Strip searching by the police: potential for abuse?
Before any diagnostic examination of a child, every paediatrician routinely obtains consent or assent from that child, as age appropriate, and ensures that a parent or carer is present and gives informed consent to whatever is proposed. There may be exceptions—for example, an older child who is an inpatient and who knows the medical team well and who is happy to be examined without a parent or carer present. In such a case, remote consent from the parent would be sought, and there would be a chaperone present who is known and trusted by the young person. This is elementary paediatrics. The only exception, which would...
Source: Archives of Disease in Childhood - January 22, 2024 Category: Pediatrics Authors: Bush, A. Tags: Press releases Editorial Source Type: research
Atoms
Such a tease Medical history is literally strewn with moments of deserved elation. Few triumphs, though, are impermeable to subsequent challenge. Even world changers like the discovery of penicillin aren’t immutable, antimicrobial resistance, now a perennial feature in the WHO top ten global health threat compilations, the spanner in the works. The (infinitely more poignant) corollary is the scenario in which a ‘new intervention’ clearly works, but persuading the (for want of a better word) ‘community’ to engage becomes an even larger hurdle than the evidence accumulated. Think of the Wright b...
Source: Archives of Disease in Childhood - January 22, 2024 Category: Pediatrics Authors: Brown, N. Tags: Highlights from this issue Source Type: research
Highlights from the literature
Organic and non-organic failure to thrive Traditionally, infants and children who were having trouble gaining weight and growing were considered to have ‘Failure to thrive’ (FTT) which is an outdated term and now we talk about ‘Faltering growth’. What about the classification or ‘organic failure to thrive’ and ‘non-organic’ or ‘psychosocial failure to thrive’? Are these outdated terms too? Many would say so, with the suggestion that faltering growth is such a complex condition that this simplistic approach is redundant. In a retrospective note review, Tiwari M et ...
Source: Archives of Disease in Childhood - December 14, 2023 Category: Pediatrics Tags: Miscellanea Source Type: research
Oral liquid medicines for children: the issues of choice
Offering choices allows accommodation of patient preferences. For many drugs, the availability of different dosage forms is designed to meet individuals’ needs, some of whom, for example, may have difficulties swallowing tablets. Accordingly, having more than one concentration of the same drug in liquid form allows us to further tailor the volume to be administered. However, in practice, choices are sometimes ‘limited’, at least on an organisational level. Among other good reasons for restricting the product range, there simply is not enough space for a pharmacy to stock every single product that is marke...
Source: Archives of Disease in Childhood - December 14, 2023 Category: Pediatrics Authors: Wan, M., Wignell, A., Tomlin, S. Tags: PostScript Source Type: research
To define reference ranges for the 3% and 4% mean desaturation nadir in healthy children under 12 years: observational study using oximetry motion-resistant technology
In 2020 we published data defining reference ranges for pulse oximetry parameters generated from oximeters which use short averaging times and contain motion rejecting algorithms in healthy children under 12 years of age.1 This paper reported the minimum saturation (SAT min), which is the lowest oxygen saturation recorded, a value that is commonly reported in the paediatric literature.1 2 This is limited by the fact that it takes into account the single most severe dip, without reflecting the pattern of desaturations occurring throughout the period of sleep. It is increasingly recognised that the SATmin may not provide a r...
Source: Archives of Disease in Childhood - December 14, 2023 Category: Pediatrics Authors: Shinde, S. S., Wen Yi Ong, J., Evans, H. J. Tags: PostScript Source Type: research
Towards evidence-based medicine for paediatricians
Vimes’ boots If you are lucky enough to have read Pratchett’s Men at Arms,1 you will almost certainly remember one of the best descriptions of the mechanics of socioeconomic inequity that has ever been delivered. It mostly concerns footwear, and I am encouraging you right now to flick away from the Archives and go seek out what Cpt Sam Vimes said about boots. Now you are back, you will wonder how this plays to evidence-based practice. Particularly if you are working in a healthcare system where access to treatment is not directly dependent on an ability to pay for assessment, care and medication. But it probabl...
Source: Archives of Disease in Childhood - December 14, 2023 Category: Pediatrics Authors: Phillips, B. Tags: ADC Archimedes Source Type: research
Can ingesting local honey reduce symptoms of allergic rhinitis (hay fever) in children and young people?
Clinical scenario A 14-year-old boy with allergic rhinitis (AR), more commonly known as hay fever, presents with sneezing, runny nose and itchy eyes. He is sensitised to grass, tree and birch pollen on skin prick testing. His symptoms affect him throughout the spring and summer months, affecting his performance at school. Despite medical therapies including oral antihistamine, nasal spray and eye drops, there are some days he remains symptomatic, and his mother is keen to find better treatment. She has heard that if you eat local honey, then this can improve the symptoms of hay fever and asks for your advice. You wonder wh...
Source: Archives of Disease in Childhood - December 14, 2023 Category: Pediatrics Authors: Yip, A., Reece, A. Tags: ADC Archimedes Source Type: research
Healthcare prioritisation and inequitable inequalities: why a child health perspective should be incorporated into the current NHS guidance
One of the main aims of the post-COVID National Health System (NHS) is to tackle inequalities in experience, access and health outcomes that compromised the health of the most vulnerable patients in the time of crisis.1 This aim suggests that in reducing the current care backlog for treatment, equity considerations should be traded off against efficiency when prioritising healthcare. Giving priority to categories of care or population groups is necessary to address preventable and undesirable health inequalities in keeping with Marmot’s proportionate universalist approach to reducing inequalities in health,2 and refl...
Source: Archives of Disease in Childhood - December 14, 2023 Category: Pediatrics Authors: Lignou, S., Wolfe, I. Tags: Open access, COVID-19 Viewpoint Source Type: research
Can universal basic income reduce poverty and improve childrens health?
This article will explain the concepts of health, poverty and BI, how BI can improve health and present evidence for its effects on child poverty and health. The WHO has defined health as a ‘state of complete physical,... (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - December 14, 2023 Category: Pediatrics Authors: Huss, R. Tags: Viewpoint Source Type: research
External validation of a multivariable prediction model for identification of pneumonia and other serious bacterial infections in febrile immunocompromised children
Conclusion
Discrimination and calibration were good for bacterial pneumonia but poorer for other SBIs. The rule-out thresholds have the potential to reduce unnecessary investigations and antibiotics in this high-risk group. (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - December 14, 2023 Category: Pediatrics Authors: Martin, A. J., van der Velden, F. J. S., von Both, U., Tsolia, M. N., Zenz, W., Sagmeister, M., Vermont, C., de Vries, G., Kolberg, L., Lim, E., Pokorn, M., Zavadska, D., Martinon-Torres, F., Rivero-Calle, I., Hagedoorn, N. N., Usuf, E., Schlapbach, L., K Tags: Original research Source Type: research
Watch your salt intake and your patients
Archivist sees many a young adult (and older ones) adding extra salt to their meals in restaurants and cafes, before even tasting the food. Why do people do this? One presumes that the chef will have seasoned their food for optimum impact. Is this an insult to the chef? Maybe it is just individual taste but, Archivist suggests it is a habit developed in adolescence and perhaps even in childhood. The ‘Childhood origins of adult disease’ is an interesting theme and those clinicians involved in paediatric care should always be on the lookout for prevention of disease and habits that have long term implications&mda...
Source: Archives of Disease in Childhood - December 14, 2023 Category: Pediatrics Tags: Miscellanea Source Type: research
Potential for Englands statutory school entry assessment to identify special educational needs and reveal structural inequalities: a population-based study
Conclusions
School readiness assessments are associated with later SEN identification. Structural inequalities may exist in SEN identification in children not entering formal education ‘school ready’. Such assessments could facilitate earlier identification of SEN and reduce structural inequalities in its identification. (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - December 14, 2023 Category: Pediatrics Authors: Wood, M. L., Gunning, L., Relins, S., Sohal, K., Wright, J., Mon-Williams, M., Atkinson, A. L. Tags: Open access Original research Source Type: research
Use of healthcare services before diagnosis of attention-deficit/hyperactivity disorder: a population-based matched case-control study
Conclusions
Two years before diagnosis, CYP with ADHD attended healthcare services twice as often as CYP without. CYP with ADHD had increased rates of physical conditions, such as asthma and eczema. These contacts may be an opportunity for earlier recognition and diagnosis of ADHD. (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - December 14, 2023 Category: Pediatrics Authors: Prasad, V., Rezel-Potts, E., White, P., Downs, J., Boddy, N., Sayal, K., Sonuga-Barke, E. Tags: Open access Original research Source Type: research
Short stature? Call the geneticist
Next generation sequencing technologies (NGS) such as exome sequencing (ES) and chromosomal microarray analysis (CMA) didn’t exist when Archivist was at medical school. There are now several well recognised genetic factors contributing to short stature including traditional chromosomal abnormalities but also copy number variations (CNVs), and single-nucleotide variants. How do these new tools help in making a diagnosis? What is the yield? Currently it is unclear. Li Q et al [JAMA Pediatr 2023;177:1149–57. doi:10.1001/jamapediatrics.2023.3566] have completed a systematic review and metanalysis to examine the val...
Source: Archives of Disease in Childhood - December 14, 2023 Category: Pediatrics Tags: Miscellanea Source Type: research
Association of early-life exposure to acid-suppressive therapy and fractures during childhood: a retrospective cohort study
Conclusions
AST was associated with a small but statistically significant increased incidence of fractures. We cannot exclude reporting bias or residual confounders. The clinical inference is currently unclear. (Source: Archives of Disease in Childhood)
Source: Archives of Disease in Childhood - December 14, 2023 Category: Pediatrics Authors: Achler, T., Chodick, G., Shaoul, R., Cohen, S., Ben-Tov, A., Goldshtein, I. Tags: Original research Source Type: research
