In light of the risk posed by sedentary lifestyles, the importance of school physical education as a health tool and the hierarchy of teachers and graduates who teach this subject is emphasized. The rights of children and adolescents to access health care, medical attention, recreation, and sports must be respected. A health certificate should be required as part of the annual documentation that students must submit, but this should not be a limitation to participate in physical education classes. Only children and adolescents who present a medical certificate indicating otherwise may be excluded from participation in these classes, either temporarily or permanently. Given the low incidence of serious events at these ages during physical exercise, the risk posed by a sedentary lifestyle is much greater.

Introduction. Congenital syphilis (CS) is a persistent public health problem, and Argentina has been experiencing an increase in its incidence in recent years. Various social factors influence the distribution of CS. The objective of this study is to describe the temporal trends in CS rates and evaluate their association with income inequality in Argentina in the period 2006-2021. Methods. An ecological study was conducted, considering the 24 Argentine jurisdictions (23 provinces plus the Autonomous City of Buenos Aires [CABA, by its Spanish acronym]) as units of analysis. CS rates were estimated by jurisdiction for each year of the study, and their temporal distribution was analyzed for the national total and by region. An exploratory analysis of the distribution of CS rates and the Gini coefficient was performed at the national level and by region. Next, mixed linear models were estimated to assess the association between the Gini coefficient and CS rates. Results. The CS rate showed an oscillating and upward trend at the national level and in most regions, with a sustained increase in the Northwest region (NOA) and recent marked increases in Cuyo. As the Gini coefficient increases, the CS rate in the provinces increases (95% CI: 0.11-0.42). Conclusion. CS rates generally showed an upward trend, with variations across different regions. Income inequality was associated with higher CS rates, highlighting the influence of structural social factors on this disease in Argentina. Income inequality was associated with higher CS rates at the provincial level, demonstrating the impact of structural factors on disparities in this disease in Argentina.

Introduction. Autism spectrum disorder (ASD) presents challenges in social communication and behavior. It is more common in males (3:1). Girls receive alternative or delayed diagnoses due to better communication skills, atypical but less unusual interests, greater presence of internalizing behaviors, and camouflage strategies. This can lead to underdiagnosis and limit access to adequate support. Objective. To describe the population of girls and female adolescents (GFA) with ASD being monitored at a tertiary hospital, comparing them according to age and clinical characteristics. Population and methods. Descriptive, cross-sectional study with retrospective analysis of medical records of GFAs evaluated between 2002 and 2024. Data on development, physical examination, and sociodemographic variables were collected. The sample was divided into preschoolers and schoolchildren, and by the presence or absence of language at the time of diagnosis. Results. A sample of 415 GFAs was obtained. Sixteen percent (n = 69) received a late diagnosis. In older girls, two profiles were identified: one compatible with the female phenotype of ASD (language present, lower intellectual disability, consultation for social difficulties) and another with characteristics of profound autism (no language, higher intellectual disability, epilepsy, regression, and greater severity). In preschoolers, cognitive impairment or failure to adapt to formal assessments predominated. A family history of ASD or an broader autism phenotype were present in 19.5% (n = 81) of cases. Conclusion. We observed a high clinical variability, which requires greater diagnostic sensitivity and specific tools to facilitate adequate support.

VACTERL association refers to the concomitant occurrence of congenital malformations such as vertebral defects, anorectal malformations, cardiac anomalies, tracheoesophageal fistula, renal anomalies, and limb defects. This case describes a newborn girl who presented with anomalies compatible with this association, such as scoliosis, sacral dysgenesis, right lower phocomelia, and multicystic renal dysplasia, also associated with myelomeningocele, which was surprising as it occurred concomitantly with the other congenital malformations. Although neural tube defects are not part of the classic criteria for VACTERL, their coexistence with the characteristic malformations of this association raises the possibility of broadening its phenotypic spectrum, encourages debate on the inclusion of new criteria to define it, and highlights the importance of considering systematic evaluation of the spinal cord in screening, aspects that have been little explored in Latin America.

Introduction. Advances in medicine have made organ and tissue transplantation a feasible therapeutic option. However, the shortage of pediatric donors leads to deaths among children on the organ waiting list in Argentina. The objective of this study was to identify variables related to the donation process that may offer opportunities to improve the pediatric donation rate. Population and methods. This was a retrospective observational study conducted in five institutions. Data were obtained from the medical records of patients aged 0 to 18 years who met the clinical criteria for death based on neurological criteria (DNC) in pediatric intensive care units (PICUs), emergency departments, and cardiovascular intensive care units between January 1, 2018, and December 31, 2022. Results. Among the participating centers, three were pediatric and two were general hospitals. A total of 124 patients with clinical DNC were included (1.3% of PICU admissions, 23% of deaths). Of these, 21 (17%) were donors. An 83% rate of missed donation opportunities was identified; the main areas for improvement were detection, diagnosis, and evaluation. Conclusion. DNC is an uncommon condition in pediatrics. This study identifies key areas for action to optimize the evaluation, detection, and management of potential donors-necessary steps to reduce deaths among children on transplant waiting lists.

The objective is to describe the presentation, evolution, and treatment of a child who presented with acute lung injury secondary to intralesional sclerotherapy with bleomycin for a venous malformation. The patient was a 4-year-old boy with a venous vascular malformation in his left lower limb, treated with percutaneous sclerosis with bleomycin (0.46 mg/kg). In the immediate postoperative period, he developed acute respiratory failure. During his evolution, pulmonary injury secondary to bleomycin was suspected. He received treatment with intravenous corticosteroids, oral corticosteroids, and supportive measures. At one year of follow-up, he was clinically stable and breathing adequately, although imaging studies showed persistent parenchymal involvement. This case reports a rare but serious complication of percutaneous bleomycin treatment. It highlights the need to maintain a high index of suspicion for acute respiratory symptoms, even at low doses, to enable timely diagnosis and treatment.

Introduction. Patient information transfers between professionals on different shifts are a particularly sensitive area for errors and omissions. Our objective was to evaluate the impact of implementing a structured handover (I-PASS) on data omission in patient information transfers between pediatric residents. Population and methods. The study was conducted in a public hospital in the province of Salta, Argentina, from November 14, 2020, to December 14, 2020 (pre-intervention) and from March 15, 2021, to April 15, 2021 (post-intervention). The design was quasi-experimental, before-and-after, uncontrolled. Pre- and post-intervention shift handovers were evaluated. The intervention included training resident physicians in a structured handover using the mnemonic rule I-PASS, teamwork training, and digitized written handover. The quality of the handover was evaluated through direct observation. Results. There were 233 pre-intervention and 245 post-intervention evaluations. The pre- and postintervention comparison showed a significant improvement in most key handover data. Distractions were reduced from 40.8% to 24.1% (p = 0.001); communication of severity increased from 36.8% to 63.2% (p =0.001). Conclusion. The introduction of the I-PASS program reduced the omission of sensitive data and interruptions, without prolonging handover duration.

Introduction. Dengue fever presents a broad clinical spectrum in pediatrics, and there is limited information on its course in children. During 2023-2024, Argentina experienced its largest dengue epidemic. Objective. To describe the clinical manifestations and hematological and biochemical alterations in pediatric patients with confirmed dengue and compare the results by age subgroup. Population and methods. Retrospective, observational, analytical study in children under 17 years of age with dengue confirmed by RT-PCR or IgM, treated between July 1, 2023, and June 30, 2024, at a privately managed tertiary general hospital. Clinical, biochemical, and hematological variables were analyzed, comparing subgroups by age (<13 vs. ≥13 years). Results. A total of 383 patients were included; 86.4% presented dengue without warning signs and 13.6% with warning signs. The most frequent symptoms were fever, headache, and myalgia. The most common laboratory abnormalities were leukopenia, thrombocytopenia, and elevated transaminases. Patients ≥13 years of age had a higher frequency of warning signs and hematological abnormalities. Most were treated on an outpatient basis; only 1.8% required hospitalization. No patients with severe dengue or deaths were recorded. Conclusions. Early leukopenia and thrombocytopenia were the most frequent findings. The group aged ≥13 years had a higher proportion of dengue with warning signs.

Adverse childhood experiences (ACEs) are associated with negative consequences for physical and mental health. ACEs are defined as harmful experiences from conception to age 18. They generate chronic toxic stress when exposed to emotional or sexual abuse or a dysfunctional home. ACEs produce "programming" on brain plasticity with immunoneuroendocrinological, cerebral, and epigenetic changes. The result is suboptimal development of physical, mental, and emotional abilities. This "programming" can be mitigated by resilience, family and social support. When faced with new stressors, psychological and physiological dysregulation will occur, exposing the individual to disease. Between the ages of 0 and 17, 55.9% have had 1 ACE, and 30.6% have had ≥2 ACEs. The consequences are aggression, drug addiction, obesity, asthma, depression/anxiety, decreased resilience, juvenile recidivism, and suicide. Pediatricians are the ones who can detect, prevent, and mitigate ACEs.

Profound prelingual sensorineural hearing loss affects oral language development. Cochlear implants, especially at an early age, enable the acquisition of functional auditory and language skills. This observational, retrospective, longitudinal study evaluated the auditory-language performance of 15 children with profound bilateral prelingual hearing loss who underwent bilateral cochlear implantation before the age of 5 and were followed up at 2 and 5 years after activation. We used an ad hoc functional scale to classify performance. The median age at implantation was 1.8 years (0.7-3.7). At 2 years, three patients showed excellent performance; at 5 years, 10 achieved this. Eleven children showed improvement between the two assessments, with no deterioration in any case.

Gastrostomy (GTT) is a procedure that surgically or endoscopically connects the stomach to the outside of the abdomen, providing a long-term enteral feeding route. It is an essential nutritional alternative for children and adolescents with oral feeding difficulties, as it significantly improves their physical, psychological, and social quality of life, as well as that of their caregivers. This consensus has several key objectives: to identify children and adolescents who are candidates for this intervention, to describe the different types of procedures, to unify diagnostic criteria, to promote rational use of resources, to detail associated complications, to improve the quality of life of patients and their families and to foster interdisciplinary collaboration. To achieve this, a comprehensive review of the scientific literature was conducted, selecting the best available evidence to develop practical recommendations specific to pediatricians and adaptable to the local context.

Background: This study aims to determine parents' cyberchondria and health literacy levels and examine how these levels affect parents' behaviors regarding their own and their children's health. Method: This descriptive cross-sectional study was conducted between January 1, 2023, and June 30, 2023. Survey forms were used, and the surveys were filled out face to face. Results: 619 parents participated in the study. The parents' Cyberchondria Severity Scale (CSS) score was 71.51±22.46 (medium-high), and the Turkish Health Literacy Scale (THLS-32) score was 21.37±6.60 (insufficient); 92.2% of the parents stated that they diagnosed themselves and 91.1% of their children via the Internet, 14.2% of parents and 12% of their children stopped taking their medication due to information they read on the Internet. Conclusion: Parental internet use for health purposes is very high. Inadequate health literacy and high levels of cyberchondria increase the risk of making wrong health decisions. Health professionals should prioritize efforts to increase parents' health literacy and reduce the severity of cyberchondria.

Avoidant/restrictive food intake disorder (ARFID), defined by the DSM-5, affects children's growth and development and is common in those with autism spectrum disorder (ASD). This update aims to describe the causes, consequences, detection strategies, and therapeutic approaches to ARFID in children diagnosed with ASD, based on published scientific articles. Original articles, reviews, meta-analyses, and clinical trials published between January 2016 and February 2025 in peer-reviewed journals were included in this review. The search was conducted in PubMed, Cochrane Library, and Google Scholar using the descriptors "ARFID AND AUTISM." Only fulltext studies in English or Spanish focusing on the pediatric population were considered; we found 23 relevant publications. This study explores how ASD characteristics can influence ARFID symptoms. Considering the findings, recommendations, and treatments based on clinical trials and meta-analyses are analyzed.

Autoimmune encephalitis (AE) is a neurological disease mediated by autoantibodies, with the anti-NMDA form being the most common. Its clinical presentation in children is usually less evident than in adults, with a predominance of motor symptoms and an absence of neuropsychiatric symptoms. Early diagnosis is difficult due to a lack of clinical suspicion. We present the case oaf a six-month-old infant with status epilepticus and initial herpetic meningoencephalitis, who later presented with loss of developmental milestones and involuntary movements. The detection of antibodies in cerebrospinal fluid confirmed the diagnosis of anti-NMDA encephalitis. Treatment with glucocorticoids and intravenous immunoglobulin was administered, with a favorable response and progressive recovery. This case highlights the importance of considering AE in infants with loss of developmental milestones and involuntary movements. Early diagnosis and treatment are crucial for a favorable prognosis and prevention of sequelae.

Breastfeeding is the gold standard in pediatric nutrition. When it is not possible, desired, or sufficient, infant formulas and foods for specific medical purposes are available, developed to meet special nutritional requirements. These products are manufactured using complex technological processes, under strict quality, hygiene, safety, and international regulations. Unlike other mass-market products (cookies, snacks), they are designed to contribute to children's nutrition. Their formulation includes adaptations in proteins, lipids, carbohydrates, vitamins, and minerals, according to the infant's needs.They are recommended in cases of prematurity, allergies, intolerances, digestive or metabolic disorders, or special conditions, and should always be recommended by a healthcare professional. Their correct use ensures the nutrients necessary for proper growth and development, as well as those essential for dietary and nutritional therapy.

Background. The COVID-19 pandemic is perceived as a major threat to health and the economy worldwide, and its effects have been ongoing for about five years. Studies were generally conducted in the early stages of the pandemic, and usually included adults or adolescents. Studies examining the impact of the pandemic on preschool children (3-6 years old) are quite scarce. This study aimed to evaluate the perceived anxiety levels of children aged 3 to 6 years and their parents, focusing on anxiety-related behavioral patterns in children and the frequency of anxiety-related expressions. The assessment was conducted at four distinct time points over four years following the onset of the COVID-19 pandemic. Method. This descriptive-cross-sectional study was conducted between May 17, 2020 and October 30, 2023. An online questionnaire form was used at four different time points. Results. 3732 parents with children aged 3-6 participated in the study. Children's anxiety-related behaviors and expressions were more frequent during the first and second time points. Anxiety-related behaviors were more common in children during the long-term bans. Conclusion. Perceived anxiety levels of the children aged 3-6 years at different time points during COVID-19 pandemic reflected the epidemic trends of the disease and parental anxiety levels. Understanding how the effects are distributed is important for the future.

Introduction. Spina bifida, particularly its most common form, myelomeningocele (MMC), is a severe congenital malformation associated with high neonatal morbidity and long-term disability. Since 2015, our center has been performing intrauterine repair of MMC using a modified open surgical technique. Objective. To describe the obstetric and perinatal outcomes, the need for treatment of hydrocephalus, and the ability to walk in children who underwent open fetal surgery for repair of spinal dysraphism, and to compare these data with those published in the Management of Myelomeningocele Study (MOMS). Population and methods. Retrospective observational study of 102 consecutive cases operated on between 2015 and 2023. Maternal, neonatal, and neurological variables were analyzed in the mediumterm follow-up. Results. The mean gestational age at the time of surgery was 26.1 weeks. Maternal and neonatal complication rates were similar to or lower than those reported in the MOMS study. The need for ventriculoperitoneal shunting at 12 months was 23.8%. At 30 months, 84.8% of patients were walking with or without orthopedic devices. Conclusion. Open fetal repair of MMC at our center, performed by a multidisciplinary team using a modified surgical technique, presented a favorable maternal-fetal safety profile. The perinatal and neurological outcomes obtained are comparable to those of international reference centers, with a low rate of ventriculoperitoneal shunting and a high percentage of children able to walk at 30 months of age. These findings support the continuation and optimization of this intervention in experienced centers.

Invasive mechanical ventilation (IMV) is widely used in pediatric intensive care units. Acute lower respiratory infection is its primary indication; it is characterized by increased inspiratory and expiratory resistance, as well as decreased lung compliance. It can progress to acute respiratory distress syndrome, which poses a challenge in optimizing IMV. Although different ventilatory modes are not presumed to generate significant clinical differences, there is a marked preference for the pressure control mode in pediatrics. In predominantly obstructive conditions, volume control mode ensures ventilation regardless of the degree of inspiratory resistance, allowing for extended expiratory time and preventing hyperinflation. In restrictive conditions, pressure control enables ventilation to be adjusted to protective parameters, albeit with the potential risk of inducing damage due to higher flow rates. The physiological basis of the different ventilation modes and their clinical application are reviewed.

Acute suppurative thyroiditis (AST) is a rare endocrinological emergency in pediatrics that may require immediate infectious disease and surgical intervention. It is generally associated with bacterial infections and, in some cases, congenital malformations of the branchial arch. We present the case of a 7-year-old girl with recurrent AST, in both episodes with cervical abscess formation, requiring intravenous antibiotics and surgical drainage. From the outset, a piriform sinus fistula was suspected, which was confirmed by direct laryngoscopy in the operating room during the hospitalization for the second episode. Chemical sclerosis of the fistulous tract was performed, with favorable evolution and no recurrence at follow-up. Although rare, this case highlights the importance of considering AST in the differential diagnosis of cervical masses in the pediatric population. It also encourages investigation of underlying causes such as congenital anomalies, which allows for early diagnosis and definitive treatment.