International Journal of Contemporary Pediatrics

Herbal wisdom in childhood obesity: a systematic review on the role of ayurvedic drugs and therapies

Himanshu Rawat — 2026-07-27

Childhood obesity is a growing global health concern linked to metabolic disorders and future chronic diseases. Conventional management has limited long-term success, whereas Ayurveda offers a holistic approach through individualized diet, herbal formulations, Panchakarma therapies, and lifestyle modifications. The objective of this systematic review was to critically evaluate and synthesize the available evidence regarding the safety, efficacy, and effectiveness of Ayurvedic interventions in the management of childhood obesity. The study reviewed randomized controlled trials (RCTs), non-RCTs, and case studies on the management of childhood obesity in Ayurveda. They were retrieved through Ayurveda research databases and Medical Journal databases such as Medline, Scopus, Web of Science, and other directories of open access journals. Hand searching was done using predefined search terms. The search was limited to articles published till July 2024. Study selection followed the symptomatology of childhood obesity. The data were documented and extracted using study ID and design, sample size, duration, interventions, outcomes, and result. Quantitative synthesis was not attempted as we aimed at only systematic review. Of the identified records, 16 studies met the inclusion criteria. Ayurvedic herbal formulations, Panchakarma therapies, dietary regulation, lifestyle modifications, and yoga were the most commonly evaluated interventions. Overall, these approaches improved body weight, BMI, waist circumference, lipid profile, digestive function, and overall well-being, with combined therapies demonstrating the most favourable clinical outcomes. Ayurvedic interventions show promise for childhood obesity; however, robust multicentre RCTs are needed to confirm effectiveness and safety.

Clinical profile and outcome of snakebites in children: a retrospective study from a tertiary hospital in North-East Nigeria

Solomon Gideon Bulus — 2026-07-27

Background: Snake bite envenomation constitutes a medical emergency that affect various organs and tissues, contingents upon the species responsible for the bite. It still remains a public health concern in Sub-Saharan Africa and children are particularly at risk due to their smaller stature, outdoor activities, and delayed presentation to hospitals. This study aims to describe the epidemiology, clinical characteristics and outcome of snake bites in children, in a tertiary hospital in Yola Northeastern Nigeria.

Methods: This was a three-year descriptive retrospective study of all cases of snake bites in children admitted at the Emergency Paediatrics Unit of Modibbo Adama University Teaching Hospital Yola. Demographic and clinical data were collected from patient records and analysed using SPSS version 24.

Results: Out of 3,606 children admitted in the emergency unit, 37 were cases of snake bites giving prevalence of 1%. The ratio of males to females in this study was 2.4:1, with a mean age +SD of 10.1±3.2 years. The lower limb is the most common site of bite in 26 (70.3%) patients and the highest prevalence of bite occurred between June and August. Characteristics of envenomation comprised local swelling 37 (100%), pain 23 (62.2%) and prolonged bleeding 17 (45.9%). Two of the patients died, giving a case fatality rate of 5.4%.

Conclusions: Our study reveals distinct patterns of snakebites in children, predominantly affecting adolescent male and high rate of envenomation. Prompt identification of snakebite and medical intervention remains a crucial factor in improving outcomes and reducing mortality.

Mapping child vulnerability in India: where does the compass point

Nayan Chakravarty — 2026-07-27

Background: Exposure to multiple and overlapping social and economic risks shapes children’s developmental outcomes, yet India lacks an integrated framework to systematically identify and map these vulnerabilities. This study addresses this gap by developing a multidimensional and spatially disaggregated framework for child vulnerability using a transdisciplinary research (TDR) approach.

Methods: Drawing on iterative consultations with academic experts, practitioners and policy stakeholders, an initial set of over 70 indicators across four domains, health, education, child protection and resilience, was identified and refined to 24 indicators based on relevance and data availability. These indicators were derived from eight large-scale, open-source government datasets covering all states in India and applied to generate district-level vulnerability rankings across 665 districts. Statistical analysis was undertaken using STATA Version 17.

Results: The resulting national and state-level maps reveal significant spatial heterogeneity in child vulnerability, both across- and within states, highlighting substantial intra-state disparities that are often masked by aggregate statistics. The findings demonstrate that vulnerability is unevenly distributed and closely linked to local socio-economic, infrastructural and demographic conditions.

Conclusions: The study contributes both empirically and conceptually by illustrating how multidimensional vulnerability frameworks can be operationalized under data constraints. At the same time, it highlights critical gaps in existing data systems, particularly in relation to psychosocial wellbeing, protection and empowerment. Overall, the study provides a scalable framework for mapping child vulnerability and underscores the need for more integrated, spatially disaggregated and child-centred data systems to support evidence-based policymaking in India.

Factors associated with diarrheal disease among children under 5 years of age in a level 5 hospital in central Kenya

Gitau M. James — 2026-07-27

Background: Diarrheal disease remains a major cause of morbidity and preventable mortality among children under five years globally. The 2022 Kenya demographic health survey reported that 14% of children under five had diarrhea in the two weeks preceding the survey, with higher prevalence among children aged 6-23 months.

Methods: A hospital-based cross sectional unmatched case control design. The dependent variable was diarrheal disease status (yes/no). Independent variables included age group, sex, caregiver education, water source, sanitation, handwashing with soap, exclusive breastfeeding for six months, rotavirus vaccination status, and nutritional status. Bivariable and multivariable logistic regression were used to estimate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). P value of <0.05 was considered significant.

Results: 150 cases and 150 controls were recruited. Cases were generally younger than controls, with a lower mean age in months (24.3±14.6 vs 27.2±16.5). Independent predictors for diarrhoea in the multivariate regression model were: Age 12-23 months: aOR 2.60, p=0.034, Unimproved water source: aOR 1.97, p=0.039, Unimproved sanitation: aOR 1.93, p=0.044, No handwashing with soap: aOR 2.21, p=0.009, Undernutrition: aOR 2.18, p=0.034 and larger household size: aOR 2.63 per additional household member, p<0.001.

Conclusions: Unsafe water, poor sanitation, inadequate hand hygiene, suboptimal infant feeding, and incomplete rotavirus immunization were major risk factors. Integrating child survival programs that combines clinical management with preventive WASH and immunization strategies is necessary to alleviate the burden of diarrheal disease in this setup.

Serum sodium changes in children with focal epilepsy receiving carbamazepine or oxcarbazepine therapy: a randomized controlled trial

Mushtab Shira Mousumi — 2026-07-27

Background: Carbamazepine and oxcarbazepine are commonly used antiseizure medications for focal epilepsy in children. Both drugs may alter serum sodium, but comparative pediatric data, particularly from South Asian settings, remain limited. The objective of this study was to compare serum sodium changes, the incidence of hyponatremia, and adverse effect profiles between children with focal epilepsy receiving carbamazepine and those receiving oxcarbazepine therapy.

Methods: This prospective, single-centre, open-label randomized controlled trial was conducted in the Department of Paediatric Neurology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh, from January to June 2020. Children aged 1 to 15 years with newly diagnosed focal epilepsy were randomized to receive either carbamazepine or oxcarbazepine. Serum sodium was measured before treatment and at 1 month, 3 months, and 6 months after treatment initiation. Hyponatremia was defined as serum sodium ≤135 mEq/l, and severe hyponatremia as serum sodium ≤128 mEq/l. The final analysis included 86 children, 42 in the carbamazepine group and 44 in the oxcarbazepine group.

Results: Baseline serum sodium was similar between groups, 136.73±1.66 mmol/l with carbamazepine and 136.09±2.54 mmol/l with oxcarbazepine, p=0.158. At 1 month, serum sodium remained comparable, p=0.845. Mean serum sodium was significantly lower in the oxcarbazepine group at 3 months, 137.15±2.49 versus 138.22±2.24 mmol/l, p=0.036, and at 6 months, 137.56±2.54 versus 138.95±2.20 mmol/l, p=0.006. Hyponatremia at 6 months occurred in 15.9% of children receiving oxcarbazepine and 4.8% receiving carbamazepine, risk ratio 3.34, 95% CI 0.74 to 15.18, p=0.157. Severe hyponatremia occurred in one child in the oxcarbazepine group, and no symptomatic hyponatremia, hospitalization, or treatment-attributable death was reported.

Conclusions: Oxcarbazepine was associated with significantly lower mean serum sodium than carbamazepine at 3 and 6 months, although categorical hyponatremia was not significantly different. Routine serum sodium monitoring should be considered during oxcarbazepine therapy in children with focal epilepsy.

Impact of hydroxyurea use on severity and hematologic profile in children with sickle cell disease at University of Benin Teaching Hospital, Benin city, Nigeria

Magdalene E. Odunvbun — 2026-07-27

Background: Sickle cell disease (SCD) is a major cause of morbidity and mortality among children in sub-Saharan African. Hydroxyurea (HU) remains the cornerstone of disease- modifying therapy, but its utilization, hematologic impact and relationship with disease severity among Nigerian children are not fully characterized. This study assessed the impact of hydroxyurea use on disease severity and haematologic profile in children with SCD attending the University of Benin of teaching Hospital, Benin city.

Methods: This cross- sectional study included 225 children with SCA aged 1-18 years in steady state. Data were obtained on socio- demographic characteristics, HU use and disease severity were using structured proforma and medical records. Disease severity was assessed using Adegoke’s scoring system while haematologic parameters including Packed cell volume and White blood cell counts were documented. Statistical associations between HU, hematologic indices and disease severity were analysed using Chi-square tests, with significance set at p<0.05.

Results: The mean age was 9.5±4.5 years: 57.8% were male and 57.3% belonged to the middle socioeconomic class. Most patients had mild (51.1%) or moderate (47.6%) disease with severe disease in only 1.3%. disease severity was significantly associated with gender (p=0.029). Hydroxyurea use was high (61.3%), more frequent in females (p=0.032). HU use was significantly associated with disease severity (ꭓ²=9.422; p=0.009). Higher PCV was linked with milder disease (p= 0.004) whereas elevated WBC counts were associated with more severe disease (p<0.001).

Conclusions: HU therapy, higher PCV and lower WBC counts are associated with milder disease among children with SCD. These findings reinforce Hydroxyurea clinical benefits and highlight the value of simple haematologic indices for disease monitoring in resource poor settings.

Clinical presentation and early diagnostic features of persistent pulmonary hypertension in newborns: insights from a tertiary care hospital

Iftekhar H. Masuk — 2026-07-27

Background: Persistent pulmonary hypertension of the newborn (PPHN) is a severe condition with significant mortality. Data on its clinical profile and early diagnostic features from low- and middle-income countries, particularly South Asia, are scarce. This study aimed to describe the clinical presentation and early echocardiographic diagnostic features of newborns with PPHN in a tertiary care hospital in Bangladesh.

Methods: This cross-sectional observational study was conducted over six months in a tertiary care hospital in Bangladesh. Data from 50 neonates with echocardiographically confirmed PPHN were retrospectively analyzed. Demographics, clinical presentation, underlying etiologies, and detailed echocardiographic findings, including associated cardiac shunts and disease severity, were recorded.

Results: The majority of neonates were male (70%) and diagnosed within the first week of life (78%). The most common presenting features were tachypnea (78%) and cyanosis (72%). Echocardiography revealed that 74% of cases had an associated cardiac shunt, with an atrial septal defect being the most frequent finding (present in 42% of the total cohort). Severe PPHN was the most common classification at presentation (48%).

Conclusions: PPHN in this setting presents early and is frequently associated with cardiac shunts, particularly ASDs. These findings highlight the critical role of early and comprehensive echocardiographic evaluation for accurate diagnosis and potential risk stratification in managing this vulnerable population.

Prevalence of anemia and its impact on scholastic performance among school-going children in Sangareddy, Telangana: a cross-sectional study

Deepanvitha Yeturi — 2026-07-04

Background: Childhood anemia may impair attention, memory and learning. This study assessed the prevalence of anemia among school-going children in Sangareddy and its association with scholastic performance.

Methods: In this cross-sectional observational study, 382 children aged 4-15 years were enrolled from the pediatric outpatient department and participating schools over 18 months (2024 June to 2025 November). Demographic details, clinical findings, hemoglobin levels and annual school marks were recorded. High scholastic performance was defined as annual marks ≥60%. Associations were analysed using chi-square test, Pearson correlation and multivariable logistic regression.

Results: Anemia was present in 168/382 children (44.0%): 126 (33.0%) had mild anemia and 42 (11.0%) had moderate anemia. Rural children had higher anemia prevalence than urban children (49.1% vs 37.5%; p=0.031). High performance increased from 45.2% in moderate anemia to 72.9% in children with normal hemoglobin (chi-square=16.40, p<0.001). Hemoglobin correlated positively with annual marks (r=0.205, p<0.001). Normal hemoglobin independently predicted high scholastic performance (adjusted OR 2.20; 95% CI 1.43-3.41; p=0.001).

Conclusions: Anemia was common and significantly associated with poorer scholastic performance. School-based screening, nutrition education, iron supplementation and deworming may improve health and educational outcomes.

Clinical and genetic profile of children with delayed puberty: a tertiary care hospital experience

Urvee Swaika — 2026-07-22

Background: Delayed puberty is defined as the absence of pubertal onset by 13 years in girls and 14 years in boys. It may result from constitutional delay, hypothalamic-pituitary disorders, or primary gonadal failure. Early identification of the underlying cause is essential for timely treatment and improved psychosocial outcomes. This study aimed to evaluate the clinical and genetic profile of children presenting with delayed puberty in a tertiary care hospital.

Methods: A retrospective descriptive observational study was conducted in the Department of Paediatric Endocrinology from June 2019 to June 2026. Children aged 13-18 years with delayed puberty and complete medical records were included. Demographic details, clinical features, anthropometry, hormonal investigations, imaging, genetic testing, diagnosis, and treatment modalities were analysed.

Results: A total of 42 adolescents were included, comprising 27 females (64.3%) and 15 males (35.7%). Consanguinity was present in 25.6%, and family history of delayed puberty in 29.3%. Among girls, breast development was present in 81.5%, but menarche had occurred in only 3.7%. Among boys, testicular enlargement was present in 13.3%. Hypergonadotropic hypogonadism (HH) was the most common diagnosis (52.4%), followed by congenital hypogonadotropic hypogonadism (CHH) (28.6%) and constitutional delay of growth and puberty (CDGP) (11.9%).

Conclusions: Comprehensive clinical, hormonal and genetic evaluation is crucial for accurate diagnosis and individualized management.

Maternal risk factors associated with preterm births in a tertiary care hospital

Rengashree V. — 2026-07-21

Background: Preterm birth remains an important contributor to neonatal morbidity and mortality, particularly in tertiary care settings. Maternal medical and obstetric conditions play a major role in the occurrence of preterm delivery. This study was conducted to assess maternal risk factors associated with preterm births among preterm neonates admitted to a tertiary care neonatal unit.

Methods: This hospital-based observational study was conducted in the Neonatal Unit of Government Medical College and Hospital, Cuddalore (dt), Tamil Nadu, over a period of 12 months. Neonates delivered before 37 completed weeks of gestation were included. Data regarding gestational age, sex, maternal medical conditions and neonatal outcome were collected using a pretested proforma and analysed using descriptive statistics.

Results: A total of 156 preterm neonates were included during the study period. Late preterm (51.9%) neonates was common in this of the total study population. The most common maternal risk factors were hypothyroidism (21.8%), pregnancy-induced hypertension (20.5%), maternal anaemia (14.1%), pre-eclampsia (10.3%), and gestational diabetes/diabetes complicating pregnancy (10.3%). Among mothers with documented risk factors, 50.6% had one risk factor, 27.5% had two risk factors, 6.4% had three or more risk factors and 15.3% had no risk factors.

Conclusions: Maternal risk factors were commonly observed among preterm births, with thyroid dysfunction, hypertensive disorders, anaemia, and diabetes being important contributors. Strengthened antenatal screening, early risk identification, and timely referral may help reduce preterm birth-related morbidity.

Effect of skin tap technique on pain during hepatitis B vaccination among newborns: a randomized controlled trial

Chitra A. — 2026-07-27

Background: Pain is all about an unpleasant sensation created by stimuli. Every child has his or her own perception of pain. It is unpleasant sensory and emotional experience associated with actual or potential tissue damage. Mechanical stimulation given by taping can diminish the influence of tiny, pain-carrying fibers. This study aimed to assess the effect of skin tap technique on pain during hepatitis-B vaccination.

Methods: A randomized controlled trial was carried out among 60 newborns in postnatal ward. Consecutive sampling technique was used to enroll the newborn who met the inclusion criteria. Data pertaining to newborn and a clinical characteristics birth order, gestation age, birth weight and mode of delivery were collected from medical record. Data regarding assess the level of pain during hepatitis-B vaccination by using the neonatal pain scale were collected from skin tap technique. Data were analyzed using Chi-square test, t-test.

Results: The data collected was analyzed by using mean and standard deviation. The study findings high light that among 30 newborns vaccinated with the skin tap technique in the experimental group, the majority of newborns, 20 (66.7%), had mild to moderate pain, and 10 (33.3%) had severe pain. Among 30 newborns vaccinated as a routine manner in the control group, the majority of newborns, 22 (73.3%), had severe pain, and 8 (26.7%) had mild to moderate pain, respectively. The skin tap technique was effective compared to the control group. The pain score was 3.83±1.147 and 5±1.174. Respectively with a statistically significant p=0.000.

Conclusions: The skin tap technique was effective in reducing pain during hepatitis-B vaccination among the newborns.

Effectiveness of planned teaching programme on knowledge regarding effects of using baby walker among mothers in selected anganawadis at Kodagu

Ranjini Singaramarnahally Nagaraj — 2026-07-27

Background: Learning to walk is one of the first milestones that the baby reaches usually between 6 to 12 months. Baby walker is a device that allows infants to walk independently to travel from one location to another location. The aim is to assess the existing knowledge among mothers, to evaluate the effectiveness of planned teaching programme on knowledge. And to identify an association between the pre-test knowledge score regarding effects of using baby walker and their selected socio demographic variables.

Methods: An evaluative approach, pre-experimental one group pre-test and post-test design with non-probability purposive sampling technique was used. Data collected from 100 mothers attending anganawadi using self-administered structured knowledge questionnaire. Planned teaching program implemented after pretest and post test was conducted after 7 days to find the effectiveness.

Results: In pre-test majority 79% of the mothers had inadequate knowledge, 21% had moderate knowledge. In post-test 11% of mothers had adequate knowledge and 69% of mothers had moderate knowledge with the paired calculated ‘t’ value of 14.39 is greater than table value (t-1.96) at 0.05 level of significance. Socio demographic variables such as gender, father’s and mother’s education significant regarding effects of using baby walker among mothers.

Conclusions: Study concludes that planned teaching programme was effective teaching method for creating awareness regarding effects of baby walker usage. Hence, study recommends t-conduct with different design and sampling method was uncertain.

Early detection of congenital anomalies in newborns: a tertiary hospital's approach to screening and risk assessment

Samhitha Narayanappa C. — 2026-07-27

Background: The spectrum of congenital anomalies ranges from minor issues like polydactyly to conditions unsustainable with life like anencephaly. The impact is on the affected children, parents or caregivers and the society at large. The most dreaded concern is death of the child. This study aims to estimate the prevalence of congenital anomalies and associated risk factors among neonates in a tertiary care hospital in Bengaluru, India.

Methods: A cross-sectional analysis was conducted over six months, involving 202 neonates. Data were collected via validated questionnaires covering socio-demographic details, comprehensive antenatal history, birth history, and the presence of congenital anomalies. Settings and design was hospital-based cross-sectional study. Statistical analysis used: The association between risk factors and congenital anomalies was assessed using Chi-square tests and Odds ratios.

Results: Out of 202 neonates included, the proportion of congenital anomalies was 8.4% (17) with congenital heart diseases (07) being the commonest followed by congenital talipes equino varus (CTEV) (04). Foetal risk factors for disability were observed among 93 (46%) of the neonates. Common neonatal risk factors observed were neonatal jaundice, Low Birth Weight, prematurity and neonatal asphyxia. Congenital anomalies were slightly higher among boys: 13 (11.7%) than girls: 4 (4.3%). Proportion of foetal risk factors was similar among boys and girls.

Conclusions: The study highlights a higher prevalence of congenital anomalies than the national average, emphasizing the need for mandatory congenital anomaly screening and establishing a comprehensive congenital malformation registry in India.

Clinical profile and outcome of neonatal thrombocytopenia in a tertiary care neonatal intensive care unit

Nooreen — 2026-07-27

Background: Neonatal thrombocytopenia is a common hematological abnormality in neonatal intensive care units (NICUs), particularly among preterm and low-birth-weight neonates. It is associated with sepsis, respiratory distress syndrome, necrotizing enterocolitis, bleeding manifestations and adverse neonatal outcome. The present study was undertaken to evaluate the clinical profile, associated risk factors, severity, management and short-term outcome of neonatal thrombocytopenia in NICU-admitted neonates.

Methods: This hospital-based observational study included 120 neonates with thrombocytopenia admitted to a tertiary care NICU. Neonatal thrombocytopenia was defined as a platelet count <150×10⁹/l and was classified as mild (100–149×10⁹/l), moderate (50–99×10⁹/l) and severe (<50×10⁹/l). It was further categorized as early onset (<72 hours of life) and late onset (≥72 hours). Maternal risk factors, neonatal morbidities, clinical manifestations, treatment details and outcomes were analyzed.

Results: Of the 120 neonates, 68 (56.7%) were males and 72 (60.0%) were preterm. Low birth weight was present in 70 (58.3%) neonates and very low birth weight in 24 (20.0%). Mild thrombocytopenia was observed in 58 (48.3%) neonates, moderate in 38 (31.7%) and severe in 24 (20.0%). Early-onset thrombocytopenia was noted in 62 (51.7%) cases. Sepsis was the commonest associated condition, seen in 59 (49.2%) neonates, followed by respiratory distress syndrome in 34 (28.3%), perinatal asphyxia in 21 (17.5%) and necrotizing enterocolitis in 20 (16.7%). Platelet transfusion was required in 26 (21.7%) neonates. Mortality increased with severity, from 3/58 (5.2%) in mild thrombocytopenia to 8/24 (33.3%) in severe thrombocytopenia.

Conclusions: Neonatal thrombocytopenia is strongly associated with prematurity, low birth weight, sepsis and necrotizing enterocolitis. Increasing severity is associated with worse clinical outcome and higher mortality.

Study of etiological spectrum and clinico-hematological profile of children with bicytopenia and pancytopenia at a tertiary centre of Chhattisgarh: a cross-sectional study

Rakesh Nahrel — 2026-07-27

Background: Early and accurate identification of etiologies of bicytopenia or pancytopenia is vital to prevent complications, initiate timely therapy and improve outcomes in affected children. There are many studies in literature in children with pancytopenia, but there are only few studies in literature in children with bicytopenia. So far, no study has been done in children with bicytopenia and pancytopenia in Chhattisgarh.

Methods: Prospective observational study was carried out among 100 cases. All children in the age group of 6 months to 14 years and who had pancytopenia defined as Haemoglobin<10 gm%, White blood cells <4000/mm³ with or without absolute neutrophil count <1500/mm³, platelet count <1lac/mm³ or bicytopenia defined as any reduction in any two cell lineages, were included.

Results: Majority belonged to the age group of 6-10 years viz. 50% with bicytopenia and those with pancytopenia belonged to the age group of 1-5 years i.e. 36.4%. Males were slightly more than females. Those with pancytopenia, the male to female ratio was equal. But those with bicytopenia, the males were more than females. The mean hemoglobin, MCV, MCH, MCHC, RDW was significantly lesser in those with bicytopenia. The mean TLC, platelet count, was significantly more in those with bicytopenia. The proportion of microcytic hypochromic and normocytic normochromic was comparable in two groups. Those with benign haematological disorders were significantly more in bicytopenia group compared to pancytopenia group. Other diseases/disorders were comparable in two groups. The outcome was comparable in two groups.

Conclusions: Bicytopenia was more common than pancytopenia and had a better prognosis. Most common etiology was SCD, Beta-thalassemia, spectrum ranging from infectious (malaria) to malignancy (leukemia). The causes reported in our study are determined by geographical locale of hospital, prevalence of malnutrition and regional occurrence of certain disease including malaria.

Clinical profile and outcome of fever with thrombocytopenia among children admitted at tertiary care hospital

Aniruddha A. Shetye — 2026-07-27

Background: Fever with thrombocytopenia is a common yet potentially serious clinical entity in paediatric patients in tropical countries, frequently associated with infections such as dengue, scrub typhus, enteric fever and septicaemia. This study aimed to describe the clinical profile and outcomes of such patients at a tertiary care hospital.

Methods: A prospective observational study was conducted over 18 months (July 2023 to January 2025) in children aged 1 month to 12 years admitted with fever and thrombocytopenia. A total of 260 patients were enrolled using simple random sampling. Clinical data, laboratory investigations, treatment details and outcomes were recorded. Statistical analysis used SPSS version 16 (Chi-square test, Student’s t-test; p<0.05 considered significant).

Results: The 6–10 years age group was most affected (40%), with male predominance (55%). Most participants were rural residents (65%) and admissions peaked during the monsoon (40%). Dengue fever (30%) was the most common identified aetiology; 46% remained undiagnosed. Severe thrombocytopenia was found in 47%. Overall mortality was 6.2%. Lower platelet counts (p<0.001), bleeding manifestations (p<0.002) and aetiologies of septicaemia and viral encephalitis (p=0.04) were significantly associated with mortality.

Conclusions: Dengue and scrub typhus are the predominant identified aetiologies. Low platelet counts, bleeding manifestations, septicaemia and viral encephalitis are significant predictors of poor outcomes. Early recognition and prompt targeted management are vital to reducing morbidity and mortality in paediatric febrile thrombocytopenia.

Growth and development status of preschool children in a rural community of Dehradun, Uttarakhand: a cross-sectional study

Nancy Baluni — 2026-07-27

Background: Growth and development monitoring consist of periodic assessment of physical parameters such as weight and height measurement and assessment of milestones. Community-based assessment of nutritional and developmental status helps in early identification of at-risk children and timely intervention.

Methods: A community-based cross-sectional study was conducted among 100 preschool children aged 3-6 years in a selected rural area of Dehradun, Uttarakhand, during June-August 2024. Children were selected through door-to-door survey using convenience sampling. Anthropometric measurements were assessed using WHO growth standards, and developmental screening was carried out using the Trivandrum developmental screening chart (TDSC).

Results: Based on weight-for-age, 90% of children had normal nutritional status, while 10% were underweight. Stunting was observed in 23% of children, and wasting in 16%. Screening using TDSC identified children with delay in one or more developmental domains, indicating the need for further developmental evaluation. A statistically significant association was observed between time of weaning and nutritional status (χ²=5.56, p=0.018).

Conclusions: Although, the majority of preschoolers had normal growth parameters, a considerable proportion showed evidence of chronic malnutrition and screened positive for developmental delay. Regular growth monitoring and developmental screening at the community level are essential to ensure early identification and intervention.

Assessment of neutrophil-to-lymphocyte ratio and mean platelet volume as inflammatory biomarkers in children with febrile seizures

Kavipriya G. — 2026-07-18

Background: Febrile seizures are common neurological events in children aged 6 months to 5 years and are usually associated with acute febrile illnesses. Inflammatory mechanisms may contribute to seizure occurrence during fever. Neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV) are simple complete blood count-derived markers that may reflect systemic inflammatory activity.

Methods: This descriptive cross-sectional study was conducted in the Department of Pediatrics at a tertiary care centre in Cuddalore district over a period of 12 months. The study included 40 children aged 6 months to 60 months who presented with febrile seizures. Demographic details, clinical profile, etiology of febrile illness and hematological parameters were recorded. NLR and MPV were calculated from complete blood count analysis. Data were summarized using descriptive statistics.

Results: During a study 40 children with febrile seizures includes in the study who fulfilled inclusion and exclusion criteria, in the study toddlers constituted the majority, accounting for 57.5%. Acute gastroenteritis was the most common etiology of febrile illness. The mean hemoglobin level was low 10.10±1.35 g/dl, mean MPV was (8.65±0.88 fL) normal, mean NLR was (4.00±1.52) elevated among the children with Febrile seizure

Conclusions: Children with febrile seizures had a low mean hemoglobin level, elevated mean NLR, and normal MPV. NLR may serve as a simple, inexpensive, and readily available inflammatory marker in children with febrile seizures. Further well-designed case-control studies are needed to determine whether NLR can be used as a reliable predictor of febrile seizures.

Effectiveness of breastfeeding on pain level during heel prick among neonates: a true experimental study

Vinita Pandey — 2026-07-27

Background: Heel prick is the most common painful procedure performed on healthy term neonates. Repeated untreated procedural pain in the neonatal period is associated with long-term adverse neurodevelopmental outcomes and altered pain thresholds. Breastfeeding is a well-established non-pharmacological analgesic, yet remains underutilized in Indian hospital settings. This study aimed to assess the effectiveness of breastfeeding on pain during heel prick among healthy term neonates.

Methods: A true experimental post-test only design was employed. Sixty healthy term neonates (gestational age 37–42 weeks, postnatal age 0–5 days, birth weight ≥2500 g) admitted to the postnatal ward of Civil Hospital, Dehradun, India, were randomly allocated to an experimental group (n=30) receiving breastfeeding during heel prick and a control group (n=30) receiving routine care. Pain was assessed using the validated Neonatal Infant Pain Scale (NIPS).

Results: The mean NIPS score was significantly lower in the experimental group (2.03±0.809) compared to the control group (5.80±1.095; t=15.152, p<0.001). In the experimental group, 73.3% of neonates experienced mild-to-no pain and none experienced severe pain, whereas 86.7% of controls experienced severe pain. A statistically significant association was observed between sex and pain level (χ²=6.140, p=0.046).

Conclusions: Breastfeeding is a highly effective, safe and cost-free non-pharmacological analgesic for procedural pain in healthy term neonates. Breastfeeding analgesia should be formally integrated into neonatal pain management protocols in Indian hospitals, with structured nursing training to support implementation.

Study on clinical profile, risk factors, morbidity and mortality pattern on intrauterine growth restricted babies admitted in sick newborn care unit in tertiary care hospital GRMCH, Ramanathapuram

Krishankant Tiwari — 2026-07-27

Background: Intrauterine growth restriction (IUGR) is an important cause of neonatal morbidity and mortality. Infants with impaired foetal growth often develop metabolic, respiratory and haematological complications during the early neonatal period. Early recognition of risk factors and clinical patterns helps improve neonatal care and outcomes. The present study aimed to assess the clinical profile of IUGR babies admitted to the sick neonatal care unit and evaluate their outcomes during their hospitalization.

Methods: A descriptive cross-sectional study was conducted in the Sick Neonatal Care Unit of Government Ramanathapuram Medical College and Hospital, Ramanathapuram. A total of 119 neonates diagnosed with IUGR and admitted during the study period were included and evaluated using clinical examination, anthropometric measurements and laboratory investigations.

Results: Most neonates were male 67 (56.3%), with term births 88 (73.9%) and birth weight >2 kg in 71 (59.7%). Asymmetrical IUGR predominated 89 (74.8%). Hypoglycaemia was most frequent 62 (52.1%), followed by sepsis 37 (26.9%), perinatal depression 33 (27.7%) and hypothermia 31 (26.1%). Other complications included thrombocytopenia 27 (22.7%), hyperbilirubinemia 25 (21.1%), hypocalcaemia 24 (20.2%) and acute kidney injury 22 (18.5%). Mortality occurred in 17 (14.3%). Hyperglycaemia was associated with birth weight (p<0.0001), polycythaemia with ponderal index (p=0.012), respiratory distress syndrome with birth weight and gestational age (p<0.0001), pulmonary haemorrhage with gestational age (p=0.005), acute kidney injury with birth weight and gestational age (p=0.008, p=0.005) and sepsis with birth weight and gestational age (p=0.01, p=0.008). Other variables showed no significant association.

Conclusions: IUGR remains an important contributor to neonatal morbidity, particularly due to metabolic and infectious complications. Careful antenatal surveillance and early neonatal monitoring are essential for timely management and improved outcomes.

Screening for sleep related breathing disorders and assessing the risk of obstructive sleep apnea in 2-18 years of children using paediatric sleep questionnaire: an observational study

Geetanjali — 2026-07-27

Background: Paediatric obstructive sleep apnea (OSA) is a prevalent yet under-recognised condition associated with significant neurocognitive, behavioural, and cardiovascular morbidity. Polysomnography, the diagnostic gold standard, remains inaccessible in many resource-limited settings. The paediatric sleep questionnaire (PSQ) offers a validated, non-invasive alternative for outpatient screening. Objectives were to screen children aged 2-18 years for sleep-related breathing disorders (SRBD) and assess the risk of OSA using the PSQ, along with associated clinical risk factors.

Methods: An observational study was conducted at a tertiary care paediatric outpatient department. Children presenting with at least one sign or symptom of SDB were enrolled using a validated structured checklist. The 22-item PSQ (Chervin et al) was administered via caregiver interview. A PSQ score≥0.33 defined high OSA risk. Associations with clinical variables were assessed by chi-square test.

Results: Of 386 children enrolled (65.5% male; majority aged 6-10 years), 235 (60.9%) had PSQ ≥0.33. Neurobehavioural daytime symptoms-hyperactivity, attention deficit, aggressive behaviour, poor school performance, and difficulty in arousing-were significantly associated with high PSQ score (all p<0.05). Nighttime symptoms including snoring, mouth breathing, restless sleep, frequent awakenings, enuresis, increased work of breathing, and diaphoresis showed significant associations (all p<0.05). Physical signs significantly associated with high PSQ score included hypertrophied nasal turbinate, tonsillar hypertrophy, adenoid facies, and obesity (all p<0.05). Among children with confirmed adenoid enlargement on lateral nasopharyngeal radiograph (n=112), higher grades of adenoid hypertrophy were significantly associated with higher PSQ score categories (p=0.001).

Conclusions: A substantial proportion (60.9%) of symptomatic children in an outpatient setting were at high OSA risk. The PSQ is a practical, validated screening tool enabling early identification of at-risk children, particularly in resource-limited settings where polysomnography is unavailable.

Patterns and determinants of child mortality in India: a multistate analysis using National Family Health Survey data

Sanjay Karande — 2026-07-27

Background: This paper, utilizing data from several rounds of the National Family Health Survey, investigated long-term differentials in child mortality rates across caste groups and seeked to identify the principal determinants of child survival.

Methods: Trends in child mortality rates were analyzed by using all five rounds of NFHS. Survival analysis and regression analysis were performed by using NFHS-5 (2019-2021). The study included children aged 1-59 months born in the five years preceding the survey, excluding infant deaths. Kaplan-Meier survival analysis, log-rank tests, and binary logistic regression models were used, taking into account the survey design. State-level analysis was performed for Uttar Pradesh, Madhya Pradesh, and Maharashtra.

Results: At the national level, the rate of child mortality was highest among Scheduled Tribes (9.03 per 1,000), followed by Scheduled Castes (8.58 per 1,000), compared with non-SC/ST children (6.04 per 1,000). The survival analysis revealed significant caste differentials in child survival (χ²=28.47, p<0.001), with the gap increasing at older ages of childhood. In unadjusted regression models, Scheduled Castes (OR=1.38; 95% CI: 1.16-1.65) and Scheduled Tribes (OR=1.56; 95% CI: 1.32-1.85) had significantly higher odds of child mortality. These associations were reduced and rendered non-significant after adjusting for proximate determinants, indicating mediation by maternal and health-related variables. Maternal education had a strong protective effect, with higher education being associated with significantly lower odds of child mortality (OR=0.27).

Conclusions: Although there has been a steady decline in child mortality rates across NFHS cycles, caste and geographic inequities in India.

Study of clinico-etiological profile and outcome of operated children of hydrocephalus in a tertiary care hospital

Arpita Adhikari — 2026-07-27

Background: Hydrocephalus is a prevalent neuro-pediatric condition associated with considerable morbidity and mortality. Ventriculo-peritoneal (VP) shunt placement remains the standard treatment, although complications are frequent. This study evaluated the clinico-etiological profile and outcomes of children with hydrocephalus who underwent VP shunt surgery at a tertiary care hospital.

Methods: A bidirectional study was conducted involving 52 children aged 1 month to 12 years who underwent VP shunt surgery. Demographics, clinical features, etiologies, imaging, surgical procedures, and outcomes were analyzed. Follow-up assessments were performed at 3, 6, 12, and 24 months to evaluate complications, clinical outcomes, and psychosocial impact.

Results: A female predominance was observed (male to female ratio=0.8:1), with most children presenting at a mean age of 3.7 years. Seizures (55.8%) and progressive head enlargement (28.8%) were the most common presenting features. Acquired hydrocephalus (65.3%) was more prevalent than congenital hydrocephalus (32.6%), with tuberculous meningitis identified as the leading cause (50%). Dandy-Walker malformation was the most frequent congenital etiology (21.1%). Communicating hydrocephalus was the predominant type (80.8%). The most common complications were shunt blockage (51.9%), infection (40.4%), and migration (40.4%). Overall mortality was 34.6%.

Conclusions: In this cohort, pediatric hydrocephalus was predominantly acquired, with tuberculous meningitis as the leading cause. VP shunt surgery improved survival but was associated with high rates of complications and revisions, particularly among younger children and those with tuberculous meningitis. Long-term morbidity included growth impairment and psychosocial challenges. Early diagnosis, regular follow-up, and prompt management of shunt complications are essential for improving outcomes.

Prevalence of nutritional problems and their association with feeding practices in children of age 1-3 years attending a tertiary care centre in South Kerala

Pooja J. Panicker — 2026-07-27

Background: Malnutrition during early childhood adversely affects growth, immunity, and neurodevelopment. Feeding practices play a major role in determining nutritional outcomes among young children.

Methods: A cross-sectional analytical study was conducted among 140 children aged 1-3 years attending a tertiary care centre in South Kerala. Sociodemographic details and feeding practices were assessed using a semi-structured questionnaire. Anthropometric assessment was performed using WHO growth standards. Associations between feeding practices and nutritional status were analysed using Chi-square/Fisher’s exact test.

Results: Among 140 children, 52.9% were male and 65.7% belonged to the lower middle socioeconomic class. Underweight, stunting, and wasting were observed in 15.7%, 17.1%, and 8.6% of children respectively. Early initiation of breastfeeding was reported in 55.7%, while 89.3% were exclusively breastfed for six months. Most children had poor dietary diversity (57.2%). No statistically significant association was found between feeding practices, dietary diversity, maternal education, socioeconomic status, and acute malnutrition (p>0.05).

Conclusions: Despite favourable breastfeeding practices, undernutrition and poor dietary diversity persist among toddlers. Strengthening caregiver counselling on complementary feeding and dietary diversity remains essential.

Study of neonatal outcome during follow-up post neonatal intensive care unit discharge with or without parental observational checklist

Ramlata Meena — 2026-07-27

Background: Checklist is a simple intervention tool which helps in early identification and treatment of new-borns. The aim is to study impact of parental observational checklists on neonatal outcomes during the early follow-up period post-NICU discharge.

Methods: An Observational prospective study was conducted in a tertiary institute wherein 135 neonates with weight of 1000 gms to 1500 gms were enrolled. A random sampling was used to form two groups. Parents in group A (n=64) received a structured pictorial checklist in addition to routine discharge advice, while those in group B (n=71) received routine discharge advice. During follow-up at 7^th and 28^th day checklist was analyzed and both groups were compared in terms of number of readmissions, mortality rates, weight gain, and the number of emergency visits to healthcare workers.

Results: The neonates in group A showed higher follow-up adherence (92.2% vs. 76.1%, p=0.011) and higher weight gain at 28^th day with mean weight being 1.90±0.22 kg in checklist group compared to 1.79±0.19 kg in group B (p=0.043). Re-admissions and emergency room visits were higher in the checklist group, reflecting timely health-seeking behaviour. Mortality was lower in the checklist group (4.7% vs. 7.0%). Majority of deaths in group A occurred after hospital admission as compared to group B suggesting earlier recognition and timely referral by checklist group.

Conclusions: Health workers do use checklist but, educating parents with a simple pictorial checklist after NICU discharge significantly improves neonatal survival and follow-up adherence. By early recognition of danger signs, this tool reduces mortality and strengthens post-discharge care in preterm in low- resource setting.

Thyroid dysfunction in children with type 1 diabetes mellitus: prevalence, patterns and clinical associations

Simran Syal — 2026-07-27

Background: To determine the prevalence and pattern of thyroid dysfunction in children with Type 1 diabetes mellitus, identify associated risk factors that predispose diabetic children to develop thyroid abnormalities and evaluate the impact on glycemic control.

Methods: This prospective observational study included 50 children with Type 1 diabetes mellitus attending a tertiary care centre. Clinical characteristics, including age, gender, duration of diabetes, other autoimmune diseases, family history of autoimmunity, along with metabolic parameters like HbA1c and daily insulin requirement, were recorded. Thyroid status was categorised as euthyroid antibody negative, euthyroid antibody positive, subclinical hypothyroidism, overt hypothyroidism and hyperthyroidism. Associations between thyroid status and clinical variables, glycemic parameters were analysed.

Results: Thyroid dysfunction was present in 9 children (18%): subclinical hypothyroidism in 4 (8%), overt hypothyroidism in 4 (8%) and hyperthyroidism in 1 (2%). Among the remaining children, 28 (56%) were euthyroid with negative anti–thyroid peroxidase antibodies, while 13 (26%) were euthyroid with positive antibodies. Thyroid dysfunction was significantly associated with longer duration of diabetes and the coexistence of other autoimmune disorders. Daily insulin requirement differed significantly across thyroid subgroups, whereas glycated haemoglobin levels were comparable between T1DM children with and without thyroid dysfunction.

Conclusions: Thyroid dysfunction is common in children with Type 1 diabetes mellitus, affecting nearly one-fifth of patients, with subclinical hypothyroidism being a frequent abnormality. Longer duration and presence of other autoimmune diseases increase the risk of thyroid dysfunction. Periodic routine thyroid screening in children with Type 1 diabetes mellitus is essential for early detection and optimal metabolic management.

The impact of social media and excessive screen time on the mental well-being and sleep patterns of school-aged children: a cross-sectional multi-stage cluster study

Sushma N. — 2026-07-27

Background: The present study was conducted to estimate the prevalence of excessive screen time and social media use, and to evaluate their association with mental well-being and sleep patterns among school-aged children.

Methods: A cross-sectional study was conducted among 672 children aged 8–14 years, selected through multistage random sampling from government and private schools in South India over a four-month period (June to Sep 2024). A pre-tested, structured questionnaire was used to collect data and patterns of screen-based device use and social media use. Mental well-being was assessed using the Strengths and Difficulties Questionnaire (SDQ), and sleep patterns using the Children's Sleep Habits Questionnaire (CSHQ). Data were analysed using SPSS 26.0 version.

Results: The mean age of participants was 11.2±1.8 years (51.8% boys). High screen time (>4 h/day) was reported in 212 children (31.5%), and 486 (72.3%) were active social media users, YouTube (89.1%) and WhatsApp (62.3%). Mean SDQ was (9.8±4.2, 13.6±5.1, and 18.9±6.3 respectively; p<0.001), and the proportion with abnormal SDQ scores (≥20) increased from 6.3% to 38.7% (p<0.001). Sleep duration declined from 9.4±0.8 to 7.3±1.1 hours/night (p<0.001), while CSHQ total scores rose from 38.2±5.6 to 52.3±7.9 (p<0.001) across the same groups. Screen time correlated positively with SDQ score (r=0.42, p<0.001) and CSHQ score (r=0.51, p<0.001), and negatively with sleep duration (r=−0.46, p<0.001).

Conclusions: Excessive screen time and social media use are significantly and independently associated with poorer psychological well-being and disturbed sleep among school-aged children. Structured screen-time guidance, parental mediation, and school-based digital wellness programmes are warranted.

Children’s eating behaviour in relation to body mass index among 2–5 year-old children in a tertiary care centre: a cross-sectional study

Tessa Jose — 2026-07-27

Background: Childhood obesity is an emerging global health concern and is associated with several metabolic, cardiovascular and psychosocial complications. Eating behaviours established during preschool years are often stable and may influence future body weight. The children’s eating behaviour questionnaire (CEBQ) is a validated tool to assess appetite-related behaviours in children. Objective was to assess the relationship between children’s eating behaviours and body mass index (BMI) among children aged 2–5 years attending a tertiary care centre.

Methods: A hospital-based cross-sectional study was conducted among 162 children aged 2–5 years in the Department of Pediatrics of a tertiary care centre. Data were collected using a structured proforma and the CEBQ completed by parents/caregivers. Anthropometric measurements were recorded and BMI SD scores were calculated using WHO growth standards. The CEBQ assessed eight subscales categorized into food-approach behaviours (food responsiveness (FR), enjoyment of food (EF), emotional overeating (EOE), desire to drink (DD)) and food-avoidant behaviours (satiety responsiveness (SR), slowness in eating (SE), emotional undereating (EUE), food fussiness (FF)). Spearman correlation was used to evaluate associations between BMI SD score and CEBQ subscales.

Results: The mean age of participants was 2.09±0.82 years; 53.7% were females. Based on BMI SD scores, 46.9% had normal BMI, 36.4% were overweight/obese and 16.7% were underweight. BMI SD score showed strong positive correlations with EF (ρ=0.786), EOE (ρ=0.717), FR (ρ=0.794) and DD (ρ=0.756) (all p<0.001). Significant negative correlations were observed with SR (ρ=−0.412), SE (ρ=−0.459), EUE (ρ=−0.373) and FF (ρ=−0.375) (all p<0.001).

Conclusions: Preschool children with higher BMI demonstrated stronger food-approach behaviours and weaker food-avoidant behaviours. Early identification of maladaptive eating patterns and family-centred behavioural interventions may help prevent childhood obesity and undernutrition.

A study on the predictive value of red blood cell distribution width as a biomarker of outcome in paediatric critical illness

Prachi Gandhi — 2026-07-27

Background: One of the pediatric population’s interest group is critically sick children requiring medical aid services, since these children are at an extreme risk of death. Red cell distribution width (RDW) measures the variability in red corpuscle size and is calculated as proportional variation in mean corpuscular cell volume (MCV), with a traditional vary of 11.5-14.5%. The ensuing acute rise in RDW could thus say the degree of the underlying inflammatory state and supply helpful prognostic data regarding intensity of resource utilization and risk of mortality. The aim and objectives were to determine the association between RDW and mortality in critically ill children admitted to PICU.

Methods: A cross sectional observational study was conducted among 103 children in the age group of 2 months to 18 years admitted to PICU at SMIMER Hospital.

Results: In this study, mean age of survivors was 16.8 years. Among survivors group, in 35 (42.1%) cases there was respiratory system involvement followed by CNS involvement in 19 (22.8%) cases while in non-survivors group only in 7 (35%) cases respiratory system was involved, in 2(10%) cases CNS involved. In RDW quartile range of 16.1-19.0, 46 cases had survived and 11 deaths were noted and significant difference was found between RDW quartiles and odd’s ratio of survivor and non-survivor group.

Conclusions: Raised RDW levels have been seen strongly associated with mortality and poor clinical parameters, including use of vasoactive-ionotropic drugs, oxygen as well as mechanical ventilator support. Hence, RDW can be used as a biomarker in prediction of risk mortality in PICU.

Diagnostic dilemma in a child with bilateral empyema and pyopericardium: a case report

Jaskirat Kaur Sandhu — 2026-07-02

Tubercular pericardial effusion in children is a rare, severe form of extrapulmonary TB, often presenting with fever, cough, tachycardia, and dyspnea, with a high incidence of cardiac tamponade. Diagnosis relies on echocardiography and pericardial fluid analysis, with treatment involving anti-tubercular therapy (ATT) and pericardiocentesis. Here we present the case of a child with bilateral pleural effusion and pericardial effusion, which was clinico-radiologically proven to be tubercular in origin and required pericardiocentesis to manage the impending cardiac tamponade.

A rare cause of salt wasting and failure to thrive in infancy: case of aldosterone synthase deficiency

Rose Mary Tom — 2026-07-27

Aldosterone synthase deficiency (ASD) is a rare autosomal recessive disorder caused by pathogenic variants in CYP11B2 that impair aldosterone biosynthesis. It presents with salt-wasting, hyponatremia, hyperkalaemia and failure to thrive in infancy and can be life‑threatening if not recognized and treated. We report an infant with early-onset salt-wasting and a novel CYP11B2 variant. A 56‑day‑old female, presented with poor weight gain and dehydration. Laboratory investigations showed hyponatremia, severe hyperkalaemia, metabolic acidosis and mildly elevated 17‑hydroxyprogesterone; cortisol and ACTH were normal. Plasma aldosterone was low (4.4 ng/dl) with low‑normal renin activity (2.39 ng/ml/h). Clinical exome sequencing identified a homozygous c.542G>C (p. Arg181Pro) likely pathogenic variant in CYP11B2, consistent with aldosterone synthase deficiency. Acute management included intravenous fluids, sodium supplementation and anti‑hyperkalemic measures. The child received empirical hydrocortisone initially and was started on fludrocortisone (200 µg/day) with oral sodium chloride supplementation. On follow‑up the infant demonstrated appropriate weight gain and normal development. ASD should be considered in infants with salt‑wasting and failure to thrive without virilization. Prompt recognition, acute electrolyte correction, and mineralocorticoid replacement lead to favourable short‑ and long‑term outcomes. Genetic testing confirms the diagnosis and enables counselling for recurrence risk.

Williams syndrome in a 7-year-old girl with characteristic facies, congenital cardiac involvement and behavioral phenotype: a case report

Nooreen — 2026-07-27

Williams syndrome is a rare multisystem genetic disorder caused by a microdeletion at chromosome 7q11.23 involving the ELN gene. It is characterized by distinctive facial features, cardiovascular abnormalities, developmental delay, endocrine disturbances, and a characteristic hypersocial behavioral profile. We report a 7-year-old girl with genetically confirmed Williams syndrome who presented with urinary tract infection. She had been diagnosed at 1 year of age after recognition of dysmorphic features and congenital cardiac disease, followed by confirmation by chromosome analysis and fluorescence in situ hybridization. Clinical findings included depressed nasal bridge, posteriorly rotated ears, long philtrum, retrognathia, mild pectus deformity, deep-set nails, and mild muscular ventricular septal defect. At follow-up, she had typical “elfin” facies and an unusually friendly personality. This case highlights the importance of early recognition and long-term multidisciplinary follow-up, including cardiovascular, developmental, behavioral, metabolic, renal, hearing, and visual surveillance.

More than coarctation: Williams syndrome with diffuse arteriopathy

Madamshetty Niharika — 2026-07-27

Williams syndrome is a rare multisystem genetic disorder caused by a microdeletion at chromosome 7q11.23 involving the elastin (ELN) gene. It commonly presents with cardiovascular abnormalities, developmental delay, connective tissue defects, and characteristic facial dysmorphism. We report a 9-month-old male infant with recurrent respiratory tract infections, developmental delay, and failure to thrive. Bronchoscopy showed mild tracheomalacia and bilateral bronchomalacia, and he had previously undergone right inguinal hernioplasty. On examination, characteristic dysmorphic facial features raised suspicion for Williams syndrome. Echocardiography revealed severe discrete coarctation of the aorta with concentric left ventricular hypertrophy and bilateral superior vena cava. During balloon coarctoplasty, right renal artery stenosis was identified, representing a rare vascular association. Genetic studies confirmed the diagnosis of Williams syndrome with deletion involving chromosome 7q11.23. This case highlights the importance of careful clinical evaluation and genetic confirmation in children with syndromic facies and vascular anomalies for early diagnosis and appropriate multidisciplinary management of Williams syndrome.

King-Denborough syndrome: a clinicogenetic case report

Ariya Venu — 2026-07-27

King–Denborough syndrome is a rare RYR1-related congenital myopathy characterized by dysmorphic features, muscle weakness, and susceptibility to malignant hyperthermia, often posing a diagnostic challenge in early infancy. We report a one-year-old female child presenting with developmental delay and generalized hypotonia. Clinical evaluation revealed craniofacial dysmorphism, bilateral ptosis, and esotropia, raising suspicion of an underlying congenital myopathy. Initial laboratory and imaging workup were inconclusive except for transient elevation of creatine kinase. Whole exome sequencing identified a heterozygous missense variant in the RYR1 gene (c.14126C>T; p.Thr4709Met), along with a likely pathogenic FOXP1 variant. In view of the characteristic clinical phenotype, a diagnosis of King–Denborough syndrome was considered. The child was managed with supportive therapy and developmental interventions, and caregivers were counselled regarding the risk of malignant hyperthermia. This case underscores the importance of clinicogenetic correlation in diagnosing rare myopathies and highlights the need for early recognition to enable appropriate counselling and prevention of anaesthetic complications.

Beyond a simple gingival enlargement: peripheral ossifying fibroma in a 12-year-old

Diksha Sharma — 2026-07-27

Lesions affecting the gingiva are frequently encountered and constitute a substantial part of cases evaluated in oral pathology. Most of these lesions are reactive in nature and may exhibit a wide range of clinical presentations. However, certain developmental and neoplastic conditions can also involve the gingiva, which may lead to difficulties in establishing a clear clinical and histopathological diagnosis. This article presents a case of 12-year-old male patient with a chief complain of a painless slowly enlarging mass on the lower left mandibular region. The fibrous mass was surgically excised and the tissue sample was sent for biopsy examination which further revealed the lesion to be peripheral ossifying fibroma.

Novel electroencephalographic delta brush pattern in typhoid encephalitis

Rahul Sinha — 2026-07-27

Extreme delta brush is a rare interictal electroencephalography (EEG) pattern first described in anti-N-methyl-D-aspartate receptor (NMDA) receptor encephalitis and initially considered pathognomonic for this autoimmune subtype. It has since been reported, rarely, in other forms of encephalitis. Typhoid encephalitis commonly presents with acute confusion and behavioral changes and may also cause severe neurologic complications, including seizures, coma, and cerebral edema. Typhoid toxins may increase blood–brain barrier permeability and contribute to neurologic dysfunction. We report this rare EEG finding in a 13-year-old girl with typhoid encephalitis. Our case highlights the diagnostic value of EEG in unexplained encephalopathy or suspected encephalitis. Although extreme delta brush is specific to anti-NMDAR encephalitis, its presence should prompt evaluation for other autoimmune or infectious encephalitis when the anti-NMDAR antibodies are negative.

Delayed diagnosis of cutaneous tuberculosis in a child with chronic skin lesions: a case report

Enboklang Suting — 2026-07-27

Cutaneous tuberculosis (CTB) is an uncommon form of extrapulmonary tuberculosis in children and often pose a diagnostic challenge due to its varied clinical presentation. We report the case of a 7-year-old boy with chronic skin lesions for three years who received multiple empirical treatments without improvement. Examination of the skin lesion revealed erythematous to violaceous plaques with lichenification, scaling and excoriated areas. The margins are relatively well defined with smaller satellite papules. Skin biopsy showed epithelioid granulomas with Langhans giant cells and caseation consistent with CTB. He completed a 6-month course of anti-tubercular therapy (ATT) and the skin lesion healed with an unsightly scar. This case highlights the need to consider biopsy in chronic non-healing lesions to prevent long term cosmetic complications.

Stage III tuberculous meningoencephalitis with brain abscess in a young infant: a rare case report

Tithi R. Patel — 2026-07-27

Tuberculous meningitis (TBM) is the most severe form of TB in children and is associated with high mortality and related morbidities. Some of the rare complications of TBM, especially in infants, are formation of brain abscess, hydrocephalus, vasculitis, and cerebral infarction. We reported a case of a 3 ½ months old female infant who presented with fever, cough, irritability, poor feeding, and continuous convulsions. Investigations revealed basal meningeal exudates, multiple cerebral and brainstem infarcts, vasculitis, tuberculomas, hydrocephalus, and a left parietal brain abscess. CSF findings were suggestive of TBM. The patient was diagnosed with stage III tuberculous meningoencephalitis complicated by multiple deep cortical and brainstem infarcts, vasculitis, tuberculomas, hydrocephalus, brain abscess and status epilepticus. She was managed successfully with anti-tubercular therapy, corticosteroids, antiepileptics, abscess evacuation, Ommaya reservoir insertion, and ventriculoperitoneal (VP) shunting. Significant improvement has been noted, and she is in stable condition.

Navigating secondary loss of response: breakthrough midbrain ischemia in deficiency of adenosine deaminase 2: a case report

Aravind Palraj — 2026-07-27

Deficiency of adenosine deaminase 2 (DADA2) is a monogenic autoinflammatory vasculopathy that may present in childhood with lacunar infarcts in deep perforator territories. Tumor necrosis factor-alpha (TNF-alpha) inhibitors have changed the outlook for stroke-predominant disease, but ischemic events can still occur during treatment. An 8-year-old girl with recurrent brainstem and deep gray matter lacunar infarcts had normal magnetic resonance angiography and negative autoimmune and antiphospholipid testing. Genetic analysis confirmed a homozygous pathogenic ADA2 variant. She received infliximab 100 mg intravenously every two months with aspirin, but after five doses developed a new right paramedian superior midbrain infarct. Infliximab was stopped and subcutaneous adalimumab 40 mg every two weeks was started. After 18 doses of adalimumab, she has had no further cerebrovascular events. TNF-alpha blockade markedly reduces stroke risk in DADA2, but it does not abolish it. In this child, switching from infliximab to adalimumab was followed by neurological stability. For a vasculitis-predominant patient without hematologic failure, an intra-class switch is a practical option to consider before hematopoietic cell transplantation, with continued neurologic surveillance.

Diaper use practices among mothers – an urban-rural comparison: a narrative review

Meena — 2026-07-27

Diaper usage is a crucial aspect of infant care, yet disparities in maternal knowledge and practices exist across different socio-geographic settings. This narrative review explored and synthesised existing literature on diaper use practices among mothers, focusing specifically on urban-rural differences. Electronic databases, including Google scholar and PubMed, were searched for relevant recent studies using keywords such as “diaper use practices,” “diaper dermatitis,” “infant hygiene,” “urban,” and “rural.” Studies focusing on maternal knowledge and practices were included and analysed thematically. The findings revealed consistent differences between the two demographics: urban mothers generally demonstrated greater awareness of hygiene, optimal diaper-changing frequency, and diaper dermatitis prevention. Conversely, rural mothers exhibited significant knowledge gaps, particularly regarding proper disposal methods and rash prevention. Socioeconomic status, maternal education level, and access to health information emerged as the primary influencing factors driving these disparities. In conclusion, significant urban-rural gaps in maternal diapering practices underscore a critical need for targeted health education interventions, particularly in rural communities. Integrating comprehensive diaper care and hygiene education into routine maternal and child health services could effectively bridge this gap, ultimately improving infant hygiene and health outcomes across diverse populations.

A global review of cerebral palsy in children: family caregiver burden, risk factors, prevalence and the evolution of technology and policy

Gaurav Chauhan — 2026-07-27

Cerebral palsy (CP) is a group of permanent disorders affecting movement and posture resulting from non-progressive disturbances in the developing foetal or infant brain and remains the most common physical disability in childhood. Despite advances in neonatal care and public health measures, CP continues to impose substantial clinical, social, and economic burdens worldwide. This narrative review aimed to examine the global prevalence of CP, associated clinical and social risk factors, family impacts, and contemporary government policies influencing its management. A comprehensive literature search was conducted using electronic databases, national CP registers, published epidemiological studies, and healthcare policy reports from both high-income and low- and middle-income countries. The review identified significant variations in CP prevalence across regions, with approximately 8.1 million children under five years of age living with CP globally. Birth prevalence has declined to approximately 1.6 per 1,000 live births in high-income countries but remains higher in low-income settings, reaching 3.4 per 1,000 live births, while the estimated prevalence in India is approximately 3 per 1,000 live births. Prematurity, low birth weight, neonatal jaundice, and perinatal complications were identified as major risk factors. Families of children with CP frequently experience increased healthcare expenditures, psychosocial stress, and caregiver burden. Recent technological advances, including machine learning–based screening and diagnostic approaches, have enabled earlier identification of CP between 9 and 18 weeks of age. The review highlights a global shift toward family-centered and technology-supported care; however, substantial disparities in access to advanced interventions persist across different socioeconomic settings. Strengthening affordable early detection strategies, rehabilitation services, and supportive national health policies is essential to reduce inequities and improve outcomes for children with CP and their families.

Various methods of engagement utilized by the mothers during weaning of their children: a narrative review

Heena — 2026-07-27

Weaning is a key stage in early childhood involving the introduction of solid foods and changing feeding interactions. Maternal engagement during this period influences infants’ eating behavior and nutritional outcomes. Various methods such as baby-led weaning, conventional feeding, and responsive feeding are commonly used. A narrative review was conducted using literature published between 2015 and 2026. Studies were identified from PubMed, Google scholar, and international health reports using relevant keywords. A total of 50 relevant articles including cross-sectional studies, cohort studies, randomized trials, and review articles were selected and analyzed. Mothers use different feeding methods based on their knowledge and preferences. Baby-led weaning promotes independence, conventional feeding provides control, and responsive feeding supports better eating habits. Maternal engagement plays a vital role during weaning. A balanced approach combining appropriate methods with responsive practices supports healthy growth and development.

Importance and barriers to hepatitis A immunization and the clinical relevance of inactivated hepatitis A vaccine (TZ84 strain): insights from the pediatric experts

Srinivas Kasi — 2026-07-27

The epidemiology of hepatitis A in India is shifting from high to intermediate endemicity, leading to a growing number of predisposed adolescents and adults who are at greater risk of symptomatic illness and sequelae. Vaccination is an efficacious preventative measure; yet, certain obstacles persist that hinder optimum vaccine use. This expert review aimed to explore the challenges associated with hepatitis A vaccination in India and to gather insights from pediatricians on the clinical relevance and factors influencing their choice of inactivated hepatitis A vaccines, with particular reference to the TZ84 strain. A focused group discussion (FGD) was conducted with 11 practicing pediatricians from various regions of India. The discussion examined opinions related to the epidemiological aspects of hepatitis A, immunization methodologies, obstacles to vaccine adoption, and determinants affecting vaccine choice. Pediatricians identified multiple challenges, such as financial obstacles, gaps in caregiver awareness, and a lack of hepatitis A vaccination in UIP. Participants highlighted the necessity for enhanced public health education and more robust policy initiatives aimed at increasing vaccination coverage. The inactivated hepatitis A vaccine (TZ84 strain) was considered clinically significant, given its demonstrated ability to elicit strong and durable immune responses and its potential for long-term protection against hepatitis A infection. The changing epidemiology of hepatitis A in India underscores the importance of strengthening vaccination strategies. Addressing policy, awareness, and accessibility barriers may improve vaccine uptake and reduce disease burden. Adoption of inactivated hepatitis A vaccines may help reduce disease burden, with TZ84 strain–based vaccine representing a reliable option for sustained protection.

A case series of septic infants with cerebral venous sinus thrombosis: novelty neonatal thromboembolism risk stratification model in the Grodno region

Pratasevich T. Sergeevna — 2026-07-27

Neonatal thromboembolism, especially cerebral venous sinus thrombosis (CVST), is a significantly recognized complication in critically ill infants. Early detection protocols remained challenging due to variable clinical presentation and lack of standard predictive models. This study aims to develop a novelty risk stratification model composed of detailed analysis from four cases. A retrospective case series evaluation was conducted on four individual cases of neonates with severe sepsis complicated by transverse sinus thrombosis confirmed radiologically. Clinical characteristics, complete blood count (CBC), coagulation parameters, biochemical markers, and inflammatory biomarkers were longitudinally assessed. A novelty neonatal thromboembolism risk score (NTRS) was derived based on persistent laboratory findings. All four patients exhibited a specific prothrombotic profile characterized by leukemoid reaction (>50×10⁹/l), thrombocytopenia (<150×10⁹/l), significantly increased D-dimer (>10,000 ng/ml), hypofibrinogenemia (<1.5 g/l), increased inflammatory markers (procalcitonin >5 ng/ml, CRP >20 mg/l), and evidence showing multiorgan dysfunction. The developed novelty NTRS (range 0–16) successfully graded all four cases into one low, two high and one critical risk categories before the confirmation of thrombosis was found. This novelty NTRS model characterizes a practical, laboratory-driven approach for early identification of neonates at risk for thromboembolism. Prospective larger cohorts are necessary to validate these findings.

Developmental trajectory and functional outcomes in children with epilepsy: a descriptive case series

Sampada S. Joshi — 2026-07-27

Early onset epilepsy has been reported in literature in as young as 2 years of age specially focusing on cognitive and executive function affection. However, effect of Epilepsy on physical function affection is under reported specially in children below 1 year of age. The objective here is to report a case series of 6 patients diagnosed with Epilepsy aged 9 months to 1.5 years at the time of their first visit to Physiotherapy OPD, with chief complaint of developmental delay/regression. This case series included six children diagnosed with Epilepsy and referred to Physiotherapy with the chief complaint of age-appropriate developmental delay in 4 children and regression in case of 2 children. Structural, genetic, and metabolic etiologies were confirmed with investigations in these children along with pre-epilepsy developmental milestone status through parent interview. Developmental status was examined before and after intervention using clinical assessment and Gross Motor Function Measure (GMFM) scores. Customised Physiotherapy intervention was given in accordance to structured short term goals. The baseline motor function ranged widely (GMFM 6%–52%). Early-onset epileptic encephalopathies demonstrated profound impairment, whereas non-progressive post-seizure cases showed moderate delay. Following intervention, five children demonstrated measurable GMFM improvement (19%-77.8%), most notably in trunk control, transitional movements, kneeling stability, and ambulation. Limited or negative progression was observed in children with progressive metabolic pathology. Thus, this case series provides the evidence for physical function affection in children with epilepsy under 1 year of age which improved substantially with neurophysiotherapy treatment.

Familial juvenile idiopathic arthritis in three siblings including dichorionic diamniotic twins: a case series highlighting familial aggregation and genetic susceptibility

Pradeep K. Ranabijuli — 2026-07-27

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatologic disorder of childhood and is considered a multifactorial disease with genetic and environmental contributions. Familial occurrence of JIA remains relatively uncommon and clinically significant. We report a case series involving three siblings born out of a non-consanguineous marriage, including dichorionic diamniotic twin male siblings, presenting with inflammatory arthritis suggestive of oligoarticular juvenile idiopathic arthritis with recurrent episodes, separated by symptom-free intervals. The elder sibling, an eleven-year-old female, presented with recurrent fever and associated inflammatory arthritis involving the right wrist and elbow. The twin siblings presented with recurrent knee and wrist arthritis, elevated inflammatory markers and ultrasonographic evidence of synovitis. Both the twins had episodes previously diagnosed as reactive arthritis before evolving into a probable JIA phenotype. Extensive investigations excluded infectious, cardiac and other connective tissue etiologies. All siblings demonstrated favorable response to non-steroidal anti-inflammatory therapy. This case series highlights possible familial aggregation, genetic susceptibility and phenotypic variability in JIA.