Paediatrics and Child Health (United Kingdom)最新文献

英文中文

Difficult-to-treat asthma: revisiting essential management principles 难治性哮喘：重新审视基本管理原则

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-06-19 DOI: 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.

难以治疗的儿童哮喘仍然是一个重大的临床挑战，往往导致高昂的医疗费用和不良的结果。尽管许多转介到专科中心，基本的管理原则往往被忽视，过早升级到高剂量皮质类固醇。这篇综述强调了对儿童哮喘采取系统方法的重要性，首先要使用客观测试（如肺活量测定法和分数呼气一氧化氮（FeNO））进行准确诊断，并仔细排除其他或共存的诊断。优化依从性、吸入器技术和环境控制，以及识别合并症，如过敏性鼻炎、肥胖和呼吸功能障碍，可以显著改善大多数病例的结果，而无需先进的治疗方法。综合教育、心理支持和个性化哮喘行动计划的多学科团队方法至关重要。对于患有真正严重的治疗性哮喘（STRA）的儿童，当传统疗法失败时，特别是在可改变因素无法纠正的情况下，生物制剂提供了有希望的控制。然而，它们的使用应该遵循彻底的评估和共同的决策。最终，在初级和二级环境中加强基础哮喘护理可以防止进展到专科转诊，并减少直接和间接的卫生保健负担。解决可改变的因素使70%以上的难治性哮喘儿童获得良好控制，强调需要重新审视和加强核心管理策略。

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引用次数: 0

Using a rights-based approach in the care of children and young people with disability: an introduction for paediatric practice 在照顾残疾儿童和青年方面采用基于权利的方法：儿科实践介绍

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-06-17 DOI: 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.

残疾儿童约占联合王国儿科人口的11%，其中一些儿童经常在社区和二级保健机构接受保健服务。他们不是一个同质的群体，每个孩子都有自己的身份、需求和信仰。然而，作为一个群体，他们特别容易受到歧视，可能更容易受到虐待和忽视。他们在发出自己的声音和实现自己的权利方面可能面临更多障碍。《联合国儿童权利公约》（《公约》）为残疾儿童作出了具体规定，并与其他一些旨在确保残疾人像同龄人一样过着充实和有尊严的生活的法律框架一起存在。本文将审查针对残疾儿童和青年的哪些人权规定，以及哪些工具可能有助于儿科医生和保健专业人员了解，以确保在作出影响残疾儿童和青年的决定时考虑到他们的权利。

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引用次数: 0

Eyes on vision – functional visual assessment in the child with a disability: a practical assessment approach for paediatricians 视力上的眼睛-残疾儿童的功能视力评估：儿科医生的实用评估方法

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-06-13 DOI: 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.

视觉在早期发育过程和当前功能中起着关键作用。儿科医生经常自信地描述当前的发展技能，但没有明确说明儿童在日常活动中使用视觉材料的方式。当我们描述儿童如何完成涉及视觉的任务以及对日常活动和参与有意义的任务时，我们描述的是儿童的功能性视觉。虽然视力评估的责任通常被认为是由眼科诊所承担的，但功能性视力评估的多个方面强烈地落在儿科实践和多学科团队其他成员的范围内。儿科医生可以发展他们的能力，帮助残疾儿童的父母了解他们的孩子可以通过视觉检测和解释的内容，并利用现有的发展知识，就最合适的视觉材料格式和风格提供建议，以支持游戏和学习。对功能性视觉技能评估的信心将支持这样的建议。这里提出了一种切实可行的评估方法。

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引用次数: 0

Diagnosis of intellectual disability: updates on multi-agency screening, assessment, reporting and interventions for children and young people 智力残疾诊断：儿童和青少年多机构筛查、评估、报告和干预措施的最新情况

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-06-11 DOI: 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.

智力残疾（ID）的诊断可以成为个人一生中的一个保护因素。ID是一种神经发育障碍、终身残疾和残疾身份。对儿童和青年进行早期筛查和评估可以减少评估过程的重复和等待名单，是干预的一个重要组成部分。评估和诊断的障碍包括评估途径的可用性有限，评估实践的专业信心有限，以及在卫生和教育环境中对儿童发展的共同理解有限。早期诊断和干预可以改善个人的身心健康、支持网络、教育成果和向成年的过渡。本文旨在概述筛查、评估和报告ID过程中的关键问题，并为临床医生提供有关评估工具和相关干预领域的清晰度。一个地方当局在保健和教育服务部门之间制定了多机构程序，以便在儿童和青年进入成年之前更好地识别和支持他们。更广泛的多学科和多机构对身份证的认识和评估可以对更广泛地确定个人和家庭的需要和支助以及提供服务具有变革意义。

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引用次数: 0

A practical approach to high-risk foreign body ingestion in children 儿童高危异物误食的实用方法

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-05-28 DOI: 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.

儿童通常有目击或未目击的摄入异物史（FB）。大多数是低风险对象，儿童或年轻人仍然无症状，无需成像或干预即可进行管理。然而，在一些高危对象和临床情况下，临床高度怀疑是很重要的，因为如果它们留在胃肠道中，可能会造成严重伤害。这类损伤包括食道梗阻、穿孔、气管、血管等周围结构的瘘管和肠梗阻或穿孔，并可导致长期并发症或死亡。吞下纽扣电池尤其危险，因为几个小时内就会发生坏死、腐蚀和穿孔，甚至在取出电池后，几天、几周或几个月后仍会出现严重的并发症。目前，还没有足够的研究来就摄入所有氟苯后的标准方法达成一致。这篇文章的目的是让临床医生遵循一种标准化的方法，制定儿童摄入的氟化硼的安全管理，同时避免不必要的调查或电离辐射。它包括指导哪些患者可以在没有调查或随访的情况下安全回家，哪些患者需要调查，哪些患者需要由专业团队进行紧急或紧急干预。

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引用次数: 0

Point-of-care ultrasound in paediatric clinical practice: transforming tomorrow today 儿科临床实践点超声：今天改变明天

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-05-20 DOI: 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.

即时超声（POCUS）已成为临床医生的宝贵工具。它最好被视为临床评估的延伸，它可以提供比传统体检更多的信息。POCUS在临床儿科中扮演着几个角色；最常见的是作为诊断辅助，通过排除不太可能的诊断或帮助提高确认其他诊断的确定性，帮助临床医生进一步提出工作假设。它的使用可以避免其他调查，如血液检查的需要，这样做可以简化病人的旅程。在某些情况下，POCUS可以完成传统成像调查的作用。它已经成为指导严重不适患者复苏和稳定的工具，正如人们最熟悉的那样，它可以用来帮助指导手术过程。本文的目的是总结目前POCUS在急性儿科护理中的应用，并强调更多新颖的，新兴的应用。

引用次数: 0

Post COVID-19 paediatric inflammatory syndrome (PIMS-TS/MIS-C): what have we learned? COVID-19后儿童炎症综合征（PIMS-TS/MIS-C）：我们学到了什么？

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-05-20 DOI: 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.

在COVID-19大流行的早期阶段，PIMS-TS成为一种影响儿童的新型高炎症性疾病。这些儿童通常情况不稳定，需要接受重症监护。患有PIMS-TS的儿童表现出类似其他炎症过程的症状，但很快就发现这是一种新的疾病，需要自己的治疗方案。通过国际合作资源共享，对包括生物制剂、IVIG和类固醇在内的几种治疗方案达成了共识，导致基于轶事和有限观察数据的共识指导。随着每一波疫情的爆发，我们对COVID-19的理解也在不断加深，对PIMS-TS的理解也在不断加深。包括RECOVERY和BATS试验在内的几项大型试验现在能够为这种疾病的治疗提供证据基础，并对一些广泛使用的管理实践提出挑战。例如，静脉注射免疫球蛋白已被证明不会改变结果，因此不再推荐用于治疗，而甲基强的松龙确实比通常的支持性治疗有一些改善。流行病学数据显示，PIMS-TS是一种暂时受限的疾病，每种COVID-19变体的患病率都在下降。从总体结果数据来看，值得庆幸的是，这是一种总体死亡率非常低、长期发病率有限的疾病。

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引用次数: 0

How to interpret creatine kinase level in neuromuscular conditions 如何解释肌酸激酶在神经肌肉疾病中的水平

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-05-16 DOI: 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.

肌酸激酶（CK）是一种用于疑似神经肌肉疾病的筛查诊断试验。它是肌肉损伤的敏感指标，比其他骨骼肌酶更受欢迎，因为它受溶血的影响最小，在细胞损伤时容易释放，在骨骼肌中相对占优势。在健康个体中，正常范围在22至200 IU/L之间（随实验室而异），尽管性别和种族会影响该范围。CK也可在非病理性暂时性情况下升高，如痉挛和运动后。在剧烈运动、肌肉注射、肌电图检查和病毒感染后，它可以增加到正常值的三倍。最高水平的CK见于炎性肌病和DMD的早期阶段，此时患者仍在走动。偶尔CK在无症状或轻度症状的儿童中升高，这会造成不必要的焦虑和诊断的不确定性。需要广泛的辅助调查和肌肉活检的临床正常个体升高CK仍然是一个悬而未决的问题。这篇综述讨论了肌酸激酶在儿童神经肌肉疾病中的诊断价值，并就如何在不同的临床情况下解释结果提供了实用的建议。

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引用次数: 0

From inquisitive toddlers to adventurous teenagers: how to navigate paediatric minor injuries 从好奇的幼儿到冒险的青少年：如何处理儿科轻伤

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-05-15 DOI: 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.

儿科轻伤是一个常见的介绍到急诊科（ED）和急性护理设置。随着孩子们从好奇的学龄前儿童发展到学会冒险的青少年，受伤的模式从较低的撞击伤害和异物插入或摄入，到较高的撞击伤害。儿科医生通常很少接受轻伤方面的培训。然而，有些伤害在儿童中更为常见，因此，主要接受成人急诊护理培训的临床医生也可能缺乏管理这些伤害的知识或经验。有效的管理不仅需要对儿科解剖学和生理学有全面的了解，而且需要一种细致入微的管理方法，根据儿童的发展需要量身定制。这通常是一个挑战，在年龄较大的儿童或成人中使用的技术可能不合适。这篇文章提供了一个实用的指导评估，诊断和治疗常见的儿科轻伤。包括一些有用的建议和技巧，如何管理这些棘手的客户。

引用次数: 0

Self-assessment 自我评估

Q3 Medicine

Paediatrics and Child Health (United Kingdom)

Pub Date : 2025-05-13 DOI: 10.1016/j.paed.2025.05.006

Leon Srikantha, Peter Heinz

引用次数: 0

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