Paediatrics & child health最新文献

Le trauma crânien causé par la maltraitance des enfants, une conséquence grave de la violence envers les enfants, est associé à une morbidité et une mortalité importantes, particulièrement chez les nourrissons et les jeunes enfants. Les professionnels de la santé ont un rôle important à jouer, y compris pour détecter et traiter ces enfants, signaler les craintes de maltraitance aux services de protection de l'enfance, évaluer les lésions et les troubles médicaux connexes, soutenir les enfants et leur famille et transmettre l'information médicale clairement aux familles, aux autres professionnels de la santé, aux services de protection de l'enfance et au milieu juridique. Les symptômes associés aux traumatismes crâniens recoupent souvent ceux d'autres maladies courantes de l'enfance, et les signes externes de lésions peuvent être discrets ou même inexistants. Par conséquent, le trauma crânien causé par la maltraitance des enfants est souvent négligé et détecté tardivement, ce qui contribue au risque que les sévices se poursuivent. Pour évaluer un traumatisme crânien en cas de soupçons de maltraitance d'enfant, il faut examiner les causes médicales éventuelles des observations cliniques et déterminer la présence de lésions occultes. Le présent point de pratique fournit aux professionnels de la santé des conseils pour qu'en cas de soupçons, ils détectent le trauma crânien causé par la maltraitance d'un nourrisson ou d'un enfant et procèdent à l'évaluation médicale des lésions et des blessures.

Preventing and managing an infant's pain effectively is an essential component of newborn care. Experiencing untreated pain in early life has been associated with immediate negative effects and long-term adverse outcomes affecting physiological stability, pain processing and neurodevelopment. Inadequate pain management during medical procedures is consistently reported by parents as one of the most stressful aspects of having a baby. Despite known ways to effectively manage infant pain, these interventions remain underutilized in clinical practice. To ensure optimal outcomes, health care facilities should establish organization-wide pain management frameworks, with dedicated resources that include: comprehensive training for care providers, implementing pain prevention and control strategies, and quality improvement measures to minimize the number of painful procedures, assess and reassess pain appropriately, reduce procedural and surgery-related pain, and actively engage parents in shared decision-making and pain care.

Somatic symptom and related disorders (SSRDs) pose significant challenges in paediatric health care due to their impacts on child and adolescent well-being, functioning, and family systems. This statement offers comprehensive guidance to health care providers on the assessment and management of SSRDs as well as communication strategies for clinical encounters. Specific SSRD diagnoses are outlined along with common clinical presentations and recommended approaches to medical investigations and patient/family communication early in the diagnostic journey. Evidence-based treatments for SSRDs once a diagnosis has been established are delineated. Psychoeducational approaches that help to shift the onus of care from unnecessary medical testing and procedures, thereby shortening the diagnostic journey and promoting more functional, rehabilitative care therapies, are reviewed. Specific strategies to support patients and their families and validate their perspectives are outlined.

Les troubles à symptomatologie somatique et apparentés (TSSA) représentent un défi important en pédiatrie en raison de leurs répercussions sur le bien-être et le fonctionnement de l'enfant et de l'adolescent ainsi que sur les systèmes familiaux. Le présent document de principes contient des directives détaillées pour les professionnels de la santé au sujet de l'évaluation et de la prise en charge de ces troubles et des stratégies de communication lors des rencontres cliniques. Les autrices présentent divers diagnostics, de même que les tableaux cliniques fréquents et les approches recommandées pour procéder aux évaluations médicales des patients et des familles et entretenir des communications avec eux dès le début du parcours diagnostique. Ils décrivent les traitements fondés sur des données probantes à adopter après la confirmation du diagnostic. Ils passent également en revue des approches psychoéducatives qui contribuent à éviter le fardeau des soins découlant des interventions et des examens médicaux inutiles et ainsi à raccourcir le parcours diagnostique et à promouvoir des traitements de réadaptation plus fonctionnels. Ils exposent enfin des stratégies particulières pour soutenir les patients et leur famille et pour valider leurs points de vue.

Traumatic head injury due to child maltreatment (THI-CM) is a serious form of child abuse with significant morbidity and mortality, particularly in infants and young children. Healthcare providers have important roles to play, including identifying and treating these children, reporting concerns of child maltreatment to child welfare authorities, assessing for associated injuries and medical conditions, supporting children and their families, and communicating medical information clearly to families and other medical, child welfare, and legal professionals. Symptoms associated with head trauma often overlap with those of other common childhood illnesses, and external signs of injury may be subtle or absent. As a result, THI-CM is frequently overlooked and its identification is often delayed, leading to a risk of ongoing injury. Assessing for head trauma in cases of possible child maltreatment includes considering medical causes for clinical findings and assessment for occult injuries. This practice point provides health care providers with guidance for identifying and medically assessing suspected THI-CM in infants and children.

Objectives: Home-based phototherapy (HP) has gained traction as an alternative to hospital-based treatment for neonatal hyperbilirubinemia, but the safety of this practice remains unclear. This study aimed to identify adverse events (AEs) associated with HP in Canada.

Methods: A one-time survey, distributed through the Canadian Paediatric Surveillance Program, collected retrospective data from paediatricians. The survey included questions about the use of HP, AEs associated with HP, potential HP AE risk factors, and outcomes. A descriptive statistical analysis was conducted.

Results: The survey response rate was 31% (844/2741), with 497 respondents indicating that they provide care for neonatal hyperbilirubinemia. Among those 497 respondents, 58 (12%) reported working at a centre that provides HP. AEs were reported by 15 (3%) physicians with 21 cases of AEs associated with HP in the preceding 12 months. Most AEs resulted in admissions or readmissions to the hospital for inpatient phototherapy. No serious AEs or long-term consequences were reported. Risk factors were identified in 67% of cases, with infant-related factors identified more frequently than provider, system, or family-related factors. Formal protocols for patient assessment and follow-up were in place at most centres that provide HP.

Conclusion: This survey revealed no serious AEs related to HP, as reported by paediatricians in Canada, in the preceding 12 months. The survey also revealed that while HP is available in Canada, there is limited access and a lack of standardization to its administration. This study provides valuable insights into the safety and practice of HP for neonatal hyperbilirubinemia in Canada.

Objectives: To characterize cannabis-related presentations to the two major paediatric emergency departments (EDs) in Alberta as well as calls to Alberta's Poison and Drug Information Services (PADIS) and detect any changes in relation to legalization.

Methods: This was a retrospective medical record review analyzing all paediatric (ages 0 to 18) ED presentations for cannabis-related concerns. The two sites included were the Stollery Children's Hospital in Edmonton and the Alberta Children's Hospital in Calgary. We searched the PADIS database for all calls in the province for 'Cannabinoids and Analogues' for ages 0 to 19. The rates prior to and after legalization were compared.

Results: While we saw no overall difference in ED visits, pre- and post-legislation we found an increase in unintentional overdoses in children under 12 years of age (7% versus 15%, proportion change 1.13). The severity of presentations did not change during this time period (37% versus 42%, P 0.254). We also found an increase in calls to PADIS in the 2 years after legalization. There was an increase in exposure to edible cannabis formulations during this time period.

Conclusion: This study combines a province-wide medical record review of ED visits with poison control centre information to provide a complete look at cannabis intoxication in paediatric patients over the time of legalization. It adds to the growing body of evidence that legalization of recreational cannabis, especially edible formulations has resulted in increased unintentional overdoses in young children.

Objectives: This clinical cross-sectional study examines the perceptions of caffeine consumption among high school students in the Greater Toronto and Hamilton Area. The purpose of the study is to gain insight into the motives behind caffeine consumption among this population.

Methods: A total of 2273 high school students participated in the study by anonymously filling out an online questionnaire via Cognito forms. The motives behind caffeine consumption can be influenced by the perceptions students hold about caffeine and its effects.

Results: This study reveals that a high proportion (97.2%) of the surveyed high school students reported daily caffeine consumption. Over 80% of these students were consuming more than 100 mg of caffeine per day, surpassing the daily limit recommended by the American Academy of Pediatrics.

Conclusions: These findings highlight the need for targeted interventions and policies aimed at promoting healthier caffeine consumption habits among high school students. The findings of this study have implications for healthcare professionals, policymakers, and parents in understanding adolescent caffeine consumption patterns and providing effective interventions to promote healthy habits.

Objective: This study aimed to address the overdiagnosis of penicillin allergies in the pediatric population, which leads to less effective antibiotic usage. We investigated the effectiveness of standardized oral amoxicillin challenges in the emergency departments (EDs) of pediatric patients with previous reactions but a low risk for serious reactions.

Methods: Children under 18 years of age who reported allergy to any penicillin presenting to the ED of the Centre Hospitalier Universitaire Sainte-Justine (CHUSJ), Montreal, Quebec, Canada, with a clinical requirement for amoxicillin treatment were included if their risk of anaphylaxis was judged to be low. We evaluated immediate and delayed reactions, patient demographics, the impact on resource utilization, and the number of patients no longer considered to be allergic to penicillins at the 1-month follow-up.

Results: From August 2021 through April 2023, 100 children received an oral amoxicillin challenge in the ED. Among them, 93% safely received amoxicillin without an immediate reaction and were discharged with amoxicillin from the ED. Seven participants had immediate reactions which included skin rashes or vomiting, with one participant experiencing an anaphylactic reaction. Five of the seven subsequently had an amoxicillin challenge by an allergist and only the one with anaphylaxis in the ED reacted. Suspected delayed reactions were observed in 4 of the other 89 (4%) participants who could be contacted within 30 days of the challenge and consisted of skin rashes. Three of the four subsequently had an amoxicillin challenge by an allergist and one reacted. Then, two patients (2%) had confirmed allergies following suspected reactions: one patient with the anaphylactic reaction, and the other with the delayed reaction. Overall, 79/89 (89%) of patients with 30-day follow-up could have their allergy label removed without an allergist consultation.

Conclusions: Standardized oral amoxicillin challenges in low-risk pediatric ED patients allowed for the removal of penicillin allergy labels in 89% of patients reached for follow-up without an allergist consultation. This approach enhanced patient care, allowing 93% of participants to be discharged from the ED with an amoxicillin prescription. Only 2 of 100 children had proven amoxicillin allergy; another 3 had reactions but no assessment by an allergist.

Objectives: Kawasaki disease (KD) is the leading cause of acquired childhood coronary aneurysms (CAA). Males are more affected than females, with lower survival from cardiac events and normalization rates. This study aimed to determine the association between biological sex and CAA risk and evaluate the association with baseline biochemical inflammatory markers by biological sex.

Methods: This multicenter retrospective cohort study involved children ≤10 years old diagnosed with KD in five Canadian centres. Adjusted CAA risk differences between sexes were computed using binomial regression. Associations between inflammatory markers and CAA risk were analyzed using logistic regression with interaction terms between sex and inflammatory markers.

Results: From 2004 to 2015, 1382 patients were diagnosed with KD and 812 (59%) were males. Median age, fever total duration, and fever duration at therapy initiation were similar between the sexes. The cumulative incidence of medium to large (Z ≥ 5) CAA was higher in males [70/812 (8.6%)] compared to females [19/570 (3.3%)], with an adjusted risk difference of 4.6 % (95% confidence interval [CI] 2.1 to 7.1). Large (Z > 10) aneurysms were more prevalent in males (adjusted risk difference of 3.3%, 95% CI 1.7 to 5.0). Most inflammatory markers were positively associated with CAA risk, but the association was not statistically different between sexes.

Conclusion: Males with KD are at higher risk of developing CAA compared to females. The majority of patients were presumed to be prepubertal, suggesting that hormonal influences are unlikely to be a significant factor. Future KD research based on biological sex categorization should focus on patient risk stratification and long-term prognostic evaluation.