Paediatria Croatica is a quarterly medical journal focused on publishing original research, case reports and review articles in pediatrics. With an open-access model and indexed in Scopus and Embase, it aims to reach healthcare professionals globally. The journal promotes collaboration and exchange of ideas among professionals and accepts manuscripts in Croatian or English. Rigorous peer review ensures scientific accuracy and reliability, covering a wide range of pediatric topics, from neonatal care to adolescent health.
Klinika za dječje bolesti Zagreb/Children's Hospital Zagreb
By publishing in Paediatria Croatica, authors retain the copyright to their work and grant others the right to use, reproduce, and share their research articles in accordance with the Creative Commons Attribution License (CC BY 4.0), which allows others to distribute and build upon the work as long as they credit the author for the original creation.
Most common causes of short stature in children
Correct linear growth is a characteristic of a healthy child. Any deviation from the normal/expected growth for an individual is a signal that something is happening. A child with short stature has a current height below the 3rd percentile on the growth curve or below 2.0 SDS for their gender and current age. It should be investigated, and the cause of stunted growth determined. Physiological short stature is the most common, presenting as constitutional growth retardation and the so-called familial short stature. However, it can also be pathologically short stature, caused by non-endocrine (chronic diseases of the blood, kidneys, heart, etc., malnutrition, inherited metabolic diseases, syndromes) and endocrinological (growth hormone deficiency, hypothyroidism, multiple hormone deficiencies, idiopathic short stature, etc.) causes. Children born small for gestational age (SGA) also belong to a special category. Using advanced molecular diagnostic techniques, many pathogenic variants in genes are now known to be associated with isolated short stature in individuals or families. Short stature can be proportional and disproportionate, depending on the child's body structure. Adequate monitoring of growth during childhood, an early assessment of short stature, detection of the causes of its occurrence, and timely treatment can prevent short adult height.
Growth Disorders; Growth Hormone; Gestational Age; Natriuretic Peptide, C-Type; Molecular Diagnostic Techniques
Copyright (c) 2026 Aleksandra Jančevska https://creativecommons.org/licenses/by/4.0
Management of a newborn infant of a mother colonized with Streptococcus agalactiae (GBS)
Neonatal sepsis remains one of the leading causes of morbidity and mortality in the neonatal period, despite significant advances in perinatal care. Streptococcus agalactiae (GBS) remains the most common cause of early-onset sepsis (EOS). Timely identification of pregnant women colonized with GBS and adequate intrapartum antibiotic prophylaxis (IAP) are key measures in the prevention of EOS. This article reviews the epidemiology, risk factors, preventive strategies, and contemporary approaches to the risk assessment and management of newborns whose mothers are colonized with GBS.
Infant, Newborn; Sepsis; Streptococcus agalactiae
Copyright (c) 2026 Branimir Peter, Jelena Mažibrada Spasojević https://creativecommons.org/licenses/by/4.0
How to care for a child with type 1 diabetes mellitus during an acute illness
Diabetes mellitus type 1 (DM1) is an autoimmune disease that results in the loss of endogenous insulin production. The treatment paradigm for DM1 has changed significantly in recent years, and the use of new technologies, including real-time continuous glucose monitoring and insulin pumps, has provided significantly better disease control. Despite this, the care of children and adolescents during acute illness remains a major burden for parents and children, but also for healthcare professionals. Most often, glucose levels increase during acute illness, but in most cases, ketone levels also increase. In contrast, acute gastrointestinal illnesses (diarrhea and vomiting) can lower glucose levels with an increased risk of hypoglycemia. The aim of this review article is to present new insights into the treatment and management of acute illnesses in pediatric patients with DM1.
Diabetes Mellitus, Type 1; Acute Disease; Child; Adolescent
Copyright (c) 2026 Marko Šimunović https://creativecommons.org/licenses/by/4.0
Respiratory distress (respiratory distress syndrome) is the most common condition for which newborns are admitted to the neonatal intensive care unit. The appropriate choice of respiratory support can significantly affect the survival of newborns, as well as the development of long-term consequences. In most cases, non-invasive respiratory support is sufficient for an optimal outcome. The choice of the best method of non-invasive ventilation (NIV) depends mostly on the gestational age and birth weight of the newborn, but also on the experience of the medical team. The review presents recommendations for optimal management of newborns of different maturity with different severity of respiratory distress. Continuous positive airway pressure (CPAP) remains the best method of NIV, but in premature infants with GD 28 weeks and more, it has almost no advantages over high-flow nasal cannula (HFNC). A large proportion of very small premature infants still require the use of surfactant. If it needs to be given, it must be done as early as possible for the optimal effect. Despite the existence of clear guidelines for ventilating infants with RDS, as well as for administering surfactant, clinical judgment and team experience are often paramount.
Respiratory Distress Syndrome; Infant, Premature; Noninvasive Ventilation; Continuous Positive Airway Pressure; Surface-Active Agents
Copyright (c) 2026 Vesna Milas, Diana Turjak, Krešimir Milas https://creativecommons.org/licenses/by/4.0
Dr. Vera Bekavac - Škarica was the first paediatrician in Split and Dalmatia. After completing her specialisation in 1926, she began working at the Civil Hospital in Split and became the head of the foundling home, marking the beginning of organised paediatric care in the city. Foundling homes were the forerunners of today’s children’s wards and hospitals. These institutions were intended for the admission and care of abandoned children, primarily newborns. Through the gradual reorganization of the foundling home into a separate pavilion of the Civil Hospital in Split, Dr. Vera Bekavac - Škarica established the first Children’s Department in Dalmatia in 1934. The department had 15 beds for infants and young children. In July 1946, the department was relocated to the new hospital at Firule, where it remains to this day. The department gradually developed organizationally, professionally, and in terms of staffing, and in 1987, it became the Clinic for Paediatrics. After the Second World War, outpatient care and treatment of children in Split were provided at the Health Centre, specifically in the Children’s Dispensary and the School Polyclinic. Today, outpatient paediatric services are carried out by paediatricians either as employees of the Health Centre or as private practitioners under lease, in private paediatric polyclinics, and by paediatricians working in other private healthcare institutions. School medicine operates as a preventive service within the Teaching Institute of Public Health.
Copyright (c) 2026 Vjekoslav Krželj https://creativecommons.org/licenses/by/4.0
Thyrotoxicosis is a clinical condition that occurs solely as a result of elevated serum concentrations of thyroid hormones. Hyperthyroidism is defined as a condition of elevated serum concentrations of thyroid hormones due to increased function, increased production, and secretion of the hormones triiodothyronine (T3) and thyroxine (T4). Any hyperthyroidism also means thyrotoxicosis, while not all thyrotoxicosis is a consequence of hyperthyroidism. Thyrotoxicosis is caused by different etiologic factors and is manifested by various clinical signs of hypermetabolism. An appropriate therapeutic approach demands prompt and correct diagnosis and depends on the cause and condition of the patient. This article presents a clinical review of thyrotoxicosis treatment based on clinically acquired data. We searched the literature on PubMed and other published materials. Clinical description includes initial evaluation and approach to thyrotoxicosis; subclinical hyperthyroidism/thyrotoxicosis; Hashimoto’s and Graves’ disease, and approach to Graves’ hyperthyroidism, including antithyroid drugs, radioactive iodine, and surgical treatment. Many recommendations and conclusions have been drawn on the basis of clinical data on the rational, safe, and optimal medical approach to patients with thyrotoxicosis. Choosing treatment for Graves’ disease is a complex process. Discussing the advantages and risks of recommended therapies with patients and parents is desirable. It is necessary to encourage parents of Graves’ disease patients with a minor chance of remission to make a quick decision on definitive care.
Thyrotoxicosis; Graves Disease; Hashimoto Disease; Antithyroid Agents; Thyroidectomy; Iodine Radioisotopes
Copyright (c) 2026 Veselin Škrabić https://creativecommons.org/licenses/by/4.0
Neurorehabilitation in the age of artificial intelligence
Aim: The aim of this paper is to present the integration of artificial intelligence (AI) into contemporary neurorehabilitation and to analyze its potential in improving assessment, treatment planning, and outcome monitoring in patients with neurological impairments. Methods: A review of current AI-based technologies is presented, including machine learning algorithms, robot-assisted therapy, biofeedback systems, and digital motor function tracking. Personalized rehabilitation models based on large datasets and predictive analytics are discussed. Special emphasis is placed on clinical applicability, ethical considerations, and interdisciplinary collaboration in AI implementation. Results: AI integration enables more precise quantification of motor performance, objective progress monitoring, and real-time adaptation of therapeutic protocols. Predictive models facilitate early identification of recovery potential and optimization of rehabilitation duration. Robotic and sensor-based systems increase therapy intensity and repetition, potentially enhancing neuroplastic processes. Challenges include data standardization, privacy protection, and professional training requirements. Conclusions: Artificial intelligence represents a major advancement toward personalized and data-driven neurorehabilitation. Its application is not intended to replace clinical judgment but to complement it with objective and measurable parameters, ultimately improving rehabilitation effectiveness and quality of care in patients with neurological disorders.
Neurological Rehabilitation; Artificial Intelligence; Motor Activity; Machine Learning; Rehabilitation
Copyright (c) 2026 Anamarija Soldo Koruga https://creativecommons.org/licenses/by/4.0
What is it like to be a parent in the digital age?
The digital age hasn’t just changed children; it has changed the structure of families. Today, we often talk about the impact of screens on brain development, attention, speech, and sleep. We talk about dopamine, the prefrontal cortex, and neuroplasticity, and it is absolutely true how important all of that is. But while we analyze children’s brains, we rarely ask ourselves — what is the state of the parents’ nervous systems? Parents today are raising children in an era of constant availability. Working hours don’t end at 4 p.m., notifications don’t stop, and WhatsApp groups never sleep. There is more information than ever, and the sense of safety is decreasing. Parents know the recommendations. They know how much screen time a child “should” have. They know that blue light affects sleep. And despite this knowledge, they often feel as though they are losing control and giving in. In many families, the screen is not a symbol of carelessness, but a regulator — an attempt to survive a day that lasts too long without a break. We live in an attention economy in which digital platforms are designed to be addictive for both children and adults. We cannot talk about children’s self-regulation while ignoring the fact that parents live in the same dopamine loop. Children do not buy mobile phones; we give them to them. And the reason for this is often fatigue, not carelessness or indifference. Parenting in the digital age is therefore not just a neurobiological challenge. It is also a psychological challenge shaped by shame. Parents seek help with the feeling that they have already made an irreparable mistake. Between professional guidelines, media warnings, and idealized images of parenting, many feel inadequate and do not know where to begin. Collective change is needed — and that can feel almost impossible. If we want to talk about children’s mental health, we also have to talk about the mental health of parents. About exhaustion, lack of support, and the realities of everyday life. Digitalization is a family phenomenon, not an individual problem of one child. The digital age is not going away. But we can decide whether we will be each other’s judges — or each other’s allies.
Digital Technology; Child; Parenting; Family
Copyright (c) 2026 Sonja Švajhler https://creativecommons.org/licenses/by/4.0
Hypothyroidism is a condition of decreased thyroid activity caused by a deficiency of thyroid hormones. There are two main hormones synthesized by the thyroid gland: triiodothyronine (T3) and thyroxine (T4), or their free fractions (FT3 and FT4). Their secretion is regulated by the level of thyroid-stimulating hormone (TSH) secreted by the anterior pituitary gland. Elevated TSH levels indicate reduced production of T3 and T4, or primary hypothyroidism. Thyroid hormones are responsible for regulating metabolic functions in the body by stimulating the synthesis of proteins, carbohydrates, and lipids, vitamin metabolism, and the activity of enzyme systems and growth factors. Thyroid hormones stimulate the growth of the child, and their role in the growth and development of the central nervous system is particularly important, given that a lack of thyroid hormones in the fetal period leads to irreversible damage to the neurocognitive functions of the brain. Thyroid disorders are the most common endocrinopathies of childhood. Hypothyroidism can be present at birth (congenital) or develop later (acquired hypothyroidism). The most common cause of congenital hypothyroidism is thyroid dysgenesis (about 85 %), while dyshormonogenesis is present in about 15 %. Newborn screening allows for early detection of the disease. Globally, the most common cause of acquired hypothyroidism is iodine deficiency; however, in developed countries, it is chronic autoimmune thyroiditis (Hashimoto thyroiditis). Central hypothyroidism is rare and may be associated with a deficiency of other pituitary hormones. Congenital hypothyroidism requires early replacement therapy with thyroxine to prevent possible neurocognitive damage. In children with acquired hypothyroidism, it is also necessary to introduce thyroxine replacement therapy to enable normal growth and development, as well as neurocognitive development. The goal of therapy is to maintain TSH < 5 mIU/l and FT4 (or T4) in the upper half of normal values, while eliminating all symptoms and signs related to hypothyroidism.
Hypothyroidism; Child; Congenital Hypothyroidism; Thyroiditis, Autoimmune; Thyroxine
Copyright (c) 2026 Srećko Severinski https://creativecommons.org/licenses/by/4.0
Risk behaviors of children and adolescents: Can strengths and difficulties in behavior explain the use of tobacco, alcohol, and marijuana?
Aim: Substance use during adolescence represents a significant public health challenge, making systematic monitoring and a better understanding of risk and protective factors essential for the development of effective prevention and intervention strategies. The aim of this study was to explain alcohol, tobacco, and marijuana use among adolescents through strengths and difficulties in behavior. Methods: A cross-sectional study was conducted in 2024 among upper-grade primary school students and secondary school students. Using stratified sampling, 925 students were included, with a mean age of 15.4 years (range 13–19 years), included 57.9 % boys (N = 536) and 42.1 % girls (N = 389). Results: Three hierarchical regression analyses were conducted. Tobacco, alcohol, and marijuana use were consistently associated with older age and more frequent behavioral problems, while male gender was associated with tobacco and alcohol use. Specifically, higher levels of hyperactivity/inattention were associated with more frequent cigarette smoking, whereas lower emotional competence was associated only with more frequent marijuana use. Contrary to expectations, prosocial behavior was positively associated with tobacco and marijuana use. Conclusions: These findings clearly indicate that substance use is associated with behavioral difficulties, while associations with strengths are more limited. Future efforts aimed at reducing the frequency of substance use should incorporate the identified risk and protective factors as part of a broader preventive approach. The results highlight the need for a more detailed conceptual clarification of prosocial behavior in adolescence and its role in substance use.
Konzumacija duhana; Pijenje alkohola; Kanabis; Adolescent; Problematično ponašanje
Copyright (c) 2026 Roberta Matković https://creativecommons.org/licenses/by/4.0
When we talk about ataxia, we mostly think of gait instability, or cerebellar ataxia. However, ataxia is manifested not only by instability in walking, but also by abnormal eye movements, dysmetria, dysdiadochokinesis, changes in speech (dysarthria), and can be caused by a number of disorders of the central and peripheral nervous system. When approaching a child with ataxia, it is important to determine at what level the dysfunction occurred, and to have a time frame to be able to differentiate whether it is acute (occurrence within 72 hours), subacute (>72 hours), or chronic ataxia. Ataxia is a symptom that usually brings worried parents to the doctor very quickly. If we defined it as an acute ataxia, in more than 70% of pediatric cases, it is acute cerebellar ataxia (ACA), especially if the child's general condition is good, we have information about a recent viral infection, and the absence of other clinical signs. ACA is a self-limiting disease; it does not require treatment or extensive diagnostic work-up, and recovery is usually expected within a week. The second most common cause of acute ataxia in children is intoxication, especially in children under the age of five. One of the more common causes is acute inflammation of the middle ear. In the approach to a child with ataxia, the most important thing is to recognize a life-threatening condition, such as a stroke, hemorrhagic or ischemic stroke, when a timely reaction must not be missed. Emergency conditions that present with ataxia include inflammatory/autoimmune diseases of the nervous system: acute cerebelitis, encephalitis, acute disseminated encephalomyelitis, longitudinal transverse encephalomyelitis, and opsoclonus-myoclonus syndrome. In every child with ataxia, both acute and especially subacute, we must think of tumor processes in the posterior cranial fossa. All the conditions described so far affect the central nervous system, but as already mentioned, ataxia can also present conditions that affect the peripheral nervous system, such as Guillain-Barré syndrome and sensory polyneuropathies. Chronic and recurrent ataxias are most often genetically determined diseases, the diagnosis and treatment of which require a gradual and complex approach, and for some of them, specific therapy has recently become possible, making an etiological diagnosis imperative. In conclusion, the diagnostic algorithm in a child with ataxia depends primarily on the time interval in which the symptoms appeared, the general condition of the child, and associated symptoms, while the treatment, if necessary, depends on the underlying disorder.
Copyright (c) 2026 Andrijana Pilon Far, Jadranka Sekelj, Sanja Pejić Roško, Lana Lončar, Ivana Đaković https://creativecommons.org/licenses/by/4.0
Tics are sudden, repetitive, and arhythmic motor movements or vocalizations that most often occur in childhood. They are a common reason for referral to a pediatrician or child neurologist, and they encompass a spectrum of disorders – from transient and mild symptoms to chronic and functionally disabling neurodevelopmental conditions. They most often appear between the ages of 4 and 8, while the peak severity of symptoms is around 10 and 12 years of age. Boys are affected more often than girls. The course of tic disorders is typically waxing and waning, with symptoms fluctuating in type, frequency, and severity over time. Stress, fatigue, excitement, and emotional tension can worsen symptoms. The classification of tics is based on the clinical picture, duration of symptoms, and etiology. According to the clinical picture, tics are divided into motor and vocal. Motor tics can be simple (e.g., blinking, grimacing, head jerking, shoulder shrugging) or complex (e.g., coordinated movement patterns, touching objects, echopraxia). Vocal tics are also divided into simple (throat clearing, sniffing, coughing, grunting) and complex (uttering words or phrases, echolalia, palilalia, coprolalia). According to the duration, there are transient tics that last less than a year and persistent (chronic) tics that last more than a year. Etiologically, tics can be primary (idiopathic) or secondary. The pathophysiology of primary tics is complex and involves the interaction of genetic, neurobiological, and environmental factors. Tics are considered a disorder of motor inhibition regulation within the cortico-striato-thalamo-cortical circuits, which are crucial for the control of voluntary movements and the suppression of undesirable motor patterns, with a strong influence of the dopaminergic system and developmental factors. Secondary tics occur as a consequence of other conditions, including drug side effects, brain injury, infections, or autoimmune processes. One of the proposed immune-mediated entities is PANS, characterized by the sudden onset of tics and/or obsessive-compulsive symptoms related to infection, and in this group, PANDAS stands out, which is closely associated with streptococcal infection. Accurate classification of tics is crucial for proper diagnosis, prognosis assessment, and therapeutic planning. Neuroradiological and laboratory examinations are usually not necessary except in severe clinical cases and suspicion of secondary tics. Treatment depends on the severity of symptoms and functional impairment. For mild tics, education and monitoring are often sufficient. The first line of therapy for more severe symptoms is behavioral therapy, while pharmacological treatment is applied according to individual assessment and most often for secondary tics.
Copyright (c) 2026 Lana Lončar https://creativecommons.org/licenses/by/4.0
Gut-brain axis – new horizons in movement disorders
The gut–brain axis is a bidirectional communication system that connects the enteric nervous system of the gastrointestinal tract to the central nervous system. Understanding the complex mechanisms of action of this axis is essential for investigating the pathophysiological processes involved in the development of various neurological and gastrointestinal disorders. The enteric nervous system is composed of an extensive network of neurons distributed throughout the gastrointestinal tract. Although it functions relatively independently of the central nervous system, it is responsible for the regulation of key gastrointestinal processes, including peristalsis, intestinal motility, secretion, and absorption of nutrients, acting as an autonomic regulator of gastrointestinal functions. The vagus nerve is the primary neural pathway connecting the gut and the brain and is composed of afferent (sensory) and efferent (motor) fibres. Afferent fibres transmit information from the gut to the brain, including signals related to satiety, nutrient availability, and gastrointestinal discomfort. Efferent fibres transmit impulses from the brain to the digestive system, modulating functions such as gastric secretion and intestinal motility. This two-way communication allows for continuous regulation and maintenance of homeostasis between the gut and the brain. The gut microbiota comprises a diverse community of microorganisms, including bacteria, viruses, and fungi, that colonize the gastrointestinal tract, with their numbers exceeding the number of human cells in the body. The microbiota participates in numerous metabolic processes, including enzymatic activity, synthesis of vitamins and other bioactive metabolites, and inhibition of pathogen growth. Furthermore, it influences neuronal signalling, immune activity, and metabolic balance through the production of neuroactive molecules, such as neurotransmitters, short-chain fatty acids (SCFAs), and cytokines. Dysbiosis refers to a disruption of the balance of the gut microbiota, characterized by a reduction in bacterial diversity and changes in the composition of the microbial community, which can lead to pathological modulation of the immune response, including changes in cytokine expression and activity. Most research on the role of the gut–brain axis in movement disorders has been conducted in the context of the pathophysiology of Parkinson's disease. Parkinson's disease is a progressive neurodegenerative disorder characterized primarily by the loss of dopaminergic neurons in the substantia nigra, leading to characteristic motor symptoms, including tremor, rigidity, and bradykinesia. However, early non-motor symptoms, such as constipation and other bowel dysfunction, often occur several years before the onset of motor manifestations, suggesting that changes in gut function and microbiota may precede neurodegeneration. Therapeutic approaches aimed at modulating the gut–brain axis, particularly the gut microbiota and enteroendocrine cells, represent a potential strategy for slowing disease progression or even preventing its onset. Prominent among such approaches are the use of prebiotics and probiotics, fecal microbiota transplantation, short-chain fatty acid supplementation, and glucagon-like peptide-1 receptor agonists, which have entered advanced stages of clinical trials.
Gastrointestinal Microbiome; Enteric Nervous System; Parkinson Disease; Dysbiosis
Copyright (c) 2026 Mario Mašić, Ana Močić Pavić https://creativecommons.org/licenses/by/4.0
MRI patterns in children with cerebral palsy
Aim: To present different MR patterns in patients with cerebral palsy depending on the type of cerebral palsy Methods: Cerebral palsy is a clinical diagnosis based on neurological symptoms and a motor disorder causing an activity limitation. Non-progressive, but often variable motor disorders are results of developmental disorders or brain damage in the early stages of development. It represents a major public health problem. In order to solve it, Surveillance of Cerebral Palsy in Europe (SCPE) was created. To improve diagnostics and thus therapy and treatment outcomes, magnetic resonance imaging of the brain has become an important tool in the workup of children suspected of having cerebral palsy. Therefore, the group of authors designed a classification system based on pathogenic patterns that occur at different developmental stages of the brain, causing different MR patterns. Results: The MR classification system (MRICS) consists of five main groups: developmental malformations, predominantly white matter injury, predominantly gray matter injury, miscellaneous patterns, and normal findings. It is based on the time of onset of brain injury and not on the cause. The same etiology causes different brain injuries depending on the moment when the noxa appears during brain development. Conclusion: This approach has facilitated interdisciplinary cooperation and better overall care for children with CP and opened the possibility for its improvement.
Cerebral Palsy; Magnetic Resonance Imaging; Fetus
Copyright (c) 2026 Ana Tripalo Batoš, Ivana Đaković https://creativecommons.org/licenses/by/4.0
Systematic examinations of a five-year-old child in a family medicine clinic - new challenges
A systematic examination of a child at the age of 4-5 is crucial for monitoring the child's growth and development. It uses the assessment of the child's social and emotional maturity for the possible elimination of deviations in development. R2 revaccination is in progress. We evaluate quantitative parameters such as anthropometric measurements of weight and height, and conduct examinations by organ systems, assessing the locomotor status, heart, lungs, vision, and hearing. The qualitative parameters and psychomotor development checked are contact when entering the space, gross and fine motor skills, speech, memory, and cognitive skills. Habits in conversation with the child and parents that are appraised are diet, adopted hygiene habits, games, spending time in nature, and the use of mobile phones. At the age of 4-5, habits are very important to doctors in assessing the psychophysical development of a preschool child. We will refer to the excessive use of mobile phones, tablets, PC devices, and watching classic television. A child's brain receives information and develops through a variety of healthy sensory stimuli. At an early age, by looking at the screens, the child receives a series of rapidly changing, colorful sounds and images that cause fleeting pleasure. The child cannot concentrate on the whole. This communication is one-way and does not develop verbal, emotional, and social skills. The mobile phone uses near vision; the image does not reach the retina, and it does not use the entire field of vision. Science has proven that excessive use of cell phones in preschool age develops premyopia and myopia at that age and later in adolescence. In Eastern Europe and Asia, the prevalence of myopia in adolescents is above 80%. In the development of hearing, no damage was recorded due to mobile phones, but the child does not have developed verbal communication, it is more difficult to unconsciously reject unnecessary, redundant voices and sounds, it is more difficult to navigate in the real sound world. The time spent on mobile phones takes the child's time for developing other skills (outdoor play, hanging out with peers, talking, arguing, and developing hobbies primarily with their hands). Moreover, sedentary obesity in children due to physical inactivity and "snacks" with mobile phones is a well-known consequence. Recommendations of the American Academy of Pediatrics limit the time spent on screens and give additional guidelines: Children under 2 years old should not use mobile phones, 2-5 years olds can use them up to 1 hour, while older children and teenagers should use them no more than 2 hours a day Use good lighting Staying outside in active play for no less than 90 min
Child, Preschool; Cell Phone Use; Habits; Social Skills; Motor Skills
Copyright (c) 2026 Marija Vrca Botica https://creativecommons.org/licenses/by/4.0
Neurophysiological foundations of what we call artificial intelligence (AI)
The question of what intelligence truly is remains fundamental. Numerous definitions exist; however, the most reliable one defines intelligence as the ability to arrive at a correct answer to a given question. This definition implies a gradation of intelligence, dependent on the complexity of the question and the accuracy of the response. Importantly, intelligence is not exclusive to humans but is also inherent to the animal kingdom. At the core of intelligence lies the nervous system, with the brain as its central paradigm. Humans have developed computers capable of providing correct answers to posed questions. Depending on whether correct answers predominantly originate from the brain or from computers, intelligence is divided into natural intelligence and artificial intelligence. When intelligence is defined through the framework of questions and answers, it essentially operates on the level of information and data. In natural intelligence, data are represented by the transmission of electrical impulses through ensembles of neurons and their connections, the synapses. In artificial systems, electrical impulses likewise induce changes in specific particles, which can be modified and reorganized into new configurations. The question then arises: which of these two foundations offers greater potential for intelligence? The answer is unequivocal—natural intelligence, with the brain as its paradigm. This holds true not only at the current level of understanding but also in the foreseeable future, even when considering advancements such as nanotechnology or the presumed promise of quantum computing. This conclusion is based on the properties of the synapse, which serves as the fundamental medium for electrical transmission within the nervous system. Its capacity to engage from a minimal to an extraordinarily large number of units, its extensive collateral influences generating immeasurable possibilities, and its ability to dynamically form and dissolve connections make it an incomparably superior substrate for the creation, disappearance, and manipulation of information than any machine.
Intelligence; Artificial Intelligence; Brain; Quantum Theory
Copyright (c) 2026 Anđelko Vrca https://creativecommons.org/licenses/by/4.0
The impact of digital technology use on the mental health of children and adolescents
This paper analyzes the impact of digital technology use on the mental health of children and adolescents, emphasizing developmental, emotional, and behavioral consequences of excessive screen exposure. Evidence indicates that in preschool children, screen time is associated with delayed maturation of white matter and delays in social communication, emotional regulation, and peer interaction. In school-aged children, excessive technology use is linked to attention and concentration difficulties, poorer academic performance, reduced physical activity, and an increased risk of anxiety, depressive symptoms, and impaired self-esteem. Social media use presents additional risks, including exposure to inappropriate content, cyberbullying, and online safety threats. Among adolescents, intensive use of digital platforms is associated with lower life satisfaction, the development of addictive behaviors, and symptoms of psychiatric disorders. Excessive use of digital devices activates the dopaminergic reward system, potentially contributing to behavioral addictions, including gaming disorder. The paper also highlights the negative impact of parental technology use on attachment formation and children’s emotional security. The findings emphasize the need for preventive measures, time limitations, and the promotion of healthy developmental activities to protect the mental health of children and adolescents.
Child; Adolescent; Mental Health; Digital Technology; Social Media; Behavior, Addictive
Copyright (c) 2026 Ljiljana Gulić https://creativecommons.org/licenses/by/4.0
Neurobiological foundations of movement and movement disorders
The central locations of primary, secondary, auxiliary, and executive motor functions are among the most widely distributed across the cortical and subcortical regions of the brain. This dispersion has historically contributed to significant misunderstandings regarding how motor functions operate, some of which persist even today. Early understanding emerged naturally through correlations between global brain lesions and movement disorders, a perspective that was refined with the advent of autopsies and more precise localization of lesions in relation to motor dysfunctions. Subsequent progress was made with insights into synapses and neurotransmitters, while advancements in neurophysiological and neuroimaging techniques further enhanced this knowledge. Among motor functions, those associated with the extrapyramidal system remain particularly intriguing. The theoretical and practical framework is relatively well established for the unidirectional pathway from the substantia nigra to the basal ganglia. However, areas outside this pathway, often described as “floating regions”, are still subject to diverse theories. While these complexities are less critical for theory, they are highly relevant for clinical practice, especially in treating extrapyramidal symptomatology. A central challenge remains: how thoughts of movement are translated into actual movement, the precise role of extrapyramidal functions, and the neurotransmitter systems involved. Here, a global model is proposed that consistently links cognitive motor planning to executed movement, offering a unified perspective for understanding and managing movement disorders.
Brain; Movement Disorders; Synapses; Neurotransmitter Agents
Cerebral palsy (CP) is a heterogeneous group of disorders of movement and posture caused by injury to the developing brain, which may occur in the prenatal, perinatal, or postnatal period. Although the brain injury is static, the clinical presentation is not—it evolves throughout the child’s growth and development under the influence of experience, biomechanical adaptations, and environmental factors. The type of movement pattern in children with CP depends on the localization of the lesion. Damage to the corticospinal tract leads to spasticity, impaired selective motor control, and rigid synergies; lesions of the basal ganglia result in involuntary and variable movements, while cerebellar lesions cause impairments in coordination and balance. In all children with CP, regardless of subtype, delayed motor development, reduced trunk control, and increased energy expenditure due to decreased movement efficiency are common findings. The management of children with CP is based on the functional development model, emphasizing optimization of function rather than mere correction of movement. Early diagnosis plays a crucial role, using tools such as the General Movements Assessment and the Hammersmith Infant Neurological Examination. These enable intervention within the “golden window” period, which is critical due to the heightened potential for neuroplasticity. Scientific evidence shows that active, task-specific, and intensive motor learning promotes reorganization of the motor cortex more effectively than passive interventions. Therefore, greater priority is given to interventions such as constraint-induced movement therapy, bimanual training, and the administration of botulinum toxin. Technology also plays an important role, including robotics, functional electrical stimulation, and virtual reality, which enable a high number of repetitions and precise sensorimotor stimulation. A multidisciplinary approach is essential, including orthopedic prevention of contractures, in order to preserve functional potential. In conclusion, the goal of CP management is not cure, but the achievement of maximally functional movement within biological limits. Early diagnosis and early intensive therapy are essential. Only in this way can maximal functional independence and quality of life be achieved.
Cerebral Palsy; Motor Skills Disorders; Muscle Spasticity; Neuronal Plasticity; Rehabilitation; Early Intervention, Educational; Motor Cortex
Copyright (c) 2026 Edita Runjić https://creativecommons.org/licenses/by/4.0
The role of artificial intelligence and machine learning (AI/ML) in the discovery of new drugs for neurological diseases in paediatrics
Drug discovery and development is a highly complex and costly process, often requiring over a decade and billions of dollars to bring a single therapeutic to market. The development of artificial intelligence (AI) and machine learning (ML) methods has overcome many obstacles in drug discovery, advancing these processes by reducing the time needed to identify potential drugs through the prediction of pharmacokinetics, toxicity, and potential side effects. AI also improves clinical trial design by enhancing patient recruitment and data analysis, thereby reducing costs and increasing the success rates of drug discovery. AI utilises ML, deep learning (DL), and natural language processing (NLP) to analyse vast datasets, enabling the rapid identification of drug targets, prediction of compound efficacy, and optimisation of drug design. AI and ML are also transforming drug discovery in neurological diseases, which are often complex and heterogeneous, affecting millions, but can also be monogenic and rare, with only a few patients. These diseases encompass over a thousand disorders that place a significant burden on human health and finances. Although computational tools have been developed and applied in neurological disease research for decades, the current era of AI leveraging ML offers significant potential to accelerate the identification and discovery of new drugs, although in some cases this is limited by our understanding of the disease. AI is also used in brain imaging and diagnostics, but predicting the permeability of the blood-brain barrier (BBB) is one of the most important applications of AI in drug discovery for brain disorders, as drug delivery to the brain is often hindered by the need to cross the BBB. Additional challenges arise from the scarcity of optimal models for preclinical drug testing and the frequently observed lack of translation from preclinical to human clinical trials. Recent advancements in assay-ready organoid platforms and microfluidic chips offer considerable potential for the use of human brain organoids in drug development. Compared with adults, paediatric patients typically experience a significant delay, often nearly a decade, in accessing novel medications. However, AI and precision medicine are increasingly influencing paediatric pharmacotherapy, where age-dependent pharmacokinetic variability requires highly individualised therapeutic strategies. Clinical trials for paediatric ADHD drugs focus on evaluating the efficacy, safety, and optimal dosing of stimulants and non-stimulants in children and adolescents, with recent trials exploring novel formulations for improved symptom management. Several studies have developed ML and DL models to identify children with ADHD using electroencephalography (EEG) data. However, it is important to note that the use of artificial intelligence in the identification and treatment of ADHD remains limited. Despite these achievements, AI-driven drug discovery still faces several limitations, including data biases, regulatory barriers, and ethical issues. Overcoming these limitations will be crucial to realising the full potential of AI in this field.
Artificial Intelligence; Attention Deficit Disorder with Hyperactivity; Blood-Brain Barrier; Child; Deep Learning; Drug Discovery; Machine Learning; Permeability; Organoids
Copyright (c) 2026 Milena Jadrijević-Mladar Takač https://creativecommons.org/licenses/by/4.0
Are neurodevelopmental disorders the new normal?
The prevalence of neurodevelopmental disorders is steadily increasing. This phenomenon results from a complex, multilayered interaction of biological, medical, and social factors. Advances in medicine have enabled improved survival of neurologically at-risk children. At the same time, children today are growing up in a substantially altered developmental environment. Changed patterns of interaction within and beyond the family, greater and different educational demands, and increasingly early and intensive exposure to digital media are reshaping the neurocognitive environment in which children develop language, attention, and social skills. The development of social cognition, communication, language, and speech is based on a precisely orchestrated interaction between genetically programmed processes of brain maturation and experience-dependent neuroplasticity. During the prenatal and early postnatal periods, critical processes of structural brain development take place, which, together with social and linguistic experiences, enable the formation of functional language networks. The establishment of socio-linguistic neural networks largely depends on the quality and quantity of early social and linguistic input. This complexity and dynamic nature of developmental processes make development highly sensitive to biological risks as well as to environmental changes. When the biological vulnerability of the system intersects with unfavorable or insufficient developmental stimulation, disorders become clinically visible. The increased prevalence of neurodevelopmental disorders reflects the current neurobiological and social context and raises the question of whether we are prepared to systematically respond to the challenges that the modern developmental environment poses to the developing brain. Understanding this complex developmental dynamic is essential for timely diagnosis, early intervention, educational adaptation, and the development of preventive strategies within interdisciplinary child care.
Neurodevelopmental Disorders; Child Development; Language Development; Social Behavior; Environmental Exposure; Neuronal Plasticity; Education
Copyright (c) 2026 Blaženka Brozović https://creativecommons.org/licenses/by/4.0
Digital dementia – The challenge of the internet generation
Digital dementia is a phenomenon of the Internet generation (Generation Z and Generation Alpha), who are growing up with intensive exposure to digital media, smartphones, tablets, and social networks. Children and adolescents are exposed to digital devices from the earliest age, using them daily during learning, play, meals, as well as immediately before sleep. Living in a digital environment, they prefer visual content and rapid information exchange. Although technology offers numerous advantages, excessive use of digital devices may lead to a decline in cognitive functions, including memory, attention, and executive functions. Due to the overuse of digital devices as an “external memory,” the brain no longer needs to retain information. This reduces the mental load on the brain, leading to cognitive offloading and the development of mental atrophy. The neurological effects of digital dementia include a reduction in gray matter in key brain areas such as the prefrontal cortex and hippocampus, which are important for emotional and cognitive regulation. Changes are also observed in the anterior cingulate cortex (impulse control), orbitofrontal cortex (reward processing and addiction), striatum (habit formation), and parahippocampal regions (memory and spatial orientation). These regions are crucial for executive functions, impulse regulation, the reward system, habit formation, and memory processes. Executive brain functions represent high-level cognitive processes that include planning, maintaining focus, and decision-making. The three main components of executive functions are inhibitory control, working memory, and cognitive flexibility. High screen exposure is associated with poorer working memory function and weakened functional connectivity of neural networks, which may encourage the development of inefficient cognitive strategies. There are also concerns about the long-term risk of Alzheimer’s disease associated with excessive use of digital devices at an early age. Although some countries have introduced bans on mobile phone use in schools, studies show that these measures have not significantly improved academic performance, mental health, or reduced cyberbullying. Therefore, the key role of physicians is to recognize excessive use of digital devices and educate patients about healthy habits. In conclusion, measures for digital detoxification are needed, which implies conscious limitation and structuring the time spent on digital media, as well as the development of strategies that will help reduce the negative effects of technology on the brain and mental health of children and adolescents.
Digital technology; Executive function; Dementia; Mental health
Copyright (c) 2026 Ana Boban Raguž, Martina Krešić Ćorić, Nataša Pejanović-Škobić https://creativecommons.org/licenses/by/4.0
Is there a place for supplements in the treatment of patients with hypoxic ischemic brain injury?
Hypoxic-ischemic brain injury is a diffuse brain injury caused by reduced blood flow and/or reduced oxygen supply (hypoxia) to brain tissue. Hypoxic-ischemic brain injury is characterized by a complex pathophysiological cascade in which the initial energy collapse due to lack of oxygen and glucose triggers a series of secondary processes responsible for long-term damage more pronounced than the primary hypoxia itself. After the initial ischemia, reperfusion injury develops over time, which can result in neuronal membrane instability, brain edema, intracranial hypertension, cerebral hypoperfusion, and reduced autoregulation. At the molecular level, this includes oxidative stress, mitochondrial dysfunction, excitotoxicity, neuroinflammation, disruption of cell membrane integrity, and delayed neuronal apoptosis. It is this prolonged phase of secondary injury that represents a theoretical space for adjuvant therapeutic interventions, including the use of supplements. The interest in supplements in the context of hypoxic-ischemic brain injury stems from their potential ability to modulate certain pathophysiological mechanisms. Antioxidants such as vitamins C and E, melatonin, and polyphenols are targeted at reducing free radicals and lipid peroxidation, but clinical outcomes remain inconsistent due to inadequate bioavailability, issues of blood-brain barrier penetration, and adequate dosing. Supplements targeting mitochondrial function, such as coenzyme Q10, alpha-lipoic acid, and creatine monohydrate, have a strong biological basis because they target neuronal energy metabolism, but there is currently insufficient high-quality clinical evidence to confirm their significant impact on functional outcome. Most rational optimism is associated with supplements that participate in stabilizing cell membranes and optimizing synaptic function, such as omega-3 fatty acids (especially DHA), citicoline, and acetyl-L-carnitine. Their potential benefit is likely in the subacute phase and during long-term neurorehabilitation, where they may contribute to neuroplasticity and recovery of function, although here too the evidence does not reach the level for routine recommendation. It is important to emphasize that no supplement treats hypoxic-ischemic brain injury; the evidence available to us today does not show consistent results, and this can be attributed to the lack of randomized controlled trials, variable doses, and treatment lengths. Most assumptions about possible benefits arise from preclinical evidence of neuroprotection. For now, the role of supplements can only be considered as an adjuvant, along with standard intensive care measures and structured rehabilitation. The greatest clinical risk associated with supplements is not their toxicity, but the creation of unrealistic expectations and the potential delay of proven effective therapeutic procedures. It is necessary to critically evaluate the mechanism of action, dose, time of administration, individual patient context, and ultimately the quality of the supplement itself.
Hypoxia-Ischemia, Brain; Dietary Supplements; Neuroprotection
Copyright (c) 2026 Marina Milošević https://creativecommons.org/licenses/by/4.0
Neuropediatric approach to a child with dystonia
Dystonia is one of the most frequent movement disorders in childhood. It can lead to delayed motor development and cause significant motor disability. For this reason, uncovering the etiology is the ultimate goal in the clinical evaluation of dystonia. Dystonia is characterized by involuntary, permanent or occasional muscle contractions that cause abnormal, often repetitive movements, positions, or both. Dystonic movements are typically structured like twisting and can be tremulous, short, or prolonged due to difficulty in muscle relaxation. Diagnostic evaluation of childhood dystonia is challenging due to phenotypic variability and heterogeneous etiology, and is very limited, as is treatment itself. The assessment is mainly based on the clinical picture, anamnestic data, and neurological status. But advances in neurological imaging studies, as well as the identification of genes involved in dystonic syndromes and the characterization of new pathological entities, are expanding our understanding of childhood dystonia and expanding the spectrum of its diagnosis. A trial with levodopa can be both diagnostic and therapeutic in children with dystonia that responds to levodopa. However, for most children with early-onset dystonia, treatment is symptomatic with variable effectiveness. Unfortunately, there is a small amount of available research on the therapy of childhood dystonia, and most recommendations for treatment are based on consensus or the opinion of experts dealing with dystonia. In this presentation, we will present the available guidelines for the diagnostic assessment and pharmacological treatment of dystonia starting in childhood.
Copyright (c) 2026 Sanja Pejić Roško https://creativecommons.org/licenses/by/4.0
Detecting the invisible: Can your phone help diagnose neurological risks in infants?
General movements (GMs) assessment is a reliable method of gestalt evaluation of movement complexity and variation with high predictive value to identify neurological issues that may lead to cerebral palsy or minor neuromotor dysfunction. The quality of GMs in the fidgety period has been found to have the highest predictive value. We developed a System for Early Neurological Deviation Detection (SENDD) using artificial intelligence to annotate and assist in the conclusion of the quality of the general movements. We included more than 1600 videos of infants in fidgety age collected institutionally or by smartphone camera/app assisted in home-setting. All videos were checked for inclusion and exclusion criteria depending on technical and child requirements. All collected videos were evaluated by trained professionals using the Hadders-Algra system. For GM annotations and assessments, 25 different machine learning (ML) models and algorithms (AI systems) were consecutively tested. At the moment, there is a fully developed and reliable 15-keypoint annotation tool. Home video can replace institutional recording and be a reliable source of videos. For this purpose, a web and mobile application was developed. The most reliable and trainable neural networks were selected. Accuracy of AI conclusions compared with trained human assessments for Hadders-Algra 4-category system and screening tool using a 2-category system (normal, abnormal). Most reliable ML models with the best precision and accuracy results are DensNet169 (pose estimation & computer vision) and CNN. Higher accuracy is directly related to the number and diversity of videos used for training, as annotation time was reduced. SENDD is of great relevance for users and families. It saves medical resources and represents a time-effective screening tool both for professionals and families.
Infant; Artificial Intelligence; Machine Learning; Neural Networks, Computer
Copyright (c) 2026 Goran Kuzmac, Goran Krakar, Zlatko Sabol, Tomislav Strgar https://creativecommons.org/licenses/by/4.0
Neurological rehabilitation using robotic devices in pediatrics
Robotic devices deliver high-intensity therapy and facilitate recovery, particularly when patients actively engage at a cognitive level throughout the therapeutic process. The interfaces of robotic devices are designed similarly to video games, which is especially appealing to pediatric patients and may enhance engagement and motivation during therapy. Robotic devices during neurological rehabilitation promote neuroplasticity, the foundation of functional recovery, owing to the interactivity and intensity of the intervention. The effectiveness of robotic neurological rehabilitation depends not only on technology but also on the human factor, which includes healthcare professionals, patients, and their parents. Parental attitudes may play a particularly important role among the complex factors contributing to therapeutic success. The lecture will present the clinical practice of robotic neurological rehabilitation implemented at the Robotic Therapy Unit of the Special Hospital for Children with Neurodevelopmental and Motor Disorders, where eight robotic devices are utilized. The therapy cycle lasts seven weeks and includes training with robotic devices for the upper limbs, trunk, and lower limbs, as well as a combination of robotic therapy with physiotherapy and occupational therapy. The decision to implement robotic or conventional therapeutic approaches is made by the multidisciplinary team in accordance with the child’s age and interests. Robotic therapy using the Amadeo device, while achieving outcomes comparable to traditional occupational therapy, can reduce the required number of therapy visits by 15.5 days, corresponding to approximately three working weeks.
Robotics; Neurological Rehabilitation; Pediatrics
Copyright (c) 2026 Ivana Kern https://creativecommons.org/licenses/by/4.0
Perinatal arterial ischemic stroke- ultrasound diagnosis and otucome
Perinatal stroke is a cerebrovascular injury to the brain that occurs between the 20th week of fetal life and the 28th postnatal day. Six different types of perinatal stroke (PS) have been described. The most common is perinatal arterial ischemic stroke (PAIS), with an incidence of about 1/1600-5000 newborns, and it is 17 times more common than stroke in older children (pediatric PS). Most PAIS occur around term, clinically manifesting between 12 and 72 hours after birth with (non)specific symptoms, most often seizures (70-90%), encephalopathy, lethargy, irritability, or apnea. Sometimes they are asymptomatic. PAIS is the leading cause of unilateral cerebral palsy (UCP) and the second most common cause of neonatal convulsions. The outcome is very often unfavorable: contralateral hemiparesis, epilepsy, cognitive decline, visual impairment, etc. Treatment is supportive. The left middle cerebral artery is most commonly involved. Although brain MRI is the “gold standard” for the diagnosis and prognosis of PAIS, brain ultrasonography (US) is the first imaging modality in the evaluation of newborns with neurological abnormalities. Early brain US within the first 48 hours has a sensitivity of 87% in detecting PAIS. Diagnosis in the neonatal period is important to determine the risk of neurological damage, inform the family about the prognosis, and initiate early intervention to promote a favorable neurological outcome. Objective: In this paper, we will present our experiences in the diagnosis, monitoring, and outcome of children with PAIMU. Study results: According to this study, PAIS was more frequently registered in term, and male children. The most frequently affected was the middle cerebral artery (MCA), predominantly the left one. Hyperechogenicity in the MCA irrigation area, registered by brain US, was the leading sign of cerebral ischemia, which was confirmed by MRI techniques. The most common risk factors were perinatal and coagulation disorders. A small number of newborns had seizures and changes in muscle tone. In infancy, all of them had abnormalities: dystonic and spastic syndrome. At the age of 2 years, most children had unilateral cerebral palsy (CP), most of them spastic UCP, visual impairment, epilepsy, and cognitive decline. Children with ischemia in the posterior cerebral artery area had a normal outcome. Most children with severe neurodevelopmental abnormalities had ischemia in the area of ​​the main branch of the MCA, especially when the posterior branch of the internal capsule was affected by the ischemia. All premature infants and all children with neonatal seizures had severe neurodevelopmental deviations. Conclusions: The neurodevelopmental outcome of PAIS depends on the vascular distribution of the damage. Lesions of the main branch of the middle cerebral artery cause the most severe neurodevelopmental deviations due to damage to the posterior branch of the internal capsule. If the cerebral hemisphere, basal ganglia, and sensory pathways are affected in addition to the internal capsule, the outcome will certainly result in hemiparesis, i.e., unilateral CP. Prematurity and neonatal seizures, as well as damage to the posterior branch of the internal capsule, are predictors of unfavorable neuromotor outcome in children with PAIS. Brain ultrasonography is a valuable neuroimaging method for the early detection of perinatal arterial ischemic stroke.
Ischemic Stroke; Ultrasonography; Cerebral Palsy; Infant, Newborn
Copyright (c) 2026 Vlasta Đuranović, Angelina Brguljan, Sara Žaja, Anamarija Jagić, Jure Jakovljević, Ivana Đaković, Ana Tripalo Batoš, Jasna Leniček Krleža, Vlatka Mejaški Bošnjak, Maria Blaić https://creativecommons.org/licenses/by/4.0
Child after hypoxic-ischemic brain injury: Development, learning, and school challenges
Advances in medicine reduce perinatal mortality but increase the number of children at risk for developmental disorders. Neurodevelopmental outcomes of perinatal brain injuries are typically categorized as major or minor impairments. Major neurological impairments include cerebral palsy, intellectual developmental disorders, epilepsy, blindness, deafness, and autism, often accompanied by dysfunctions in other systems. Minor impairments occur in children with overall normal development and may affect various functional systems independently of major neurological deficits; these are classified as specific developmental difficulties. The aim of this lecture is to describe the psychological outcomes in children with hypoxic-ischemic brain injury, which may manifest in different aspects of functional development, including general intellectual abilities, specific neuropsychological functions, academic skills, behavior, emotional responses, social interactions, quality of life, and, in adulthood, professional and family functioning. In studies of psychological outcomes, the most numerous investigations focus on general cognitive abilities. The prevalence of intellectual difficulties remains relatively stable over time, around 10% among children with extremely low birth weight or low gestational age, compared to approximately 2% in the general population. Regarding specific cognitive difficulties, the most common are problems with perceptual–spatial organization, but difficulties are also observed in verbal memory, arithmetic, and language development. Deficits in cognitive functioning in this group of children can directly impact school learning. They interfere with the acquisition, consolidation, and application of academic skills, including reading, writing, and mathematics. Executive function deficits are common in children with hypoxic-ischemic brain injuries, regardless of intellectual abilities, and hinder a child’s ability to follow routines and cope with increasing cognitive demands, especially in structured school environments. Behavioral and emotional consequences of hypoxic-ischemic injury are studied far less frequently than general cognitive abilities. Although often transient, they can disrupt the natural course of a child’s development and learning, making it harder to achieve key developmental tasks such as attachment, initiative, self-confidence, self-control, and social skills. Behavioral and emotional regulation problems can negatively affect academic performance and peer relationships, often requiring tailored support. The school environment plays a crucial role in meeting academic and emotional needs; inadequate support can increase the risk of social isolation and poor school adjustment. A review of the literature emphasizes the importance of early identification of difficulties, continuous neurodevelopmental monitoring, and a multidisciplinary and individualized approach to optimize developmental and educational outcomes for these children.
Hypoxia-Ischemia, Brain; Executive Functions; Academic Performance; Schools
Copyright (c) 2026 Marina Vidaković https://creativecommons.org/licenses/by/4.0
Artificial intelligence as a developmental environment: Implications for child and adolescent psychiatry
Children and adolescents today are growing up in an environment shaped not only by family, school, and peers, but also by algorithmically structured systems. Artificial intelligence is becoming increasingly accessible, highly personalized, and capable of generating a sense of being understood, although no human with independent emotions and lived experience stands behind the responses. From a developmental perspective, this represents a novel experience of relatedness - an interaction that simulates reciprocity without genuine emotional vulnerability, misunderstanding, or relational repair after conflict. Within attachment theory, emotion regulation develops through repeated experiences of affective attunement and coregulation between the child and an emotionally available adult. Through frustration, waiting, ambivalence, and conflict - followed by resolution and relational restoration - the child internalizes regulatory patterns and develops capacities for self-regulation and mentalization. Artificial intelligence, however, provides predictable, continuously available, and adaptive responses, potentially reducing exposure to frustration and shifting regulatory processes from the interpersonal context to a technologically mediated system. This may foster an illusion of emotional reciprocity, whereby the child experiences understanding without true mutuality or affective involvement of the other, with possible implications for the formation of secure attachment patterns. Children with insecure attachment patterns, neurodevelopmental difficulties, and anxiety or depressive symptoms may be at increased risk, as artificial intelligence may become a primary and controlled form of interaction that mimics interpersonal relatedness. In adolescence, this further raises questions about identity development within a digitally mediated and algorithmically shaped sense of self. Artificial intelligence may also serve a supportive role in psychoeducation and structured social skills training, provided that it remains embedded in developmentally meaningful relationships. The strongest developmental protective factor remains authentic, reciprocal, and emotionally available interaction with another person. One important developmental question concerns how the persistent presence of artificial intelligence reshapes the context in which emotion regulation and identity develop.
Artificial Intelligence; Child Psychiatry; ,Adolescent Psychiatry; Child Development; Emotions
Copyright (c) 2026 Aleksandra Klobučar https://creativecommons.org/licenses/by/4.0
School readiness in a changing world: Between neuroscience and educational practice
Preparation for school entry is a complex and multidimensional process encompassing cognitive, social, emotional, and motor development. School readiness extends beyond the acquisition of emergent literacy and numeracy skills and includes the ability to regulate emotions, sustain attention, follow instructions, cooperate with peers, and develop responsibility. Contemporary neuroscience highlights early childhood as a period of heightened neuroplasticity, during which environmental experiences profoundly shape neural networks underlying learning, memory, language, and executive functions. The family environment plays a central role in fostering foundational competencies required for successful school adjustment. Secure attachment, emotional warmth, and consistent boundary setting promote self-regulation, self-confidence, and resilience. Adequate sleep, balanced nutrition, and regular physical activity directly influence attention, behavior, and cognitive performance. Conversely, excessive screen exposure, reduced opportunities for spontaneous play, and chronic stress may adversely affect executive functioning and socioemotional development. Early developmental screening in the preschool period enables timely identification of deviations in speech-language, motor, cognitive, and socioemotional domains. Early intervention, particularly during periods of maximal brain plasticity, significantly improves developmental outcomes. An integrated approach involving parents, educators, pedagogues, psychologists, and healthcare professionals ensures comprehensive support for the child and family. Systematic intersectoral collaboration increases the likelihood of successful adaptation to the school environment and contributes to long-term academic achievement and emotional well-being.
School; Child Development; Emotional Regulation; Early Intervention, Educational; Neuronal Plasticity; Child, Preschool
Copyright (c) 2026 Radenka Kuzmanić Šamija https://creativecommons.org/licenses/by/4.0