Belgian Journal of Paediatrics

Congenital Esophageal Myofibrotic Stenosis as a Rare Cause of Progressive Vomiting and Faltering Growth in a 5 Month-old: A Case Report and Review of the Literature

Tue, 30 Dec 2025 00:00:00 -0500

Congenital oesophageal stenosis is a rare congenital anomaly of the gastro-intestinal tract characterized by a fixed narrowing of the oesophagus. Onset of symptoms such as vomiting, dysphagia and faltering growth is variable, depending on the extent of the stenosis. There is often a significant delay between first symptoms and diagnosis We report on a five month-old infant presenting with symptoms of progressive nonbilious vomiting and weight loss. The diagnosis in this case was revealed by upper gastro-intestinal endoscopy after failed attempts to place a nasogastric feeding tube.

Impact of a Protocol Change on Antibiotic Prescription for Acute Otitis Media in Children: A Retrospective Study in a Belgian Paediatric Emergency Department

Till Terrando, Thielemans Elise, Oren Cavel, Inge Roggen — Tue, 30 Dec 2025 00:00:00 -0500

Introduction:
Acute otitis media (AOM) is a major driver of antibiotic use in children, though most cases are self-limiting. In October 2023, a revised protocol was introduced to align with national antibiotic stewardship guidelines. This study evaluated the impact of the protocol change on antibiotic prescribing and identified factors associated with prescription decisions.

Methods:
We conducted a retrospective cohort study of children aged 3 months to 16 years diagnosed with AOM during two six-month periods: before (PRE) and after (POST) protocol implementation. Patients with comorbidities, prior antibiotic use, or incomplete records were excluded. Logistic regression was used to assess the effect of the protocol and clinical variables on systemic and local antibiotic use.

Results:
Of 1,868 visits, 1,669 were included (905 PRE, 764 POST). Systemic antibiotic prescriptions decreased significantly from 59.0% to 46.6% (p < 0.001). POST-period presentation was associated with lower odds of systemic antibiotic use (OR = 0.59; 95% CI: 0.43–0.81). Factors increasing systemic antibiotic use included younger age and clinical red flags. Five-day treatment courses rose from 16.2% to 45.2%, while delayed prescriptions increased modestly. Overall local antibiotic use remained stable. Older children were more likely to receive local treatment.

Conclusion:
The revised protocol significantly reduced systemic antibiotic use and encouraged shorter, more targeted treatments. Further education is needed to limit unnecessary local antibiotic use.

Autosomal Dominant Polycystic Kidney Disease. KDIGO 2025 Guideline, a Belgian Paediatric Perspective

Tessa Van der Auwera, Femke Elen, Djalila Mekahli — Tue, 30 Dec 2025 00:00:00 -0500

Autosomal dominant polycystic kidney disease (ADPKD) is traditionally viewed as an adult-onset condition. However, increasing evidence highlights a broad phenotypic and genotypic spectrum in children, including very early-onset cases. Despite the absence of curative therapies, early identification of modifiable risk factors such as arterial hypertension, proteinuria, and obesity may delay progression and improve long-term outcomes. This narrative review provides a Belgian paediatric perspective on the updated KDIGO 2025 guidelines for ADPKD. We discuss the clinical variability of paediatric ADPKD, the role of genotype in disease severity, and the emerging paediatric-specific risk stratification tools to identify children at risk of rapid progression. We further explore the benefits and considerations of screening at-risk children and offer practical recommendations for diagnosis, counselling, and early management. By raising awareness among general paediatricians, we aim to promote timely intervention and structured follow-up for affected children and their families.

Diagnostic Value of Brain MRI in Newborns with Congenital Cytomegalovirus Infection

Caroline Vande Walle — Tue, 30 Dec 2025 00:00:00 -0500

Five Easy Pieces about the Past and the Coming 30 Years

Frank Raes — Tue, 30 Dec 2025 00:00:00 -0500

Climate Change, Child Health and Children’s Rights: From Inequality to Inequity

Laura Reali, Ann De Guchtenaere — Tue, 30 Dec 2025 00:00:00 -0500

Climate change is now recognized as the most significant global threat to child health and a major driver of inequity. The UNICEF Children’s Climate Risk Index estimates that around one billion children are currently exposed to extremely high levels of climate and environmental risk, including heatwaves, air pollution, flooding, water scarcity, and vector-borne diseases. Children are biologically, developmentally, and socially more vulnerable than adults, and they will live longer into a warming world, accumulating a greater lifetime burden of exposure. At the same time, the countries where children are most at risk contribute only a small fraction of global greenhouse gas emissions, while high-emitting countries experience comparatively lower vulnerability. This mismatch between responsibility and impact exemplifies climate-related inequity and intergenerational injustice.

The 2025 Lancet Countdown confirms that children are increasingly exposed to extreme heat, air pollution, food insecurity, and climate-sensitive infectious diseases, with impacts that disproportionately affect the most vulnerable populations. These are not merely inequalities but structural inequities—avoidable and unjust differences arising from policy choices, governance gaps, and insufficient protection of children’s rights. This narrative review synthesizes evidence on: [1] the dynamics of the climate crisis and its intersection with environmental pollution; [2] health effects across the paediatric life course; [3] mechanisms underlying children’s unique vulnerability; and [4] the ways in which climate change undermines the rights set out in the UN Convention on the Rights of the Child, transforming inequalities into structural inequities. Finally, it outlines implications for paediatric practice, health systems, and climate governance, arguing that climate action must be explicitly child-centred and equity-oriented.

Protecting Children’s Health through Hospital Decarbonisation

Brecht De Tavernier, Maarten Van Laere, Isabel Verniers — Tue, 30 Dec 2025 00:00:00 -0500

World on Fire

Elisabeth LIM Duval, Eva Van Zanten — Tue, 30 Dec 2025 00:00:00 -0500

Climate change is accelerating, with rising global temperatures leading to more frequent and severe heatwaves. This manuscript aims to outline current knowledge on the impact of heat, both direct and indirect, on child health, from the prenatal period to adolescence. Children represent a particularly vulnerable group due to their physiology, developmental stage, and dependence on adults.

Direct health effects include dehydration, heat exhaustion and life-threatening heatstroke, while indirect consequences range from increased asthma exacerbations and infectious diseases to reduced learning capacity and heightened exposure to air pollution. Pregnant women exposed to extreme heat are at higher risk of adverse outcomes such as preterm birth, low birth weight, and congenital anomalies. In addition to physical illnesses, climate change can have long-term implications for neurodevelopment and the development of chronic diseases.

Paediatricians play a key role in prevention, adaptation and advocacy, both at the clinical and policy levels. Establishing heat emergency protocols, integrating environmental health education in paediatric training, and supporting mitigation strategies are essential to safeguard future generations. Addressing the paediatric dimension of climate change is not only our medical duty but also a societal imperative. In this review we aim to oversee the consequences of heat on the paediatric population in Belgium.

The Impact of Air Pollution on Children’s Health

Hanne Hendrickx, Annelies van Eyck, Kevin Lamote, Roeland Samson, Stijn Verhulst — Tue, 30 Dec 2025 00:00:00 -0500

Air pollution poses a major environmental risk to our health. Particulate matter affects more people than any other pollutant and is therefore commonly used as a proxy indicator for air pollution. Children are of particular interest, since they are uniquely vulnerable to the effects of exposure to air pollution.

Little is known about the effects of air pollution in healthy children as studies often focus on an adult or elderly population, or children with an underlying condition such as asthma. Additionally, the large variation in study design across available research leads to inconsistent results. This review will give an overview of existing studies on the effect of air pollution in children.

Overall, evidence can be found, supporting the detrimental effects of exposure to air pollution on certain health outcomes. As such, negative associations were found between both children’s respiratory health and neurocognitive functions and exposure to air pollution. Moreover, a possible link could be unveiled between endothelial dysfunction and cardiovascular, respiratory or neurocognitive effects in response to exposure to air pollution. A future challenge remains to generalize study designs as much as possible. Acute respiratory effects, neurocognitive changes or effects on endothelial function in children in relation to PM exposure are still scarcely studied in healthy children, especially based on high resolution personal monitoring data. Furthermore, there is still insufficient evidence for causal associations.

The Impact of Climate Change on the Neurodevelopment of Children: A Scoping Review

Ibtissam El Ouakili , Carolien Van brabant, Dirk van West — Tue, 30 Dec 2025 00:00:00 -0500

Objective: Climate change introduces environmental stressors that may affect the developing brain. Children are particularly vulnerable due to biological sensitivity and social exposure. This review summarizes evidence on climate-related impacts on neurodevelopment.

Methods: A scoping review was conducted focusing on four major exposures: air pollution, extreme temperatures, natural disasters, and endocrine-disrupting chemicals (EDCs). Findings across cognitive, behavioral, and neurobiological outcomes were synthesized.

Results: Air pollution is linked to structural brain alterations, disrupted functional connectivity, and higher risks of autism, ADHD, and cognitive delay. Extreme heat and cold are associated with poorer language and cognitive performance, sleep disturbances, and behavioral problems. Natural disasters influence development through prenatal stress, trauma, and unstable environments. Increased EDC exposure contributes to neuroinflammation, oxidative stress, and epigenetic changes. Socioeconomically disadvantaged children show the greatest vulnerability.

Conclusion: Climate change presents a significant risk to child neurodevelopment through interacting environmental and psychological pathways.

Infectious Diseases Threats in a Changing Climate

Tue, 30 Dec 2025 00:00:00 -0500

Background: Factors related to human activity, such as international travel, globalisation, trade, urbanisation and the disruption of ecosystems and biodiversity, have a significant impact on the epidemiology of infectious diseases. Climate change is an additional factor which often amplifies this impact. It is estimated that climate change has exacerbated over half of all infectious diseases worldwide, contributing to 60–80% of emerging infectious diseases.

Objective: The aim of this narrative review is to provide a concise overview of infectious disease threats linked to climate change, with a focus on Europe.

Methods: A literature search was conducted in PubMed using the keywords 'climate change', 'infectious diseases' and 'Europe', with results limited to publications from the last 5 years. Additional information was obtained from the websites of the European Centre for Disease Prevention and Control, the European Commission, the European Food Safety Authority, the World Health Organization, the US Centers of Disease Control and Prevention, and Google Scholar.

Results: The eco-epidemiology of existing and emerging infectious diseases in Europe is impacted by global warming, changing rainfall patterns and extreme weather events resulting from climate change, either directly or indirectly. This article reviews the risk of a new pandemic and of waterborne, foodborne, vectorborne diseases.

Conclusion: The eco-epidemiology of infectious diseases is complex and influenced by various factors, including climate change. A coordinated, multisectoral approach is required from a One Health perspective to ensure proactive preparedness.

In Our Own Backyard: An Unusual Case of Atraumatic Purpuric Rash in a School-Aged Girl

Ine I. Decuyper, Niels Horst, Sofie Stappers — Tue, 30 Dec 2025 00:00:00 -0500

The Health of the Earth and Human Health Are Inextricably Linked (Pierre Rabhi)

Christophe Chantrain, Marc Raes — Tue, 30 Dec 2025 00:00:00 -0500

Guest Editors' Editorial

Elisabeth LIM Duval, Marek Wojciechowski — Tue, 30 Dec 2025 00:00:00 -0500