Belgian Journal of Paediatrics

A Qualitative Study to Investigate the Parental Perspectives on Children with Bedwetting

Laura Noppe, Jaan Toelen, Stéphanie De Rechter — Mon, 03 Nov 2025 00:00:00 -0500

Objective:

Nocturnal enuresis (NE) is a common condition in children. It is clinically defined as the involuntary urination of children aged five years or older, occurring at least twice per week over the past three months, in the absence of an identifiable somatic cause. NE affects not only the child with the condition, but also their wider environment and the well-being of their parents. This qualitative study aims to examine the repercussions of NE for parents and identify the specific daily life challenges they face as a result of their child's condition.

Methodology:

We conducted semi-structured interviews with parents of children experiencing NE. Participants were recruited after providing informed consent following paediatric nephrology consultations at University Hospitals Leuven or Regional Hospital Heilig Hart Leuven, both of which are located in Flanders, Belgium.

Results:

The study included interviews with 11 parents of children aged between 6 and 13 years old. Of these children, 64% were boys (n = 7) and 36% were girls (n = 4). Parents identified the impact of bedwetting on their children across three key domains: emotional well-being, social interactions and triggering factors. Furthermore, the effects on parents were categorised into five dimensions: parental concerns; the parent–child relationship; family dynamics; advice for other parents; and the influence of societal taboos.

Conclusion:

NE can affect various aspects of life for both children and their parents, potentially impacting their overall quality of life. It is therefore crucial for healthcare providers to openly discuss this issue to deliver comprehensive, holistic care.

COVID-19 Lockdown and its Effects on Pediatric Oral Ingestions with Toxic Substances: A Retrospective Study of the Belgian Poison Center Reports

Dorian Deroo, Jonas Van Baelen, Jaan Toelen — Mon, 03 Nov 2025 00:00:00 -0500

Background: The COVID-19 lockdown led to significant changes in household behaviors, including an increase in the use of disinfectants, hand sanitizers, and cleaning agents, potentially raising pediatric intoxication risks. This study examines the impact of lockdown measures on oral exposures to toxic products in children reported to the Belgian Poison Center.

Methods: A retrospective analysis was conducted on pediatric cases of oral ingestion with hand sanitizers, bleach, detergents, or medicines reported during the first lockdown (March –May 2020) and compared to the same period in 2019, 2021, and 2022. Descriptive and comparative statistical analyses evaluated frequency, characteristics, and trends in exposure cases.

Results: A total of 2604 cases were reported during the 2020 lockdown. Compared to 2019, exposures to hand sanitizers increased by 329%, with continued elevated numbers following years. Bleach and detergent exposures increased by 163% and 30% respectively. Medicine-related cases decreased by 14%. Young children, particularly those under six, accounted for over 75% of cases, with a significant overrepresentation of exposures among 2–6-year-olds. Adolescent cases were significantly underrepresented. Cases in educational institutions and hospitals decreased and were significantly underrepresented. Referrals to emergency departments decreased, with non-referrals increasing correspondingly.

Conclusion: The lockdown period saw a marked increase in pediatric oral ingestions to hand sanitizers and household chemicals, highlighting the unintended consequences of the public health measures on child safety. These findings underscore the need for targeted public health interventions, including public awareness campaigns and stricter product safety regulations, to mitigate pediatric poisoning risks during future public health emergencies.

Effectiveness of the Buzzy Device in Managing Needle Pain in Children: A Systematic Review.

Mon, 03 Nov 2025 00:00:00 -0500

Background:

Needle procedures often cause pain and anxiety in children, highlighting the necessity for effective pain management strategies. This systematic review aimed to evaluate the effectiveness of the Buzzy® device, a non-pharmacological intervention combining cold and vibration, in managing paediatric needle pain using a standardized pain assessment tool.

Methods:

A systematic search was conducted in December 2024 using PubMed, CINAHL, Embase, and Google Scholar databases to identify randomized controlled trials. Inclusion criteria were studies involving children aged 2–18 years undergoing needle-related procedures, employing the Faces Pain Scale-Revised (FPS-R), and comparing the Buzzy® device against control groups or alternative interventions such as topical anesthetics, distraction techniques, or other non-pharmacological methods. Study quality was assessed using the Risk of Bias 2 (RoB 2) tool.

Results:

8 RCTs comprising 1.569 pediatric participants were included. Studies consistently demonstrated significant pain reduction with Buzzy® compared to no intervention. Comparisons with topical anesthetics showed mixed results: Buzzy® provided rapid analgesia advantageous in emergency settings but was commonly less effective in pain reduction than topical anesthetics like EMLA cream. Buzzy® persistently outperformed other non-pharmacological methods, such as ShotBlocker® and DistrACTION® Cards, and was most effective when combined with distraction techniques. Risk of bias was moderate across studies, primarily due to the inability to blind participants and practitioners.

Conclusion:

Our work provides nuanced support for the claim that the Buzzy® effectively reduces needle-related procedural pain in children, particularly in acute clinical settings where a rapid onset of analgesia is required. Further research employing standardised methodologies is recommended to strengthen the evidence base for multimodal paediatric pain management strategies.

Clinical Outcomes of Belgian Children Following Kidney Transplantation, Comparative Analysis from 2005 to 2022

Mon, 03 Nov 2025 00:00:00 -0500

The aim of this study was to analyze the annual cross-sectional data on the outcome of all patients followed after pediatric kidney transplantation in Belgium, as collected for the Convention of Pediatric Nephrology from 2018-2022. During this period, a total of 569 entries of individual follow-up data were included in the registry with a mean of 113.8 entries annually, mean follow-up time was 5.6 years post-transplantation. Most patients were classified as having chronic kidney disease (CKD) stage 2 or 3 (36.4% and 41.3% respectively). The mean estimated glomerular filtration rate (eGFR) was lower compared to the 2005 cohort (61.8 + 25.4 ml/min/1.73 m²vs. 68.1 + 17 ml/min/1.73 m², respectively (p<0.05)). eGFR decreased with the number of years of follow-up, which was particularly evident in boys but not in girls. We compared our findings to the Belgian registry cohort of 2005 and to the recently published data from North-American and European registries. Overall, we observed a positive evolution in growth and cardiovascular outcomes, with mean height and blood pressure standard deviation scores (SDS) significantly improving compared to both the 2005 and the international cohorts.

Diagnostic Challenges and Novel Insights in Kawasaki Disease, a Case Report

Rik Muskens, Marlies Potoms — Mon, 03 Nov 2025 00:00:00 -0500

This report highlights the case of a 3-year-old girl with Kawasaki disease and concurrent Mycoplasma pneumoniae infection. Treatment with intravenous immunoglobulin, high-dose aspirin and corticosteroids led to clinical remission and resolution of cardiac abnormalities. This case highlights the need for timely recognition of KD and co-infection, and stresses the role of early, tailored management in preventing serious complications. Co-infection, pathophysiological hypotheses and pharmacogenetics are briefly explored.

Nasal Dermoid Sinus Cyst in a 17-Year-Old Female: A Case Report

Anna Driesen, Jeroen Romeijn — Mon, 03 Nov 2025 00:00:00 -0500

Introduction: Nasal dermoid sinus cysts are rare congenital anomalies that account for 1% of dermoid cysts. They typically present as midline nasal lesions and may involve intracranial structures.

Observation: A 17-year-old female presented with a congenital midline nasal bridge nodule, which became noticeable during adolescence due to coarse dark hairs. Clinical examination revealed a well-defined nodule with a hyperpigmented patch inferiorly. MRI confirmed the absence of intracranial extension. The lesion was surgically excised, resulting in satisfactory cosmetic and functional outcomes.

Conclusion: This case highlights the importance of including nasal dermoid sinus cysts in the differential diagnosis of midline nasal lesions. Imaging is essential for preoperative planning to assess intracranial involvement and guide safe surgical management.

An Unusual Skin Reaction after Bexsero® Vaccination in a Paediatric Patient: A Case Report

Mon, 03 Nov 2025 00:00:00 -0500

Bexsero® is a multicomponent vaccine protecting against Neisseria meningitidis serogroup B, a major cause of meningococcal disease. Common side effects include injection site reactions (pain, redness, swelling) and systemic symptoms (fever, irritability, fatigue), while rarer complications like febrile seizures and Kawasaki disease occur in less than 1%. This case report describes a previously undocumented reaction in a twelve-week-old infant who developed immediate pale spots on the leg after vaccination, later progressing to a necrotic lesion. Possible hypotheses, including an immune response, intra-arterial injection with embolization, and vasospasm, are discussed.

NONO-Associated Syndrome: A Rare Case Report in a 2-Month-Old Belgian Male Infant

Vincent Catinus, Gladys Battisti , Anna Bruscaglia — Mon, 03 Nov 2025 00:00:00 -0500

We report the first Belgian case of NONO-associated syndrome, which was identified in a male infant presenting with hypotonia, macrocephaly, dysmorphic features, and severe non-compaction cardiomyopathy. A likely pathogenic NONO variant was identified through whole exome sequencing. While cardiac monitoring was guided by clinical findings, the genetic diagnosis allowed for personalised care and counselling. This case highlights the importance of combining phenotype recognition with molecular testing for early diagnosis. Continued case reporting is essential to improve our understanding of this rare X-linked disorder, and to guide future management and family planning strategies.

Don’t Forget the Forgotten Disease: Lemierre Syndrome. Case Report

Elise Nauwynck, Hanne Vermeulen, Anton Martens, Siel Daelemans — Mon, 03 Nov 2025 00:00:00 -0500

We present the case of a three-year-old boy with Lemierre syndrome. He presented with the typical symptoms of an oropharyngeal infection, followed by bacteraemia and thrombophlebitis of the internal jugular vein. However, the infection was atypically caused by Group A Streptococcus. The patient underwent surgical drainage of the abscess and received intravenous antibiotics and subsequently anticoagulation therapy. This case report highlights the importance of early recognition and initiatiniation of appropriate antibiotics with coverage for both gram-positive and anaerobic bacteria to prevent adverse outcomes. The indications for anticoagulation therapy in paediatric patients remain controversial, but in general, it should only be administered if the thrombus involves critical areas or if septic emboli occur or the thrombus progresses despite antibiotic therapy.

Syndromic Meningoencephalitis Panels - Multiplex PCR : the Limits of an Innovative Tool

Mon, 03 Nov 2025 00:00:00 -0500

The main challenge in a clinical presentation of meningoencephalitis lies in the early detection of a pathogens in the cerebrospinal fluid. Owing to their rapid results and imperviousness to prior antibiotic use, syndromic panels using multiplex PCR have emerged as an innovative tool for the etiological diagnosis of meningoencephalitis.

However, this test presents limitations, as illustrated by two patient cases, one questionable and the other strongly suggestive of likely false-positive result for Haemophilus influenzae on multiplex PCR.
This case report highlights the importance of interpreting the results provided by this technique by integrating the patient's clinical and biological data.

Mycoplasma Pneumoniae Associated Reactive Infectious Mucocutaneous Eruption (RIME). Case Report

Céline De Cuyper, Elke De Wachter, Martine Grosber — Mon, 03 Nov 2025 00:00:00 -0500

Mycoplasma pneumoniae is a well-known cause of community-acquired pneumonia. In a subset of patients, it causes mucocutaneous eruptions with prominent mucositis, termed as “Mycoplasma pneumoniae induced rash and mucositis” (MIRM). Recently, “Reactive infectious mucocutaneous eruption” (RIME) has been proposed as the umbrella term for MIRM as other pathogens than Mycoplasma species can cause rash and mucositis. In this report, we describe a case of M. pneumonia-associated RIME. This article is intended to raise disease awareness and provide diagnostic tools for differentiating M. pneumoniae-associated RIME from other, more severe mucocutaneous diseases.

A Novel X-linked AVPR2 Variant in Congenital Nephrogenic Diabetes Insipidus. Case Report

Mon, 03 Nov 2025 00:00:00 -0500

Congenital nephrogenic diabetes insipidus (NDI) is a rare hereditary renal disorder caused by variants in the arginine vasopressin receptor 2 (AVPR2) or aquaporin 2 (AQP2) genes, resulting in the kidney’s inability to concentrate urine.
We report the case of a 52-day-old boy presenting with feeding difficulties and poor weight gain. Laboratory findings revealed hypernatremia and hyperchloremia, associated with a marked disparity between high serum osmolality and low urine osmolality. Genetic analysis identified a novel missense variant in the AVPR2 gene. The therapeutic approach consisted of nasogastric free water supplementation and oral hydrochlorothiazide therapy, with good clinical response.
This case highlights the importance of early recognition and genetic testing in infants with suspected diabetes insipidus and expands the phenotypic spectrum of AVPR2-related NDI.

Kingella kingae Bacteremia: A Case Series

Lieselotte Wijnants, Inge Van Wambeke, Kaatje Van Aerschot — Mon, 03 Nov 2025 00:00:00 -0500

Background

Up to the early 1990s, when culture techniques and molecular detection methods were developing, Kingella kingae was considered a rare bacterium in the human body. Meanwhile, K. kingae is regarded as a prime etiology of skeletal system infections in children between 6-48 months.

In this case report, we will discuss three distinct cases of K. kingae bacteremia in young children.

Cases

Despite their different presentations, the three cases were unified by the common finding of a respiratory tract infection along the course of their illness. The severity of the disease varied among the cases; going from a mild upper airway infection to a septic child, however, antibiotic therapy, whether administered intravenously or otherwise, was consistently selected in all three instances, yielding favorable outcomes.

Conclusion

Kingella kingae is well known to cause septic arthritis. Other types of presentation are less well known and probably under-reported, as we will demonstrate here. It is therefore important to recognize these clinical courses and respond promptly with appropriate treatment for the patient. After all, there is always a risk of secondary endocarditis and osteomyelitis. However, the bacteriological identification of K. kingae can be challenging. Proper interpretation of blood cultures or utilization of genetic testing is therefore critical..

E-Cigarette or Vaping-Associated Pneumomediastinum: A Case Report and Pathophysiological Explanation

Sarah Bisschop, Lisette Veling — Mon, 03 Nov 2025 00:00:00 -0500

We report the case of a 16-year-old male who presented to the emergency room with chest pain, fever and shortness of breath. Upon physical examination Hamman’s sign was positive. The patient was diagnosed with spontaneous pneumomediastinum, most probably caused by e-cigarette use and/or asthma exacerbation. He was treated with nebulizations with salbutamol, corticosteroids and antibiotics and made a full recovery.

This case adds to the evidence of e-cigarette or vaping-associated pneumomediastinum in adolescents. We identified three mechanisms by which vaping can cause pneumomediastinum: the act of smoking itself, through alveolar damage as part of e-cigarette or vaping product use-associated lung injury or, in a secondary way, by triggering an asthma exacerbation.

This case highlights the importance for pediatricians to ask about the use of e-cigarettes in adolescents presenting with chest pain, gastro-intestinal, constitutional and/or respiratory complaints. It also shows that we must educate our patients about the risks of e-cigarette use whenever the opportunity is there. Spontaneous pneumomediastinum should be considered in the differential diagnosis of adolescents with chest pain who use e-cigarettes.

Top 10 Guidelines for Following up a Person with Epilepsy

Mon, 03 Nov 2025 00:00:00 -0500

The “Vlaams Netwerk Zeldzame Ziektes / Epilepsy (VNZZ)” has in recent years worked on a number of guidelines that can be used in the follow-up of a person with new or already known epilepsy. The VNZZ/epilepsy consists of representatives of first (Domus Medica), second (regional hospitals) and third line (university centres and epilepsy centres), with also members of the Flemish Epilepsy League and patient associations (RadiOrg, Ikaros). The guidelines should improve the cooperation between the different lines in medical care, so that every person with epilepsy can be followed correctly by the general practitioner, paediatrician and (paediatric) neurologist. It will also allow the difficult-to-treat patient to be referred adequately and quickly enough to the more specialised third line, for expert diagnosis and treatment. Although these guidelines are made both for children and adults with epilepsy, we believe also the paediatrician can benefit from the insights more specifically relevant for adults.

Protecting Every Child: A Global Call for Action amid Humanitarian Crises

Ann De Guchtenaere, Amber van Baele, Maarten Buytaert — Mon, 03 Nov 2025 00:00:00 -0500

Children In Conflict Zones: Nothing But Victims

Christophe Chantrain, Marc Raes — Mon, 03 Nov 2025 00:00:00 -0500