Belgian Journal of Paediatrics

Should Universal Chickenpox Vaccination Be Included in Routine Vaccination? A Critical Analysis of the Literature

Lydia Van Kesteren, Marek Wojciechowski — Tue, 01 Sep 2026 00:00:00 -0400

Background: Varicella is a well-known infectious disease caused by the varicella zoster virus. It usually is a self-limiting disease. However, severe complications requiring hospitalisation, and long-term sequelae can occur.

Methods: A critical analysis of the literature was performed to analyse arguments pro and contra universal vaccination.

Results: The currently licensed vaccines are highly effective in preventing varicella infection and the possible severe complications. They are safe with generally mild adverse effects. Cost-effectiveness studies show a benefit for the society. However, high vaccine coverage rates are needed to prevent the shift in varicella cases to older age groups. This can be achieved when administered in combination with the already established measles mumps rubella (MMR) vaccination at the age of 12 months.

Conclusion: Universal varicella vaccination is recommended if high coverage rates can be achieved.

Management of Facial Palsy in Children: A Narrative Review

Tue, 01 Sep 2026 00:00:00 -0400

Background and Objective: Facial nerve palsy in children arises from diverse aetiologies, including Bell’s palsy as well as infectious, neoplastic, and neurologic conditions. Differentiating peripheral from central causes is critical, as each entails distinct management and prognostic implications. This narrative review summarizes the diagnostic criteria and management strategies of paediatric facial palsy by comparing protocols from major reference centres and reviewing the recent literature. We present four clinical cases that underscore the importance of a multidisciplinary approach, provide practical clues for timely diagnosis, and offer key messages for the management of facial palsy. Finally, we propose a management algorithm derived from these findings.

Methods: We reviewed literature (2010–2025), reference centre protocols, and four Hôpital Universitaire de Bruxelles paediatric cases to summarize diagnosis, management, and outcomes of paediatric facial palsy, adapting adult guidelines where paediatric data were lacking.

Key Content and Findings: Paediatric facial palsy requires a systematic diagnostic and multidisciplinary approach, as both aetiology and management vary. This review covers clinical diagnosis, indications for imaging, multidisciplinary follow-up, treatment options and prognosis. Severe cases benefit from corticosteroids; antivirals are reserved for Ramsay Hunt syndrome. Neuroborreliosis should be considered in endemic areas, even with initially negative serological tests. Early ophthalmologic care and multidisciplinary follow-up are essential to prevent complications.

Conclusions: Early, thorough evaluation and a multidisciplinary approach are essential to identify underlying causes of paediatric facial palsy. Corticosteroid use remains debated and varies across centres; based on our review, we propose an algorithm to guide management.

Non-Invasive Measurement of Cortisol in Children with Adverse Childhood Experiences: A Systematic Review

Margaux Demonie, Elliot Brosens, Levi Hoste, Ann De Guchtenaere — Tue, 01 Sep 2026 00:00:00 -0400

Purpose: Adverse Childhood Experiences (ACEs) encompass various traumatic events during childhood, linked to adverse health outcomes in later life. Traditional screening methods have possible pitfalls, leading to a growing interest in the use of biomarkers.

Methods: A comprehensive literature review was conducted resulting in the inclusion of 27 studies examining biomarkers of toxic stress in children. These studies employed diverse methodologies, including hair and saliva sampling techniques, and utilized various assessment tools for childhood adversity.

Results: The studies analyzed 1,787 hair samples and 4,170 saliva samples for associations between childhood adversity and cortisol. Hair cortisol concentration (HCC) showed a robust positive correlation with cumulative adversity, while salivary cortisol measures showed a less consistent correlation to adversity.

Discussion: Age, gender and adversity influence the hypothalamic pituitary adrenal (HPA) axis. Hair cortisol emerged as a possible biomarker for chronic stress exposure, while salivary cortisol measures offered insights into acute stress responses with conflicting results. The discrepancies in findings highlight the need for further research to elucidate the complex interplay between childhood adversity and cortisol dynamics, informing targeted interventions to mitigate long-term health effects.

Incidence of and Risk Factors for Postoperative Paediatric Cerebellar Mutism Syndrome in Children with Posterior Fossa Tumours

Frances Claus, Jef Willems, Edward Baert, Barbara De Moerloose, Leen Willems — Tue, 01 Sep 2026 00:00:00 -0400

Objective Postoperative paediatric cerebellar mutism syndrome (pCMS) can occur in children after resection of a posterior fossa brain tumour. It is characterised by mutism or reduced speech and emotional lability, often with disturbances in motor and cognitive functions. This study aimed to analyse the clinical features and risk factors for pCMS in the Ghent University Hospital.

Methods Retrospective data of children treated for posterior fossa tumours in the Ghent University Hospital between 2008 and 2022 were reviewed, using the 2016 Delphi consensus definition of pCMS.

Results Twenty-two out of 69 patients (32%) developed pCMS. Motor deficits were most frequent. Dysarthria was the leading speech impairment, mutism was the primary language disorder. The most prevalent affective disorder was anxiety. Univariate analysis showed significant associations with medulloblastoma (OR 3.41; 95%CI 1.19-9.78), brain stem invasion (OR 4.76; 95%CI 1.24-18.31) and midline tumour location (OR 1.58; 95%CI 1.30-1.91). Conversely, pCMS was less frequent in pilocytic astrocytomas (OR 0.21; 95%CI 0.06-0.73) and in tumours larger than 5 cm (OR 0.08; 95%CI 0.02-0.39).

Conclusion This study highlights the clinical features and risk factors of pCMS in children treated for posterior fossa tumours. While motor deficits were most commonly reported, disorders in speech, language, and affective and cognitive function may have been underrecognised. Risk factors such as tumour type, brain stem invasion and midline location, are consistent with existing literature, whereas a “protective” effect of larger tumours might be attributed to the predominance of large pilocytic astrocytomas in this cohort.

Impact of RSV Prevention on Paediatric Patients Hospitalized for a Severe Acute Respiratory Infection (SARI): A Single Centre “Pre-Post” Cohort Study

Tue, 01 Sep 2026 00:00:00 -0400

Objective

This study aims to evaluate the impact of the first year of respiratory syncytial virus (RSV) prevention on hospitalisations for severe acute respiratory infection (SARI) in a paediatric department.

Methods

We conducted a prospective study in the paediatric department at CHU UCL Namur (Dinant site) during two consecutive RSV seasons (2023–24 and 2024–25). All paediatric patients presenting to the emergency department with acute respiratory symptoms who were subsequently hospitalised underwent a nasopharyngeal aspiration/swab for internal virological analysis and subsequent multiplex respiratory panels performed by Sciensano® (SARI sentinel hospital surveillance programme).

Results

During the 2023–24 and 2024–25 winter seasons, 215 and 191 patients were included, respectively, with 105 (49%) and 47 (25%) documented RSV infections, respectively. The proportion of nirsevimab-eligible patients testing positive decreased by 78% between the two seasons. Seven of the 48 (14.6%) patients who received prophylaxis and four of the five (80%) patients who did not received prophylaxis had an RSV infection. The median age of children testing positive for RSV increased from 7.2 months in the 2023–24 season to 20.2 months in the 2024–25 season, and the median length of stay decreased from three to two days, respectively.

Interpretation/conclusion

The implementation and reimbursement of nirsevimab significantly affected RSV-related hospitalisations when comparing pre- and post-surveillance years. A significant increase of 13 months in the median age of RSV-positive hospitalised patients and a decrease in the median length of hospital stay were also observed.

Parents’ Risk Perception of Second-hand Smoke in Children Followed Up in Paediatric Consultations at H.U.B Erasme Hospital

Gaetane de Patoul, Chloé Joris, Françoise Vermeulen — Tue, 01 Sep 2026 00:00:00 -0400

Introduction
Exposure to second-hand smoke (SHS) is associated with numerous adverse health effects in children and remains a major public health concern. Analysing parents’ risk perception of SHS can help improve interventions aimed at reducing children’s SHS-related health risks.

Methods
This study was conducted using an anonymous online questionnaire. Participants rated the children’s health risk, on a scale from 1 (no risk) to 7 (high risk), in described situations or photographs depicting an adult smoking in the presence of a child. A risk perception score (RPS) was calculated, with higher scores indicating greater perceived risk. Linear and multivariate regression analyses were performed to identify factors associated with risk perception.

Results
A total of 112 parents or legal guardians who attended paediatric consultations at the Brussels University Hospital (H.U.B) – Erasme Hospital, fully completed the questionnaire. On average, participants perceived a high risk (5/7) to the child’s health (mean RPS = 86.18/119, SD = 19.67). Participants aged 50–65 years (p = 0.01), of Caucasian ethnicity (p = 0.045), smokers (p = 0.042), and those who smoke both indoors and outdoors (p = 0.022) had a significantly lower RPS.

Conclusion
Firstly, parents should be aware that exposure occurs even in the absence of visible or perceptible signs. Secondly, measures aimed at shielding children from the harmful effects of SHS should focus on factors associated with lower risk perception. Finally, paediatricians should be encouraged to take SHS exposure into account when assessing paediatric illnesses.

Publishing in the Belgian Journal of Paediatrics: Insights from Authors and Paediatric Trainees

Levi Hoste, Vanessa Guy-Viterbo, Marieke Verhaeghe, Valentine Franeau — Tue, 01 Sep 2026 00:00:00 -0400

Background: The Belgian Journal of Paediatrics serves as a national platform for paediatric research. However, recent data suggest an imbalance in contributions between French- and Dutch-speaking universities, raising questions about linguistic and institutional disparities in publishing practices.

Objective: To explore the motivations, barriers, and institutional support related to publishing among Belgian paediatric trainees and authors of the Belgian Journal of Paediatrics, with attention to linguistic differences.

Methods: A mixed-methods online survey was distributed to paediatric trainees (2016–2025) and first authors of the Belgian Journal of Paediatrics (2016–2024). Data on motivations, publishing experiences, perceived institutional support, and language barriers were collected and analyzed descriptively.

Results: Seventy-nine trainees and thirty Belgian Journal of Paediatrics authors completed the survey. Among trainees, publication was mainly motivated by diploma requirements (71.4%) and personal initiative (47.6%), with limited institutional encouragement (43%) or support (24.1%). Writing in English was not perceived as a barrier by most respondents (83.5%); however, those who did—predominantly affiliated with French-speaking universities—reported less institutional support for writing. Encouragement and guidance were significantly more common among Dutch-speaking universities. Training in scientific writing was limited (62% untrained), though most trainees had received critical reading instruction (73.4%).

Conclusion: The findings reveal persistent disparities between linguistic communities in institutional support and language-related confidence. Strengthening mentorship and integrating academic English and writing training across universities could promote more equal participation in national scientific publishing and enhance the inclusivity of the Belgian Journal of Paediatrics.

Patient and Disease Characteristics of ADHD in Clinical Practice: A Retrospective Population-based Study in Children and Adolescents

Jana Rouquart, Eva Cloet, Ine Hoogwijs — Tue, 01 Sep 2026 00:00:00 -0400

Background: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that frequently co-occurs with various developmental, medical and psychosocial conditions. This study profiled children assessed for ADHD in a tertiary care setting.

Methods: Records of 164 children (3–18 years) assessed in 2023, resulting in 55 children suspected of and 109 diagnosed with ADHD, were retrospectively reviewed. Developmental, medical and psychosocial characteristics were analysed descriptively.

Results: Developmental coordination disorder (19.5%), learning disorders (13.4%) and language impairments (12.2%) were commonly associated. Medical comorbidities included atopic (14.6%), neurological (13.4%) and respiratory disorders (12.2%). Prematurity (21.3%) was also a notable risk factor for ADHD. Parental separation (31.1%) and family history of neurodevelopmental disorders (38.4%) were prevalent.

Conclusions: The clinical profile of children referred for ADHD assessment largely reflects patterns described in literature, underscoring the complexity of ADHD as a neurodevelopmental condition and highlighting the need for increased awareness, context-sensitive assessment and multidisciplinary collaboration.

Tuberculous Osteomyelitis with Associated Cutaneous Abscessation: A Paediatric Case Report of Extrapulmonary Tuberculosis

Fran Capitaine, Benjamin Sohier, Hannah De Houwer, Inge Roggen — Tue, 01 Sep 2026 00:00:00 -0400

Tuberculosis remains a global health concern, with children at higher risk of extrapulmonary involvement. An 8-year-old immunocompetent Eritrean girl in Belgium presented with painful ankle swelling. Imaging showed osteomyelitis and systemic calcifications. Mycobacterium tuberculosis was isolated from surgical drainage. She was diagnosed with osteomyelitis and scrofuloderma in the context of miliary tuberculosis, though a metastatic abscess could not be excluded. Tuberculosis should be considered in children from endemic regions presenting with persistent osteoarticular or cutaneous lesions to ensure early diagnosis and prevent complications.

Challenges in Diagnosing and Treating Early-Stage Streptococcal Toxic Shock Syndrome: about an Invasive Group A Streptococcal Case Report

Tue, 01 Sep 2026 00:00:00 -0400

We report the case of a 7-year-old girl with severe torticollis caused by invasive Group A Streptococcal infection (iGAS) complicated by early Streptococcal Toxic Shock Syndrome (STSS). Despite the absence of hypotension, she developed multiorgan damage. Imaging revealed multiple abscess at the base of the skull. Rapid intravenous antibiotics and supportive care led to full recovery. This case illustrates the diagnostic challenges of atypical STSS and emphasizes the importance of early recognition and treatment, particularly given the recent rise in pediatric iGAS cases across Europe following the COVID-19 pandemic.

Dynamic Monitoring and Risk Assessment of Fatigue in Survivors of Childhood Cancer

Deveny Vanrusselt — Tue, 01 Sep 2026 00:00:00 -0400

Background: Persistent fatigue is one of the most common and burdensome late effects in childhood cancer survivors (CCS), yet its mechanisms remain poorly understood.

Methods: This PhD combined longitudinal surveys, physical fitness testing, blood biomarkers, and real-time ecological momentary assessment with wearable monitoring in adolescent and young adult CCS, with comparisons to healthy controls.

Results: Fatigue was highly prevalent, multidimensional, and fluctuated markedly over time. Psychological distress, poor sleep, and reduced physical fitness were key modifiable contributors. Biomarker analyses revealed biological alterations and two distinct subgroups, underscoring fatigue heterogeneity.

Conclusion: Fatigue in CCS is a dynamic, multifactorial condition requiring systematic screening and personalized, multidisciplinary care.

Real-world Evidence from Diabetes Technology in Type 1 Diabetes: Towards Clinically Meaningful, Person-centered and Healthcare-informing Insights

Jolien De Meulemeester — Tue, 01 Sep 2026 00:00:00 -0400

Prevention: a Shared Responsibility?!

Marc Raes, Christophe Chantrain — Tue, 01 Sep 2026 00:00:00 -0400