Pub Date : 2024-09-11DOI: 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.
{"title":"Breaking down communication barriers","authors":"Qasim Malik, Evangeline Buck, Mary Salama","doi":"10.1016/j.paed.2024.08.008","DOIUrl":"10.1016/j.paed.2024.08.008","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 11","pages":"Pages 436-438"},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142530933","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 : 2024-09-10DOI: 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。
{"title":"Hirschsprung's disease","authors":"Hemanshoo Thakkar, Joe Curry","doi":"10.1016/j.paed.2024.07.001","DOIUrl":"10.1016/j.paed.2024.07.001","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 10","pages":"Pages 359-362"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312382","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 : 2024-09-10DOI: 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.
{"title":"Online life for a child in care","authors":"Vicki Walker","doi":"10.1016/j.paed.2024.08.001","DOIUrl":"10.1016/j.paed.2024.08.001","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 11","pages":"Pages 393-397"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142530930","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 : 2024-09-10DOI: 10.1016/j.paed.2024.08.005
Jessica Slater, Eleanor Boddy
Processes around adoption are not always well understood amongst medical professionals, who may have limited contact with this particular system. This article provides an overview of adoption procedures in England and the integral role that the medical advisor contributes. Adoption panels are discussed, including their structure, overview of processes, and how the medical advisor provides expert support. Ethical and moral challenges are explored, initially relating to implications of the mental and physical health of both adopters and adoptees. The impact of societal expectations on the adoption process is also discussed, from the uncertain future of genetic testing to the consideration of where an individual gets their identity. The second part of this article provides a trainees’ perspective and reflections having attended Adoption Panel, touching on interesting cases. We discuss the impact of attending panel on clinical practice and how it can alter perspectives in various aspects of work in Community Child Health.
{"title":"Adoption: insights from a medical advisor and paediatric trainee","authors":"Jessica Slater, Eleanor Boddy","doi":"10.1016/j.paed.2024.08.005","DOIUrl":"10.1016/j.paed.2024.08.005","url":null,"abstract":"<div><div>Processes around adoption are not always well understood amongst medical professionals, who may have limited contact with this particular system. This article provides an overview of adoption procedures in England and the integral role that the medical advisor contributes. Adoption panels are discussed, including their structure, overview of processes, and how the medical advisor provides expert support. Ethical and moral challenges are explored, initially relating to implications of the mental and physical health of both adopters and adoptees. The impact of societal expectations on the adoption process is also discussed, from the uncertain future of genetic testing to the consideration of where an individual gets their identity. The second part of this article provides a trainees’ perspective and reflections having attended Adoption Panel, touching on interesting cases. We discuss the impact of attending panel on clinical practice and how it can alter perspectives in various aspects of work in Community Child Health.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 11","pages":"Pages 419-423"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142530929","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 : 2024-09-03DOI: 10.1016/j.paed.2024.08.004
Kim S. Golding
Children who experience maltreatment from within their families can suffer trauma that is devastating to their physical and psychological development. The label developmental trauma has developed to describe this trauma and to guide diagnosis. The impact of this can increase when children live within marginalized communities or when their family is impacted by intergenerational trauma. The definition of developmental trauma has been expanded to describe seven domains of impairment. Together these help the clinician to provide a formulation of a child's difficulties which avoids multiple diagnoses and can guide treatment planning. Dyadic Developmental Psychotherapy and Practice (DDP) is an intervention model that can meet the therapeutic needs of the children alongside the support needs of parents and practitioners caring for them. The attitude of PACE (playfulness, acceptance, curiosity and empathy) is central within DDP interventions, used by therapists, parents and practitioners who together make up the network around the child. Tailoring DDP interventions can be guided by a pyramid of need developed by the author. This helps clinicians develop flexible intervention packages tailored to the needs of the child, family and practitioner. Within the article these ideas are explored illustrated by the fictional example of Janice. She was maltreated in early childhood and now lives in foster care with Mary and Simeon.
遭受家庭虐待的儿童可能会遭受对其身心发展具有毁灭性的创伤。发育性创伤这一标签就是用来描述这种创伤和指导诊断的。如果儿童生活在被边缘化的社区，或者他们的家庭受到代际创伤的影响，这种创伤的影响就会加剧。发育性创伤的定义已扩展到七个损伤领域。这些领域共同帮助临床医生对儿童的困难进行表述，从而避免多重诊断，并指导治疗计划。发展心理治疗与实践（Dyadic Developmental Psychotherapy and Practice，DDP）是一种干预模式，可以满足儿童的治疗需求，同时也能满足家长和照顾儿童的从业人员的支持需求。PACE（玩乐、接纳、好奇和同理心）态度是 DDP 干预的核心，由治疗师、家长和从业人员共同组成儿童周围的网络。作者开发的需求金字塔可以为定制 DDP 干预措施提供指导。这有助于临床医生根据儿童、家庭和从业人员的需求制定灵活的干预方案。文章以珍妮丝（Janice）为例，对这些观点进行了探讨。她在幼年时受到虐待，现在与玛丽和西蒙一起生活在寄养家庭中。
{"title":"Understanding and helping children who have experienced maltreatment","authors":"Kim S. Golding","doi":"10.1016/j.paed.2024.08.004","DOIUrl":"10.1016/j.paed.2024.08.004","url":null,"abstract":"<div><div>Children who experience maltreatment from within their families can suffer trauma that is devastating to their physical and psychological development. The label developmental trauma has developed to describe this trauma and to guide diagnosis. The impact of this can increase when children live within marginalized communities or when their family is impacted by intergenerational trauma. The definition of developmental trauma has been expanded to describe seven domains of impairment. Together these help the clinician to provide a formulation of a child's difficulties which avoids multiple diagnoses and can guide treatment planning. Dyadic Developmental Psychotherapy and Practice (DDP) is an intervention model that can meet the therapeutic needs of the children alongside the support needs of parents and practitioners caring for them. The attitude of PACE (playfulness, acceptance, curiosity and empathy) is central within DDP interventions, used by therapists, parents and practitioners who together make up the network around the child. Tailoring DDP interventions can be guided by a pyramid of need developed by the author. This helps clinicians develop flexible intervention packages tailored to the needs of the child, family and practitioner. Within the article these ideas are explored illustrated by the fictional example of Janice. She was maltreated in early childhood and now lives in foster care with Mary and Simeon.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 11","pages":"Pages 412-418"},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142530928","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 : 2024-09-03DOI: 10.1016/j.paed.2024.08.003
Tessa Morgan, Francesca Crozier-Roche, Taliah Drayak, Jack Smith, David Graham, Nicole Marshall, Julia Mannes, Robbie Duschinsky
Children and young people with a social worker (CYPwSW) have particular mental health profiles and needs. Research indicates that despite having higher levels of mental health distress this group tend to experience inequitable access to specialist mental health services. Therefore, much of their mental health support currently falls to generalists including paediatricians. We are currently undertaking a four-year study the CAMHS Referrals and Outcomes for Adolescents and Children with Social Workers (COACHES). Here we present initial insights from an analysis of 20,166 unique case notes which identified 1) High thresholds for entry to CAMHS 2) A requirement that young people must be perceived as stable prior to accessing services 3) that young people often did not feel that their voices were taken seriously 4) the importance of time for trust. Based off these findings and expert-by-experience's insights, we conclude by suggesting ways that paediatricians and health care professionals can best support CYPwSW. These include being the ‘connective tissue’ around young people's support network, gently and proactively building relationships, redressing power imbalances and supporting transitions to adulthood.
有社工陪伴的儿童和青少年（CYPwSW）具有特殊的心理健康特征和需求。研究表明，尽管这一群体的心理健康困扰程度较高，但他们往往无法平等地获得专业的心理健康服务。因此，他们的大部分心理健康支持目前都由包括儿科医生在内的全科医生承担。目前，我们正在开展一项为期四年的研究，名为 "青少年与儿童社工转介与结果"（CAMHS Referrals and Outcomes for Adolescents and Children with Social Workers，COACHES）。在此，我们介绍了对 20,166 份独特病例记录进行分析后得出的初步结论：1）进入 CAMHS 的门槛较高 2）要求青少年在获得服务前必须被视为情绪稳定 3）青少年往往认为他们的声音没有得到重视 4）信任时间的重要性。根据这些发现和专家的经验见解，我们提出了儿科医生和医疗保健专业人员为青少年工作者提供最佳支持的方法。这些方法包括成为青少年支持网络的 "连接组织"、温和而积极地建立关系、纠正权力失衡以及支持他们向成年过渡。
{"title":"Addressing the mental health needs of children with a social worker","authors":"Tessa Morgan, Francesca Crozier-Roche, Taliah Drayak, Jack Smith, David Graham, Nicole Marshall, Julia Mannes, Robbie Duschinsky","doi":"10.1016/j.paed.2024.08.003","DOIUrl":"10.1016/j.paed.2024.08.003","url":null,"abstract":"<div><div>Children and young people with a social worker (CYPwSW) have particular mental health profiles and needs. Research indicates that despite having higher levels of mental health distress this group tend to experience inequitable access to specialist mental health services. Therefore, much of their mental health support currently falls to generalists including paediatricians. We are currently undertaking a four-year study the CAMHS Referrals and Outcomes for Adolescents and Children with Social Workers (COACHES). Here we present initial insights from an analysis of 20,166 unique case notes which identified 1) High thresholds for entry to CAMHS 2) A requirement that young people must be perceived as stable prior to accessing services 3) that young people often did not feel that their voices were taken seriously 4) the importance of time for trust. Based off these findings and expert-by-experience's insights, we conclude by suggesting ways that paediatricians and health care professionals can best support CYPwSW. These include being the ‘connective tissue’ around young people's support network, gently and proactively building relationships, redressing power imbalances and supporting transitions to adulthood.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 11","pages":"Pages 406-411"},"PeriodicalIF":0.0,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142530507","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 : 2024-09-02DOI: 10.1016/j.paed.2024.08.002
Sophie Pach, Allison Ward , Sarah Eisen
Children who are looked after (CLA), including children and young people seeking asylum and refugees who are unaccompanied (CYPSAR-U), experience multiple intersecting vulnerabilities leading to an increased risk of infections throughout childhood. This population experiences a higher risk of maternal to child transmission of blood borne viruses as well as a higher risk of acquiring infections in childhood and adolescence. This article summarizes the infections of importance in children who are looked after, including blood borne viruses (TB, HIV, hepatitis B and C and syphilis) as well as more commonly neglected infectious diseases with maternal to child transmission (e.g. herpes simplex virus and Chlamydia) and infections of particular relevance to the CYPSAR-U population (e.g. schistosomiasis and strongyloidiasis). It is the responsibility of health care professional to identify and reduce the risks of infection in CLA. This article describes best practice at every stage of care; from identifying risk factors, through informed consent and counselling, to testing and sharing results, and finally with robust follow-up and ongoing education. We also describe where services are currently falling short, and give recommendations for service improvement and further research, with a particular emphasis on integrating the views of the children themselves.
{"title":"Testing for infections: getting it right for children in care","authors":"Sophie Pach, Allison Ward , Sarah Eisen","doi":"10.1016/j.paed.2024.08.002","DOIUrl":"10.1016/j.paed.2024.08.002","url":null,"abstract":"<div><div>Children who are looked after (CLA), including children and young people seeking asylum and refugees who are unaccompanied (CYPSAR-U), experience multiple intersecting vulnerabilities leading to an increased risk of infections throughout childhood. This population experiences a higher risk of maternal to child transmission of blood borne viruses as well as a higher risk of acquiring infections in childhood and adolescence. This article summarizes the infections of importance in children who are looked after, including blood borne viruses (TB, HIV, hepatitis B and C and syphilis) as well as more commonly neglected infectious diseases with maternal to child transmission (e.g. herpes simplex virus and Chlamydia) and infections of particular relevance to the CYPSAR-U population (e.g. schistosomiasis and strongyloidiasis). It is the responsibility of health care professional to identify and reduce the risks of infection in CLA. This article describes best practice at every stage of care; from identifying risk factors, through informed consent and counselling, to testing and sharing results, and finally with robust follow-up and ongoing education. We also describe where services are currently falling short, and give recommendations for service improvement and further research, with a particular emphasis on integrating the views of the children themselves.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 11","pages":"Pages 398-405"},"PeriodicalIF":0.0,"publicationDate":"2024-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142531065","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 : 2024-08-31DOI: 10.1016/j.paed.2024.07.002
Christabella Ng, Andrew Prayle
Cystic fibrosis is a multisystem disorder, and gastrointestinal (GI) disease contributes significantly to its morbidity. This review outlines the major gastrointestinal manifestations of CF, and highlights areas of common misunderstanding. Areas particularly important to practice, such as impact upon malabsorption, bowel obstruction and gastro-oesophageal reflux are considered in detail. The impact of new CFTR modulator therapies on CF-related GI conditions is discussed and treatment options for individual pathologies is discussed.
{"title":"Gastrointestinal complications of cystic fibrosis","authors":"Christabella Ng, Andrew Prayle","doi":"10.1016/j.paed.2024.07.002","DOIUrl":"10.1016/j.paed.2024.07.002","url":null,"abstract":"<div><div>Cystic fibrosis is a multisystem disorder, and gastrointestinal (GI) disease contributes significantly to its morbidity. This review outlines the major gastrointestinal manifestations of CF, and highlights areas of common misunderstanding. Areas particularly important to practice, such as impact upon malabsorption, bowel obstruction and gastro-oesophageal reflux are considered in detail. The impact of new CFTR modulator therapies on CF-related GI conditions is discussed and treatment options for individual pathologies is discussed.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 10","pages":"Pages 363-367"},"PeriodicalIF":0.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312383","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 : 2024-08-30DOI: 10.1016/j.paed.2024.07.003
Ishaq Abu-Arafeh
Cyclical vomiting syndrome (CVS) was described over 100 years ago, but it is often underdiagnosed and undertreated, even after a diagnosis is made. It is relatively common, affecting almost 2% of school-age children in some studies. Although it is traditionally seen as a childhood disease related to migraine, CVS does occur in adults. The main characteristic of CVS is the stereotypical recurrent nature of episodes of intense nausea and vomiting lasting from few hours to few days and followed by a complete resolution of symptoms. The diagnosis is predominantly a clinical one and there are internationally accepted criteria for diagnosis. The management of acute attacks of CVS aims to relieve symptoms, reduce the duration of attacks and prevent dehydration and hospital admission. Management also includes appropriate counselling on healthy lifestyle, provision of individual management plans and preventive medications. The aim of management is to reduce the number of attacks and improve quality of life. About half the children with CVS start to have migraine with or without aura in late adolescence and around 40% continue with CVS into early adult life. This article is aimed at healthcare professionals looking after children with CVS and describes the clinical presentation, the criteria required for diagnosis and outlines the different treatment options.
{"title":"Cyclical vomiting syndrome","authors":"Ishaq Abu-Arafeh","doi":"10.1016/j.paed.2024.07.003","DOIUrl":"10.1016/j.paed.2024.07.003","url":null,"abstract":"<div><div>Cyclical vomiting syndrome (CVS) was described over 100 years ago, but it is often underdiagnosed and undertreated, even after a diagnosis is made. It is relatively common, affecting almost 2% of school-age children in some studies. Although it is traditionally seen as a childhood disease related to migraine, CVS does occur in adults. The main characteristic of CVS is the stereotypical recurrent nature of episodes of intense nausea and vomiting lasting from few hours to few days and followed by a complete resolution of symptoms. The diagnosis is predominantly a clinical one and there are internationally accepted criteria for diagnosis. The management of acute attacks of CVS aims to relieve symptoms, reduce the duration of attacks and prevent dehydration and hospital admission. Management also includes appropriate counselling on healthy lifestyle, provision of individual management plans and preventive medications. The aim of management is to reduce the number of attacks and improve quality of life. About half the children with CVS start to have migraine with or without aura in late adolescence and around 40% continue with CVS into early adult life. This article is aimed at healthcare professionals looking after children with CVS and describes the clinical presentation, the criteria required for diagnosis and outlines the different treatment options.</div></div>","PeriodicalId":38589,"journal":{"name":"Paediatrics and Child Health (United Kingdom)","volume":"34 10","pages":"Pages 368-372"},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142312384","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 : 2024-08-23DOI: 10.1016/j.paed.2024.07.006
James E Davison
Basic biochemical tests are frequently obtained in acutely unwell neonates and children, as well as in some elective situations. Correct interpretation is essential in identifying rare inherited primary metabolic disorders, but secondary causes of hyperammonaemia, elevated blood lactate or acid-base derangement are more common and require appropriate treatment of the underlying cause. Ammonia is the waste product of protein metabolism and is highly toxic. Ammonia should be measured in any sick neonate, and in children with unexplained encephalopathy. Further testing is needed to determine if it is secondary to other factors, or due to a primary metabolic disorder affecting urea cycle function. Specific treatment should be instigated urgently to avoid long term neurological sequelae. Lactate elevation indicates anaerobic respiration and is often secondary to hypoxia or poor tissue perfusion but can indicate a metabolic disorder affecting mitochondrial function or energy metabolism. Blood gas analysis to review acid-base status is a critical test in any sick neonate or child, and correct interpretation will indicate if there is a respiratory or metabolic basis. A metabolic acidosis with elevated anion gap may indicate a primary metabolic disorder. These tests can help identify patients who may have a primary metabolic disorder, and management should be discussed urgently with a specialist metabolic centre.
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