Paediatrics and Child Health (United Kingdom)最新文献

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.

Health equity enables everyone to have the best possible opportunity for good health regardless of their social circumstance. In this article we set out why it is so vital that this begins in childhood, particularly at a time when increased costs of living in many countries are exacerbating health inequities further. We examine the impact of addressing the social determinants of health at individual, population and systems levels, and why this is the business of all partners involved in the local health economy. In the UK, integrated care systems (ICS) are early in their development. In this short article, we describe the work of the Children and Young People's Health Equity Collaborative: a collaboration between children's charity Barnardo's, the Institute of Health Equity, Birmingham and Solihull ICS, Cheshire and Merseyside ICS, and South Yorkshire ICS. This details a three-year programme designed to establish enablers for this whole systems approach. This includes a Children and Young People's Health Equity Framework, a dynamic data measurement tool to direct action for longer term outcomes and supporting child health equity interventions. Children and young people's voice is central to our work, combining academic evidence with lived experience of what really matters to them.

The UK immunisation programme for children and adolescents is highly successful with generally high uptake of vaccines and low rates of vaccine preventable diseases. However, for the past 10 years there has been a year on year small but concerning decrease in vaccine uptake. This was accelerated by the impact of the COVID-19 pandemic. In this article we consider the reasons for less-than-optimal vaccine uptake, discuss recent changes to the schedule and describe the significant further changes in prospect.

Many babies cared for on a neonatal unit are at risk of adverse neurodevelopmental outcomes. The aim of early intervention (EI), therefore, is to support a child and their family to achieve the best outcome possible. Notably, EI is not one specific thing. The term encompasses a wide range of approaches and interventions that can vary in a number of ways, including who undertakes them, where they happen and when they start. There is debate as to the most effective approach, but the evidence supports the implementation of EI from soon after birth, continuing post-discharge. Furthermore, involving the parents in EI is critical, not only to ensure sustained effects throughout childhood, but also because of the beneficial impact on parental wellbeing. All in all, the evidence shows improved neurodevelopmental outcomes for children exposed to EI, particularly in the short-term. This review will explore what EI means in practice, considering the variations in application, as well as the evidence of benefit. It will also consider the limitations of current research.

In the UK, school nurses play a crucial role in promoting the health and wellbeing of children and young people, giving them the best start in life and supporting them to sustain optimal health. They have a vital and unique link between education settings, home and the community. Their key role is within the public health arena, they are an important part of the primary health care team and a key link for acute and community paediatric teams and therapies. The onset of school nursing came in the Victorian era with a focus on improving the health of children living in poverty, this coincided with a report from the British army at the time which highlighted that young men joining the service were unfit for purpose. Now, in the 21^st century, we are faced with widening health inequalities, shocking levels of poverty and increases in the number of people living with major illness and mental health problems. It is argued that the school nurse has never been more essential in supporting the health and well-being of children and young people which includes their integral role in safeguarding. In this article we will explore why this might be the case, the difficulties and opportunities and, importantly, how, alongside our paediatric colleagues in both community and acute settings, we can best garner our combined efforts to rise above and beyond the escalating challenges.