This article examines the environmental, economic, and public-health implications of menstrual hygiene products within a One Health perspective, highlighting how individual choices can contribute to sustainability. Menstrual products—used monthly for roughly 40 years of reproductive life—generate significant waste due to their widespread use and high plastic content. Historically, menstrual management evolved from rudimentary natural materials to industrial products shaped largely by male-driven design choices, leading to a proliferation of disposable items with heavy reliance on plastics, applicators, and individualized packaging. Today, most disposable pads and tampons contain multiple plastic components, contributing substantially to non-recyclable waste. In Italy, absorbent hygiene products account for about 3% of total non-recoverable waste—approximately 900,000 tonnes per year. Growing awareness has led to increasing interest in sustainable alternatives such as menstrual cups, absorbent washable underwear, reusable cloth pads, biodegradable pads, and, to a lesser extent, sea-sponges, though the latter raise hygiene and ecological concerns. Political initiatives, including reduced VAT on biodegradable or reusable menstrual products and local programs distributing menstrual cups and washable nappies to families, promote cultural and behavioral change. Economic analyses reveal that women use 10,000–14,000 pads or tampons over a lifetime, spending around €5,000, with “period poverty” affecting socially vulnerable groups lacking access to adequate products and sanitation. The article also addresses the environmental impact of condoms, widely used for contraception and STI prevention. Although essential for sexual health, condoms—whether latex or synthetic—are not compostable and must be disposed of as general waste. Their production involves significant environmental costs due to synthetic additives and small, non-recyclable aluminum or composite packaging. Overall, sustainable menstrual and sexual health practices require informed consumer choices, supportive public policies, improved product design, and accessible education on proper waste disposal.
In the pediatric population, cerebrovascular disease—although numerically less frequent than in adults—ranks among the top ten causes of death and has a significant impact on the quality of life of affected children and their families. Neurological sequelae are common, as well as emotional, social, and caregiving repercussions for both patients and caregivers. In recent years, the distinctive etiopathogenetic and pathophysiological features of pediatric stroke have prompted the development of multicenter studies and dedicated national registries, after a long period in which clinical and therapeutic management relied largely on evidence derived from adult populations.
This study investigates maternal parenting style in adolescents diagnosed with restrictive anorexia nervosa (ANr), aiming to identify relational patterns that may inform family-based therapeutic approaches. Fifty-six patients (mostly female, mean age 14.6 years) were assessed between 2022 and 2024 using standardized tools evaluating eating pathology (EAT-26, BUT-A), emotional intelligence (EQ-i:YV), behavioral functioning (CBCL), and maternal parenting style (Parents Preference Test). The sample showed markedly pathological scores on eating-disorder scales, with nearly half having BMI <5th percentile (Graph 1, page 63). Emotional functioning was impaired, particularly in intrapersonal skills, general mood, and total emotional quotient, while CBCL scores indicated high rates of internalizing symptoms such as anxiety and depression. Maternal parenting profiles were predominantly active, emotionally oriented, and rule-focused, with strong attentional focus on the child (Tables on pages 62–63). Pearson correlations revealed that higher assertiveness and intrapersonal emotional skills in adolescents were associated with greater maternal self-focus, suggesting that maternal over-focus on the child may hinder autonomy and self-awareness. Conversely, mothers with strong emotional experiential styles more frequently reported significant socio-emotional difficulties in their children. The findings reinforce the central role of family dynamics in ANr and support the importance of evaluating parenting style when planning interventions, particularly within Family-Based Treatment models. The study’s limitations include small sample size and absence of a control group. Future directions include expanding the sample, incorporating paternal parenting evaluation, and conducting long-term follow-up.
This article explores the psychological and social complexities of children’s and adolescents’ engagement with digital media, using the case of Francesco—a 12-year-old who developed sleep disruption, school refusal, and distress linked to compulsive nighttime gaming—as a starting point. The authors highlight how shame, secrecy, and inadequate parental mediation can lead to problematic digital behaviors, often masked by somatic complaints such as abdominal pain. The text situates the issue within broader societal “moral panics,” noting how new technologies historically provoke adult anxiety and polarized public debate. Contrary to alarmist narratives, research shows that digital media—when age-appropriate and properly mediated—can support learning, identity development, and socialization. Children naturally move between online and offline contexts, integrating skills across both worlds. Drawing on recent studies, the authors introduce the concept of the “cyborg child,” emphasizing how digital devices have become embedded in family routines and relational environments. Effective evaluation of digital habits must therefore consider both content (what children access) and context (where, when, with whom, and under which relational dynamics). Parental mediation plays a central role. Restrictive strategies—such as prohibiting smartphone use or confiscating devices—are shown to be ineffective, limit digital competence, reduce communication, and prevent children from safely learning to manage risks. In contrast, enabling or active mediation strategies, which involve adults using and exploring digital media together with children, foster autonomy, emotional openness, and the transition from external to self-regulation. The case of Francesco illustrates what happens when rules are absent, inconsistent, or unaccompanied by open dialogue. The article argues that clinicians must incorporate digital life into clinical history-taking, asking about online behaviors, parental mediation styles, and children’s regulation strategies. Pediatricians can become key figures in helping families understand that difficulties arise not from technology itself but from the interaction of individual vulnerabilities, relational patterns, and social factors. Ultimately, interventions should address these multiple levels and promote collaborative action between families, schools, and health professionals to support healthy, developmentally appropriate digital engagement.
In recent years, the need for Pediatric Palliative Care (PPC) in Italy has increased, supporting both child and family throughout the illness. However, PPC management still faces major challenges, especially in building an integrated interdisciplinary care network. The study examined the role of primary care paediatricians, their involvement, organizational difficulties, and emotional experiences. Results show a growing commitment to complex cases, but also a lack of resources and coordination. Emotional challenges include coping with the suffering of children and families without adequate psychological support. The network needs to be strengthened through continuous training and integration between hospital and community professionals.
Moving from a recent experience of nicotine intoxication in a teenager, we briefly explore the lesser-known methods of nicotine intake known as nicotine pouches and snus. In Northern Europe, but now also in our country, they represent a gateway to the use of tobacco derivatives that is not without risks.
This article presents the early results of WIN4ASD, a telemedicine-based platform implemented in Lombardy to enhance neurodevelopmental surveillance during the first 1,000 days of life. Rooted in a “trans-domain” model of mental health promotion, the system integrates screening into routine well-child visits, emphasizing early identification of autism spectrum disorder (ASD) and other neurodevelopmental conditions. The platform uses the CHAT for 16–18-month screening and, since late 2024, the SDQ for children up to 36 months. As of September 2024, all regional pediatricians were registered, 61,182 children had been screened, and 775 were referred for specialist evaluation, with high concordance between positive screens and confirmed neurodevelopmental disorders. WIN4ASD enables real-time scoring, secure referral to NPIA services, and fast-track diagnostic pathways, forming an integrated network between primary care and specialized autism units. Early data indicate the platform’s reliability, scalability, and value as a public health tool. Its success demonstrates how structured telemedicine, combined with a universal health system, can strengthen prevention, early detection, and continuity of care in the field of neurodevelopment.
This article highlights the essential collaboration between pediatricians and dermatologists in managing pediatric dermatoses, with a focus on atopic dermatitis (AD) as a model condition. AD is a chronic, inflammatory skin disease affecting up to 20–30% of children in industrialized countries, marked by pruritus, age-dependent lesion morphology, and significant impact on the child’s and family’s quality of life. Early recognition and coordinated care improve diagnostic accuracy, therapeutic outcomes, and parental education. Diagnosis is primarily clinical, based on history, lesion morphology, distribution, chronicity, and family atopy, following the Hanifin & Rajka criteria and their later revisions. Because AD presentations vary with age—from exudative facial/extensor lesions in infants to flexural involvement in older children—differential diagnosis is essential. The article provides a structured diagnostic framework supported by multiple clinical images (pp. 153–155) illustrating AD, psoriasis, seborrheic dermatitis, scabies, tinea, and other conditions. Key differential diagnoses include seborrheic dermatitis, irritant/allergic contact dermatitis, psoriasis, tinea infections, scabies (with characteristic burrows), genodermatoses such as ichthyosis and Netherton syndrome, metabolic diseases (e.g., acrodermatitis enteropathica), immunodeficiencies (e.g., Omenn syndrome, hyper-IgE syndrome), and early cutaneous T-cell lymphoma. The article emphasizes the importance of assessing onset timing, lesion characteristics, systemic symptoms, and family history. Clinicians should perform a complete skin examination, identify the primary lesion, avoid premature use of topical corticosteroids that may obscure diagnosis, and request targeted investigations (e.g., mycological examination, biopsy, genetic testing) when needed. Ultimately, a multidisciplinary approach between pediatrician and dermatologist reduces diagnostic errors, ensures timely management, and safeguards personalized, effective care for children with suspected AD or atypical skin presentations.
We describe the case of an infant with diencephalic syndrome (DS), with the aim of raising awareness among pediatricians about this rare cause of failure to thrive (FTT) and reducing diagnostic delay. DS is a rare condition characterized by emaciation, hyperkinesia and/or euphoria, despite normal caloric intake and linear growth. It is a rare manifestation of low-grade gliomas or craniopharyngiomas involving the hypothalamus and the diencephalon. Clinical manifestations beyond DS are mainly neurological and visual in nature, sometimes associated with endocrinological alterations and hypothalamic dysfunctions. However, neurological or endocrine signs often appear in the advanced stages, leading to diagnostic and therapeutic delays and an increased risk of long-term complications. DS generally regresses after cytoreductive surgery and/ or chemotherapy, but subsequent evolution towards hypothalamic obesity is frequent.
The case of a child with microhematuria and proteinuria is the starting point to investigate abnormalities in urine examination. Although transient and benign conditions are frequently encountered, in some cases, it’s necessary to proceed with the diagnostic process, employing renal biopsy and genetic evaluation. In particular, Alport syndrome is a multisystemic hereditary disease involving kidneys, visual and auditory system. Early diagnosis and proper follow-up are essential to improve outcomes and prevent long-term complications.
Alagille syndrome is an autosomal dominant multisystem disorder caused by mutations in the JAG1 and NOTCH2 genes. It can present with a characteristic facial appearance and involvement of organs like the liver, heart, eyes, skeleton, kidneys and blood vessels. Its estimated prevalence is around 1 in 30,000; however, due to high phenotypic variability and poor genotype-phenotype correlation, it is likely underdiagnosed. Severe cholestasis and itching are often the most debilitating manifestations. Treatment involves a multidisciplinary approach, including specialists such as hepatologists, nutritionists, nephrologists, and cardiologists.
Umaru, a three-year-old boy born in Germany to Nigerian parents, is reported by his nursery school as a pupil with likely special educational needs (SEN). The Child and Adolescent Neuropsychiatry Public Service carries out an observational assessment during spontaneous play. The initial diagnostic hypothesis is unspecified neurodevelopmental disorder, with a recommendation for further neuropsychological testing. However, these tests do not reveal any deficits. The team then re-evaluated the reported delays in motor and language development and behavioural dysregulation, considering the family migrant background, characterised by educational methods derived from ethnoparental theories very unlike from those reported in Europe.
Child sexual abuse is defined as the intentional involvement of a minor in sexual activities that are inappropriate for their developmental level and to which they cannot consent because of age or power imbalance. It can occur with or without physical contact and often involves familiar or trusted adults. Its prevalence is difficult to determine due to underreporting, but international estimates range from 3% to 31%, and Italian data confirm substantial hidden cases. Sexual abuse is recognized as a traumatic experience capable of producing significant psychological, behavioral, and somatic consequences. Children may show hyperarousal, dissociation, anxiety, depressive symptoms, self-harm, or sexualized behaviors. No single symptom is pathognomonic; clinicians must evaluate clusters of signs, timing, recurrence, and contextual factors. The medical examination, though often normal, is essential to identify injuries, reassure the child, and collect forensic evidence when necessary. Physical findings frequently heal rapidly and are absent in 90–95% of confirmed cases. Screening for sexually transmitted infections is indicated only in selected scenarios, particularly when penetration is reported or suspected. The child’s narrative remains the most specific diagnostic indicator, but must be collected with non-leading, developmentally appropriate interviewing. Multidisciplinary collaboration—healthcare, social services, legal authorities—is crucial for diagnosis, protection, and treatment. The pediatrician has the legal duty to report any well-founded suspicion of abuse, not only confirmed cases. Safety assessment is paramount, including evaluation of potential continued exposure to the perpetrator. Accurate documentation, including precise transcription of the child’s words and high-quality photographic evidence when appropriate, is required. Families should be informed about procedures, supported emotionally, and encouraged to cooperate with investigative agencies. Early identification and integrated intervention significantly improve clinical and psychosocial outcomes for victims. The article emphasizes continuous training for pediatricians to recognize signs, conduct appropriate examinations, and navigate legal obligations.
Estrogen/progestin therapies (EPTs) have been associated with the development of chorea. Questions on this topic addressed to a patients’ association (the Sydenham’s Chorea Association, www.sydenhamschorea.com) prompted our mapping review of the literature (multiple databases, from the beginning to August 2024), from which emerged that Sydenham’s chorea (Sc) may represent an indicator of the risk of developing chorea with EPTs. This has stimulated a reflection on the use and need for balanced information on EPTs in people with a history of Sc. A more accurate detection of the phenomenon of chorea reactivation during the use of EPTs in persons with previous Sc and the identification of the most suitable therapeutic strategy (e.g. hormonal contraception) and the most appropriate time to discuss it with these patients would be of relevance in this regard. The full English version is available from: https://gbox.garr.it/garrbox/s/v4poBtZdKA1AzkA
This article explores the complexity behind parental complaints such as “My child doesn’t eat,” emphasizing that such statements carry both factual content and relational requests. Drawing from Watzlawick’s communication theory, the author explains how pediatricians and parents enter consultations with pre-existing images of each other, shaped by heuristics and past experiences. These mental shortcuts can lead clinicians to premature or inaccurate interpretations. Through the case of a mother reporting that her 5-year-old son “eats nothing,” the article illustrates the phenomenon of “chaotic narration,” where multiple concerns, emotions, and interpretations are presented without hierarchy or clarity. The pediatrician’s challenge is to slow down automatic reasoning and avoid offering rapid reassurances or prescriptive advice that overlook the family’s dynamics, values, and emotions. The text highlights how feeding behaviors are embedded in family traditions, beliefs, and norms, many of which are resistant to simple correction. Pediatricians must distinguish what they actually know from what remains unexplored—such as the child’s emotional life, parental tensions, attempted strategies, and daily routines. Effective communication requires shifting from a one-way model (“I explain, you follow”) to a collaborative, two-way approach based on open, narrative, reflective, and circular questions (Box 3 on page 89). These questions help uncover hidden meanings, differentiate concerns, and activate parental competence. The pediatrician’s goal is not to impose change but to co-construct possible paths for modification, tailored to the family’s context. This responsive communication strengthens the therapeutic alliance, reduces conflict, and supports more sustainable behavioral change in feeding and beyond. Ultimately, the article argues that pediatric counseling must integrate clinical expertise with communication skills to navigate the educational and relational challenges that emerge around child behavior.
Immunoglobulin A vasculitis (IgAV), formerly known as Henoch Schonlein Purpura, is the most common systemic vasculitis of childhood. The diagnosis is made clinically, but the heterogeneous manifestations and the absence of the typical rash at the onset, necessary for diagnosis, can represent a challenge for the clinician. The disease is self-limiting in most cases, however a few patients can have a severe course because of gastrointestinal and renal involvement. This review aims to define first and second line treatment indications and hospital admission criteria for patients affected with IgAV.
Pediatric Palliative Care (PPC) goes beyond clinical treatment, addressing the emotional and relational dimensions of the child or adolescent patient. Often, the patient develops a sense of emotional responsibility toward their family, seeking to protect them from suffering and experiencing guilt. Additionally, the child’s experience is deeply influenced by family dynamics and the quality of communication with caregivers. Active listening and open dialogue help the child construct a personal narrative of illness, supporting their psychological well-being. For healthcare professionals, emotional involvement can become a significant burden, making emotional management strategies essential for effective and sustainable care. Through Teo’s experience, the complexities of the “burden of feeling” emerge, highlighting the importance of building a care pathway based on authenticity, listening, and shared support.
This article provides a structured clinical approach to evaluating children whose parents report frequent respiratory illnesses, aiming to distinguish physiological infection patterns from underlying disease. Most pediatric infections involve the upper respiratory tract and are considered normal if below seven episodes per year in preschool age and five thereafter. The article outlines three groups: (1) otherwise healthy children with typical seasonal, self-limiting viral infections who require no tests; (2) children with risk factors such as prematurity, atopy, passive smoke exposure, congenital airway anomalies, cardiac disease, or neurological disorders, for whom a watchful waiting strategy is appropriate; and (3) children with red flags—severe or atypical infections, early onset, recurrent pneumonia, poor growth, persistent chest findings, or family history—who warrant immediate investigation. Diagnostic algorithms (page 33) summarize indications for bronchoscopy, high-resolution CT, immunologic work-up, ENT evaluation, ciliary studies, sweat testing, and reflux assessment, depending on whether disease is focal or multifocal. The goal is to identify serious underlying conditions early while avoiding unnecessary tests in children with normal variants of infection frequency.
Situations of psychological and/or psychosocial distress that come to the attention of health and social health services during the perinatal period have undergone a significant increase. Similarly, we are witnessing the increasing prevalence of psychopathology among adolescents and young adults. Given that today’s adolescents will soon be the adults and parents of tomorrow, we wondered what types of parenting they will be able to express and, finally, what the impact of all this could be on the immediately following generation. And, above all, we asked ourselves how it would be best to move today in a preventive and systemic perspective.
Our increasingly sedentary lifestyle, characterized by excessive use of electronic devices, negatively impacts vision, especially in children. On the other hand, spending time in green spaces and exposure to natural light can positively influence visual health, even preventing certain conditions such as myopia. Numerous studies suggest that spending more time outdoors reduces the risk of developing myopia, as natural light stimulates the production of dopamine, which prevents the elongation of the eyeball. Conversely, spending too much time in front of screens may increase the prevalence of myopia. Additionally, outdoor physical activity offers many benefits, including maintaining good flexibility and function of the eye muscles, improving microcirculation, and preventing eye diseases such as cataracts and macular degeneration. However, the blue light emitted by screens can cause eye strain, dryness, and disrupt sleep, negatively impacting general and eye health. Limiting exposure to electronic devices, particularly before bedtime, is advisable to address these issues. Encouraging children to play outdoors can stimulate their vision and enhance their psychological well-being. In conclusion, a natural environment and outdoor physical activity can effectively prevent visual disorders and promote good eye health, especially during childhood.
