Paediatrics and Child Health (United Kingdom)最新文献

英文中文

Self-assessment 自我评估

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

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

Ewan Spencer, Peter Heinz

引用次数: 0

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

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

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

Carolyn Sampeys, Deborah Price Williams

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

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

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引用次数: 0

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

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

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

David McCreary

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

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

引用次数: 0

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

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

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

Michelle Bond, Dannika Buckley

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

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

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引用次数: 0

Breaking down communication barriers 打破沟通障碍

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

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

Qasim Malik, Evangeline Buck, Mary Salama

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

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

引用次数: 0

Hirschsprung's disease 赫氏综合症

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

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

Hemanshoo Thakkar, Joe Curry

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

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

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引用次数: 0

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

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

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

Vicki Walker

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

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

引用次数: 0

Adoption: insights from a medical advisor and paediatric trainee 收养：医学顾问和儿科实习生的见解

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2024-09-10 DOI: 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.

医疗专业人员对收养程序的了解并不总是很透彻，因为他们与这一特殊系统的接触可能很有限。本文概述了英格兰的收养程序以及医疗顾问的重要作用。文章讨论了收养小组，包括其结构、程序概述以及医疗顾问如何提供专家支持。文章探讨了伦理和道德方面的挑战，首先是对收养人和被收养人身心健康的影响。文章还讨论了社会期望对收养过程的影响，从基因检测的不确定前景到个人身份来源的考虑。文章的第二部分提供了受训者参加领养小组讨论后的观点和反思，其中涉及一些有趣的案例。我们讨论了参加小组讨论对临床实践的影响，以及它如何改变社区儿童健康工作各方面的视角。

引用次数: 0

Understanding and helping children who have experienced maltreatment 了解并帮助遭受虐待的儿童

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2024-09-03 DOI: 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。

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引用次数: 0

Addressing the mental health needs of children with a social worker 与社工一起满足儿童的心理健康需求

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2024-09-03 DOI: 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。

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