## 4 Discussion
This dynamic tends to generate hostile reactions, helping to establish a negative perception in the child that may detract from his involvement in the use of the prosthesis. Interestingly, the percentage of distal usage for both the stump and prosthesis increased during tasks requiring peculiar actions (items 3, 6, 7, 8, and 9). Examples include tasks like putting on socks, grasping scooter handlebars with both hands, detaching Lego bricks, opening a crayon case, and extracting a crayon. This suggests that children can overcome established compensatory strategies and adapt to utilize the prosthesis distally for specific tasks. This adaptation to using the prosthesis distally for specific tasks could be influenced by factors such as patient satisfaction, functional outcomes, and the perceived value of prosthetic use. Studies have shown that the age at the first prosthetic fitting can impact later functional outcomes in children with limb deficiencies, highlighting the importance of early intervention [33]. Furthermore, the effectiveness of prosthetic devices in children is influenced by factors such as the prescription of the first prosthesis, with studies indicating lower rejection rates in children fitted with their first prosthesis at a younger age [24]. Additionally, advancements in pediatric prostheses and considerations for future developments underscore the importance of designing prosthetic devices that facilitate the effective performance of daily tasks and promote healthy social interactions [34]. Another critical aspect concerns postural balance, both in static and dynamic conditions. The child, without a prosthesis, has autonomously developed its own balance strategy, resorting to different forms of adaptation and compensation that take into account the amputated/agenetic limb. The introduction of the prosthesis represents, in the initial stages, an element of disharmony that can generate feelings of discomfort. In particular, the weight of the artificial limb may negatively affect postural stability. However, it is important to emphasize that time, together with adequate training and adaptation, can play a crucial role in facilitating the acquisition of greater stability and optimal posture. Consequently, it can be inferred that the prescription of a prosthesis should not be intended as a passive act but should necessarily be integrated into a motor re-educational program, thus making the prosthetic intervention fully effective [35]. Our data also suggest a potential link between age and motor skills without a prosthesis, with school-aged children exhibiting higher performance compared to preschoolers. This difference may be attributed to the extended adaptation time afforded to school-aged children, allowing for the consolidation of compensatory strategies that enhance motor skills and functional performance during activities. The only child who received a 12-month follow-up revealed a progressive optimization in the use of the prosthesis. The child went from a passive use of the prosthesis to an active mode of use of the prosthesis, which is expressed by an increased use of the end part of the aid. The performance of the same activities without the prosthesis did not show any variation. Over time, the adaptation to the use of the stump had probably already taken place and been consolidated. On the contrary, the child still had to adapt to the use of the prosthesis. Motor re-education aims to bridge this gap by promoting the active integration of the prosthesis and fostering the development of motor skills that enhance dexterity and fluidity for daily tasks. It is also possible that initially, wearing the prosthesis disrupted the postural balance learned by the child for dynamic and static compensations with the agenetic/amputated limb. In the subsequent evaluations, the adaptation to the prosthesis may have led to an improvement of the postural balance, with a better use of the prosthesis at different times.