{"title":"Breaking down communication barriers","authors":"Qasim Malik, Evangeline Buck, Mary Salama","doi":"10.1016/j.paed.2024.08.008","DOIUrl":"10.1016/j.paed.2024.08.008","url":null,"abstract":"<div><div>Breaking down language barriers in paediatric care is pivotal for effective communication and positive health outcomes, particularly for vulnerable groups such as refugees, asylum seekers, the deaf and neurodivergent patients. This paper highlights the importance of culturally competent care. The specific needs of children with deafness and neurodiverse conditions are also considered.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 11","pages":"Pages 436-438"},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142530933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Hirschsprung's disease","authors":"Hemanshoo Thakkar, Joe Curry","doi":"10.1016/j.paed.2024.07.001","DOIUrl":"10.1016/j.paed.2024.07.001","url":null,"abstract":"<div><div>Hirschsprung's disease (HD) is a congenital functional disorder characterized by the absence of ganglion cells in the enteric nervous system. The estimated incidence of HD is 1 in 5000 live births with up to 60% of patients having associated anomalies. This short article aims to provide paediatricians with an overview of the condition and the recent developments in our understanding. Short-segment rectosigmoid disease is seen in 75% of cases with infants presenting with abdominal distension, bilious vomiting and delayed passage of meconium. A bedside rectal suction biopsy is the gold-standard in confirming the diagnosis of HD. The absence of ganglion cells in the myenteric and submucosal plexi in the presence of thickened hypertrophic nerves (more than40 microns diameter) is diagnostic of HD. There are no medical options to treat HD, however rectal washouts can be used to bridge the gap to surgery. Contemporary management of this condition involves a single-stage pull-through that can be performed using various techniques including minimal access surgery. Long-term problems in with HD are common and these include obstructive symptoms (10–30%), constipation (10–15%), enterocolitis (10–15%) and true faecal incontinence (1–2%). Furthermore 20–30% of adults report symptoms of incontinence and constipation as well as poor sexual function. Future research is being focussed on novel gene therapies including stem-cell therapy and the use of CRISPR/CA9 to edit parts of the genome.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 10","pages":"Pages 359-362"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Online life for a child in care","authors":"Vicki Walker","doi":"10.1016/j.paed.2024.08.001","DOIUrl":"10.1016/j.paed.2024.08.001","url":null,"abstract":"<div><div>For children and young people their online life is as real to them as their real life. This article considers the positives and negatives of online life, why children in care are more vulnerable, and the specific impact for child protection and health. It provides advice and guidance for healthcare professionals working with children. There are useful resources about managing disclosures and safeguarding concerns. We will consider how to incorporate online life in a paediatric medical history and the impacts of online use on physical and emotional health.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 11","pages":"Pages 393-397"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142530930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Adoption: insights from a medical advisor and paediatric trainee","authors":"Jessica Slater, Eleanor Boddy","doi":"10.1016/j.paed.2024.08.005","DOIUrl":"10.1016/j.paed.2024.08.005","url":null,"abstract":"<div><div>Processes around adoption are not always well understood amongst medical professionals, who may have limited contact with this particular system. This article provides an overview of adoption procedures in England and the integral role that the medical advisor contributes. Adoption panels are discussed, including their structure, overview of processes, and how the medical advisor provides expert support. Ethical and moral challenges are explored, initially relating to implications of the mental and physical health of both adopters and adoptees. The impact of societal expectations on the adoption process is also discussed, from the uncertain future of genetic testing to the consideration of where an individual gets their identity. The second part of this article provides a trainees’ perspective and reflections having attended Adoption Panel, touching on interesting cases. We discuss the impact of attending panel on clinical practice and how it can alter perspectives in various aspects of work in Community Child Health.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 11","pages":"Pages 419-423"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142530929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Understanding and helping children who have experienced maltreatment","authors":"Kim S. Golding","doi":"10.1016/j.paed.2024.08.004","DOIUrl":"10.1016/j.paed.2024.08.004","url":null,"abstract":"<div><div>Children who experience maltreatment from within their families can suffer trauma that is devastating to their physical and psychological development. The label developmental trauma has developed to describe this trauma and to guide diagnosis. The impact of this can increase when children live within marginalized communities or when their family is impacted by intergenerational trauma. The definition of developmental trauma has been expanded to describe seven domains of impairment. Together these help the clinician to provide a formulation of a child's difficulties which avoids multiple diagnoses and can guide treatment planning. Dyadic Developmental Psychotherapy and Practice (DDP) is an intervention model that can meet the therapeutic needs of the children alongside the support needs of parents and practitioners caring for them. The attitude of PACE (playfulness, acceptance, curiosity and empathy) is central within DDP interventions, used by therapists, parents and practitioners who together make up the network around the child. Tailoring DDP interventions can be guided by a pyramid of need developed by the author. This helps clinicians develop flexible intervention packages tailored to the needs of the child, family and practitioner. Within the article these ideas are explored illustrated by the fictional example of Janice. She was maltreated in early childhood and now lives in foster care with Mary and Simeon.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 11","pages":"Pages 412-418"},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142530928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tessa Morgan, Francesca Crozier-Roche, Taliah Drayak, Jack Smith, David Graham, Nicole Marshall, Julia Mannes, Robbie Duschinsky
{"title":"Addressing the mental health needs of children with a social worker","authors":"Tessa Morgan, Francesca Crozier-Roche, Taliah Drayak, Jack Smith, David Graham, Nicole Marshall, Julia Mannes, Robbie Duschinsky","doi":"10.1016/j.paed.2024.08.003","DOIUrl":"10.1016/j.paed.2024.08.003","url":null,"abstract":"<div><div>Children and young people with a social worker (CYPwSW) have particular mental health profiles and needs. Research indicates that despite having higher levels of mental health distress this group tend to experience inequitable access to specialist mental health services. Therefore, much of their mental health support currently falls to generalists including paediatricians. We are currently undertaking a four-year study the CAMHS Referrals and Outcomes for Adolescents and Children with Social Workers (COACHES). Here we present initial insights from an analysis of 20,166 unique case notes which identified 1) High thresholds for entry to CAMHS 2) A requirement that young people must be perceived as stable prior to accessing services 3) that young people often did not feel that their voices were taken seriously 4) the importance of time for trust. Based off these findings and expert-by-experience's insights, we conclude by suggesting ways that paediatricians and health care professionals can best support CYPwSW. These include being the ‘connective tissue’ around young people's support network, gently and proactively building relationships, redressing power imbalances and supporting transitions to adulthood.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 11","pages":"Pages 406-411"},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142530507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Testing for infections: getting it right for children in care","authors":"Sophie Pach, Allison Ward , Sarah Eisen","doi":"10.1016/j.paed.2024.08.002","DOIUrl":"10.1016/j.paed.2024.08.002","url":null,"abstract":"<div><div>Children who are looked after (CLA), including children and young people seeking asylum and refugees who are unaccompanied (CYPSAR-U), experience multiple intersecting vulnerabilities leading to an increased risk of infections throughout childhood. This population experiences a higher risk of maternal to child transmission of blood borne viruses as well as a higher risk of acquiring infections in childhood and adolescence. This article summarizes the infections of importance in children who are looked after, including blood borne viruses (TB, HIV, hepatitis B and C and syphilis) as well as more commonly neglected infectious diseases with maternal to child transmission (e.g. herpes simplex virus and Chlamydia) and infections of particular relevance to the CYPSAR-U population (e.g. schistosomiasis and strongyloidiasis). It is the responsibility of health care professional to identify and reduce the risks of infection in CLA. This article describes best practice at every stage of care; from identifying risk factors, through informed consent and counselling, to testing and sharing results, and finally with robust follow-up and ongoing education. We also describe where services are currently falling short, and give recommendations for service improvement and further research, with a particular emphasis on integrating the views of the children themselves.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 11","pages":"Pages 398-405"},"PeriodicalIF":0.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142531065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Gastrointestinal complications of cystic fibrosis","authors":"Christabella Ng, Andrew Prayle","doi":"10.1016/j.paed.2024.07.002","DOIUrl":"10.1016/j.paed.2024.07.002","url":null,"abstract":"<div><div>Cystic fibrosis is a multisystem disorder, and gastrointestinal (GI) disease contributes significantly to its morbidity. This review outlines the major gastrointestinal manifestations of CF, and highlights areas of common misunderstanding. Areas particularly important to practice, such as impact upon malabsorption, bowel obstruction and gastro-oesophageal reflux are considered in detail. The impact of new CFTR modulator therapies on CF-related GI conditions is discussed and treatment options for individual pathologies is discussed.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 10","pages":"Pages 363-367"},"PeriodicalIF":0.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cyclical vomiting syndrome","authors":"Ishaq Abu-Arafeh","doi":"10.1016/j.paed.2024.07.003","DOIUrl":"10.1016/j.paed.2024.07.003","url":null,"abstract":"<div><div>Cyclical vomiting syndrome (CVS) was described over 100 years ago, but it is often underdiagnosed and undertreated, even after a diagnosis is made. It is relatively common, affecting almost 2% of school-age children in some studies. Although it is traditionally seen as a childhood disease related to migraine, CVS does occur in adults. The main characteristic of CVS is the stereotypical recurrent nature of episodes of intense nausea and vomiting lasting from few hours to few days and followed by a complete resolution of symptoms. The diagnosis is predominantly a clinical one and there are internationally accepted criteria for diagnosis. The management of acute attacks of CVS aims to relieve symptoms, reduce the duration of attacks and prevent dehydration and hospital admission. Management also includes appropriate counselling on healthy lifestyle, provision of individual management plans and preventive medications. The aim of management is to reduce the number of attacks and improve quality of life. About half the children with CVS start to have migraine with or without aura in late adolescence and around 40% continue with CVS into early adult life. This article is aimed at healthcare professionals looking after children with CVS and describes the clinical presentation, the criteria required for diagnosis and outlines the different treatment options.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 10","pages":"Pages 368-372"},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ammonia, lactate and blood gases: a user's guide","authors":"James E Davison","doi":"10.1016/j.paed.2024.07.006","DOIUrl":"10.1016/j.paed.2024.07.006","url":null,"abstract":"<div><div>Basic biochemical tests are frequently obtained in acutely unwell neonates and children, as well as in some elective situations. Correct interpretation is essential in identifying rare inherited primary metabolic disorders, but secondary causes of hyperammonaemia, elevated blood lactate or acid-base derangement are more common and require appropriate treatment of the underlying cause. Ammonia is the waste product of protein metabolism and is highly toxic. Ammonia should be measured in any sick neonate, and in children with unexplained encephalopathy. Further testing is needed to determine if it is secondary to other factors, or due to a primary metabolic disorder affecting urea cycle function. Specific treatment should be instigated urgently to avoid long term neurological sequelae. Lactate elevation indicates anaerobic respiration and is often secondary to hypoxia or poor tissue perfusion but can indicate a metabolic disorder affecting mitochondrial function or energy metabolism. Blood gas analysis to review acid-base status is a critical test in any sick neonate or child, and correct interpretation will indicate if there is a respiratory or metabolic basis. A metabolic acidosis with elevated anion gap may indicate a primary metabolic disorder. These tests can help identify patients who may have a primary metabolic disorder, and management should be discussed urgently with a specialist metabolic centre.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 10","pages":"Pages 388-392"},"PeriodicalIF":0.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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