Pub Date : 2025-07-01DOI: 10.1016/j.paed.2025.05.009
Elizabeth Homer, Sarah Hughes
The process of preparing for adulthood (transition) comes at a critical time in a young person's life. When they additionally have a neurodisability, this needs careful consideration to ensure we support them to safely navigate to new services and not fall into the gaps between. This paper advocates for development of systems that can be tailored to individuals, suggesting models and processes which could be applied. Our focus will be on the healthcare transition and our roles as paediatricians in this process. This article shares examples of local practice including transition care plans, transfer clinics and the role of the general practitioner. Cases are provided to give examples of ways to approach transition and illustrate the importance of early planning, effective collaboration and the need for an individualized approach. The article also considers the role of Senior leadership within trusts, commissioners and the importance of hearing the young person's voice, to allow evolution of transition pathways that are representative of the ever-changing world of neurodisability.
{"title":"Preparing young people with neurodisability for transition to adult health services","authors":"Elizabeth Homer, Sarah Hughes","doi":"10.1016/j.paed.2025.05.009","DOIUrl":"10.1016/j.paed.2025.05.009","url":null,"abstract":"<div><div>The process of preparing for adulthood (transition) comes at a critical time in a young person's life. When they additionally have a neurodisability, this needs careful consideration to ensure we support them to safely navigate to new services and not fall into the gaps between. This paper advocates for development of systems that can be tailored to individuals, suggesting models and processes which could be applied. Our focus will be on the healthcare transition and our roles as paediatricians in this process. This article shares examples of local practice including transition care plans, transfer clinics and the role of the general practitioner. Cases are provided to give examples of ways to approach transition and illustrate the importance of early planning, effective collaboration and the need for an individualized approach. The article also considers the role of Senior leadership within trusts, commissioners and the importance of hearing the young person's voice, to allow evolution of transition pathways that are representative of the ever-changing world of neurodisability.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 8","pages":"Pages 267-274"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723372","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 : 2025-06-19DOI: 10.1016/j.paed.2025.05.011
Emine Nebati, Sejal Saglani
Difficult-to-treat asthma in children remains a significant clinical challenge, often resulting in high healthcare costs and poor outcomes. Despite many referrals to specialist centres, basic management principles are frequently overlooked, with premature escalation to high-dose corticosteroids. This review highlights the importance of a systematic approach to paediatric asthma, beginning with accurate diagnosis using objective tests such as spirometry and fractional exhaled nitric oxide (FeNO) and careful exclusion of alternative or co-existing diagnoses. Optimizing adherence, inhaler technique and environmental control—alongside identifying comorbidities such as allergic rhinitis, obesity and dysfunctional breathing—can dramatically improve outcomes in most cases without requiring advanced therapies. A multidisciplinary team approach, incorporating education, psychological support, and personalized asthma action plans, is essential. For children with truly severe therapy-resistant asthma (STRA), biologics offer promising control when traditional therapies fail, especially where modifiable factors are non-correctable. However, their use should follow thorough evaluation and shared decision-making. Ultimately, reinforcing fundamental asthma care in primary and secondary settings can prevent progression to specialist referral and reduce both direct and indirect healthcare burdens. Addressing modifiable factors enables over 70% of children with difficult asthma to achieve good control, emphasizing the need to revisit and reinforce core management strategies.
{"title":"Difficult-to-treat asthma: revisiting essential management principles","authors":"Emine Nebati, Sejal Saglani","doi":"10.1016/j.paed.2025.05.011","DOIUrl":"10.1016/j.paed.2025.05.011","url":null,"abstract":"<div><div>Difficult-to-treat asthma in children remains a significant clinical challenge, often resulting in high healthcare costs and poor outcomes. Despite many referrals to specialist centres, basic management principles are frequently overlooked, with premature escalation to high-dose corticosteroids. This review highlights the importance of a systematic approach to paediatric asthma, beginning with accurate diagnosis using objective tests such as spirometry and fractional exhaled nitric oxide (FeNO) and careful exclusion of alternative or co-existing diagnoses. Optimizing adherence, inhaler technique and environmental control—alongside identifying comorbidities such as allergic rhinitis, obesity and dysfunctional breathing—can dramatically improve outcomes in most cases without requiring advanced therapies. A multidisciplinary team approach, incorporating education, psychological support, and personalized asthma action plans, is essential. For children with truly severe therapy-resistant asthma (STRA), biologics offer promising control when traditional therapies fail, especially where modifiable factors are non-correctable. However, their use should follow thorough evaluation and shared decision-making. Ultimately, reinforcing fundamental asthma care in primary and secondary settings can prevent progression to specialist referral and reduce both direct and indirect healthcare burdens. Addressing modifiable factors enables over 70% of children with difficult asthma to achieve good control, emphasizing the need to revisit and reinforce core management strategies.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 8","pages":"Pages 282-288"},"PeriodicalIF":0.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723373","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 : 2025-06-17DOI: 10.1016/j.paed.2025.05.008
Alison McLuckie
Children with disabilities account for around 11% of the United Kingdom paediatric population and some attend frequently to healthcare services, both in the community and to secondary care. They are not a homogenous group and each child will have their own identity, needs and beliefs. As a group, however, they are particularly vulnerable to discrimination and may be more at risk of abuse and neglect. They may face additional barriers to having their voice heard and their rights fulfilled. The United Nations Convention on the Rights of the Child (UNCRC) makes specific provision for children with disabilities and exists alongside several other legal frameworks which aim to ensure that people with disability live as full and dignified a life as their peers. This article will examine which human rights provisions exist for children and young people with disability and which tools might be helpful for paediatricians and healthcare professionals to have awareness of to ensure that children and young people with disability have their rights considered when decisions are taken which affect them.
{"title":"Using a rights-based approach in the care of children and young people with disability: an introduction for paediatric practice","authors":"Alison McLuckie","doi":"10.1016/j.paed.2025.05.008","DOIUrl":"10.1016/j.paed.2025.05.008","url":null,"abstract":"<div><div>Children with disabilities account for around 11% of the United Kingdom paediatric population and some attend frequently to healthcare services, both in the community and to secondary care. They are not a homogenous group and each child will have their own identity, needs and beliefs. As a group, however, they are particularly vulnerable to discrimination and may be more at risk of abuse and neglect. They may face additional barriers to having their voice heard and their rights fulfilled. The United Nations Convention on the Rights of the Child (UNCRC) makes specific provision for children with disabilities and exists alongside several other legal frameworks which aim to ensure that people with disability live as full and dignified a life as their peers. This article will examine which human rights provisions exist for children and young people with disability and which tools might be helpful for paediatricians and healthcare professionals to have awareness of to ensure that children and young people with disability have their rights considered when decisions are taken which affect them.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 8","pages":"Pages 263-266"},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723371","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 : 2025-06-13DOI: 10.1016/j.paed.2025.05.007
Jenefer Sargent, Eleanor Yule
Vision plays a critical role in early developmental processes and current functioning. Descriptions of current developmental skills are often confidently made by paediatricians without making explicit the ways in which visual materials are used by the child in everyday activities. When we describe how the child functions in the performance of tasks that involve vision and which are meaningful to everyday activity and participation, it is the child's functional vision that is being described. Although responsibility for vision assessment is often assumed to lie with the eye clinic, multiple aspects of functional vision assessment fall strongly within the scope of paediatric practice and of other members of the multidisciplinary team. Paediatricians can develop their ability to help parents of disabled children understand what their child can visually detect and interpret and use existing developmental knowledge to contribute to advice on the most appropriate format and style of visual materials to support play and learning. Confidence in assessment of functional visual skills will support such advice giving. A practical approach to such assessment is set out here.
{"title":"Eyes on vision – functional visual assessment in the child with a disability: a practical assessment approach for paediatricians","authors":"Jenefer Sargent, Eleanor Yule","doi":"10.1016/j.paed.2025.05.007","DOIUrl":"10.1016/j.paed.2025.05.007","url":null,"abstract":"<div><div>Vision plays a critical role in early developmental processes and current functioning. Descriptions of current developmental skills are often confidently made by paediatricians without making explicit the ways in which visual materials are used by the child in everyday activities. When we describe how the child functions in the performance of tasks that involve vision and which are meaningful to everyday activity and participation, it is the child's functional vision that is being described. Although responsibility for vision assessment is often assumed to lie with the eye clinic, multiple aspects of functional vision assessment fall strongly within the scope of paediatric practice and of other members of the multidisciplinary team. Paediatricians can develop their ability to help parents of disabled children understand what their child can visually detect and interpret and use existing developmental knowledge to contribute to advice on the most appropriate format and style of visual materials to support play and learning. Confidence in assessment of functional visual skills will support such advice giving. A practical approach to such assessment is set out here.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 8","pages":"Pages 257-262"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723370","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 : 2025-06-11DOI: 10.1016/j.paed.2025.05.010
Miranda Eodanable, Hannah MacLean
Diagnosis of intellectual disability (ID) can be a protective factor for individuals across their life course. ID is a neurodevelopmental disorder, lifelong disability, and disability identity. Early screening and assessment in children and young people can reduce duplication of assessment processes, waiting lists and is an essential component for intervention. Barriers to assessment and diagnosis have included limited availability of assessment pathways, professional confidence in assessment practice, and limited shared developmental understanding of a child across health and education settings. Early diagnosis and intervention can improve individuals’ physical and mental health, support networks, educational outcomes, and transition into adulthood. This article seeks to outline key issues in the processes of screening, assessment, and reporting of ID and provide clarity for clinicians regarding assessment tools and areas for relevant intervention. Multi-agency processes have been developed in one local authority between health and education services to improve identification and support for children and young people before they enter adulthood. Wider multidisciplinary and multi-agency awareness and assessment of ID can be transformative for a broader formulation of individual and family needs and supports, and service delivery.
{"title":"Diagnosis of intellectual disability: updates on multi-agency screening, assessment, reporting and interventions for children and young people","authors":"Miranda Eodanable, Hannah MacLean","doi":"10.1016/j.paed.2025.05.010","DOIUrl":"10.1016/j.paed.2025.05.010","url":null,"abstract":"<div><div>Diagnosis of intellectual disability (ID) can be a protective factor for individuals across their life course. ID is a neurodevelopmental disorder, lifelong disability, and disability identity. Early screening and assessment in children and young people can reduce duplication of assessment processes, waiting lists and is an essential component for intervention. Barriers to assessment and diagnosis have included limited availability of assessment pathways, professional confidence in assessment practice, and limited shared developmental understanding of a child across health and education settings. Early diagnosis and intervention can improve individuals’ physical and mental health, support networks, educational outcomes, and transition into adulthood. This article seeks to outline key issues in the processes of screening, assessment, and reporting of ID and provide clarity for clinicians regarding assessment tools and areas for relevant intervention. Multi-agency processes have been developed in one local authority between health and education services to improve identification and support for children and young people before they enter adulthood. Wider multidisciplinary and multi-agency awareness and assessment of ID can be transformative for a broader formulation of individual and family needs and supports, and service delivery.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 8","pages":"Pages 275-281"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144723374","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 : 2025-05-28DOI: 10.1016/j.paed.2025.05.001
Sarah Stibbards
Children commonly present with a history of witnessed or unwitnessed ingested foreign body (FB). Most are low risk objects, with the child or young person remaining asymptomatic enabling management without imaging or intervention. However, there are a several high-risk objects and clinical scenarios where it is important to have high clinical suspicion as they can cause serious injury if they remain in the gastrointestinal tract. Such injuries include oesophageal obstruction, perforation, fistulae into surrounding structures e.g. trachea, blood vessels, and bowel obstruction or perforation and can lead to long term complications or death. Button battery ingestion is particularly dangerous as necrosis, erosion and perforation can occur within hours and even after the battery has been removed, serious complications can still develop days, weeks, or months later. Currently there is not enough research to agree a standard approach following the ingestion of all FBs. This article aims to allow clinicians to follow a standardised approach and enact safe management of ingested FBs in children, whilst avoiding unnecessary investigation or ionising radiation. It includes guidance on which patients can go home safely without investigation or follow-up, which patients require investigations and which patients require emergent or urgent intervention by specialty teams.
{"title":"A practical approach to high-risk foreign body ingestion in children","authors":"Sarah Stibbards","doi":"10.1016/j.paed.2025.05.001","DOIUrl":"10.1016/j.paed.2025.05.001","url":null,"abstract":"<div><div>Children commonly present with a history of witnessed or unwitnessed ingested foreign body (FB). Most are low risk objects, with the child or young person remaining asymptomatic enabling management without imaging or intervention. However, there are a several high-risk objects and clinical scenarios where it is important to have high clinical suspicion as they can cause serious injury if they remain in the gastrointestinal tract. Such injuries include oesophageal obstruction, perforation, fistulae into surrounding structures e.g. trachea, blood vessels, and bowel obstruction or perforation and can lead to long term complications or death. Button battery ingestion is particularly dangerous as necrosis, erosion and perforation can occur within hours and even after the battery has been removed, serious complications can still develop days, weeks, or months later. Currently there is not enough research to agree a standard approach following the ingestion of all FBs. This article aims to allow clinicians to follow a standardised approach and enact safe management of ingested FBs in children, whilst avoiding unnecessary investigation or ionising radiation. It includes guidance on which patients can go home safely without investigation or follow-up, which patients require investigations and which patients require emergent or urgent intervention by specialty teams.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 7","pages":"Pages 221-226"},"PeriodicalIF":0.0,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144481712","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 : 2025-05-20DOI: 10.1016/j.paed.2025.05.003
David J McCreary, Niall Mullen
Point-of-care ultrasound (POCUS) has emerged as a valuable tool for clinicians. It is best considered as an extension of the clinical assessment, where it can provide greater information than is available via traditional physical examination alone. POCUS fulfils several roles within clinical paediatrics; most commonly it serves as a diagnostic aid, helping to further a clinician's working hypothesis by excluding less likely diagnoses or helping to improve certainty in confirming others. Its use can obviate the need for other investigations such as blood tests and in doing so it can streamline the patient journey. In certain scenarios POCUS can fulfil the role that a conventional imaging investigation has done previously. It has emerged as a tool to guide resuscitation and stabilization of the seriously unwell patient and, as is perhaps most familiar, it can be used to help guide procedures. The aim of this article is to summarize the current applications of POCUS in acute paediatric care as well as to highlight more novel, emerging applications.
{"title":"Point-of-care ultrasound in paediatric clinical practice: transforming tomorrow today","authors":"David J McCreary, Niall Mullen","doi":"10.1016/j.paed.2025.05.003","DOIUrl":"10.1016/j.paed.2025.05.003","url":null,"abstract":"<div><div>Point-of-care ultrasound (POCUS) has emerged as a valuable tool for clinicians. It is best considered as an extension of the clinical assessment, where it can provide greater information than is available via traditional physical examination alone. POCUS fulfils several roles within clinical paediatrics; most commonly it serves as a diagnostic aid, helping to further a clinician's working hypothesis by excluding less likely diagnoses or helping to improve certainty in confirming others. Its use can obviate the need for other investigations such as blood tests and in doing so it can streamline the patient journey. In certain scenarios POCUS can fulfil the role that a conventional imaging investigation has done previously. It has emerged as a tool to guide resuscitation and stabilization of the seriously unwell patient and, as is perhaps most familiar, it can be used to help guide procedures. The aim of this article is to summarize the current applications of POCUS in acute paediatric care as well as to highlight more novel, emerging applications.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 7","pages":"Pages 234-240"},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144481774","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 : 2025-05-20DOI: 10.1016/j.paed.2025.05.005
David Reynolds, Patrick Davies
During the early phase of the COVID-19 pandemic, PIMS-TS emerged as a new hyper-inflammatory disorder affecting children. These children were often unstable requiring admission to critical care. Children with PIMS-TS displayed symptoms mimicking other inflammatory processes but it was quickly apparent this was a novel condition requiring its own treatment regime. Through international co-operative resource sharing, agreement grew over several treatment options including biological agents, IVIG and steroids leading to consensus guidance based on anecdotal and limited observed data. As our understanding of COVID-19 grew with each wave of the pandemic, so has our understanding of PIMS-TS. Several large trials, including the RECOVERY and BATS trials, are now able to provide an evidence base for the treatment of this condition, and challenge some of the management practices that were widely utilized. IV Immunoglobulin, for example, has been shown not to change outcomes and would therefore no longer be recommended for treatment, whereas methylprednisolone did show some improvements over usual supportive care. Epidemiology data shows PIMS-TS to have been a temporally limited condition, reducing in prevalence with each variant of COVID-19. Looking at overall outcome data, this was thankfully a condition with overall very low mortality and limited long term morbidity.
{"title":"Post COVID-19 paediatric inflammatory syndrome (PIMS-TS/MIS-C): what have we learned?","authors":"David Reynolds, Patrick Davies","doi":"10.1016/j.paed.2025.05.005","DOIUrl":"10.1016/j.paed.2025.05.005","url":null,"abstract":"<div><div>During the early phase of the COVID-19 pandemic, PIMS-TS emerged as a new hyper-inflammatory disorder affecting children. These children were often unstable requiring admission to critical care. Children with PIMS-TS displayed symptoms mimicking other inflammatory processes but it was quickly apparent this was a novel condition requiring its own treatment regime. Through international co-operative resource sharing, agreement grew over several treatment options including biological agents, IVIG and steroids leading to consensus guidance based on anecdotal and limited observed data. As our understanding of COVID-19 grew with each wave of the pandemic, so has our understanding of PIMS-TS. Several large trials, including the RECOVERY and BATS trials, are now able to provide an evidence base for the treatment of this condition, and challenge some of the management practices that were widely utilized. IV Immunoglobulin, for example, has been shown not to change outcomes and would therefore no longer be recommended for treatment, whereas methylprednisolone did show some improvements over usual supportive care. Epidemiology data shows PIMS-TS to have been a temporally limited condition, reducing in prevalence with each variant of COVID-19. Looking at overall outcome data, this was thankfully a condition with overall very low mortality and limited long term morbidity.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 7","pages":"Pages 247-252"},"PeriodicalIF":0.0,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144481772","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 : 2025-05-16DOI: 10.1016/j.paed.2025.05.004
Nermin Alashal, Nahin Hussain
Creatine kinase (CK) is a screening diagnostic test for suspected neuromuscular disease. It is a sensitive indicator of muscle injury and is preferred to other skeletal muscle enzymes as it is least affected by haemolysis, is readily released in cellular injury and has a relative predominance in skeletal muscle. In a healthy individual the normal range varies between 22 and 200 IU/L (varies with laboratory), although gender and race can influence this range. CK can also be elevated in non-pathological transient situations such as cramps and post-exercise. It can increase up to three times the normal value after strenuous exercise, intramuscular injections, EMG studies and viral infections. Highest level of CK is seen in inflammatory myopathies and in early stages of DMD when patients are still ambulant. Occasionally CK is elevated in asymptomatic or mildly symptomatic children and this creates unwarranted anxiety and diagnostic uncertainties. The need for extensive ancillary investigations and muscle biopsy in clinically normal individuals with elevated CK remains an unresolved issue. This review discusses the diagnostic value of creatine kinase in neuromuscular conditions in children and offers practical advice about how results should be interpreted in different clinical situations.
{"title":"How to interpret creatine kinase level in neuromuscular conditions","authors":"Nermin Alashal, Nahin Hussain","doi":"10.1016/j.paed.2025.05.004","DOIUrl":"10.1016/j.paed.2025.05.004","url":null,"abstract":"<div><div>Creatine kinase (CK) is a screening diagnostic test for suspected neuromuscular disease. It is a sensitive indicator of muscle injury and is preferred to other skeletal muscle enzymes as it is least affected by haemolysis, is readily released in cellular injury and has a relative predominance in skeletal muscle. In a healthy individual the normal range varies between 22 and 200 IU/L (varies with laboratory), although gender and race can influence this range. CK can also be elevated in non-pathological transient situations such as cramps and post-exercise. It can increase up to three times the normal value after strenuous exercise, intramuscular injections, EMG studies and viral infections. Highest level of CK is seen in inflammatory myopathies and in early stages of DMD when patients are still ambulant. Occasionally CK is elevated in asymptomatic or mildly symptomatic children and this creates unwarranted anxiety and diagnostic uncertainties. The need for extensive ancillary investigations and muscle biopsy in clinically normal individuals with elevated CK remains an unresolved issue. This review discusses the diagnostic value of creatine kinase in neuromuscular conditions in children and offers practical advice about how results should be interpreted in different clinical situations.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 7","pages":"Pages 241-246"},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144481713","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 : 2025-05-15DOI: 10.1016/j.paed.2025.05.002
Melissa Leadbetter, Laura Duthie
Paediatric minor injuries are a frequent presentation to the Emergency Department (ED) and acute care settings. As children develop from curious pre-schoolers to teenagers who are learning to take risks, the pattern of injury changes from lower impact injuries and foreign body insertion or ingestions, to injuries sustained at higher impact. Paediatricians typically receive little training in minor injuries. However, some injuries are seen more commonly in children, therefore knowledge or experience in managing them may also be lacking for clinicians who are primarily trained in adult emergency care. Effective management not only requires a comprehensive understanding of paediatric anatomy and physiology, but a nuanced approach to management, tailored to the developmental needs of the child. This can often be a challenge and techniques used in an older child or adult may not be appropriate. This article provides a practical guide to the assessment, diagnosis, and treatment of common minor injuries in Paediatrics. Including some helpful tips and tricks on how to manage those tricky customers.
{"title":"From inquisitive toddlers to adventurous teenagers: how to navigate paediatric minor injuries","authors":"Melissa Leadbetter, Laura Duthie","doi":"10.1016/j.paed.2025.05.002","DOIUrl":"10.1016/j.paed.2025.05.002","url":null,"abstract":"<div><div>Paediatric minor injuries are a frequent presentation to the Emergency Department (ED) and acute care settings. As children develop from curious pre-schoolers to teenagers who are learning to take risks, the pattern of injury changes from lower impact injuries and foreign body insertion or ingestions, to injuries sustained at higher impact. Paediatricians typically receive little training in minor injuries. However, some injuries are seen more commonly in children, therefore knowledge or experience in managing them may also be lacking for clinicians who are primarily trained in adult emergency care. Effective management not only requires a comprehensive understanding of paediatric anatomy and physiology, but a nuanced approach to management, tailored to the developmental needs of the child. This can often be a challenge and techniques used in an older child or adult may not be appropriate. This article provides a practical guide to the assessment, diagnosis, and treatment of common minor injuries in Paediatrics. Including some helpful tips and tricks on how to manage those tricky customers.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"35 7","pages":"Pages 227-233"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144481773","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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