HighlightsWhat are the main findings?In generalized anxiety disorder and other anxiety disorders, significant differences were observed in emotion regulation compared to the healthy group, while no significant differences were observed in impulsivity.Anxiety sensitivity did not mediate the relationship between emotion regulation and impulsivity in anxiety disorders; a direct relationship between emotion regulation and impulsivity was observed.What is the implication of the main finding?Children who have been diagnosed with anxiety disorders may display inappropriate, impulsive coping behaviors in response to emotional regulation difficulties.Addressing emotional regulation skills in treatment may be important for behavioral control in anxiety disorders.Background and Objectives: The aim of this study is to evaluate impulsivity in childhood anxiety disorders and to examine its relationship with anxiety sensitivity and emotion regulation. Materials and Methods: The study group consisted of a total of 60 children aged 8–12 years diagnosed with generalized anxiety disorder (GAD, n = 30) and other anxiety disorders (n = 30). The control group consisted of 40 healthy children of similar age without a psychiatric diagnosis. Data collection forms included the Barratt Impulsiveness Scale Short Form (BIS-S), the Children’s Anxiety Sensitivity Index (ASI-3), the Emotion Regulation Checklist (ERC), and The Screen for Child Anxiety Related Emotional Disorders (SCARED). Results: Our study found no significant differences in BIS-S scores between GAD, other anxiety disorders, and the control group. The total/physical and ERC subscales of the ASI-3 were higher in the generalized anxiety disorder and other anxiety disorder group than in the control group. However, there were no significant differences in the social dimension and cognitive dimension scores of the ASI-3. It has been determined that anxiety sensitivity does not significantly mediate the relationship between emotion regulation and impulsivity, and that emotional variability/negativity is directly and completely related to impulsivity. Conclusions: Our study suggests that children with anxiety disorders experience greater difficulties in regulating their emotions compared to healthy children, and that emotional variability is directly related to impulsivity. In this context, enhancing emotion regulation skills in anxiety disorders may prove to be a pivotal factor in the efficacy of treatment and the maintenance of behavioral control.

HighlightsWhat are the main findings?•The aggression subscales of the CEVEO demonstrate adequate psychometric properties for use with Chilean adolescents, enabling the assessment of aggression in both school and leisure contexts.•These subscales allow for the classification of aggressors into distinct types based on the frequency and context of their aggressive behaviors.What are the implications of the main findings?•A high-risk profile (Profile 3) was identified, consisting of adolescents who exhibited a high frequency of aggression across both contexts (school and leisure) and elevated levels of moral disengagement.•Measuring aggression in both school and leisure settings allows for a more comprehensive identification of high-risk aggressor profiles, as those involved in multiple contexts show higher levels of moral disengagement regardless of frequency.Background: Adolescent violence occurs both within and beyond the school setting. Furthermore, risk factors for aggression, such as Moral Disengagement (MD), do not operate uniformly and may be triggered in one context but not another. This highlights the need for instruments that assess aggression’s manifestation across contexts to enable a more comprehensive understanding of the phenomenon. Objective: To assess the psychometric properties of the Bullying at School and Bullying during Leisure subscales from the Questionnaire for Assessing Peer Violence in School and Leisure Settings (CEVEO) in Chilean adolescents, and to examine differences in MD among perpetrator profiles based on both frequency and context of aggression. Method: Instrumental, multivariate, cross-sectional, quantitative, and correlational design. The sample comprised 864 Chilean students (M age = 15.4; SD age = 1.3). Girls represented 58% of the sample. Results: A 13-item unifactorial model was supported for both subscales, with good internal consistency. Scores correlated positively with MD, and boys scored higher than girls on both subscales. Three profiles were identified: (1) no high aggression; (2) high aggression in one context; and (3) high aggression in two contexts. MD increased with the number of contexts, regardless of aggression frequency. Conclusions: Findings provide validity evidence for the CEVEO bullying subscales in Chilean adolescents, based on their internal structure, associations with external variables, and reliability. The instrument is useful for detecting violence across settings and identifying profiles based on the contextual extent of aggression.

HighlightsWhat are the main findings?•Watching TV and playing video/computer games has differential associations with sleep duration among adolescents, and these associations differ by grade, gender, and ethnicity.What are the implications of the main findings?•These contextual differences in screentime should be considered when exploring how media use influences other health behaviors and outcomes. Researchers and policymakers involved in creating screentime guidelines should take into account the differences between passive and interactive media use. In essence, not all screentime is created equally.Background: Although several studies have reported associations between screentime and shortened sleep duration among adolescents, contextual relationships between different forms of screentime are not well understood. The purpose of this study was to examine how television (TV) watching (passive media use) and video/computer gaming (interactive media use) are associated with short sleep duration among 8th and 11th grade adolescents. Methods: We used data from adolescents (8th and 11th grade students) who participated in the Texas School Physical Activity and Nutrition (Texas SPAN) survey in 2015–2016. Sleep duration was the outcome variable, which was dichotomized into short sleep duration (less than 8 h) and meeting sleep recommendations (more than 8 h). Independent variables included daily TV screentime and video/computer game screentime. We used weighted logistic regression models to understand associations between sleep duration and both TV screentime and video/computer game screentime. Results: Among both 8th grade boys and Hispanic 8th grade girls, spending more than 2 h/day playing video/computer games was associated with greater odds of shorter sleep duration. Among 11th graders, TV screentime was associated with lower odds of shorter sleep duration. Conclusions: Watching TV and playing video/computer games have differential associations with sleep duration among adolescents, and these associations differ by grade, gender, and ethnicity. Researchers and public health agencies interested in associations between meeting sleep recommendations and screentime in adolescents should consider these contextual differences when designing and conducting studies related to electronic media use and sleep.

HighlightsWhat are the main findings?•Parents of children using AFOs, receiving botulinum toxin, undergoing pelvic surgery, or engaging in intensive physical therapy (>2 h/week) reported significantly lower scores in multiple domains of quality of life, including “Social well-being”, “Emotional well-being”, “Feelings about functioning”, and “Family health”.•The ‘Feelings about Functioning’ domain was 62% explained by motor and activity-related measures (GMFM-88, PEDI-CAT Activity, and PEDI-CAT Social/Cognitive), with PEDI-CAT Activity emerging as the strongest predictor.What are the implications of the main findings?•The association between specific medical interventions and lower quality-of-life scores underscores the need for holistic care strategies that address psychosocial well-being alongside physical treatment in children with CP.•Identifying PEDI-CAT Activity as the strongest predictor of the ‘Feelings about Functioning’ domain highlights the importance of prioritizing functional activity in rehabilitation programs to enhance perceived quality of life.Background/Objectives: To analyze the parent-perceived quality of life (QoL) in children with cerebral palsy (CP) and to study the relationship between sociodemographic and clinical factors and this perception, under the perspective of the International Classification of Functioning, Disability and Health (ICF). Methods: A cross-sectional study was conducted with 95 participants (ages 5–19 years) with CP. Participants’ parents were asked about sociodemographic and clinical characteristics and compiled Cerebral Palsy Quality of Life (CP-QoL) and Pediatric Disability Inventory-Computer Adaptive Test (PEDI-CAT). Participants were assessed and classified into the following functional domains: gross motor function (GMFM-88, GMFCS), manual ability (MACS), eating and drinking abilities (EDACS), and communication function (CFCS). Correlations between CP-QoL domains and variables were investigated using Spearman’s correlation coefficient and multivariate predictive models were used to investigate the variables predicting CP-QoL scores for each domain. Results: A total of 95 children with a mean age of 12.4 ± 3.5 years (range 5–19 years) were included. Participants demonstrated moderate-high GMFM-88 level (228.8 ± 44.7) and high functional performance across PEDI-CAT domains: Activity (57.2 ± 5.1), Mobility (63.1 ± 5.6), and Social/Cognitive (70.2 ± 4.3). Parent-perceived QoL was significantly higher when children did not require AFOs, botulinum toxin, or recent hospitalizations, and lower among children who attended physical therapy >2 h/week. Moderate correlations were consistently found between the ‘Feelings about Functioning’ domain and functional variables, being positive for GMFM-88 and all PEDI-CAT domains, and negative for GMFCS, MACS, EDACS and CFCS. That domain of CP-QoL was best explained by the regression model (R2 = 0.619, p < 0.001), with the combination of three variables: GMFM-88, PEDI-CAT Activity and PEDI-CAT Social/Cognitive. Among them, PEDI-CAT Activity was the strongest predictor (β = 0.1436). Conclusions: In children with CP, to enhance family well-being, interventions should prioritize social participation and carefully balance the intensity and frequency of therapy against family burden and daily life demands, as QoL is primarily driven by manual ability and functional performance.

HighlightsWhat are the main findings?Cine phase contrast MRI for time-resolved assessment of leg muscle function during voluntary and electrically evoked motion was feasible in typically developing children.The success rates of cine phase contrast MRI during both voluntary and electrically evoked leg motion were reduced in pediatric patients with cerebral palsy.What is the implication of the main finding?Further optimization of the electrical muscle stimulation protocol, the voluntary motion task, and the MRI acquisition—particularly with regard to scan acceleration—is required.These improvements would enable cine phase-contrast MRI to serve as a feasible method for studying muscle dynamics and assessing treatment effects in pediatric patients with neuromuscular diseases.Background/Objectives: Magnetic resonance imaging (MRI) can be used to assess muscle function while performing a motion task within the scanner. Quantitative measures such as contraction velocity and strain can be derived from the images. Cine phase contrast (PC) MRI for time-resolved imaging of muscle function relies on the consistently repeated execution of the motion task for several minutes until data acquisition is complete. This may be difficult for patients with neuromuscular dysfunctions. To date, this approach has been applied only in adults, but not pediatric populations. The aim of this pilot study was to investigate the feasibility of PC MRI for assessing calf muscle function during electrically evoked and voluntary motion in children with cerebral palsy (CP) using open-source hardware and software. Methods: Cine PC MRI was performed at 3T in ambulatory pediatric patients with CP and typically developing children under electrical muscle stimulation (EMS) (n = 14/13) and during voluntary plantarflexion (n = 4/4) using a home-built pedal with a force sensor. A visual feedback software was developed to enable synchronized imaging of voluntary muscle contractions. Muscle contraction velocity and strain were calculated from the MRI data. Data quality was rated by two readers. Results: During EMS, the velocity data quality was rated as sufficient in 21% of scans in patients compared with 82% of scans in controls. During the voluntary task, all patients demonstrated increased compliance and greater generated force output than during EMS. Voluntary motion imaging was successful in all controls but none of the patients, as motion periodicity in patients was worse during voluntary than during stimulated contraction. Conclusions: Cine phase-contrast MRI combined with EMS or voluntary motion proved challenging in pediatric patients with CP, particularly in those with more severe baseline muscle dysfunction or reduced tolerance to stimulation. In contrast, the approach was successfully implemented in typically developing children. Although the scope of the patient-based findings is limited by data heterogeneity, the method demonstrates considerable potential as a tool for monitoring treatment-related changes in muscle function, particularly in less severely affected patients. Further refinement of the EMS and voluntary motion protocols, together with a reduction in MRI acquisition time, is required to improve motion periodicity, tolerability, and consequently the overall success rate in the intended pediatric patient cohort.

Background: Congenital diaphragmatic hernia (CDH) is a rare but serious congenital anomaly linked to high mortality rates and significant long-term morbidity. Although numerous prognostic factors for short-term outcomes have been identified through hospital-based studies, data on long-term mortality at the population level are limited. Specifically, nationwide assessments of long-term outcomes for infants with CDH are scarce. This study aimed to estimate the national 5-year all-cause mortality for CDH and to create a population-level risk stratification nomogram utilizing nationwide health insurance claims data. Methods: We conducted a retrospective cohort study of infants with CDH using nationwide insurance claims data from 2002 to 2016, allowing for complete 5-year follow-up. We analyzed population-level demographic and clinical proxy variables with Cox proportional hazards models and developed a nomogram for long-term mortality risk stratification. Results: Factors such as rural residence, middle-to-high SES, respiratory distress in newborns, and CHD were associated with increased 5-year mortality in infants with CDH. The claims-based nomogram, which incorporated sociodemographic and comorbidity variables, demonstrated moderate discriminatory power (AUC 0.76; C-index 0.78) for population-level risk stratification. Conclusions: This nationwide claims-based cohort study provides population-level estimates of 5-year mortality associated with CDH and introduces a nomogram that offers moderate discriminatory ability for long-term risk stratification.

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

Background/Objectives: Habitual patellar dislocation is a rare but debilitating form of patellofemoral instability in children and adolescents, frequently associated with underlying anatomical abnormalities and ligamentous laxity. Despite multiple surgical techniques, recurrence and suboptimal functional recovery remain concerns. This study aimed to identify the demographic, clinical, and imaging factors associated with postoperative recurrence and poorer functional outcomes in pediatric patients surgically treated for habitual patellar dislocation. Methods: A retrospective cohort study was conducted on pediatric patients treated between 2016 and 2024 for habitual patellar dislocation. Inclusion criteria required age ≤ 18 years, a minimum 12-month follow-up, and complete imaging documentation. Clinical evaluation included the Beighton hyperlaxity score, lower-limb alignment, and Lysholm Knee Score. Imaging parameters assessed patellar height (Caton–Deschamps Index), trochlear dysplasia, patellar tilt, patellar subluxation, genu valgum, and tibial tubercle–trochlear groove (TT–TG) distance. Surgical treatment consisted of individualized combinations of soft-tissue realignment, quadriceps lengthening, Roux–Goldthwait procedures, and MPFL reconstruction. Statistical analyses evaluated predictors of recurrence and postoperative Lysholm score. Results: Thirty-four patients (45 knees; mean age 12 years; 73.5% female) were included. Preoperative Lysholm scores improved from a mean of 73 to 94 postoperatively (p < 0.0001). Recurrence occurred in 32.35% of patients and was significantly associated with generalized hyperlaxity (p = 0.0041), trochlear dysplasia (p = 0.045), and lateral patellar subluxation (p = 0.039). Suboptimal postoperative Lysholm scores (<85) were observed in 11.76% of patients, all with recurrence, and were significantly associated with genu valgum (p = 0.0011) and patella alta (p = 0.036). No significant associations were found for rotational deformities or femoral condyle hypoplasia. Conclusions: Habitual patellar dislocation in children is multifactorial, and the likelihood of recurrence increases with cumulative risk factors such as hyperlaxity, trochlear dysplasia, lateral subluxation, patella alta, and genu valgum. Comprehensive preoperative assessment is essential to guide combined, individualized surgical strategies that optimize stability and functional recovery. No single technique is universally curative; rather, tailored multimodal approaches yield the most favorable outcomes.

HighlightsWhat are the main findings?Non-operative treatment of pediatric proximal humerus fractures provides excellent long-term functional outcomes, even in Neer–Horowitz grade III–IV injuries.Surgical management does not improve recovery, shoulder function, or return-to-sport rates compared with conservative care.What are the implications of the main findings?Conservative treatment should remain the standard of care, with surgery reserved only for exceptional indications such as open fractures or neurovascular compromise.Avoiding unnecessary surgery reduces healthcare costs, minimizes postoperative issues, and limits the psychosocial burden for children and families.Background: Pediatric proximal humerus fractures (PHFs) typically heal well due to their strong remodeling potential, supporting non-operative management even in displaced injuries. However, surgery for Neer–Horowitz grade III–IV fractures has become more frequent despite limited evidence of superior outcomes. Methods: A retrospective analysis of 152 children (<14 years) treated for isolated PHFs at a tertiary pediatric orthopedic center (2004–2023) was performed. Clinical records and telephone follow-up provided demographic data, fracture classification, management, complications, and functional outcomes (QuickDASH, Tegner, return to sport). A direct cost analysis compared conservative and surgical pathways. Results: Of 152 patients, 133 were treated non-operatively and 19 surgically. Conservative management achieved excellent results across all fracture types: nearly all patients reported normal QuickDASH scores and full shoulder function. Among Neer III–IV fractures (n = 37), functional outcomes, activity levels, and sport resumption were similar between treatment strategies. Minor transient issues (pin migration, temporary stiffness, delayed return to sport) occurred only after surgery. No meaningful complications were observed in the conservative cohort. Mean costs differed substantially: €1452.09 for non-operative management versus €7832.12 for surgical treatment. Conclusions: Long-term outcomes of pediatric PHFs were uniformly excellent, regardless of fracture severity or treatment modality. Surgery did not improve recovery, function, or return to sport and was associated with higher costs and minor postoperative issues. Conservative management should remain the standard of care for nearly all pediatric PHFs, with surgery reserved for exceptional circumstances such as open fractures, neurovascular compromise, or failed closed reduction.

Background: Although significant progress has been made in Neonatal Hearing Screening (NHS) over the past two decades, the available data on Universal Neonatal Hearing Screening (UNHS) practices across Asia remain limited. The aim of this scoping review was therefore twofold: (a) to identify and synthesize the most recent literature (within the past 20 years) concerning NHS/UNHS programs in Asian states, and (b) to summarize evidence on screening procedures, the intervention strategies, and the estimated prevalence of congenital hearing loss (HL), with particular attention to cases of bilateral impairment. Methods: In line with previous reports from our group on the screening practices in Europe and in Africa, queries were conducted via the PubMed, Scopus and Google Scholar databases for the time window of 2005–2025. The Mesh terms used were “Otoacoustic Emissions (OAE)”, “Universal Neonatal Hearing Screening”, “congenital hearing loss”, “well babies” and “ASIA”, as well as all 50 Asian state names. Only research articles and review papers were considered as good candidates. The standard English language filter was used. Results: To maintain homogeneity in terms of state area and population, the studies conducted in China and India were excluded from this report and will be the focus of a dedicated paper. Data from 31 papers were considered, reflecting the neonatal hearing practices of 17 Asian states, of which in 12, UNHS programs are considered mandatory. Conclusions: The information on the Asian NHS is limited to a low percentage of Asian states. The available data strongly suggest that audiologists and other hearing professionals, involved in regional or national screening initiatives, should collect systematically and disseminate the screening information through peer-reviewed scientific publications. The latter will contribute to a broader understanding of program effectiveness and will facilitate international benchmarking.