BMJ Paediatrics Open最新文献

Background: Currently, no validated instruments exist for professionals to verify suspected sexual abuse in young children. The aim of the Picture Instrument for Child Sexual Abuse Screening study was to evaluate the diagnostic accuracy of the Sexual Knowledge Picture Instrument (SKPI) in identifying young victims of child sexual abuse (CSA) based on assessments of non-verbal reactions and verbal disclosures.

Methods: Over a 5-year period, 155 children 3-9 years of age were enrolled: 65 children with a suspected history of CSA and 90 without. In line with the study protocol, 50 confirmed cases were expected, but none could be verified. All children underwent SKPI interviews conducted by trained interviewers. Independent conclusions from the Dutch Child Abuse Counselling and Reporting Center (CACRC) and the Dutch National Police Vice Squad, obtained 6 months post-interview, served as the reference standard.

Results: No children from the control group were reported to the CACRC or police. For only 27 of the 65 suspected cases, a reference standard outcome was available, confirming CSA in six children.

Conclusion: Due to the absence of a reliable reference standard, the diagnostic accuracy of the SKPI could not be determined. Beyond organisational challenges and stricter data protection laws, the gap between medical diagnostics, child protection and law enforcement highlights the need for a novel, collaborative approach in this type of research.

Background: Children with congenital heart disease demonstrate developmental and functional impairment throughout their life. Published literature is limited but suggests postsurgical physiotherapy positively impacts developmental and functional outcomes in these children. We aimed to understand parental opinions of their child's development or function, their experiences of physiotherapy services, how they feel physiotherapy could be used to support their child and what impacted access to services.

Methods: A qualitative study using semistructured online interviews was conducted among parents of children with a diagnosis of congenital heart disease under the age of 16 years, who had undergone cardiac surgery in the UK. Data were collected between July and December 2024. The data were explored using reflexive thematic analysis and the study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist.

Results: 12 semistructured interviews were completed involving 12 mothers and 1 father. Themes identified were parental priorities; understanding and experience of physiotherapy; access to physiotherapy and ideal physiotherapy service. Parental expectations of their child's development were influenced by antenatal care and postnatal experiences. Parents continually evaluate the need for their child to access developmental and functional support. Engagement with physiotherapy is influenced by parental understanding, quality of service provision, impact of interventions on their child and the practical and emotional consequences to their family. Parents want physiotherapy services to deliver parental education and individualised support throughout their child's life, particularly around key life events.

Conclusions: Parental engagement with physiotherapy services is influenced by parental expectations of their child's development and function, and their understanding of the potential benefits of physiotherapy. Physiotherapists should prioritise promoting and increasing awareness of physiotherapists' role in children with congenital heart disease, alongside parental education and individualised care, to facilitate engagement.

Introduction: Speech and language disorders are common developmental concerns. Identifying language issues in bilingual children presents a significant challenge. In this study, we examined how bilingualism, gender and age predicted the timing and types of diagnoses in a large clinical sample of children referred to speech and language therapy (SLT) services in a Swedish healthcare setting.

Methods: A retrospective analysis of medical record data was undertaken involving 1025 children under the age of 7 referred to public speech and language clinics. Data on age, gender, bilingualism and speech and language diagnoses were analysed.

Results: Bilingual children and boys were diagnosed at a younger age compared with monolingual children and girls. Speech and language diagnoses were associated with bilingualism and age. Bilingual children were more likely to have mixed receptive-expressive language disorders and developmental disorders of speech and language unspecified, and less likely to have specific speech articulation disorder and expressive language disorder, compared with monolingual Swedish-speaking children.

Conclusions: The timing and type of speech and language diagnoses were associated with sex, bilingualism and age. These observations may stem from the resources, tools and guidance available to professionals assessing bilingual children. Professionals should be cautious of these potential biases and take suitable measures to address them. Further studies in other geographical settings are warranted.

Introduction: The combination of non-invasive ventilation, particularly nasal intermittent positive pressure ventilation (NIPPV), and exogenous surfactant therapy has been shown to significantly reduce mortality and morbidity in neonates with respiratory distress syndrome (RDS). The 2022 European Consensus Guidelines on RDS recommend a universal fraction of inspired oxygen (FiO₂) threshold of 0.30 for surfactant administration, irrespective of gestational age. However, this recommendation lacks validation through randomised controlled trials, and the optimal FiO₂ threshold remains uncertain. Therefore, this study aims to compare clinical outcomes associated with two different FiO₂ thresholds for surfactant administration (0.25 vs 0.30).

Methods and analysis: We designed a multicentre randomised, controlled, superiority trial investigating the effect of fraction of oxygen inspired (0.25 vs 0.30) in very preterm infants with RDS in 24 tertiary neonatal intensive care units in China. 394 preterm infants, born 26⁺⁰ to 31^+6/7 weeks' gestation, will be randomised to the intervention (FiO₂ threshold: 0.25) or control (FiO₂ threshold: 0.30) group during initial NIPPV. The primary outcome will be NIPPV failure (the need for invasive mechanical ventilation (IMV) within 72 hours after birth).

Ethics and dissemination: Our protocol has been approved by the Ethics Committee of Jiangxi Maternal and Child Health Hospital. The study results will be disseminated to guardians and the public through public health education and neonatal academic conferences.

Trial registration number: NCT07100652.

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.