Paediatrics & child health最新文献

Objectives: Paediatricians deliver developmental care through surveillance, diagnosis, management, and advocacy. Although developmental concerns are among the most common reasons for paediatric visits, care in this area is complex, intersecting medical, mental health, and educational systems. Increasing international migration, persistent health inequities, and diverse cultural concepts of child development require paediatricians to build skills for culturally informed care. However, there is limited research describing how paediatricians perceive and navigate cultural factors when providing developmental care, and how current training and systems support or hinder this. This qualitative study explored paediatricians' perceptions of providing culturally informed developmental care to diverse populations.

Methods: Semi-structured interviews were conducted with paediatricians who primarily provide developmental care, to understand perceived challenges, opportunities, and educational needs. Thematic analysis of transcribed interviews used both inductive and deductive approaches.

Results: Eighteen interviews yielded three major themes. First, cultural translation encompassed language barriers, use of interpreters, and trust-building within physician-family relationships. Second, inequity described systemic barriers faced by diverse families, power imbalances in healthcare, and the pandemic's amplification of inequities. Third, educational opportunities highlighted the value of reflective practice, immersive experiences in diverse settings, and building communities of practice to strengthen cultural competence.

Conclusion: Paediatricians described unique aspects of developmental care that may benefit from practice changes and curriculum reform. Enhanced training in interpreter use, multicultural health brokers, and care coordination teams is recommended. Peer mentorship from diverse colleagues may reduce stereotypes and broaden perspectives. Infrastructure to monitor and close culturally based health gaps is a critical priority for developmental paediatrics in Canada.

Objective: To characterize children with congenital nasolacrimal duct obstruction (NLDO) seen by a pediatric ophthalmologist in terms of initiation of tear duct massage and need for lacrimal duct probing.

Design: Retrospective chart review.

Participants: All children with a diagnosis of congenital NLDO managed by one pediatric ophthalmologist (SH) at a tertiary pediatric center (McMaster Children's Hospital, Hamilton, Ontario, Canada).

Methods: Charts were reviewed to determine the percentage of patients requiring nasolacrimal duct probing. Secondary outcomes were percentage of patients who had tear duct massage, accurate or inaccurate, initiated by the referring provider.

Results: Overall, 113 patients with a mean age of 1.8 ± 1.5 years at presentation were included, and 55 (48.7%) were male. Most patients (83.2%) were referred by a primary care provider (family physician or pediatrician) and the remainder by optometrists (13.3%) or ophthalmologists (3.5%). Accurate tear duct massage was initiated by referring providers in 23% of cases. Ultimately, 44.2% of cases required probing, and 4.4% were still pending follow-up at time of data collection. Of children who learned accurate massage technique, 56% avoided surgical intervention, even when proper massage is introduced after 12 months of age.

Conclusion: Most patients referred to pediatric ophthalmology for congenital NLDO did not have an appropriate trial of tear duct massage before referral, and less than half of patients required probing after appropriate massage was initiated. Educating primary care providers and optometrists on proper initiation of tear duct massage may reduce the volume of congenital NLDO referrals to pediatric ophthalmology, a subspecialty with limited physicians and long wait times.

[This corrects the article DOI: 10.1093/pch/pxaf028.].

While proton pump inhibitors (PPIs) are widely recognized for their effectiveness in treating gastroesophageal reflux disease in older children and adults, their use in infants is controversial due to the paucity of well-controlled studies demonstrating clear benefits. Furthermore, concerns about potential adverse effects, such as increased risks of gastrointestinal and respiratory infections, nutrient malabsorption and alterations in gut microbiota, complicate the decision-making process for health care providers and care givers. The current guidelines emphasize nonpharmacologic management for infantile reflux and recommend PPIs for very specific indications. Despite this, PPIs continue to be widely prescribed to infants.

Our aim was to safely decrease unnecessary invasive urinary catheterizations in infants 90 days to <6 months of age by 50% over 24 months in our emergency department without unintended consequences. A multi-professional study team was established, and key stakeholders engaged. Using the Model for Improvement, we implemented a modified 2-step urine bag urinary tract infection (UTI) screening pathway along with reminders and education as our main change ideas. The mean catheterization rate decreased from a baseline of 62.5% to 43.9% during the intervention period, demonstrating special cause variation. Urine cultures also decreased from a mean of 64.7% to 47.3% with special cause variation. There was no increase in length of stay or return visits. There was one potential missed UTI (1/843 patients). Overall, a 2-step non-invasive urine bag UTI screening pathway can be successfully and safely used in the emergency department for young infants aged 90 days and older to improve resource allocation.

Objectives: This study aims to describe and compare the rate of self-harm visits to the emergency department (ED) among children and youth in Alberta, before and after the COVID-19 pandemic.

Methods: Data from 2010 to 2022 were obtained from administrative databases held at Alberta Health Services, which capture all ED visits across Alberta. An interrupted time series was implemented using autoregressive moving average models.

Results: Findings indicate a step decrease in self-harm visits at pandemic onset (-2.94 patients per 10,000; P = 0.008). However, the rate of increase in self-harm visits remained consistent with the prepandemic rate of visits (slope change: 0.047 per 10,000, P = 0.24). There were also significant step changes found among males and females, several age subsets and among rural and urban subsets, but there were no significant slope changes among any subgroups.

Conclusion: Overall, findings indicate that the rate of self-harm visits following the onset of the pandemic did not differ from that which would be expected based on the upward trend in the 10 years before the pandemic, and this finding was consistent when stratifying by sex, age, and rurality. There was a significant reduction in self-harm visits at the onset of the COVID-19 pandemic.