Cranford Hospice is Hawke's Bay's leading palliative care provider. Our dedicated team is available 24 hours a day, seven days a week.
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The Apollonion Private Hospital is an ultra-modern Hospital purposely built to offer the best medical care to its patients.
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Al Zahra Hospital Sharjah is the first and the largest private general hospital in the UAE with both inpatient and outpatient treatment at an international standard,
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UT Health East Texas is passionate about delivering the highest quality care with unmatched compassion, outstanding service and innovative technology.
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WORLD HOSPITAL DIRECTORY
Pediatrics Medical Archives of Disease in Childhood current issue
<sec id="s1"><st>Can you really puff this, Magritte?</st> <p>I expect (well, at least hope) you’re all familiar with the wonderful, understated Moderna Museet in Stockholm, a gallery that overlooks Djurgården to the East, Södermalm to the South, each just a stone’s throw from the Skeppsholmen jetty above which the collection sits and, in front of which the Baltic archipelago ferries limber up. I visit so often that my membership card is battered, but even those of you who aren’t in Östermalm as often will feel a tingle of familiarity at the mention of the Surrealistic exhibition on the ground floor where Salvador, Jean and Pablo mingle.<cross-ref type="bib" refid="R1">1</cross-ref> Now that’s established, you’ll be prepared for the next small step—a mere skip to the notion that opening one’s mind—just allowing it to liberate itself from the fetters that is routine thinking and just as our authors have done this month, is...
<p>Child and adolescent gender medicine is currently one of the most heatedly debated fields in medicine. The recent Cass Review,<cross-ref type="bib" refid="R1">1</cross-ref> underpinned by a comprehensive research programme from the University of York, has corroborated growing worldwide concern regarding the use of puberty blockers (PBs) and gender-affirming hormone treatment (GAHT) for young people with gender dysphoria (GD). The review has contributed to an important professional debate about the future of these treatments—a debate which, at times, has been marred by serious misrepresentations of Cass’s processes, findings and recommendations.<cross-ref type="bib" refid="R2">2–4</cross-ref><cross-ref type="bib" refid="R3"></cross-ref><cross-ref type="bib" refid="R4"></cross-ref></p> <p>Given the growing debate, the newest systematic review and meta-analysis (SR/MA)<cross-ref type="bib" refid="R5">5</cross-ref> evaluating psychosocial and physical outcomes of GAHT for young people (under 26 years of age) with GD is a welcome and important addition to the literature. Researchers from the department of health research at McMaster University followed the highest methodological standards for...
<p>Non-therapeutic circumcision of boys (‘circumcision’) is legitimised by consent from those with parental responsibility for the child. As common law decisions accumulate, both the questions put to the family court and the resulting judgements reveal how difficult it can be to determine where the individual child’s interests lie, amidst the factual complexities of family life, in turn, where boys and their parents and their doctors stand.</p> <p>The early case of <I>Re J</I><cross-ref type="bib" refid="R1">1</cross-ref> settled the issue of who is required to consent on behalf of the boy, prior to circumcision. It concerned the 5-year-old son of a ‘non-practising Christian’ mother and a Muslim father who ‘....did not actively observe many tenets of his faith’. J, therefore, had a mixed heritage and essentially, a secular lifestyle. The family court found that he did not have ‘a settled religious faith’. Father sought a court order that his son should be...
<p>Within every paediatric respiratory and general paediatric clinic there will be a number of children and families who are exposed to sub-standard environments within their homes. This may be impacting on their health and in particular, respiratory health. As clinicians it is important that we are aware of the risks to health, how to address it and act as advocates for patients. This review walks through from the health impacts to the way we can advocate and support patients and families.</p>
<p>The <I>Archivist’s</I> son had his tonsils out at the age of 5; he had recurrent tonsillitis and the surgery improved the quality of his life and his family’s life. No more time off work, anxious parents and no more recurrent fevers with a miserable, mildly snoring, mouth-breathing child. There were no more sleepless nights, regular visits to the general practitioner and family arguments/discussions about the role of antibiotics. <I>The Archivist</I> knew that the literature at that time was that the only indication for adenotonsillectomy was severe sleep apnoea. The <I>Archivist’s</I> clinical advice to parents was that their child did not need a tonsillectomy with recurrent infections or mild snoring symptoms; it will get better with time; contrary to the <I>Archivist’s</I> own actions as a parent! So, it was interesting to read an editorial entitled ‘The butterfly effect of adenotonsillectomy’ by Lam DJ (<I>JAMA Otolaryngol Head Neck Surg</I>. doi:10.1001/jamaoto.2025.0117) describing...
<sec><st>Rationale</st>
<p>While there are numerous published paediatric asthma scores, it is unknown how commonly scores are recommended in asthma guidelines across different geographical regions globally, and what their validation status is.</p>
</sec>
<sec><st>Objectives</st>
<p>(1) To describe which clinical guidelines recommend asthma scores across different geographical regions. (2) To describe the initial and subsequent validation of the commonly recommended asthma scores.</p>
</sec>
<sec><st>Methods</st>
<p>Observational study of asthma scores recommended in guidelines for the management of acute paediatric asthma from institutions across the Pediatric Emergency Medicine Network; global paediatric emergency medicine research network comprising all eight local and regional paediatric emergency medicine research networks.</p>
</sec>
<sec><st>Main results</st>
<p>158 guidelines were identified. Overall, 83/158 (53%) guidelines recommend a bedside clinical score for assessment of asthma severity. While a single country-specific clinical score was recommended in all guidelines from Spain and Canada, 27/28 (96%) of the USA guidelines recommend a wide variety of scores, and scores are rarely recommended in guidelines from other research networks (PERUKI, Paediatric Emergency Research in the UK and Ireland and PREDICT, Paediatric Research in Emergency Departments International Collaborative in Australia and New Zealand) and other countries (Costa Rica, South Africa, Nigeria, Singapore, India).</p>
<p>The Pediatric Respiratory Assessment Measure (PRAM) and the pulmonary score (PS) were the most frequently used scoring instruments. While the PRAM has undergone the most extensive validation, including construct validity, validation studies for the PS are limited. Inter-rater reliability, as well as the criterion, responsiveness and discriminative validity aspects represent the most common limitations in many of the scores.</p>
</sec>
<sec><st>Conclusions</st>
<p>There are marked geographical differences in both the recommendation for and the type of clinical asthma score in clinical practice guidelines. While many asthma scores are recommended, most have insufficient validation.</p>
</sec>
<sec><st>Aim</st>
<p>Gender dysphoria (GD) refers to the psychological distress associated with the incongruence between one’s sex and one’s gender identity. To manage GD, individuals may delay the development of primary and secondary sex characteristics with the use of puberty blockers. In this systematic review, we assess and summarise the certainty of the evidence about the effects of puberty blockers in individuals experiencing GD.</p>
</sec>
<sec><st>Methods</st>
<p>We searched Medline, Embase, PsychINFO, Social Sciences Abstracts, LGBTQ+ Source and Sociological Abstracts from inception to September 2023. We included observational studies comparing puberty blockers with no puberty blockers in individuals aged <26 years experiencing GD, as well as before–after and case series studies. Outcomes of interest included psychological and physical outcomes. Pairs of reviewers independently screened articles, abstracted data and assessed risk of bias. We performed a meta-analysis and assessed the certainty of a non-zero effect using the grading of recommendations assessment, development and evaluation (GRADE) approach.</p>
</sec>
<sec><st>Results</st>
<p>We included 10 studies. Comparative observational studies (n=3), comparing puberty blockers versus no puberty blockers, provided very low certainty of evidence on the outcomes of global function and depression. Before–after studies (n=7) provided very low certainty of evidence addressing gender dysphoria, global function, depression, and bone mineral density.</p>
</sec>
<sec><st>Conclusions</st>
<p>There remains considerable uncertainty regarding the effects of puberty blockers in individuals experiencing GD. Methodologically rigorous prospective studies are needed to understand the effects of this intervention.</p>
</sec>
<sec><st>Trial registration number</st>
<p>PROSPERO CRD42023452171.</p>
</sec>
<sec><st>Objective</st>
<p>In this systematic review and meta-analysis, we assessed and summarised the certainty of the evidence about the effects of gender affirming hormone therapy (GAHT) in individuals with gender dysphoria (GD).</p>
</sec>
<sec><st>Methods</st>
<p>We searched Medline, Embase, PsychINFO, Social Sciences Abstracts, LGBTQ+ Source and Sociological Abstracts from inception to September 2023. We included studies comparing GAHT with no GAHT in individuals aged <26 years with GD. Outcomes of interest included psychological and physical effects. Pairs of reviewers independently screened articles, abstracted data and assessed the risk of bias in the included studies. We performed meta-analyses and assessed the certainty of the evidence using the grading of recommendations assessment, development and evaluation (GRADE) approach.</p>
</sec>
<sec><st>Results</st>
<p>We included 24 studies. Comparative observational studies (n=9) provided mostly very low certainty evidence regarding GD, global function and depression. One comparative observational study reported that the odds of depression may be lower (OR 0.73 (95% CI 0.61 to 0.88), n (number of studies)=1, low certainty) in individuals who received GAHT compared with those who did not. Before–after studies (n=13) provided very low certainty evidence about GD, global function, depression and bone mineral density. Case series studies (n=2) provided high certainty evidence that the proportion of individuals with cardiovascular events 7–109 months after receiving GAHT was 0.04 (95% CI 0.03 to 0.05, n=1, high certainty).</p>
</sec>
<sec><st>Conclusion</st>
<p>There is considerable uncertainty about the effects of GAHT and we cannot exclude the possibility of benefit or harm. Methodologically rigorous prospective studies are needed to produce higher certainty evidence.</p>
</sec>
<sec><st>Trial registration number</st>
<p>PROSPERO CRD42023452171.</p>
</sec>
<p>In 2018, Her Majesty's Government published statutory and operational guidance setting out how children’s deaths are reviewed in England, aiming to ensure practice is standardised and review of each child’s death is of uniform quality.</p>
<sec><st>Objective</st>
<p>A national survey of paediatric intensive care units (PICUs) to review the implementation of the statutory guidance.</p>
</sec>
<sec><st>Design</st>
<p>Online survey exploring child death review (CDR) practices against expected operational standards across three domains: (1) Logistics and administration of the CDR process, (2) the CDR meeting and (3) communication with bereaved families.</p>
</sec>
<sec><st>Results</st>
<p>19/21 (91%) English PICUs, 1/1 Welsh and 1/1 Northern Irish PICUs responded to the survey request. 6/21 PICUs reported no remuneration for their CDR work. 18/21 reported routinely notifying the local child death overview panel of a child death within 48 hours as per statutory guidance. 8/21 (38%) achieved the current National Health Service England quality outcome target of holding the CDR meeting within 3 months of a child’s death. 17/21 (81%) PICUs appointed a ‘key worker’ as a single point of access to bereaved families. 12/21 (52%) PICUs routinely offered families the option to be informed of the outcome of the CDR meeting at bereavement follow-up.</p>
</sec>
<sec><st>Conclusions</st>
<p>This survey is the first to report on CDR practices in PICUs. It highlights significant variation between units in the application of national guidance. It suggests that further recommendations are required in the application of the statutory guidance to ensure greater parity between units, that learning is shared effectively between agencies and that all bereaved families receive the appropriate information and support.</p>
</sec>
<sec><st>Objective</st>
<p>To determine whether any children in the UK had variant Creutzfeldt-Jakob disease (vCJD).</p>
</sec>
<sec><st>Design</st>
<p>This active prospective epidemiological study used the British Paediatric Surveillance Unit, asking UK paediatricians to notify all childhood cases of progressive intellectual and neurological deterioration (PIND), a group that would include all cases of vCJD. Clinical data were obtained by questionnaire or via a site visit. An independent expert group classified the cases. If vCJD was suspected, referral to the National Creutzfeldt-Jakob Disease Research and Surveillance Unit was recommended.</p>
</sec>
<sec><st>Results</st>
<p>Between May 1997 and April 2024 (27 years), 5222 children were notified. There were four groups. (1) 2540 were ‘not cases’—they did not meet the case definition or there were notification errors. (2) 2367 had a known underlying diagnosis other than vCJD; the group contained more than 220 different diseases. (3) 309 had no diagnosis to explain their deterioration; there was evidence that none of these cases had vCJD. (4) There were six cases of vCJD: two males and four females. They developed symptoms between 1998 and 2000, aged 12–15 years, and the last two died in 2003. Their clinical features were similar to those of adults. Four were classified as definite vCJD and two as probable vCJD.</p>
</sec>
<sec><st>Conclusions</st>
<p>This study has provided unique data about neurodegenerative diseases in UK children. There is no reliable vCJD screening test; so for 27 years, the PIND study has provided reassurance that childhood vCJD cases were not missed. New vCJD cases with the methionine/valine genotype could appear.</p>
</sec>
<sec><st>Objective</st>
<p>To explore how birth weight and size-for-gestation may contribute to school absences and educational attainment and whether there are different associations across sex and income groups.</p>
</sec>
<sec><st>Design</st>
<p>Longitudinal linked cohort study.</p>
</sec>
<sec><st>Methods</st>
<p>Data were drawn from the Millennium Cohort Study, a nationally representative cohort of children born in 2000–2001; percentage of authorised and unauthorised absences from Year 1 to Year 11, and Key Stage test scores at ages 7, 11 and 16 in English and Maths were linked from the National Pupil Database. Birth outcomes and covariates were derived from the 9-month survey, and linear regressions with complex survey weights were fitted.</p>
</sec>
<sec><st>Results</st>
<p>Being born small-for-gestational-age (vs average-for-gestational-age) was associated with an increase of 0.47%, 0.55% and 0.40% in authorised absences in Years 1, 3 and 4 (n=6659) and with a reduction of 0.16–0.26 SD in all English and Maths test scores (n=6204). Similar associations were found for birth weight. After adjusting for prior test scores, English (b=0.07) and Maths (b=0.05) performance at age 11 remained associated with birth weight. Socioeconomic status modified the associations: there were larger disparities in test scores among higher-income families, suggesting that higher income did not compensate for being born small-for-gestational-age.</p>
</sec>
<sec><st>Conclusion</st>
<p>Children born smaller missed slightly more classes (~1 day per year) during primary school and had lower English and Maths performance across compulsory education. Exploring specific health conditions and understanding how education and health systems can work together to support children may help to reduce the burden.</p>
</sec>
<sec><st>Objective</st>
<p>To determine if out-of-home care (OOHC) reduces the risk of death in children with prenatal drug exposure (PDE).</p>
</sec>
<sec><st>Design</st>
<p>Population-based cohort study.</p>
</sec>
<sec><st>Setting</st>
<p>New South Wales, Australia.</p>
</sec>
<sec><st>Patients</st>
<p>Children with PDE, born between 2001 and 2020 and discharged alive after birth.</p>
</sec>
<sec><st>Exposure</st>
<p>PDE was defined as intrauterine exposure to maternal use of drugs of addiction, categorised into (1) neonatal abstinence syndrome (NAS) (n=5978); (2) exposure to maternal drugs of addiction, but not meeting diagnostic criteria for NAS (n=12 162); and (3) exposure to maternal exclusive tobacco smoking (n=187 827). Subanalyses by type of maternal drug use (opioids, stimulants and cannabis) were conducted.</p>
</sec>
<sec><st>Main outcome measures</st>
<p>Multivariate regression analyses of linked administrative data were used to determine the primary outcome of death after birth hospital discharge. Causal mediation analyses assessed the mediating effect of OOHC between PDE and mortality.</p>
</sec>
<sec><st>Results</st>
<p>Compared with no exposure, PDE was associated with a higher risk of childhood death. Risks were highest for infants with NAS (HR=4.20, 95% CI=3.23 to 5.44), followed by infants with PDE but no NAS diagnosis (HR=2.53, 95% CI=2.01 to 3.18). Mediation analyses demonstrated a natural indirect protective effect of OOHC in reducing risk of death (NAS: OR=0.5, 95% CI=0.5 to 0.5; PDE but no NAS diagnosis: OR=0.8, 95% CI=0.8 to 0.8). Subanalyses demonstrated a protective effect of OOHC for three types of maternal drug use (opioids: OR=0.7; stimulants: OR=0.8; cannabis: OR=0.9).</p>
</sec>
<sec><st>Conclusions</st>
<p>Any OOHC intervention was associated with reduced risk of death for children with PDE, emphasising the importance of strengths-based, culturally-sensitive support for this vulnerable population.</p>
</sec>
<sec><st>Objectives</st>
<p>To examine the prospective associations between infant sleep patterns and subsequent autism characteristics and diagnosis in a population-derived sample.</p>
</sec>
<sec><st>Design, setting and participants</st>
<p>Population-derived birth cohort study in Victoria, Australia’s Barwon region, with 1074 mother–infant pairs recruited from June 2010 to 2013.</p>
</sec>
<sec><st>Main outcome measures</st>
<p>Infant sleep characteristics via the Brief Infant Sleep Questionnaire at 6 months (n=925) and 12 months (n=885). Parent-reported autism characteristics measured using the Child Behaviour Checklist for Ages 11/2–5 (CBCL/11/2–5; n=676) at 2 years and Strengths and Difficulties Questionnaire for report for ages 4–10 (SDQ/P4–10; n=791) at 4 years. Autism Diagnostic and Statistical Manual for Mental Disorders fifth edition (DSM-5) diagnoses (n=64) were confirmed by 11.5 years.</p>
</sec>
<sec><st>Results</st>
<p>At 6 months, each 10% increase (~1 hour) in night sleep duration was associated with fewer autism characteristics at 2 years (4.5% decrease, CBCL/11/2–5) and 4 years (4.5% decrease, SDQ/P4–10) and 22% lower autism DSM-5 diagnosis odds by 11.5 years (adjusted mean difference (AMD): –0.02, 95% CI: –0.04 to –0.01; AMD: –0.02, 95% CI: –0.03 to –0.007; adjusted OR (AOR): 0.78, 95% CI: 0.65 to 0.94). At 12 months, each 25% increase in sleep latency (~5 min) was associated with more autism characteristics (1.5% increase, CBCL/11/2–5, AMD: 0.006, 95% CI: 0.002 to 0.01) and 7.7% higher autism diagnosis odds (AOR: 1.08, 95% CI: 1.03 to 1.13). Among diagnosed school-aged children, 42% used melatonin in the past month.</p>
</sec>
<sec><st>Conclusions</st>
<p>Poor infant sleep quality was linked to increased autism characteristics and diagnosis odds in a population-derived Australian sample. The extent to which this reflects common determinants of poor sleep and autism is not known. These findings suggest early monitoring of sleep issues as a potential autism indicator.</p>
</sec>
<sec><st>Objective</st>
<p>To examine the health, education and social inequities experienced by children with deafblindness in low- and middle-income countries.</p>
</sec>
<sec><st>Design</st>
<p>Secondary analysis of 36 Multiple Indicator Cluster Surveys (2017–2020), using age-adjusted modified Poisson models to compare outcomes between children with and without deafblindness.</p>
</sec>
<sec><st>Setting</st>
<p>36 low- and middle-income countries.</p>
</sec>
<sec><st>Patients</st>
<p>446 233 children aged 2–17, including 232 children with deafblindness.</p>
</sec>
<sec><st>Main outcome measures</st>
<p>Education (primary school attendance rate, secondary school attendance rate, early childhood education and the Early Childhood Development Index), health (stunting, wasting, health insurance, diarrhoeal disease and acute respiratory infection) and well-being (inadequate supervision, violent discipline, living arrangements, birth registration and poverty status) were measured.</p>
</sec>
<sec><st>Results</st>
<p>Children with deafblindness faced inequities in health and education indicators compared with children with other disabilities and children without disabilities. Children with deafblindness had consistently lower school attendance rates across school ages (primary: adjusted Prevalence Ratio (aPR) 0.30 (0.18 to 0.50); secondary: aPR 0.42 (0.20 to 0.87)), had worse Early Childhood Development Indices (aPR 0.35 (0.22 to 0.55)) and had 2–3 times higher prevalence of nutritional disorders (stunting: aPR 1.24 (1.03 to 1.50); wasting: aPR 2.79 (1.99 to 3.92)). However, there were non-significant differences in well-being indicators, such as poverty, inadequate supervision, birth registration and living situation. Children with deafblindness were also less likely to experience violent discipline.</p>
</sec>
<sec><st>Conclusion</st>
<p>Children with deafblindness constitute a heterogeneous group of children with disabilities. They face persistent barriers in accessing education and have poorer health, which must be addressed through building more disability-inclusive health and education systems.</p>
</sec>
<p>Unlicenced medicines (‘specials’) for children pose a pervasive and important safety concern for the National Health Service (NHS). Specials are usually supplied when no suitable licenced product exists and thus are an essential resource in the appropriate treatment of children. They represent around 1% of all prescriptions in the UK but account for more than 75 000 formulations.<cross-ref type="bib" refid="R1">1</cross-ref> These medicines may have different strengths, tastes, excipients, bioavailability, storage conditions and stability (shelf life). In hospital settings, many of these problems with specials are mitigated, for example, through experience and risk management with specific products, and limiting the range of options. However, problems increase when liquid specials medicines are initiated in hospital but resupplied in the community.</p> <p>One of the most common errors occurs due to a change in concentration of the liquid supplied without the parent or carer being aware of the change, potentially leading to severe, even...
<p>Brensocatib is a reversible inhibitor of dipeptidyl peptidase 1 (DPP-1) which targets neutrophil serine proteases, and these proteases are the main stimulants of neutrophilic inflammation. It is this neutrophilic inflammation that causes children and adults with non-cystic fibrosis bronchiectasis to develop exacerbations. Eventually, these processes cause deterioration of their disease. The great news is these drugs can be taken orally. Chalmers JD <I>et al</I> (<I>N Engl J Med</I> 2025;392:1569–1581 DOI: 10.1056/NEJMoa2411664) have reported a phase 3, double-blind trial, where 1721 patients (1680 adults and 41 adolescents) with non-cystic fibrosis bronchiectasis who were randomly assigned in a 1:1:1 ratio for adults and a 2:2:1 ratio for adolescents to receive oral brensocatib (10 mg or 25 mg once per day) or placebo. They reported that within a year, episodes of pulmonary exacerbations were 1.02 in the 10 mg brensocatib group, 1.04 in the 25 mg brensocatib group and 1.29 in the placebo group (rate ratio, brensocatib...
<p>Recently, two important papers on paediatric trauma were published by investigators from the Paediatric Emergency Care Applied Research Network (PECARN): a validation paper for the prediction rules for computed tomography (CT) imaging of children with minor head and blunt abdominal trauma<cross-ref type="bib" refid="R1">1</cross-ref> and a prediction rule for cervical spine imaging of children with blunt neck trauma.<cross-ref type="bib" refid="R2">2</cross-ref></p> <p>Funded by the Health Resources and Services Administration of the US government for over two decades, PECARN is an emergency research collaboration of tertiary paediatric emergency departments in the US. One of the research areas for PECARN has been the development of prediction rules for traumatic injuries to optimise decision-making in radiographic imaging, particularly CT imaging and to reduce the risk of radiation-associated malignancies. The key questions the PECARN trauma rules set out to answer were how to identify children at low risks of the injuries of interest who could...
<sec id="s1"><st>Introduction</st> <p>‘The art of medicine consists of amusing the patient while nature cures the disease.’ This likely apocryphal quote attributed to Voltaire (1694–1778) remains relevant as a powerful reminder of the intersection between the science of medicine and psychological well-being—in paediatrics Voltaire’s ‘amusement’ is facilitated by play.</p> <p>It is a wonder, therefore, that it was not until the 1970s that this art of so-called ‘amusement’ was formalised in paediatrics with the birth of health play specialists.<cross-ref type="bib" refid="R1">1</cross-ref> There are currently 644 health play specialists integrated into the UK’s National Health Service (NHS)<cross-ref type="bib" refid="R2">2</cross-ref> serving an increasingly diverse range of needs and performing a broad variety of tasks. The transformation of an unwell child through play is a unique facet of paediatrics and our specialty continues to improve as we harness the holistic benefits of hospital play. Children, however, have not always had access to such facilities.</p>...
<p>The Mental Capacity Act 2005 (MCA) and <I>Gillick</I> judgement,<cross-ref type="bib" refid="R1">1</cross-ref> taken together, establish clear legal principles to guide consent practices in paediatrics. However, a recent retrospective review of local consent practices highlighted significant shortcomings, primarily concerning clinical documentation.</p> <p>Our study reviewed consent practices in oncology and surgery in a UK children’s hospital, analysing clinical notes and consent forms from 63 children. Among under-16s, only three patient records explicitly documented competence, while most children <I>apparently</I> deferred consent to parents, although this conclusion remains speculative since no explanation was recorded. Even among presumedly capacitous 16-year-olds and 17-year-olds, documentation of decision-making processes was very poor. We have no reason to believe our hospital is an outlier in this respect.</p> <p>Parental involvement, while essential, can sometimes overshadow the child’s voice, raising concerns about autonomy. Emotional and ethical pressures in sensitive cases, such as those involving serious illness or invasive procedures, may also...
<p>The transition to adult healthcare is a vulnerable period for young people (YP) with chronic conditions linked to non-adherence and suboptimal health outcomes, including increased mortality.<cross-ref type="bib" refid="R1">1 2</cross-ref><cross-ref type="bib" refid="R2"></cross-ref> Addressing these risks requires identifying factors driving non-adherence and implementing targeted interventions. While broad challenges during transition are well documented, there is limited research specifically exploring medication-related needs of YP.</p> <p>We explored these needs through a cross-sectional observational study at a District General Hospital in Northwest London (April–September 2023). YP with long-term conditions (aged 11–16) admitted to the paediatric ward completed a pharmacist-administered questionnaire exploring their medication-related knowledge and adherence behaviours. Two young co-researchers with lived experience were integral to the research team, contributing to study design, data interpretation and a plain-language summary.</p> <p>Our findings revealed strengths and gaps in YP’s medication-related knowledge and behaviours. Of the 30 YP who participated (73% response rate), most (80%, 24/30) reported...
<p>Higher rates of childhood <I>Streptococcus pyogenes</I> (group A <I>Streptococcus</I> (GAS)) infections following the COVID-19 pandemic have exposed uncertainty about the epidemiology of immune-mediated complications of GAS in high-income settings.<cross-ref type="bib" refid="R1">1</cross-ref> Acute rheumatic fever (ARF) is of primary concern due to its potential to cause life-threatening carditis. Early recognition of ARF is critical to prevent progression to rheumatic heart disease, a significant cause of premature death globally.</p> <p>Accordingly, we reanalysed data from a hitherto unpublished British Paediatric Surveillance Unit (BPSU) ARF study run from May 2015 to May 2016. Briefly, UK and Republic of Ireland (RoI) consultant paediatricians were asked to provide monthly reports and details of ‘Any cases of children or young people 0–16 years of age with either a confirmed or suspected new diagnosis of ARF seen in the past month’. Subsequently, we categorised reported cases into ‘confirmed ARF’ using the Jones Criteria for ‘low-risk’ populations<cross-ref type="bib"...
<p>During 2023, the 10 district general hospitals (DGHs) in the south west of England highlighted to the Paediatric Critical Care Operational Delivery Network (PCC ODN) the increasing capacity and workload pressures due to caring for children and young people (CYP) with mental health admissions in the acute paediatric ward setting.</p> <p>In response to this, in autumn 2023, the PCC ODN added two questions to their daily regional dashboard of all inpatient paediatric activity:</p> <p><l type="ord"><li><p>Total numbers of child and adolescent mental health service (CAMHS) inpatients today.</p> </li><li> <p>Total numbers of eating disorder inpatients today.</p> </li></l></p> <p>Nurses on the wards completed the activity dashboard once a day. Each morning, they were asked to report mental health inpatients as either ‘CAMHS ‘or ‘eating disorder’, so any CYP with a mental health admission should only have been entered with one of those diagnoses. CYP with disordered eating due to a physical problem...
<sec id="s1"><st>Topical steroid withdrawal syndrome: did you know about this?</st> <p>Topical corticosteroids (TCS) are the main treatment for atopic eczema. What is topical steroid withdrawal syndrome (TSW)? Although it is characterised by steroid dependence and skin disease worsening after steroid discontinuation, it is a poorly defined entity. <I>Lucina</I> found this paper helpful. Larney <I>et al</I> (<I>Journal of Paediatrics and Child Health</I> 2025;61(4): 527-658. <A HREF="https://doi.org/10.1111/jpc.70018">https://doi.org/10.1111/jpc.70018</A>) have attempted to classify TSW. There is, of course, concern about the overuse of topical steroids, and steroid phobia, no doubt, prevents some dermatoses from being treated adequately by clinicians and may put off parents from using the higher-dosed creams. So how can you tell the difference between a flare-up of atopic dermatitis (and undertreatment) or the development of TSW? TSW appears to mainly have an impact on the face and genitals, and the risk factors are prolonged TCS use, higher potency TCS,...
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