BMJ Paediatrics Open最新文献

{"title":"Using cognitive interviews with children to test the content validity of a paediatric patient reported experience measure.","authors":"Karlen R Barr, Erika Fortunati, Zachary Studniberg, Jessica Nikolovski, Leslie White, Sarah Elliott, Lynn McCartney, Dianna Smith-McCue, Mary Noah, Girish Swaminathan, James R John, Claire Treadgold, Aaron Hall, Ann Dadich, Barb Vernon, Elesha Toscano, Harriet Hiscock, Josephine Chow, Leanne Johnston, Lisa Whitehead, Mandie Foster, Valerie Sung, Valsamma Eapen","doi":"10.1136/bmjpo-2026-004589","DOIUrl":"10.1136/bmjpo-2026-004589","url":null,"abstract":"<p><strong>Background: </strong>Paediatric patient reported experience measures (pPREMs) can help children's voices be heard to evaluate and improve healthcare delivery. However, no standardised child-completed pPREM has been co-designed with children and validated in Australia. This research aimed to test the content validity of a co-created pPREM using an iterative, participatory approach with children.</p><p><strong>Methods: </strong>21 children aged 6-11 years were recruited across four Australian hospitals. Children participated in online cognitive interviews to evaluate pPREM items and rating scales (using 'stars' or 'smiley faces') for their understandability, usability, relevance and importance related to their needs in hospital. Framework analysis was conducted iteratively, with items refined after the first round of interviews based on children's feedback.</p><p><strong>Results: </strong>Most (n=20; 95%) children understood the instructions. After nine interviews, two items were revised: 'Someone I knew could stay with me' changed to 'Family and friends could be with me' and 'I was able to talk to other patients', to 'I was able to talk to other kids in hospital'. Following these revisions, all children understood most (13 of 18=72%) items. In the remaining five items, some phrases, such as 'Care and treatment', were not easily understood, and items were edited according to children's feedback. Most children (n=14; 67%) preferred the 'smiley faces' rating system, and 83% (n=15) reported the number of questions as the right amount. Children generally found all items important, although some items did not apply to all and a 'Does not apply to me' response option was added.</p><p><strong>Conclusions: </strong>Children aged 6-11 years can meaningfully engage with a co-designed pPREM. Cognitive interviews and an iterative approach helped identify and rectify comprehension issues. It is feasible to involve children in the design of pPREMs and doing so strengthens pPREMs' usability and understandability.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058194","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":"Parental awareness, attitudes and decision-making of off-label use in children: a systematic review and meta-analysis.","authors":"Tingyu Cao, Yujing Fei, Rong Jiang, Rong Shao","doi":"10.1136/bmjpo-2026-004987","DOIUrl":"10.1136/bmjpo-2026-004987","url":null,"abstract":"<p><strong>Objective: </strong>To systematically evaluate parental awareness, acceptance, refusal rate and influencing factors of off-label use in children, aiming to provide evidence for optimising informed consent and physician-parent communication.</p><p><strong>Methods: </strong>We searched PubMed, Web of Science, Elsevier ScienceDirect, CNKI, Wanfang and VIP from inception to March 2026 for observational, mixed-methods and qualitative studies on parental awareness, attitudes and decision-making about off-label use in children. A random-effects single-group rate meta-analysis pooled awareness and refusal rates; conditional acceptance rates were summarised narratively due to extreme heterogeneity in operational definitions; unconditional acceptance rates were reported as individual study estimates. Influencing factors and psychological experiences were synthesised thematically.</p><p><strong>Results: </strong>Seven studies were included. The pooled parental awareness rate was 20.2% (95% CI: 10.6% to 31.9%), conditional acceptance ranged from 20.6% to 85.1% due to inconsistent operational definitions, unconditional acceptance was reported in two studies with individual estimates of 18.2% and 22.7%, and refusal was 36.5% (95% CI: 14.6% to 61.8%). Influencing factors fell into three themes: child clinical characteristics, parental cognition and emotion, and physician communication and qualification.</p><p><strong>Conclusion: </strong>Parental awareness of off-label use in children is low. Part of parents accept conditionally; unconditional acceptance is limited, and refusal rates are relatively high. These three themes interact throughout the decision-making process. Postdecision caregiving experiences may lead to long-term scepticism and influence future attitudes. In clinical practice, informed consent should shift from procedural notification to trust-centred communication. Prescription and drug supply processes should be optimised to reduce parental care burden.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058227","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":"Socioeconomic differences in primary healthcare use before childhood cancer diagnosis: a register-based cohort study in Sweden.","authors":"Julia Reißinger, Christina-Evmorfia Kampitsi, Maria Feychting, Hanna Mogensen, Marios Rossides, Eric Chen, Arja Harila, Kleopatra Georgantzi, Giorgio Tettamanti, Javier Louro","doi":"10.1136/bmjpo-2026-005059","DOIUrl":"10.1136/bmjpo-2026-005059","url":null,"abstract":"<p><strong>Background: </strong>Early diagnosis of childhood cancer remains challenging because initial symptoms are common, nonspecific and have low predictive value in primary healthcare (PHC). We assessed whether socioeconomic differences shape pre-diagnostic PHC pathways before childhood cancer diagnosis.</p><p><strong>Methods: </strong>We conducted a register-based matched cohort study using PHC data from three Swedish regions between 2001 and 2022, covering 54% of the general paediatric population in Sweden. Children aged 0-19 years with a first cancer diagnosis were matched 1:25 to cancer-free population references by age, sex and region. In-person PHC physician contacts in the year before the index date were analysed. Logistic and negative binomial regression models were used to assess socioeconomic differences in PHC utilisation and PHC contact frequency, respectively stratified by diagnostic group.</p><p><strong>Results: </strong>The study included 3711 childhood cancer patients and 93 181 references. Children with cancer had more PHC contacts than population references in the year before diagnosis (mean 2.28 vs 1.27, mean difference 1.01, 95% CI 0.94 to 1.08; p<0.001), although 22%-49% had no PHC contact 3 months before diagnosis depending on diagnostic group. Maternal educational gradients in PHC use were present in the general paediatric population but largely absent among children with cancer. An exception was central nervous system (CNS) tumours, for which children of mothers with low educational attainment had 28% more prediagnostic PHC contacts than those with highly educated mothers.</p><p><strong>Conclusion: </strong>Socioeconomic differences in PHC utilisation by maternal educational level largely diminish as children approach a cancer diagnosis, except for CNS tumours, where increased contacts among children of mothers with low educational attainment may indicate a prolonged or delayed diagnosis.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058167","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":"Identifying factors associated with childhood stunting in West Java, Indonesia: an explanatory sequential mixed-methods study.","authors":"Dwita Nitoya Esterini, Anahí Venzor Strader, Muhummed Nadeem Kasmani, Nia Reviani, Peter Rohloff","doi":"10.1136/bmjpo-2026-004666","DOIUrl":"10.1136/bmjpo-2026-004666","url":null,"abstract":"<p><strong>Objective: </strong>Stunting impairs child development and long-term economic productivity. In Indonesia, prevalence has declined substantially but progress has slowed. We aim to understand the contextual factors of childhood stunting in two rural communities in the Sumedang district, West Java, which is prioritised by health authorities due to its high stunting prevalence.</p><p><strong>Methods: </strong>We used an explanatory sequential mixed-methods design. A cross-sectional household survey (172 children under 5 years of age) informed the adaptation of interview guides for a qualitative phase consisting of 34 in-depth interviews with caregivers and community key informants, which were analysed inductively and integrated with the survey findings in a joint display.</p><p><strong>Results: </strong>Measured stunting prevalence was similar in the two communities (20.5% and 29.8%) and higher than the routine district estimates. Exploratory models showed common associations such as with household wealth, consistent with the wider literature. The interviews uncovered important resources and risks. These included informal nutrition education networks, delegated caregiver arrangements, coping with food insecurity through borrowing, credit, subsistence farming and fishing and health-worker accompaniment and village-funded social assistance programmes as buffers.</p><p><strong>Conclusions: </strong>Stunting in these communities was high and socially patterned. Sustained reductions will require ongoing intergenerational policies that address structural socioeconomic disadvantage and strengthen caregiving environments, rather than stand-alone nutrition or health interventions.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029830","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":"Epilepsy in children with cerebral palsy: perinatal, clinical and neuroimaging correlates - a cross-sectional study from a tertiary care centre in North India.","authors":"Arvinder Wander, Roshwanth A, Sameer Peer, Ratan Gupta, D Vignesh, Rajni Sharma, Madhu S Gaddigoudar, Soumya Swaroop Sahoo, Vaibhav Saini, Anuradha Raj","doi":"10.1136/bmjpo-2026-005050","DOIUrl":"10.1136/bmjpo-2026-005050","url":null,"abstract":"<p><strong>Background: </strong>Cerebral palsy (CP) frequently coexists with epilepsy, amplifying disability through compounded neurological impairments. This cross-sectional study at a tertiary care centre in Northern India characterises seizure profiles, epilepsy severity, motor function, neuroimaging correlates and perinatal predictors in 95 children aged 1-13 years with CP and epilepsy.</p><p><strong>Methods: </strong>Consecutive paediatric neurology patients underwent prospective evaluation with clinical, electroencephalographic and MRI assessments to characterise seizures in CP and examine their relation to Gross Motor Function Classification System (GMFCS) and MRI severity. Epilepsy severity was assessed using the Early Childhood Epilepsy Severity Scale (E-CHESS), CP severity using GMFCS and MRI severity using the scoring system by Trivedi <i>et al</i>. MRI findings and perinatal factors were analysed in relation to epilepsy severity in children with CP.</p><p><strong>Results: </strong>Spastic quadriplegic CP was predominant (78.9%), and generalised tonic-clonic seizures were the most common seizure types. E-CHESS was weakly and non-significantly associated with GMFCS (r=0.079, p=0.12); MRI severity increased with E-CHESS scores (p=0.0427); grey matter injury was associated with severe seizures, while white matter lesions were more often associated with moderate severity. Low/moderate 5 min APGAR score was strongly associated with severe seizures (adjusted OR 47.4-52.1, p<0.013), and children with quadriplegic CP more often showed perinatal compromise, including low 5 min APGAR scores.</p><p><strong>Conclusion: </strong>Epilepsy severity in CP was associated with grey matter MRI injury and low 5 min APGAR but showed less association with motor impairment. Low 5 min APGAR scores may serve as early clinical markers of increased risk of severe seizure in CP and may help prioritise MRI assessment and closer seizure surveillance. This study emphasises the need for parallel management strategies-addressing seizures and motor deficits separately but comprehensively.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036385","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":"Exploratory bidirectional Mendelian randomisation analysis of cerebrospinal fluid metabolites associated with cerebral palsy and epilepsy.","authors":"Longkun Mao, Ting Cui, Yun Liu, Xianrui Chen, Kaishou Xu","doi":"10.1136/bmjpo-2025-004390","DOIUrl":"10.1136/bmjpo-2025-004390","url":null,"abstract":"<p><strong>Background: </strong>Cerebral palsy (CP) and epilepsy are prevalent neurodevelopmental disorders with shared aetiological complexities. This study employs bidirectional Mendelian randomisation (MR) to investigate associations consistent with potential causal effects between cerebrospinal fluid (CSF) metabolites and the pathogenesis of CP and epilepsy.</p><p><strong>Methods: </strong>We conducted a two-sample MR analysis using genome-wide association study (GWAS) data from FinnGen, including 482 CP cases, 11 740 epilepsy cases and European ancestry controls. Instrumental variables for 338 CSF metabolites were selected using a relaxed threshold (p<1×10^-5) due to the modest size of the metabolite GWAS. Nominal statistical significance was defined as p<0.05; to account for multiple comparisons, Benjamini-Hochberg false discovery rate (FDR) correction (Q<0.05) was applied across all five MR methods for each outcome.</p><p><strong>Results: </strong>Six CSF metabolites showed nominal significant associations with CP risk in inverse variance weighted analyses, after FDR correction, three remained significant: 3-hydroxypyridine sulfate (OR=1.23, Q=0.040), isoleucine (OR=0.49, Q=0.046) and sphingomyelin (OR=1.12, Q=0.040). 17 metabolites were linked to epilepsy, of these, five remained significant after FDR correction, including 2,3-dihydroxy-5-methylthio-4-pentenoate (OR=0.81, Q=0.009) and 3-ureidopropionate (OR=1.09, Q=0.024). γ-Glutamylvaline showed nominally significant associations with both disorders but in opposite directions (CP: OR=1.25, p=0.040; epilepsy: OR=0.95, p=0.031); neither survived FDR correction. Reverse MR analyses did not support reverse associations for CP (all p>0.05), although genetic liability to epilepsy was associated with two CSF metabolites. Sensitivity analyses did not detect evidence of directional pleiotropy.</p><p><strong>Conclusions: </strong>These findings provide hypothesis-generating evidence regarding metabolic pathways potentially involved in CP and epilepsy and may inform future experimental and clinical investigations. Independent validation and functional studies are required before clinical application can be considered.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023784","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":"Are we back to normal? Evaluating the impact of the COVID-19 pandemic on referrals to a child protection service in a tertiary care centre in Vienna, Austria.","authors":"Chryssa Grylli, Sophie Klomfar, Johanna Brandlechner, Laura Schaller, Katharina Weimann, Anastasia Pantazidou, Eva Mora-Theuer, Christoph Krall, Catherine Quantin, Susanne Greber-Platzer","doi":"10.1136/bmjpo-2026-005049","DOIUrl":"10.1136/bmjpo-2026-005049","url":null,"abstract":"<p><strong>Background: </strong>Reports worldwide on suspected child maltreatment (CM) during and after the COVID-19 pandemic have been inconsistent. As no study has yet systematically examined whether structural disruptions to child protection systems have left measurable and lasting traces in referral patterns beyond the acute crisis phase, this study investigated the pandemic's impact on suspected CM referrals to the Forensic Examination Center for Children and Adolescents (FOKUS) in Vienna, Austria, and whether enduring shifts in CM presentation and referral dynamics have occurred.</p><p><strong>Methods: </strong>Retrospective study using patient administrative data of suspected CM cases referred to FOKUS between 16 March 2019 and 15 March 2023, covering the periods before, during and after the pandemic.</p><p><strong>Results: </strong>A total of 401 patients were referred to FOKUS during the study period. During the COVID-19 period, suspected physical abuse cases declined by 55.3% (p=0.029), while sexual abuse cases remained stable. Post-pandemic reports of suspected physical abuse returned to pre-pandemic levels, whereas suspected sexual abuse cases increased (p=0.013). Suspected sexual abuse cases showed a progressive increase in median age over time (p=0.025). Psychological support was more frequently required during the pandemic (63.5% vs 43.8% pre-pandemic, p=0.019), with elevated need continuing into the post-pandemic period (59.8%, p=0.018).</p><p><strong>Conclusion: </strong>The ongoing rise in suspected sexual abuse cases accompanied by different age victim profiles and increased need of psychological support following the pandemic indicates that a return to pre-pandemic norms is unlikely and the notion of 'back to normal' seems an oversimplification.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599858/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007806","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":"Happiness Toolkit in a paediatric outpatient setting for children with social, emotional, behavioural and/or mental health difficulties: a prospective cohort study.","authors":"Kate Eustace, Sarah Alexandra McCrory, Farhana Sharif","doi":"10.1136/bmjpo-2026-005011","DOIUrl":"10.1136/bmjpo-2026-005011","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the feasibility, acceptability and clinical outcomes of the Happiness Toolkit (HTK), a structured, low-intensity, family-delivered intervention for children aged 0-16 years screening positive for social, emotional, behavioural and/or mental health difficulties (SEMHD) in a paediatric outpatient setting.</p><p><strong>Design: </strong>Single-site prospective cohort study; validated age-specific baseline screening, parent-reported outcomes at 6 weeks and 6 months.</p><p><strong>Setting: </strong>General paediatric outpatient department, secondary hospital, Ireland.</p><p><strong>Participants: </strong>Consecutive paediatric outpatient attendees screening positive for SEMHD on the Ages and Stages Questionnaires: Social-Emotional, Second Edition (under 6 years) or Screen for Child Anxiety Related Emotional Disorders questionnaire (6-16 years) were enrolled for intervention.</p><p><strong>Interventions: </strong>The HTK comprises six evidence-based components practised for 5 minutes morning and evening, introduced during routine outpatient consultation.</p><p><strong>Main outcome measures: </strong>Primary: consent rate, positive screen rate and 6-week response rate (feasibility); parental willingness to recommend (acceptability). Secondary: parent-reported functional changes at 6 weeks and 6 months, component uptake and adverse events.</p><p><strong>Results: </strong>240 of 277 families approached across 16 outpatient clinics consented (86.6%); 94 children screened positive for SEMHD (39.2%) and received the HTK. At 6-week follow-up (n=46; 48.9% response rate), 95.2% of parents reported a positive or very positive experience, 73.9% noted improved mood in their child, 43.5% reduced screen time and 37.0% improved sleep patterns. 97.8% would recommend, with no adverse events. At 6-month follow-up (n=13; 13.8% response rate), 61.5% reported sustained child mood improvement and 92.3% would still recommend.</p><p><strong>Conclusions: </strong>This study demonstrates strong feasibility and high parental acceptability for the HTK when embedded in routine paediatric outpatient care. Parent-reported improvements at 6 weeks and no adverse events at both time points support progression to a controlled evaluation. In Ireland, 4462 children await Child and Adolescent Mental Health Services and over 28 000 await primary care psychology; the HTK represents a promising, pragmatic early and bridging support for emerging SEMHD.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007935","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":"Climate change health impacts on children in Canada: a systematic review.","authors":"Daniel Helldén, Kirsten Sjonnesen, Luis D Virla, Sherilee L Harper, Francois Bernier, Steven Bryant, Benedikt Hallgrímsson","doi":"10.1136/bmjpo-2026-004559","DOIUrl":"10.1136/bmjpo-2026-004559","url":null,"abstract":"<p><strong>Background: </strong>Climate change is accelerating; however, effects on child health remain poorly understood. Countries need context-specific evidence to translate global knowledge into adaptation. Canada is warming faster than the global average and provides an informative case of paediatric climate risks.</p><p><strong>Methods: </strong>We conducted a systematic review with narrative synthesis of the impacts of climate change on child health in Canada. Eligible studies explicitly attributed a change in a child health risk factor or exposure to climate change. Findings were narratively synthesised and study quality was appraised using design-appropriate tools.</p><p><strong>Results: </strong>Of 3614 records identified, 54 original articles and 17 reviews were included. A Canada-specific framework linked rising temperatures, changes in precipitation, increased wildfires, alterations to ecosystems and the spread of vector-borne diseases with child health. These impacts appear to follow existing health inequities. Quality appraisal identified frequent concerns about representativeness and control of confounding in quantitative studies, while most reviews were judged at high risk of bias.</p><p><strong>Conclusions: </strong>Evidence increasingly demonstrates climate change impacts on child health in Canada, but knowledge gaps remain. The findings demonstrate that children remain vulnerable even in a high-income country when climate hazards interact with developmental needs, inequity, infrastructure and relationships to land. The framework offers a transferable approach for countries to identify locally important hazards, vulnerable groups and intervention points. Strengthened efforts are urgently needed to implement these interventions in order to protect the health of current and future generations of Canadian children.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007809","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":"Validation of neurodevelopmental assessments for early detection of high-risk infants in Zimbabwe: protocol for the Child Development Observation study (ChiDO study).","authors":"Louisa Mudawarima, Nicole Santos, Gwendoline L Chimhini, Hilda A Mujuru, Rosemary Magonya, Rakesh Ghosh, Susanne P Martin-Herz","doi":"10.1136/bmjpo-2025-004460","DOIUrl":"10.1136/bmjpo-2025-004460","url":null,"abstract":"<p><strong>Introduction: </strong>Appropriate neurodevelopmental assessment tools are often unavailable in low- and middle-income countries (LMICs) due to lack of validation, cost and cultural-linguistic challenges. This reduces the availability of high-quality developmental evaluation, resulting in clinical gaps that impact individual child outcomes and modifiable risk detection for prevention. The objective of this study is to validate three neurodevelopmental assessment tools for early detection in low-resource settings through recruitment of infants across the neurodevelopmental impairment (NDI) risk spectrum related to perinatal asphyxia and neonatal encephalopathy (NE).</p><p><strong>Methods: </strong>This prospective, longitudinal cohort study in Harare, Zimbabwe will collect data at 3 months, 6 months, 12 months, 18 months and 24 months. The sample of approximately 600 caregiver-infant dyads will include: (1) infants without clinical concern for perinatal asphyxia or other complications (low risk); (2) infants who do not cry at birth and require resuscitation but do not have NE (moderate risk) and (3) infants who experience NE (high risk). In addition to demographic, antenatal and perinatal data collected at enrolment, neurodevelopmental assessments to be conducted include the Prechtl General Movement Assessment (GMA); Hammersmith Infant Neurological Examination (HINE); Global Scales for Early Development (GSED); Mullen Scales of Early Learning (MSEL) and caregiver-reported Ages and Stages Questionnaire. At the 24-month visit, a comprehensive diagnostic evaluation for NDI will be conducted adhering to international guidance. Predictive ability of all tools will be assessed by receiver operating characteristic (ROC) analyses, including area under the ROC curve. Construct validity of the GSED will be assessed by comparing to the MSEL. The GSED's ability to differentiate subgroups defined by correlates of NDI risk will be assessed using generalised estimating equations.</p><p><strong>Ethics and dissemination: </strong>Ethical approvals have been obtained. If shown to be valid, the GMA and HINE could provide earlier, feasible and low-cost detection of children at elevated risk for NDI.</p>","PeriodicalId":9069,"journal":{"name":"BMJ Paediatrics Open","volume":"10 1","pages":""},"PeriodicalIF":2.6,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007950","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}