Archives of Disease in Childhood最新文献

Objective: Charles Bonnet syndrome (CBS) refers to the presence of visual hallucinations occurring secondary to visual impairment. The aim of this study was to understand the phenomenology of CBS in children and assess the emotional impact and support needs of patients and their families.

Design: Semistructured qualitative interview study.

Setting: UK.

Participants: Children (7-15 years) with an inherited retinal disease living with CBS and their parents.

Results: 10 participants were recruited from six families (dyadic interviews n=4; parent-only interviews n=2). Thematic analysis identified five superordinate themes relating to experiences of CBS: (1) diagnosis journey, (2) hallucination phenomenology, (3) impact of hallucinations, (4) understanding and managing hallucinations and (5) experiences of support. The impact of CBS was broad and heterogenous, causing significant disruption to patients' daily life. Limited awareness led to parents expressing largely negative healthcare experiences. Overall, the extent of knowledge and understanding of CBS was an indicator of successful self-management of the condition.

Conclusions: The journey towards understanding and managing CBS for both parents and children is challenging. Although coping strategies can lead to improved adjustment, visual hallucinations compounded the difficulty of living with a chronic visual impairment. Healthcare providers have an integral role in ensuring patients and families are effectively supported to allay fears and promote psychological well-being.

There is a common perception that peanut/tree nut particles can be transmitted through aircraft ventilation systems and pose a significant risk to passengers with food allergies. In fact, food-induced allergic reactions are around 10-100 times less common during flights than 'on the ground', perhaps because of the multiple precautions food-allergic passengers take when flying. We review the evidence for strategies to help prevent accidental allergic reactions while travelling on commercial flights (review registered at PROSPERO, ref CRD42022384341). Research studies (including aircraft simulations) show no evidence to support airborne transmission of nut allergens as a likely phenomenon. Announcements requesting 'nut bans' are not therefore supported, and may instal a false sense of security. The most effective measure is for passengers to wipe down their seat area (including tray table and seat-back entertainment system). Food proteins are often 'sticky' and adhere to these surfaces, from where they are easily transferred to a person's hands and onto food that might be consumed. Airline companies can help to facilitate this through pre-boarding. Passengers at risk of anaphylaxis should be prescribed two adrenaline [epinephrine] autoinjector devices, to carry on their person at all times-including when flying. Airlines should consider including a separate supply of 'general use' adrenaline autoinjectors in the onboard medical kit for use in an emergency. All airlines should have clear policies relating to food allergies which are easily available from their websites or on request. These policies should be applied consistently by both ground staff and cabin crew, in order to provide reassurance to food-allergic passengers and their caregivers.

Objective: To determine the incidence and describe the presentation and management of unexpected symptomatic glucocorticoid-induced adrenal suppression (AS) in children and young people aged 0-15 years.

Setting and design: Surveillance study of symptomatic glucocorticoid (GC)-induced AS with supportive biochemical evidence or presenting as an adrenal crisis, reported via the British Paediatric Surveillance Unit (BPSU) from September 2020 to September 2022.

Results: Over a 25-month period, 190 reports of symptomatic GC-induced AS/adrenal crisis were made, of which 22 were confirmed cases: 18 AS and 4 adrenal crises. This translates to an incidence rate of 0.09 new cases of GC-induced AS per 100 000 children aged 0-15 per year in the UK. There was a broad range of underlying diagnoses requiring GC prescription (16) and GC preparations (13). Of the 22 patients, 7 had more than 1 type of GC prescribed. The administration of oral GC occurred in 19 of the cases, inhaled GC use in 7, topical use in 5 and 1 case occurred after a single intramuscular injection of GC. All patients were discussed with a paediatric endocrinology team.

Conclusions: The incidence of AS from this UK-based BPSU study is lower than a similar Canadian study. This may indicate that paediatricians in the UK and Ireland are becoming more aware of the potential for GC-induced AS and thus are more proactive to prevent its occurrence. The clinical cases still highlight the need to educate families and healthcare professionals with a view to further reducing the morbidity and potential mortality associated with GC-induced AS.

Objectives: To understand (1) healthcare professionals' (HCPs) perceptions and experiences of commercial milk formula (CMF) marketing to consumers and HCPs and (2) HCPs' perspectives on regulation of CMF marketing.

Setting: UK.

Design: In-person and online interviews with 41 HCPs with regular contact with pregnant women and mothers. Individual semistructured interviews were conducted from October 2019 to March 2021, focusing on experiences of CMF marketing and perceptions of legislation. Data were analysed using reflexive thematic analysis.

Results: Three themes were developed: (1) 'Industry relationships have changed and not disappeared'-some HCPs reported contact with industry ceasing due to the Baby Friendly Initiative (BFI) but contact with HCPs in other roles was believed to have increased; (2) 'Direct-to-consumer marketing presents challenges for HCPs'-to support women to make informed choices about infant feeding, HCPs felt they had to challenge misinformation families receive from the CMF industry; (3) 'System changes are needed to support informed infant feeding decisions'-HCPs wanted policy changes, including effective legislation to restrict CMF marketing to both HCPs and families. They also felt initiatives to normalise breastfeeding were important.

Conclusions: Reduced contact with CMF representatives was reported by HCPs covered by the BFI but continued or increased contact was seen with other HCPs. HCPs believed CMF marketing impacted women's beliefs about infant feeding and they had to work hard to provide a balanced perspective. HCPs wanted stricter regulation of CMF marketing.

Introduction: This systematic review aims to collate evidence of the causes of genital bleeding, other than child sexual abuse and accidental injuries, presenting in prepubertal girls. It provides an update to the 2015 Royal College of Paediatrics and Child Health publication 'The Physical Signs of Child Sexual Abuse', an evidence-based review also known as the Purple Book.

Methods: MEDLINE, EMBASE and Scopus databases were searched for studies published between March 2014 and June 2023. Eligible studies were primary studies reporting on genital bleeding with extractable data for prepubertal girls.

Results: 99 studies, describing a total of 672 prepubertal girls, met the inclusion criteria. The most common medical conditions with genital bleeding as a presenting feature were lichen sclerosus, infections and infestations, hormonal causes, urethral prolapse, vaginal foreign bodies and tumours. Meta-analysis was not possible due to the large heterogeneity of the studies.

Conclusion: This review added further evidence to the 2015 edition of the Purple Book, describing the multiple medical conditions that may present with genital bleeding. Several of these conditions can mimic the presentation of child sexual abuse or may coexist with child sexual abuse.