Effectiveness of biofeedback therapies in pediatric populations: An umbrella review

Objective To assess the effectiveness of biofeedback therapies in children and adolescents Introduction: Biofeedback is a mind–body intervention that uses real-time physiological feedback to help individuals regulate bodily functions through behavioural modification, potentially reducing symptoms related to pain, attention, movement, and emotional control. Inclusion criteria: Systematic reviews, with or without meta-analysis, evaluating biofeedback therapies in children and adolescents were included regardless of medical condition or disability. Outcomes of interest included attention, cognitive function, functional mobility, behaviour, emotional regulation, and quality of life. Methods A comprehensive search up to July 2025 was conducted in MEDLINE (PubMed), Scopus, CINAHL, Cochrane Database of Systematic Reviews, JBI Evidence Synthesis, ProQuest Dissertations and Theses, and Epistemonikos, with supplementary searches in Google Scholar and OAIster. Study selection, data extraction, and critical appraisal were performed independently by two reviewers. Findings were summarised using tables and narrative synthesis. Evidence certainty was assessed using GRADE, and reporting followed PRIOR guidelines. Results Six systematic reviews published between 2015 and 2025, including approximately 2,600 pediatric participants, were analysed. Neurofeedback, particularly theta/beta ratio and slow cortical potential protocols, demonstrated moderate improvements in ADHD symptoms, mainly inattention and impulsivity. EMG biofeedback improved motor outcomes such as gait performance in children with cerebral palsy. HRV biofeedback showed potential benefits for emotional regulation. Study heterogeneity limited cross-review comparability. Conclusion Biofeedback therapies show promising benefits across several pediatric conditions, particularly ADHD and cerebral palsy. Nonetheless, methodological variability highlights the need for standardized protocols and further high-quality research.