Paediatrics and Child Health (United Kingdom)最新文献

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Children and young people with mental health issues admitted to the hospital: a toolkit for the general paediatrician 入院就诊的有精神健康问题的儿童和青少年：普通儿科医生工具包

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2024-10-22 DOI: 10.1016/j.paed.2024.09.005

Marianne Leach, Laura Sand, Mel Wood

As the number of children and young people (CYP) attending the emergency department (ED) with a mental health crisis is increasing, it has become evident that neither the environment nor the training for general paediatricians is adequate to meet CYPs’ mental health needs. This short article provides an essential toolkit for paediatricians and other healthcare professionals working with CYP. It provides a resource encompassing skills and knowledge to promote understanding of mental health crises and strategies to address these when CYP are in ED or admitted to the ward. It will allow general paediatricians to address the agitation and distress experienced by many CYP in EDs or on paediatric wards and use verbal de-scalation techniques rather than medications. The toolkit highlights how to take an appropriate mental health history, perform a mental state examination and if necessary medical investigations required, as well as providing an overview of the legal framework under which mental health conditions are managed in different age groups. A short section highlights the most common mental health issues and their management. Lastly, the CAMHS structure is explained to support the multi-professional collaboration needed to ensure CYP are managed appropriately between teams and have the best support and care possible in the ED and on paediatric wards.

随着因心理健康危机而到急诊科（ED）就诊的儿童和青少年（CYP）人数不断增加，普通儿科医生所处的环境和所接受的培训显然都不足以满足儿童和青少年的心理健康需求。这篇短文为儿科医生和其他从事儿童青少年工作的医护人员提供了一个重要的工具包。它提供了一个包含技能和知识的资源，以促进对心理健康危机的理解，以及在儿童急诊室或住进病房时应对这些危机的策略。它将使普通儿科医生能够处理许多儿童在急诊室或儿科病房中经历的躁动和痛苦，并使用口头镇静技巧而不是药物。该工具包重点介绍了如何采集适当的精神健康病史、进行精神状态检查和必要的医学检查，并概述了不同年龄段儿童精神健康状况管理的法律框架。有一小部分重点介绍了最常见的心理健康问题及其处理方法。最后，还介绍了儿童心理健康服务的结构，以支持所需的多专业合作，确保儿童在各团队之间得到适当的管理，并在急诊室和儿科病房得到最好的支持和护理。

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引用次数: 0

Acute-onset psychosis in children and young people 儿童和青少年的急性发作性精神病

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2024-10-05 DOI: 10.1016/j.paed.2024.09.001

Sofia Manolesou, Marinos Kyriakopoulos

The acute presentation of psychotic symptoms such as hallucinations, delusions and disorganized behavior in a child is a complex and severe clinical problem that requires a prompt response. A thorough assessment of the possible psychiatric and organic causes that can lead to the manifestation of psychosis is necessary; a detailed history and clinical examination will guide further medical investigations. The treatment will be directed by the diagnosis and the underlying cause but acute psychotic symptoms should be targeted without delay. This short article provides background and practical advice for healthcare professionals working with children.

儿童急性出现幻觉、妄想和行为紊乱等精神病症状是一个复杂而严重的临床问题，需要及时应对。有必要对可能导致精神病表现的精神和器质性病因进行全面评估；详细的病史和临床检查将为进一步的医学检查提供指导。治疗方法将根据诊断结果和潜在病因而定，但应立即针对急性精神病症状进行治疗。这篇短文为从事儿童工作的医护人员提供了背景知识和实用建议。

引用次数: 0

Counselling prospective adoptive parents about the mental health of birth parents: what does this mean for the child? 就亲生父母的心理健康问题为未来的收养父母提供咨询：这对孩子意味着什么？

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2024-09-23 DOI: 10.1016/j.paed.2024.09.002

Shuang Wang, Lynn Snow

As part of the adoption process in the UK, adoption medical advisors, often community paediatricians, meet prospective adoptive parents to share health information about the child and discuss potential implications for the future. As well as physical health, mental health needs to be addressed especially if there is possible mental illness in the birth parents. However, there is often lack of precise, reliable information available for the birth parents posing a challenge to the counselling process. This article discusses the challenges in addressing the issue of mental health in birth parents and how to approach conversations involving genetic risk when counselling prospective adoptive parents.

作为英国领养程序的一部分，领养医疗顾问（通常是社区儿科医生）会与未来的领养父母会面，分享孩子的健康信息并讨论对未来的潜在影响。除了身体健康，心理健康也需要关注，尤其是当亲生父母可能患有精神疾病时。然而，亲生父母往往缺乏准确、可靠的信息，这给咨询过程带来了挑战。本文讨论了在解决亲生父母心理健康问题时所面临的挑战，以及在为未来的收养父母提供咨询时如何处理涉及遗传风险的对话。

引用次数: 0

Self-assessment 自我评估

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2024-09-17 DOI: 10.1016/j.paed.2024.09.004

Ewan Spencer, Peter Heinz

引用次数: 0

Resilient and healthy enough to care? Exploring the role of the medical adviser for adoption and fostering in providing advice on the health of substitute carers 有足够的复原力和健康状况来照顾孩子？探讨收养和寄养医疗顾问在为替代照料者的健康提供建议方面的作用

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2024-09-14 DOI: 10.1016/j.paed.2024.08.006

Carolyn Sampeys, Deborah Price Williams

The assessment of physical and mental health is an integral part of the process of choosing substitute carers for children and young people. It must be done during adoption, foster care or kinship and special guardian assessments. Medical Advisers for adoption and fostering from a paediatric or general practice background are ideally placed to undertake this review of the GP-completed Adult Health report. Having the knowledge and experience to write evidence-based advice for social workers undertaking the assessment of the substitute carers is paramount. While medical advisers are able to review health conditions in substitute carers which may impact on their ability to care and be emotionally available, they are also able to hold the possible short and long-term needs of a vulnerable and possibly damaged child at the centre of the process. The complexity of children for whom substitute carers are sought has increased and carers need to be resilient, emotionally available and healthy enough to care for and nurture a child until adulthood which can be at 18 years, or beyond if there are additional needs.

身心健康评估是为儿童和青少年选择替代照料者过程中不可或缺的一部分。在评估收养、寄养或亲属关系和特别监护人时必须进行评估。儿科或全科背景的收养和寄养医疗顾问是对全科医生完成的成人健康报告进行审查的理想人选。最重要的是要具备相关知识和经验，能够为负责评估替代照料者的社会工作者撰写以证据为基础的建议。医疗顾问能够审查替代照护者的健康状况，这些健康状况可能会影响到他们的照护能力和情感，同时他们也能够在评估过程中以脆弱的、可能受到伤害的儿童的短期和长期需求为中心。需要寻找替代照料者的儿童的复杂性增加了，照料者需要有足够的适应能力、情感上的可支配性和健康状况，以照料和培养儿童直至其成年（可能是 18 岁），如果有额外的需求，也可以超过 18 岁。

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引用次数: 0

Point-of-care ultrasound (POCUS) for the child with acute abdominal pain 为急性腹痛患儿进行护理点超声检查 (POCUS)

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2024-09-14 DOI: 10.1016/j.paed.2024.09.003

David McCreary

We present two cases of paediatric appendicitis diagnosed using point-of-care ultrasound (POCUS) with very differing outcomes. For one young boy having commenced early IV antibiotics he avoided operative intervention altogether with full recovery. For the other boy of a similar age an inflamed appendix caused acute bowel obstruction resulting in surgery and a more protracted post operative course. We describe the central role POCUS played in positively influencing the evaluation of each child presenting with acute abdominal pain. These cases help further the case for its integration into the clinical assessment of such children presenting to the Paediatric Emergency Department.

我们介绍了两例使用护理点超声（POCUS）诊断出的小儿阑尾炎病例，结果却大相径庭。其中一名小男孩在早期开始静脉注射抗生素后，完全避免了手术干预，并完全康复。而另一位年龄相仿的男孩则因阑尾发炎导致急性肠梗阻而不得不接受手术治疗，术后病程更加漫长。我们描述了 POCUS 在对每个急性腹痛患儿的评估中发挥的核心作用。这些病例有助于进一步证明应将 POCUS 纳入儿科急诊室对此类患儿的临床评估中。

引用次数: 0

Drugs and alcohol in pregnancy: what a paediatrician needs to know, how to ask and why it matters 孕期吸毒和酗酒：儿科医生需要知道什么、如何询问以及为什么重要

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2024-09-11 DOI: 10.1016/j.paed.2024.08.007

Michelle Bond, Dannika Buckley

Antenatal substance misuse is a significant problem and the effects on the developing child can be long lasting. It is estimated that 20–30% of pregnant women smoke, 15% drink alcohol, 3–10% use cannabis and 0.5–3% use cocaine worldwide. Many parents make efforts to stop or cut down alcohol, cigarette and drug use during pregnancy. However, many pregnancies are unplanned and may be recognized late. Addicted parents may not be able to stop drug and alcohol use without support. Illicit drugs, nicotine and alcohol in the maternal blood stream cross to the foetus via the placenta and have a direct effect of the developing foetus. These effects can include poor fetal growth, increased risk of stillbirth, congenital malformations, and long-lasting impacts on development. The impact of these antenatal exposures might not become apparent until much later in childhood. Children who have been exposed to drugs and alcohol in utero may present to paediatricians at any stage in childhood with a range of health and developmental problems. This article will explore the immediate and long-term impact of exposure to these substances in pregnancy and consider how to obtain an accurate history of exposure to drugs and alcohol in pregnancy as part of standard paediatric history taking.

产前滥用药物是一个严重的问题，对发育中的婴儿的影响可能是长期的。据估计，全世界有 20-30% 的孕妇吸烟，15% 的孕妇饮酒，3-10% 的孕妇吸食大麻，0.5-3% 的孕妇吸食可卡因。许多父母都努力在怀孕期间停止或减少饮酒、吸烟和吸毒。然而，许多怀孕都是计划外的，而且可能很晚才被发现。吸毒成瘾的父母可能无法在没有支持的情况下停止吸毒和酗酒。母体血液中的非法药物、尼古丁和酒精会通过胎盘进入胎儿体内，对发育中的胎儿产生直接影响。这些影响可能包括胎儿发育不良、死产风险增加、先天性畸形以及对发育的长期影响。这些产前暴露的影响可能要到童年晚期才会显现出来。在子宫内接触过毒品和酒精的儿童可能会在童年的任何阶段出现一系列健康和发育问题。本文将探讨妊娠期接触这些物质的直接和长期影响，并探讨如何在标准儿科病史采集过程中准确获取妊娠期毒品和酒精接触史。

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引用次数: 0

Breaking down communication barriers 打破沟通障碍

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2024-09-11 DOI: 10.1016/j.paed.2024.08.008

Qasim Malik, Evangeline Buck, Mary Salama

Breaking down language barriers in paediatric care is pivotal for effective communication and positive health outcomes, particularly for vulnerable groups such as refugees, asylum seekers, the deaf and neurodivergent patients. This paper highlights the importance of culturally competent care. The specific needs of children with deafness and neurodiverse conditions are also considered.

消除儿科护理中的语言障碍对于有效沟通和取得积极的健康成果至关重要，尤其是对于难民、寻求庇护者、聋哑人和神经变异患者等弱势群体而言。本文强调了文化适应性护理的重要性。本文还考虑了耳聋和神经系统疾病儿童的特殊需求。

引用次数: 0

Hirschsprung's disease 赫氏综合症

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2024-09-10 DOI: 10.1016/j.paed.2024.07.001

Hemanshoo Thakkar, Joe Curry

Hirschsprung's disease (HD) is a congenital functional disorder characterized by the absence of ganglion cells in the enteric nervous system. The estimated incidence of HD is 1 in 5000 live births with up to 60% of patients having associated anomalies. This short article aims to provide paediatricians with an overview of the condition and the recent developments in our understanding. Short-segment rectosigmoid disease is seen in 75% of cases with infants presenting with abdominal distension, bilious vomiting and delayed passage of meconium. A bedside rectal suction biopsy is the gold-standard in confirming the diagnosis of HD. The absence of ganglion cells in the myenteric and submucosal plexi in the presence of thickened hypertrophic nerves (more than40 microns diameter) is diagnostic of HD. There are no medical options to treat HD, however rectal washouts can be used to bridge the gap to surgery. Contemporary management of this condition involves a single-stage pull-through that can be performed using various techniques including minimal access surgery. Long-term problems in with HD are common and these include obstructive symptoms (10–30%), constipation (10–15%), enterocolitis (10–15%) and true faecal incontinence (1–2%). Furthermore 20–30% of adults report symptoms of incontinence and constipation as well as poor sexual function. Future research is being focussed on novel gene therapies including stem-cell therapy and the use of CRISPR/CA9 to edit parts of the genome.

赫氏病（Hirschsprung's disease，HD）是一种先天性功能性疾病，其特征是肠神经系统缺乏神经节细胞。据估计，每 5000 名活产婴儿中就有 1 例患有该病，其中高达 60% 的患者伴有异常。这篇短文旨在向儿科医生概述这种疾病以及我们对这种疾病认识的最新进展。75%的病例可见直肠乙状结肠短节病，婴儿表现为腹胀、胆汁性呕吐和胎粪排出延迟。床旁直肠抽吸活检是确诊 HD 的金标准。肠肌层和粘膜下层没有神经节细胞，但存在增厚肥大的神经（直径超过 40 微米），即可诊断为 HD。目前还没有治疗 HD 的药物，但可以使用直肠冲洗术来弥补手术的不足。这种疾病的现代治疗方法包括采用各种技术（包括微创手术）进行单阶段拉通。HD 常见的长期问题包括阻塞症状（10-30%）、便秘（10-15%）、肠结肠炎（10-15%）和真正的大便失禁（1-2%）。此外，20%-30% 的成人报告有大小便失禁和便秘症状以及性功能低下。未来的研究重点是新型基因疗法，包括干细胞疗法和使用 CRISPR/CA9 编辑部分基因组。

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引用次数: 0

Online life for a child in care 托管儿童的网上生活

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2024-09-10 DOI: 10.1016/j.paed.2024.08.001

Vicki Walker

For children and young people their online life is as real to them as their real life. This article considers the positives and negatives of online life, why children in care are more vulnerable, and the specific impact for child protection and health. It provides advice and guidance for healthcare professionals working with children. There are useful resources about managing disclosures and safeguarding concerns. We will consider how to incorporate online life in a paediatric medical history and the impacts of online use on physical and emotional health.

对于儿童和青少年来说，他们的网络生活和现实生活一样真实。本文探讨了网络生活的积极和消极因素、受照料儿童更易受到伤害的原因，以及对儿童保护和健康的具体影响。它为从事儿童工作的医疗保健专业人员提供了建议和指导。文章还提供了有关管理披露和保护问题的有用资源。我们将考虑如何将在线生活纳入儿科病史，以及在线使用对身体和情绪健康的影响。

引用次数: 0

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Paediatrics and Child Health (United Kingdom)

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