Introduction: The numbers of children and young people living with chronic conditions are rising, with many experiencing significant functional limitations and complex healthcare needs. As life expectancy improves, there is a growing need to support families in managing care at home and promoting age-appropriate self-care behaviors. Existing frameworks provide evidence that self-care is essential for maintaining health, monitoring and managing changes, as it evolves with the child's development. Few instruments comprehensively assess self-care in pediatric populations or consider the role of parents. Objective(s): To develop and initially validate an instrument designed to assess self-care behaviors in children and young people with complex chronic conditions, and the contribution of their parents across different developmental stages. Methods: This initial validation study, conducted between 2022 and 2023, included four phases: 1) scale development based on theoretical evidence; 2) content and face validation through expert interviews; 3) calculation of Content Validity Indexes; and 4) cognitive interviews for face validity. Eleven variants of the instrument were developed to tailor it to five age groups and addressed three core dimensions of self-care: maintenance, monitoring, and management. Eighty-six expert participants (healthcare providers, parents, and patients) took part in phases 2 and 3, while cognitive interviews were conducted with 5 patients and 13 parents in phase 4. Statistical analyses included Item-Content Validity Indexes and Scale-Content Validity Indexes. Results: The final instrument, with an average of 37 items per variant, showed strong content validity, with Scale-Content Validity Indexes ranging from 0.91 to 0.98 and Item-Content Validity Indexes between 0.63 and 1. Minimal item revisions were made based on experts’ feedback. The instrument demonstrated good face validity and feasibility for online administration, with completion times between 6 and 14 min. Discussion: A new comprehensive instrument that measures self-care behaviors in children and young people with complex chronic conditions and the contribution of parents was developed, considering the various developmental stages. Initial evidence supports its content and face validity. Study registration: The study was ‘not registered’ in any public registry.

Thoracic and abdominal radiographies are standard X-ray examinations often performed to diagnose a wide range of traumas and diseases. These practices inherently involve exposure to ionizing radiation which must be kept as low as reasonably achievable (based on the ALARA principle). Consequently, the optimization of imaging examinations is a critical requirement for all diagnostic practices, especially for those addressed to pediatric patients. In this work, a methodology for protocol optimization applied to young patients has been developed. The main aim is to reduce the dose delivered to patients maintaining good diagnostic image quality and investigate the strengths and weaknesses experienced during the workflow definition. The study evaluates the dose-area product (DAP) and image quality data in 12,919 abdominal and 82,873 thoracic X-ray examinations conducted in a specialized pediatric hospital. Images were acquired using direct digital radiography equipment. Analysis was performed on patients below 18 years of age. Results showed that the strategy for the protocols standardization can be applied with excellent outcomes in the clinical routine. The process can be slow and complex, particularly when applied to pediatric patients, because it requires an adequate number of examinations and organized efforts by healthcare professionals. Nevertheless, the findings demonstrated an improvement in dose standardization and radiological safety aligning with diagnostic reference levels for this vulnerable population.

Antimicrobial resistance (AMR) is a growing global threat, particularly for children under 5 years. This study is aimed to investigate temporal trends and describe the epidemiological characteristics of MDR bacteria isolated in hospitalized children from 2017 to 2023 in an academic children’s hospital in Italy. We included all bacterial isolates obtained from blood or cerebrospinal fluid (CSF) cultures collected from pediatric patients evaluated in both inpatient settings and the Emergency Department between 1 January 2017 and 31 December 2023. The study included the main ESKAPE pathogens (including Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa) and other relevant MDROs such as Escherichia coli. Data were extracted from the hospital microbiology data warehouse, and resistance proportions were calculated as MDR isolates over total isolates for each pathogen. Associations between year, patient characteristics, ward type, and MDRO infections were evaluated using univariable and multivariable logistic regression; trends over time were evaluated using the Cochrane-Armitage test for categorical variables. Out of 51,886 blood or CSF cultures, 1,528 (2.9

An outbreak of Candida viswanathii bloodstream infections in a pediatric hospital was linked to a contaminated milrinone lot. Retrospective analysis showed an 8.5% attack rate, with infection risk independently associated with longer milrinone treatment duration.

As with previous pandemics, recent research hints that suicidality may have increased after the COVID-19 outbreak among younger people. This study aimed to better understand the trend of suicidality phenomenon in relation to pandemic and to determine whether the mental profile of children and adolescents with suicidality has changed following the COVID-19 outbreak. We retrospectively compared pediatric inpatients admitted to hospital for suicidality before and after the outbreak of COVID-19 during 2017-2022 period Suicidality demonstrated an upward trend, increasing from 44% in 2017 to 67% in 2022, with an interim decline in 2019; nevertheless, the overall trajectory showed significant growth. We reported a significant increase of depressive disorders (p < 0.001) and of eating disorders (p = 0.02) after the COVID-19 outbreak. By multivariable logistic regression, we analyzed factors independently associated with suicidality upon the hospital admission after the COVID-19 outbreak. The odds of a history of self-harm increased after the COVID-19 outbreak (p < 0.001), conversely, the likelihood of family history of suicidal behaviors, neuropsychiatric disorders, and personal history of ACEs decreased by 84% (OR 0.16, p < 0.001), 57% (OR 0.43, p < 0.001), and 73% (OR 0.27, p < 0.001), respectively. The COVID-19 pandemic period was associated with nullification of pre-pandemic prevention efforts to curb the uptrend of suicidality among children and adolescents and was associated with changes in the pattern of risk factors and the mental profile of patients hospitalized for suicidality.

BACKGROUND:Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen that can be carried asymptomatically or cause invasive infections. Screening for asymptomatic carriers in healthcare settings reduces MRSA transmission and limits the burden of infections. METHODS:We calibrated an individual-based model to replicate MRSA colonization diagnoses in eight units at higher MRSA risk of an academic Italian pediatric hospital. We used the calibrated model to gain insights on transmission dynamics and on the epidemiological impact of different screening strategies. RESULTS:Under existing screening protocols, we estimated an effective reproduction number of 0.57 (95% Prediction Interval, PrI: 0.41-0.71), with highly heterogeneous transmission: 69% of carriers did not transmit MRSA, while 10% accounted for 58% of hospital-acquired colonizations. These superspreaders had significantly longer hospital stays (mean 81 days) compared to the remaining 90% (mean 30 days). Under all considered scenarios, the hospital setting remained a key reservoir and transmission hub for MRSA, given that MRSA transmission can occur repeatedly under non-outbreak conditions. Removing screening would increase the reproduction number to 1.01 (95% PrI: 0.68-1.38). Adding a biweekly screening to implemented protocols could reduce the incidence of MRSA colonizations by about 33% at the cost of a 56% increase in the number of screening tests. However, a targeted screening of patients selected by a trained machine learning classifier would achieve comparable reductions with only a 20% additional screening effort. CONCLUSION:These results suggest that targeted, risk-based screening algorithms may improve the cost-benefit of MRSA control strategies in hospitals and reduce the spillover to the community.

Cordylobia anthropophaga, commonly known as the tumbu fly, is a leading cause of cutaneous myiasis in sub-Saharan Africa. This condition is characterized by a papulopustular lesion that evolves in a painful boil-like nodule with central ulceration. Human infestations typically occur on covered body parts, due to the fly's habit of laying eggs on damp clothing. This report describes the first cluster of three pediatric cases of furuncular myiasis caused by C. anthropophaga, diagnosed at the Bambino Gesù Children's Hospital (Rome, Italy) between April 2024 and April 2025. All patients had recent travel history to endemic African regions and presented with cutaneous nodules, some accompanied by systemic signs such as fever or regional lymphadenopathy. Diagnosis was confirmed through clinical evaluation and morphological identification of the extracted larvae. Treatment consisted of occlusive therapy to facilitate larval expulsion or surgical extraction of the maggots and systemic antibiotics. One patient also exhibited a family cluster, with larval extraction from a parent. Laboratory results were largely unremarkable, consistent with localized infection. These cases highlight the growing relevance of imported myiasis in non-endemic countries like Italy, due to increased international travel and potential climate-driven changes in vector distribution. Enhanced awareness among travelers and healthcare providers, together with proactive public health measures, is crucial. By documenting these cases, we hope to contribute to the understanding of emerging parasitic diseases in non-endemic regions and reinforce the need for vigilance in this time of global environmental changes.

Background: Rapid etiological diagnosis of bacterial meningitis is crucial in children, as delays can lead to neurological sequelae. The BioFire FilmArray Meningitis/Encephalitis (ME) panel is widely used on cerebrospinal fluid (CSF), but its target spectrum may miss healthcare-associated or multidrug-resistant pathogens. We evaluated the diagnostic performance and stewardship-oriented clinical impact of off-label BioFire FilmArray Blood Culture Identification 2 (BCID2) testing on CSF from pediatric patients with suspected bacterial CNS infection and negative ME results. Methods: We retrospectively analyzed CSF samples collected between January 2023 and March 2025 at a tertiary pediatric hospital. In ME-negative cases with persistent suspicion and abnormal CSF parameters, BCID2 was performed off-label on residual CSF aliquots after routine testing, without additional sampling. We assessed pathogen detection, agreement with culture, resistance-gene identification, and documented stewardship actions. Results: Among 76 ME-negative CSF samples tested with BCID2, 23 (30.3%) were positive, all involving organisms not included in the ME panel. BCID2 was concordant with culture in 19/23 cases (82.6%); 4/23 (17.4%) were BCID2-positive/culture-negative, consistent with reduced culture sensitivity in frequently pretreated cases. Resistance genes (VIM, vanA/B, CTX-M) were detected in 30.4% of BCID2-positive samples. Overall agreement with culture was 94.7% (PPA 100%, NPA 93.0%). Escalation was documented in 13/23 episodes (56.5%), discontinuation in 2/23 (8.7%), and confirmation in 9/23 (39.1%), with no de-escalation events; clinical outcomes were not systematically available. Conclusions: In selected ME-negative pediatric cases with abnormal CSF profiles, BCID2 testing on residual CSF provided rapid, clinically meaningful microbiological information that may support antimicrobial optimization.

The recent implementation of preventive strategies against Respiratory Syncytial Virus (RSV) in infants has raised questions about potential changes in RSV seasonality and the circulation of other respiratory viruses. This study aimed to compare respiratory virus activity among paediatric patients presenting to the Bambino Gesù Children’s Hospital (Rome, Italy), with respiratory symptoms and available BioFire Respiratory Panel 2.1 plus results during September-December 2024 (N = 670) and 2025 (N = 905). RSV detection decreased significantly in December 2025 compared with the same period in 2024 (6.3

The purpose of this study is to evaluate the effectiveness and safety of an integrated antimicrobial stewardship approach in critically ill children with suspected infection admitted to a pediatric intensive care unit (PICU). The approach combined procalcitonin (PCT)-guided decision-making with serial clinical and microbiological assessment to reduce antibiotic duration. Secondary aims included evaluating additional biomarkers, such as pancreatic stone protein (PSP) and C-reactive protein (CRP) in the context of antibiotic de-escalation. This prospective observational cohort study with historical control was conducted in a tertiary PICU. PCT and pediatric Sequential Organ Failure Assessment (p-SOFA) scores were assessed at baseline, 48–72 h, and 5–7 days. Microbiological samples were obtained before initiation of empirical antibiotic therapy and repeated when clinically indicated. Antibiotic decisions were made through multidisciplinary reassessment and were based on predefined PCT thresholds integrated with microbiological findings and clinical status. PSP and CRP were measured. Fifty-three children were prospectively enrolled. Median days of therapy (DOT) were lower compared with the historical cohort (10 days [IQR 5–16] vs. 16 days [IQR 7–29]). No increase in short-term adverse outcomes was observed. Restart of intravenous antibiotics or PICU readmission within 7 days occurred in 7.1

BACKGROUND:In recent months, Bordetella pertussis has reappeared after maintaining a low rate for many years. Although pertussis is usually characterized by a favorable course, several factors can contribute to the severity of the disease, such as mixed respiratory infections. In this study, we evaluate B.pertussis cases observed in the pediatric population followed at the Bambino Gesù Children's Hospital and analyzed the potential impact of co-infections in relation to disease severity. METHODS:From January to May 2024, a total of 1,151 children and adolescents (both inpatients and outpatients) were screened for the presence of respiratory pathogens, including B.pertussis, with clinically relevant respiratory symptoms. RESULTS:Among the 1,151 patients screened, 66 tested positive for B.pertussis. Fourteen patients had respiratory failure, and six of them required intensive care unit (ICU) admission, while 52 had mild infection. 23.3% of patients had B.pertussis alone, while 76.7% had co-infections (including 5 patients admitted to the ICU). A higher co-infection rate was observed in patients with respiratory failure than in those without failure (92.9% vs. 69.0%, p-value:0.041). Rhinovirus, Metapneumovirus and Parainfluenza-virus were the most prevalent in our pediatric population. Co-infections of human bocavirus with B.pertussis were observed exclusively in patients with respiratory failure. CONCLUSIONS:Our results highlighted an increase in B.pertussis cases from January to May 2024, reaching a peak of cases in the month of May. This study shows a high rate of B.pertussis co-infection, and a trend toward association between B.pertussis and specific viruses, that might play a role in increasing disease severity.

Background/Objectives: We evaluated the efficacy of a good lifestyle intervention on the severity of metabolic dysfunction-associated steatotic liver disease (MASLD) in children with Down syndrome (DS). Methods: This retrospective longitudinal study included 31 children with Down syndrome (DS) who were affected by MASLD and attended nutritional counseling based on a nutritional approach (e.g., Mediterranean diet and antioxidant supplements), as well as physical exercise. Clinical parameters, markers of low-grade systemic inflammation, and hepatic steatosis, as assessed by ultrasound, were evaluated at baseline (T0) and after 6 months (T1). Results: Several anthropometric and biochemical parameters, including body mass index, waist circumference, diastolic and systolic blood pressure, aspartate aminotransferase, basal insulin, insulin resistance, pro-inflammatory interleukin-1β, and anti-inflammatory interleukin-10, showed significant improvement after 6 months of a nutritional approach. This study also found a regression of at least one grade of hepatic steatosis in a significant portion of patients, especially in those who received antioxidant supplements. Conclusions: Our study further supports the hypothesis that a healthy lifestyle intervention, based on adherence to the Mediterranean diet, natural supplements with antioxidant properties, and regular physical activity, can be considered a safe therapeutic approach for reducing the risk and severity of MASLD in children with DS.

AIM:To explore the phenomenon of nurse-patient's illness experience. DESIGN:A multicentre phenomenological qualitative study was conducted in Italy. METHODS:A convenience sample of nurses with an acute illness experience, requiring at least one hospitalisation of ≥ 3 days, was enrolled. Semi-structured interviews were conducted. Data were transcribed verbatim and analysed according to Giorgi's descriptive method. Ethics committee approval was obtained for this study. The COnsolidated criteria for REporting Qualitative research checklist guided the study reporting. RESULTS:Eleven interviews were conducted from August 2022 to July 2023. The essential structure 'being on the other side of the fence' and six common themes, 'role reversal', 'expanded awareness', 'professional identity', 'emotional swing', 'having experienced it on their own skin' and 'reframing the healthcare context', were identified. Nurses' awareness of the healthcare system and pathways related to their professional background at the onset of their illness experience turns into an expanded awareness of the illness experience in itself, having it 'lived on their own skin'. When nurses return from the 'other side of the fence' to their professional role this new awareness triggers a more compassionate and cognizant relationship with patients and colleagues. CONCLUSION:This study highlights the lived experience of nurses who became patients, showing characterising elements of 'being on the other side of the fence' and the potential of this experience for expanding nurses' awareness of other patients' experiences under their care. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:Nurse-patients' illness experience may be instrumental to reinforce nurses' awareness, empathy and any positive attitude or practice devised to improve patient's illness experiences and patient centred care in hospitals. PATIENT OR PUBLIC CONTRIBUTION:Nurses participated as interview respondents.

SARS-CoV-2 Omicron variant evolved into multiple sub-lineages, some showing increased transmissibility and immune evasion. Despite decreased risk of severe disease, paediatric hospitalization rose. However, factors influencing clinical outcomes remain unclear. A total of 458 whole-genome Omicron sequences from patients 0-17 years, diagnosed with SARS-CoV-2 at Bambino Gesù Children's Hospital (January-December 2023) were analysed. Clinical features, disease severity and circulating variants were assessed. Phylogenetic analysis was performed, and logistic regression identified factors associated with hospitalization. Among patients, 249 (54.4%) were male, with median age 0.6 years. Comorbidities were present in 105 (22.9%) patients, mainly immunocompromised (21.0%). Infections were predominantly from XBB (75.0%), JN.1 (12.4%), BA.5 (7.4%) and BA.2 (5.2%) clades. Upper respiratory infections predominated (73.8%), followed by asymptomatic (17.2%) and lower respiratory infections (4.6%), with nine patients having ≥ 1 co-infection. Comorbidities and lower respiratory infections were positively associated with hospitalization, while upper respiratory infections showed a negative association. Given the recent shift to RGN integrin-binding motif in Omicron sub-lineages, leading to altered pathogenesis, its presence was evaluated, revealing a predominance of RGN (N = 378, 84.6%). In conclusion, COVID-19 severity in paediatric patients was primarily driven by comorbidities and co-infections, while milder cases in healthy children may be associated with RGN integrin-binding motif.

AIM:Explore the care escalation process initiated by parents concerned about their hospitalised child's deterioration and healthcare providers' response to parental concerns. DESIGN:A qualitative study using Charmaz's constructivist grounded theory. METHODS:Participants included healthcare providers, cultural mediators and parents of children hospitalized for ≥ 3 days, who had experienced previous urgent intensive care admission or parental concern during hospitalization, in a tertiary pediatric hospital. Data were collected through focus groups, and analyzed using a grounded theory methodology with NVivo Software. RESULTS:A total of 13 parents, 7 cultural mediators and 68 healthcare providers participated in 16 focus groups. Two main categories were identified: (1) Parents navigating the uncertainty of the escalation system to get a response; (2) Healthcare providers balancing parents' concerns, their own situation awareness, escalation processes and team relations. We developed a Grounded theory called 'Parents Supporting Timely Escalation Processes' (P-STEP). By monitoring their children, parents identify early signs of deterioration and advocate for escalation. Reasons for concern are their child's behaviour, communication failure and admission on an off-service ward. Parents escalate by contacting ward providers, their child's specialist or the most trusted staff and, only selected parents, the Rapid Response Team. Staff escalate parents' concern according to their own situation awareness, parent evaluation and ward escalation practices. Parent's emotions and trust are influenced by the timeliness and type of staff response. CONCLUSION:While some parents effectively advocate for their child, others face obstacles due to unclear and lack of formal care escalation systems. Understanding how parents escalate care and healthcare providers respond is essential to identify facilitators, barriers, key stakeholders, and implement a formal system for parent-initiated escalation of care. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE:Integrating parents into processes of escalation and rapid response systems could optimise early recognition and improve responsiveness in paediatric deterioration. REPORTING METHOD:The study adheres to the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines. PATIENT OR PUBLIC CONTRIBUTION:Parents and HCPs participated as interview respondents.

BACKGROUND:Pancreatic Stone Protein (PSP) has been proposed as a sepsis biomarker, but its role in severity stratification in pediatric intensive care and its relation to infectious source have not been explored. METHODS:We conducted a retrospective analysis of 97 pediatric patients admitted to the PICU with new-onset sepsis (within 24h from diagnosis). Blood samples were collected within 24h to measure PSP levels and compared with microbiological culture results. RESULTS:Among 97 patients, PSP levels were significantly higher in those with positive blood cultures (n = 24; median 108 ng/mL) compared with negatives (n = 73; 82 ng/mL, p = 0.008). When combining blood molecular testing with cultures, PSP remained higher in positives (n = 31; 111 ng/mL) than negatives (n = 66; 85 ng/mL, p = 0.026). PSP levels also correlated with sepsis severity: Non-septic (n = 55, median 72 ng/mL), sepsis (n = 22, median 238 ng/mL), septic shock (n = 20, 375 ng/mL) (p = 0.001). Receiver operating characteristic (ROC) curve analysis showed that PSP had superior accuracy in predicting sepsis severity (AUC 0.75, 95% CI 0.64-0.87) compared with C-reactive protein (C-RP, AUC 0.54, 95% 0.37-0.64) and procalcitonin (PCT, AUC 0.60, 95% CI 0.35-0.67). CONCLUSIONS:PSP is a promising biomarker for sepsis detection and severity prediction in critically ill pediatric patients. Further studies are required to validate its integration into diagnostic protocols.

Introduction: Teleconsultation is a valuable tool for sharing clinical information among different professionals. The aim of this study was to assess the impact of teleconsultation for infectious disease management in pediatric intensive care unit (PICU), by assessing antibiotic consumption and healthcare-associated infections (HAIs), prior and after the implementation of a systematic multidisciplinary teleconsultation. Methods & Materials: The study was conducted at a PICU of IRCCS Bambino Gesù Children Hospital (OPBG) Palidoro site. Since 2024, teleconsultation with intensivists, pediatricians, nurses, pharmacist, and hygienists was conducted on weekly basis to verify antibiotic therapy and prophylaxis and suspected HAIs in patient admitted for => 24 hours.Teleconsultations were documented in patient electronic clinical records (ECRs). Demographic and clinical data were retrieved from ECRs. Antibiotic consumption stratified by antibiotic molecules (DOT/100 patient-days) and number of HAIs were compared in January-February 2023 (pre-intervention) and January-February 2024 (post-intervention). Results: Seventy-three patients were included in the study, 35 (47,9%) in pre-intervention and 38 (52,1%) in post intervention period. Patients were evenly distributed by sex (female n=37; 50.7%), had a median age of 5.1 years (IQR: 0.2–15.1) and a median length of stay of 7 days (IQR: 3.5–11). We found no significant differences in demographics and clinical characteristics by study period. We conducted 30 teleconsultations in 2024. The proportion of patients treated with at least one antibiotic was 87.7% overall, being 94.3% (33/35) in 2023 and 81.6% (31/38) in 2024 (P=0.09). The 64 patients treated with antibiotics received 125 therapies: 64 in 2023 and 61 in 2024, with an average of 1.8 and 1.6 molecules per patient, respectively (p=0.9). DOT/100 patient-days significantly decreased from 110.3 in 2023 to 91.5 in 2024 (p<0.001); DOT/100 patient-days decreased for vancomycin and teicoplanin from 3.0 and 6.6 in the pre-intervention period to 1.8 and 1.3 in the post-intervention period, respectively. We detected on HAI due to Pseudomonas aeruginosa in the pre-intervention periodo, and none in the post-intervention period. Discussion: This study documented a significant reduction in the use of antibiotics expressed as DOT/100 patient-days, suggesting that multidisciplinary teleconsultations were valuable in PICU patient infection disease management and appropriate use of antimicrobials.This preliminary analysis did not show a statistically significant reduction in the proportion of patients treated with at least one antibiotic in the two periods; the extension of the study period and a larger sample size could better investigate this issue. Conclusion: Teleconsultation contributed to reducing antibiotic consumption in PICU suggesting its effectiveness in the multidisciplinary management of PICU patients within an antimicrobial stewardship program.

BackgroundChewing is a fundamental motor activity, but there is no specific assessment tool in Italian for paediatric rehabilitation. The Karaduman Chewing Performance Scale (KCPS) is a performance-based assessment tool that allow to classify chewing performance in childhood.ObjectiveTo translate, culturally adapt and assess reliability, criterion validity and cross-cultural validity of the KCPS into Italian in a paediatric population.MethodsFollowing international guidelines, the KCPS was translated and culturally adapted into Italian. Inter-rater reliability was measured using the intraclass correlation coefficient (ICC), the criterion validity using the Pearson correlation coefficient comparing KCPS score with the Paediatric Screening-Priority Evaluation Dysphagia (PS-PED), and cross-cultural validity was examined across diagnostic groups.ResultsThe study included 165 children with a mean age of 6.33 with different health conditions, namely autism spectrum disorder, cerebral palsy and genetic syndromes. The analysis revealed that KCPS was reliable measure with a ICC 0.93, and a moderate positive linear correlation with the PS-PED (Pearson 0.48) was found. In each diagnostic group, chewing performance disorders were found, highlighting specific characteristics.ConclusionsDespite limited sample in reliability analysis and the need of exploring the relationship with chewing abilities and severity of diseases, the KCPS was found a reliable and valid tool for determining the level of chewing performance in paediatric population. Now Italian clinicians can use it with more confidence in their clinical practice and research.

Background: Anorexia nervosa is a serious eating disorder that mainly affects children and adolescents. Most patients present with extreme body dissatisfaction and an obsessive focus on body weight and food. Anorexia nervosa is a complex and multifactorial condition characterised by biological, psychological, and social factors. However, studies that have explored the cumulative risk that predisposes to anorexia nervosa are limited. This study aims to explore the potential risk factors for a severe form of the disease in patients affected by anorexia nervosa and to identify whether they may interact and reinforce each other, contributing to the severity of the disorder. Methods: For this study, we enrolled children and adolescents under 18 years of age hospitalised at IRCCS Bambino Gesù Pediatric Hospital, Rome, Italy, for anorexia nervosa from 1 December 2022 to 31 August 2024, identifying and analysing potential risk factors. Elevated shape and weight concerns were found in all patients. Psychiatric and neurodevelopment comorbidities were identified in 76 patients (51.35%), life stress events in 69 (46.62%), and a family history of eating and weight control behaviours in 39 (26.35%). Out of the sample size, 20.27% of patients did not live in a traditionally structured family. This study used the Kiddie-SADS-Present and Lifetime Version interview, the Coddington Life Events Scales, and the Trauma Symptom Checklist for Children questionnaires. Results: Patients with an extreme or severe index of anorexia nervosa are more likely to have multiple predisposing factors. In detail, four predisposing factors were found in 18.6% of patients with an extreme severity index, in 15.5% of those with a severe score, and in 10.3 and 10.6% of those with a moderate and mild score, respectively. Conclusions: Cumulative potential risk factors are more likely to be found in cases of severe course disease and patients hospitalised for anorexia. Prompt identification of predisposing factors and an effective plan of action are required to avoid a severe course disorder.