Background: Few studies are reported on interventions that have been carried out in children and adolescents using diaphragmatic breathing (DB) together with methods like counseling, muscle relaxation, therapeutic exercise, and music therapy. Objective: The goal of the review is to evaluate the effectiveness of DB as complementary therapy in the stress of the pediatric population (6–18 years old). Methods: Detailed research was carried out in the current literature to find relevant studies published from 2010 to October 2024 in PubMed and Cochrane Library. Thirteen studies that fulfilled the inclusion criteria were included in the study. Nine studies involved obese and overweight pediatric populations and the other four involved pediatric patients. Results: The interventions comprised two 8-week studies in an obese pediatric population, seven studies in healthy children and adolescents with normal weight. The studies were based on DB, muscle relaxation, nutrition, counseling, music therapy, and slow breathing exercises. The participants in the intervention group improved in comparison to those in the control group in terms of stress and depression in most included studies, in terms of school performance in two studies, in terms of better family relationships in one study, and showed improvement in anthropometric indicators in two studies. In four studies that involved pediatric patients, stress and fear of medical procedures were reduced. Conclusions: DB can effectively contribute on its own or in combination with other therapeutic methods to improving physiological and psychological indicators in the pediatric population. It is useful to integrate stress management programs that include DB training as clinical practice in primary healthcare and in school schedules for elementary and high-school students.

Type 1 diabetes mellitus (T1DM) is a chronic disease that can affect the physical and mental health of children and adolescents, often leading to anxiety disorders with chronic activation of the hypothalamic axis (HPA). Moreover, a great proportion of adolescents with T1DM also demonstrate anorexia nervosa (AN), due to the increased preoccupation with food and the need to have an acceptable body image. Herein is described the first case study of an adolescent patient diagnosed with T1DM, anxiety disorder (AD), and AN. A 14-year-old girl with T1DM since the age of 12 years presented weight loss at age 13 years and 3 months and low body mass index (BMI), which did not improve despite dietary recommendations and adequate disease control. Additionally, she presented menstrual disorders at the age of 12 years and 11 months (menstrual age 12 years and 1 month). A psychological evaluation of the teenager was conducted using a semi-structured interview that assessed perceived stress, health status, quality of life, and depression. AD and AN were diagnosed and the patient initiated an intervention focusing on psychological health and nutrition and which incorporated physiotherapeutic relaxation sessions and breathing exercises. After 3 months of treatment, the patient’s BMI was increased, and a normal menstrual cycle was apparent. These results have since remained consistent. Stress leads to the appearance of AN and menstrual disorders. Therefore, physiotherapeutic programs could reduce stress and effectively ameliorate AN and AD.

Background: Chronic stress in childhood and adolescence leads to excessive cortisol secretion, adipokines production and obesity with all the negative mental and physical effects on the health of individuals and adulthood. Objectives: The aim of the present non-randomized controlled trial was to investigate the effect of a stress management protocol with diaphragmatic breathing (DB) and physiotherapy exercise on stress, body composition, cardiorespiratory and metabolic markers of children and adolescents with morbid obesity. Methods: The study included 31 children and adolescents (5–18 years old) with morbid obesity (22 in the intervention arm and 9 controls). All participants completed anxiety questionnaires and a self-perception scale. Forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), blood pressure (BP) and SpO₂ were measured. Fasting glucose, uric acid, triglycerides, HbA1c, (AST/SGOT), (ALT/SGPT), HDL, LDL, insulin, ACTH, cortisol, HOMA-IR, 17-OH, S-DHEA, SHBG were assessed, and anthropometric measurements were also performed. Results: In the intervention group, 4 months after the treatment, an improvement was noted in the BMI, BMI z-score, waist-to-height ratio, FEV1, SpO₂, pulse and systolic BP. HDL increased, ALT/SGPT and insulin resistance improved. Positive changes were observed in temporary and permanent stress and self-esteem of children in the intervention group, including anxiety, self-perception, physical appearance, etc. Conclusions: A combined exercise and DB protocol has a positive effect on stress, by improving body composition, reducing insulin resistance, and ameliorating physical and mental health and quality of life of pediatric patients with morbid obesity.