Search

PURPOSE To compare the accuracy of the Barrett Universal II (BUII) five-variable formula to previous generation formulae in calculating intraocular lens (IOL) power following paediatric cataract extraction. METHODS Retrospective study of consecutive paediatric patients who underwent uneventful cataract extraction surgery along with in-the-bag IOL implantation between 2012 and 2018 in the Hospital for Sick Children, Toronto, Ontario, Canada. The accuracy of five different IOL formulae, including the BUII, Sanders-Retzlaff-Kraff Theoretical (SRK/T), Holladay I, Hoffer Q and Haigis, was evaluated. Constant optimization was performed for each IOL and for each formula separately. Mean prediction error (PE) and the mean and median absolute PE (APE) were calculated for the five different IOL formulae investigated. RESULTS Sixty-six eyes of 66 children (59% males) with a median age at surgery of 6.2 years (IQR, 3.2-9.2 years) were included in the study. The mean IOL power that was implanted was 23.3 ± 5.1 D (range; 12.0-39.0 D). Overall, the BUII had a comparable median APE to the Hoffer Q, Holladay I, SRK/T and Haigis formulae (BUII: 0.49D versus 0.48D, 0.61D, 0.74D and 0.58D respectively; p = 0.205). The BUII, together with Hoffer Q, produced better predictability within 0.5D from target refraction compared with the SRK/T formula (BUII:51.5%, Hoffer Q:51.5% versus SRK/T:31.8%, p = 0.002 for both). CONCLUSION The BUII formula had comparable accuracy to other tested formulae and outperformed the SRK/T formula, when calculating IOL power within the 0.5D range from target refraction in paediatric eyes undergoing cataract surgery with in-the-bag IOL implantation.

In this special interview series, we profile members of The FEBS Journal editorial board to highlight their research focus and perspectives on the journal and future directions in their field. Brent Derry is Professor at the Department of Molecular Genetics of University of Toronto and Senior Scientist of the Developmental & Stem Cell Biology Program at The Hospital for Sick Children (Toronto, Canada). He has served as an editorial board member of The FEBS Journal since 2017.

To discuss the experience in using a visual arts-based method of draw and talk with hospitalized children, lessons learnt and strategies for practice.Discussion paper.Data were drawn from two sources: first, the databases Ovid MEDLINE, CINAHL, and SCOPUS were searched for approaches to visual arts- based data collection with children. Secondly, relevant literature and the experience of our research team using visual arts-based data collection with children informed this paper.This paper draws on the literature and our experiences of using a visual arts-based approach when conducting research with hospitalized children and foreshadows practical approaches that can be applied when undertaking such research.When undertaking research with sick children a high level of reflexivity is essential when planning and implementing a visual arts-based approach.The paper discusses a visual arts-based method and the issues that are important considerations to the conduct of research with hospitalized children. We provide suggestions for practice and argue that nurses and healthcare professionals researching with hospitalized children using an arts-based method, practice a high level of reflexivity.目标: 探讨与住院儿童使用视觉艺术为基础的绘画和交谈方法的经历、经验教训和实践策略。 设计: 讨论性论文。 数据来源: 数据来自两个来源:首先,在Ovid MEDLINE、护理学数据库(CINAHL),SCOPUS数据库用于搜索基于视觉艺术的儿童数据收集方法。其次,相关文献和我们的研究团队使用视觉艺术为基础的儿童数据收集的经验作为本文的参考。 对护理的启示: 本文借鉴了文献和我们在对住院儿童进行研究时使用视觉艺术方法的经验,揭示在进行此类研究时可以采用的实用方法。 结论: 当对患病儿童进行研究时,在规划和实施以视觉艺术为基础的方法时,高度的自反性必不可少。 影响: 本文讨论了一种以视觉艺术为基础的方法,以及在对住院儿童进行研究时需要考虑的重要问题。我们提供实践建议,并主张护士和医疗保健专业人员使用以艺术为基础的方法,以高度自反性的做法对住院儿童进行研究。.

In Nepal, an at‐scale, multisectoral programme—Suaahara (2011–2023)—aims to improve nutrition behaviours. Suaahara II (2016–2023) transitioned from a mother/child dyad focus to explicitly targeting all family members. Evidence is scant, however, regarding how exposure by men to social and behaviour change interventions relates to nutrition outcomes. This study uses a 2019 cross‐sectional monitoring dataset to test associations between maternal and male household head exposure to Suaahara II interventions (interacting with a frontline worker, participating in a community event or listening to the Bhanchhin Aama radio programme) and adoption of three infant and young child feeding practices: minimum dietary diversity, minimum acceptable diet and sick child feeding, in households with a child under 2 years (n = 1827). Maternal exposure to Suaahara II had a positive association with minimum dietary diversity (OR: 1.71, 95% CI [1.27, 2.28], P

Aim The Ethiopian primary care of sick children is provided within the integrated Community Case Management of childhood illnesses by Health Extension Workers (HEW). There is limited knowledge whether this cadre correctly assess and classify common diseases. The aim was to study their ability to correctly classify common childhood illnesses. Methods A survey was conducted from December 2016 to February 2017 in four regions of Ethiopia. Observations of the HEWs’ assessment and classification of sick children were followed by child re‐examination by a trained health officer. Results The classification by the HEWs of 620 sick children as compared to the re‐examiner had a sensitivity of 89% and specificity of 94% for diarrhoea, sensitivity 52% and specificity 91% for febrile disorders, and a sensitivity of 59% and specificity of 94% for acute respiratory tract infection. Malnutrition and ear infection had a sensitivity of 39 and 61%, and a specificity of 99 and 99%, respectively. Conclusion Most cases of diarrhoea were correctly classified, while other illnesses were not frequently identified. The identification of malnutrition was especially at fault. These findings suggest that a significant number of sick children were undiagnosed that could lead to absent or incorrect management and treatment.

Background: Home care service (HCS) for sick children is a complex healthcare service, which can be organised in various models. Despite the possibility to support family everyday life, the accessibility and utilisation may still be limited. The aim of this study was to (i) determine characteristics in referrals to county-based HCS, (ii) determine characteristics of referred children and (iii) assess acceptability of parents and children in county-based HCS. Methods: Data on characteristics of referrals and referred children were collected from medical records of children 0–17 years of age, referred to eight HCS units during 2015–2018. Data on parental and child overall experience, satisfaction of, safety with, and preference for care, were collected from parents by a questionnaire. Descriptive and comparative statistics were used to analyse the data. Results: Three hundred and fifty-five referrals led to one or more periods of HCS for 171 children in various ages with a wide range of illnesses. Children with cancer (30%) composed the largest group and administration of intravenous antibiotics accounted for 56% of the care tasks. Seven per cent of the referrals were to palliative home care. Thirty-eight referrals of 34 children were refused. There was an uneven distribution of the indication for referral, acceptance rate and diagnoses of children among HCS units. Parents reported their and their child's experience with the HCS visit as highly positive and preferred home care to hospital care in over 96% of the HCS in 212 visits. Conclusion: County-based HCS constitutes a supplement to hospital care for sick children with various illnesses through different stages of acute and long-term illness and at end of life, with high levels of acceptability. Few referrals and variation in referral characteristics and acceptance rate of referrals between HCS units led to unequal and inequitable accessibility and utilisation of HCS.

Aim To evaluate an integrated community case management programme for sick children aged 2 to 59 months in western Kenya using the Research, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. Methods This was a prospective observational research project conducted between December 2013 and February 2016. Outcome variables were measured before, during and at end of implementation using a series of surveys as well as by looking at routine service statistics. Results A total of 2604 community health workers were trained in 245 community units. The average post-training knowledge level (73.5%) and retention rates (89.7) of trained community health workers was high. At the end of study, there was an increase in the proportion of children who received appropriate treatment for diarrhoea (49.2%), pneumonia (19.5%), malaria (16.4%) and vitamin A (51.5%) from baseline. Community health workers were able to assess, classify and treat sick children with a similar quality as that provided by facility-based healthcare workers (>85% concordance). Conclusion Based on the RE-AIM metrics, our results demonstrate promising practical approaches and outcomes of a large-scale implementation of integrated community case management in western Kenya. The findings have important implications for future design and expansion of the programme in Kenya.

BACKGROUND: The successful introduction of prophylaxis with anti-RhD immunoglobulin has resulted in a significant decline of pregnancy-related RhD immunizations but also has decreased the availability of naturally immunized women as (new) anti-D donors. An influx of new donors is necessary to maintain a sufficient pool of anti-D donors. We investigated motivators, barriers, and predictors for anti-D donorship in RhD-immunized women. STUDY DESIGN AND METHODS: A mixed-methods design was applied, including focus group discussions and questionnaires. Two focus groups (including 11 women) served as input for the questionnaire. RESULTS: In total, 47.6% of 750 anti-D donors and potential donors completed the questionnaire (50.4% donors; 38% nondonors; 11.6% former donors). Almost 70% of the nondonors would have become donors if they had known about the possibility. Travel time investment was reported as a disadvantage; one-half of donors mentioned no disadvantages. Motivators for anti-D donorship were “doing something in return” (31.2%) and “preventing others having a sick child or losing a child” (33.9%). In multivariable analysis, living single (odds ratio, 5.8; p = 0.02) and living partnered without resident children (odds ratio, 7.9; p = 0.03), compared with living partnered with children, were predictors for anti-D donorship. Not being registered as an organ donor (odds ratio, 0.25; p < 0.001) predicted that the individual would not be an anti-D donor. CONCLUSION: The main barrier for anti-D donorship was a lack of knowledge. Positive predictors of anti-D donorship were living without resident children, altruism, and being registered as an organ donor. A blood bank should develop targeted recruitment strategies with a focus on spreading knowledge about anti-D donorship among RhD-immunized women.

Objective To estimate the prevalence of persistent obstructive sleep apnea postadenotonsillectomy in children with complex chronic conditions. Study Design A retrospective cohort study. Setting The Hospital for Sick Children Sleep laboratory. Subjects Children ≤18 years of age who had moderate to severe obstructive sleep apnea and had polysomnography pre- and postadenotonsillectomy. Methods Medical and polysomnographic data were reviewed. The prevalence of persistent obstructive sleep apnea postadenotonsillectomy was determined for the following groups: no complex chronic conditions, single-system complex chronic conditions, and multisystem complex chronic conditions. Results We reviewed data of 133 (84 male) children. Their mean (standard deviation) age was 5.5 (3.8) years. The persistent obstructive sleep apnea rate postadenotonsillectomy was highest in children with multisystem complex chronic conditions (57%), intermediate in children with single-system complex chronic conditions (29%), and lowest in children without complex chronic conditions (15%), P = .0004. The odds (confidence interval) of having persistent obstructive sleep apnea postadenotonsillectomy was 7.42 (2.16-25.51) times higher in children with multisystem complex chronic conditions vs no complex chronic conditions and 3.35 (1.16-9.64) times higher in children with multisystem complex chronic conditions vs single-system complex chronic conditions. Conclusions Although adenotonsillectomy is considered first-line therapy in healthy children older than 2 years for the treatment of obstructive sleep apnea, there is a significantly greater risk of persistent obstructive sleep apnea postadenotonsillectomy in children with complex chronic conditions. Therefore, other surgical procedures or nonsurgical management may need to be considered as first-line treatment for this cohort.

Disruption of parental sleep in hospital, with frequent awakenings and poor sleep quality, limits the parents' resources to meet the child's needs and maintain parental wellbeing. The aim of the study was to explore and describe how parents perceive their sleep when staying overnight with their sick child in hospital. A further aim was to explore and describe parents’ perception of what circumstances influence their sleep in the hospital. Twenty‐two parents who were accommodated with their sick child (0–17 years) in paediatric wards in Norway and Sweden participated. Interviews were conducted during the hospital stay to elicit their perspectives. Phenomenography was used to analyse data. Two descriptive categories were found: (a) “Perceptions of sleep”, with two sub‐categories: “Sleep in the paediatric ward” and “Consequences of sleep loss”; and (b) “Circumstances influencing sleep in the paediatric ward” with three sub‐categories: “The importance of the family”, “Information and routines at the paediatric ward”, and “Accommodation facilities”. Parents’ sleep and needs must be acknowledged in paediatric wards. An individual plan of care for the upcoming night could be a valuable tool for both the parents and nurses. The child's medical needs must be met with respect to the parents’ willingness to take part in the child's care during the night, and the need for rest and sleep for both parent and child. This study was supported by Crown Princess Victoria Children's Hospital, Linköping, Sweden, Perth Children's Hospital Foundation, Nedlands, WA, and Oslo Metropolitan University, Oslo, Norway.

The representations and experiences of children inside pauper lunatic asylums embody a significant lacuna in the understanding of children and childhood during the nineteenth century. Considering the Victorian period as a time when the conceptual notion of a sheltered and romantic childhood emerged it is essential, both to studies of childhood and to the history of the asylum, to examine how children thought to be mentally abnormal were incorporated into a discourse of innocence. Families and medical professionals played important roles in the admissions process by providing testimonies that led to certifications of insanity. This article examines the concept of the insane child and how it related to ideas of childhood that emerged during the period. Furthermore, important issues are explored such as the fluid nature of describing mental illness during the period, the motives of both family and medical professionals in creating polarized narratives of the sick child, and the place of the child within the medical institution.

Summary This study aimed to determine the validity of the Habitual Activity Estimation Scale (HAES) for assessing physical activity (PA) in children and adolescents with severe obesity. Data were obtained from participants (n = 17) in the High Impact Strategies Toward Overweight Reduction in Youth study at the Hospital for Sick Children in Toronto. Objective measurement of PA was recorded with accelerometers and interpreted using counts-per-minute (CPM) cut­points developed for children and adolescents. Self-report measurement of PA was collected using the HAES questionnaire. Pearson correlations revealed HAES significantly overestimated average daily duration of vigorous (+48 ± 64 min, p

To study the prevalence of pediatric cancer patients who have underlying inherited bone marrow failure syndrome (IBMFS), we retrospectively reviewed the medical records of newly diagnosed pediatric cancer patients at The Hospital for Sick Children from June 2009 to May 2010, focusing on clinical, laboratory, and treatment-related findings which may indicate underlying IBMFS. We found five (1.8%) patients out of 276 who had two or more findings suggestive of IBMFS. We conclude that a small fraction of patients with cancer have clinical features that indicate investigations to rule out underlying IBMFSs. A prospective study is needed to determine their prevalence.

Summary Objective Hydrocortisone via nasogastric (NG) tube is used in sick children with adrenal insufficiency; however, there is no licensed formulation for NG administration. Methods We investigated hydrocortisone recovery after passage through NG tubes in vitro for three formulations: liquid suspension, crushed tablets mixed with water, and hydrocortisone granules designed for oral administration to children. Cortisol was measured by LC‐MS/MS. Results Hydrocortisone content was variable and recovery low after preparation in syringe and prior to passage through NG tubes. For doses, 0.5 and 2.0 mg mean percentage recovery was as follows: liquid suspension 57% and 58%; crushed tablets 46% and 30%; and hydrocortisone granules 78% and 71%. Flushing the administering syringe increased recovery. Hydrocortisone recovery after passage with flushing through 6‐12Fr gauge NG tubes was variable: liquid suspension 61%‐92%, crushed tablets 40%‐174%, hydrocortisone granules 61%‐92%. Administration of hydrocortisone granules occluded 6 and 8Fr NG tubes; however, administration using a sampling needle to prevent granules being administered gave a recovery of 74%‐98%. Conclusions The administration of hydrocortisone through NG tubes is possible; however, current methods deliver a variable dose of hydrocortisone, generally less than that prescribed. Attention should be placed on the technique used to optimize drug delivery such as flushing of the administering syringe. Hydrocortisone granules block small NG tubes but behaved as well as the commonly used liquid suspension when prepared with a filtering needle that filters out granules.

Objective To determine the accuracy and reliability of triage of children in public hospital EDs using the Australasian Triage Scale (ATS). This is the first study to examine these issues in paediatric triage following the 2007 development of the Emergency Triage Education Kit (ETEK) to foster accurate and consistent application of the ATS. Methods A convenience sample of 167 triage nurses working at three general hospitals and one speciality paediatric hospital in greater metropolitan Melbourne assigned triage ratings for nine paediatric clinical scenarios using the ATS. Scenarios were derived from the ETEK or from other published sources. Kappa was used to assess interrater reliability within and between hospitals. Results Triage nurses correctly assigned triage scores to an average of 5.3 of nine paediatric clinical scenarios. Accuracy in specific hospitals ranged from a low of 15% on one scenario, to 100% accuracy on a different scenario at a different hospital. Interrater reliability within and across the EDs studied was found to be kappa = 0.27. Both accuracy and interrater reliability were marginally higher at the speciality paediatric hospital. Conclusions Our findings demonstrate inconsistencies in the accuracy and reliability in which sick children presenting to EDs receive triage scores both within and across hospitals. These results suggest the need for improvements either in current triage nurse training or training resources. Use of the ETEK alone has not resulted in high levels of paediatric triage accuracy or reliability.

Background Due to the long-term sequelae of cranial radiotherapy (CRT), contemporary treatment protocols for children with acute lymphoblastic leukemia (ALL) aim to limit the use of prophylactic CRT. For patients with central nervous system (CNS) involvement with ALL at diagnosis, the use of CRT remains common. Children

SummaryBackground We report on the long-term survival of children initiated on invasive and noninvasive positive pressure ventilation (NiPPV) before the age of 1 to assess the safety and efficacy of long-term ventilation at home. Methods A chart review was performed of children initiated on long-term home mechanical ventilation (LTHV) before the age of 1 year, at The Hospital for Sick Children (SickKids), Canada, between January 1991 and April 2014. Results We report on 51 children. Twenty-five children (49%) received NiPPV and 26 (51%) received invasive mechanical ventilation via tracheostomy (IMV). There was one NiPPV initiation between 1991 and 2001, the rest were in subsequent years. Most children had a “musculoskeletal disorder” in the NiPPV cohort, n = 14 (56%) and a “central nervous system” disorder in the IMV cohort, n = 13 (50%). The pCO2 improved with the initiation of NiPPV, P =

Objective To identify barriers to compliance with paediatric clinical practice guidelines (CPGs) in emergency departments in rural and regional New South Wales (NSW), Australia, and to propose strategies to increase their use. Design Cross-sectional survey. Setting Ten emergency departments in rural and regional NSW. Participants Fifty medical officers. Main outcome measures Use of clinical practice guidelines and perceived barriers to their usage. Results Only 22% of medical officers reported that they used the CPGs frequently when managing sick children. Major barriers to the use of CPGs were a lack of awareness of their existence, a lack of training in their use and poor access to the guidelines in printed or electronic format. Conclusion In order to increase compliance with the paediatric CPGs, medical officers in rural and regional NSW require further training and education. The CPGs need to be readily available in either printed or electronic format.

Aims and objectives To investigate the experiences of Swedish community nurses in caring for sick children at home, as this is a growing population of patients in community care. Background There is international consensus that sick children should receive care in their homes as far as possible. Home health care allows the family to stay together while the child is undergoing treatment and thus reduces strain on the family. However, it can also be demanding for parents to take on increased responsibilities for their sick child. Children as a patient group is a relatively new phenomenon in community home health care in Sweden and represents a small part of the community nurse responsibilities, making it difficult to accumulate experience. Design A qualitative descriptive design. Methods In-depth interviews with twelve nurses in community health care. Qualitative content analysis was used. Results ‘Feeling confident in order to instil confidence’ was key in nurses’ experiences. Two main themes emerged: ‘Building a trusting relationship with the family’ and ‘Feeling confident in the role as caregiver’. Nurses aimed at creating a trusting nursing relationship and working closely with parents. The nurses’ feeling of confidence in their role as caregivers depended on the support they received and the knowledge they had. Conclusion Many community nurses felt unconfident about caring for children at home but experienced it as manageable when peer support and a distinct collaboration with the paediatric clinic/hospital were present. The ongoing shift from hospital to home care urges paediatric clinics/hospitals and community health care to develop formal policies of transmural collaboration to train and support home nurses to deliver adequate care to sick children and their families at home and safeguard good outcomes. Relevance to clinical practice The implication of the study may contribute to efforts being made to extend and improve cooperation between paediatric clinics/hospitals and community health care.

Aim: Bacteraemias in children are an important cause of morbidity and mortality. Knowledge of local epidemiology and trends is important to inform practitioners of likely pathogens in the sick child. This study aimed to determine trends over time in pathogenic organisms causing paediatric bacteraemia in North Queensland and to audit a hospital's blood culture results with respect to contamination rate. Methods: This was a retrospective review of 8385 blood cultures collected from children attending a tertiary centre in North Queensland over a 10-year period (2001–2010). Results: There were 696 positive blood cultures (8.3%) with 70 different bacterial species detected. Gram-positive and Gram-negative bacteria accounted for 48.6% and 51.4% of isolates, respectively. Overall, bacteraemia accounted for 4.7 per 1000 admissions. The rate of contamination was 60.6% among positive blood cultures and 5.0% for all blood cultures sampled. These results were compared with previous published reports. Notable differences were seen in the frequencies of Salmonella and group A Streptococcus bacteraemias in North Queensland when compared with other reports. There was also a decline in vaccine-preventable infections such as S. pneumoniae and an increasing trend of community-acquired MRSA bacteraemia. Conclusion: This study has demonstrated the unique profile of causative pathogens of paediatric bacteraemias in tropical Australia. In light of the increasing prevalence of MRSA, empiric treatment for sepsis for children in this region needs to be reconsidered.

*Hemophilia Work Group, Beijing Children’s Hospital affiliated to Capital Medical University, Beijing, China; †Children’sHospital of Eastern Ontario, University of Ottawa, Ottawa, ON; ‡Foothills Hospital, University of Calgary, Calgary, AB;and §The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

Background Children presenting with medulloblastoma have a wide range of initial presenting symptoms. However, the influence of underlying tumor biology on the initial presentation of medulloblastoma is currently unknown. In light of the recent discovery of distinct medulloblastoma subgroups, we sought to define the initial presentation of childhood medulloblastoma in a subgroup specific manner. Procedure We assembled a cohort of 126 medulloblastoma cases at the Hospital for Sick Children between 1994 and 2012 and determined subgroup affiliation using nanoString. Clinical details pertaining to the initial presentation were determined through a retrospective chart review. Results The median pre-diagnostic interval across all medulloblastoma cases was 4 weeks (IQR: 4–12 weeks). Strikingly, when the pre-diagnostic interval was then determined in a subgroup specific manner, cases with WNT and Group 4 tumors showed significantly longer median pre-diagnostic intervals of 8 weeks compared to 2 weeks for SHH and 4 weeks for Group 3 (P = 0.0001). Younger age was significantly associated with a prolonged pre-diagnostic interval (P = 0.02 for all). When stratifying by subgroup the association with age was only significant in Group 4 (P = 0.04 for Group 4). Improved survival was significantly associated with a longer pre-diagnostic interval (P = 0.02), however is no longer significant when controlling for subgroup (P = 0.07). Conclusions The duration of the pre-diagnostic interval in childhood medulloblastoma is highly subgroup dependent, further highlighting the clinical heterogeneity and biological relevance of the four principle subgroups of medulloblastoma. Pediatr Blood Cancer 2014;61:1190–1194. © 2014 Wiley Periodicals, Inc.

Aims Influenza and influenza-like illness (ILI) in otherwise healthy children has considerable impact on their parents. This study explored the impact of children's ILI on parental quality of life (QoL). Methods We conducted qualitative in-depth interviews with parents of children aged 6 months–3 years with severe ILI. Children from childcare centres in Sydney, Australia were followed through the 2010 influenza season. Questions covered child's symptoms, parents' experiences including medical care visits, impact on the family's daily routine, and emotional, physical and social well-being. Interviews were analysed using a modified grounded theory approach. Results We conducted 21 interviews with 23 parents. Five main themes emerged: ‘sudden changes in daily life’, ‘emotional impact’, ‘social isolation and relationship changes’, ‘importance of family and friend support’ and ‘interaction with the medical system’. Perceived practical and emotional support from family and/or friends and consultations with the doctor appeared to moderate the impact. Conclusions Severe ILI in children has a considerable impact on their parents' QoL, through disruptions of normal life routine, social isolation and stress in coping with the sick child. These impacts should be considered when introducing flexible workplace policies designed to minimise the impact on parental QoL. Prevention strategies such as vaccinating children against influenza may help alleviate this impact at a population level.

Aim To examine Chinese mothers' experience of caring for their hospitalized sick child. Background Engaging the mother in providing care for a hospitalized sick child is considered one of the key elements for high-quality care in advanced paediatric nursing. There is evidence that a mother's belief in her capacity to manage stressful situations could improve the nurse–parent relationship because they might play an important role in protecting mothers against heightened stress during crisis situation. Design An interpretive phenomenological approach involving semi-structured interview and thematic analysis was used. Method Fifteen interviews were conducted in Hong Kong, China from April 2009–January 2010, with 15 mothers caring for their hospitalized sick children with acute injury or illness. Crist and Tanner's circular process of hermeneutic interpretive phenomenology was chosen to guide the data analysis. Findings The prevailing concept identified through analysis was the ‘constant vigilance’ that mothers developed. Interpretation of data resulted in the identification of four key themes: ‘being sensitive to others’, ‘providing helping hands’, ‘monitoring health conditions’, and ‘maintaining dialogues’. The findings highlight Chinese mothers' desire for participation in caring for their hospitalized child, their unexpressed needs for communication, and concern about being uncared by the busy health professionals, which affect their care for the child's health outcomes. Conclusion The findings facilitate the development of family-centred care focuses on partnership of care between the nurse and family to enhance the Chinese family's active and participatory role.

Peter W. Collins, Elizabeth Chalmers, Daniel P. Hart, Ri Liesner, Savita Rangarajan, Kate Talks, Mike Williams and Charles R. Hay School of Medicine, Cardiff University, University Hospital of Wales, Wales, Royal Hospital for Sick Children, Glasgow, The London School of Medicine and Dentistry, Royal London Hospital, Barts, Queen Mary University, London, Great Ormond Street NHS Trust, London, Hampshire Hospital NHS Foundation Trust, Basingstoke & North Hampshire Hospital, Basingstoke, Royal Victoria Infirmary, Newcastle upon Tyne, Birmingham Childrens’ Hospital NHS Foundation Trust, Birmingham and Central Manchester University Hospitals, Manchester, UK

More than ever before, public institutions are expected to have accessible guidelines on what they do, both for their staff and for those served by them. With this in mind, some principles of treatment and care of sick children were drafted for the Children's Hospital at Westmead. These were centred on ethics, primarily of what was best for the child. They were neither all-inclusive nor specific. They were labelled as a charter. They were rejected by a parent committee and met with unenthusiastic responses at meetings of hospital and ethics professionals. Reasons for this are unclear, but it is speculated that fear of the unknown and distrust of institutions may be factors. To date, the charter has not proved useful, except in provoking further discussion on how general guidelines are written, used and valued and on end-of-life decision-making more generally.

Background: The optimal serum level of 25-hydroxyvitamin D (25-(OH)D) for bone health is still unclear, especially in children. Hypovitaminosis D is also re-emerging in developed and developing countries. The purpose of the present study was therefore to determine optimal serum 25-(OH)D level and preliminarily identify the vitamin D nutritional status in Nanjing children. Methods: All subjects (76 healthy, 66 suffering from infectious diseases) aged 0–10 years were recruited during the period December 2007–March 2008. Venous blood samples were collected before breakfast and the levels of serum 25-(OH)D, parathyroid hormone (PTH), bone-specific alkaline phosphatase (BAP), calcium (Ca), phosphorus (P) were determined. The optimal level of serum 25-(OH)D was explored using the three response curves of 25-(OH)D versus PTH, 25-(OH)D versus BAP, and 25-(OH)D versus Ca×P product. Results: For 25-(OH)D ≤ 50 nmol/L, PTH and BAP were both inversely correlated with 25-(OH)D (PTH, r=−0.864, P 50–60 nmol/L, levels of PTH and BAP remained steady. With regard to the Ca×P product, for 25-(OH)D ≤ 50 nmol/L, Ca×P product increased as 25-(OH)D increased (r= 0.037, P > 0.05). For 25-(OH)D > 50–60 nmol/L, Ca×P product remained steady. The mean serum level of 25-(OH)D was 80.5 ± 29.3 nmol/L (mean ± SD) in the healthy children, and 65.7 ± 32.3 nmol/L in the sick children. Conclusion: The optimal 25-(OH)D level may be 50–60 nmol/L for bone health in Nanjing children. The vitamin D nutritional status of Nanjing children is relatively good in winter.

Aim: To describe the characteristics of the activities of multifunction paediatric ‘short-stay units’ (SSU) including observation unit (OU), medical assessment and planning unit (MAPU) and holding unit (HU), to evaluate their effectiveness and to explore predictors of inappropriate admissions for OU patients. Methods: Admissions to nine French paediatric SSUs were analysed. The main outcome measures were SSU length of stay with associated outcome for all patients and appropriate admission rate for OU patients. Results: Of 1084 patients included in the study, 66% were OU patients (n = 718), 21% MAPU patients (n = 225) and 13% HU patients (n = 141). The OU patients constituted the majority of the SSU admissions. The appropriate OU admission rates ranged from 52% to 86%. Head trauma and seizure were the conditions with the highest appropriate OU admission rates (82%). Age

L. A. VALENTINO,* M. CARCAO, P. MATHEW, C. A. LEISSINGER,§ E. BERNTORP,– V. BLANCHETTE, C. ESCURIOLA-ETTINGSHAUSEN,** B. EWENSTEIN, N. EWING, A. GRINGERI,§§ W. K. HOOTS–– and C. NEGRIER*** *Departments of Pediatrics and Internal Medicine, Rush University Medical Center, Chicago, IL, USA; Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of New Mexico Health Science Center, Albuquerque, NM, USA; §Louisiana Center for Bleeding and Clotting, Tulane University Medical Center, New Orleans, LA, USA; –Department of Coagulation Disorders, Malmo University Hospital, Malmo, Sweden; **Department of Pediatrics, J. W. Goethe University Hospital, Franklin, Germany; Baxter Bioscience, Westlake Village, CA, USA; Division of Pediatrics, City of Hope National Medical Center, Duarte, CA, USA; §§Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy; ––Department of Pediatrics, University of Texas Medical School, Houston, TX, USA; and ***Hemophilia Center, Hopital Edouart Herriot, Lyon, France

Aims and objectives. To investigate parent participation in the hospitalized child’s care from the perspectives of children, parents and nurses. Background. Parent participation in the hospitalized child’s care has been increasingly promoted in paediatric nursing for many years because it ameliorates the adverse aspects of hospitalization, avoids parental separation and contributes to quality care for sick children. Parent participation is assumed to be unproblematic but evidence exists that nurses often have difficulty caring for parents. Design. Using grounded method, data were collected through in-depth interviews, questionnaires and observation with 12 nurses from four paediatric wards in two hospitals in England. Results. The dominant process appeared to be the socialization of parents to their role on the ward through inclusionary and exclusionary tactics. Nurses controlled the nature of parents’ participation and parents had to ‘toe the line’. Although participation was presented as optional, parents were presented with no course other than acceptance. Parents were expected to stay with their child, behave properly and be involved in care. When parents did not adhere to these norms, they caused disruption to the order and routine of the ward. Compliance or non-compliance to the set of norms and rules was followed by reward or punishment. Conclusion. The nurses’ dependence on parents’ active participation in the organization and delivery of the work suggests that parent participation as it is practised is clearly about administrative efficiency, not consumer empowerment. Relevance to clinical practice. Organizational and managerial issues must be examined to ensure that nurses are adequately prepared and resourced to support parents on the ward. Continuing assessment of parents’ expectations though a structured assessment tool would help reduce misunderstandings and conflict. Nurses should assess the situational context before relying on subjective impressions and assumptions about parents’ participation in care.

SUMMARY Both the age of the infant and the birthweight in relation to age are relevant factors in studying prenatal and neonatal physiology and in evaluating immediate and future clinical risks to the fetus and the newborn. Since the true age of the infant (the time-span from conception) is not available, the first day of the last menstrual period is commonly used as the time reference. In many cases, however, there is doubt as to the accuracy of this reference day, necessitating other criteria to indicate the duration of fetal development or of the postmenstrual age of the newborn. The authors discuss the use of pre- and postnatal evaluations of the developmental changes in various organ systems-by physical measurement, observation, physiological registrations and biochemical analysis - for the estimation of the postmenstrual age. They use the following criteria: Does the observable phenomenon change suddenly from absent to present at a particular postmenstrual age? Does the phenomenon remain unaltered in sick children? Is the method relatively easy and reliable? Is the technique without risk for the fetus, the mother and the newborn? At present, a combination of parameters, serially measured, on the developing nervous system and the developmental changes of the skin seem to be most helpful in pre- and postnatal life, and the authors report that the optimal accuracy obtainable so far still has a range of plus or minus 2–3 weeks. The reasons for this wide range are discussed. RESUME Estimation de & lcar;âge post-menstruel: vue d'ensemble L'âge de l'enfant et le poids de naissance en fonction de l'âge sont tout deux des facteurs importants dans l'etude de la physiologie prenatale et neo-natale, dans l'evaluation clinique des risques immediats et futurs du foetus et du nouveau-ne. Puisque l'âge vrai de l'enfant (duree depuis la conception) ne peut etre connu, le premier jour des dernieres regies est pris generalement comme reference. Dans de nombreux cas cependant, on peut douter de la precision de cette reference et d'autres criteres sont neces-saires pour indiquer la duree du developpement foetal ou l'âge post-menstruel du nouveau-ne. Les auteurs discutent l'emploi de mesures pre et post-natales de modifications liees au developpement au niveau de certains organes pour la determination de l'âge post-menstruel (par mesure physique, observations, enregistrement physiologique et analyse biochimique). lis utilisent les criteres suivants: Le phenomene observe“passe-t-il de l'absence a la presence brusquement a un âge post-menstruel particulier? Ce phenomene persiste-t-il chez les enfants malades? La methode est-elle suffisamment facile et fidele? La technique est-elle sans risque pour le foetus, la mere et le nouveau-ne? A l'heure actuelle, une combinaison de parametres, determines sur des series, au niveau du developpement du systeme nerveux et des modifications progressives de la peau semble etre la plus utile durant la vie pre ou post-natale; les auteurs precisent que la precision optimale atteinte jusqu'a ce jour est de plus ou moins deux ou trois semaines. lis discutent les raisons de cette large erreur. ZUSAMMENFASSUNG Die Schatzung des postmenstruellen Alters: Eine umfassende Synopse Sowohl das Gewicht eines Sauglings als auch das Verhaltnis zwischen Geburtsgewicht und Alter sind wichtige Faktoren beim Studium der pranatalen und neonatalen Physiologie und bei der Bestimmung des unmittelbaren und zukunftigen Risikos des Foetus und des Neugeborenen. Da das wahre Alter des Kindes (die Zeit von der Konzeption an) nicht zu erfahren ist, wird im allgemeinen der erste Tag der letzten Menstruationsperiode als Orientierungspunkt gewahlt. In vielen Fallen mus man jedoch Zweifel haben an der Genauigkeit dieser Angabe, woraus sich die Notwendigkeit ableitet, andere Kriterien fur die Dauer der foetalen Entwicklung oder des postmenstruellen Alters des Neugeborenen zu finden. Die Autoren diskutieren die Verwendung pra- und postnataler Ermittlungen der durch die Entwicklung bedingten Veranderungen in verschiedenen Organsystemen–durch physikalische Messung, Beobachtung, physiologische Bestimmungen und biochemische Analysen–fur die Bestimmung des postmenstruellen Alters. Sie benutzen die folgenden Kriterien: Wechselt das zu beobachtende Phanomen plotzlich von nicht vorhanden zu vorhanden bei einem bestimmten postmenstruellen Alter? Bleibt dieses Phanomen bei kranken Kindern unverandert? Ist die Methode verhaltnimasig einfach und verlaslich? Ist die Technik fur den Foetus, die Mutter und das Neugeborene ohne Risiko? Zur Zeit scheint eine Kombination von regelmasig gemessenen Parametern uber die Entwicklung des Nervensystems und die Veranderungen der Haut im pra- und postnatalen Leben besonders hilfreich zu sein, und die Autoren berichten, das die bisher erreichte Genauigkeit immer noch eine Spanne von plus minus zwei bis drei Wochen betragt. Die Grunde fur diese weite Spanne werden diskutiert.

The current meal delivery system at The Hospital for Sick Children is a cold-plating tray delivery system. Our goal was to determine the effect of a room service model on satisfaction, food costs/waste and macronutrient intake in an inpatient paediatric setting. A prospective cross-sectional study of inpatients (n = 54) was studied over 6 days, 3 days under the current system and 3 days under the pilot model. A satisfaction questionnaire was used to assess satisfaction, and tray tickets were used to assess food costs/waste and dietary intake. With room service, satisfaction increased (P

Katherine A. Rauen,* Erin Hefner, Kristin Carrillo, Jill Taylor, Laure Messier, Yoko Aoki, Karen W. Gripp, Yoichi Matsubara, Virginia K. Proud, Peter Hammond, Judith E. Allanson, Marie-Ange Delrue, Marni E. Axelrad, Angela E. Lin, Daniel A. Doyle, Bronwyn Kerr, John C. Carey, Frank McCormick, Alcino J. Silva, Mark W. Kieran, Aleksander Hinek, Tan T. Nguyen, and Lisa Schoyer Department of Pediatrics, Division of Medical Genetics, University of California, San Francisco, California UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California Costello Syndrome Family Network, Altadena, California Department of Medical Genetics, Tohoku University School of Medicine, Sendai, Japan Division of Medical Genetics, Alfred I. DuPont Hospital for Children, Wilmington, Delaware Children’s Hospital of the King’s Daughters, Norfolk, Virginia Molecular Medicine Unit, Institute of Child Health, UCL, London, UK Children’s Hospital of Eastern Ontario, Ontario, Canada Department of Medical Genetics, Centre Hospitalier Pellegrin Enfant, Bordeaux University, Bordeaux, France Learning Support Center for Child Psychology, Department of Pediatrics, Texas Children’s Hospital, Houston, Texas Genetics Unit, MassGeneral Hospital for Children, Boston, Massachusetts Division of Endocrinology, Alfred I. duPont Hospital for Children, Wilmington, Delaware Academic Unit of Medical Genetics, St. Mary’s Hospital, Manchester, UK Department of Pediatrics, Division of Medical Genetics, University of Utah Health Sciences Center, Salt Lake City, Utah Departments of Neurobiology, Psychology, and Psychiatry, Brain Research Institute, UCLA, Los Angeles, California Dana-Farber Cancer Institute, Department of Pediatric Oncology, Boston, Massachusetts Division of Cardiovascular Research, Hospital for Sick Children, Toronto, Canada Office of Orphan Products Development, Food and Drug Administration, Rockville, Maryland

This article reports an investigation in further education colleges in the north west of England into the language and communication content of courses for students with severe learning difficulties. The inquiry was undertaken for the M.Ed degree of Liverpool University. Sue Roulstone is currently the chief speech therapist at Bristol Royal Hospital for Sick Children and teaches part time at Bristol Polytechnic.

Aim: To compare the predictive value of impedance index (ZI, height2/impedance) with anthropometric measurements for estimating fat-free mass (FFM). Methods: FFM of 120 white paediatric children (46 males, 74 females), aged 2.5–18 years was measured by using dual energy X-ray absorptiometry. Weight, height, mid-upper arm circumference (MUAC), skinfold thickness (biceps, triceps, subscapular and suprailiac) and bioelectrical impedance were also obtained. Stepwise multiple regression analysis and residual plots were performed to determine the most significant variables to predict FFM. Results: The single best predictor of FFM was ZI, which explained 96.2% of the variance in FFM (r = 0.981, SEE = 2.15 kg). Addition of weight to the model containing ZI increased the explained variance of FFM to 96.6% (r = 0.983, SEE = 2.03 kg). BMI and MUAC were the poorest predictors of FFM: r = 0.422, SEE = 10.2 kg and r = 0.621, SEE = 8.93 kg, respectively. Conclusion: Impedance index is a more significant single predictor of FFM than other anthropometric measurements. The predictive accuracy of bioelectrical impedance analysis-based prediction equations for FFM was improved by addition of weight.

We have explored the working patterns and perceptions of a group of teachers who provide home tuition for children who cannot attend school due to medical problems. These teachers reported high levels of experience in teaching, enthusiasm for their work, and clear managerial structures. Home tutors found it very rewarding to build relationships with children and families, and see children making progress. Challenging aspects of the work included relationship issues, both with the children and their families and with the professional network around the child. Liaison with other professionals was reported to be variable, sometimes helpful and well structured, and sometimes very poor. Those interviewed felt additional training on specific issues related to their work in this context would be beneficial.

Our objective was to determine costs and trends in treating boys with severe haemophilia A before our centre routinely used prophylaxis. One reviewer extracted data from patient charts to determine resource consumption for 17 boys with severe haemophilia A from 1978 to 1998 at Toronto's Hospital for Sick Children. Resources included factor concentrate, doctors and health care professionals (physiotherapists/social workers), tests (laboratory, radiological and diagnostic) and hospitalizations. Subgroup analysis on those patients infected with HIV and/or hepatitis were also performed. Costs in Canadian Dollars were taken from standard lists and discounted at 3%. Total average cost (range) 62 292 dollars (3339-121 738) per year patient(-1); the largest fraction, 59 910 dollars (3103-119 480), 96.2% was accounted for by factor VIII. Hospitalizations accounted for 1832 dollars (0-5217) per patient year(-1) including drugs, nursing care and stay. Doctor and health care professionals visits averaged 252 dollars (36-462) and 72 dollars (0-175) per patient year(-1), laboratory and other tests cost 201 dollars (22-377) and 26 dollars (2-60) per patient year(-1), respectively. The average number of bleeds was 12.9 (2.0-22.0) per patient year(-1), decreasing since 1977 by 0.68 per patient year(-1) (R(2) = 0.56). Hospitalizations averaged 0.22 (0-4) per patient year(-1), lasting 2.3 days. From 1984, hospitalizations decreased by 0.025 patient(-1) year(-1) (R(2) = 0.76). Concurrently, the average treatment costs increased by 5456 dollars patient(-1) year(-1) (R(2) = 0.81). Clotting factor concentrate cost per patient increased by 5521 dollars year(-1) (R(2) = 0.82). Patients with virally transmitted diseases had considerable higher costs. The cost per year was substantial. Costs increased with virally transmitted diseases. Number of bleeds and hospitalizations over the period of study decreased and costs increased because of factor use in secondary prophylaxis.

Purpose: To characterize abnormal corneal topographic changes using corneal computerized videokeratography (CVK) in a paediatric population with Down syndrome, and in their parents. Methods: Prospective, non-randomized clinical trial. Twenty-one children with Down syndrome (mean age 6.9 years) recruited from The Hospital for Sick Children, 18 of their parents, and a paediatric control group of 60 otherwise well children (mean age 9 years), underwent complete ocular examination and CVK using the EyeSys system. Corneal topographic maps were assessed subjectively, and three objective parameters analysed: central corneal power (CP), difference in central corneal power between the two eyes (DCP), and inferior–superior steepening asymmetry (I-S). Results: Corneal curvature in children with Down syndrome was significantly steeper than in the paediatric control population (CP 46.66 vs 42.60 D, P

Little research has been done in developing countries on the emotional impact experienced by families who have a child diagnosed with leukemia. This preliminary study looked at parents in Mexico who had to cope with their child's leukemia in the face of meager financial and social resources. The 51 children in the study were under 15 years and being treated for leukemia in hospitals affiliated with the Mexican Social Security Institute (IMSS) where their parents were interviewed using a questionnaire to ascertain their emotional responses to the illness. The data are analyzed and reported in five domains: perceived illness; psychological impact; coping strategies; family relationships; socio-economic impact. A strengthening of family bonds was found the most common response (82.4%). The second most common responses were concern for the expenses incurred by the illness and the time dedicated to caring for the sick child (both 78.4%). It is especially important to assess families with meager social and financial resources as to their emotional responses to life-threatening illness because these limitations impose greater burdens and make coping more difficult. Psychosocial interventions are key to ensuring adequate treatment of the child in these circumstances. Copyright © 2003 John Wiley & Sons, Ltd.

1 The Hospital for Sick Children, The University of Toronto, Toronto, Ontario, Canada 2 Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA 3 Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada 4 Etablissment Francais du Sang – Pays de la Loire, Nantes, France 5 L’lnstitut de Consultation et de Recherche en Ethique et en Droit, Quebec, Canada 6 Elliott and Kim LLB, Toronto, Ontario, Canada 7 The Canadian Hemophilia Society, Toronto, Ontario, Canada 8 The University of Toronto, Toronto, Ontario, Canada 9 The Chiropractic Association, Mississauga, Ontario, Canada

OBJECTIVE To evaluate if INFECTOM, a multicomponent behaviour change strategy, would alter the care received by children visiting private healthcare providers so that it was more consistent with the IMCI algorithm. METHODS Community surveys in two low income communities in Pakistan identified children who had visited healthcare providers in the preceding 2 weeks complaining of diarrhoea, cough or rapid breathing, or fever. Interviewers asked the mothers of these children whether providers performed specific behaviours recommended by the Integrated Management of Childhood Illness (IMCI) algorithm. These data were analysed to generate provider-specific IMCI-related behaviour profiles. A team including community representatives met with the providers, discussed the correct IMCI algorithm behaviour, reviewed the percentage of time each of their practices was consistent with IMCI recommendations, and negotiated a contract with a numerical target for improved practices. This cycle of survey, discussion of results and contracting was repeated three times over 10 months. RESULTS Twenty-two providers, 13 of whom (59%) had a medical degree, regularly treated children in the two communities. Sixteen of the 21 targeted behaviours (76%) occurred with significantly increased frequency during the course of the intervention. Of the 10 practices that ill children with any of the syndromes should have received, at baseline children averaged receiving 4.3. In the final model, each subsequent round of evaluation was associated with a 0.57 increase in the number of appropriate practices performed at visits to non-Bachelor's Degree in Medicine (MBBS) qualified providers (P

Charles Robson (Figure 1) was born in New Westminster, British Columbia (now a suburb of Vancouver), in 1884 and graduated in medicine from McGill University in Montreal in 1913. Having interned and with some anesthesia training at the Royal Victoria Hospital in Montreal, he was sent overseas to work in a Canadian Army Hospital where he founded a school to train military anesthetists. Returning to Canada in 1919, he joined the staff of the Hospital for Sick Children in Toronto as chief anesthetist, a position he held until 1951 (1). During most of this time, he was the sole full-time anesthetist at the hospital; administration of anesthesia at this hospital was not limited to staff anesthetists until 1950 (1). Figure 1. Dr Charles Robson. Download figure to PowerPoint

Summary.Aim. To investigate the dental status and oral cleanliness of a group of patients with haemorrhagic diatheses and to compare these to values for a group of healthy controls. Design. Cross-sectional study of patients and controls. Methods. The group of patients was made up of 80 children aged 4–18 years. The total included 77 patients with type A or type B haemophilia and three with von Willebrand’s disease. The control group consisted of 80 healthy children of the same age range. A clinical examination was carried out to determine dental status and oral hygiene in the two groups. Results and conclusions. No significant differences were found between the dental status of sick and healthy children. However, worse dental status was seen in children with severe forms of haemophilia A and von Willebrand’s disease compared to other sick children. Oral hygiene status was worse in the sick children than in healthy children.

The needs of parents with chronically sick children: a literature review Aims. This paper aims to provide health care professionals with an enhanced knowledge of the needs of parents with chronically sick children. Design. The article takes the form of a critical literature review and examines eight research studies that were carried out from 1987 to 1997, written in the English language and analysing solely the needs or experiences of both parents with at least one chronically sick child. Findings. Appropriately all eight studies were carried out from the naturalistic paradigm and yielded rich data. The synthesis of the results of the papers found three main themes emerging: the need for normality and certainty, the need for information, and the need for partnership. Conclusion. The results of the review serve to emphasize and reiterate the burden of the demands made on these parents, and act as a reminder of the need for empathetic care delivery.

Purpose To present the findings from a pilot-test of an innovative curriculum for parent education classes that included information about well child care and the care of sick children presented to substance abusing women at a residential drug treatment facility. Data Sources Selected literature and the results of a comparison of pre- and post-tests from the 37 women who received the classes over a 6 week period. Conclusions The Healthy Children, Happy Children parent education program was successful overall in increasing the knowledge of the mothers about common skin disorders, care of infants, toddlers, and preschoolers, and basic first aid. Implications for Practice Nurse practitioners (NPs) are well suited to teach parent education classes that contain information on growth and development, well child care and diagnosis and management of acute minor conditions. The Healthy Children, Happy Children curriculum can be adapted to a variety of settings and populations.

Childhood cancer can have a substantial emotional impact on the siblings of the sick child. In order to help these siblings adjust to the illness, supportive groups were started in 1994 at our medical center. The program is based on a model of psychosocial support; the aim of the group is to enhance control strategies and, thus, to reduce anxiety. It consists of five sessions and is offered to siblings aged 7-18. The study objective is to evaluate the effect of group participation on sibling anxiety. The State Trait Anxiety Inventory for Children was administered to 24 siblings before and after group participation. Results showed that siblings experience less anxiety after participating in the group. Before group participation, a majority of the siblings were more anxious compared with normal peers. The sibling's age and sex, whether the ill child is in treatment, survival perspective, and time since diagnosis were not related to anxiety reduction. The continuation of the group is supported by its positive impact on siblings. Results must nevertheless be interpreted cautiously, considering the small number of siblings participating in the study, the lack of a control group and the restriction to one outcome measure.

The purpose of this study was to investigate how parents use the GP out-of-hours service. There was a lack of information about how parents managed childhood illness and what strategies they put in place to help them to cope before calling the GP. The investigation of parental perceptions was based on a qualitative design using in-depth interviews of 29 families from a semi-rural location in the south-east of England. All parents said they found dealing with a sick child out-of-hours stressful and were concerned to make the right decision for their child. Furthermore, parents usually employed a reasonable strategy in attempting to manage the child’s illness. This study demonstrated that the decision to call the doctor was not taken lightly. Many parents had implemented useful strategies prior to calling the doctor. However, most parents were also aware of their limitations and feared doing the wrong thing. It would seem that on occasion this fear combined with factors such as a lack of social support and loss of parental confidence resulted in calling the doctor out of hours to seek ‘peace of mind’. A rethink is needed among health professionals about the ‘problem’ of out-of-hours calls. GPs could actively seek to empower parents by educating them about minor illness during visits and consultations. It is not enough to offer reassurance to parents that their children are fine. Health visitors and other health professionals who come into contact with young families may help to educate and empower.

A retrospective analysis of the first 50 cases of neonatal cleft lip repair performed at the Hospital for Sick Children is presented. The patient population included 11 expremature infants of less than 45 weeks postconceptual age. There was no mortality at the time of follow-up. There was one case of peroperative hypoxaemia. There was one case of postoperative laryngospasm requiring reintubation. Postoperatively there were four cases of mild hypoxaemia and one patient with transient apnoea. No patients required blood transfusion. Seventy-six percent of patients did not require opioid analgesia. The remainder received a single dose of intramuscular codeine phosphate. The advantages and risks of anaesthesia for cleft lip in the neonatal period are reviewed. Recommendations for safe practice include the selection of gestationally mature infants with no intercurrent illness, avoidance of opioid analgesia, adequate staffing ratios of experienced postoperative nursing care, appropriate monitoring including oximetry and apnoea detectors.