Paediatrics and Child Health (United Kingdom)最新文献

Ankle instability is a common problem in children and adolescents. What may seem like an initial, relatively benign ankle injury for a child may lead to chronic pain, chronic instability and gradual loss of the ability to participate in certain activities. The complications of an ankle injury can include osteochondral defects, which may require urgent surgical attention and may be associated with an increased long-term risk of osteoarthritis. This article aims to provide trainees and general orthopaedic surgeons with a systematic approach to the assessment, diagnosis and management of ankle instability in the paediatric population. We explore the mechanisms of the initial injury together with factors that may increase the risk of injury to the child. Guidance on clinical examination and of the ankle joint is provided. Though short periods of immobilization and proprioceptive activities are the mainstay of treatment, there is a small subset of these patients who will benefit from further imaging and surgical intervention to prevent the chronic sequelae of ankle instability.

Abdominal pain is a common experience during childhood and frequently presents to secondary healthcare facilities. Although non-specific abdominal pain and appendicitis are the most common causes, the clinician should also be aware of the diagnosis and management of all causes of abdominal pain in children. This article provides an overview of abdominal pain in children, including history and examination, initial management, diagnostic categories, modes of investigation, and definitive treatment.

Genu valgum is a common lower limb deformity seen in children. There are multiple causes for the development of genu valgum but to be able to accurately assess the child it is important to understand the physiological development of the lower limbs. Although often asymptomatic and idiopathic, genu valgum can be associated with underlying pathology, such as rickets, previous proximal tibia fracture leading to valgus deformity, tumours and dysplasias which often require a multidisciplinary approach to management of the condition. This article will review the common causes of genu valgum in children, explain how to clinically assess the child and cover possible management options for each condition.

Making decisions to withhold or withdraw treatment in the paediatric intensive care setting can be complex, emotive and morally challenging. The process draws on the expertise and experience of both the families and the medical teams, their understanding of the needs and (where possible) choices of the child, and a balance of trust between all parties to want to achieve the right outcome. It is important that all healthcare professionals caring for children, particularly those living with potentially life-limiting or life-threatening conditions, are aware of the processes involved so they can support patients and families with confidence and sensitivity. This paper explores the basic aspects of withholding and withdrawing interventions in the PICU with the aim of demonstrating the situations in which these decisions might be necessary. It explains the frameworks and considerations guiding the decision-making process and describes the practicalities of providing ongoing care through collaboration with hospital and community services.

Male infants and children are frequently referred with parental or health care provider concerns about small penis size. A micropenis is defined as stretched penile length less than 2.5 standard deviations of the mean for age. The term ‘inconspicuous penis’ has been used to describe a group of conditions that result in the penis appearing abnormally small. These conditions include: congenital megaprepuce, trapped penis (secondary to scarring following surgery, most commonly post circumcision), concealed penis (due to enlarged suprapubic fat pad) and webbed penis. Hypospadias is another cause for abnormal penis appearance which can be confused with an inconspicuous penis. Concerns about penile size and appearance can cause significant anxiety for families and older children. It is therefore important for all healthcare providers working with children to have an understanding of the varying pathologies as well as what is considered normal. This short article is aimed at paediatricians and healthcare professionals who might be the first point of contact for families with concerns about penis size. It offers advice about assessment and provides guidance about when onward referral is required.

Children receiving cancer therapy have particular dietary needs. Most have issues with eating. The combination of extended duration of treatment, high frequency admissions and prolonged length of stay impacts more on this group of children than most others. With advancements in more effective diagnosis and tailored multimodal therapy more children than ever are being treated with increasingly intense therapeutic regimens. Hence, more children are also surviving new second and third line treatments for relapsed disease. This has increased the number of children with cancer who are susceptible to nutritional problems associated with their disease treatment and survivorship. It is important that health professionals are aware of predisposing factors which can lead to inadequate nutrition. Understanding can help alleviate them and prompt recognition and treatment can help prevent nutrition becoming a problem for these children. This article provides an overview of the particular problems faced by children with cancer obtaining adequate nutrition, nutritional risk factors and highlights why good nutrition status is essential for any child undergoing cancer therapy. The aims of nutritional therapy, a guide to nutritional assessment/interventions and long-term nutritional considerations are discussed.

Simulation-based education (SBE) has become an integral part of postgraduate medical education in the last decade. More settings are using SBE to deliver teaching sessions, both in simulation laboratories and in the day-to-day clinical environment (in situ). This article draws on the experience in SBE course development from the paediatric simulation team at The Royal Wolverhampton NHS Trust. We address several considerations in setting up effective SBE teaching. This includes technical and practical aspects such as acquiring equipment and involving appropriate faculty, as well as more abstract principles such as how to embed simulation in your workplace culture. We also include an introduction to effective debriefing using the Diamond Debrief model. We aspire to empower other paediatric practitioners to develop and deliver high quality SBE for postgraduate paediatric healthcare professionals.

Recognizing what is normal constitutes a key skill for medical practitioners, especially paediatricians. It is a necessary requisite to providing reassurance and avoiding unnecessary referrals, investigations and treatment. Normal variants are atypical or uncommon findings in a given population which are of no clinical or pathological significance yet fall within the spectrum of what is considered the normal range. The list of conditions discussed in this article is by no means complete or comprehensive but merely a reflection of frequently encountered issues in primary care, paediatric outpatients and the paediatric emergency department; they include infantile dyschezia, ‘catch down’ growth, familial macrocephaly, positional plagiocephaly, asymmetrical thigh creases, sacral dimples, physiological anisocoria, PURPLE screaming episodes, gastro-oesophageal reflux and infant gratification and also provide guidance on what not to miss. This short article provides essential guidance for those new to paediatric outpatients or those less familiar with providing advice and guidance to worried parents.

Advancements in genomics have had a significant impact on our ability to diagnose and treat several health conditions, notably cancer. In this article, we discuss the evolution of genomic methods from the early first-generation genome sequencing methods such as Sanger sequencing to the latest technology. We also discuss how clinicians can decide which test to use depending on what type of result is required. We discuss the clinical significance of genomic testing including identification of cancer predispositions syndromes, the role of genomics in accurately diagnosing a number of cancers, as well as the utility of genomic data to predict response to targeted therapies. Finally, we detail some of the targeted therapies currently available to treat the various types of childhood cancers. The expansion of genomic testing within the NHS and the essential nature of genomic data to accurately diagnose and optimally treat childhood cancers also poses challenges to the healthcare system both in terms of infrastructure and personnel.