BMJ Paediatrics Open最新文献

Background: Mediation is a process which allows conflicting parties to come together with the support of a mediator to try and find an agreed way forward. Mediation has been increasingly used in paediatric medical treatment disputes, but there is little empirical data exploring participant experiences of mediation and/or the role of religion in resolving these disputes.

Method: This qualitative study aimed to improve understanding of the role of mediation in resolving paediatric medical treatment disputes, in light of high-profile conflict about children's medical treatment reaching the courts in England and Wales in recent years. Analysis of 17 semi-structured interviews with healthcare professionals, mediators and a family member of a patient was carried out and analysed thematically. The role of religion was an inductive theme identified in data analysis.

Results: The analysis found that religion was a relevant factor for the majority of participants. Three themes in relation to the role of religion are identified: religious beliefs as a factor in the cause of conflict and entrenched views, religious beliefs and compromise in mediation, the role of religious support for family members in mediation. The findings show that there was no evidence to suggest that when religious disputes were mediated, it led to agreements undermining the child's best interests, that the presence of religious views among family members did not mean that the dispute could not be mediated and that there may be benefit in having religious supporters present at mediation. Instead, the research showed that openness to mediation and openness to resolution was key.

Conclusions: That mediation can be used in paediatric best interests disputes with a religious dimension and that mediators should develop further ways of delineating which cases could be effectively mediated. Finally, the article sets out some suggestions for areas of further research.

An ideal rota should support training, allow for good work-life balance and ensure safe staffing, as set out in the British Medical Association good rostering guide. We aimed to improve resident well-being and training through a self-rostering approach. An initial pilot scheme, followed by a full-scale roll-out over a 1-year period, was implemented. Serial surveys, informal feedback and analysis of rota data and locum costs were reviewed to assess the success of the project. Post-implementation surveys showed significant improvements in well-being, rest and training opportunities. We demonstrate that self-rostering can improve resident well-being and training while delivering significant financial savings.

Background: Early intervention is critical for optimising outcomes in children with neurodevelopmental disorders. The International Classification of Functioning, Disability and Health (ICF) identifies the role of family, interventions through early detection and intervention services within environmental and personal factors. This study explored the perspectives of professionals regarding the implementation and effectiveness of family-centred early intervention within the Sri Lankan context and evaluated the applicability of the ICF model in this setting.

Methods: A qualitative, phenomenological study was conducted with 30 professionals from healthcare and education settings. Participants were selected through purposive sampling based on their experience in child development. Data was collected through semistructured interviews, transcribed and analysed thematically to identify key themes and subthemes. The validity of the data was ensured through thick descriptions and member checking.

Results: Analysis revealed that Sri Lankan early intervention practices show a positive trajectory, more emphasis is placed on the medical model and curative care, with less focus on preventive care and child activity and participation. Participants identified family-centred early intervention as a necessary and potentially effective approach for the Sri Lankan context. Key promoters included professional knowledge, environmental modifications and access to information, while socioeconomic barriers, limited resources and difficulties in implementing the ICF model effectively were challenges.

Conclusion: The findings highlighted resources available within the Sri Lankan health and education system to introduce family-centred early intervention and identified families as a key resource as framed within the ICF model. Therefore, it is essential to adopt culturally sensitive methods to implement and sustain such programmes.

Objective: To assess the association between maternal common mental disorders (CMD), as measured by the Self-Reporting Questionnaire-20 (SRQ-20), and child nutritional outcomes wasting, stunting and underweight in rural Sindh, Pakistan, using an e-health clinical model.

Design: A cross-sectional observational study was conducted to explore the relationship between maternal mental health and child nutritional status. Data were collected through nurse-facilitated consultations at e-health clinics, with maternal CMD assessed via the WHO-validated SRQ-20 tool and child nutritional status measured using standardised anthropometric indicators (weight-for-height Z-score, height-for-age Z-score, weight-for-age Z-score) based on WHO growth standards. Multivariate logistic regression was applied to determine adjusted associations.

Setting: Six nurse-assisted e-health clinics operating under the Sehat Kahani telemedicine platform across rural regions of Sindh.

Participants: A total of 455 mother-child dyads with children aged 6-59 months who visited clinics between April and June 2025. Eligible mothers had resided in the local area for 6 months and were not undergoing treatment for any mental health disorder.

Results: Stunting affected 62% of children, underweight 46.8% and wasting 43.3%. Maternal CMD was prevalent in 76.9% of participants (SRQ-20 score ≥7). Multivariate logistic regression revealed that children of mothers with CMD were about twice as likely to be stunted (adjusted odds ratio (AOR)=2.006, p=0.006) and nearly 1.6 times more likely to be underweight (AOR=1.688, p=0.05), though CMD showed no link with wasting. Maternal education was protective against stunting (AOR=0.458, p=0.012), while paternal unemployment was linked to increased odds of stunting and underweight. No significant associations were found with environmental factors, water source and toilet facilities.

Conclusion: Maternal CMD, educational attainment and paternal employment status are key predictors of child nutritional status in rural, low-resource contexts. These findings underscore the need for integrated maternal mental health and child nutrition interventions within digital healthcare delivery models.

Background: Parents of children newly diagnosed with autism spectrum disorder (ASD) often feel overwhelmed by the volume and complexity of information provided at diagnosis. For the culturally and linguistically diverse (CALD) families in our district, these challenges are compounded by language barriers and limited health literacy. This quality improvement initiative aimed to develop and evaluate an Autism Information Pack to support families during the postdiagnostic period, assessing its feasibility, acceptability and appropriateness, with parent feedback incorporated into future resource development.

Methods: A mixed methods convergent design was used. The pack was developed as part of the first cycle of a quality improvement project by a multidisciplinary clinician stakeholder team, incorporating high-quality existing resources and new content aligned with health literacy principles. Evaluation was conducted across Child Development Assessment Service clinics in South Western Sydney. 19 parents from culturally diverse backgrounds received the pack and completed a baseline questionnaire, followed by a phone interview 3 weeks later. Measures assessed ASD understanding, service navigation confidence, pack engagement and suggestions for improvement.

Results: 14 parents completed follow-up. Of these, six read the full pack, four read part of it and four did not engage. Among readers, most reported that it improved their understanding of ASD and confidence in finding supports. All found the content clear, though six noted it was not in their preferred language. Qualitative feedback emphasised the pack's cultural relevance, value in clarifying ASD and role in supporting navigation. Parents recommended more practical strategies, emotional support and diverse delivery formats.

Conclusion: This initiative addressed a key service gap for CALD families. The resource is now in routine use and will be translated into Arabic and Vietnamese. Parent feedback will directly inform the next codesigned iteration, which will improve content and multimodal delivery to meet the needs of diverse communities.

Background: Undernutrition significantly contributes to infant mortality and underlies approximately 45% of global deaths in children under 5, making it one of the most concerning global child health issues. The PRObiotics and SYNbiotics in infants in Kenya (PROSYNK) trial is assessing whether supervised pro/synbiotic doses daily for the first 10 days and then weekly to age 6 months has a positive impact on gut health and thereby growth and nutrition. This study provides a cost analysis of the PROSYNK trial, estimates the costs of implementing the intervention, and offers feasability insights for delivering it to infants 0-5 months in rural Kenya.

Methods: This provider perspective costing study used a combination of the ingredients approach, activity-based costing and microcosting. First, an empirical cost analysis of the PROSYNK trial was conducted by review of trial documentation and time and motion observations. Next, semistructured interviews with key informants informed a thematic analysis of implementation feasibility and the development of a theoretical programme structure, which formed the basis for estimating total economic programme costs.

Results: The economic cost of delivering the full pro/synbiotics course under trial conditions was measured as US$701.61 per participant. Experience gained during PROSYNK and discussions with key informants suggest that it could be feasible for the Ministry of Health (MoH) to implement programmatic delivery of the pro/synbiotics, particularly through community-based delivery, without a cold chain and with pro/synbiotic administered directly into infants' mouths. Incremental economic costs to the MoH of delivering the pro/synbiotic programmatically were estimated to be US$9.14 per infant per full course under the baseline scenario.

Conclusion: Pro/synbiotic administration in early life may be feasible and bear similar costs to existing nutrition interventions. This study will provide policy makers and stakeholders with cost and feasibility insights to inform effective programmatic implementation in Kenya and similar settings.

Background: Birth defects, which comprise a series of severe congenital abnormalities, impose a significant burden on society, families and individuals. Consequently, it is crucial to identify the underlying causes of birth defects and reduce their occurrence. Although an increasing number of risk factors for birth defects have been identified, few associations can be established as causal. Furthermore, the distribution of aetiology related to birth defects remains unclear. This study aims to analyse birth defect cases from the China Birth Cohort Study (CBCS) to elucidate the aetiological profile of these conditions.

Methods: A total of 3873 abnormal cases were recorded in the CBCS from November 2017 to August 2021. Abnormal fetuses (including both live births and foetal losses) were diagnosed by obstetricians, ultrasound specialists and geneticists based on prenatal screening and clinical examinations. The causes of birth defects were categorised into chromosomal anomalies, genetic anomalies, environmental exposures and twinning. Chromosomal and genetic anomalies were identified through genetic screening. Data on exposure, including the substances involved and the duration of exposure, were reviewed to determine whether environmental factors contributed to the birth defects.

Results: After excluding cases with minor malformations, a total of 2123 birth defect cases were reviewed. The most common birth defects among the included cases were congenital heart disease, polydactyly, trisomy 21 and cleft palate with cleft lip. Of these, only 22.4% (475/2123) had identifiable causes. Specifically, 415 cases were attributed to chromosomal anomalies, while 31 cases were diagnosed as monogenic disorders. Additionally, 23 cases were linked to environmental exposures, and 6 cases were associated with twinning. The proportions of birth defect cases with known causes were significantly higher in the spontaneous abortion group (12/27, 44.4%), the therapeutic abortion group (314/1044, 30.1%) and perinatal death group (13/36, 36.1%) compared with live births (136/1016, 13.4%).

Conclusions: Nearly 80% of birth defect cases in the CBCS lack a clear identifiable cause. Therefore, translating statistical associations between risk factors and birth defects into causal relationships is both necessary and important.

Background: Caring for children with life-limiting conditions (LLCs) is emotionally and existentially demanding for nurses. While much research emphasises distress, burnout and moral challenges, less attention has been focused on the potential for personal and professional growth resulting from these experiences. This narrative review synthesises qualitative research on personal and professional growth among nurses caring for children with LLCs.

Methods: A narrative literature review was conducted across Medline, CINAHL, Web of Science, PsycINFO and PubMed (2005-2025). The review included qualitative and mixed-methods studies focusing on nurses' growth experiences in caring for children with LLC in various settings. Data were extracted and analysed inductively using thematic analysis, supported by narrative synthesis. Methodological quality was appraised using the critical appraisal skills programme (CASP) tool.

Results: Seventeen studies from diverse global contexts were included. CASP appraisal indicated moderate-high quality across included studies. Six themes and thirteen subthemes reflected multidimensional growth, encompassing existential and life perspective changes, emotional and psychological development, professional identity, relational enrichment, meaning-based, and spiritual and transcendent transformation. Growth often emerged implicitly, rather than as the primary focus of included studies. The findings resonate with established theoretical frameworks, highlighting growth as both an outcome of adversity and as embedded in caring relationships and reflective learning.

Conclusion: Nurses caring for children with LLCs undergo multidimensional growth that enhances well-being and strengthens the quality of care they provide. Supporting these processes through reflective practice, education and institutional strategies may foster resilience, improve retention and elevate the quality of paediatric palliative care.

Introduction: Building the capability of primary schools to support children's mental health needs is important in the face of the increasing prevalence of mental health difficulties in children. The Mental Health in Primary Schools (MHiPS) initiative has shown promising results in the pilot phase, increasing the confidence of teachers in supporting student mental health and well-being. Delivering the project at scale presents implementation, monitoring and evaluation challenges. An open cohort (mix of longitudinal and cross-sectional data), non-randomised stepped-wedge design, will be used to evaluate the implementation, effectiveness, impact and sustainability of MHiPS as it expands state-wide. In this paper, we outline our protocol and monitoring and evaluation framework for a statewide expansion of the MHiPS initiative.

Methods and analysis: All government and low-fee, non-government primary schools in the state of Victoria, Australia, will be included in the MHiPS initiative over a 4-year period from 2023 to 2026. The design incorporates mixed methods data collection (eg, surveys, focus groups and case studies), conducted with multiple informants (eg, school staff and Department of Education staff) over multiple years to reflect the staged state-wide rollout.

Ethics and dissemination: Ethics approval for this project was received through the Royal Children's Hospital's Human Research Ethics Committee (#65924), DE RISEC (#2020_004332) and relevant Catholic diocese. Dissemination of findings will be through annual government reports, publications and national and international conferences.