Children admitted to pediatric intensive care units (PICUs) are at risk of acquired weakness, delirium, and long-term functional and neurocognitive morbidity. Although early rehabilitation is recommended to mitigate these adverse outcomes, its delivery remains challenging. Virtual reality (VR) has been proposed as a means of enhancing engagement in rehabilitation in this setting. This systematic review evaluated the feasibility, safety, and outcomes of VR delivered to children during routine pediatric intensive care to support rehabilitation, participation in rehabilitation, or emotional regulation. Three databases were searched through 8 August 2026, and the reference list of one relevant scoping review was screened; two reviewers independently screened all records (Cohen's κ = 0.85). Six studies involving 188 children were included: one randomized pilot trial, one prospective single-arm trial, two cross-sectional single-arm studies, and two case reports. Risk of bias was high, serious, or critical in every appraised study, and the certainty of evidence was very low across all outcome domains. The randomized trial found higher consciousness scores at 2 weeks in the VR group but no difference in social and personal functional ability at 3 months. In uncontrolled studies, most children were rated as highly engaged and reported enjoying VR, while parents reported a calming effect more frequently than the children themselves; a transient increase in one heart rate variability parameter occurred during VR but was not sustained afterward. Adverse events were reported in four of the six studies at rates of 3.1% to 20%, comprising dizziness, nausea, visual discomfort, and mild irritability, with one serious event adjudicated as unrelated to VR; the two studies that applied pre-specified criteria recorded no events and one unrelated event, respectively. VR appears feasible and safe for hemodynamically stable, alert children in the PICU and is consistently associated with high engagement. However, whether VR improves functional outcomes remains uncertain. Eligibility, rather than tolerability, may be the principal barrier to implementation, and the available evidence applies to only a minority of the PICU population. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024607286, PROSPERO, CRD42024607286.
Objectives This is a protocol for a Cochrane review (intervention). The objectives are as follows: To assess the efficacy and safety of osmotic and stimulant laxatives for the treatment of functional constipation in children.
The concept of the "cannabidiol (CBD) Hazard Triangle" reflects the unique position of CBD at the intersection of three overlapping dimensions: CBD as a substance associated with medicinal and pharmacological effects ("Drug"); CBD as a food ingredient subject to the EU Novel Food regulatory framework ("Novel Food"); and CBD as a potential source of food safety concerns ("Hazard"). This study investigates the growing presence of CBD-containing food products, their associated regulatory challenges, safety concerns, and market dynamics through an analysis of notifications reported in the EU Rapid Alert System for Food and Feed (RASFF), complemented by evidence from the scientific literature and authoritative regulatory sources. During the eight years (2018-2025), more than 400 CBD-related notifications were reported, predominantly involving food supplements (66.7%) and confectionery products, particularly gummies (12.6%). Significant discrepancies between the labelled and actual CBD content were frequently identified, along with unauthorized health claims implying therapeutic benefits. CBD-containing products were also found to contain other cannabinoids, most notably tetrahydrocannabinol (THC), which was reported in 26.7% of CBD-related hazard notifications. In several cases, THC concentrations exceeded legally permitted limits. Furthermore, these products are often marketed in forms that may promote casual or unintentional consumption, including by children. Overall, the widespread availability of CBD-containing food products raises important safety and regulatory concerns, particularly for vulnerable population groups. The CBD food market remains highly heterogeneous, characterized by inconsistent labelling practices, strong consumer demand, and increasing regulatory pressure. These findings underscore the need for clearer regulatory frameworks, improved market surveillance, and harmonized standards. Further research is essential to address unresolved issues related to product safety, quality, and market integrity.
Background Medication errors are a leading preventable cause of harm in hospitalized children. The pediatric population is particularly vulnerable due to weight-based dosing requirements, developmental pharmacokinetic variability, and limited capacity for self-advocacy. Objectives To map and synthesize the available evidence on factors associated with the occurrence of medication administration errors in hospitalized pediatric patients. Eligibility criteria Studies addressing administration phase medication errors (per the National Coordinating Council for Medication Error Reporting and Prevention, NCC MERP) in hospitalized children aged 0 to 18 years, published in English, Spanish, or Portuguese, using quantitative, qualitative, or mixed methods designs. Sources of evidence Nine electronic databases were searched from inception to July 2026 using English, Spanish, and Portuguese (DeCS) terms, supplemented by hand searching of reference lists. Charting methods The review followed the Joanna Briggs Institute (JBI) methodology; data were charted with the JBI standardized instrument and synthesized narratively with thematic analysis. Results Of 1,012 records, 25 studies met the inclusion criteria. Incorrect dosing was the most prevalent error type (18 studies, 72%). Neonates and infants were the most vulnerable group, and PICU and NICU the highest-risk settings, although a direct observation study reported that 37% of administrations on general wards involved an error. Human factors, particularly knowledge deficits, were the most frequently reported contributors (13 studies, 52%). Five complementary mitigation strategies were identified: professional education, dual verification, unified non-punitive reporting, technology, and interprofessional communication. Conclusions Medication administration errors in pediatric inpatients are driven by a multilayered interplay of human, environmental, communicative, and medication related factors. Effective prevention demands integrated, systems-based approaches combining education, technology, standardized protocols, and a non-punitive safety culture.
Motta Robayo CL, Martínez Pinto J, Tabango Goyes B et al.
Importance Stakeholder voices advance client-centered, culturally responsive occupational therapy research. Objective To describe how engagement of culturally diverse, multilingual, and multidisciplinary stakeholders shaped a project aimed at culturally adapting an evidence-based autism intervention. Design A mixed-methods design was used to evaluate stakeholder engagement. Quantitative data were used to measure engagement frequency and quality, and qualitative data captured stakeholders' experiences. Setting Engagement activities conducted online and in person at a local community setting. Participants Twenty-five stakeholders-7 parents or caregivers of autistic children, 3 autistic adults, 4 occupational therapy practitioners, 2 psychologists, 3 medical doctors, 3 cultural experts, and 3 teachers-were recruited through snowball sampling. Method Stakeholders engaged in activities designed to support a project that evaluates two methods of engagement and completes the cultural adaptation of an evidence-based intervention. Activities were guided by the foundational expectations for partnerships as outlined by the Patient-Centered Outcomes Research Institute. Outcomes and measures The Stakeholder-Centric Engagement Evaluation measured engagement on a Likert scale ranging from 1 (never/poor) to 5 (always/excellent) for how often and how well engagement occurred. Qualitative data were collected using open questions in the survey. Results Engagement frequency (M = 4.45, SD = 0.24) and quality (M = 4.29, SD = 0.23) were highly rated. Open-ended responses indicated that stakeholders were satisfied with their engagement and interested in additional capacity-building; their feedback shaped the main project in areas including recruitment, retention, data monitoring, and dissemination. Conclusions and relevance Stakeholders rated their research experiences highly. Engagement is vital to integrating lived experiences and cultural context into occupational therapy, advancing health equity through culturally responsive, client-centered care. Plain-Language Summary: The main project aimed to culturally adapt an evidence-based occupational therapy intervention for Hispanic and Latino autistic children and compare two methods of engagement. Hispanic and Latino families often face barriers accessing culturally and linguistically appropriate services and being included in research. This work was needed to ensure interventions are relevant, equitable, and supportive of their needs. The voices of those impacted by this work were included to guide the research process. We engaged 25 people-including parents, autistic adults, occupational therapy practitioners, psychologists, teachers, and cultural experts-to work closely with the research team. They supported the team through advisory boards and helped shape the project in important ways, such as improving how families are invited to join and how information is shared. Meetings were held mostly on Zoom, with some held in person. We measured how often and how meaningfully stakeholders were involved, and both were rated very highly. This shows that strong partnerships are possible and valuable. Listening to community voices can help ensure that research is more relevant, respectful, and effective. Projects such as this can make occupational therapy more accessible for children and families from different cultural and language backgrounds, ultimately improving health equity and quality of care. Positionality Statement: We use the terms Hispanic and Latino throughout this article to support inclusivity. The term Hispanic typically refers to people with Spanish ancestry or Spanish as a primary language; however, it is sometimes viewed as problematic because of its association with Spanish colonization. In contrast, Latino refers to people from Latin America, including the Caribbean. Given the variation in individual and community preferences, we acknowledge the complexity of these identities (Martínez & Gonzalez, 2021). Furthermore, we implement the identity-first terminology for autistic persons on the basis of their preference for using such language (Taboas et al., 2023). The first author, Lady Rios-Vega, identifies as a Latina. She is an occupational therapy practitioner and researcher who has served minoritized families. We acknowledge that her perspectives may influence how data are presented. In addition, the diverse backgrounds and experiences of all contributing authors shape our work, guiding us to pursue our objectives with a strong focus on equity and inclusivity. The senior author, Roseann Schaaf, identifies as a White woman from a middle-class background. She is an occupational therapy practitioner and an experienced autism researcher. She acknowledges the potential impact of her privileged positionality in studying the experiences of marginalized communities, and she is committed to mitigating any biases that may arise from her own perspective.
Introduction Infantile hemangiomas (IH) usually undergo spontaneous involution; however, some lesions remain visible after infancy and may cause psychosocial distress in children and their families. Evidence regarding the effectiveness of topical beta-blockers when treatment is initiated after infancy remains limited. Methods This real-world study evaluated the efficacy of topical timolol therapy in children aged 1-5 years with persistent IH. Children with IH were evaluated at a specialized vascular anomalies center in Ukraine between 2019 and 2024. Parents of children older than 1 year with persistent visible IH associated with psychosocial distress were offered vascular laser therapy or topical timolol treatment. Because topical therapy could be administered safely at home under remote medical supervision during ongoing military action, all families chose this option. A short initial treatment period of 2-4 weeks was used to assess the therapeutic response, and treatment was continued if improvement was observed. Results A total of 2419 children with IH were evaluated during the study period. Among them, 1287 patients used topical timolol as monotherapy. Treatment was initiated after the age of 1 year in 113 patients with persistent lesions. Positive outcomes were observed in 1151 (98.04%) patients who started therapy before the age of 1 year and in 78 (69.03%) patients who initiated treatment between 1 and 5 years of age (p < 0.001). Topical timolol 0.5% demonstrated limited effectiveness in older children, whereas switching to topical timolol 1% resulted in clinical improvement. In six patients previously treated with systemic beta-blockers, topical timolol remained effective even after systemic therapy had lost effectiveness. Natural involution of IHs may be partially responsible for the positive effect observed in some of our patients. Conclusions These findings suggest that topical timolol 1% may provide clinically meaningful improvement in persistent IH beyond infancy and support telemedicine-based treatment when access to in-person care is limited.
Discretionary child protection system (CPS) reporting policies allow some substance-exposed infants to be discharged from the hospital without a maltreatment report, but it is unknown whether risk for later system involvement varies according to exposure status. We conducted a retrospective cohort analysis of CPS involvement in the first 5 years of life as predicted by prenatal substance exposure among California births in 2018. At 5 years, less than 14% of exposed children experienced CPS reports of maltreatment harm or substantiated CPS reports. Exposed children were more likely to be reported for maltreatment harm at 5 years (adjusted Risk Difference (aRD)=0.03, 95%CI: 0.02, 0.04), including a subgroup with only cannabis exposure (aRD = 0.03, 95%CI: 0.02, 0.04) compared with unexposed infants. Prenatally exposed children were more likely to experience a substantiated report within 5 years compared with those without exposure (aRD = 0.03, 95%CI: 0.02, 0.03). Findings suggest that families affected by prenatal substance exposure who do not have apparent safety concerns at birth may benefit from support to prevent future instances of system intervention or child maltreatment.
BACKGROUND: Severe long-segment coarctation of the aorta in children is traditionally managed surgically; however, transcatheter stent implantation is emerging as a viable alternative in selected cases. The use of large-diameter covered stents in small children raises concerns regarding vascular access, procedural safety, and future reintervention. CASE PRESENTATION: An 8-year-old male child (21.7 kg) with global developmental delay presented with breathlessness. Clinical examination revealed radio-femoral delay, absent lower limb pulses, and upper limb hypertension (130/80 mmHg). Echocardiography demonstrated severe coarctation with left ventricular hypertrophy. CT aortography confirmed long-segment narrowing involving the aortic isthmus and proximal descending thoracic aorta, with a minimum diameter of 2.2 mm and a proximal descending aortic diameter of 12.3 mm. Cardiac catheterization showed an 80 mmHg peak systolic gradient. A transcatheter approach was undertaken. Right femoral arterial access was obtained using stepwise dilatation to accommodate a 12 Fr sheath. After systemic anticoagulation, a Zephyr XL covered stent (ZPXL 34) was deployed across the lesion under fluoroscopic guidance. Controlled expansion was performed, and mild residual narrowing was intentionally accepted to reduce the risk of aortic injury and allow staged dilatation. The post-procedural gradient decreased to 15 mmHg. Angiography confirmed satisfactory stent position with preserved left subclavian artery flow, and Doppler assessment showed no vascular complications. Lower limb pulses improved immediately. CONCLUSION: Transcatheter implantation of a large-diameter covered stent can be performed safely in selected young children with long-segment coarctation when meticulous attention is given to vascular access, device selection, and controlled, staged dilatation strategies.
Background Despite increasing interest in the association between active commuting to school (ACS) and health-related behaviors, the existing literature presents inconsistent findings regarding the relationships between ACS and preceding behaviors such as sleep duration and daily breakfast consumption. The current study aimed to analyze the associations between the mode of commuting to school and independent mobility to school with sleep duration and daily breakfast consumption among Spanish children and adolescents, and the secondary aim was to conduct this analysis separately by gender. Methods It was a cross-sectional study conducted in 27 schools from 11 Spanish cities involving 226 children (6-11 years) and 1155 adolescents (12-17 years). Mode of commuting to school, independent mobility to school (yes/no), sleep duration (adequate/non-adequate), and daily breakfast consumption (yes/no) were self-reported. Multilevel mixed-effects logistic regressions examined these associations across age groups and gender. Results The results showed that children with adequate sleep duration were more likely to actively commute to school (OR: 2.98, 95% CI: 1.06 to 8.40), with stronger associations in boys (OR: 6.26, 95% CI: 1.32 to 29.8). Regarding adolescents, those who consumed breakfast daily were more likely to commute independently to school (OR: 1.47, 95% CI: 1.05 to 2.07). No other significant associations were observed in children and adolescents (all, p > 0.05). Conclusions Based on our findings, there may be a tendency for preceding behaviours, such as adequate sleep duration and daily breakfast consumption, to influence whether children and adolescents commute to school actively or passively, and whether they do so independently or with adult supervision. Programs promoting these behaviors should involve families, schools, and communities to support healthier lifestyles and enhance the well-being of children and adolescents.
Ramírez-Osuna A, Huertas-Delgado FJ, Aibar-Solana A et al.
Prediction models for asthma remission in school-age are lacking, limiting clinicians’ ability to tailor follow-up. Most prediction tools focus on pre-school diagnosis or require lung function testing. We developed and validated a simple, history-based clinical prediction tool for asthma remission. We analyzed prospective data from the Swiss Paediatric Airway Cohort (SPAC), including 1860 children (aged 5-16 years) with physician-diagnosed asthma. We derived asthma remission predictors from parental questionnaires capturing demographics, symptoms, triggers, and family history. We defined clinical remission at 2-3 years following asthma diagnosis, as absence of wheeze and inhaler use during the past 12 months. We developed the model using LASSO regression with multiple imputations for missing data, and assessed its performance by area under the curve (AUC), Hosmer-Lemeshow (HL) test, and calibration plots. We then derived a simplified score and validated it in the German All-Age Asthma Cohort (ALLIANCE). From 12 candidate variables, the final score retained: sex, wheeze frequency, night-time awakening, exercise-induced wheeze, pollen-triggered wheeze, animal-triggered wheeze, maternal asthma, and paternal asthma. The score demonstrated moderate discrimination in the development cohort (AUC 0.71) and maintained discriminative ability in the external validation (AUC 0.71). This practical, prognostic tool for asthma remission based only on clinical history, allows clinicians to identify children who have lower chances for remission, enabling their closer monitoring. Abstract Figure
