{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T23:12:42Z","timestamp":1785539562762,"version":"3.56.0"},"reference-count":130,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T00:00:00Z","timestamp":1773964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>Despite considerable research and established guidelines, postoperative pain management in children remains suboptimal. This review aims to outline the significant developments in pediatric postoperative pain management over the past decade and to provide updated, evidence-based recommendations. A comprehensive literature search was conducted across major databases, followed by detailed analysis. In addition to the core strategies of systemic non-opioids, systemic opioids, and regional analgesia, two major developments have significantly affected clinical practice: the widespread implementation of Enhanced Recovery After Surgery (ERAS) protocols and the emerging research on chronic postsurgical pain (CPSP). ERAS protocols have played a crucial role by incorporating minimally invasive surgical techniques, which effectively reduce postoperative pain and accelerate recovery. A fundamental component of ERAS is the intentional minimization of opioid exposure, achieved through standardized opioid-sparing multimodal protocols and the proactive application of regional anesthesia. Concurrently, there is increasing awareness of CPSP as a significant long-term complication. Although its pathophysiology mechanisms remain incompletely understood, but research has shown a strong statistical correlation between CPSP development and both high levels of postoperative pain intensity and increased opioid consumption. This connection guides current preventive strategies, as CPSP affects up to 50% of pediatric surgical patients, with a higher prevalence after major surgeries. Consequently, optimizing acute pain management within an ERAS framework\u2014by reducing both pain and opioid use\u2014is hypothesized to serve as a protective measure against CPSP. Finally, effective postoperative pain management in children requires a multifaceted approach. This includes multidisciplinary collaboration, adherence to standardized, evidence-based protocols, continuous professional education, and individualized patient follow-up.<\/jats:p>","DOI":"10.3389\/fped.2026.1777446","type":"journal-article","created":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T05:23:17Z","timestamp":1773984197000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Postoperative pain management in children"],"prefix":"10.3389","volume":"14","author":[{"given":"Pierre","family":"Pardessus","sequence":"first","affiliation":[{"name":"Universit\u00e9 de Paris-Cit\u00e9","place":["Paris, France"]},{"name":"Department of Anesthesia and Intensive Care, Robert Debr\u00e9 University Hospital","place":["Paris, France"]},{"name":"FHU I2D2, Robert Debr\u00e9 University Hospital","place":["Paris, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yara","family":"Maroun","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Paris-Cit\u00e9","place":["Paris, France"]},{"name":"Department of Anesthesia and Intensive Care, Robert Debr\u00e9 University Hospital","place":["Paris, France"]},{"name":"FHU I2D2, Robert Debr\u00e9 University Hospital","place":["Paris, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynda","family":"Ferahtia","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Robert Ballanger Hospital","place":["Aulnay-Sous-Bois, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zied","family":"Sammoud","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Robert Ballanger Hospital","place":["Aulnay-Sous-Bois, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Refka","family":"Kaddour","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Robert Ballanger Hospital","place":["Aulnay-Sous-Bois, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiraz","family":"El Bachraoui","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Robert Ballanger Hospital","place":["Aulnay-Sous-Bois, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myriam","family":"Abdelmassih","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Robert Ballanger Hospital","place":["Aulnay-Sous-Bois, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joelle","family":"Saroufim","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Robert Ballanger Hospital","place":["Aulnay-Sous-Bois, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Brouns","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Paris-Cit\u00e9","place":["Paris, France"]},{"name":"Department of Anesthesia and Intensive Care, Robert Debr\u00e9 University Hospital","place":["Paris, France"]},{"name":"FHU I2D2, Robert Debr\u00e9 University Hospital","place":["Paris, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Julien-Marsollier","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Paris-Cit\u00e9","place":["Paris, France"]},{"name":"Department of Anesthesia and Intensive Care, Robert Debr\u00e9 University Hospital","place":["Paris, France"]},{"name":"FHU I2D2, Robert Debr\u00e9 University Hospital","place":["Paris, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Benkalifa","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care, Robert Ballanger Hospital","place":["Aulnay-Sous-Bois, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Souhayl","family":"Dahmani","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Paris-Cit\u00e9","place":["Paris, France"]},{"name":"Department of Anesthesia and Intensive Care, Robert Debr\u00e9 University Hospital","place":["Paris, France"]},{"name":"FHU I2D2, Robert Debr\u00e9 University Hospital","place":["Paris, France"]},{"name":"Department of Anesthesia and Intensive Care, Robert Ballanger Hospital","place":["Aulnay-Sous-Bois, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,20]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1007\/s40272-013-0062-0","article-title":"Postoperative pain management in children and infants: an update","volume":"16","author":"Brasher","year":"2014","journal-title":"Paediatr Drugs"},{"key":"B2","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1111\/pan.12170","article-title":"Postoperative pain, nausea and vomiting following adeno-tonsillectomy\u2014a long-term follow-up","volume":"23","author":"Stanko","year":"2013","journal-title":"Paediatr Anaesth"},{"key":"B3","doi-asserted-by":"publisher","first-page":"100159","DOI":"10.1016\/j.pcorm.2021.100159","article-title":"Prevalence and contributing factors associated with postoperative pain in pediatric patients: a cross-sectional follow-up study","volume":"23","author":"Mekonnen","year":"2021","journal-title":"Perioper Care Oper Room Manag"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1037","DOI":"10.1213\/ANE.0000000000007352","article-title":"Comparative effectiveness of analgesia for early pain management after pediatric tonsillectomy: a systematic review and network meta-analysis","volume":"141","author":"Deng","year":"2025","journal-title":"Anesth Analg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"101427","DOI":"10.1016\/j.accpm.2024.101427","article-title":"Postoperative pain management in children: guidance from the pain committee of the European Society for Paediatric Anaesthesiology (ESPA pain management ladder initiative) part II","volume":"43","author":"Vittinghoff","year":"2024","journal-title":"Anaesth Crit Care Pain Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1016\/j.sjpain.2017.09.002","article-title":"Predictors of chronic neuropathic pain after scoliosis surgery in children","volume":"17","author":"Julien-Marsollier","year":"2017","journal-title":"Scand J Pain"},{"key":"B7","doi-asserted-by":"publisher","first-page":"679","DOI":"10.2217\/pmt-2020-0100","article-title":"Effects of opioid-reduced anesthesia during scoliosis surgery in children: a prospective observational study","volume":"11","author":"Julien-Marsollier","year":"2021","journal-title":"Pain Manag"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1222","DOI":"10.1016\/j.surg.2024.06.035","article-title":"Surgery and pain relief: a closer look at opioid prescription trends","volume":"176","author":"Sutyak","year":"2024","journal-title":"Surgery"},{"key":"B9","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1111\/j.1460-9592.2008.02433.x","article-title":"Postoperative pain assessment in preverbal children and children with cognitive impairment","volume":"18","author":"Ghai","year":"2008","journal-title":"Paediatr Anaesth"},{"key":"B10","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1016\/j.pain.2006.08.014","article-title":"Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years","volume":"127","author":"von Baeyer","year":"2007","journal-title":"Pain"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1212","DOI":"10.3390\/children10071212","article-title":"Pain evaluation and treatment in children: a practical approach","volume":"10","author":"Sansone","year":"","journal-title":"Children (Basel)"},{"key":"B12","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/j.jpain.2010.10.002","article-title":"Development of a 10-item short form of the parents' Postoperative pain measure: the PPPM-SF","volume":"12","author":"von Baeyer","year":"2011","journal-title":"J Pain"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2132","DOI":"10.1097\/j.pain.0000000000000305","article-title":"Systematic review of the face, legs, activity, cry and consolability scale for assessing pain in infants and children: is it reliable, valid, and feasible for use?","volume":"156","author":"Crellin","year":"2015","journal-title":"Pain"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1185","DOI":"10.2147\/JPR.S397064","article-title":"A systematic review of the measurement properties of face, legs, activity, cry and consolability scale for pediatric pain assessment","volume":"16","author":"Peng","year":"2023","journal-title":"J Pain Res"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1097379","DOI":"10.3389\/fpain.2023.1097379","article-title":"Digital health in pain assessment, diagnosis, and management: overview and perspectives","volume":"4","author":"Hadjiat","year":"2023","journal-title":".Front Pain Res (Lausanne)"},{"key":"B16","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1002\/pan.70096","article-title":"Evaluation of the nociception level Index (NOL) for intraoperative analgesia monitoring in pediatrics","volume":"36","author":"Julien-Marsollier","year":"2026","journal-title":"Paediatr Anaesth"},{"key":"B17","doi-asserted-by":"publisher","first-page":"462","DOI":"10.1016\/j.bja.2018.03.034","article-title":"Evaluation of the analgesia nociception index for monitoring intraoperative analgesia in children","volume":"121","author":"Julien-Marsollier","year":"2018","journal-title":"Br J Anaesth"},{"key":"B18","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1093\/bja\/aev361","article-title":"Postoperative pain assessment in children: a pilot study of the usefulness of the analgesia nociception index","volume":"115","author":"Gall","year":"2015","journal-title":"Br J Anaesth"},{"key":"B19","doi-asserted-by":"publisher","first-page":"2862","DOI":"10.1038\/s41598-022-06993-z","article-title":"Comparison between analgesia nociception Index (ANI) and self-reported measures for diagnosing pain in conscious individuals: a systematic review and meta-analysis","volume":"12","author":"Baroni","year":"2022","journal-title":"Sci Rep"},{"key":"B20","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1111\/j.1460-9592.2011.03566.x","article-title":"Ketamine for perioperative pain management in children: a meta-analysis of published studies","volume":"21","author":"Dahmani","year":"2011","journal-title":"Paediatr Anaesth"},{"key":"B21","doi-asserted-by":"publisher","first-page":"55","DOI":"10.4037\/ajcc2010624","article-title":"Reliability and validity of the face, legs, activity, cry, consolability behavioral tool in assessing acute pain in critically ill patients","volume":"19","author":"Voepel-Lewis","year":"2010","journal-title":"Am J Crit Care"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1180","DOI":"10.1007\/s12630-013-0043-3","article-title":"Randomized comparison between the combination of Acetaminophen and ibuprofen and each constituent alone for analgesia following tonsillectomy in children","volume":"60","author":"Merry","year":"2013","journal-title":"Can J Anaesth"},{"key":"B23","doi-asserted-by":"publisher","first-page":"841","DOI":"10.1111\/pan.13464","article-title":"Acetaminophen, ibuprofen, and tramadol analgesic interactions after adenotonsillectomy","volume":"28","author":"Hannam","year":"2018","journal-title":"Paediatr Anaesth"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1875","DOI":"10.2106\/JBJS.23.00223","article-title":"Opioid analgesia compared with non-opioid analgesia after operative treatment for pediatric supracondylar humeral fractures: results from a prospective multicenter trial","volume":"105","author":"Belardo","year":"2023","journal-title":"J Bone Joint Surg Am"},{"key":"B25","doi-asserted-by":"publisher","first-page":"168","DOI":"10.1213\/ANE.0000000000005284","article-title":"Comparison of monotherapy versus combination of intravenous ibuprofen and propacetamol (Acetaminophen) for reduction of postoperative opioid administration in children undergoing laparoscopic hernia repair: a double-blind randomized controlled trial","volume":"133","author":"Lee","year":"2021","journal-title":"Anesth Analg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1007\/s12630-025-02921-7","article-title":"Prolonged opioid use after surgery in children, adolescents, and young adults: a systematic review","volume":"72","author":"Sun","year":"2025","journal-title":"Can J Anaesth"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e207367","DOI":"10.1001\/jamanetworkopen.2020.7367","article-title":"Rate and risk factors associated with prolonged opioid use after surgery: a systematic review and meta-analysis","volume":"3","author":"Lawal","year":"2020","journal-title":"JAMA Netw Open"},{"key":"B28","doi-asserted-by":"publisher","first-page":"e20172439","DOI":"10.1542\/peds.2017-2439","article-title":"Persistent opioid use among pediatric patients after surgery","volume":"141","author":"Harbaugh","year":"2018","journal-title":"Pediatrics"},{"key":"B29","doi-asserted-by":"publisher","first-page":"585","DOI":"10.1007\/s00405-018-5202-2","article-title":"The use of steroids to reduce complications after tonsillectomy: a systematic review and meta-analysis of randomized controlled studies","volume":"276","author":"Titirungruang","year":"2019","journal-title":"Eur Arch Otorhinolaryngol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1007\/s12630-024-02817-y","article-title":"Effects of dexamethasone on opioid consumption in pediatric tonsillectomy: a systematic review with meta-analysis","volume":"72","author":"Niimi","year":"2025","journal-title":"Can J Anaesth"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1731","DOI":"10.1056\/NEJMoa2028982","article-title":"Dexamethasone and surgical-site infection","volume":"384","author":"Corcoran","year":"2021","journal-title":"N Engl J Med"},{"key":"B32","doi-asserted-by":"publisher","first-page":"2621","DOI":"10.1001\/jama.2008.794","article-title":"Dexamethasone and risk of nausea and vomiting and postoperative bleeding after tonsillectomy in children: a randomized trial","volume":"300","author":"Czarnetzki","year":"2008","journal-title":"JAMA"},{"key":"B33","doi-asserted-by":"publisher","first-page":"1221","DOI":"10.1001\/2012.jama.11575","article-title":"Perioperative dexamethasone administration and risk of bleeding following tonsillectomy in children: a randomized controlled trial","volume":"308","author":"Gallagher","year":"2012","journal-title":"JAMA"},{"key":"B34","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1007\/s11916-023-01137-y","article-title":"Rational multimodal analgesia for perioperative pain management","volume":"27","author":"Joshi","year":"2023","journal-title":"Curr Pain Headache Rep"},{"key":"B35","doi-asserted-by":"publisher","first-page":"101706","DOI":"10.1016\/j.accpm.2025.101706","article-title":"Oral prednisolone for postoperative analgesia management in paediatrics tonsillectomy: a meta-analysis of published studies","volume":"45","author":"Pardessus","year":"2025","journal-title":"Anaesth Crit Care Pain Med"},{"key":"B36","doi-asserted-by":"publisher","first-page":"1153","DOI":"10.1001\/jamapediatrics.2025.3099","article-title":"Digital health interventions in pediatric perioperative care: a network meta-analysis","volume":"179","author":"Luo","year":"2025","journal-title":"JAMA Pediatr"},{"key":"B37","doi-asserted-by":"publisher","first-page":"1872","DOI":"10.1097\/j.pain.0000000000000636","article-title":"Psychological interventions in managing postoperative pain in children: a systematic review","volume":"157","author":"Davidson","year":"2016","journal-title":"Pain"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1710","DOI":"10.1213\/ANE.0000000000005255","article-title":"Parental psychosocial factors moderate opioid administration following Children's surgery","volume":"132","author":"Kain","year":"2021","journal-title":"Anesth Analg"},{"key":"B39","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1097\/00000542-200701000-00013","article-title":"Family-centered preparation for surgery improves perioperative outcomes in children: a randomized controlled trial","volume":"106","author":"Kain","year":"2007","journal-title":"Anesthesiology"},{"key":"B40","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1542\/peds.2005-2920","article-title":"Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery","volume":"118","author":"Kain","year":"2006","journal-title":"Pediatrics"},{"key":"B41","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1097\/00000542-200007000-00024","article-title":"Attenuation of the preoperative stress response with midazolam: effects on postoperative outcomes","volume":"93","author":"Kain","year":"2000","journal-title":"Anesthesiology"},{"key":"B42","doi-asserted-by":"publisher","first-page":"112031","DOI":"10.1016\/j.jclinane.2025.112031","article-title":"The impact of preoperative carbohydrate ingestion one hour before surgery on children's preoperative anxiety and postoperative pain under ultrasound monitoring: a randomized controlled trial","volume":"107","author":"Zhang","year":"2025","journal-title":"J Clin Anesth"},{"key":"B43","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1093\/bja\/aew463","article-title":"Early postoperative oral fluid intake in paediatric day case surgery influences the need for opioids and postoperative vomiting: a controlled randomized trial\u2020","volume":"118","author":"Chauvin","year":"2017","journal-title":"Br J Anaesth"},{"key":"B44","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1016\/j.accpm.2017.11.013","article-title":"Paediatric minimally invasive abdominal and urological surgeries: current trends and perioperative management","volume":"37","author":"Bellon","year":"2018","journal-title":"Anaesth Crit Care Pain Med"},{"key":"B45","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1016\/j.euros.2023.03.004","article-title":"Day surgery in children undergoing retroperitoneal robot-assisted laparoscopic pyeloplasty: is it safe and feasible?","volume":"51","author":"Broch","year":"2023","journal-title":"Eur Urol Open Sci"},{"key":"B46","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1001\/archoto.2011.93","article-title":"Modern technology-assisted vs conventional tonsillectomy: a meta-analysis of randomized controlled trials","volume":"137","author":"Alexiou","year":"2011","journal-title":"Arch Otolaryngol Head Neck Surg"},{"key":"B47","doi-asserted-by":"publisher","first-page":"481945","DOI":"10.1155\/2015\/481945","article-title":"Minimally invasive scoliosis surgery: a novel technique in patients with neuromuscular scoliosis","volume":"2015","author":"Sarwahi","year":"2015","journal-title":"BioMed Res Int"},{"key":"B48","doi-asserted-by":"publisher","first-page":"1068","DOI":"10.1111\/pan.13988","article-title":"Enhanced recovery after surgical correction of adolescent idiopathic scoliosis","volume":"30","author":"Julien-Marsollier","year":"2020","journal-title":"Paediatr Anaesth"},{"key":"B49","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1007\/s43390-021-00310-w","article-title":"Enhanced recovery after surgery (ERAS) in adolescent idiopathic scoliosis (AIS): a meta-analysis and systematic review","volume":"9","author":"Gadiya","year":"2021","journal-title":"Spine Deform"},{"key":"B50","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1111\/pan.13380","article-title":"Enhanced recovery after surgery in children: promising, evidence-based multidisciplinary care","volume":"28","author":"Rove","year":"2018","journal-title":"Paediatr Anaesth"},{"key":"B51","doi-asserted-by":"publisher","first-page":"46","DOI":"10.21037\/tgh-20-188","article-title":"Enhanced recovery after surgery in children","volume":"6","author":"Rafeeqi","year":"2021","journal-title":"Transl Gastroenterol Hepatol"},{"key":"B52","doi-asserted-by":"publisher","first-page":"473","DOI":"10.1177\/0003134820951440","article-title":"The enhanced recovery after surgery (ERAS) elements that most greatly impact length of stay and readmission","volume":"87","author":"Olson","year":"2021","journal-title":"Am Surg"},{"key":"B53","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1111\/pan.13639","article-title":"The society for pediatric anesthesia recommendations for the use of opioids in children during the perioperative period","volume":"29","author":"Cravero","year":"2019","journal-title":"Paediatr Anaesth"},{"key":"B54","doi-asserted-by":"publisher","first-page":"e2024068752","DOI":"10.1542\/peds.2024-068752","article-title":"Opioid prescribing for acute pain management in children and adolescents in outpatient settings: clinical practice guideline","author":"Hadland","year":"2024","journal-title":"Pediatrics"},{"key":"B55","doi-asserted-by":"publisher","first-page":"2009","DOI":"10.1007\/s00134-003-1899-4","article-title":"Postoperative pain in the neonate: age-related differences in morphine requirements and metabolism","volume":"29","author":"Bouwmeester","year":"2003","journal-title":"Intensive Care Med"},{"key":"B56","doi-asserted-by":"publisher","first-page":"642","DOI":"10.1093\/bja\/aeg121","article-title":"Age- and therapy-related effects on morphine requirements and plasma concentrations of morphine and its metabolites in postoperative infants","volume":"90","author":"Bouwmeester","year":"2003","journal-title":"Br J Anaesth"},{"key":"B57","doi-asserted-by":"publisher","first-page":"51","DOI":"10.2165\/11536750-000000000-00000","article-title":"Predictive performance of a recently developed population pharmacokinetic model for morphine and its metabolites in new datasets of (preterm) neonates, infants and children","volume":"50","author":"Krekels","year":"2011","journal-title":"Clin Pharmacokinet"},{"key":"B58","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1213\/ANE.0000000000001244","article-title":"Patient-Controlled analgesia plus background opioid infusion for postoperative pain in children: a systematic review and meta-analysis of randomized trials","volume":"123","author":"Hayes","year":"2016","journal-title":"Anesth Analg"},{"key":"B59","doi-asserted-by":"publisher","first-page":"e753","DOI":"10.1542\/peds.2014-2673","article-title":"A case of respiratory depression in a child with ultrarapid CYP2D6 metabolism after tramadol","volume":"135","author":"Orliaguet","year":"2015","journal-title":"Pediatrics"},{"key":"B60","doi-asserted-by":"publisher","first-page":"1662","DOI":"10.1213\/01.ane.0000216036.95705.c2","article-title":"Development of acute opioid tolerance during infusion of remifentanil for pediatric scoliosis surgery","volume":"102","author":"Crawford","year":"2006","journal-title":"Anesth Analg"},{"key":"B61","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1097\/00000542-200008000-00019","article-title":"Acute opioid tolerance: intraoperative remifentanil increases postoperative pain and morphine requirement","volume":"93","author":"Guignard","year":"2000","journal-title":"Anesthesiology"},{"key":"B62","doi-asserted-by":"publisher","first-page":"145","DOI":"10.36076\/ppj.2011\/14\/145","article-title":"A comprehensive review of opioid-induced hyperalgesia","volume":"14","author":"Lee","year":"2011","journal-title":"Pain Physician"},{"key":"B63","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1097\/ACO.0000000000000110","article-title":"Chronic pain after surgery in children","volume":"27","author":"Nikolajsen","year":"2014","journal-title":"Curr Opin Anaesthesiol"},{"key":"B64","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1093\/bja\/aew260","article-title":"Chronic postsurgical pain in children: prevalence and risk factors. A prospective observational study","volume":"117","author":"Batoz","year":"2016","journal-title":"Br J Anaesth"},{"key":"B65","doi-asserted-by":"publisher","first-page":"1252","DOI":"10.1002\/ejp.1025","article-title":"Predicting the pain continuum after adolescent idiopathic scoliosis surgery: a prospective cohort study","volume":"21","author":"Chidambaran","year":"2017","journal-title":"Eur J Pain"},{"key":"B66","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1213\/ANE.0000000000001984","article-title":"Intraoperative \u201canalgesia nociception index\"-guided fentanyl administration during sevoflurane anesthesia in lumbar discectomy and laminectomy: a randomized clinical trial","volume":"125","author":"Upton","year":"2017","journal-title":"Anesth Analg"},{"key":"B67","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1213\/ANE.0000000000006947","article-title":"Perioperative regional anesthesia on persistent opioid use and chronic pain after noncardiac surgery: a systematic review and meta-analysis of randomized controlled trials","volume":"139","author":"Pepper","year":"2024","journal-title":"Anesth Analg"},{"key":"B68","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1111\/pan.14918","article-title":"A systematic review of the prevalence of chronic postsurgical pain in children","volume":"34","author":"Sim","year":"2024","journal-title":"Paediatr Anaesth"},{"key":"B69","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1136\/rapm-2024-105696","article-title":"Prognostic factors of chronic postsurgical pain in children and adolescents: a systematic review and meta-analysis","volume":"50","author":"Rosenbloom","year":"2025","journal-title":"Reg Anesth Pain Med"},{"key":"B70","doi-asserted-by":"publisher","first-page":"856","DOI":"10.1097\/EJA.0000000000002046","article-title":"Intravenous lidocaine for postoperative analgesia management in paediatrics: a systematic review with meta-analysis of published studies","volume":"41","author":"Pardessus","year":"2024","journal-title":"Eur J Anaesthesiol"},{"key":"B71","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1007\/s40272-016-0196-y","article-title":"Opioid-Sparing effect of ketamine in children: a meta-analysis and trial sequential analysis of published studies","volume":"18","author":"Michelet","year":"2016","journal-title":"Paediatr Drugs"},{"key":"B72","doi-asserted-by":"publisher","first-page":"1505408","DOI":"10.3389\/fmed.2025.1505408","article-title":"Effect of perioperative esketamine use on emergency delirium in children undergoing tonsillectomy and adenoidectomy: a systematic review and meta-analysis of randomized controlled trials","volume":"12","author":"Liu","year":"2025","journal-title":"Front Med (Lausanne)"},{"key":"B73","doi-asserted-by":"publisher","first-page":"1393","DOI":"10.1213\/ANE.0b013e3181d41dc2","article-title":"Gabapentin use in pediatric spinal fusion patients: a randomized, double-blind, controlled trial","volume":"110","author":"Rusy","year":"2010","journal-title":"Anesth Analg"},{"key":"B74","doi-asserted-by":"publisher","first-page":"719","DOI":"10.1016\/j.bja.2023.02.041","article-title":"Non-opioid analgesics for the prevention of chronic postsurgical pain: a systematic review and network meta-analysis","volume":"130","author":"Doleman","year":"2023","journal-title":"Br J Anaesth"},{"key":"B75","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1111\/pan.15015","article-title":"Perioperative intravenous lignocaine for pediatric postoperative pain-A systematic review and meta-analysis","volume":"35","author":"Gupta","year":"2025","journal-title":"Paediatr Anaesth"},{"key":"B76","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1111\/pan.15124","article-title":"Perioperative intravenous lidocaine infusion therapy as an adjunct to multimodal analgesia for adolescent idiopathic scoliosis surgical correction: a double-blind randomized controlled trial","volume":"35","author":"Luo","year":"2025","journal-title":"Paediatr Anaesth"},{"key":"B77","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1213\/ANE.0000000000006347","article-title":"Appropriate duration of perioperative intravenous administration of lidocaine to provide satisfactory analgesia for adult patients undergoing colorectal surgery: a meta-analysis of randomized controlled trials","volume":"136","author":"Yang","year":"2023","journal-title":"Anesth Analg"},{"key":"B78","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1080\/17512433.2024.2343915","article-title":"Opioid use disorder in pediatric populations: considerations for perioperative pain management and precision opioid analgesia","volume":"17","author":"Chen","year":"2024","journal-title":"Expert Rev Clin Pharmacol"},{"key":"B79","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1111\/jebm.12230","article-title":"Magnesium sulfate for postoperative complications in children undergoing tonsillectomies: a systematic review and meta-analysis","volume":"10","author":"Xie","year":"2017","journal-title":"J Evid Based Med"},{"key":"B80","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1111\/j.1399-6576.2009.02207.x","article-title":"Premedication with clonidine is superior to benzodiazepines. A meta analysis of published studies","volume":"54","author":"Dahmani","year":"2010","journal-title":"Acta Anaesthesiol Scand"},{"key":"B81","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1111\/pan.13712","article-title":"Safety and efficacy of clonidine on postoperative vomiting and pain in pediatric ophthalmic surgery: a systematic review and meta-analysis","volume":"29","author":"Hsu","year":"2019","journal-title":"Paediatr Anaesth"},{"key":"B82","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1007\/s40122-016-0045-2","article-title":"Efficacy of intraoperative dexmedetomidine compared with placebo for postoperative pain management: a meta-analysis of published studies","volume":"5","author":"Bellon","year":"2016","journal-title":"Pain Ther"},{"key":"B83","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1001\/jamasurg.2023.2009","article-title":"Association of intraoperative opioid administration with postoperative pain and opioid use","volume":"158","author":"Santa Cruz Mercado","year":"2023","journal-title":"JAMA Surg"},{"key":"B84","doi-asserted-by":"publisher","first-page":"e17361","DOI":"10.7759\/cureus.17361","article-title":"Intraoperative remifentanil dosage in surgery for adolescent idiopathic scoliosis does not increase postoperative opioid consumption when combined with epidural analgesia: a retrospective cohort study","volume":"13","author":"Aoki","year":"2021","journal-title":"Cureus"},{"key":"B85","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1097\/ALN.0000000000001705","article-title":"Pupillometry-guided intraoperative remifentanil administration versus standard practice influences opioid use: a randomized study","volume":"127","author":"Sabourdin","year":"2017","journal-title":"Anesthesiology"},{"key":"B86","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1097\/ACO.0000000000001141","article-title":"Monitoring of analgesia level during general anesthesia in children","volume":"35","author":"Sabourdin","year":"2022","journal-title":"Curr Opin Anaesthesiol"},{"key":"B87","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1213\/ANE.0000000000004362","article-title":"Effect of different concentrations of propofol used as a sole anesthetic on pupillary diameter: a randomized trial","volume":"131","author":"Sabourdin","year":"2020","journal-title":"Anesth Analg"},{"key":"B88","doi-asserted-by":"publisher","first-page":"1160","DOI":"10.1111\/pan.12243","article-title":"Pupillary reflex dilatation and analgesia nociception index monitoring to assess the effectiveness of regional anesthesia in children anesthetised with sevoflurane","volume":"23","author":"Migeon","year":"2013","journal-title":"Paediatr Anaesth"},{"key":"B89","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1097\/EJA.0000000000002013","article-title":"Effects of goal-directed analgesia using the analgesia nociception index in children undergoing surgery for moyamoya disease: a randomised controlled trial","volume":"41","author":"Park","year":"2024","journal-title":"Eur J Anaesthesiol"},{"key":"B90","doi-asserted-by":"publisher","first-page":"101207","DOI":"10.1016\/j.accpm.2023.101207","article-title":"Nociception level response to calibrated stimulations in children: first assessment of the nociception level index in pediatric anesthesia","volume":"42","author":"Chemam","year":"2023","journal-title":"Anaesth Crit Care Pain Med"},{"key":"B91","doi-asserted-by":"publisher","first-page":"1258","DOI":"10.1111\/pan.15013","article-title":"Assessment of the antinociceptive effect of a single fentanyl bolus dose in children: a pharmacokinetic and pharmacodynamic analysis based on the nociception level index during sevoflurane general anesthesia","volume":"34","author":"Cruzat","year":"2024","journal-title":"Paediatr Anaesth"},{"key":"B92","doi-asserted-by":"publisher","first-page":"1461","DOI":"10.3390\/jpm13101461","article-title":"Pain assessment using the analgesia nociception index (ANI) in patients undergoing general anesthesia: a systematic review and meta-analysis","volume":"13","author":"Kim","year":"2023","journal-title":"J Pers Med"},{"key":"B93","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1016\/j.bja.2024.09.020","article-title":"Comparison of different monitors for measurement of nociception during general anaesthesia: a network meta-analysis of randomised controlled trials","volume":"134","author":"Snoek","year":"2025","journal-title":"Br J Anaesth"},{"key":"B94","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.egja.2018.05.003","article-title":"Bilateral suprazygomatic maxillary nerve block versus palatal block for cleft palate repair in children: a randomized controlled trial","volume":"34","author":"Elyazed","year":"2018","journal-title":"Egypt J Anaesth"},{"key":"B95","doi-asserted-by":"publisher","first-page":"e51754","DOI":"10.7759\/cureus.51754","article-title":"Effectiveness and safety of intrathecal morphine for pediatric patients undergoing scoliosis surgery: a systematic review and meta-analysis","volume":"16","author":"Daud","year":"2024","journal-title":"Cureus"},{"key":"B96","doi-asserted-by":"publisher","first-page":"110725","DOI":"10.1016\/j.jclinane.2022.110725","article-title":"Practice advisory on the prevention and management of complications of pediatric regional anesthesia","volume":"79","author":"Ecoffey","year":"2022","journal-title":"J Clin Anesth"},{"key":"B97","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/j.bpa.2024.05.003","article-title":"Pediatric regional anesthesia and acute pain management: state of the art","volume":"38","author":"Barnett","year":"2024","journal-title":"Best Pract Res Clin Anaesthesiol"},{"key":"B98","volume-title":"Pediatric Regional Anesthesia. StatPearls","author":"Feehan","year":"2025"},{"key":"B99","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1111\/j.1460-9592.2010.03448.x","article-title":"Epidemiology and morbidity of regional anesthesia in children: a follow-up one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists (ADARPEF)","volume":"20","author":"Ecoffey","year":"2010","journal-title":". Paediatr Anaesth"},{"key":"B100","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1136\/rapm-2021-102529","article-title":"Local anesthetic systemic toxicity in children: a review of recent case reports and current literature","volume":"46","author":"Singaravelu Ramesh","year":"2021","journal-title":"Reg Anesth Pain Med"},{"key":"B101","doi-asserted-by":"publisher","first-page":"408","DOI":"10.1177\/0310057X231198255","article-title":"Incidents relating to paediatric regional anaesthesia in the first 8000 cases reported to webAIRS","volume":"51","author":"Mistry","year":"2023","journal-title":"Anaesth Intensive Care"},{"key":"B102","doi-asserted-by":"publisher","first-page":"1128","DOI":"10.1111\/pan.13741","article-title":"Epidemiology of regional anesthesia in children: lessons learned from the European multi-institutional study APRICOT","volume":"29","author":"Dadure","year":"2019","journal-title":"Paediatr Anaesth"},{"key":"B103","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1097\/ALN.0000000000002372","article-title":"Complications in pediatric regional anesthesia: an analysis of more than 100,000 blocks from the pediatric regional anesthesia network","volume":"129","author":"Walker","year":"2018","journal-title":"Anesthesiology"},{"key":"B104","doi-asserted-by":"publisher","first-page":"CD011436","DOI":"10.1002\/14651858.CD011436.pub3","article-title":"The use of ultrasound guidance for perioperative neuraxial and peripheral nerve blocks in children","volume":"2","author":"Guay","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"B105","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1111\/pan.14332","article-title":"Comparative evaluation of landmark technique and ultrasound-guided caudal epidural injection in pediatric population: a systematic review and meta-analysis","volume":"32","author":"Jain","year":"2022","journal-title":"Paediatr Anaesth"},{"key":"B106","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.1213\/ane.0b013e3181b20c52","article-title":"A comparison of high volume\/low concentration and low volume\/high concentration ropivacaine in caudal analgesia for pediatric orchiopexy","volume":"109","author":"Hong","year":"2009","journal-title":"Anesth Analg"},{"key":"B107","doi-asserted-by":"publisher","first-page":"744","DOI":"10.1213\/01.ane.0000195439.54650.dc","article-title":"Continuous epidural block versus continuous popliteal nerve block for postoperative pain relief after Major podiatric surgery in children: a prospective, comparative randomized study","volume":"102","author":"Dadure","year":"2006","journal-title":"Anesth Analg"},{"key":"B108","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1007\/s12630-009-9169-8","article-title":"Continuous peripheral nerve blocks for postoperative analgesia in children: feasibility and side effects in a cohort study of 339 catheters","volume":"56","author":"Dadure","year":"2009","journal-title":"Can J Anaesth"},{"key":"B109","doi-asserted-by":"publisher","first-page":"e40412","DOI":"10.7759\/cureus.40412","article-title":"Continuous epidural analgesia versus continuous peripheral nerve block in unilateral lower extremity pediatric orthopedic surgery: a matched case comparison study","volume":"15","author":"Vij","year":"2023","journal-title":"Cureus"},{"key":"B110","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1213\/ANE.0b013e3182a08fd4","article-title":"Ambulatory continuous peripheral nerve blocks in children and adolescents: a longitudinal 8-year single center study","volume":"118","author":"Gurnaney","year":"2014","journal-title":"Anesth Analg"},{"key":"B111","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1016\/j.anclin.2018.05.003","article-title":"Pediatric ambulatory continuous peripheral nerve blocks","volume":"36","author":"Antony","year":"2018","journal-title":"Anesthesiol Clin"},{"key":"B112","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1093\/bja\/aev220","article-title":"Peripheral nerve catheters in children: an analysis of safety and practice patterns from the pediatric regional anesthesia network (PRAN)","volume":"115","author":"Walker","year":"2015","journal-title":"Br J Anaesth"},{"key":"B113","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1080\/24694193.2017.1319432","article-title":"A systematic review of the impact of educational programs on factors that affect Nurses' Post-Operative pain management for children","volume":"41","author":"AlReshidi","year":"2018","journal-title":"Compr Child Adolesc Nurs"},{"key":"B114","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1186\/s44158-025-00271-w","article-title":"Perineural dexamethasone: neurotoxicity or neuroprotection? A systematic review of preclinical evidence","volume":"5","author":"De Cassai","year":"2025","journal-title":"J Anesth Analg Crit Care"},{"key":"B115","doi-asserted-by":"publisher","first-page":"1569","DOI":"10.1213\/ANE.0000000000002434","article-title":"Evidence for the efficacy of systemic opioid-sparing analgesics in pediatric surgical populations: a systematic review","volume":"125","author":"Zhu","year":"2017","journal-title":"Anesth Analg"},{"key":"B116","doi-asserted-by":"publisher","first-page":"520","DOI":"10.1213\/ANE.0000000000003346","article-title":"Dexamethasone as an adjuvant for caudal blockade in pediatric surgical patients: a systematic review and meta-analysis","volume":"127","author":"Chong","year":"2018","journal-title":"Anesth Analg"},{"key":"B117","doi-asserted-by":"publisher","first-page":"2072","DOI":"10.1213\/ANE.0000000000002453","article-title":"Effect of an intravenous dexamethasone added to caudal local anesthetics to improve postoperative pain: a systematic review and meta-analysis with trial sequential analysis","volume":"125","author":"Kawakami","year":"2017","journal-title":"Anesth Analg"},{"key":"B118","doi-asserted-by":"publisher","first-page":"165","DOI":"10.12659\/MSM.913098","article-title":"The efficacy and safety of dexmedetomidine combined with bupivacaine on caudal epidural block in children: a meta-analysis","volume":"25","author":"Tu","year":"2019","journal-title":"Med Sci Monit"},{"key":"B119","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1007\/s12519-021-00507-z","article-title":"Dexmedetomidine as an adjunct to peripheral nerve blocks in pediatric patients","volume":"18","author":"Yang","year":"2022","journal-title":"World J Pediatr"},{"key":"B120","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1111\/pan.12825","article-title":"Alpha-2 adrenoceptor agonists as adjuncts to peripheral nerve blocks in children: a meta-analysis","volume":"26","author":"Lundblad","year":"2016","journal-title":"Paediatr Anaesth"},{"key":"B121","doi-asserted-by":"publisher","first-page":"723191","DOI":"10.3389\/fmed.2021.723191","article-title":"Clonidine as an additive to local anesthetics in caudal block for postoperative analgesia in pediatric surgery: a systematic review and meta-analysis","volume":"8","author":"Wang","year":"2021","journal-title":"Front Med"},{"key":"B122","doi-asserted-by":"publisher","first-page":"e21397","DOI":"10.1097\/MD.0000000000021397","article-title":"Caudal dexmedetomidine in pediatric caudal anesthesia: a systematic review and meta-analysis of randomized controlled trials","volume":"99","author":"Wang","year":"2020","journal-title":"Medicine (Baltimore)"},{"key":"B123","doi-asserted-by":"publisher","first-page":"2215","DOI":"10.1097\/j.pain.0000000000003267","article-title":"The prevalence of chronic pain in children and adolescents: a systematic review update and meta-analysis","volume":"165","author":"Chambers","year":"2024","journal-title":"Pain"},{"key":"B124","doi-asserted-by":"publisher","first-page":"103976","DOI":"10.1016\/j.otsr.2024.103976","article-title":"Benefits of a spine team for the surgical management of paediatric scoliosis","volume":"111","author":"Julien-Marsollier","year":"2025","journal-title":"Orthop Traumatol Surg Res"},{"key":"B125","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.1213\/ANE.0000000000007075","article-title":"Contribution of coordination theories to the determination of human factors associated with operating room perceived performance","volume":"139","author":"Dahmani","year":"2024","journal-title":"Anesth Analg"},{"key":"B126","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1001\/jamasurg.2022.8228","article-title":"Association between familiarity of the surgeon-anesthesiologist dyad and postoperative patient outcomes for Complex gastrointestinal cancer surgery","volume":"158","author":"Hallet","year":"2023","journal-title":"JAMA Surg"},{"key":"B127","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1097\/ALN.0000000000002324","article-title":"Critical role of the surgeon-anesthesiologist relationship for patient safety","volume":"129","author":"Cooper","year":"2018","journal-title":"Anesthesiology"},{"key":"B128","first-page":"430","article-title":"Educational intervention to strengthen pediatric postoperative pain management: a cluster randomized trial","volume-title":"Pain Manag Nurs","author":"Smeland","year":"2022"},{"key":"B129","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1111\/pan.13373","article-title":"Postoperative pain management in children: guidance from the pain committee of the European society for paediatric anaesthesiology (ESPA pain management ladder initiative)","volume":"28","author":"Vittinghoff","year":"2018","journal-title":"Paediatr Anaesth"},{"key":"B130","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1097\/EJA.0000000000001953","article-title":"Perioperative pain management for appendicectomy: a systematic review and procedure-specific postoperative pain management recommendations","volume":"41","author":"Freys","year":"2024","journal-title":"Eur J Anaesthesiol"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1777446\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T05:23:19Z","timestamp":1773984199000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2026.1777446\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,20]]},"references-count":130,"alternative-id":["10.3389\/fped.2026.1777446"],"URL":"https:\/\/doi.org\/10.3389\/fped.2026.1777446","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,20]]},"article-number":"1777446"}}