Highlights from the literature
CBT for migraine In April 2017, Lucina reported on evidence that most of the apparent effectiveness of drugs used for migraine prevention is probably placebo effect (doi.org/10.1136/archdischild-2017–3 12 882). Wouldn’t it be good if there was a treatment that was highly effective in the real world, whether through placebo effect or not, without any risk of drug side-effects? Well there is, according to a systematic review and meta-analysis (Ng QX, et al; Headache 2017 doi: doi.org/10.1111/head.13016). The Singaporean authors looked for trials investigating cognitive behavioural therapy (CBT) in childhood migra...
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Scott-Jupp, R. Tags: Miscellanea Source Type: research

Art therapy with a child with pulmonary hypertension
An 11-year-old girl with life-limiting pulmonary hypertension was offered art therapy as a mode of communication about her condition. Hour-long therapy sessions were weekly, over 5 years during which her condition improved and she prepared to move on to college. No claims are made for art therapy apart from it being part of her treatment. She said she needed art therapy because when she tried to express her fears to her parents they would begin to cry. The images illustrate the process of art therapy in her adjustment to chronic illness. In the first session she made a clay butterfly (figure 1) alongside the art thera...
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: McGregor, S., Morton, M. Tags: Journalology, Other rehabilitative therapies, Drugs: cardiovascular system, Stroke, Hypertension, Child health, Competing interests (ethics) Images in paediatrics Source Type: research

Question 2 Is levosimendan better than milrinone in preventing post operative low cardiac output syndrome and improving cardiac function in children with congenital heart disease?
Scenario You work in a paediatric cardiac intensive care unit (ICU), the unit protocol is to start prophylactic milrinone intraoperatively to prevent low cardiac output syndrome (LCOS). You receive a patient for whom levosimendan was started intraoperatively instead of milrinone, and you wonder whether levosimendan is superior to milrinone. Structured clinical question In postoperative congenital heart disease children (population), is levosimendan (intervention) better than milrinone (comparison) in improving cardiac function and prevention of LCOS (outcome), shown by heart rate, cardiac output/stroke volume, lactate clea...
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Udayasankar, S. Tags: Archimedes Source Type: research

Towards evidence-based medicine for paediatricians
Damned if you do and damned if you do not? The field of systematic review, of which Archimedes we believe sneaks in under the 'rapid review' heading, has long since held a solid foundation to what a systematic review needs to do. It needs to have a clear question, with a comprehensive search, and assessment of included studies bias/quality, a synthesis (which may be mathematical; meta-analysis) and a set of conclusions that draw this together.1 What it has been long struggling with is how to 'best do' each of these areas. 'Best' is itself problematic—take 'best' searches, for example. Do they find every single p...
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Phillips, B. Tags: Archimedes Source Type: research

Question 1 What is the best treatment option for empyema requiring drainage in children?
Scenario A 4-year-old girl attends with a 3-day history of cough, breathlessness and fever. She is started on antibiotics but fails to improve over the subsequent 48 hours. A chest X-ray and ultrasound of the thorax reveals a large, loculated pleural effusion amenable to drainage. Structured clinical question In managing children with a large empyema (patient), does a pleural drain with fibrinolytics or primary video-assisted thorascopic surgery (VATS) (intervention) result in better treatment outcome (outcome)? Search There are currently no applicable reviews in the Cochrane database. The PubMed Index was searched with th...
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Course, C. W., Hanks, R., Doull, I. Tags: Archimedes Source Type: research

Strengthening the global paediatric workforce: the need for a global strategy to ensure better health outcomes for children
Background Paediatric training and the practise of paediatrics is built on the bedrock of ensuring best possible health outcomes for all children, optimising opportunity for those without full health and contributing to a voice, in advocacy, for children. In the world’s high-income countries (HICs), child health outcomes are comparatively good, and the paediatric workforce well trained to manage the health issues of children. Paediatric training and continuing professional development is generally under the authority of paediatric societies or colleges. Such organisations are well funded and supported, have long trad...
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Forsyth, K. D. Tags: Global child health Source Type: research

Cardiovascular health, growth and gonadal function in children and adolescents with congenital adrenal hyperplasia
After the introduction of replacement therapy with glucocorticoids and mineralocorticoids in the 1950s, congenital adrenal hyperplasia (CAH) is no longer a life-limiting condition. However, due to the successful introduction of medical steroid hormone replacement, CAH has become a chronic condition, with associated comorbidities and long-term health implications. The aim of treatment is the replacement of mineralocorticoids and glucocorticoids and the normalisation of elevated androgen concentrations. Long-term consequences of the condition and current treatment regimens include unfavourable changes in the cardiovascular r...
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Mooij, C. F., Webb, E. A., Claahsen van der Grinten, H. L., Krone, N. Tags: Review Source Type: research

Pituitary dysfunction after traumatic brain injury: are there definitive data in children?
In the past decade, several studies in adults and children have described the risk of pituitary dysfunction after traumatic brain injury (TBI). As a result, an international consensus statement recommended follow-up on the survivors. This paper reviews published studies regarding hypopituitarism after TBI in children and compares their results. The prevalence of hypopituitarism ranges from 5% to 57%. Growth hormone (GH) and ACTH deficiency are the most common, followed by gonadotropins and thyroid-stimulating hormone. Paediatric studies have failed to identify risk factors for developing hypopituitarism, and therefore we h...
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Casano-Sancho, P. Tags: Drugs: CNS (not psychiatric), Neurological injury, Child health, Screening (epidemiology), Trauma, Pituitary disorders, Injury, Screening (public health) Review Source Type: research

Management of children and young people with vision impairment: diagnosis, developmental challenges and outcomes
Vision impairment (VI) has a significant impact on an individual's ability to engage with everyday tasks. Severe early-onset VI presents different challenges to adult onset visual loss since reduced visual input presents a major obstacle to the acquisition and development of fundamental developmental skills in early and later childhood. Early referral of the child with reduced vision is vital to ensure accurate diagnosis and prompt treatment of any modifiable aspects of the condition. Guidance to ensure optimisation of developmental opportunity through adaptation of play and care is vital from the earliest stages. Cognitiv...
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Keil, S., Fielder, A., Sargent, J. Tags: Eye Diseases, Ophthalmology Review Source Type: research

Implementation of the TRACHE care bundle: improving safety in paediatric tracheostomy management
Introduction Tracheostomy management has been the focus of a number of reviews in the UK over the last decade; however, paediatric patients have thus far been excluded from the analysis.1 2 Currently, there are no formally accepted national standards in the UK for paediatric tracheostomy management. Paediatric tracheostomies are associated with risks and complications in the order of two to three times higher than morbidity and mortality rates reported in adults. The mortality rate for a complication directly related to a paediatric tracheostomy is 0.7%.3 The majority of reported adverse incidents do not occur in the immed...
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Hall, A., Bates, J., Ifeacho, S., Hartley, B., Albert, D., Jephson, C., Hewitt, R. J., Cochrane, L., Wyatt, M., Cooke, J. Tags: Surgery, Epidemiologic studies, Neonatal and paediatric intensive care, Paediatric intensive care, Guidelines Quality reports Source Type: research

The Romanian adoption 'Experiment
How much does very early physical and emotional deprivation damage long-term cognitive ability and mental health? Population cohort studies are inevitably subject to all sorts of ongoing confounding factors. So the only way to answer this question would be to do a controlled trial. Unethical, surely? Well yes, but a unique set of circumstances in the 1990s presented an opportunity for a natural experiment. Readers will remember that, after the fall of the notorious Ceausescu regime in Romania in 1989, it was revealed that thousands of young children had been consigned to orphanages. These institutions were austere and the ...
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Scott-Jupp, R. Tags: Miscellanea Source Type: research

Hypopituitarism in children with cerebral palsy
We present a series of four children with cerebral palsy who were born before 29 weeks gestation who were referred to the regional endocrinology service, three for delayed puberty and one for short stature, in whom investigations identified MPHD. All patients had a height well below –2 standard deviation score (2nd centile) at presentation and three who had MRI scans had an ectopic posterior pituitary gland. We therefore recommend that the possibility of MPHD should be considered in all children with cerebral palsy and poor growth or delayed puberty. Early diagnosis and treatment is essential to maximise growth ...
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Uday, S., Shaw, N., Krone, R., Kirk, J. Tags: Epidemiologic studies, Cerebral palsy, Reproductive medicine, Child health, Radiology, Sexual health, Clinical diagnostic tests, Radiology (diagnostics), Pituitary disorders Case report Source Type: research

Vitamin A toxicity presenting as bone pain
A 4-year-old boy presented with severe bone pains, refusal to walk, diffuse bony swelling of forelimbs, skin changes and abdominal pain, with symptoms evolving over 6 weeks. Blood screening tests were normal except for raised aspartate aminotransferase (AST). Radiographs revealed thickened periosteum, widening of the diaphyses of long bones and lifted periosteum in mid-shaft of ulnae and right femur. Skeletal scintigraphy showed a high uptake of radionuclide at clinically affected and unaffected sites, suggestive of multifocal osteoblastic skeletal lesions. After repeated enquiries, his parents admitted to giving him ...
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Baineni, R., Gulati, R., Delhi, C. K. Tags: Liver disease, Pain (neurology), Radiology, Clinical diagnostic tests, Radiology (diagnostics), Screening (epidemiology), Screening (public health) Case report Source Type: research

The value of paediatric assessment in historic child sexual abuse
Conclusions This study highlights the value of a comprehensive paediatric assessment in a dedicated clinic for cases of suspected or alleged historic CSA, by identifying a broad variety of unmet health needs in this group. The findings have important implications for the child, their families and the multiagency team. (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Al-Jilaihawi, S., Borg, K., Maguire, S., Hodes, D. Tags: Original article Source Type: research

An alternative sensor-based method for glucose monitoring in children and young people with diabetes
Conclusions Accuracy, safety and user acceptability of the FreeStyle Libre System were demonstrated for the paediatric population. Accuracy of the system was unaffected by subject characteristics, making it suitable for a broad range of children and young people with diabetes. Trial registration number NCT02388815. (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Edge, J., Acerini, C., Campbell, F., Hamilton-Shield, J., Moudiotis, C., Rahman, S., Randell, T., Smith, A., Trevelyan, N. Tags: Open access Original article Source Type: research

Deformational plagiocephaly in normal infants: a systematic review of causes and hypotheses
Conclusions and relevance The evidence on the aetiology of DP is fragmentary and heterogeneous. In addition, factors possibly relevant to the development of DP have not been appreciated in the scientific discussion. (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: De Bock, F., Braun, V., Renz-Polster, H. Tags: Original article Source Type: research

Ethnic differences in coeliac disease autoimmunity in childhood: the Generation R Study
This study was embedded within a multi-ethnic population-based prospective cohort study. Setting and patients 4442 six-year-old children born between 2002 and 2006 were included. Information on ethnicity, environmental and lifestyle characteristics was assessed by questionnaires. Ethnicity was categorised into Western (Dutch, European, Indonesian, American, Oceanian) and non-Western (Turkish, Moroccan, Cape Verdean, Antillean, Surinamese). Serum transglutaminase type 2 antibody (TG2A) levels were measured with fluorescence enzyme immunoassay. Serum IgG levels against cytomegalovirus (CMV) were measured by ELISA. Main out...
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Jansen, M. A. E., Beth, S. A., van den Heuvel, D., Kiefte-de Jong, J. C., Raat, H., Jaddoe, V. W. V., van Zelm, M. C., Moll, H. A. Tags: Original article Source Type: research

Natural course of chronic fatigue syndrome/myalgic encephalomyelitis in adolescents
Conclusions The prevalence of CDF lasting 6 months or longer (a proxy for clinically diagnosed CFS/ME) increases from 13 to 18 years. However, persistent CDF is rare in adolescents, with approximately 75% recovering after 2–3 years. (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Norris, T., Collin, S. M., Tilling, K., Nuevo, R., Stansfeld, S. A., Sterne, J. A., Heron, J., Crawley, E. Tags: Open access Original article Source Type: research

Does increased duration of consultant presence affect length of hospital stay for unplanned admissions in acute paediatrics?: an observational before-and-after analysis using administrative healthcare data
This study aims to review whether implementation of increased duration of consultant presence is associated with reduction in length of hospital stay (LoS) in children with an unplanned admission to hospital. Method (design/setting/participants/interventions/outcome measures) An observational before-and-after study of all unplanned general paediatric admissions to a UK hospital between 1 September 2012 and 31 August 2015, comparing LoS and readmission rates before and after implementation of a policy mandating consultant review within 12 hours of unplanned hospital admission. Results 5367 inpatient admissions were a...
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Cromb, D., Carter, C., Lemer, C., Cheung, C. R. Tags: Original article Source Type: research

Female genital mutilation in children presenting to Australian paediatricians
Objective The WHO reports that female genital mutilation/cutting (FGM/C) is an ancient cultural practice prevalent in many countries. FGM/C has been reported among women resident in Australia. Our paper provides the first description of FGM/C in Australian children. Design Cross-sectional survey conducted in April–June 2014. Setting Paediatricians and other child health specialists recruited through the Australian Paediatric Surveillance Unit were asked to report children aged
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Zurynski, Y., Phu, A., Sureshkumar, P., Cherian, S., Deverell, M., Elliott, E. J., for Australian Paediatric Surveillance Unit Female Genital Mutilation Study Steering Committee Tags: Open access Original article Source Type: research

Adult height of preterm infants: a longitudinal cohort study
Background Many infants born prematurely experience growth failure following delivery, with subsequent catch-up growth. Traditionally catch-up was thought to be complete in the first few years of life. Most studies have focused on groups of infants defined by birth weight, for example
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Ferguson, E. C., Wright, N. P., Gibson, A. T., Carney, S., Wright, A., Wales, J. K. Tags: Original article Source Type: research

Ethnic and socioeconomic variation in incidence of congenital heart defects
Conclusions Significant ethnic variations exist in the incidence of CHDs, including for specific defects with high infant mortality. It is essential that healthcare provision mitigates ethnic disparity, including through timely identification of CHDs at screening, supporting parental choice and effective interventions. Future research should explore the factors underlying ethnic variation and impact on longer-term outcomes. (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Knowles, R. L., Ridout, D., Crowe, S., Bull, C., Wray, J., Tregay, J., Franklin, R. C., Barron, D. J., Cunningham, D., Parslow, R. C., Brown, K. L. Tags: Open access Original article Source Type: research

'The Score Matters: wide variations in predictive performance of 18 paediatric track and trigger systems
Conclusions There is considerable variation in the performance of published PEWS, and as such the choice of PEWS has the potential to be clinically important. Trigger-based systems performed poorly overall, but it remains unclear what factors determine optimum performance. More complex systems did not necessarily demonstrate improved performance. (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Chapman, S. M., Wray, J., Oulton, K., Pagel, C., Ray, S., Peters, M. J. Tags: Editor's choice Original article Source Type: research

Preventing rotavirus in Africa
In the West, rotavirus immunisation became routine several years ago, and we are now enjoying the benefits of fewer admissions for infectious diarrhoea. In low-income countries, rotavirus gastroenteritis is not just an inconvenience, but a common and frequently fatal illness. This is particularly true of sub-Saharan Africa. Uptake of mass immunisation has been slow, because of cost and difficulty in getting refrigerated vaccine to remote communities: the ‘cold-chain’ problem. Unlike bacterial enteric pathogens, rotavirus rates are not much reduced by access to clean water and sanitation. Vaccination is the only...
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Scott-Jupp, R. Tags: Miscellanea Source Type: research

Recruitment and retention in paediatrics: challenges, opportunities and practicalities
Introduction Paediatrics is a popular specialty with medical students who enjoy its variety, fun and multi-professional working. This enthusiasm is often not reflected in applications to specialty training and in many countries, paediatrics is less popular than medicine, surgery and family medicine.1 More worryingly, paediatric training programmes are finding it increasingly difficult to retain doctors, with a consequent increase in rota gaps. In the UK, for example, applications to commence paediatric training were down 11.5% in 2016 compared with the number of applications filed in 2015.2 Here, we identify some strategie...
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Jacob, H., Shanmugalingam, S., Kingdon, C. Tags: Leading article Source Type: research

Rudeness
‘Who is that rude man? He must be someone important.’ The man referred to was a very self-important associate medical director, well known for his lack of common courtesy. My colleague’s remark held another grain of truth, too: the ability to be rude, and for this to go unchallenged, is clearly associated with hierarchy. If you are someone important, you can get away with behaviours that would not necessarily be tolerated in another context. But rudeness can also arise between equals and from patients (or parents). It can be corrosive in a workplace where there are plenty of other stress factors, and may ...
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Ward Platt, M. Tags: Editorial Source Type: research

Paediatric early warning systems (PEWS and Trigger systems) for the hospitalised child: time to focus on the evidence
Paediatric early warning systems (PES) detect trends of abnormality and indicate the need for care escalation, the extent of which depending on the value of score, for example, from nursing review to consultant input being required. Two broad systems exist: Trigger systems and early warning scores (PEWS). Trigger systems operate in an ‘all or nothing’ fashion as they activate an urgent clinical review when one of the trigger criteria is reported. PEWS systems assign an aggregated score according to the degree of physiological derangement and the presence or absence of other factors such as staff or carer concer...
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Lillitos, P. J., Maconochie, I. K. Tags: Editorial Source Type: research

Thank you to our reviewers
The Editor would like to publicly acknowledge the people listed below who served as reviewers on the journal during 2016. Without their efforts, the quality of the journal could not be sustained. Aarnoudse-Moens, Cornelieke Aarvold, Alexander Abdalla, Safa Abdel-Rahim, Ali Abdel-Rahman, Susan Absoud, Michael Abu-Arafeh, Ishaq Acerini, Carlo Aceti, Arianna Adappa, Roshan Ades, Anne Afzal, Nadeem Agarwal, Shakti Agopian, A.J. agrawal, shakti Ahmed, Mansoor Ainsworth, Sean Akikusa, Jonathan Alansari, Khalid Alexander, Mark Alimovic, Sonja Allegaert, Karel Allegaert, Karel Allen, Stephen Allport, Tom Almossawi, Ofran Alonge, O...
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Tags: Thank you to our reviewers Source Type: research

Highlights from this issue
PEWS: settling the score ‘Early Warning’ or ‘Track and Trigger’ charts are now a ‘must have’ for acute paediatric care. They have even found their way onto postnatal wards and into neonatal transitional care, and there has been an assumption that local units can invent their own versions without any need for a rigorous assessment of effectiveness. Chapman et al bring some welcome clarity into this area in a paper that sets out to evaluate the relative merits of 18 different systems, yet tellingly managed only to evaluate 12 of these properly. Using a case-control method in over 300 patie...
Source: Archives of Disease in Childhood - May 23, 2017 Category: Pediatrics Authors: Ward Platt, M. Tags: Atoms Source Type: research

Highlights from the literature
Placebo works in abdominal pain In April 2017, Lucina commented on the high placebo response rate seen in studies comparing migraine headache treatments (doi.org/10.1136/archdischild-2017–3 12 882). Now a review paper has looked specifically at placebo effects reported in studies of abdominal pain-related functional gastrointestinal disorders (AP-FGIDs) in children (HoekmanJ et al. J Pediatr 2017. doi.org10.1016/j.jpeds.2016.12.022). They found 21 randomised placebo-controlled trials, which used a variety of pain-rating scales. Looking only at the placebo groups, they found that the proportion of children ending up w...
Source: Archives of Disease in Childhood - April 19, 2017 Category: Pediatrics Tags: Lucina Source Type: research

Ethnicity as a confounding factor for the incidence of developmental dysplasia of the hip in the UK
In May 2004, eight new member states (A8) joined the European Union (EU), broadening the free movement of people to include more of Eastern Europe.1 The 2011 census for Southampton city reported a 212% rise in numbers of residents from EU accession countries since 2001. Of 11 370 immigrants, 8391 were Polish-born, making up 3.5% of total city residents. The Polish-born population of the UK increased from 75 000 in 2003 to an estimated 831 000 in 2015. Poland has overtaken India and is the single largest foreign national group resident in the UK2 with 21 156 Polish babies born in 2012, a number larger th...
Source: Archives of Disease in Childhood - April 19, 2017 Category: Pediatrics Authors: Judd, J., Aarvold, A., Clarke, N. M. P. Tags: PostScript Source Type: research

Intestinal failure in children and young people with neurodisabling conditions
Gastrointestinal dysmotility is common in children and young people with neurodisabling conditions. In this article we seek to highlight the increasing difficulties faced by paediatricians in managing intestinal failure in this patient group. It is becoming clear that, as the median age for survival increases, intestinal failure is a significant problem, and can in some cases become life-limiting. The ethical issues around starting children with life-limiting conditions on parenteral nutrition (PN) are extremely complicated, not least because we are ignorant of the mechanism of intestinal failure in these children, and ind...
Source: Archives of Disease in Childhood - April 19, 2017 Category: Pediatrics Authors: Wahid, A. M., Powell, C. V., Davies, I. H., Evans, J. A., Jenkins, H. R. Tags: Childhood nutrition, Childhood nutrition (paediatrics) Case report Source Type: research

The choking hazard of grapes: a plea for awareness
We present the cases of three children who presented to our institution after grape aspiration. Increased dissemination of the learning points among health professionals working with children may aid in the prevention of further episodes. (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - April 19, 2017 Category: Pediatrics Authors: Lumsden, A. J., Cooper, J. G. Tags: Press releases Case report Source Type: research

A premenarcheal girl with urogenital bleeding
An 8-year-old Caucasian girl was referred with perineal bleeding of sudden onset during micturition. There was no history of trauma, fever or dysuria, but she had a history of constipation. Family history was unremarkable. Physical examination showed a prepubertal girl with a red ‘doughnut’-shaped lesion surrounding the urethral meatus (figure 1). Laboratory findings, including platelet count and coagulation, were normal. A vaginoscopy, performed using sedation, was negative. Swabs tested negative for sexually transmitted pathogens. A diagnosis of urethral prolapse (UP) was made on clinical appearance. Treatmen...
Source: Archives of Disease in Childhood - April 19, 2017 Category: Pediatrics Authors: Lora, A., Scrimin, F., Taddio, A., Ventura, A., Barbi, E. Tags: Constipation, Urology, Journalology, Pain (neurology), Reproductive medicine, Child abuse, Child health, Sexual health, Competing interests (ethics), Drugs: endocrine system Images in paediatrics Source Type: research

'I have to live with the decisions I make: laying a foundation for decision making for children with life-limiting conditions and life-threatening illnesses
The relationship between parents and clinician is critical to the care and treatment of children with life-limiting conditions (LLCs) and life-threatening illnesses (LTIs). This relationship is built and maintained largely in consultations. In this article we lay out factors that bear on the success of clinical consultations and the maintenance of the essential clinician–parent relationship at progression or deterioration of LLCs or LTIs. We suggest an approach to engaging parents in conversations about care and treatment that recognises and appreciates the dilemmas which clinicians and parents face and in so doing p...
Source: Archives of Disease in Childhood - April 19, 2017 Category: Pediatrics Authors: Bluebond-Langner, M., Hargrave, D., Henderson, E. M., Langner, R. Tags: Open access Review Source Type: research

What can be done to lessen morbidity associated with fetal alcohol spectrum disorders?
Fetal alcohol syndrome and its wider spectrum of presentation fetal alcohol spectrum disorders represent a range of disorders that are sometimes difficult to recognise as they may present in a way that overlaps with other conditions. This makes identification and recognition challenging, which increases the burden associated with the disorder. When considering the reduction in morbidity, both prevention of exposure to alcohol by the fetus and early identification of cases are required. This selective review seeks to highlight some of the complexities involved as well as highlighting the challenges. By considering populatio...
Source: Archives of Disease in Childhood - April 19, 2017 Category: Pediatrics Authors: Mukherjee, R., Cook, P. A., Fleming, K. M., Norgate, S. H. Tags: Epidemiologic studies, Pregnancy Review Source Type: research

Squaring the circle: health as a bridge to global solidarity in the Sustainable Development Goals
The Sustainable Development Goals (SDGs), launched in September 2015 to follow on from the Millennium Development Goals, require action by all countries. The new goals range from traditional areas of health and education to a newer focus on global trade and environmental protection. We discuss how all countries can be incentivised to engage and commit and argue that thoughtful target-setting and benchmarking, a more aggressive focus on equity and an emphasis on the interdependence of health and non-health development goals are key to meaningful progress. Fundamental shared values and aspirations around health, and in parti...
Source: Archives of Disease in Childhood - April 19, 2017 Category: Pediatrics Authors: Williams, B., Taylor, S. Tags: ADC Global child health Source Type: research

Highlights from this issue
Quality of life For a very long time one of the key metrics of the successful treatment of children’s conditions has been school attendance. It has the advantage of being easily and objectively measured, and serves as a proxy for participation in social activities. But in the last 20 years, paediatricians have come to recognise that we need something more nuanced that can tell us about the lived experience of children with health conditions, regardless of the extent to which they make it to school. Measures of quality of life appear to be the best tools for this: quality of life is a multi-dimensional subjective expe...
Source: Archives of Disease in Childhood - April 19, 2017 Category: Pediatrics Authors: Ward Platt, M. Tags: First page Source Type: research

Archivist: Joint injections and methotrexate in JIA: better together?
Over the past two decades, treatment of juvenile idiopathic arthritis (JIA) has improved immensely, and much of this improvement pre-dates the use of new biologic drugs. This is largely due to greater willingness to use methotrexate, a long-established disease-modifying agent, early in the disease, and greater use of intra-articular corticosteroid injections: getting the steroid directly into the joint is effective and avoids most of the side-effects. What hasn’t been clear is whether these two modalities should be used together early on in the majority of children who present with relatively mild, oligoarticular dis...
Source: Archives of Disease in Childhood - April 19, 2017 Category: Pediatrics Tags: Miscellanea Source Type: research

Acute otitis media guidelines in selected developed and developing countries: uniformity and diversity
Conclusions Guidelines for AOM from developing and developed countries are similar in many aspects, with variation in specific recommendations, due to local epidemiology and healthcare accessibility. Formulation of regional guidelines may help reduce AOM burden. (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - April 19, 2017 Category: Pediatrics Authors: Ovnat Tamir, S., Shemesh, S., Oron, Y., Marom, T. Tags: Health policy, Drugs: infectious diseases, Otitis, Child health Original article Source Type: research

Snake bite mortality in children: beyond bite to needle time
Objective To study the clinical characteristics and predictors of mortality from snake bite envenomation in children. Design Prospective observational study with a one-group cohort design. Setting Paediatric intensive care unit of a tertiary care hospital in South India. Subjects The study cohort consisted of 145 children (55 girls and 90 boys)
Source: Archives of Disease in Childhood - April 19, 2017 Category: Pediatrics Authors: Jayakrishnan, M., Geeta, M., Krishnakumar, P., Rajesh, T., George, B. Tags: Epidemiologic studies, Drugs: cardiovascular system, Poisoning, Trauma, Occupational and environmental medicine, Injury Original article Source Type: research

Cardiopulmonary exercise testing in children with cystic fibrosis: one centre's experience
Background While exercise testing is increasingly used as a prognostic indicator in cystic fibrosis (CF), it is reported to be underused in UK CF centres, particularly in children. Here, we evaluated the cardiopulmonary exercise testing (CPET) results in children and young people with CF at CF annual review and its possible clinical value. Method An observational study comparing CPET results using a cycle ergometer ramp test (peak oxygen uptake (Vo2peak)) and pulmonary function (forced expiratory volume in 1 s (FEV1)) was performed with body mass index (BMI) used as a disease severity marker. Data were identified fro...
Source: Archives of Disease in Childhood - April 19, 2017 Category: Pediatrics Authors: Weir, E., Burns, P. D., Devenny, A., Young, D., Paton, J. Y. Tags: Pancreas and biliary tract, Cystic fibrosis Original article Source Type: research

Health profiles of overweight and obese youth attending general practice
Conclusions Our study highlights the need for effective weight management given that overweight and obese youth consult their GP more often. Since young people do not present with weight issues, it becomes important for GPs to find ways to initiate the discussion about weight, healthy eating and exercise with youth. Trial registration number ISRCTN16059206. (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - April 19, 2017 Category: Pediatrics Authors: Paulis, W. D., Palmer, M., Chondros, P., Kauer, S., van Middelkoop, M., Sanci, L. A. Tags: Obesity (nutrition), Adolescent health, Child health, Health education, Obesity (public health), Health promotion Original article Source Type: research

Developmental and behavioural associations of burns and scalds in children: a prospective population-based study
Objective To investigate child developmental and behavioural characteristics and risk of burns and scalds. Design Data on burns in children up to 11 years from 12 966 participants in the Avon Longitudinal Study of Parents and Children were linked to developmental profiles measured before the burn injury. Measures Preinjury profiles of the children derived from maternal questionnaires completed in pregnancy, and at 6, 18, 42, 47 and 54 months. Injury data collected by questionnaire at 6, 15 and 24 months and 3.5, 4.5, 5.5, 6.5, 8.5 and 11 years of age. Results Incidence: Burn rates were as follow...
Source: Archives of Disease in Childhood - April 19, 2017 Category: Pediatrics Authors: Emond, A., Sheahan, C., Mytton, J., Hollen, L. Tags: Epidemiologic studies, Open access, Pregnancy, Reproductive medicine Original article Source Type: research

Archivist: Is appendicectomy really necessary?
In 1902, King Edward VII developed appendicitis on the eve of his coronation. He was successfully operated on by Sir Frederick Treves, and since then surgery has been the treatment of choice for this condition. Ironically, many years later Treves died from peritonitis, possibly from a ruptured appendix. Back then they had no antibiotics or intravenous (IV) fluids, and appendicitis was usually fatal. The dogma that every inflamed appendix must be removed has been challenged recently, and some trials in adults have shown successful outcomes with medical treatment only. A systematic review of the current literature in childre...
Source: Archives of Disease in Childhood - April 19, 2017 Category: Pediatrics Tags: Miscellanea Source Type: research

Randomised controlled trial and economic evaluation of the 'Families for Health programme to reduce obesity in children
Objective Evaluating effectiveness and cost-effectiveness of ‘Families for Health V2' (FFH) compared with usual care (UC). Design Multicentre randomised controlled trial (RCT) (investigators blinded, families unblinded) and economic evaluation. Stratified randomisation by family; target of 120 families. Setting Three National Health Service Primary Care Trusts in West Midlands, England. Participants Overweight or obese (≥91st or ≥98th centile body mass index (BMI)) children aged 6–11 years and their parents/carers, recruited March 2012–February 2014. Interventions FFH; a 10-week community-b...
Source: Archives of Disease in Childhood - April 19, 2017 Category: Pediatrics Authors: Robertson, W., Fleming, J., Kamal, A., Hamborg, T., Khan, K. A., Griffiths, F., Stewart-Brown, S., Stallard, N., Petrou, S., Simkiss, D., Harrison, E., Kim, S. W., Thorogood, M. Tags: Open access Original article Source Type: research

Immunotherapy for arterial ischaemic stroke in childhood: a systematic review
Conclusions Immunotherapies are used in children with AIS, mainly as steroids for children with arteriopathy. However, there is currently little robust evidence to either encourage or discourage this practice. There is weak evidence consistent with the hypothesis that in certain children at risk, steroids may both reduce the risk of occurrent/recurrent stroke and enhance neurological outcomes. As the potential benefit is still uncertain, this indicates that a trial of steroids in childhood AIS may be justified. (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - April 19, 2017 Category: Pediatrics Authors: Edwards, H. B., Mallick, A. A., O'Callaghan, F. J. K. Tags: Clinical trials (epidemiology), Epidemiologic studies, Immunology (including allergy), Stroke, Child health Original article Source Type: research

Randomised crossover trial of rate feedback and force during chest compressions for paediatric cardiopulmonary resuscitation
Conclusions While visual feedback restricted excessive compression rates to within the prescribed range, applied force remained widely variable. The forces required may differ with growth, but such variation treating one manikin is alarming. Feedback technologies additionally measuring force (effort) could help to standardise and define effective treatments throughout childhood. (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - April 19, 2017 Category: Pediatrics Authors: Gregson, R. K., Cole, T. J., Skellett, S., Bagkeris, E., Welsby, D., Peters, M. J. Tags: Clinical trials (epidemiology), Open access, Editor's choice, Resuscitation Original article Source Type: research

Using reporting guidelines to publish paediatric research
Many medicines and devices used for the healthcare of children are unlicensed and untested for use in paediatrics, and clinicians often have to rely on evidence in adults that may not be generalisable to children.1 2 There are a number of reasons why evidence in adults cannot always be safely extrapolated to children, including different pharmacokinetic and pharmacodynamic processes, and drug safety and efficacy being dependent on stage of development. Growing recognition of these issues has led to initiatives to increase the number of paediatric trials.3 In addition, recognition of the important differences in design and ...
Source: Archives of Disease in Childhood - April 19, 2017 Category: Pediatrics Authors: Harron, K. Tags: Open access, Child health, Medicines regulation Leading article Source Type: research

Paediatric health-related quality of life: what is it and why should we measure it?
Introduction As a paediatrician, you follow a number of children with chronic health conditions in your practice. You provide them with a variety of therapies and would like to know whether your treatments are having an impact, in particular whether there has been a change in the patient's health-related quality of life (HRQOL). HRQOL measures have the potential to augment the information that clinicians have available, to enhance their clinical decisions and assess the impact of a chronic health condition on a child's life. How should you try to capture this information? What is health-related quality of life? The WHO def...
Source: Archives of Disease in Childhood - April 19, 2017 Category: Pediatrics Authors: Haverman, L., Limperg, P. F., Young, N. L., Grootenhuis, M. A., Klaassen, R. J. Tags: Drugs: cardiovascular system, Child health Leading article Source Type: research