Paediatrics and Child Health (United Kingdom)最新文献

Kidney replacement therapy (KRT) can provide lifesaving support for children with severely impaired kidney function. The decision about who needs KRT and when is often complex. Many acute kidney problems will resolve with conservative maanagemenent but some children with chronic or acute kidney impairment will find themselves in a position where KRT is required either as a bridge to recovery or kidney transplantation. Less commonly, children with metabolic disorders may find that the ability of their own kidneys is overwhelmed by excessive production of certain metabolites. These children may also benefit from short term KRT. This article aims to help paediatricians in training understand which children need kidney replacement therapy, the various types of treatment available, and when they are used.

Intravenous fluids are commonly prescribed to children in hospitals. However, there are risks associated with their use. In order to safely prescribe these clinicians should understand the indications for their use, the principles underpinning their use and know the likely complications associated with intravenous fluid administration in children. Intravenous fluids should be prescribed depending on individual needs of each child and with careful monitoring and re-assessment. This review aims to provide a general approach to fluid prescription in children, providing some background of different physiological principles, different fluid composition, and the role of anti-diuretic hormone in fluid homeostasis. Fluid prescription is discussed, with an approach taking into consideration resuscitation boluses, dehydration, replacing ongoing losses and maintenance requirements. Case examples are provided to further facilitate readers’ comprehension. Electrolyte abnormalities and an approach to the management of deranged electrolytes is addressed. Complications associated with fluid administration are highlighted, in particular, emphasizing the assessment and emergency management of the child with suspected cerebral oedema or hyponatraemic encephalopathy. Special consideration and discussion is given to the differing approach to fluid management of children in the setting of burns or diabetic ketoacidosis.

We would like the reader to consider the current paediatric point-of-care ultrasound (POCUS) landscape. Even in the most developed European healthcare systems, paediatric POCUS programmes and users mostly operate in silos and are un-, or at best underrepresented by major professional bodies. While international societies focus on the extent and content of POCUS investigations, guidelines and associated evidence, there is little to no established framework for education and clinical governance standards on this explosively advancing field. Borrowing from fluid dynamics, this rapid advancement generates cavitation, leaving providers and educators exposed in certain crucial areas of ongoing clinical practice covered contemporaneously, or worse, post hoc, allowing for clinical governance or medico-legal scrutiny. We give a glimpse into our prospective local POCUS clinical practice initiative and how it complements, advances and affirms our clinical decision making on a daily basis. We'll guide the reader through ward rounds, procedural applications, specialist assessments with allied health professionals, referrals, remote consultations, new patient admissions, and grand rounds. As we are in the process of building a robust, reliable and accountable clinical governance structure around our daily practice, we would also like to demonstrate the need and utility for introductory courses, ongoing educational sessions, established mentorship and regular governance meetings ensuring optimal clinical outcomes. We hope to give insights to clinical practice, deployment, recruitment, education and potential future applications like telemedicine.

A smooth and coordinated handover to adult health services for young people with additional needs is important. Yet equally as important is preparing the young person for self-management of their health care and independence. A central goal of occupational therapy is to empower young people to lead a meaningful life, as independently as possible. Occupational therapists (OTs) therefore have an important role to play in helping young people with additional needs to prepare for their adult lives. However this article outlines suggestions, signposting and strategies that all professionals could consider which will empower young people with additional needs to prepare for their adulthood during every interaction. It provides a list of recommended materials that the authors have found particularly helpful. It is aimed at all health care professionals working with children and young people.

Occupational therapy practice for children and young people with cerebral palsy targets many areas to support direct and indirect needs to achieve health, activity performance, and participation outcomes. This aligns with and is complemented by the World Health Organization (2001) International Classification of Functioning, Disability and Health (ICF) framework. This article seeks to support understanding of how occupational therapy practice fits into the ICF framework and to demonstrate the need to address all ICF domains. A broad overview of areas supported by occupational therapists working with children and young people with cerebral palsy GMFCS level III to V is therefore presented. Consideration here is given to environmental factors, hand function and management of secondary effects of neural mechanisms, and supporting activity performance and participation. Additionally, in consideration of these practice examples, this article aims to show that support needs for children and young people with cerebral palsy are ongoing throughout childhood and adolescence and into adulthood. Complexity of presentation means that surveillance mechanisms in services are required. Concurrently, children and young people and their parents/carers require support to enhance abilities to facilitate performance and participation goals independently.

Health visiting has been described as the backbone of early years services across the UK and the safety net around all families. This paper explores the role of health visitors and the current context in England. Health visitors lead and deliver the Healthy Child Programme which is the national preventative public health programme covering pregnancy and the first five years of life. It aims to ensure that every child has the best start in life, regardless of where they live. With child health deteriorating, more children falling behind with their development, growing concerns about invisible vulnerable children, widening inequalities and soaring costs of late intervention, there is a clear imperative to act. Health visitors provide an important part of the solution; however, the service is facing significant challenges. When sufficiently resourced, health visitors play a crucial role in ensuring that families get good, joined up support – preventing, identifying and treating problems before they reach crisis point. The benefits of an effective health visiting service accrue to numerous government departments, contributing to a whole system response to address a multitude of policy priorities for babies, children and families across health, education and social care.

The evolution of paediatric care in the UK is a compelling journey that reflects medical progress and a profound commitment to improving the health and wellbeing of children. Paediatric medicine has undergone significant transformations, from a nascent field with limited understanding to a dynamic and multidisciplinary domain focused on specialized care and groundbreaking research. This review aims to summarize the major advancements in the various paediatric specialties in the UK. As paediatric care evolved, the emergence of paediatric subspecialties became increasingly prevalent. Paediatric cardiology, haematology, and various other disciplines gained prominence, allowing for more targeted and effective treatments. The integration of research into paediatric medical practice became a driving force, leading to innovative discoveries and therapies. Contemporary paediatric care in the UK is characterized by a holistic approach that extends beyond treating illnesses to promoting overall wellbeing. The ongoing journey reflects a dynamic field that continues to adapt and innovate, promising a brighter and healthier future where every child receives the most effective and compassionate healthcare possible.

COVID-19 has had serious, negative impacts on children's health and development. But the impacts have not been felt equally. Disabled children and their families have been hit particularly hard. In this paper we summarize UK legislation to limit the spread of the virus and describe how services to disabled children changed as a result. We discuss the long-term deleterious impacts of changes in service provision on the health and wellbeing of disabled children and the parent carers supporting them. We close with lessons learned for resetting services to support the ongoing recovery of children and their families and recommendations for delivering services better in future emergencies to ensure that disabled children's health and wellbeing is maintained.

Speech, language and communication needs (SLCN) remain one of the main areas of concern impacting children and young people's life outcomes. This article sets out the case for taking a population-health based approach to anticipating need and building whole systems around children in their functional contexts, whether home, early years setting, school or further education. The demand on services providing speech and language therapy continues to increase year on year. Using a population-health approach to predicting areas of higher anticipated SLCN and establishing robust collaborative approaches to improving the context for children and young people vulnerable to SLCN, there is the potential to address a significant number needs within everyday contexts. This approach continues to require a highly skilled speech and language therapy workforce. For maximum impact, those skills should be deployed in the places children and young people live, learn and have leisure, working directly with children but also ensuring the wider workforce are supported to enable early identification, prevention, and intervention. This approach requires a move away from a traditional referral model to one of easy access to expertise. Finally, the implications for paediatric services and the opportunities presented by a different way of using the multi-disciplinary team are proposed.

Outpatient triage is an expectation on the Consultant team and is often not a training opportunity that arises frequently to the doctor in training. Understanding the process of triage from the point of referral to the appointment being offered can help ensure that the process is effective. To provide the best patient journey, that is both safe and timely is important and triage is crucial to ensuring this occurs. Understanding your directory of services, the triage process and systems used and looking at how primary care-secondary care services work together is vital to being able to effectively triage.