Berthold Koletzko

Aim: Recruitment and retention are significant issues in paediatrics. High workload, poor working conditions, and burnout are reported. Burnout is associated with physician ill‐health and dissatisfaction at work. Understanding burnout among paediatric residents may aid in supporting doctors' wellbeing and maintaining a sustainable paediatric workforce. We aimed to establish the prevalence of burnout in European paediatric residents and identify associated factors. Methods: A survey was disseminated via SurveyMonkey via the Young European Academy of Paediatrics (YEAP) to residents. Demographic data was collected; burnout was assessed using the Copenhagen Burnout Inventory (CBI). Burnout prevalence was calculated, regression analysis performed on potential associated factors, and COVID‐19 impact assessed. Content analysis was performed on free text responses. Results: Two hundred and five residents from 11 countries responded. 60% (124/205) scored as burnt‐out (43% primarily personally related, 15% primarily work‐related or patient related). Thirty‐nine percent considered quitting paediatric training. Scoring as burnt‐out was associated with lack of training flexibility, working over 40 h/week and 24‐h oncall. Content analysis highlighted practical organisational challenges, excessive administrative work and additional working outside of working hours. COVID‐19 increased burnout and impacted on training for 73%. Conclusion: Burnout remains a significant issue. Modifiable workplace factors contribute to burnout and are urgent targets for change.

Physical activity (PA) supports health across the life course, yet the biological pathways linking habitual PA to long-term health remain incompletely understood. Metabolomics provides a powerful tool to study PA-related metabolic adaptations, but how habitual PA shapes the metabolome in childhood remains poorly characterized. Addressing this gap, we examined cross-sectional associations between accelerometer-measured habitual PA and the plasma metabolome in 515 children aged 5.5 to 11 years from the European Childhood Obesity Project (CHOP) and additionally determined whether associations differed between sexes and across the body mass index (BMI) range. Using targeted metabolomics, we quantified 315 metabolites and derived 91 metabolite sums and ratios. Associations with PA were assessed using linear mixed-effects models. Replication was performed in an independent pediatric cohort. Among the 406 metabolite variables, 73 were associated (p < 0.05) with at least one PA variable, of which 12 replicated, including lysophosphatidylcholine (LPC) a C14:0 and LPCs/phosphatidylcholines (PCs) with higher levels in more active children, and PC aa C40:6, monounsaturated PCs/saturated PCs, and valine/LPC a C18:1 with lower levels in more active children. At the metabolite-class level, intensity-dependent association patterns emerged. Amino acids and acylcarnitines were lower in more active children predominantly for time spent in higher-intensity PA, whereas LPCs were higher mainly with more total PA (80% light PA) and less sedentary time. Associations were more pronounced at older ages and differed (p < 0.05) by BMI for 42 metabolite variables and by sex for 45 variables in the interaction analyses. These findings provide insights into PA-related metabolic adaptations early in life and may help elucidate biological pathways linking childhood PA to long-term health.

Background/Objectives: As birth weight is related to later obesity risk, its associations with maternal pre-pregnancy body mass index (BMI) and leptin values in serum during pregnancy are of interest for obesity prevention. This study aimed to describe the association of leptin levels in maternal circulation and cord blood as well as pre-pregnancy BMI (pBMI) with infant anthropometry at birth and until the age of four months. Methods: Data on maternal pBMI, at delivery and four months after birth, and on infant weight and length at delivery and at age four months were collected in an observational study in Bangkok, Thailand. In a subgroup of 38 mother–infant dyads, leptin was measured in maternal blood serum at delivery and infant age 4 months and in cord and infant serum at 4 months. Associations were tested with correlation and multiple linear regression analyses in this explorative study. Results: The maternal serum leptin was 32.4 ± 17.8 ng/mL at delivery and 11.1 ± 8.9 ng/mL at four months (p < 0.001 for difference) and correlated (r = 0.45). Cord serum leptin was significantly higher in female than male infants (17.5 ± 9.8 ng/mL vs. 7.7 ± 4.9 ng/mL, p < 0.05) and not related to infant leptin at age four months. There was no significant association between maternal and cord serum leptin levels. Birth weight was strongly associated with pBMI (standardized β = 0.77, p < 0.001) and inversely related to maternal delivery leptin levels (standardized β = −0.44, p = 0.008), while the association with cord serum leptin was not significant. Conclusions: Our findings indicate that pBMI is strongly related to birth weight, while higher maternal leptin concentrations were independently associated with lower birth weight after accounting for pBMI. Cord serum leptin did not significantly correlate with maternal leptin levels and only tended to be positively associated with birth weight.

Since late 2025, precautionary recalls of specific infant and follow‐on formula batches in Europe have occurred due to contamination with cereulide, a heat‐ and acid‐stable emetic toxin produced by certain Bacillus cereus strains. Contamination was traced to arachidonic acid (ARA)‐containing algal oil from a single supplier; no viable bacteria were detected in the affected products. The European Food Safety Authority established a conservative acute reference dose for infants, and available monitoring data indicate that detected concentrations were generally low and unlikely to pose significant health risks, although some batches may have exceeded precautionary thresholds. This commentary reviews the toxicological background, current risk assessment, analytical challenges, and clinical implications. While cereulide should not be present beyond unavoidable trace levels in infant formula, risk management must remain proportionate and avoid promoting nutritionally inadequate substitutes. Ensuring validated analytical surveillance, stringent raw material control, transparent communication, and continued provision of appropriately regulated formulas containing recommended long‐chain polyunsaturated fatty acids, including docosahexaenoic acid (DHA) and ARA, is essential to safeguard infant health and maintain public confidence.

Zusammenfassung: Die seit vielen Jahren von der WHO kritisierten und kontrovers diskutierten Interaktionen von PädiaterInnen und ihrer Fachorganisationen mit kommerziellen Anbietern diätetischer Lebensmittel waren Thema einer Expertendiskussion im Rahmen des 51. DACH-Symposiums für pädiatrische Präventiv- und Ernährungsmedizin der ÖGKJ im Januar 2026. Alle Teilnehmer sprechen sich für eine proaktive Förderung, Schutz und Unterstützung des Stillens als bester Form der Säuglingsernährung aus, insbesondere auch durch KinderärztInnen. Die Regelungen für die angemessene Vermarktung von Säuglingsnahrungen bedürfen aus Sicht der Pädiatrie weiterer Anpassungen, insbesondere hinsichtlich der Begrenzung der Bewerbung von Folgenahrungen für Säuglinge und der digitalen und Influencer-basierten Werbung. Interaktionen von PädiaterInnen und ihrer Organisationen mit kommerziellen Akteuren tragen Risiken potenzieller Interessenkonflikte und erfordern klare gesetzliche und berufsrechtliche Regelungen sowie die Einhaltung transparenter Verhaltenskodizes. Eine finanzielle Förderung von Kongressen und anderen edukativen und wissenschaftlichen Aktivitäten medizinisch-wissenschaftlicher Fachgesellschaften und Berufsorganisationen durch kommerzielle Akteure ist nur eine Option, sofern stringente gesellschaftliche, rechtliche, wissenschaftliche und ethische Standards eingehalten werden. Dazu zählen insbesondere der Ausschluss jeglichen Einflusses auf Programm und Inhalte sowie die Sicherstellung der Transparenz über finanzielle Unterstützungen. Risiken bestehen sektorenübergreifend, sodass entsprechende Regelungen einheitlich für alle Unternehmen anzuwenden sind. Die Pädiatrie fordert die Unternehmen zur Einstellung ihrer Förderung rein kommerzieller ausgerichteter Fortbildungsformate, welche ohne Leitung durch eine seriöse pädiatrische Organisation angeboten werden und sich direkt gegen die Interessen der Pädiatrie und oftmals auch der Kindergesundheit und der Allgemeinheit wenden. Die öffentliche Förderung pädiatrischer Fortbildung sollte nachhaltig gestärkt werden, um den Anteil kommerzieller Sponsoren an der Fortbildungsfinanzierung zu reduzieren.

The recently published German evidence-based guideline on “Breastfeeding Duration” recommends that infants in Germany should be exclusively or predominantly breastfed for 6 months, with a total breastfeeding duration of 12 months. These recommendations rely exclusively on low- and very low-certainty evidence, and fall short of what would be expected for an evidence-based guideline. The guideline has been criticized by a large number of eight professional organizations, which is very unusual. As delegates or deputy delegates of our respective medical-scientific societies participating in the six-year guideline development process, we disagree with the published guideline recommendations and present here our key methodological and content-related concerns. In our view, there is no sufficient evidence that would demonstrate superiority of the proposed recommendation with respect to benefits and harms compared to the long-standing recommendation of exclusive breastfeeding for 4–6 months and continued breastfeeding for as long as mother and child desire for healthy populations in Germany and Western Europe.

Purpose: While the Mediterranean diet (MD) is associated with numerous health benefits, in children there is limited information on effects of assessment methods, cross-country differences, and the tracking of MD adherence over time. We aimed to compare and combine dietary assessment tools in young children, to provide an informative method for scoring adherence to MD, and to examine cross-country variations. Methods: 3-Day Food Diaries (3-DFD) and Food Frequency Questionnaires (FFQ) were assessed at 4 time points during the ages of 3 to 6 years across five European countries: Belgium, Germany, Italy, Poland, and Spain. Information from both tools was used to calculate the Mediterranean Diet Quality Index for children and adolescents (KIDMED), both independently and in combination. For the latter, country and time point differences were examined. Individual diet score variance per country across time points was determined using Intraclass Correlation Coefficient (ICC). Results: The combined KIDMED score (3.76 ± 2.28) was higher compared to both the FFQ (3.31 ± 2.33) and the 3-DFD score (1.78 ± 2.45) across follow-ups. The combined KIDMED score was higher in Mediterranean countries (Italy 5.00 ± 1.60; Spain 4.54 ± 1.70) than non-Mediterranean countries (Belgium 1.96 ± 2.07; Germany 3.13 ± 2.01; Poland 1.65 ± 2.12) ( p < 0.01), driven by more children from Mediterranean countries consuming fruits , vegetables , fish , pulses , and olive oil . The combined KIDMED score was rather stable over time. Intra-individual consistency over time was poor to moderate (Germany: 0.620, Belgium: 0.604, Italy: 0.429, Poland: 0.564, and Spain: 0.493). Conclusions: Combining FFQ and 3-DFD led to a higher KIDMED score reflecting more detected details of frequencies in food consumption. MD adherence was poor to moderate and remained stable over time in early childhood, suggesting that dietary patterns established at a young age are likely to persist. Trial registration: This trial was registered at clinicaltrials.gov as NCT00338689 .