://doi.org/10.1016/j.jposna.2025.100311
JBI Evid Implement. 2026 Mar 26.

Reducing extravasation and infiltration in the pediatric population: a best practice implementation project.

Brandy Wilson, Linda Upchurch.

   INTRODUCTION: Peripheral intravenous (PIV) therapy, the most common invasive procedure in hospitals, frequently results in complications. Infiltrations occur when infused fluids enter the surrounding tissue without harming the skin, while extravasations irritate the skin and tissue, occasionally necessitating surgical intervention. Evidence-based practices recommend the use of quality standards, such as Assess, Compare, Touch (ACT) and a 60-minute rounding tool to address the rising incidence of intravenous complications.
OBJECTIVES: The objective of this evidence implementation project was to decrease the complications associated with infiltration and extravasation at the site of PIV catheters in pediatric populations.
METHODS: This project was guided by the JBI Evidence Implementation Framework. A baseline audit identified inconsistent adherence to policy, including the crucial hourly rounding to assess the infusion site. Barriers to best practice were identified and improvement strategies were implemented, including education on hourly PIV assessment using ACT and a rounding tool for nurses. Additionally, an algorithm for extravasations and infiltrations was implemented. A follow-up audit was conducted to determine changes in practice.
RESULTS: The baseline audit revealed that although 100% of PIV sites were properly stabilized with adhesive dressings, only 9.09% of catheters were assessed every hour using ACT. Additionally, 100% of catheters were removed and infusions stopped immediately after extravasation or infiltration, but none of the affected extremities were elevated. Only 27.27% of cases involved notifying a physician or nurse practitioner, and there was no established protocol for managing extravasation or infiltration. Survey results from 40 nurses showed that 72.5% felt educated on catheter securement and assessment, but only 52.5% had received education on managing PIV-related injuries.
CONCLUSIONS: Continuing education and protocols can improve the quality of care of pediatric patients with PIV by strengthening staff knowledge and skills to prevent infiltrations and extravasations.
SPANISH ABSTRACT: http://links.lww.com/IJEBH/A545.

Keywords:  extravasation; infiltration; medical complexity; pediatric

DOI:  https://doi.org/10.1097/XEB.0000000000000580
J Investig Allergol Clin Immunol. 2026 Mar 27. 0

Safety and Tolerability of Bilastine 0.6% Ophthalmic Solution in Children and Adolescents: An 8-Week Phase 3 Study.

Teresa Garriga-Baraut, Clara Padró-Casas, Adelaida Sánchez Bacallao, Pablo Durán-Pérez, Eva M Lasa Luaces, Porfirio Fernández González, Amalia Leceta, Cristina Martínez Ostalé, Inmaculada Gilaberte.

   BACKGROUND AND OBJECTIVE: Preservative- and phosphate-free bilastine ophthalmic solution with sodium hyaluronate provides additional benefits for ocular surface protection and hydration compared with second-generation antihistamines. These advantages are especially relevant for long-term pediatric treatment, although no previous study has evaluated the safety of the solution in this population. Objective: To evaluate the safety and tolerability of preservative-free bilastine 0.6% ophthalmic solution after 8 weeks of once-daily administration in children and adolescents with allergic conjunctivitis.
METHODS: This multicenter, randomized, double blind, placebo-controlled, parallel-group, phase 3 study included patients aged >2 to <18 years who were randomized 2:1 to receive bilastine or placebo for 8 weeks. The primary endpoint was the incidence of ocular-related treatment-emergent adverse events (ocular r-TEAEs).
RESULTS: Sixty-five patients were enrolled, and 59 were randomized: 42 to bilastine and 17 to placebo. No ocular r-TEAEs occurred in bilastine-treated patients (0/42 [95%CI, 0.0%-8.4%]), while 1 was reported in a placebo-treated patient (1/17 [95%CI, 1.1%-27.0%]). The overall incidence of ocular TEAEs was similar in both groups (bilastine 16.7% [95%CI, 8.3%-30.6%]; 7/42; placebo 17.6% [95%CI, 6.2%-41.0%]; 3/17). No serious or severe TEAEs occurred. Moderate TEAEs were reported in 4.8% (2/42, 95%CI, 1.3%-15.8%) of bilastine patients and 5.9% (1/17, 95%CI, 1.1-27.0%) of placebo patients. Most participants reported no or only slight ocular symptoms or discomfort after instillation, both at baseline and after 8 weeks.
CONCLUSIONS: Preservative- and phosphate-free bilastine 0.6% ophthalmic solution with sodium hyaluronate was safe and well-tolerated in pediatric patients aged >2 years after a once-daily, 8-week treatment, with a safety profile comparable to that of placebo.

Keywords:  Allergic conjunctivitis; Bilastine; Children; Hyaluronate; Ophthalmic formulation; Pediatric; Preservative-free; Safety

DOI:  https://doi.org/10.18176/jiaci.1169
J Pediatr Urol. 2026 Feb 23. pii: S1477-5131(26)00113-0. [Epub ahead of print]22(3): 105834

Children with enuresis - are they more constipated than others?

Malin Borgström, Maria Tunebjer, Barbro H Skogman, Tryggve Nevéus.

   INTRODUCTION: The bowel-bladder interaction is well established, as is the fact that constipation can lead to daytime incontinence and/or recurrent urinary tract infections. However, the link between constipation and enuresis is less clear. The bowel's influence on enuresis is possibly important even though fecal disimpaction by itself will not make the child dry at night. Furthermore, parents and patients may be unaware of the child's constipation until the enuresis is evaluated. The same should apply to healthy children. The hypothesis that a full bowel affects bladder function appears to be logical; however, this may not be applicable in enuresis. A crucial question is if constipation is more common among children with enuresis than in the general population.
AIM: To evaluate the prevalence of constipation in children with enuresis as compared to children without bladder problems.
SUBJECTS AND METHODS: In this case-control study the former group was recruited from a pediatric clinic and the latter from the general population in the same geographic area. All children had their horizontal rectal diameter measured via abdominal ultrasound. Their bowel movements over two weeks and bladder function over two days were recorded at home.
RESULTS: We recruited 66 children with enuresis and 58 healthy controls. The ages ranged from 6 to 11 (mean 7.3 ± 1.3) years and 50 (40 %) of them were girls. The groups had no difference in rectal diameter (28.9 ± 7.7 vs 28.2 ± 10.1 mm, P = 0.672) and they had a similar prevalence of constipation according to the Rome IV criteria. The children with enuresis had fewer bowel movements per two weeks (11.2 ± 4.1 vs 14.8 ± 6.9, P < 0.001) than controls, but they had no more constipation symptoms. However, bladder diaries showed that children with enuresis had smaller voided volumes (87.1 ± 31.8 vs 127.5 ± 44.5 % of expected bladder capacity; P < 0.001) than controls.
CONCLUSION: We did not find support for constipation being more prevalent among children with enuresis than controls. But we did find decreased functional bladder capacity in patients with enuresis which may be an indirect sign of detrusor overactivity.

Keywords:  Case control study; Children; Constipation; Nocturnal enuresis

DOI:  https://doi.org/10.1016/j.jpurol.2026.105834
Curr Opin Organ Transplant. 2026 Mar 23.

Updates in pediatric kidney transplantation.

Rachel M Engen.

   PURPOSE OF REVIEW: This manuscript highlights key areas of recent pediatric nephrology research that may be relevant to clinical practice.
RECENT FINDINGS: Recent reviews of registry data have emphasized the long-term harms of even limited dialysis exposure in children, while studies of 'nonideal' donor kidneys in children have shown positive outcomes. New observational research suggests a benefit to thromboprophylaxis and aggressive fluid management immediately posttransplant, though the best prescriptions remain unclear. Belatacept and letermovir are emerging options for immunosuppression and CMV prophylaxis, respectively, that may have fewer side effects compared to standard of care; interventional studies of these drugs are ongoing.
CONCLUSION: Transplant teams should consider using a broader range of donor organs in select pediatric patients. Further interventional research on peritransplant thromboprophylaxis and fluid management is needed to optimize management strategies. The completion of ongoing belatacept and letermovir trials have the potential to substantially alter posttransplant standards of care.

Keywords:  cytomegalovirus; immunosuppression; kidney donor; pediatric kidney transplant; thromboprophylaxis

DOI:  https://doi.org/10.1097/MOT.0000000000001281
JMIR Public Health Surveill. 2026 Mar 24. 12 e75769

Digital Tools' Effectiveness on Physical Activity Outcomes in Children and Adolescents: Umbrella Review.

Garden Tabacchi, Antonino Scardina, Antonella Amato, Marta Giardina, Giulia Accardi, Valentina Di Liberto, Giuseppe Giglia, Sonya Vasto, Monica Frinchi, Paolo Boffetta, Walter Mazzucco, Marianna Bellafiore.

   Background: A substantial proportion of children and adolescents worldwide do not meet current physical activity (PA) guidelines. So digital tools interventions have been implemented worldwide. However, evidence regarding the effectiveness of these remains inconsistent, underscoring the need for a comprehensive synthesis of the available literature.
Objective: This umbrella review aimed to summarize and critically evaluate the characteristics and effectiveness of digital interventions designed to increase PA in children and adolescents.
Methods: An overview of systematic reviews (SRs) and meta-analyses of randomized controlled trials (RCTs) was conducted in accordance with the PRIOR (Preferred Reporting Items for Overviews of Reviews) and the PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Literature Search Extension) checklists. Reviews published between 2018 and 2025 were searched in SCOPUS, PubMed or MEDLINE, Web of Science, Cochrane Database of Systematic Reviews, and SPORTDiscus or EBSCO, using a combination of terms addressing the type of digital tool (eg, apps, wearables, etc) and device-based PA outcomes. Eligible SRs and meta-analyses focused on populations aged 6-17 years and evaluated digital interventions aimed at increasing PA. Methodological quality was assessed using AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) for SRs and meta-analyses, and Risk of Bias 2 for RCTs. Intervention characteristics and effectiveness outcomes were summarized as frequencies, and chi-square tests were applied to explore differences in effectiveness across study features.
Results: Forty-eight SRs or meta-analyses comprising 62 RCTs were included. The reviews' quality was moderate to poor, and 7/62 (11.3%) of RCTs were judged to have a high risk of bias. The mainly addressed PA outcomes were moderate-to-vigorous PA and step counts, commonly measured using accelerometers and pedometers. Overall, 45.2% of interventions demonstrated effectiveness for at least 1 PA outcome. Higher effectiveness rates were observed in RCTs that targeted PA as the sole primary outcome (19/32, 59.4%), used wearables as both the digital intervention component (7/11, 63.6%) and delivery device (8/12, 66.7%), and used pedometers for PA outcome measurement (13/16, 81.3%). Significant differences in effectiveness were found for the type of PA assessment device (P=.003) and for interventions targeting low-income populations, which showed lower effectiveness (P=.01). Additional trends were identified for geographic region (P=.06), intervention setting (P=.09), baseline activity level (P=.06), intervention focus (P=.09), and device brand (P=.09).
Conclusions: This novel umbrella review provides a comprehensive synthesis of digital PA interventions in youth, foreseeing potential factors that may influence their effectiveness, and highlighting methodological limitations. It offers evidence-based insights for practitioners, educators, and policymakers, helping to identify digital tools most likely to successfully increase PA in youth. Future research should prioritize stronger methodological rigor and more precise intervention designs. This has clear value for the public health practice to reduce long-term disease risk.

Keywords:  adolescents; children; digital; effectiveness; mobile phone; physical activity

DOI:  https://doi.org/10.2196/75769
Dtsch Arztebl Int. 2026 May 15. pii: arztebl.m2026.0032. [Epub ahead of print]123(10):

ADHD in Children, Adolescents, and Adults: Incidence, Prevalence, and Treatment. An Analysis of Routine Health Insurance Data.

Felix Betzler, Jana Knop, Martina Grönig, Patrick Timpel, Vukašin Višković, Daniel Schöttle.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders in children and adolescents, with symptoms often persisting into adulthood. We studied epidemiology and health care provision for ADHD in Germany by analyzing recent billing data.
METHODS: Anonymized billing data from 2017 to 2023 were examined. Patients with ≥ 2 outpatient or one inpatient ADHD diagnosis were included. Application of the inclusion and exclusion criteria yielded 78 919 ADHD cases for analysis.
RESULTS: The administrative prevalence of ADHD in 2023 was 3.6% in children/adolescents and 0.6% in adults. In 2023, 40.9% of children and adolescents with ADHD received no treatment, 47.8% were treated with drugs alone, 4.2% were treated with psychotherapy alone, and 7.1% received multimodal therapy. 44.4% of adults with ADHD received no treatment, 38% were treated with drugs alone, 7.6% were treated with psychotherapy alone, and 10% received multimodal therapy. Over the period of observation, the prevalence of ADHD and the frequency of drug treatment, psychotherapy, and multimodal therapy rose slightly.
CONCLUSION: This secondary data analysis characterizes the care of ADHD in Germany. In 2023, the administrative prevalence was much lower in adults than in children and adolescents. Over the period of observation, there was a continuous rise in the provision of psychotherapeutic services-especially behavioral therapy-while the percentage of patients treated with neither drugs nor psychotherapy fell; yet overall rates of treatment are still low, particularly for psychotherapy.

DOI: https://doi.org/10.3238/arztebl.m2026.0032
Ital J Pediatr. 2026 Mar 27.

Seasonal allergic rhinitis in children: diagnostic markers of extreme allergic phenotype formation.

Tetyana O Kryuchko, Viktoriia V Shcherbak, Olha Ya Tkachenko, Inna M Nesina, Olha A Poda, Mariya O Melnyk.

   BACKGROUND: Patients with severe allergic rhinitis may encounter an elevated risk of developing asthma and other associated allergic conditions. It is known that "allergic rhinitis" and "allergic rhinitis + asthma" are two clinically distinct phenotypes of allergic rhinitis. Consequently, the aim of our study was to establish the diagnostic criteria for the progression of the allergic phenotype in children with seasonal allergic rhinitis (SAR).
METHODS: This cohort study included 47 patients aged between 6 to 17 years diagnosed with SAR, who were categorised into two groups: SAR/SAR with associated allergic conjunctivitis (AC) (Group 1), SAR with concomitant asthma/atopic dermatitis (Group 2). All participants underwent assessments to evaluate their Quality of Life (QoL), as well as the overall severity of nasal and non-nasal symptoms. Serum levels of Interleukin-33 (IL-33.) and STimulation expressed gene 2 (ST2) were quantified using enzyme immunoassay techniques. Additionally, the number of blood eosinophils, nasal eosinophils, Immunoglobulin E (IgE), and Secretory Immunoglobulin A (SIgA) were measured. Statistical analyses were conducted employing SPSS version 26.0 program. The diagnostic accuracy of the revised and simplified system was assessed using the receiver operating characteristic (ROC) curve.
RESULTS: Throughout the study, we observed a significant reduction in the estimated total QoL score among children in both groups, with scores of 69.73 and 86.75 for the first and second groups, respectively, indicating a significant decrease decline in quality of life. A particularly critical criterion that exhibited a strong statistically significant correlation was the stress factor. Nearly 90% of patients in the second group, who are currently residing in conflict-affected areas, reported experiencing anxiety, which serves as a significant trigger for exacerbations. In our examination of the primary diagnostic criteria for the progression of SAR, we conducted a ROC analysis to assess the significance of predictors that may indicate an extreme allergic phenotype. These predictors included Visual Analogue Scale scores, blood eosinophil counts, nasal eosinophil levels, IgE, SIgA, IL-33, and ST2 levels. The analysis of potential prognostic factors allowed the creation of a practical algorithm for identifying patients at risk of developing an extreme allergic phenotype. This algorithm illustrates how our findings can be used to prognostically assess the severity of seasonal allergic rhinitis from a practical point of view.
CONCLUSIONS: The conducted study identified the main diagnostic criteria that characterise the extreme allergic phenotype in children with SAR and determine the severity of its progression. Future research in this area will not only expand the existing diagnostic capabilities, but also contribute to the development of new treatment strategies for patients with allergic diseases.

Keywords:  Children; IL-33; IgE; Nasal eosinophils; Phenotype; Quality of Life; SIgA; ST2; Seasonal allergic rhinitis; VAS

DOI:  https://doi.org/10.1186/s13052-026-02241-6
Children (Basel). 2026 Feb 25. pii: 321. [Epub ahead of print]13(3):

Mixed-Method Follow-Up of Toddler-Aged Children with Spastic Cerebral Palsy After an Intense Physical/Occupational Therapy Intervention.

Heidi L Pottinger, Nicole P Yuan, Burris Duncan.

   BACKGROUND/OBJECTIVES: A plethora of articles report the effectiveness of many different interventions for managing cerebral palsy (CP), but there are few long-term follow-up studies of children after an intervention designed to improve function in children with CP. This observational mixed-methods study examined the functional gains observed more than one year after toddlers completed a 48-week investigation that included 5 days per week for 12 weeks of occupational and physical therapy using the Perception-Action Approach (P-AA). The aim was to observe whether the functional gains made by the children continued to improve, plateaued, or declined at long-term follow-up.
METHODS: The sample was 23 children with a mild-to-moderate level of CP (Gross Motor Function Classification System I, II, or III) who completed the original study at least one year prior. The follow-up assessment included quantitative data using the Gross Motor Function Measure-66 (GMFM) and the Pediatric Evaluation of Disability Inventory-Functional Skills (PEDI-FS). Seventeen of 23 children were evaluated with both instruments. Qualitative data were collected from 14 of the 23 families who completed the PEDI-FS. Those families completed a survey with an open-ended questionnaire that assessed the caregivers' perspectives about their children's functioning and the impact of the intervention.
RESULTS: Findings from the quantitative data based on prognostic GMFM-66 developmental curves by age for children with CP: seven of the 17 children who had GMFM evaluations showed greater than expected improvement (all 5 with GMFCS II), four met the expected improvement, and six did not. Children with GMFCS II or III maintained their positions relative to the mean on the PEDI-FS mobility subset. Findings from the qualitative data revealed that some parents believed the intervention contributed to the changes in their children's physical, mental, and social functioning. Many parents indicated that the study helped them overcome financial barriers related to accessing intensive therapies. Most parents reported that their child's functioning was better than they expected when given the diagnosis of CP.
CONCLUSIONS: Many months following an intense physical and occupational therapeutic intervention, based on predicted age-appropriate percentiles for motor function, roughly one-third of the children exceeded expectations, and one-third did not meet expectations. Despite the time invested in the intense protocol, caregivers felt the intervention was largely responsible for improvements in their children's functioning.

Keywords:  Perception-Action Approach; cerebral palsy; evaluation; mixed methods; parents’ perceptions

DOI:  https://doi.org/10.3390/children13030321
Children (Basel). 2026 Mar 10. pii: 388. [Epub ahead of print]13(3):

Buprenorphine for Children and Adolescents with Sickle Cell Disease: A Scoping Review.

Joseph deBettencourt, Matthew Nagy, Chloe Rotman, Christine Greco, Charles Berde, Natasha M Archer.

  Background and Objective: Sickle cell disease (SCD) is an inherited blood disorder associated with recurrent painful crises. Sickle cell pain crises are a significant source of distress for patients and contribute substantially to hospital utilization among SCD populations. Many children with SCD also experience chronic pain, which is often multifactorial in nature. The management of both acute and chronic pain in SCD commonly relies on opioid medications. Acute and chronic use of opioids is associated with health risks and potential complications, which has raised interest in alternatives. Buprenorphine is a partial μ-receptor agonist with strong affinity that confers pain relief and may have an improved side-effect profile. While there is emerging evidence for its use in adult patients, the data is less developed in pediatrics. Methods: A scoping review was designed in accordance with PRISMA guidelines to systematically explore the literature on buprenorphine use in pain management for children with sickle cell disease (SCD). Results: This review shows that the published literature in this area is of low quality and extremely limited, and there is a lack of trials specifically designed to address the use of buprenorphine for this patient population. Studies are limited in their generalizability but suggest that buprenorphine may be useful in managing pain in this population. Conclusions: While promising, more data is required both retrospectively and prospectively to understand the utility of buprenorphine. The development of pediatric-specific protocols for transitioning from full µ-receptor agonist opioids to buprenorphine is also needed.

Keywords:  buprenorphine; opioids; pain management; pediatrics; sickle cell disease

DOI:  https://doi.org/10.3390/children13030388
Pediatr Rep. 2026 Mar 03. pii: 34. [Epub ahead of print]18(2):

Pediatric Evans Syndrome as a Multisystem Immune Disorder: A 13-Year Longitudinal Experience from a Single Academic Center.

Dimitrios Karamitsos, Ioanna Paraskevi Papandrea, Nikoletta Rokidi, Ioanna Saougou, Chrysoula Kosmeri, Alexandros Makis.

  Background: Pediatric-onset Evans syndrome (pES) is a rare autoimmune disorder defined by the coexistence or sequential development of immune thrombocytopenia (ITP) and autoimmune hemolytic anemia (AIHA), frequently accompanied by autoimmune neutropenia (AIN) and characterized by a relapsing, multilineage course. Increasing evidence suggests that pES may represent a broader immune dysregulation phenotype rather than an isolated hematologic disorder. Methods: We conducted a retrospective, single-center study of children diagnosed with pES and followed for up to 13 years at a tertiary referral center. Clinical data regarding hematologic evolution, extra-hematological immunopathological manifestations, treatment requirements, infectious complications, and genetic findings were analyzed descriptively. Results: Six children (4 males) were included, with a median age at first cytopenia of 7 years (range 3-15) and a median follow-up of 8 years (range 1-13). ITP preceded AIHA in 3/6 patients (50%), one patient (16.7%) developed AIHA first, and two (33.3%) showed partial or evolving multilineage disease with DAT positivity prior to overt hemolysis. AIN occurred in 3/6 patients (50%). Extra-hematological immunopathological manifestations occurred in 5/6 patients (83.3%), with two (33.3%) developing more than one. Second-line therapy was required in 3/6 patients (50%). Infectious episodes occurred in 83.3% of patients, predominantly viral or mild bacterial infections, with no life-threatening events. Whole-exome sequencing performed in three patients identified a heterozygous TNFAIP3 variant of uncertain significance in one case; no pathogenic variants were detected. Conclusions: pES demonstrates clinical heterogeneity, frequent multilineage cytopenia, and substantial extra-hematological immune involvement. Multisystem manifestations may be associated with increased treatment burden. Long-term multidisciplinary monitoring and cautious interpretation of genetic findings are essential for individualized pediatric care.

Keywords:  Evans syndrome; TNFAIP3; autoimmune neutropenia; immune dysregulation; inborn errors of immunity; pediatric autoimmune cytopenia

DOI:  https://doi.org/10.3390/pediatric18020034
Cureus. 2026 Feb;18(2): e103802

Evaluating Study Techniques for Australian Medical Students During Clinical Placement: A Scoping Review.

Georgia Bartley, Samantha Waugh, Vinod Gopalan.

  Transitioning from pre-clinical to clinical phases of medical education represents a unique challenge as students learn most content through self-directed learning (SDL), rather than the more prescriptive pre-clinical curriculum. There is a range of SDL study techniques employed by medical students on placement. The COVID-19 pandemic accelerated the adoption of digital resources, prompting a need to reassess the study techniques that best support clinical-year medical students. However, there is a lack of research on which study techniques Australian clinical-year medical students find most effective. The objective of this study is to evaluate the evidence on student-perceived utility of common study techniques for SDL whilst on clinical placement in Australia. A qualitative scoping review of literature on PubMed and Medline Ovid was performed in 2024. Study inclusion criteria for articles were published articles, English language, publication within 20 years, and focus on clinical-year medical students. Exclusion criteria were review articles, investigations focusing on a specific educational intervention, and studies including only pre-clinical students. Studies were qualitatively appraised and synthesised by tabulation in Microsoft Excel (Microsoft Corp., Redmond, WA, US). Risk of bias analysis was not performed. Nine studies from Australia, the USA, the UK, Thailand, Saudi Arabia, and Malaysia were analysed. This included seven cross-sectional, one mixed-methods, and one qualitative analysis. Sample size ranged from 12 to 350 students. Only two studies were conducted after the COVID-19 pandemic. Overall, the results of the included studies demonstrate a consistent trend towards third-party online tools, including question banks, mobile applications, and revision courses for SDL. The strength of evidence on students' perceived efficacy of study techniques in the post-pandemic era presented is limited due to the small number of included studies and the lack of formal study appraisal. There is also poor generalisability of pre-pandemic and international studies to the contemporary Australian context. As there is a lack of a standardised tool to evaluate study technique utility, comparison between studies is difficult. Ongoing research is required to develop evidence-based guidelines that can assist students in commencing SDL whilst on clinical placement.

Keywords:  clinical placement; medical students; post-pandemic; self-directed learning; study techniques

DOI:  https://doi.org/10.7759/cureus.103802