BACKGROUND:This study systematically reviewed and meta-analyzed the prevalence and risk of child malnutrition following extreme weather events in low- and lower-middle-income countries. METHODS:We searched PubMed, EMBASE, and Cochrane Library for studies assessing child stunting, wasting, underweight, or overweight/obesity after extreme weather events. Random-effects models were used to pool prevalence and association estimates, with subgroup and sensitivity analyses by event type. Risk of bias was assessed using tools appropriate to study design. RESULTS:Twenty-six studies, including over 320,000 children met the inclusion criteria, focusing exclusively on floods and/or droughts; none addressed overweight/obesity. The pooled prevalence of stunting, wasting, and underweight following extreme weather events was 39% (95% CI: 31-48%), 19% (95% CI: 12-28%), and 42% (95% CI: 22-64%), respectively. Wasting prevalence was higher after droughts than floods (22% vs. 13%, p = 0.04), while stunting did not differ by event type (p = 0.68). Meta-analyses revealed no significant long-term association between extreme weather events and stunting, though a transient increase in risk was observed within three months of flood exposure. CONCLUSIONS:Child malnutrition remains highly prevalent in these settings. The complex climate-malnutrition link underscores the need for standardized exposure definitions and robust nutritional surveillance. IMPACT:This meta-analysis provides the first pooled prevalence estimates of wasting, stunting, and underweight after droughts and floods-19%, 39%, and 42%, respectively. Wasting was significantly higher following droughts than floods, suggesting possible climate- and geography-specific nutritional associations. Evidence linking extreme weather events to pediatric malnutrition in low- and lower-middle-income countries remains limited and inconsistent. Findings highlight major research gaps and the need for standardized definitions, baseline data, and climate-resilient nutrition strategies.

IntroductionSustainable dietary patterns are increasingly promoted to improve human health while reducing environmental impacts. However, their implications for nutritional status and health outcomes in pediatric populations remain unclear.ObjectiveThis systematic review aims to synthesize the available evidence on the association between dietary patterns evaluated with sustainability-oriented indexes and nutrition-related outcomes in children and adolescents.MethodsA systematic search of PubMed, Embase, Scopus, and Web of Science was conducted up to January 3rd, 2026, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and with prospective registration in PROSPERO. Observational and interventional human studies involving participants aged 0-18 years were included if they assessed sustainable dietary patterns or sustainability-related dietary metrics and reported nutrition-related outcomes.ResultsTen studies met the inclusion criteria, revealing a heterogeneous body of evidence characterized by substantial variability in study design, age groups, sustainability metrics, and outcome definitions. Most studies focused on anthropometric indicators, primarily body weight and body mass index (BMI), whereas fewer investigated broader outcomes such as cardio-metabolic health or nutrition-related behaviors. Associations between sustainable dietary patterns and anthropometric outcomes were inconsistent across studies and age groups, with more favorable findings observed mainly in later childhood, adolescence, and long-term follow-up, and predominantly null results in early childhood. Evidence from intervention studies was limited and mixed, with only one intervention demonstrating a significant difference in weight-related outcomes between intervention and control groups, indicating that environmentally sustainable dietary patterns do not necessarily translate into a negative energy balance sufficient to induce weight loss.Discussion and ConclusionOverall, sustainable dietary patterns did not consistently translate into lower body weight or BMI, suggesting that sustainability-oriented diets should not be interpreted primarily as weight-loss strategies in pediatric populations. More consistent associations were found with cardio metabolic indicators such as waist circumference, metabolic syndrome (MeS), and ideal cardiovascular health (ICH). These findings suggest that the potential health benefits of sustainable diets in children and adolescents extend beyond body weight alone, highlighting the need for high-quality longitudinal and interventional studies across all pediatric life stages.Systematic review registrationhttp://www.crd.york.ac.uk/PROSPERO/view/CRD420251272851.

BACKGROUND:Malnutrition is highly prevalent among surgical children in sub-Saharan Africa, but data on its association with postoperative outcomes are limited. This study presents the first dataset on malnutrition and postoperative outcomes in children undergoing major gastrointestinal (GI) surgery in Uganda. We retrospectively evaluated the association between preoperative malnutrition and postoperative outcomes in young children undergoing major GI surgery. METHODS:A retrospective cohort study of children aged 1-59 months who underwent major GI surgery at the Children's Surgical Hospital, Entebbe, between April 2021 and November 2024. Nutritional status was assessed at admission using WHO Z-scores and mid-upper arm circumference (MUAC) cut-offs, classifying children as stunted (height-for-age Z-score < -2) and/or wasted (weight-for-length/height Z-score < -2, or MUAC below the age-specific cut-off). Outcomes included postoperative complications (primary), complication severity, length of hospital stay, and pediatric intensive care unit admission. Multivariable regression models adjusted for demographic and clinical covariates. RESULTS:We included 274 children, 117 (42.7%) female, with a mean age of 24.5 ± 14.1 months. The most frequent diagnoses were anorectal malformations in 190 (69.3%) and Hirschsprung's disease in 64 (23.4%). At admission, 107 (39.0%) were stunted and 68 (24.8%) wasted. Overall, 95 (35.6%) experienced at least one postoperative complication, and 21 (7.7%) experienced two, resulting in a total of 116 complications. The most frequent were wound infections or dehiscence in 62 (53.4%) and urinary tract infection in 25 (21.6%). There were 6 fatalities (2.2%). After adjustment, wasting was independently associated with postoperative complications (OR 3.74; 95% CI 1.14-13.38; p = 0.03), while stunting showed no such association. Neither stunting nor wasting was associated with other outcomes. CONCLUSIONS:Wasting is associated with higher odds of postoperative complications in pediatric abdominal surgery, although the confidence interval is wide. These findings underscore the need for prospective interventional studies to clarify causal relationships and determine whether targeted perioperative nutritional interventions can improve postoperative outcomes in pediatric surgical patients.

Climate change (CC) poses a major global threat to the health of current and future generations, disproportionately affecting pediatric populations. Investigating the links between CC and pediatric diseases is crucial to inform research and prevention strategies aimed at breaking the transgenerational cycle of social inequalities. This narrative review explores the complex interactions between early-life exposures to CC, food insecurity, and malnutrition, and their impact on infectious and noncommunicable diseases (NCDs) in pediatric populations. Data reveal a concerning global scenario: half of the world's children live in areas highly vulnerable to CC; malaria, enteric, and lower respiratory-tract infections account for ∼60% of the global communicable disease burden and related deaths in children and adolescents; over 2.1 billion people under-20 suffer from NCDs; almost 865 million children under-15 experience moderate-to-severe food insecurity; and millions of children under-5 face stunting (150.2), wasting (42.8), or obesity (35.5). The greatest burdens fall on low- and middle-income countries and the most disadvantaged households. Although the causal pathways and mechanisms linking CC to health outcomes have not been fully elucidated, epidemiological evidence shows that exposure from conception through adolescence increases risks of acute and chronic diseases, potentially altering lifelong health trajectories. This is plausibly driven by climate-induced disruptions in eco-agrofood systems, which compromise nutrition security and worsen malnutrition. Food systems are both vulnerable to and significant contributor to CC, and poor dietary patterns further amplify disease burdens. Addressing these intertwined challenges requires a holistic approach promoting healthy, sustainable, and equitable diets from infancy through adolescence, and employing an integrated "glocal" strategy taking into account both global and local contexts. Cross-sector collaboration and targeted pediatric research are paramount to enhance understanding of causal pathways and develop effective interventions to safeguard child health and well-being within a planetary health framework.

Complementary feeding is a critical window for child growth and long-term health. Yet, practices remain suboptimal in many low-resource settings, where undernutrition and food insecurity are prevalent and pose a significant threat to child survival and well-being. This narrative review examines the key barriers to adequate complementary feeding and explores feasible, sustainable strategies to improve its quality, with particular attention to locally available food resources. Major constraints to adherence to global complementary feeding recommendations include structural poverty; fragile agro-food and health systems; weak enabling environments; limited caregiver time, resources, and knowledge; and established socio-cultural norms. In alignment with global commitments to nutrition and climate action, sustainable complementary feeding approaches that prioritize locally produced, nutrient-dense, and safe foods offer a promising pathway to enhance nutrition while strengthening local economies and community resilience. Emerging evidence, including intervention studies, across several low-resource countries indicates that strategic combinations of traditional, affordable food resources, such as indigenous crops, insects, and products from small-scale fisheries, together with appropriate processing techniques, can improve the nutritional adequacy and acceptability of complementary foods. These approaches have demonstrated potential to support optimal growth and overall health outcomes in children aged 6–23 months. Context-sensitive, culturally aligned, and community-centered interventions, integrated with caregiver education and supported by coordinated, multisectoral, and holistic strategies, are more likely to achieve lasting and equitable improvements in child nutrition and food system resilience.

PURPOSE OF REVIEW:This review investigates protein intake in early childhood (2-5 years), with particular attention to the context of climate change. Specifically, it draws on recent evidence regarding different protein sources and their respective benefits and concerns for both human and planetary health. RECENT FINDINGS:While high protein intake, particularly from animal sources, during early childhood may contribute to excessive weight gain, both the quantity and quality of protein may shape growth trajectories and low intake of total protein or indispensable amino acids may result in growth restriction. The relevance of protein quality and amino acid composition is increasingly recognized. Plant-based and insect-derived proteins are emerging as sustainable alternatives with promising nutrient profiles, though uncertainties persist regarding digestibility, allergenicity, and long-term effects. Early childhood offers a key opportunity to introduce these proteins, yet evidence on acceptance and integration in children aged 2-5 years is still limited. Sensory preferences, food neophobia, and parental attitudes are major determinants of children's willingness to try and regularly consume alternative proteins. SUMMARY:Meeting protein needs in early childhood requires balancing developmental demands with environmental sustainability. Alternative proteins may support this transition, but their nutritional adequacy, safety, and cultural acceptability must be ensured. Personalized nutrition strategies will be essential for guiding appropriate protein choices and promoting healthy growth during this formative period.

BACKGROUND/OBJECTIVES:Feeding difficulties in childhood can persist over time, affecting health and family dynamics. Timely identification is crucial to prevent atypical eating behaviors and nutrition-related consequences. However, data on childhood feeding difficulties remain limited. This study provides the first pilot characterization of eating behaviors among Italian children aged 5-11 years in order to characterize feeding difficulties, identify protective or detrimental factors, and assess relationships with anthropometric indices or blood pressure. METHODS:In 2023, a 1-year cross-sectional pilot study was launched by the Società Italiana delle Cure Primarie Pediatriche involving child-parent dyads. Family pediatricians collected anthropometric data and blood pressure, after which parents completed an online questionnaire purposely developed for this study. The questionnaire generated a feeding difficulty score (0-10) where higher values reflected greater risk of atypical eating behaviors. Scores were categorized as follows: low risk (0-1), intermediate risk (2-6), and high risk (7-10). RESULTS:A total of 742 questionnaires were collected. Overall, 19.8% of the children were categorized as high risk (7-10) for atypical behavior, 43.8% as intermediate risk (2-6), and 36.4% as low risk (0-1). Children with two omnivorous parents showed significantly lower odds of feeding difficulty scores at or above any threshold (OR 0.46, 95% CI 0.30-0.71; p < 0.0001). Borderline associations were observed for a breastfeeding duration of at least 9 months (OR 0.79, 95% CI 0.61-1.02; p = 0.075) and baby-led weaning (OR 0.72, 95% CI 0.52-1.00; p = 0.053). High-risk children had a significantly lower BMI percentile with respect to the other groups. CONCLUSIONS:A significant proportion of Italian children aged 5-11 years exhibited moderate to severe risk of atypical behaviors. Parental eating appears to play a key role in shaping children's eating behaviors in middle childhood, underscoring the pivotal role of pediatricians in guiding families. Further research and targeted strategies are needed to prevent childhood feeding difficulties.

Importance Upper respiratory tract infections (URTIs) are prevalent in children, prompting frequent health care consultations, especially among those with fever. Probiotics show potential as an adjuvant treatment for URTIs, but evidence in children is limited. Objective To evaluate the efficacy of a probiotic mixture containing Bifidobacterium breve M-16V, Bifidobacterium lactis HN019, and Lactobacillus rhamnosus HN001 in shortening fever duration among children with URTIs. Design, Setting, and Participants This randomized clinical trial was conducted between November 19, 2021, and June 20, 2023, at the pediatric emergency department of the Ca' Granda Ospedale Maggiore Policlinico in Milan, Italy. Patients between 28 days and 4 years of age with a fever (>= 38.5 degrees C) and URTI were eligible. Exclusion criteria included recent probiotic use, chronic autoimmune diseases, immunosuppressive treatment, and requirement for hospitalization. Randomization was computer generated and assigned participants to either the intervention (probiotics) or control (placebo) group. Participants, parents or caregivers, and investigators were masked to the group assignments. The primary analysis followed the intention-to-treat approach. Interventions The probiotic group received daily single dose of 0.5 mL probiotic mixture containing Bifidobacterium breve M-16V, Bifidobacterium lactis HN019, and Lactobacillus rhamnosus HN001 for 14 days. The placebo group received daily single dose of 0.5 mL placebo for 14 days. Main Outcomes and Measures The primary outcome was fever duration, defined as the number of days between the first and the last days with fever. Results Of the 128 patients enrolled (69 males [54%]; mean [SD] age 2.5 [1.3] years), 65 (51%) were randomly assigned to receive placebo and 63 (49%) to receive probiotics. The median (IQR) fever duration was shorter in the probiotic group than the placebo group (median [IQR], 3 [2-4] days vs 5 [4-6] days; adjusted risk ratio, 0.64; 95% CI, 0.51-0.80). Few mild adverse events were reported and did not significantly differ between the probiotic and placebo groups, including constipation (6 [16%] and 6 [12%]; P = .80) and abdominal pain (3 [8%] and 2 [4%]; P = .65). Conclusions and Relevance In this randomized clinical trial, administering a probiotic mixture reduced fever duration by 2 days compared with placebo, with no meaningful safety concerns. The probiotic mixture under investigation could be an effective adjuvant for shortening fever duration in children with URTIs.

Background/Objectives: Poor nutrition in early life represents a relevant public health issue globally. The current study aimed to characterize eating habits among preschoolers and investigate the relationship with parents’ nutritional status. Methods: A secondary analysis of a cross-sectional study carried out at the Child Dentistry Clinics of the Istituto Stomatologico Italiano, Milan, Italy, including 171 patients aged 12–71 months and their parents, was conducted. Demographic data, anthropometric measurements, and information on children’s eating habits were collected. Results: The duration of exclusive breastfeeding was 5.9 (±6.8) months in 65% of children, and complementary feeding began at a mean (±SD) of 6.2 (±1.7) months in accordance with present recommendations. In contrast, the consumption of fruit juice 3.2 (±2.9) times/week, a protein intake of 3.0 (±0.6) g/kg, and a sugar intake of 20 (±8)% were over guideline limits. Overweight/obese children were introduced to cow’s milk earlier (p = 0.033) and consumed a higher percentage of total fats (p = 0.026) whilst consuming a lower percentage of carbohydrates (p = 0.050). In terms of children with both parents being obese or overweight, they consumed more carbohydrates (p = 0.048). Finally, we found that birth weight correlated positively with maternal BMI (ρ = 0.159; p < 0.05). The number of offspring correlated positively with the weekly frequency of sugar-sweetened beverage consumption before 24 months (ρ = 0.282; p < 0.001) whilst correlating negatively with the age of cow’s milk introduction (ρ = −0.226; p < 0.01). Conclusions: Our findings, according to recommendations, suggest that the prevention of obesity needs to begin in infancy. As parents play a pivotal role in establishing children’s food choices, nutritional education aimed at families is needed.

Upper respiratory tract infections (URTIs) are prevalent in children, prompting frequent health care consultations, especially among those with fever. Probiotics show potential as an adjuvant treatment for URTIs, but evidence in children is limited. To evaluate the efficacy of a probiotic mixture containing Bifidobacterium breve M-16V, Bifidobacterium lactis HN019, and Lactobacillus rhamnosus HN001 in shortening fever duration among children with URTIs. This randomized clinical trial was conducted between November 19, 2021, and June 20, 2023, at the pediatric emergency department of the Ca' Granda Ospedale Maggiore Policlinico in Milan, Italy. Patients between 28 days and 4 years of age with a fever (≥38.5 °C) and URTI were eligible. Exclusion criteria included recent probiotic use, chronic autoimmune diseases, immunosuppressive treatment, and requirement for hospitalization. Randomization was computer generated and assigned participants to either the intervention (probiotics) or control (placebo) group. Participants, parents or caregivers, and investigators were masked to the group assignments. The primary analysis followed the intention-to-treat approach. The probiotic group received daily single dose of 0.5 mL probiotic mixture containing Bifidobacterium breve M-16V, Bifidobacterium lactis HN019, and Lactobacillus rhamnosus HN001 for 14 days. The placebo group received daily single dose of 0.5 mL placebo for 14 days. The primary outcome was fever duration, defined as the number of days between the first and the last days with fever. Of the 128 patients enrolled (69 males [54%]; mean [SD] age 2.5 [1.3] years), 65 (51%) were randomly assigned to receive placebo and 63 (49%) to receive probiotics. The median (IQR) fever duration was shorter in the probiotic group than the placebo group (median [IQR], 3 [2-4] days vs 5 [4-6] days; adjusted risk ratio, 0.64; 95% CI, 0.51-0.80). Few mild adverse events were reported and did not significantly differ between the probiotic and placebo groups, including constipation (6 [16%] and 6 [12%]; P = .80) and abdominal pain (3 [8%] and 2 [4%]; P = .65). In this randomized clinical trial, administering a probiotic mixture reduced fever duration by 2 days compared with placebo, with no meaningful safety concerns. The probiotic mixture under investigation could be an effective adjuvant for shortening fever duration in children with URTIs. ClinicalTrials.gov Identifier: NCT06052540.

In July 2022, we conducted a pilot cross-sectional study, within a project funded by the United Nations International Children’s Emergency Fund, to investigate the prevalence and predictors of anemia in children aged 6–59 months living in the Ntele camp (Mozambique), created for internally displaced persons (IDPs). We analyzed blood samples for hemoglobin (Hb) and Plasmodium antigens; stool and urine for parasites. Associations between variables were assessed by performing univariate and multivariate logistic regressions. Based on the World Health Organization’s Hb cut-offs, we defined anemia (Hb < 110 g/L) as mild (Hb = 100–109 g/L), moderate (Hb = 70–99 g/L), and severe (Hb < 70 g/L). We included 245 children, 212 (83

Stunting, wasting, hidden hunger, and overweight/obesity are the main nutrition problems affecting, respectively, 149, 45, 340, and 39 million of children. Epidemiological evidence reveals that worldwide the Sustainable Development Goals to eliminate malnutrition by 2030 are far to be reached. Inadequate infant and young child feeding practices, food insecurity, poverty, and limited access to health services contribute to malnutrition, which is also affected by socioeconomic, commercial, and political factors, and occurs in an intergeneration cycle. Furthermore, child malnutrition has been challenged by the economic crisis and food- and health-system disruptions related to the COVID-19 pandemic. The existing key interventions have the potential to be further scaled up to address undernutrition and overnutrition concurrently, notably by cross-cutting education, agriculture, food systems, social safety nets, and “water, hygiene, and sanitation”. Despite their positive nutrition outcomes, data on programmes coverage and costs are still lacking. Several stakeholders are called to sustain global nutrition.

Inadequate breastfeeding and complementary feeding practices are key determinants of child malnutrition and impact one-third of the under-five mortality rate worldwide. The district of Namuno in Cabo Delgado (Mozambique) has been long registering a high prevalence of acute malnutrition. To date, no data exists about Infant and Young Child Feeding (IYCF) practices in the area. The current pilot study explores the feeding practices among children aged 0–23 months in Namuno and sets out its main drivers. This cross-sectional study was realized between August and September 2019 and drew on questionnaires for mothers/caregivers of children aged 0 to 23 months. We computed IYCF indicators and correlated them with mothers’/caregivers' school attendance, delivery setting, and distance between home and the place where livelihood activities took place (workplace), using univariate and multivariate (age-adjusted) logistic regression analysis. The survey was data derived from a sample of 632 mothers/caregivers. 62

Early childhood feeding practices are fundamental for a child’s healthy growth, development and potential [...]

The pandemics of obesity, undernutrition, and climate change represent severe threats to child health. They co-occur; interact with each other to produce sequelae at biological, psychological, or social levels; and share common underlying drivers. In this paper, we review the key issues concerning child diet and nutritional status, focusing on the interactions with climate and food systems. Inadequate infant and young child feeding practices, food insecurity, poverty, and limited access to health services are the leading causes of malnutrition across generations. Food system industrialization and globalization lead to a double burden of malnutrition, whereby undernutrition (i.e., stunting, wasting, and deficiencies in micronutrients) coexists with overweight and obesity, as well as to harmful effects on climate. Climate change and the COVID-19 pandemic are worsening child malnutrition, impacting the main underlying causes (i.e., household food security, dietary diversity, nutrient quality, and access to maternal and child health), as well as the social, economic, and political factors determining food security and nutrition (livelihoods, income, infrastructure resources, and political context). Existing interventions have the potential to be further scaled-up to concurrently address undernutrition, overnutrition, and climate change by cross-cutting education, agriculture, food systems, and social safety nets. Several stakeholders must work co-operatively to improve global sustainable nutrition.

OBJECTIVES:The primary aim of this study was to compare the immunological profiles of children affected by recurrent acute otitis media (rAOM) with and without spontaneous tympanic membrane perforation (STMP). The secondary aim was to compare immunological features of children without parameters outside the normal range and affected by either rAOM or recurrent respiratory tract infections (rRTI).METHODS:In this study, otherwise healthy children (<10 years of age) with rAOM or rRTI were included. Data on perinatal history, vaccination status, presence of risk factors for rAOM or rRTI (including personal or family history of allergy) and number of infectious episodes in the previous 12 months were retrospectively obtained. Furthermore, data on immunological profile (blood cell count, circulating IgA, IgG, IgM and total IgE, IgG subclasses and lymphocyte subpopulations) were collected. The immune profile of children affected by rAOM with and without STMP were compared. Among children with parameters within normal range, we compared the levels of the immunological parameters of children affected by rAOM (with and without STMP) and rRTI.RESULTS:The study involved a total of 751 children: 566 (75.3%) with rAOM and 185 (24.7%) with rRTI. Among the 566 children with rAOM, 39.7% had uncomplicated rAOM and 60.3% had rAOM with STMP. The mean age of the study population was 34.9 (SD 20.5) months. The frequency of children with parameters outside the normal range was similar among children with rAOM with (4.9%) and without STMP (6.1%). Among subjects without parameters outside the normal range, children with uncomplicated rAOM had significantly lower serum IgG, lymphocyte CD8+ and CD19+ and significantly higher IgG2 levels than children affected by rAOM with STMP. Finally, children with rAOM had lower levels of IgA, IgM and IgG2 and higher levels of IgG, lymphocyte CD19+ and CD16/56+ compared to children with rRTI.CONCLUSIONS:A low (<6.5%) percentage of children with rAOM with or without STMP present parameters outside the normal range. Among subjects without parameters outside the normal range, children with uncomplicated rAOM have a different immune profile as compared to those with STMP and rRTI. New prospective studies are needed to further explore the immune features of children affected by rAOM with and without STMP.