Journal of paediatrics and child health最新文献

{"title":"Emergency Department Mental Health Presentations in Young Children Letter to the Editor “Addressing the Unique Challenges of Paediatric Mental Health Emergency Care” Response","authors":"Elyssia M. Bourke, Daniela F. Say, Anna Carison, Sinead M. O'Donnell, Franz E. Babl, the Paediatric Research in Emergency Departments International Collaborative (PREDICT) research network","doi":"10.1111/jpc.70005","DOIUrl":"10.1111/jpc.70005","url":null,"abstract":"<p>In reply:</p><p>We thank the authors for their thoughtful response to our article <i>Emergency department mental health presentations in young children: a retrospective chart review</i> [<span>1</span>]. Their efforts to highlight potential interventions for young children with autism spectrum disorder (ASD) who present to the Emergency Department (ED) with acute behavioural disturbance are commendable.</p><p>We agree that utilising strategies to reduce or eliminate the use of restrictive interventions including mechanical and physical restraint is a high priority when caring for young people presenting to the ED with behavioural disturbance. This is true regardless of whether the young person is neurotypical or neurodiverse. There is limited literature assessing the experience of young people when restrictive interventions are used in the context of behavioural disturbance management. Adults who were physically restrained during an episode of behavioural disturbance have reported feelings of dehumanisation as well as anxiety relating to seeking healthcare in the future [<span>2</span>]. Due to the negative effects of restrictive interventions, alternate strategies to manage acute behavioural disturbance are vital.</p><p>The suggestion from Chen et al. regarding the use of non-pharmacological strategies to de-escalate the young person's behaviour is logical. It is worth noting though that currently there have been no studies which have objectively assessed the effectiveness of these strategies for young people experiencing acute behavioural disturbance in the ED setting. A concerted focus on establishing an evidence base for which non-pharmacological strategies are most effective is therefore a high research priority.</p><p>We support the suggestion from the authors to consider the involvement of caregivers in guiding the most effective non-pharmacological strategies for these young people. However, an episode of acute behavioural disturbance—and in particular one that has necessitated an ED presentation—can be a unique situation. Evidence suggests that in this particular circumstance the caregivers of these young people are often overwhelmed, exhausted and have tried every strategy that would normally assist in calming their child down prior to presenting to ED [<span>2</span>]. These parents may therefore need to take a step back from guiding their child's management to provide them with a physical and emotional break.</p><p>It is also worth highlighting that although using least restrictive strategies is a priority in these presentations, this needs to be balanced against the risk of physical and psychological harm that these young people pose to themselves, their caregivers and to healthcare staff [<span>3, 4</span>]. Emergency care workers report the highest rates of occupational violence and aggression across the health system, and acute behavioural disturbance presentations account for a large proportion of these incidents [<span>5</spa","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 4","pages":"655-656"},"PeriodicalIF":1.6,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpc.70005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143390471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing the Unique Challenges of Paediatric Mental Health Emergency Care: Response to Bourke et al.'s Study on Young Children's Emergency Department Presentations","authors":"Li-Hua Chen,&nbsp;Lien-Chung Wei","doi":"10.1111/jpc.70004","DOIUrl":"10.1111/jpc.70004","url":null,"abstract":"<p>I appreciate the timely study by Bourke et al. [<span>1</span>], which investigates mental health (MH) presentations among young children in emergency department (ED) settings. The focus on children aged 12 or younger is particularly relevant, as it sheds light on the growing challenges faced by healthcare providers globally, including in Taiwan.</p><p>Building upon their work, this correspondence aims to further address gaps in intervention strategies, especially for children with neurodevelopmental disorders like autism spectrum disorder (ASD) presenting with acute behavioural disturbances. Below, I propose evidence-supported recommendations to enhance emergency care and reduce the burden on EDs.</p><p>Bourke et al. [<span>1</span>] underscore the lack of adequate post-discharge support, which contributes to repeated ED visits. Strengthening connections between EDs and community mental health services is imperative. In Taiwan, initiatives that integrate caregivers, schools, and paediatric MH specialists have shown promise in preventing crises from escalating to the ED level. Evidence indicates that proactive follow-up systems significantly lower readmission rates and improve long-term outcomes [<span>6</span>].</p><p>While Bourke et al. provide valuable insights, this correspondence emphasises the need for actionable solutions to improve outcomes for young children experiencing mental health crises. By adopting non-pharmacological de-escalation techniques, engaging caregivers, integrating multidisciplinary teams, and ensuring robust follow-up systems, healthcare providers can enhance the quality of care and alleviate the burden on EDs. Collaborative efforts between EDs and community MH services remain essential to addressing the unique challenges faced by this vulnerable population.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 4","pages":"653-654"},"PeriodicalIF":1.6,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpc.70004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Red Flags in the Evaluation of the Tiptoeing Child","authors":"Francesco Baldo,&nbsp;Arianna Traunero,&nbsp;Andrea Ballaben,&nbsp;Alessandro Zago,&nbsp;Egidio Barbi","doi":"10.1111/jpc.16793","DOIUrl":"10.1111/jpc.16793","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Tiptoeing is a common phenomenon in gate development. However, in some cases, it can be the first clinical sign of a medical condition, more often a neurological or muscle disorder.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To provide a practical guide for paediatricians on how to approach tiptoeing and its possible causes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Input from the literature were used to construct this guide. We evaluated articles both on the general topic and the various conditions associated with tiptoeing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Red flags in tiptoeing are its persistence for more than 6 months after the establishment of independent walking, its persistence after 2 years of age and its appearance afterwards. Historical and physical examination clues, together with few blood tests and radiological investigations, are key elements to direct the clinician's diagnosis in the right direction, especially nowadays, considering that many of these conditions have a specific treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In presence of red flags, tiptoeing should never be underestimated and must be considered a sign of a pathological condition until proven otherwise.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 4","pages":"540-544"},"PeriodicalIF":1.6,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Swallowing and Oral-Sensorimotor Characteristics in a Sample of Young Hospitalised Children With Severe Acute Malnutrition","authors":"Casey Jane Eslick,&nbsp;Alta Kritzinger,&nbsp;Marien Alet Graham,&nbsp;Esedra Krüger","doi":"10.1111/jpc.16790","DOIUrl":"10.1111/jpc.16790","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To describe swallowing and oral-sensorimotor characteristics in a sample of young hospitalised children with severe acute malnutrition (SAM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The Schedule of Oral-motor Assessment was used to compare oral-sensorimotor skills of 45 hospitalised patients with SAM (<i>M</i> = 15.98 months; SD = 8.03), to pairwise-matched controls (<i>M</i> = 15.96 months; SD = 8.08). Participants were matched for age, gender, TB, HIV-status, socio-economic status including maternal education, paternal employment, housing and transport access. Caregivers reported demographic information, feeding practices and behaviours during feeding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In comparison to controls (<i>n</i> = 6; 13.3%), participants with SAM (<i>n</i> = 25; 55.6%) presented with significantly more oral-sensorimotor difficulties (<i>p</i> &lt; 0.001), across all consistencies except liquids from the trainer cup and bottle. Difficulties included jaw opening and stabilisation, tongue and lip control for chewing, bolus formation and transport, sustained bite and uncoordinated swallowing. Delayed sitting development significantly correlated with uncoordinated swallowing and head extension on puree and cup drinking, and multiple swallows on puree and semi-solids. Force-feeding and slow swallow initiation in semi-solids significantly correlated. Disruptive feeding behaviours and higher levels of food refusal at the beginning of meals were reported. Clinical signs of aspiration were identified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Oral-sensorimotor dysfunction and possible aspiration were observed in 55.6% of participants with SAM. Safe swallowing function for overall health and nutritional recovery is emphasised. Under-identification of oral-sensorimotor difficulties, lack of referral to speech-language therapists and disruption to continuity of care warrants further research.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 5","pages":"721-728"},"PeriodicalIF":1.6,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpc.16790","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuropsychiatric Side Effects of Hydroxychloroquine in a Patient With Idiopathic Pulmonary Hemosiderosis","authors":"Didar Ağca Cengiz,&nbsp;Abdurrahman Erdem Başaran,&nbsp;Betül Bankoğlu Parlak,&nbsp;Irmak Tanal Şambel,&nbsp;Ayşen Bingöl","doi":"10.1111/jpc.70001","DOIUrl":"10.1111/jpc.70001","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Idiopathic pulmonary hemosiderosis (IPH) is a rare interstitial lung disease. Glucocorticosteroids and hydroxychloroquine are the most commonly used treatments. Although neuropsychiatric side effects related to hydroxychloroquine use are seen in adult cases, only one paediatric patient has been reported in the literature.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>We report a case of a 6-year-old girl with IPH, who developed neuropsychiatric symptoms, including restlessness, confusion and myoclonic movements, after the therapeutic use of hydroxychloroquine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>With increasing knowledge and experience of interstitial lung disease, the use of hydroxychloroquine treatment is increasing. It is important to remember that hydroxychloroquine is a central nervous system stimulant, and neuropsychiatric side effects may be seen in children. This report highlights the importance of recognising potential neuropsychiatric side effects in paediatric patients using hydroxychloroquine, especially when combined with corticosteroids or other risk factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 4","pages":"639-642"},"PeriodicalIF":1.6,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpc.70001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Perinatal Factors and Family Sociodemographic Characteristics With Cardiometabolic Health in Pre-Adolescence: Cross-Sectional Results From Healthy Growth Study","authors":"Ioanna Nakaki,&nbsp;Aikaterini M. Kontochristopoulou,&nbsp;Costas Anastasiou,&nbsp;George Moschonis,&nbsp;Anela Halilagic,&nbsp;Yingting Cao,&nbsp;Eva Karaglani,&nbsp;Yannis Manios","doi":"10.1111/jpc.16791","DOIUrl":"10.1111/jpc.16791","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Study the influence of a variety of perinatal factors on the presence of metabolic syndrome and its parameters in prepubertal age, considering socio-demographic factors, sex, Tanner stage and weight status of the preadolescent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data collected from the cross-sectional Healthy Growth Study (2007) in students from four prefectures of Greece and their families. Cardiometabolic risk factors (waist circumference, blood pressure and blood indices) and perinatal data (from parents and health records) were collected. Single and a multiple logistic regression performed to assess the associations with cardiometabolic risk in preadolescence. Dependent variables included waist circumference, blood glucose, HDL-C, TG, blood pressure and metabolic syndrome presence, while independent variables encompassed perinatal factors categorised as pre-pregnancy, during and post-pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>2666 pre-adolescents (mean age 11.2 year) participated in the study. After adjustment for parental educational level, family income, sex, Tanner stage and weight category, maternal pre-pregnancy weight was positively associated with high waist circumference (OR, 95% CI 1.02 (1.00–1.04)), low HDL-C levels (OR, 95% CI 1.01 (1.00–1.03)) and metabolic syndrome (OR, 95% CI 1.02 (1.00–1.05)). Timing of solid foods' introduction was positively associated with high waist circumference (OR, 95% CI 1.09 (1.01–1.08)), gestational age with high glucose levels (OR, 95% CI 1.12 (1.04–1.19)), smoking (OR, 95% CI 1.07 (1.00–1.14)) and alcohol consumption (OR, 95% CI 2.35 (1.05–5.27)) during the first trimester of breastfeeding with high glucose levels and low HDL-C levels, respectively. Number of previous miscarriages was positively associated with low HDL-C levels (OR, 95% CI 1.28 (1.04–1.57)). Gestational age was negatively associated with high waist circumference (OR, 95% CI 0.87 (0.80–0.95)) and iron supplementation in the third pregnancy trimester negatively association with high TG levels (OR, 95% CI 0.34 (0.12–0.91)).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Maternal weight, perinatal behaviours, infant feeding and miscarriages influence pre-pubertal cardiometabolic health, independent of sociodemographics, sex, Tanner stage and weight.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 5","pages":"701-713"},"PeriodicalIF":1.6,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpc.16791","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of COVID-19 on Hospital Admissions for Children With Developmental Disadvantages: A Western Sydney Metropolitan Hospital Experience on Health Inequity","authors":"Lanxin Li,&nbsp;Habib Bhurawala,&nbsp;Anthony Liu","doi":"10.1111/jpc.16798","DOIUrl":"10.1111/jpc.16798","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To investigate the impact of Sydney's COVID-19 lockdown on children with developmental disadvantages and reflect on current clinical practice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective data was collected from a western Sydney metropolitan hospital's electronic database and patients. We reviewed all children with Autism Spectrum Disorder (ASD), Cerebral Palsy (CP) or Intellectual Disability (ID) admitted 36 months prior to and after lockdown policy being implemented.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prevalence of hospital presentation was reduced during the lockdown period. The average length of stay (LoS) increased by approximately 1.5 folds. Comparatively, the average LoS of the general paediatric population increased minimally. Seizures, asthma, and upper respiratory tract infections were the three commonest issues for hospital admissions in both periods. COVID-19 infection accounted for 4% of admissions in the lockdown period. Around 20.8% of patients with disadvantages were admitted with more than two major issues. None of these patients had concurrent COVID-19 infection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Children with developmental disabilities experience greater disadvantages during lockdown. The likely reasons include inequity caused by increased barriers to healthcare service. The indirect benefit of reducing infection transmission during lockdown was not reflected in our patient group, contributing to the disease burden. Chronic diseases remain the most common causes of admissions in all periods, suggesting the essentiality of improving chronic disease management in future clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 5","pages":"714-720"},"PeriodicalIF":1.6,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpc.16798","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Child With Bilateral Lucencies on Chest X-Ray: What Is the Diagnosis?","authors":"Gloria Tze Yan Lau,&nbsp;Richard Warne,&nbsp;Stephen Oo","doi":"10.1111/jpc.70002","DOIUrl":"10.1111/jpc.70002","url":null,"abstract":"","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 3","pages":"518-520"},"PeriodicalIF":1.6,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating an Uninformative Genomic Test Result: A Practical Guide","authors":"Laura St Clair,&nbsp;Claire Wong,&nbsp;Christopher Elliot,&nbsp;Kristi J. Jones,&nbsp;Margit Shah,&nbsp;Sarah Josephi-Taylor,&nbsp;Sarah Sandaradura,&nbsp;Lesley Adès,&nbsp;Janine Smith,&nbsp;Rani Sachdev,&nbsp;Alan Ma","doi":"10.1111/jpc.16792","DOIUrl":"10.1111/jpc.16792","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although genomic testing is increasingly standard of care for diagnosing children and adults with genetic conditions, over 50% of genomic testing will return an uninformative result.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To provide a practical guide for paediatricians on how to approach an uninformative genomic test result, and the pathways which may be available to uncover a genetic diagnosis for their patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Input from multiple genetics healthcare professionals including genetic counsellors, the literature, and a general paediatrician were used to construct this guide. We also provide a hypothetical case vignette, to further demonstrate the various options for a patient after receiving an uninformative result.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There are several reasons why an underlying genetic diagnosis may not be diagnosed with current testing, including incomplete phenotyping, a different underlying genetic mechanism requiring specialised testing, and limitations in knowledge at the time of the test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Uninformative results are very common, and it is important to understand these results in the context of the limitations of genomic testing. General paediatricians play an important role in supporting families through their diagnostic odyssey, as well as reassessing the phenotype, referring for sub-specialty inputs, and discussion with local genetics services for consideration of alternative testing options or enrolment into research pathways.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 3","pages":"344-353"},"PeriodicalIF":1.6,"publicationDate":"2025-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpc.16792","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“Chemical Restraint” for Children and Adolescents in Victoria","authors":"Daryl Efron,&nbsp;Connie Wu,&nbsp;Chidambaram Prakash,&nbsp;Mandy Donley","doi":"10.1111/jpc.16800","DOIUrl":"10.1111/jpc.16800","url":null,"abstract":"&lt;p&gt;Children and adolescents with neurodevelopmental disorders such as autism spectrum disorder and intellectual disability commonly exhibit challenging behaviours, including agitation, irritability, aggression, and self-injurious behaviour [&lt;span&gt;1&lt;/span&gt;]. Such behaviours are a major contributor to morbidity, functional impairments, and reduced quality of life in these individuals, and cause great distress for their families and carers. In severe cases carer burnout and relinquishment is a genuine risk.&lt;/p&gt;&lt;p&gt;Psychotropic medications including stimulants, antidepressants and anti-psychotics are prescribed for a high proportion of paediatric patients with neurodevelopmental disorders in Australia [&lt;span&gt;2&lt;/span&gt;], for symptom management or the treatment of comorbid mental health conditions. These medications are often extremely helpful, enabling patients to function better, engage with allied health and behavioural interventions, and participate more fully in school and society. However they also carry a substantial risk of adverse effects, and patients with developmental disabilities may be at particularly high risk [&lt;span&gt;3&lt;/span&gt;], as well as being less able to report their subjective experiences. Therefore medications need to be used judiciously and monitored closely.&lt;/p&gt;&lt;p&gt;The NDIS Quality and Safeguards Commission is responsible the National Quality and Safeguarding Framework, which is aimed at protecting and preventing harm to persons with disability. The intention is to ensure NDIS participants ‘live free from abuse, neglect, violence and exploitation’. The context for this policy framework is the historical practice of off-label use of medications for institutionalised people with disabilities, for the intentional purpose of sedation—often administered by support staff, with minimal oversight by the prescriber.&lt;/p&gt;&lt;p&gt;Restrictive practices include seclusion, mechanical restraint, physical restraint, environmental restraint, and “chemical restraint” (CR). According to the NDIS Rules 2018, CR is defined as ‘the use of medication for the primary purpose of influencing a person's behaviour, as opposed to treatment of a diagnosed mental disorder or physical condition’ [&lt;span&gt;4&lt;/span&gt;]. The Disability Act [&lt;span&gt;5&lt;/span&gt;] and NDIS Rules are based on the purpose for which the medication is used. The NDIS definition is different to that under the Victorian Mental Health and Wellbeing Act [&lt;span&gt;6&lt;/span&gt;] which is much narrower: ‘the giving of a drug to a person for the primary purpose of controlling the person's behaviour by restricting their freedom of movement but does not include the giving of a drug to a person for the purpose of treatment or medical treatment’. In these definitions no distinction is made between which type of medical practitioner prescribes the medication.&lt;/p&gt;&lt;p&gt;Note that these definitions do not incorporate any evaluation of the clinical appropriateness of the medications, nor are the parent or guardian's wishes considered ","PeriodicalId":16648,"journal":{"name":"Journal of paediatrics and child health","volume":"61 3","pages":"523-525"},"PeriodicalIF":1.6,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/jpc.16800","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}