Asthma deaths amongst young people in the United Kingdom are amongst the highest in the world. However, it is widely acknowledged that effective self-management can improve asthma control and ultimately outcomes. Good quality patient education is key to this effective self-management, and this is especially true when young people are preparing for transition to adult services. The Respiratory Research Team at Sheffield Children's NHS Foundation Trust has developed an educational resource to support healthcare professionals with the delivery of this education. This article considers the framework adopted, content creation, the hosting of videos, the review process for draft materials, promoting the resource and finally, assessing its impact. In conclusion the challenges, relating to the adoption of the materials in clinical practice and to patient education as a tool for the empowerment of patients and improvement of asthma outcome, are addressed.
{"title":"Developing a video-based educational resource for young people with asthma","authors":"Moira Gibbons, Nicki Barker, Nichola Butler, Heather Elphick","doi":"10.1016/j.paed.2025.07.004","DOIUrl":"10.1016/j.paed.2025.07.004","url":null,"abstract":"<div><div>Asthma deaths amongst young people in the United Kingdom are amongst the highest in the world. However, it is widely acknowledged that effective self-management can improve asthma control and ultimately outcomes. Good quality patient education is key to this effective self-management, and this is especially true when young people are preparing for transition to adult services. The Respiratory Research Team at Sheffield Children's NHS Foundation Trust has developed an educational resource to support healthcare professionals with the delivery of this education. This article considers the framework adopted, content creation, the hosting of videos, the review process for draft materials, promoting the resource and finally, assessing its impact. In conclusion the challenges, relating to the adoption of the materials in clinical practice and to patient education as a tool for the empowerment of patients and improvement of asthma outcome, are addressed.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 10","pages":"Pages 333-340"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.paed.2025.07.003
Lauren Williams, Thomas Maycock, Vanessa Hewertson, Jahnaky Suththanantha, Jasmine Krieg, Sarusan Kugarajah, Desaline Joseph
Anecdotally sleep takes up a third of a person's life, however, for many Children and Young People (CYP), it can feel like a good night's sleep is elusive. The refrain “my child won't sleep” is common in both general practitioner and paediatric clinics and it can feel overwhelming for both parents, carers, and professionals. With over 70 sleep disorders, differentiation and treatment options can feel confusing. This article focuses on circadian rhythm disorders, insomnia, parasomnia, and sleep related movement disorders providing an outline of these conditions and giving treatment advice. We will discuss the importance of utilizing behavioural interventions as a first line treatment, with pharmacological interventions used to support behavioural interventions, or in cases where behavioural intervention alone has not been effective. In all cases of children who struggle to sleep, it is important that treatment decisions are made on a case by case basis, allowing for individual needs, and neurodiversity. With appropriate, individualized support nearly all CYP can sleep well.
{"title":"My child won't sleep! Recognising and managing sleep disorders in children and young people","authors":"Lauren Williams, Thomas Maycock, Vanessa Hewertson, Jahnaky Suththanantha, Jasmine Krieg, Sarusan Kugarajah, Desaline Joseph","doi":"10.1016/j.paed.2025.07.003","DOIUrl":"10.1016/j.paed.2025.07.003","url":null,"abstract":"<div><div>Anecdotally sleep takes up a third of a person's life, however, for many Children and Young People (CYP), it can feel like a good night's sleep is elusive. The refrain “my child won't sleep” is common in both general practitioner and paediatric clinics and it can feel overwhelming for both parents, carers, and professionals. With over 70 sleep disorders, differentiation and treatment options can feel confusing. This article focuses on circadian rhythm disorders, insomnia, parasomnia, and sleep related movement disorders providing an outline of these conditions and giving treatment advice. We will discuss the importance of utilizing behavioural interventions as a first line treatment, with pharmacological interventions used to support behavioural interventions, or in cases where behavioural intervention alone has not been effective. In all cases of children who struggle to sleep, it is important that treatment decisions are made on a case by case basis, allowing for individual needs, and neurodiversity. With appropriate, individualized support nearly all CYP can sleep well.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 10","pages":"Pages 325-332"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.paed.2025.07.005
Geraldine Campbell, Peter Mallett, Shaun O'Hagan
Respiratory syncytial virus (RSV) has a significant global impact, especially amongst vulnerable infants with immature immune systems. Elevated hospitalization and mortality rates within this group underscore this substantial risk. Until 2022, the only available preventive was the costly monoclonal antibody, palivizumab, which requires monthly winter injections, limiting its use to high-risk infants. Significant progress has led to the recent ground-breaking approval of two further RSV preventatives for infants: an extended half-life monoclonal antibody, nirsevimab (Beyfortus®) and a protein-based maternal vaccine, RSVpreF (Abrysvo®). Following authorization, several European countries, including Spain, France and Italy introduced nirsevimab during the 2023/24 RSV season. In contrast, the maternal RSV vaccine was integrated into antenatal immunization programmes within the United Kingdom and Argentina. Given the swiftly changing landscape of RSV prevention, this review offers timely insights into significant clinical trials and emerging real-world evidence; emphasizing the considerable effectiveness of current preventatives, as well as considering those under development. We also consider the potential impact on the National Health Service (NHS), including a changing disease burden, and the role of the paediatrician and broader multidisciplinary team in enhancing public health policy, supporting immunization campaigns and contributing to future research.
{"title":"Respiratory syncytial virus (RSV): recent advances in preventative strategies and visions for the future","authors":"Geraldine Campbell, Peter Mallett, Shaun O'Hagan","doi":"10.1016/j.paed.2025.07.005","DOIUrl":"10.1016/j.paed.2025.07.005","url":null,"abstract":"<div><div>Respiratory syncytial virus (RSV) has a significant global impact, especially amongst vulnerable infants with immature immune systems. Elevated hospitalization and mortality rates within this group underscore this substantial risk. Until 2022, the only available preventive was the costly monoclonal antibody, palivizumab, which requires monthly winter injections, limiting its use to high-risk infants. Significant progress has led to the recent ground-breaking approval of two further RSV preventatives for infants: an extended half-life monoclonal antibody, nirsevimab (Beyfortus®) and a protein-based maternal vaccine, RSVpreF (Abrysvo®). Following authorization, several European countries, including Spain, France and Italy introduced nirsevimab during the 2023/24 RSV season. In contrast, the maternal RSV vaccine was integrated into antenatal immunization programmes within the United Kingdom and Argentina. Given the swiftly changing landscape of RSV prevention, this review offers timely insights into significant clinical trials and emerging real-world evidence; emphasizing the considerable effectiveness of current preventatives, as well as considering those under development. We also consider the potential impact on the National Health Service (NHS), including a changing disease burden, and the role of the paediatrician and broader multidisciplinary team in enhancing public health policy, supporting immunization campaigns and contributing to future research.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 10","pages":"Pages 341-346"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.paed.2025.07.001
Muhammad F Zulkifli, Michael P Yanney, Jayesh Mahendra Bhatt
It is well documented that asthma outcomes for children and young people in the UK are amongst the worst in Europe and in high-income countries worldwide. Several reports in the last 10 years have evaluated the reasons for the poor outcomes, with a high degree of concordance between the report findings. In this review, we summarise the key findings of these reports and how they are being addressed by new treatment strategies in updated guidance published annually by the Global Initiative for Asthma (GINA) and the latest update of the joint British Thoracic Society (BTS), National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) Asthma guideline. We discuss the importance of an early and accurate asthma diagnosis; the problem of poor recognition of asthma severity and the dangers of short acting beta agonists (SABA) overuse and inhaled corticosteroid (ICS) underuse. We summarise the evidence for anti-inflammatory reliever (AIR) strategy and maintenance and reliever therapy (MART) which are now advocated in all new asthma guidance due to compelling evidence showing their positive impact on most treatment outcome measures. Finally, we highlight changes to Salbutamol weaning guidance in children discharged from hospital following an acute asthma exacerbation.
{"title":"What's new in paediatric asthma?","authors":"Muhammad F Zulkifli, Michael P Yanney, Jayesh Mahendra Bhatt","doi":"10.1016/j.paed.2025.07.001","DOIUrl":"10.1016/j.paed.2025.07.001","url":null,"abstract":"<div><div>It is well documented that asthma outcomes for children and young people in the UK are amongst the worst in Europe and in high-income countries worldwide. Several reports in the last 10 years have evaluated the reasons for the poor outcomes, with a high degree of concordance between the report findings. In this review, we summarise the key findings of these reports and how they are being addressed by new treatment strategies in updated guidance published annually by the Global Initiative for Asthma (GINA) and the latest update of the joint British Thoracic Society (BTS), National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) Asthma guideline. We discuss the importance of an early and accurate asthma diagnosis; the problem of poor recognition of asthma severity and the dangers of short acting beta agonists (SABA) overuse and inhaled corticosteroid (ICS) underuse. We summarise the evidence for anti-inflammatory reliever (AIR) strategy and maintenance and reliever therapy (MART) which are now advocated in all new asthma guidance due to compelling evidence showing their positive impact on most treatment outcome measures. Finally, we highlight changes to Salbutamol weaning guidance in children discharged from hospital following an acute asthma exacerbation.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 10","pages":"Pages 315-319"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.paed.2025.07.002
Matthew Hurley
Respiratory problems are common in children with a neurodisability. These respiratory issues are a common cause of morbidity and death. Children with neurodisability are at particular risk of respiratory infection due to impaired respiratory drive, poor cough strength an increased cough threshold and aspiration. This leads to recurrent infections and eventually to chronic bacterial infection in many cases. Gastro-oesophageal reflux, muscle weakness and development of kyphoscoliosis may also contribute to chronic ongoing morbidity. Common paediatric respiratory conditions such as asthma and chronic lung disease of prematurity may co-exist, complicating the presentation. The adverse effects of polypharmacy needs to be considered carefully. To optimize care of children with medical complexity, a multidisciplinary team should include a respiratory physician and physiotherapist. This short article provides an overview of the evidence for optimal respiratory care for children with neurodisability and, in the absence of such, offers some practical advice based upon the experience of the author.
{"title":"Respiratory complications of neurodisability in children and young people","authors":"Matthew Hurley","doi":"10.1016/j.paed.2025.07.002","DOIUrl":"10.1016/j.paed.2025.07.002","url":null,"abstract":"<div><div>Respiratory problems are common in children with a neurodisability. These respiratory issues are a common cause of morbidity and death. Children with neurodisability are at particular risk of respiratory infection due to impaired respiratory drive, poor cough strength an increased cough threshold and aspiration. This leads to recurrent infections and eventually to chronic bacterial infection in many cases. Gastro-oesophageal reflux, muscle weakness and development of kyphoscoliosis may also contribute to chronic ongoing morbidity. Common paediatric respiratory conditions such as asthma and chronic lung disease of prematurity may co-exist, complicating the presentation. The adverse effects of polypharmacy needs to be considered carefully. To optimize care of children with medical complexity, a multidisciplinary team should include a respiratory physician and physiotherapist. This short article provides an overview of the evidence for optimal respiratory care for children with neurodisability and, in the absence of such, offers some practical advice based upon the experience of the author.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 10","pages":"Pages 320-324"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145247883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.paed.2025.06.003
Laura Duthie
Eating disorders are common and the incidence has risen significantly over recent years, particularly in children and young people. However, there is less familiarity with and understanding of their management than other common long-term illnesses. The consequences of having an eating disorder can be devastating and can affect all aspects of a young person's life as well as those around them. However, as mental health services are struggling to cope with the increased demand, there is a higher threshold to access specialist services and long waiting lists. It is therefore more likely that children and young people will present to primary care or paediatricians with disordered eating or the medical complications. This article provides guidance on how to assess a young person who presents acutely with an eating disorder or the features suggestive of one, focusing on how to assess risk and the potential for medical complication.
{"title":"The changing landscape of eating disorders in children: a guide to understanding, diagnosis and management","authors":"Laura Duthie","doi":"10.1016/j.paed.2025.06.003","DOIUrl":"10.1016/j.paed.2025.06.003","url":null,"abstract":"<div><div><span><span>Eating disorders are common and the incidence has risen significantly over recent years, particularly in children and young people. However, there is less familiarity with and understanding of their management than other common long-term illnesses. The consequences of having an eating disorder can be devastating and can affect all aspects of a young person's life as well as those around them. However, as </span>mental health services<span> are struggling to cope with the increased demand, there is a higher threshold to access specialist services and long waiting lists. It is therefore more likely that children and young people will present to primary care or paediatricians with </span></span>disordered eating or the medical complications. This article provides guidance on how to assess a young person who presents acutely with an eating disorder or the features suggestive of one, focusing on how to assess risk and the potential for medical complication.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 9","pages":"Pages 301-306"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.paed.2025.06.001
Lynne Latten
Optimal nutrition is a cornerstone of recovery for critically ill children in the paediatric critical care unit, influencing metabolic stability, immune function, and tissue repair. This paper explores current practices in paediatric critical care nutrition, examining the metabolic changes induced by critical illness, strategies for assessing energy and protein requirements and the challenges in implementing early enteral or parenteral nutrition. It highlights the role of a multidisciplinary healthcare team in ensuring appropriate nutritional interventions tailored to the child's evolving clinical status. This short article discusses key evidence, guidelines, and practical considerations for choosing the right feeding route and regimen, addressing concerns such as feed intolerance, delayed gastric emptying, and the risk of complications like aspiration and infection. Additionally, the timing of parenteral nutrition and its potential benefits when delayed are examined, as well as alternative feeding options, such as peptide-based formulas. This paper aims to provide a comprehensive overview of best practices for optimizing nutritional support in critically ill paediatric patients.
{"title":"Nutrition in paediatric critical care","authors":"Lynne Latten","doi":"10.1016/j.paed.2025.06.001","DOIUrl":"10.1016/j.paed.2025.06.001","url":null,"abstract":"<div><div><span>Optimal nutrition is a cornerstone of recovery for critically ill children in the paediatric </span>critical care<span><span><span> unit, influencing metabolic stability, immune function, and tissue repair. This paper explores current practices in paediatric critical care nutrition, examining the metabolic changes induced by </span>critical illness, strategies for assessing energy and protein requirements and the challenges in implementing early enteral or </span>parenteral nutrition<span><span>. It highlights the role of a multidisciplinary healthcare team in ensuring appropriate nutritional interventions tailored to the child's evolving clinical status. This short article discusses key evidence, guidelines, and practical considerations for choosing the right feeding route and regimen, addressing concerns such as feed intolerance, delayed gastric emptying, and the risk of complications like aspiration and infection. Additionally, the timing of </span>parenteral nutrition and its potential benefits when delayed are examined, as well as alternative feeding options, such as peptide-based formulas. This paper aims to provide a comprehensive overview of best practices for optimizing nutritional support in critically ill paediatric patients.</span></span></div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 9","pages":"Pages 289-293"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.paed.2025.06.005
Miriam Smyth, Lee D Hudson
Avoidant restrictive food intake disorder (ARFID) is a feeding and eating disorder characterized by restricted food intake with limited dietary variety often resulting in suboptimal nutrition and poor growth. While it is a relatively new condition, emerging from DSM5 criteria in 2013, it has a high prevalence in children, with studies suggesting it affects between 1 in 5 and 1 in 20 children. It is more common in children with other medical conditions and particularly in those with neurodivergence. This short article provides an overview of what is known about ARFID and how it can be managed.
{"title":"The presentation of avoidant restrictive food intake disorder (ARFID) in children with complex backgrounds","authors":"Miriam Smyth, Lee D Hudson","doi":"10.1016/j.paed.2025.06.005","DOIUrl":"10.1016/j.paed.2025.06.005","url":null,"abstract":"<div><div>Avoidant restrictive food intake disorder (ARFID) is a feeding and eating disorder characterized by restricted food intake with limited dietary variety often resulting in suboptimal nutrition and poor growth. While it is a relatively new condition, emerging from DSM5 criteria in 2013, it has a high prevalence in children, with studies suggesting it affects between 1 in 5 and 1 in 20 children. It is more common in children with other medical conditions and particularly in those with neurodivergence. This short article provides an overview of what is known about ARFID and how it can be managed.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 9","pages":"Pages 307-310"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.paed.2025.06.004
Hugo Brundle, Debora M Freitas
Doctors are often required to demonstrate leadership skills in a wide variety of environments. Despite this, throughout medical school and in postgraduate training, opportunities to foster such skills are limited. This is especially true in consultant-led specialties such as paediatrics. We aim to highlight ways to improve these skills through non-clinical and clinical examples. Good leadership requires a range of styles, skills, and abilities, and the wherewithal to change and adapt as necessary. There are a variety of leadership styles – from commanding to democratic – that paediatric trainees will be required to develop during training, as well as the emotional intelligence to change as the situation requires. Focusing down to clinical and non-clinical examples, paediatric trainees will be faced with events such as cardiac arrests, complaints and errors, audits, and teaching. These events provide opportunities to develop the ability to lead with care, develop others, evaluate the service, make changes, and inspire others. These are cornerstones of medical leadership, and opportunities to develop them must be taken. In summary, paediatric trainees can maximize opportunities to develop a wide range of leadership skills and styles throughout training, in both clinical and non-clinical roles. These skills can be developed at any stage of training and will be applicable throughout training and beyond.
{"title":"Developing leadership skills in paediatric training","authors":"Hugo Brundle, Debora M Freitas","doi":"10.1016/j.paed.2025.06.004","DOIUrl":"10.1016/j.paed.2025.06.004","url":null,"abstract":"<div><div>Doctors are often required to demonstrate leadership skills in a wide variety of environments. Despite this, throughout medical school and in postgraduate training<span>, opportunities to foster such skills are limited. This is especially true in consultant-led specialties such as paediatrics. We aim to highlight ways to improve these skills through non-clinical and clinical examples. Good leadership requires a range of styles, skills, and abilities, and the wherewithal to change and adapt as necessary. There are a variety of leadership styles – from commanding to democratic – that paediatric trainees will be required to develop during training, as well as the emotional intelligence to change as the situation requires. Focusing down to clinical and non-clinical examples, paediatric trainees will be faced with events such as cardiac arrests, complaints and errors, audits, and teaching. These events provide opportunities to develop the ability to lead with care, develop others, evaluate the service, make changes, and inspire others. These are cornerstones of medical leadership, and opportunities to develop them must be taken. In summary, paediatric trainees can maximize opportunities to develop a wide range of leadership skills and styles throughout training, in both clinical and non-clinical roles. These skills can be developed at any stage of training and will be applicable throughout training and beyond.</span></div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 9","pages":"Pages 311-314"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01DOI: 10.1016/j.paed.2025.06.002
Mary Iwaret Otiti, Stephen John Allen
Acute malnutrition in under 5s, manifest by wasting and nutritional oedema, remains a persistent global challenge with the greatest burdens in Asia and Sub-Saharan Africa. This article outlines practical, evidence-based approaches to diagnosis, management and prevention based on the 2023 WHO guidelines. Current terminology and classification of wasting and nutritional oedema and key pathophysiological mechanisms are described. A systematic management approach distinguishes between uncomplicated and complicated severe acute malnutrition. The cornerstones of community-based therapeutic care for uncomplicated cases are the use of ready-to-use therapeutic food and close monitoring. Acute malnutrition with complications such as poor appetite and infections require admission. To account for the reductive adaptation that occurs in malnutrition and avoid the risks of rapid re-feeding, inpatient management occurs in 2 phases: stabilization that addresses immediate life-threatening issues and complications followed by nutritional rehabilitation with preparation for discharge. Infants under 6 months are an especially vulnerable group requiring specialized approaches characterized by integrated care that recognizes the interdependence of children and caregivers. Prevention strategies emphasize multisectoral approaches aligned with the Global Action Plan for Child Wasting. By implementing these evidence-based approaches, health professionals can significantly improve outcomes for children with or at risk of wasting and nutritional oedema particularly in low resource settings and make an essential contribution to global efforts to achieve many of the Sustainable Development Goals.
{"title":"Current approaches to the assessment, management and prevention of wasting and nutritional oedema in children","authors":"Mary Iwaret Otiti, Stephen John Allen","doi":"10.1016/j.paed.2025.06.002","DOIUrl":"10.1016/j.paed.2025.06.002","url":null,"abstract":"<div><div>Acute malnutrition in under 5s, manifest by wasting and nutritional oedema, remains a persistent global challenge with the greatest burdens in Asia and Sub-Saharan Africa. This article outlines practical, evidence-based approaches to diagnosis, management and prevention based on the 2023 WHO guidelines. Current terminology and classification of wasting and nutritional oedema and key pathophysiological mechanisms are described. A systematic management approach distinguishes between uncomplicated and complicated severe acute malnutrition. The cornerstones of community-based therapeutic care for uncomplicated cases are the use of ready-to-use therapeutic food and close monitoring. Acute malnutrition with complications such as poor appetite and infections require admission. To account for the reductive adaptation that occurs in malnutrition and avoid the risks of rapid re-feeding, inpatient management occurs in 2 phases: stabilization that addresses immediate life-threatening issues and complications followed by nutritional rehabilitation with preparation for discharge. Infants under 6 months are an especially vulnerable group requiring specialized approaches characterized by integrated care that recognizes the interdependence of children and caregivers. Prevention strategies emphasize multisectoral approaches aligned with the Global Action Plan for Child Wasting. By implementing these evidence-based approaches, health professionals can significantly improve outcomes for children with or at risk of wasting and nutritional oedema particularly in low resource settings and make an essential contribution to global efforts to achieve many of the Sustainable Development Goals.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 9","pages":"Pages 294-300"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144933890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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