BMJ Paediatrics Open最新文献

Background: In Indonesia, at least 5% of youths aged 10-17 report having a diagnosed mental health condition. Despite evidence from other countries showing substantial economic costs associated with youth mental health conditions, data on their broader economic impact in Indonesia remain limited. This study estimates the economic costs of anxiety and depression among Indonesian youths aged 10-17.

Methods: This study employs a low-cost web panel approach to estimate economic costs, providing a replicable model for countries lacking data. We administered a cross-sectional online survey to 3038 Indonesian citizens (adult proxies) aged at least 18 years via a web panel. Respondents filled out the Patient Health Questionnaire-4 (PHQ-4) on behalf of youths in their household to capture prevalence rates, resulting in data on 4328 youths. Proxies of youths who screened positive for anxiety and/or depression symptoms based on the PHQ-4 (N=174) were then asked about mental healthcare utilisation (medication use, outpatient visits, and ED visits and hospitalisations), days missed from work by caregivers to provide care, and days missed from school and reductions in productivity resulting from mental health symptoms. Healthcare utilisation and caregiver costs were monetised and extrapolated based on unit costs/average wages, prevalence rates within the sample and national youth population counts.

Results: 10.6% reported symptoms consistent with anxiety and/or depression, yet 68.9% were never formally diagnosed, indicating a substantial diagnosis gap. Direct healthcare costs averaged IDR1 319 872 (US$83.15) per youth. Lost productivity of caregivers due to missing work to take care of these youths averaged IDR7 510 576 (US$473.17) per youth. These costs generate total annual medical costs of IDR5577.54 billion (US$0.35 billion) and total caregiver costs of IDR27 771.06 billion (US$1.75 billion). Overall, the total annual economic burden is IDR33 348.60 billion (US$2.1 billion). Youths with these symptoms also missed 187.1 hours of school per year and experienced a 45% decline in school performance.

Conclusions: Evidence-based interventions should be adopted to address the significant health and economic burden associated with these symptoms.

Background: India is witnessing a growing concern around neurodevelopmental disorders, with nearly one in eight children potentially affected. The early years of life, especially the first 1000 days offer a crucial window to support brain development and positive long-term outcomes. Global early intervention (EI) strategies focus on caregiver involvement, enriched environments and learning through meaningful repetition. However, applying these approaches in everyday community settings remains challenging due to the need for specialised training which is inaccessible for grassroots-level workers. Interestingly, many traditional Indian caregiving practices echo these global principles, though they remain undocumented in scientific literature.

Objective: This study aimed to explore traditional Indian child-rearing practices aligned with evidence-based EI and developing culturally rooted, easy-to-follow video resources to train grassroots-level workers (Accredited Social Health Activists (ASHA)).

Methods: We conducted 11 focus group discussions with 121 mothers and grandmothers from varied regions and cultural backgrounds across India. Using open-ended prompts, we gathered insights into daily caregiving routines for infants under 1 year of age. Conversations were recorded, transcribed and thematically analysed by age group (0-3, 3-6, 6-9 and 9-12 months). Based on recurring patterns, a series of EI videos was created and validated through community and expert feedback.

Results: Findings revealed that many common Indian practices-such as massage, floor play, lullabies and face-to-face interaction-align closely with global EI principles. The videos developed from these practices were well-received by caregivers and experts for their clarity, cultural relevance and practical usefulness.

Conclusions: Indian families already practise many nurturing routines that support early development. By capturing these practices in simple, accessible videos, we can bridge traditional wisdom with modern science-empowering parents and ASHA workers to support children's development meaningfully in the home environment.

Introduction: Childhood mortality rates following hospital discharge may outpace inpatient mortality rates in some sub-Saharan African settings. Broadly validated risk assessment tools and biomarkers to identify children at risk for post-discharge mortality (PDM) are lacking. Moreover, clinical diagnoses (eg, pneumonia, sepsis, etc.) that confer high risk of PDM share a common pathobiology that culminates in endothelial dysfunction. The objectives of this study are to (1) externally validate existing risk assessment tools for PDM at 60 days and (2) test the association between a marker of endothelial dysfunction (ie, the global arginine bioavailability ratio [GABR]) and 60-day PDM among young children.

Methods and analysis: This is a prospective, observational cohort study of neonates (aged 0-28 days, n=1000) and infants and children (aged 1-59 months, n=1000) consecutively discharged from two hospitals in Western Kenya (ie, Jaramogi Oginga Odinga Teaching and Referral Hospital [JOOTRH] and Siaya County Referral Hospital). Candidate variables for previously developed risk assessment tools identified through a systematic review and plasma samples will be collected on the day of hospital discharge. Caregivers of participants will receive telephone calls 30 days and 60 days following discharge to ascertain participants' vital status. Test characteristics and area under the receiver operating characteristic curves will be calculated for each risk tool to determine their discriminatory value. Risk predictiveness and calibration of each tool will also be determined. Mean and median levels of GABR will be compared between cases and matched controls, and conditional logistic regression will be used to test the association between GABR and PDM.

Ethics and dissemination: This protocol has received clearance from the Kenya Medical Research Institute Scientific Ethics Review Unit, the JOOTRH Ethics Research Committee, and the Emory University institutional review board. Our results will be disseminated through scientific presentations at national and international conferences and peer-reviewed publications.

Objective: Differentiating between functional and organic gastrointestinal disorders in infants and young children remains a diagnostic challenge. Faecal calprotectin (FC) has emerged as a non-invasive biomarker that can help to exclude organic pathology. This study aimed to establish age-specific reference ranges for FC in healthy Hungarian children aged 0-36 months, providing a practical tool for paediatric clinical decision-making.

Methods: A total of 282 stool samples were obtained from 245 healthy children (142 boys, 103 girls). Eligibility was determined using strict inclusion criteria based on parental interviews and questionnaires. FC concentrations were measured with a single-test ELISA assay (Orgentec Sebia Diagnostika). Data analysis employed Random Forest Regression and non-parametric statistical methods, following the Clinical and Laboratory Standards Institute EP28-A3c guideline.

Results: Median FC concentrations by age group were: 0-4 months, 181 µg/g (IQR 92.5-289.6); 4-12 months, 40.6 µg/g (IQR 14.2-100.3); and 12-36 months, 24.7 µg/g (IQR 4.62-59.27). FC levels peaked in the youngest age group (0-4 months) and declined steadily thereafter, showing a consistent downward shift in both median and upper percentile values with increasing age. No significant associations were found between FC and gender, birth weight, mode of delivery or type of nutrition.

Conclusions: This study provides age-specific reference values for FC in Hungarian children under 3 years of age. These results support the clinical use of FC testing to help exclude organic gastrointestinal disease, while emphasising the importance of appropriate test indication. The assay used proved to be reliable, minimally invasive, cost-effective and well suited for routine paediatric practice.

Background: Admission of preterm infants (PTIs) to neonatal care units (NCUs) is stressful for parents, potentially affecting infant-parent attachment, parents' mental health and parenting behaviour. Identifying stressors is essential for designing interventions that reduce this burden. However, evidence on parental stress among parents of PTIs in the Nepali context is limited. We aimed to assess parental stress and its associated factors among parents of NCU-admitted PTIs.

Methods: A descriptive cross-sectional study was conducted among 305 parents of PTIs admitted to NCUs in five randomly selected public hospitals in Nepal. Data were collected through in-person interviews using a 5-point Likert scale-based Parental Stress Questionnaire (1=not stressful to 5=extremely stressful). Stress levels were categorised as mild (<3), moderate (3-4) and severe (≥4) based on median scores. Descriptive and inferential statistics, including multivariable logistic regression, were applied.

Results: Parents had moderate levels of stress (median score and IQR: 3.0 (2.6-3.4)). Their most common stressor was separation and altered parental role 3.3 (2.6-3.6), which was significantly higher among mothers (p<0.001). Stress level showed significant associations with parental variables (age, education, family income and antenatal clinic check-up status) and infant variables (mode of birth, birth weight and hospitalisation duration) (p<0.050). Parents whose infants were hospitalised for ≥15 days were 2.4 times more likely to experience higher stress compared with those with ≤14 days of stay (adjusted OR 2.415; 95% CI 1.420 to 4.081; p<0.001).

Conclusions: NCU admission of PTIs imposes considerable stress on parents. Separation and altered parental roles are the main stressors, particularly among mothers. Longer hospitalisation significantly increases stress levels. Interventions that minimise parent-infant separation and promote parental involvement in care may help to mitigate parental stress.

Objectives: To evaluate the implementation and outcomes of the Layered Assessment of Neurodevelopmental Needs, Evaluation of Referrals and Navigation of support (LANTERN) triage system developed to improve referral quality, reduce unnecessary delays and enhance support for children referred for autism diagnostic assessment.

Design: Service improvement informed by action-based methodology and clinical audit, employing descriptive analysis of administrative and outcome data.

Setting: A UK National Health Service community paediatric service covering 59 000 children aged 4-16.

Participants: All referrals to the neurodevelopmental pathway for autism assessment from April 2019 to March 2025.

Intervention: The LANTERN system incorporates senior diagnostician-led triage, expanded evidence review and detailed guidance for families and referrers.

Main outcome measures: Referral volume and acceptance rates, rates per 1000 population, patient experience via friends and family test and cost-effectiveness.

Results: Referral rates fell 25% over 5 years, and acceptance rates dropped from 79.6% (2019-2020) to 61% (2024-2025), compared with 92% in the wider region. LANTERN achieved a local referral rate of 4 per 1000 versus 33 system-wide. 'Good' or 'very good' family satisfaction rose from 35% to 95%. The system incurred an annual cost of £58 695 but avoided £96 025 in assessments not indicated, yielding a net saving of ~£37 330.

Conclusions: The LANTERN system reduced assessments not indicated while improving family satisfaction and support for children, families and referrers. A senior-led, evidence-informed triage can enhance quality and efficiency in the autism diagnostic pathway.

Background: Schools play a crucial role in shaping children's growth and development. In Indonesia, however, school food environments face major challenges in promoting nutrition and healthy lifestyles. These environments are increasingly dominated by unhealthy ultra-processed products (UPPs), limited nutritious options and inadequate opportunities for physical activity-key contributors to rising childhood obesity rates.

Methods: We explored the drivers of childhood obesity and barriers to prevention in selected school food environments using qualitative data from in-depth interviews and focus group discussions with 165 purposefully selected participants across four study areas, field observations and a desk review of relevant regulations. Data were analysed through an iterative content analysis approach, using a predefined variable indicator matrix outlining key study themes.

Results: Findings show frequent consumption of unhealthy snacks and sweetened drinks in and around schools, driven by a lack of food environment regulations. Barriers to healthier diets include children's food preferences, limited parental time and the widespread availability of UPPs. While school-based physical activity was generally adequate, sedentary behaviours at home were common. Key gaps include limited teacher capacity, inadequate health education materials and weak data sharing and referral mechanisms for obesity between schools and community health services.

Conclusion: Strengthening school food environments regulations in Indonesia is urgently needed. Priorities include developing national canteen guidelines, restricting the sale and marketing of UPPs and high-fat, salt and sugar foods, adopting interpretative front-of-pack labelling schemes and promoting equitable physical activity opportunities. Improving knowledge, capacity and coordination among schools, parents and health workers is also critical.

Adolescents and young adults (AYAs) with leukaemia represent a unique population but face fragmented care between paediatric and adult systems. A retrospective study of AYA patients (≥14 years old) with leukaemia treated at Shanghai Children's Medical Center between September 2023 and March 2025 found acute lymphoblastic leukaemia (ALL) was predominant (152/189). AYA ALL patients showed a higher prevalence of high-risk subtypes like T-ALL and BCR::ABL1, while favourable ETV6::RUNX1 was rare. Paediatric protocols achieved a 5-year event-free survival of 75.2% and overall survival of 89.6%, comparable to young children. These findings show that paediatric-based therapy for AYA ALL can be effective, although prospective comparative studies are still needed.

Background: Autism spectrum disorder (ASD) is defined by persistent social communication difficulties and restricted, repetitive behaviours. Its increasing prevalence heightens the demand for earlier diagnosis and intervention. ASD can be diagnosed between 18 and 24 months, the typical kindergarten entry age, highlighting the vital role of kindergarten teachers in early detection. In Lebanon, the economic crisis has increased the demand for kindergarten services as both parents are working. This study aims to assess the knowledge of kindergarten teachers in Lebanon about ASD, emphasising their role in early detection and intervention referral.

Methods: A descriptive cross-sectional study was conducted between June 2023 and January 2024 using convenience sampling. Data were collected through a survey administered to 355 kindergarten teachers from all Lebanese governorates. The questionnaire assessed participants' sociodemographic characteristics, perceived knowledge of ASD and included the validated Autism Spectrum Knowledge Scale-General.

Results: Responses were obtained from 355 kindergarten teachers, aged 18 to 50 years, representing 57 kindergartens. Overall, Lebanese kindergarten teachers demonstrated moderate knowledge of ASD, with a mean score of 17.7/32 (55.3%). The level of knowledge regarding the symptoms and associated behaviours, assessment and diagnosis, treatment, outcomes and prognosis of the disease was moderate (59.9%, 58.2%, 54.3% and 52%, respectively). The lowest scores were observed in items related to the aetiology and prevalence of ASD (48.3%). Moreover, areas of residence, years of experience, sources of information and prior interactions with children with ASD were all statistically significant predictors of ASD knowledge (p=0.046, p=0.002, p=0.043 and p<0.001, respectively). Multivariate linear regression revealed that area of residence (p=0.009) and prior interaction with children with ASD (p<0.001) were significantly associated with knowledge scores.

Conclusions: Many teachers are unfamiliar with ASD and its implications for children, yet it is crucial to raise awareness of ASD and incorporate it into educational curricula.