OBJECTIVES: Enhancing Health-related quality of life (HRQoL) among adolescents is a major public health goal. HRQoL is associated with the modifiable factors health literacy and self-efficacy. Theory and research suggest that individuals with higher health literacy are more capable of managing health experiences, which may strengthen self-efficacy and improve HRQoL. However, the mediating role of self-efficacy in the association between health literacy and HRQoL is scarcely studied. The overall aim of this study is to examine the relationship between self-reported health literacy and HRQoL, and the potential mediating role of self-efficacy in 13-year-old boys and girls. STUDY DESIGN: The study employed a cross-sectional, school-based design. METHODS: Self-report data were collected from 1425 13-year-old students (71% response rate) across 48 schools in 19 municipalities across Norway. HRQoL, health literacy, and self-efficacy were assessed using KIDSCREEN-27, HLSAC, and GSE-5, respectively. Mediation analysis was conducted within a causal mediation framework to estimate the potential total, direct, and indirect effects on HRQoL associated with a hypothetical 10-percentage-point increase in the health literacy score, with general self-efficacy as the proposed mediator. RESULTS: Overall, higher health literacy showed a significant increase in HRQoL across all subscales.The largest total effects were observed for the School Environment domain. A hypothetical 10 percentage-point increase in health literacy was associated with increases of 2.47 T-score points (95% CI 2.08-2.85) among girls and 1.86 (95% CI 1.40-2.35) among boys. The proportion potentially mediated through self-efficacy ranged from 30% to 76% across HRQoL subscales. CONCLUSIONS: This study contributes to the literature by suggesting that general self-efficacy may be a potential mediator of the association between health literacy and HRQoL. Future interventions targeting health literacy should be evaluated using longitudinal designs that can assess the temporal ordering from health literacy to general self-efficacy and subsequently to HRQoL.
Kristin Sofie Waldum-Grevbo, Solveig Holen, Tore Wentzel-Larsen et al.
OBJECTIVES: To examine nativity and age of immigration to U.S. and epigenetic age acceleration among Hispanics/Latinos residing in the U.S. METHODS: A subsample of 961 Hispanic/Latino adults participating in the Hispanic Community Health Study/Study of Latinos was included in the analyses. DNAm was measured from whole blood, at two different time points six years apart, using the Illumina MethylationEPIC BeadChip and epigenetic age acceleration (EAA) was calculated using the PhenoAge, GrimAge and DunedinPACE second-generation epigenetic clocks. Nativity was categorized as U.S.-born, non-U.S.-born arriving as a child (<18 years), and non-U.S.-born arriving as an adult (≥18 years). Linear regression models were adjusted for age and cell-type proportions as time-dependent covariates and sex, educational attainment, and smoking status at baseline. RESULTS: Foreign-born status was associated with lower GrimAge Acceleration (GrimAA). In age-stratified models, non-U.S.-born persons who arrived in the U.S. as adults and were aged 18-39 (GrimAA: B = -1.09, 95% CI: -2.00, -0.17) and 40-54 (GrimAA: B = -1.16, 95% CI: -1.97, -0.35) years at baseline had lower GrimAA compared to their U.S.-born counterparts. There were no differences in EAA among non-U.S.-born participants who arrived in the U.S. as children (vs. U.S.-born), regardless of age. CONCLUSION: Among Hispanic/Latino adults, foreign-born status was associated with lower epigenetic aging. Further research is needed to understand the migration-related, social, and environmental factors underlying these differences.
PURPOSE: The initial identification of children at risk for sleep disordered breathing (SDB) commonly relies on parental reports of symptoms, particularly snoring. This study aims to assess how age affects the association between parent-reported snoring and SDB-related findings on polysomnography (PSG). We hypothesized that parent-reported snoring correlates more strongly with SDB-related findings on PSG in younger children. METHODS: This study was part of the Child Sleep project, a longitudinal birth cohort study on children born at Tampere University Hospital, which was carried out between 2013 and 2025 and included clinical examinations at ages 2, 6, and 12 years, where children were compared based on whether their parents reported them to snore. RESULTS: An association between parent-reported snoring and PSG-diagnosed obstructive sleep apnea (OSA) was found in children aged 2 years (p = 0.009) and 6 years (p = 0.045). Parent-reported snoring showed a high sensitivity (1.0) and negative predictive value (1.0) for OSA in both 2- and 6-year-olds, with its predictive performance diminishing in 12-year-olds. 2-year-olds who were reported to snore had higher respiratory effort than non-snorers (p = 0.022). In children aged 6 and 12 years there was more flow limitation among those reported to snore than among non-snorers. CONCLUSION: Parent-reported snoring may be a clinically useful screening tool for excluding SDB in younger children alongside other examination methods. However, its reliability appears to decrease as children approach puberty and during puberty. Thus, it is important to consider age-related changes in the pathophysiology of SDB and changes in parental observational behavior as children approach adolescence.
Ella Ruikka, Timo Peltomäki, Outi Saarenpää-Heikkilä et al.
OBJECTIVE: To externally validate two recently developed deep-learning approaches for FCD detection, MELD Graph and 3D-nnUNet, in a pediatric cohort. BACKGROUND: Focal cortical dysplasias (FCDs) are among the most common structural causes of drug-resistant epilepsy in children but are frequently subtle and difficult to detect on MRI. Several automated lesion detection methods have been proposed to support neuroradiological assessment. We externally validated two recently developed deep-learning approaches for FCD detection, MELD Graph and 3D-nnUNet, in a pediatric cohort. METHODS: In this retrospective single-center study, we analyzed brain MRI scans of 70 children evaluated for epilepsy, including 34 MRI-positive patients with suspected FCD and 36 MRI-negative patients, based on primary radiology reports. Both models were applied to 3D T1-weighted and 3D FLAIR images. The detected lesions were reviewed by an experienced pediatric neuroradiologist and classified as true positive, false positive, or false negative. False-positive cases were additionally reviewed using electroclinical findings. RESULTS: MELD Graph and 3D-nnUNet achieved comparable lesion precision (0.86 vs. 0.90) but only moderate recall (0.63 vs. 0.47). At the patient level, MELD Graph demonstrated higher sensitivity (0.71 vs. 0.53), whereas 3D-nnUNet achieved substantially higher specificity (0.86 vs. 0.47) owing to fewer false-positive detections. 3D-nnUNet showed higher sensitivity with the improved FLAIR sequence, whereas MELD Graph performance was strongly influenced by the accuracy of cortical surface reconstruction. Both models failed to detect a clinically relevant proportion of FCDs. CONCLUSION: MELD Graph and 3D-nnUNet generalize to pediatric MRI and represent valuable decision-support tools for highlighting suspicious cortical regions. However, their moderate sensitivity and susceptibility to false-positive findings indicate that they should complement, rather than replace, expert neuroradiological interpretation.
Andrea Dell'Orco, Enrico De Vita, Felice D'Arco et al.
Levetiracetam (LEV) is widely used in the treatment of pediatric epilepsy and is typically well tolerated. We hereby present a case involving an infant who exhibited a notable and isolated elevation of alkaline phosphatase (ALP) during a treatment of LEV, with subsequent normalization following drug cessation. Liver function tests and bone turnover markers remained within normal limits, and the patient was asymptomatic. ALP levels returned to normal within four weeks of discontinuing LEV. LEV may cause significant, reversible ALP elevation in children, most likely due to bone origin. Although rare, this potential adverse effect should be considered, particularly during long-term therapy.
Kim Dao, Emmannuella Bonègre, Hassib Chehade et al.
BACKGROUND: Planetary health is an emerging field of growing global importance. Environmental changes increasingly threaten maternal and child health, while nurses and midwives play central roles across care processes. Despite these opportunities, planetary health education and training in nursing and midwifery are underdeveloped and a mapping of current approaches is critically needed. OBJECTIVE: To map existing planetary health education and training initiatives for nurses and midwives and examine their reported educational and practice outcomes related to maternal and child health. METHODS: A scoping review was conducted following the Arksey and O'Malley framework Searches were conducted in Medline/PubMed, Scopus, and EMBASE for English-language studies published from 1 January 2015 to 31 January 2026. Eligible studies addressed planetary health education and/or training for nurses or midwives. We used a standardized form to extract data, and narrative synthesis was applied given the diversity of interventions and outcomes. RESULTS: Out of 258 records identified, seven studies published from 2019 to 2026 met the inclusion criteria. These were conducted in Australia(n = 1), Australia and New Zealand (n = 1), Spain (n = 1), Turkey (n = 2), and Uganda (n = 2). The evidence showed marked heterogeneity in study design, settings, and educational approaches. Study designs included two randomized controlled trials, one quasi-experimental study, one cross-sectional survey, two qualitative studies, and one implementation study. Educational approaches varied widely, from online courses and curriculum validation to community-based biomass smoke education and simulation-based training. Reported outcomes were grouped into five categories: knowledge, attitudes, confidence and self-efficacy, behavioral practice change, and clinical or system-level outcomes. Five studies reported improvements in attitude and satisfaction. Confidence and self-efficacy outcomes were infrequently reported. Behavioral or practice change was noted in three studies. Two studies reported direct maternal and child health benefits through reduced household air pollution exposure, but no study reported direct maternal or neonatal clinical outcomes. CONCLUSION: Evidence on planetary health education for nurses and midwives is emerging but remains limited. Current studies focus mainly on immediate educational outcomes rather than sustained practice change or patient-level impact. Future research should evaluate long-term competency development, clinical practice change, and measurable maternal, neonatal, and child health outcomes. REGISTRATION: OSF | Planetary Health Education and Training for Midwives and Nurses: A Scoping Review of Reported Educational and Practice Outcomes Related to Maternal and Child Health, registered 5/2/2026, https://doi.org/10.17605/OSF.IO/JU3GY. SOCIAL MEDIA ABSTRACT: Current planetary health education and interventions for nurses and midwives have improved knowledge, attitudes, and some practice-related behaviors but lack direct patient-level outcomes. @zamansohag08.
Sadia Afrin, Pascal Petit, Nicolas Vuillerme et al.
BACKGROUND: The majority of children in developed economies attend childcare services during the first five years of life-a period coinciding with their developmental transition from regular napping to consolidated nighttime sleep. Whether childcare attendance affects this transition is not well understood. Previous studies have relied primarily on cross-sectional designs or widely spaced longitudinal observations, limiting their ability to distinguish childcare effects from differences between children and families. METHODS: To provide greater clarity, we draw on data from the Sleep Transitions and Regularities Study (STARs), a longitudinal study of sleep behaviours among Australian children aged 1-4.5 years (N = 188; 45.74% female). We fit hybrid mixed-effects models over multiply imputed data to estimate associations between daily childcare attendance and napping frequency at both the within- and between-child levels. We test interaction effects to determine whether these associations are moderated by child age. RESULTS: Attending childcare was associated with a 4% within-child reduction in same-day napping frequency (IRR = 0.96, 95% CI [0.93, 0.98]). This association was moderated by age (IRR = 1.07, 95% CI [1.03, 1.11]), such that the association was negative before children were ∼2.18 years and became positive after ∼4.32 years. CONCLUSION: These findings may reflect the impacts of nap-scheduling practices that are standard in many childcare services, and direct future attention to the effects of such practices on children's sleep health. Our results also underscore the importance of longitudinal designs for capturing within-child change and the effects of children's social environments on their sleep and development.
George Patterson Michael Normore, Peter Rankin, Karen Thorpe et al.
Procedural pain and fear are common during pediatric immunizations and other needle-related procedures. This narrative review examined distraction-based, non-pharmacological interventions and the outcome measures used to assess pain and fear in children aged 6-12 years, with particular attention to AI-based interactive games and the Buzzy/Buzzle Bee cold-vibration device. A structured search of multiple databases identified 30 peer-reviewed studies published between 2015 and 2024. Studies were synthesized narratively according to intervention type, pain/fear outcomes, and measurement approach. Technology-based distraction, particularly virtual reality (VR), was associated with reduced pain, fear, or anxiety across multiple studies. Cold-vibration devices also reduced procedural pain and distress, while low-cost distraction methods provided practical alternatives. Outcome measures included self-report pain scales, fear scales, behavioral measures, proxy ratings, and physiological indicators. The findings support distraction-based approaches while highlighting substantial variation in outcome measurement and the need for consistent, developmentally appropriate assessment tools. Although these interventions show promise, the studies vary widely in how pain and fear are measured. The studies included used a variety of outcome measures, including self-report pain scales, fear scales, behavioral assessment tools, proxy ratings, and physiological indicators, making direct comparisons across studies more difficult. These inconsistencies highlight the need for more standardized and developmentally appropriate outcome measures. By summarizing current evidence and identifying gaps in assessment practices, this review underscores the importance of using reliable, child-centered tools to evaluate distraction-based interventions. Integrating these evidence-based distraction strategies into routine pediatric care may help reduce procedural trauma, improve children's experiences, and support more child-centered care.
Let’s get one thing clear: the world does not need “just another conference” where everyone agrees that children deserve better, applauds the ambition, exchanges business cards and flies home. Children do not need more declarations of good intent. They need adults to turn those intentions into action. And that is precisely why the Second Global Ministerial Conference on Ending Violence Against Children, taking place in Manila on 18–19 November 2026, matters. Co-organized by the Government of the Philippines, the World Health Organization (WHO) and UNICEF, in collaboration with the UN Special Representative of the Secretary-General on Violence Against Children, it offers an opportunity to turn political commitment into something that changes children’s lives. So, no. It is not “just another conference”. It is a moment to make decisions, shift priorities, unlock resources and challenge the comfortable distance between what the world says about protecting children and what children actually experience. And child helplines need to be right at the heart of it. One billion children. One very uncomfortable reality. According to the World Health Organization, an estimated one billion children aged 2–17 experience physical, sexual or emotional violence or neglect in a single year. Violence against children is not a niche issue. It is not confined to a particular region, income group or type of family. It is a global emergency, with consequences that reach into every community, every school, every digital space and every child protection system. The challenge is enormous. But so is our opportunity to change course. The first Global Ministerial Conference, held in Bogotá in 2024, brought together 109 Member States and generated close to 400 pledges to prevent and respond to violence against children. Since then, a majority of pledge-making governments have reported that they are either on track to deliver their commitments or have already done so. That is encouraging progress. It demonstrates what collective political commitment can achieve. But it also raises an important question: how do we ensure that progress reported by governments translates into meaningful change experienced by children? The Manila conference builds on Bogotá’s momentum, focusing on scaling proven prevention approaches, strengthening response systems and addressing escalating threats, including technology-facilitated violence and violence in humanitarian and climate-affected settings. These are the right priorities. But pledges are not protection. Commitments are not care. And a policy document, however beautifully written, cannot answer the phone when a child is frightened, isolated or in danger. The test is not simply what governments promise in Manila. The test is what becomes possible for children when they get home. Child helplines: not the supporting cast, but essential infrastructure Every day, child helplines operate at the point where children’s lives meet the systems designed to protect them. A child or young person might contact a child helpline because they are experiencing abuse at home, being threatened online, bullied, exploited or coerced. They might be struggling with their mental health. Or they might simply know that something is wrong, without having the words to explain it, and need one safe person to listen. Sometimes, that first conversation is the first time they have told anyone. Child helplines offer an accessible, child-centred route to support, information, referral and protection. They help children make sense of what is happening, identify risks and find a way forward. They can also help adults and communities raise concerns when a child may be at risk. And they bring something else to the table: insight into what children are experiencing, what they are willing to disclose, what is changing and where protection systems are failing to respond. Child helplines are both a lifeline for individual children and a listening post for the wider child protection system. That combination should make them indispensable to any serious strategy to end violence against children and young people. Yet we cannot take their existence, accessibility or capacity for granted. Not every child has access to a national child helpline. Not every child helpline has the resources to operate around the clock, respond across multiple channels or meet growing demand. And not every child who needs help can easily find it. Our ambition at Child Helpline International is clear: a child helpline in every country of the world by 2030, with services that children can access and trust. This is not an optional extra for child protection systems. It is part of the infrastructure we need to make those systems work for children. From Livingstone to Manila: turning commitment into protection For Child Helpline International, Manila is not the beginning of this conversation. Through our Livingstone Declaration and our work to carry its ambitions forward to Manila, we have been advocating for stronger recognition of child helplines and their contribution to national child protection systems. That work is grounded in a simple conviction: children’s right to be heard must be matched by their ability to reach support, and by the willingness and capacity of institutions to respond. Manila’s prevention-first approach is important. Supporting parents and caregivers, making schools safe and strengthening response systems are all essential to preventing violence at scale. But prevention and response are not competing priorities. We need both. We need to prevent harm before it happens. We need to identify it when it does. We need to ensure that children can disclose it safely, that someone takes them seriously, and that the right support follows. A child helpline can be the bridge between a child’s first disclosure and a wider system of protection. But that bridge only works when it connects to services that are available, adequately resourced, trained and ready to respond. Behind every successful contact are trained counsellors, safeguarding protocols, secure communications and case-management systems, referral partnerships, quality standards, accessible helpline numbers and sustainable funding. A short, easy-to-remember number is not much use if it does not connect. A counsellor cannot make a referral to a service that does not exist. And a child helpline cannot sustain its promise on goodwill alone. That is why governments, telecommunications providers, donors, technology companies and child protection partners all have a role to play. Accessibility must be designed in. Referral pathways must work in practice. Funding must be sustainable. And the people who answer children’s calls, messages and chats must have the support they need to do their jobs safely and effectively. This is what investment in response systems looks like: the practical foundations that allow children and young people to reach help when it matters. Three commitments that would make a difference If Manila is to accelerate meaningful progress, we need governments to make commitments that translate into stronger, more accessible support for children. For child helplines, three priorities stand out. First, recognize child helplines as integral parts of national child protection systems. They should be included in national violence-prevention and response strategies, with clearly defined roles and effective links to statutory child protection, health, education, justice and other essential services. Second, invest in their accessibility, quality and sustainability. This means reliable and affordable ways for children and young people to make contact, trained and supported personnel, secure technology, effective safeguarding and referral arrangements, and predictable funding that enables services to meet children’s needs. Third, include child helplines and the children and young people they serve in the development and monitoring of national commitments. Children and young people must have meaningful opportunities to shape the systems intended to protect them. The evidence and insights emerging from child helplines can help identify changing risks, barriers to help-seeking and unmet needs. That evidence must, of course, be handled responsibly. Child helpline data is not a substitute for population-level research, and children’s privacy must always be protected. But it provides an essential perspective on experiences that might otherwise remain invisible to policymakers. These priorities are particularly important when governments address technology-facilitated violence, sexual abuse, mental health crises and the needs of children affected by conflict, displacement or climate-related emergencies. How can we credibly claim to be building child-centred protection systems without including the services children and young people themselves turn to for help? A pledge is a beginning. Accountability is what makes it count. The Manila conference is an opportunity to celebrate progress, learn from what is working and encourage governments to make stronger commitments. It is also an opportunity to ask harder questions. Are pledges specific, measurable and adequately funded? Are governments tracking whether children are actually benefiting? Are children, young people and survivors shaping decisions, rather than simply appearing on a stage? Are frontline services involved in designing the systems they will be expected to deliver? And are commitments reaching the children who are easiest to overlook? We need to move beyond counting announcements to measuring change. For Child Helpline International and our members, that means continuing to advocate for recognition, investment, effective referral pathways and meaningful participation in the design and monitoring of national commitments. It also means ensuring that children’s experiences inform decisions long after the conference has ended. The global movement to end violence against children will only be as strong as the systems that turn its ambition into reality. And those systems must be built around children, not around the convenience of institutions. Our ambition has to be bigger than two days in Manila Child Helpline International connects child helplines around the world. Our network sees the ingenuity, dedication and determination of people working every day to make support accessible to children and young people. We also see the barriers: limited resources, uneven coverage, fragmented services and the persistent gap between a child needing help and a system being ready to provide it. We know what becomes possible when child helplines are connected, supported and recognized as part of the wider child protection ecosystem. Now we need to take that ambition to scale. Manila should be a springboard for a global commitment to make child helplines accessible, sustainable and connected to effective protection systems in every country. It should help turn frontline experience into national action, national commitments into measurable progress, and global ambition into practical investment. It should also remind us that children are not simply the beneficiaries of our decisions. They are people with rights, views, experiences and ideas — and they deserve systems that listen to them. So, by all means, let’s have the conference. Let’s bring ministers, young people, survivors, practitioners, funders and global partners into the same room. Let’s challenge each other, share what works and make commitments that match the scale of the crisis. But let’s be clear about what comes next. The real measure of Manila will not be the speeches delivered, the photographs taken or the pledges announced. It will be whether more children can reach someone who listens, whether that person can connect them to meaningful support, and whether governments put the resources behind making that possible. A conference lasts two days. Its consequences can last for generations. That is why it matters. And that is why child helplines must be part of what happens next. Helen Mason Executive Director The post <p style='font-size:20px'>The Countdown to Manila: Where Promises to Children Must Become Action</p><p style='font-size:16px'>Why Manila matters – and why child helplines must be at the heart of the global movement to end violence against children</p> appeared first on Child Helpline International.
LaMonika Jones of the Food Research & Action Center shares how nutrition assistance programs provide critical support for young children and their caregivers. The post Policy Q&A: How Strengthening Food Security Can Support Early Childhood Development appeared first on Center on the Developing Child at Harvard University.
