Paediatrics & child health最新文献

{"title":"Therapeutic dilemma: how to treat severe chronic sleep concerns in youth with neurodevelopmental disorders.","authors":"Jessica Youssef, Megan Thomas","doi":"10.1093/pch/pxag050","DOIUrl":"10.1093/pch/pxag050","url":null,"abstract":"<p><p>Sleep concerns are very common in children and adolescents with neurodevelopmental disorders (NDDs) and are associated with significant impairments in daytime functioning, behaviour, physical health and family well-being. Clinicians often face a therapeutic dilemma regarding optimal management. Melatonin has recently been licensed for paediatric insomnia in Canada. Medications used off-label may shorten sleep onset or promote longer sleep but are sedating rather than promoting normal sleep and are frequently associated with unwanted side effects. Behavioural interventions take longer to work, require a degree of commitment but lead to lasting improvements. The described case report illustrates how a family-centred, nonpharmacological sleep intervention focusing on behavioural, environmental and circadian factors can effectively address sleep concerns, maintain improvements long term and transform daytime functioning, even in complex cases, with the resolution of symptoms requiring medications prescribed for behaviour and medical conditions, highlighting the importance of healthy sleep for optimal physical and mental health.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"31 5","pages":"459-461"},"PeriodicalIF":2.5,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13382893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148606064","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":"The danger beneath: the insidiousness of subgaleal hemorrhage and its devastating impact in a newborn (from the Office of the Chief Coroner's Obstetrics and Perinatal Death Review Committee).","authors":"Michelle Gordon, Gabrielle Salmers, Louise McNaughton-Filion, Darine El-Chaâr, Sarah L Lawrence","doi":"10.1093/pch/pxag034","DOIUrl":"10.1093/pch/pxag034","url":null,"abstract":"","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"31 5","pages":"427-430"},"PeriodicalIF":2.5,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13382890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148606077","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":"School Age pearls of wisdom: Teaching Tools for updated skill-specific parenting strategies.","authors":"Cara Dosman, Dorrie Koscielnuk, Manisha Bharadia, Sheila Gallagher, Colin Wilbur","doi":"10.1093/pch/pxaf048","DOIUrl":"10.1093/pch/pxaf048","url":null,"abstract":"<p><p>Knowledge translation tools are lacking for pediatric clinicians to address highly prevalent mental health concerns with behavioural interventions. Teaching Tools for pediatric residents fill this gap, for clinical use with School Age children (age 6 to 12 years) and their caregivers (parents). Evidence-informed pearls integrate older \"consequence/rewards behavioural\" strategies with up-to-date \"relational care/skill-building\" strategies to support development and optimal health outcomes. Tips are provided for how to provide safe, stable, nurturing relationships and coach children to learn regulation, task initiation, sustained attention, problem-solving, and perspective taking. These core life skills decrease concerning behaviours during typical child development and provide prevention and behavioural treatment of anxiety, ADHD, and depression, the most common childhood mental health disorders. Parenting Pearls and Tips for Children handouts are provided, to solidify understanding and follow-through. For image description, please refer to the figure legend and surrounding text.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"31 5","pages":"436-444"},"PeriodicalIF":2.5,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13382903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148606051","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":"Teaching Tools for developmental evaluation: Clinic prompts.","authors":"Cara Dosman, Sheila Gallagher, Sandra Sahagian Whalen, Dorrie Koscielnuk, Patricia LaBerge, Cynthia Brown, Beverley Hanson, Daniella Ongaro, Courtenay Mayowski, Colin Wilbur","doi":"10.1093/pch/pxaf049","DOIUrl":"https://doi.org/10.1093/pch/pxaf049","url":null,"abstract":"<p><p>This article presents tools for the pediatric resident doing developmental evaluation after developmental surveillance has detected a problem. <i>Crucial skills with prompts</i> developmental attainments charts and succinct tables provide a practical and structured approach to figuring out what the child's developmental disorder might be. Charts include wording for history and observations on physical exam, as prompts. 'Crucial skills' content is novel and holistic to meet the standards of modern developmental care when providing parenting guidance and determining diagnoses. Skills are placed in the chart according to oldest age of attainment, signalling that the skill will have been attained by most children of that age. The teaching tools in this article will equip residents to subdue complex presentations into manageable cases, to enjoy as satisfyingly simple.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"31 6","pages":"575-592"},"PeriodicalIF":2.5,"publicationDate":"2026-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13580637/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991074","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":"Far from home: the impact of geographic distance from a tertiary paediatric hospital in Canada on family stress and financial expenses.","authors":"Asia L van Buuren, Laura M Best, Melissa Braschel, Brittany Udall, Adam Sage, Michelle Kim, Adam Sernoskie, Claire Seaton, Thomas McLaughlin, Matthew Carwana","doi":"10.1093/pch/pxag033","DOIUrl":"https://doi.org/10.1093/pch/pxag033","url":null,"abstract":"<p><strong>Objectives: </strong>Many children and families living in rural/remote communities in Canada travel to receive health care at tertiary hospitals. While distance from the hospital has been shown to impact health outcomes, less is known about the psychosocial consequences. Our objective was to evaluate the association between distance travelled to receive inpatient care at a tertiary paediatric centre, and the financial and emotional costs of hospitalization.</p><p><strong>Methods: </strong>A prospective cohort study comparing demographics, financial costs and emotional stress associated with hospitalization (<i>N</i> = 148) of children admitted to a general paediatrics ward, comparing near (<50 km) and far (≥50 km) groups. Descriptive statistics, linear and logistic regressions were used to investigate the relationship between linear distance travelled and out-of-pocket costs or stress.</p><p><strong>Results: </strong>Forty percent of families travelled over 50 kilometres to the tertiary hospital. Multivariate linear and logistic regressions revealed that farther distance travelled predicted higher daily (95% CI [16,108] <i>P</i> = 0.009) and total (95% CI [8.4,551] <i>P</i> = 0.04) costs, as well as higher stress related to travel (95% CI [0.33,2.7]<i>P</i> = 0.013), finances (95% CI [0.99,3.5] <i>P</i> < 0.001 and isolation (95% CI[0.02, 2.6] <i>P</i> = 0.047).</p><p><strong>Conclusion: </strong>These data suggest that families who travel farther to receive paediatric tertiary health care incur greater financial costs and stress, specifically related to finances, travel and isolation, compared to local families. These data highlight gaps in resources available. Increased stress may impact or defer decisions around when and where to present for care and should be considered within the context of additional factors that may be impacting a family's access to care.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"31 6","pages":"624-631"},"PeriodicalIF":2.5,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13580640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991057","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":"Time from symptom onset to treatment in familial mediterranean fever: determinants and clinical implications.","authors":"Yasemin Uğur Es, Emine Özçelik, Şeyma Erdem Torun, Didem Öztürk, Sultan Nilay Yoğun, Mehveş Işıklar Ekici, Elif Çelikel, Zahide Ekici Tekin, Şeyma Ertem, Cüneyt Karagöl, Esra Esen, Merve Cansu Polat, Banu Çelikel Acar","doi":"10.1093/pch/pxag036","DOIUrl":"https://doi.org/10.1093/pch/pxag036","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the time from symptom onset to diagnosis in Familial Mediterranean Fever (FMF) patients, identify the clinical characteristics associated with diagnostic delay, and evaluate the effect of age at symptom onset on the time to diagnosis.</p><p><strong>Methods: </strong>Medical records of FMF patients aged 0 to 18 years followed at a tertiary pediatric rheumatology center between 2013 and 2024 were retrospectively analyzed. Patients fulfilling the 2019 Eurofever/PRINTO criteria were included. Clinical, genetic, treatment data and disease severity assessed by the International Severity Scoring System for FMF (ISSF) were evaluated.</p><p><strong>Results: </strong>A total of 1259 FMF patients were included. The median time from symptom onset to diagnosis was 17 (IQR 10 to 36) months. Patients were categorized into 2 groups based on the elapsed time from symptom onset to diagnosis (≤12 months, n = 469 and >12 months, n = 790). Those with a longer diagnostic delay had a younger age at symptom onset but higher ages at referral and diagnosis (<i>P</i> < 0.001). Fever (<i>P</i> = 0.007), abdominal pain (<i>P</i> = 0.006), and erysipelas-like erythema (<i>P</i> = 0.017) were more frequent in the delayed group, whereas a positive family history was linked to shorter diagnostic intervals (<i>P</i> = 0.012 for parents, <i>P</i> < 0.001 for siblings). No significant differences were found in MEFV variant distribution (<i>P</i> = 0.972) or ISSF scores (<i>P</i> = 0.151). Age at symptom onset was negatively correlated with time to diagnosis (ρ = -0.210, <i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Diagnostic delay remains common in pediatric FMF, especially among young children with early and nonspecific symptoms. Increasing awareness among primary and secondary care physicians may help shorten diagnostic intervals and improve outcomes.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"31 6","pages":"639-646"},"PeriodicalIF":2.5,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13580636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991131","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":"Dyslipidemia in children: diagnosis, evaluation, and management.","authors":"Michael Khoury, Jean-Luc Bigras, Elizabeth A Cummings, Kevin C Harris, Robert A Hegele, Mélanie Henderson, Katherine M Morrison, Julie St-Pierre, Peter D Wong, Brian W McCrindle","doi":"10.1093/pch/pxag021","DOIUrl":"https://doi.org/10.1093/pch/pxag021","url":null,"abstract":"<p><p>Atherosclerosis begins in youth and is directly linked to the presence and severity of cardiovascular risk factors, including dyslipidemia. Timely identification and management of dyslipidemia in childhood can slow atherosclerotic progression and decrease risk for future cardiovascular disease, especially in children with a genetic disorder predisposing to dyslipidemia (e.g., familial hypercholesterolemia, which is frequently undiagnosed). Existing screening strategies can identify cases of paediatric dyslipidemia effectively but should be conducted both earlier and more broadly. Evaluating for secondary causes of dyslipidemia in children, including medication use and systemic disorders, is essential. First-line therapy centres on lifestyle modifications and dietary changes specific to the dyslipidemia phenotype. Indications for medication depend on the severity of dyslipidemia and assessment for cardiovascular risk on an individual basis.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"31 4","pages":"392-399"},"PeriodicalIF":2.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212121","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":"Limiter les pertes sanguines et le recours aux transfusions chez les nouveau-nés.","authors":"Souvik Mitra, Emer Finan, Deepak Manhas","doi":"10.1093/pch/pxaf133","DOIUrl":"https://doi.org/10.1093/pch/pxaf133","url":null,"abstract":"<p><p>Il est prioritaire de limiter les pertes sanguines et le recours aux transfusions dans le cadre des soins aux nouveau-nés prématurés et gravement malades. Pour favoriser ce résultat à la naissance, on peut reporter le clampage du cordon d'au moins 60 secondes, tant chez les nouveau-nés prématurés qu'à terme. De plus, l'utilisation d'un prélèvement de sang du cordon ombilical pour effectuer un premier bilan sanguin chez les nouveau-nés prématurés et, dans la mesure du possible, l'évitement des bilans sanguins systématiques contribuent à limiter les pertes sanguines et les transfusions. Une stratégie restrictive de transfusion de globules rouges stratifiée en fonction de l'assistance respiratoire et de l'âge postnatal est recommandée auprès des nouveau-nés très prématurés et de très faible poids à la naissance. Chez les nouveau-nés à terme ou peu prématurés qui présentent une instabilité hémodynamique ou une hypoxémie aiguë marquée, les stratégies relatives aux transfusions sanguines doivent être adaptées à leur état clinique. Chez les nouveau-nés prématurés qui sont dans un état stable et qui ne présentent pas d'hémorragie intracrânienne fœtale ni de saignement actif majeur, un seuil de transfusion de plaquettes inférieur à 25 × 10⁹/L est à privilégier.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"31 4","pages":"384-391"},"PeriodicalIF":2.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245157/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148212096","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":"Minimizing blood loss and need for transfusions in newborns.","authors":"Souvik Mitra, Emer Finan, Deepak Manhas","doi":"10.1093/pch/pxaf130","DOIUrl":"10.1093/pch/pxaf130","url":null,"abstract":"<p><p>Minimizing blood loss and need for blood transfusions is a priority in the care of preterm and critically ill term newborns that can be facilitated at birth by deferring cord clamping for at least 60 seconds in both preterm and term infants. Also, using umbilical cord blood sampling for initial blood work in preterm infants, whenever feasible, and avoiding routine blood work whenever possible, help to minimize blood loss and transfusion need. In very preterm and very low birth weight infants, a restrictive red cell transfusion strategy stratified by respiratory support and postnatal age is recommended. In late preterm and term neonates who are hemodynamically unstable or in acute severe hypoxemia, blood transfusion strategies should be individualized based on clinical condition. In stable preterm infants without fetal intracranial hemorrhage or major active bleeding, a platelet transfusion threshold of <25 × 10⁹/L should be used.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"31 4","pages":"377-391"},"PeriodicalIF":2.5,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13390604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562586","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":"Practical tips for paediatricians: implementing cognitive behavioural therapy for adolescent insomnia.","authors":"Tasnim Youssef, Rafiaa Valji","doi":"10.1093/pch/pxag029","DOIUrl":"10.1093/pch/pxag029","url":null,"abstract":"<p><p>Insomnia, a sleep condition defined as persistent difficulties initiating or maintaining sleep, affects up to 40% of adolescents, with most continuing to experience symptoms once they begin. It is linked with mood disturbance, academic impairment, fatigue, and reduced quality of life. Despite its significance, few adolescents seek care on their own, and parents frequently underestimate the issue, highlighting the importance of pediatricians in early detection and treatment. Insomnia must be distinguished from delayed sleep-wake phase disorder (DSWPD), a circadian rhythm condition presenting similar complaints but requiring different treatments. Cognitive behavioural therapy for insomnia (CBT-I) is the first-line treatment recommended for adults and increasingly supported in adolescents. CBT-I integrates behavioural and cognitive strategies to target perpetuating factors and has demonstrated meaningful, durable improvements in sleep outcomes. CBT-I can be delivered in groups, individually, or digitally. Pediatricians can direct access to suitable interventions and offer families guidance on core sleep principles.</p>","PeriodicalId":19730,"journal":{"name":"Paediatrics & child health","volume":"31 5","pages":"447-450"},"PeriodicalIF":2.5,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13382892/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148606018","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}