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Choosing Wisely initiative, launched in 2012, is an international physician-led movement promoting rational, safe, and patient-centred healthcare. Its aim is to reduce the overuse of diagnostic tests, procedures, and treatments that often do not lead to better outcomes and may be burdensome or even harmful. Current data suggest that approximately 20-30% of healthcare provides no real benefit to patients. The call to reconsider certain routine practices has also extended to paediatrics, where this philosophy carries particular importance given the vulnerability of the paediatric population. This article presents the development of the initiative with an emphasis on the pa ediatric field and illustrates how the early American and Canadian lists gradually shaped the emerging European agenda. Following the finding that more than 80% of European paediatricians perceive overuse of care as a significant problem, the European Academy of Paediatrics (EAP) published the first European set of paediatric recommendations in 2 023 (the Choosing Wisely Top 10 List). Four of the ten recommendations address the overuse of antibiotics, while others highlight, for example, the inappropriate treatment of cough in children or gastroesophageal reflux in infants. This publication opens a series of expert communications that will discuss individual recommendations from the Choosing Wisely Top 10 List and their relevance for Czech paediatrics.

The advent of generative artificial intelligence (AI) is reshaping the digital landscape and becoming one of its defining elements. Adolescents and young adults readily adopt new digital technologies, and generative AI is rapidly becoming an integral part of their daily lives. Evidence from earlier phases of digital technology expansion shows that adolescent users may face increased health risks a ssociated with new behavioral patterns. However, empirical and evidence-based data on the health hazards of generative AI remain limited. This article provides an overview of the first insights and considerations regarding the potential influence of generative AI on adolescents' health and mental well-being, focusing on health information, cognitive abilities, critical thinking, mental health, addiction potential, body image perception, social interactions, physical activity, and sleep.

Physical, sexual, psychological, emotional abuse, and neglect of a child can have serious consequences - both immediate, including fatal outcomes, and long-term or lifelong effects. Perpetrators are most often parents or other family members. Physical abuse may be identified by various external injuries, fractures, and damage to soft tissues or internal organs. A specific and severe form is abusive head trauma in infants and young children, where violent shaking may cause subdural hemorrhage and brain injury. Sexual abuse can sometimes present with physical signs of past violence, though more often the physical findings are normal. In such cases, changes in the child's behavior and medical history are key to diagnosis. Psychological and emotional abuse involves repeated humiliation and intimidation. Observing interactions between the parent and child can aid in detecting this type of abuse. Child neglect can take many forms, including failure to meet the child's hygienic, nutritional, educational, health, or emotional needs, or failure to provide age-appropriate supervision. A specific form of abuse is medical child abuse, in which a caregiver fabricates or induces illness in the child. Hospital admission is warranted when physical abuse is suspected. Depending on the case, the evaluation may include a detailed medical history, physical examination, targeted laboratory tests, and imaging studies. For children presenting with acute neurological symptoms, an immediate CT scan of the head is indicated. In all children under one year of age with suspected physical abuse, MRI of the brain and cervical spine may be performed - even if there are no neurological symptoms. Children under two years of age undergo a radiographic skeletal survey. Treatment depends on the type of abuse. Initial care focuses on stabilizing the child's condition, often in an intensive care unit for severe cases, followed by thorough examination and trauma management. Ongoing care is complex and multidisciplinary, typically involving physicians and surgeons from various specialties, psychologists, social workers, and the Czech Police.

Gastroesophageal reflux (GER) in infants is, in the majority of cases, a physiological phenomenon that resolves spontaneously. The cornerstone of diagnosis is a careful medical history and physical examination, with particular attention to excluding alarm signs that may indicate gastroesophageal reflux disease (GERD) or another underlying condition. The vast majority of infants without alarm features thrive well and do not de velop respiratory or neurological complications. The mainstay of management consists of parental education combined with conservative measures (avoiding overfeeding, continuing breastfeeding, and thickening feeds). If these measures are insufficiently effective, an extensively hydrolyzed formula or, if appropriate, an amino acid-based formula may be used for 2-4 weeks, considering the possible presence of cow's milk protein allergy. Proton pump inhibitors (PPIs) are being prescribed with increasing frequency in the pediatric population, and their use as part of "reflux treatment" in infants is rising. However, current evidence does not demonstrate the effectiveness of PPIs in reducing nonspecific symptoms such as irritability or crying, while the risk of adverse effects is significant. In infants treated with PPIs, an increased risk of dysbiosis, gastrointestinal and respiratory infections, impaired mineral absorption, disruption of bone metabolism, and a higher incidence of allergic diseases has been reported. Therefore, expert recommendations emphasize that PPIs should be indicated only for clearly defined conditions, particularly erosive esophagitis and objectively confirmed GERD. Initiation of this therapy should always be preceded by a comprehensive evaluation of the infant by a specialist. The use of prokinetic agents in infants with GER or GERD is not routinely recommended.

Accurate differentiation between viral and bacterial pharyngitis is crucial for the targeted use of antibiotic therapy and for limiting the rising problem of antibiotic resistance. Clinical signs alone are insufficient to reliably determine the etiology, which is why rapid antigen detection tests (so-called streptests) are used in paediatric practice. The streptest represents a quick and generally useful diagnostic tool when appropriately indicated. Its results must be interpreted in the context of the patient's overall clinical condition, the epidemiological situation, and other relevant factors. At the same time, testing should be avoided in situations where it may detect only asymptomatic carriage, as this could lead to inappropriate antibiotic prescribing.

Haemophilus influenzae is a common part of the microflora of the upper respiratory tract, and is also one of the main causative agents of a wide range of diseases from uncomplicated respiratory tract infections to life-threatening infections. Traditional drugs for the treatment of hemophilic infections are beta-lactam antibiotics. Resistance to beta-lactams in hemophili is caused by the production of beta-lactamase or arises on the basis of mutations in the ftsI gene encoding penicillin-binding protein 3. These strains are referred to as rPBP3 (genotype showing a mutation in the ftsI transpeptidase region). According to the results of antibiotic resistance surveillance, the proportion of H. influenzae strains of the rPBP3 genotype is increasing in the Czech Republic. There is an assumption that cefuroxime stimulates the formation of rPBP3 H. influenzae more than aminopenicillins. In the Czech Republic, the proportion of rPBP3 strains increased during the same period when the consumption of cefuroxime increased twofold. The aim of the project NU21-09-00028, Characterization of Haemophilus influenzae strains with non-enzymatic resistance to beta-lactam antibiotics in the Czech Republic (2020–2024), was to assess possible risk factors associated with the development of non-enzymatic resistance in H. influenzae. Phylogenetic analysis did not demonstrate the spread of a specific clone. In vitro investigation of the effect of ampicillin and cefuroxime on the selection of mutations in the ftsI gene revealed differences in the selection potential of both antibiotics. It was shown that both antibiotics have the potential to cause mutations in PBP3, but exposure to cefuroxime tends to generate mutations more frequently compared to ampicillin. Also, in H. influenzae strains passaged in increasing concentrations of cefuroxime, there was a greater increase in the minimum inhibitory concentration compared to ampicillin. The increase in the prevalence of non-enzymatic resistance to beta-lactams in the Czech Republic was therefore probably more related to the increasing consumption of cefuroxime and increased selection pressure.

Acute otitis media (AOM) in children remains a key issue in pediatric practice due to its high incidence and impact on antibiotic prescribing. Modern diagnostic procedures emphasize the objectification of findings using magnifying otoscopy. Therapy focuses on the selective indication of antibiotics, the preference for basic penicillin antibiotics in risk groups , and the optimization of treatment duration. Emphasis is placed on analgesia, proper patient stratification, and support for antibiotic administration. This review summarizes current recommendations and new procedures aimed at more accurate diagnosis and individualized treatment of AOM in the pediatric population. The statement reflects the call of the European Academy of Pediatrics (EAP) as part of the global Choosing Wisely campaign.

Introduction:
Social networking sites represent a major space for social comparison during adolescence and may be linked to body dissatisfaction and eating disorder (ED) symptoms. In clinical practice, risk is often discussed primarily in terms of "screen time", although mechanisms such as negative social comparison and problematic use may be more informative than time alone.
Methods:
This is a cross-sectional study in a non-clinical sample of 267 girls (14-17 years old). Eating disorder symptoms were assessed using the EDE-Q questionnaire (22 items scored; α = 0.938). Instagram and TikTok use was measured by time spent, problematic use scales (Instagram 23 items; TikTok 25 items), and negative social comparison (5 items for each platform). Hypotheses were tested using hierarchical linear regression analysis with covariates (age, BMI, sleep, impulsivity).
Results:
Instagram was used by 93.6% and TikTok by 77.5% of respondents. EDE-Q scores correlated most strongly with negative social comparison (both p < 0.001), whereas associations with time spent were weak. Time spent on these social networking sites did not predict the level of EDE-Q score. In the fully adjusted model (Model C), negative social comparison was the strongest predictor (p < 0.001); BMI (p = 0.001) and sleep (p = 0.008) also remained statistically significant.
Conclusion:
In adolescent girls, eating disorder symptoms are more strongly associated with negative social comparison than with the amount of time spent on social networking sites. For clinical practice, these data support focusing preventive questions on areas such as appearance comparison and using social media for emotion regulation, rather than only on the number of hours spent on social media.

The article describes the history of the discovery of Legionnaires' disease, including the complications and confusion that accompanied this discovery. The second part of the text provides a brief summary of the pathogenesis of the disease, its diagnosis, and treatment.

Bacterial skin infections are some of the most commonly occurring infections of patients which visit pediatric and dermatology outpatient department. It is important to have a good understanding of the common clinical manifestations and patogens involved in bacterial skin infections to be able to manage them approprietely. Bacterial impetigo is one of the most common skin infection in childhood. The classification, etiology and current management of the disease is presented.

Streptococcus pneumoniae remains the leading cause of pneumonia in children under 5 years of age worldwide, despite established vaccination programs. This case report describes a severe course of pneumonia complicated with fluidothorax, lung atelectasis and necrosis of lung parenchyma, requiring surgical intervention. The causative pathogen was identified as Streptococcus pneumoniae, specifically serotype 3, which is included in the pneumococcal conjugate vaccine administered to the patient previously according to the recommended schedule. Serotype 3 in one of the most frequently reported pneumococcal serotypes assosiated with vaccine failure.

Bronchial asthma is the most common chronic inflammatory disease of the airways in childhood. Its prevalence ranges between 9-11%. The disease is characterized by chronic inflammation, bronchial hyperresponsiveness, and variable bronchial obstruction. In children, the clinical presentation varies depending on age. Diagnosis is based on the evaluation of medical history and clinical symptoms, as well as laboratory tests and, depending on age, available pulmonary function tests. Management is individual, age-specific, and includes anti-inflammatory and relief treatment, with the main goal being to achieve full disease control with minimal side effects. A fully controlled disease should not limit the patient's everyday activities. This text summarizes current knowledge on the epidemiology, pathophysiology, clinical manifestations, diagnosis, and treatment of bronchial asthma in childhood, with an emphasis on the specifics of different age groups.

Since most, exclusively genetically determined diseases manifest in childhood, genetics is an important part of pediatrics. Genetic testing should be considered, for example, in children with significant developmental delay, intellectual disability of unclear origin , dysmorphic features, abnormal physical growth, unusually early or severe onset of clinical conditions, or a positive family history of genetic disease. Genetic variations from the reference sequence range from a single nucleotide alteration in a DNA strand to changes in the number of entire chromosomes and can therefore be detected by various molecular or cytogenetic methods. The development of these techniques and the availability of testing also raise ethical issues that should be adequately considered. Completely new possibilities for gene therapy are also opening up. The recognition of genetically determined diseases will thus e nable adequate treatment decisions, assess potentially related comorbidities, and determine the risk of transmission to the offspring.

An 18-year-old girl was referred by a psychiatrist to pediatric department for examination due to weight loss and for objectifying her condition. The girl was already known to have celiac disease and hyperthyroidism due to autoimmune thyroid disease. Clear signs of advanced diabetic ketoacidosis were already present upon admission. The examination also considered other serious conditions, particularly Addison's disease or relapse of thyrotoxicosis. However, she apparently newly manifested type 1 diabetes mellitus with blood glucose 28.5 mmol/l, HbA1c 122 mmol/mol, and pH 6.985. The girl is now on an intensified insulin regimen and remains under the care of the diabetes and endocrine outpatient clinic. The discussion is focused on differential diagnosis of weight loss, and on associated autoimmune conditions.

The authors present case report of a mother and a daughter with a highly similar phenotype of generaliz ed overgrowth, musculoskeletal abnormalities, multiple dysmorphic features, recurrent respiratory tract infections, a range of neurodevelopmental and psychosocial difficulties, congenital heart defects and urogenital tract malformations. Following multiple genetic testing, whole-exome sequencing identified the same variant, c.370A>T, in the SUZ12 gene in both patients. This gene encodes a subunit of the polycomb repressive complex 2 (PRC2) which plays a crucial role in the regulation of gene expression during development. Variants of SUZ12 are associated with Imagawa-Matsumoto syndrome, a rare genetic condition with an estimated incidence of approximately 1 in 1,000.000. This case highlights the importance of novel genetic methods in diagnostic process of rare diseases.

Acute and subacute syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a common complication in acute medicine, including children. Long-term euvolemic hyponatremia is rare in children, except for long-term administration of drugs affecting natremia. It can be caused by various forms of SIADH. A case report of 14 years old boy with agenesis of the corpus callosum presents diagnostic and differential diagnostics options within the SIADH syndrome.

The role of the paediatrician is crucial in the care of children and adolescents with gender issues. Basic concepts facilitate communication with patients, their families, and among professionals. The new version of the International Classification of Diseases (ICD-11) offers a new perspective on the topic and introduces the term gender incongruence. In recent years, there has been a significant increase in the number of individuals, particularly adolescents, seeking medical care for gender issues, and the patient spectrum has also shifted. Consequently, recently developed and currently used care guidelines are undergoing reassessment because, considering changes in the patient population, they may no longer be universally applicable. At the same time, despite heated debates, it is crucial to maintain the quality of care for children and adolescents with gender issues, as has long been established in the Czech Republic, while staying informed about new scientific findings.

Artificial intelligence (AI) is rapidly finding its application in pediatrics across various areas of medicine. This review presents seven of the most current topics in the use of AI in pediatric care, including diagnostic imaging, predictive analytics for early warning of deterioration, personalized medicine with a focus on genomics and pharmacogenomics, support in diagnosing neurodevelopmental and behavioral disorders, intelligent clinical decision support systems, telemedicine and remote monitoring, as well as the ethical challenges related to implementing AI in children. In each of these domains, research already demonstrates tangible benefits - from improving t he accuracy and speed of diagnosis to enabling individualized treatment and more efficient care. At the same time, we highlight the specific characteristics of the pediatric population that require caution when developing and deploying AI, especially regarding data quality, safety, transparency, and ethical standards. For pediatricians, it is important to become familiar with both the possibilitie s and limitations of artificial intelligence in order to responsibly harness its potential to improve child healthcare.

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. It primarily affects the lungs but can involve any organ system. Children at higher risk include those from socioeconomically disadvantaged environments, with a family history of TB, of Roma ethnicity, or migrants from regions with a high incidence of tuberculosis. Therefore, TB can be regarded as a social disease caused by a bacterium. Diagnosis is based on three main pillars: the presence of an epidemiological link, a positive tuberculin skin test (TST) and interferon gamma release assay (IGRA), and characteristic radiological findings. Treatment consists of a combination of antituberculosis drugs and is best managed by a pulmonologist, ideally within a specialized pediatric TB center. Non- tuberculous mycobacterial infections (NTM) in children most commonly occur in toddlers, typically presenting as unilateral cervical lymphadenitis caused by Mycobacterium avium. The incidence of NTM lymphadenitis in children has clearly increased since the discontinuation of nationwide BCG vaccination.

Glucocorticoids are hormones of the adrenal cortex, whose synthetic derivatives are widely used in the therapy of various diseases, mainly due to their anti-inflammatory and immunosuppressive effects. However, their administration may result in so-called hypercortisolism, the clinical symptoms of which resemble the consequences of overproduction of endogenous glucocorticoids. This article presents the pathophysiological background of glucocorticoid induced changes in pediatric patients, the understanding of which is essential for proper therapeutic practice.

Congenital hypothyroidism is the most frequent inborn endocrine disorder and also the most frequent disease diagnosed by newborn screening. Nation-wide neonatal screening for congenital hypothyroidism was introduced in the Czech Republic 40 years ago. This article summarises its history and the present as well. Despite the fact that early diagnostics and immediate substitution treatment with levothyroxine are the main factors playing role in psychomotor, mental and somatic development of the majority of children with congenital hypothyroidism, more than 70 percent of babies worldwide are not born in the area with established neonatal screening.

Pneumococcal infections pose a significant threat to the pediatric population, especially infants and young children under 5 years of age. Vaccination against pneumococcal disease is among the most effective preventative measures in combating invasive pneumococcal diseases (IPD). The conjugate vaccine Prevenar 20 (PCV20) broadens the spectrum of serotypes compared to previous vaccine generations, offering new possibilities for protecting the pediatric population. This article focuses on current practical experiences with PCV20, results of studies, and the potential for its inclusion in the pediatric vaccination schedule in the Czech Republic.

The incidence of invasive pneumococcal disease (IPD) depends on age, the presence of chronic diseases and other risk factors. Young children under 4 years of age are among the most at risk age groups. In the Czech Republic (CZ), pneumococcal diseases are a significant cause of morbidity and mortality in children. In 2023, the recorded morbidity rate was 4.4/100,000 in the 0-11 months age group and 7.1/100,000 in the 1-4 years age group. In 2020-2023, 4 children died in the 0-4 years age group in the CZ. Voluntary, fully-funded vaccination of children, including selected health-risk groups, is currently in place in the CZ. The recommended and covered vaccines are 20/15/13 valent conjugate vaccines. The preferred vaccines for childhood vaccination are PCV20 and PCV15. Vaccination coverage with at least one dose of some vaccine was reported to be 76.4% for children born in 2022. With the increasing numbers of pneumococcal serotypes in vaccines, the theoretical coverage and prevention of IPD cases is increasing. In 2019-2023, the theoretical coverage of IPD cases in the 0-11 months age group would be 38% for PCV13, 45% for PCV15 and 62% for PCV20. The most common pneumococcal serotypes in IPD cases in 2023 in the CZ were 3, 19A and 8. Serotypes 3 and 19A are included in all recommended conjugate vaccines (PCV20, PCV15, PCV13). Serotype 8 is included and therefore potentially covered only in PCV20. To achieve the maximum benefit of vaccination in children, the earliest possible vaccination is the most optimal.

Vaccination during pregnancy is one of the preventive procedures used worldwide, leading to a reduction in morbidity and mortality of both pregnant women and, in particular, their newborn children. The safety and effectiveness of these measures have been verified. The article provides a basic overview of four infectious diseases against which vaccination during pregnancy can be used: pertussis, in fluenza, RSV infection and SARS-CoV-2 infection. The risk factors for their development and possible complications that can affect both - the pregnant woman and the newborn child - are discussed. The space is devoted in particular to the recommended procedure for vaccination against these diseases, the vaccines used, their safety, adverse effects and the method of transmission of maternal antibodi es to the fetus. The ideal vaccination schedule for pregnant women is presented. Other options for vaccination during pregnancy are also mentioned, in specific situations.

The benefits of vaccinating pregnant women clearly outweigh the risks that threaten both mother and child if they fall ill with an infectious disease. Vaccination during pregnancy is beneficial not only for the mother, but also for the newborn, who receives protection from the mother through maternal antibodies. Newborns and infants are thus protected until they are vaccinated themselves. Vaccination against influenza, pertussis, covid-19 and respiratory syncytial virus (RSV) infection is indicated for all pregnant women. Influenza vaccination effectively prevents infection in pregnant women as well as in their newborns and infants through the transmission of maternal antibodies. All women should be vaccinated against influenza during every pregnancy in order to protect the woman, pregnancy and child in the first months of life. Pregnant women should also be vaccinated with the covid-19 vaccine for that season during any trimester of pregnancy, regardless of gestational age. Like the flu vaccine, vaccination protects both the pregnant woman and her baby. The timing of vaccination can be adapted to the current situation of community spread of the SARS CoV 2 virus in the population. Vaccination against pertussis during pregnancy reduces the risk of the disease for the pregnant woman, but above all it effectively protects the child in the first months of life. After birth, the child is protected by maternal antibodies against a severe course of the disease during the most critical period of the first two months of life, when it cannot yet be vaccinated. In the case of RSV vaccination, the vaccinated woman is actively immunized and newborns and infants are also passively immunized and can receive protection against RSV infection from birth until 6 months of age. The pediatrician, who will become the future registering physician and who may also take care of siblings, should be one of those who explains the risks of specific diseases and may even be involved in the vaccination of pregnant women. Thanks to the possible sharing of data on vaccinations performed in the electronic system from 2023, the argument of unavailable information in the case of vaccination for other healthcare professionals is eliminated.