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Aim: This study aimed to understand parents' online health information‐seeking behaviour and the potential influence of this on their relationship with their child's physician. Methods: A survey regarding parental online health information‐seeking behaviour was administered to parents of children aged under 18 years admitted to an Australian tertiary paediatric hospital, paediatric hospital ward and paediatric clinic, and in their social media networks. Responses were presented as frequencies and percentages. Associations between parents' trust in their child's doctor and survey responses were analysed using χ2 tests. Results: In all, 300 surveys were completed. Most parents (89%) reported searching for online health information when their child was sick. Some (31%) followed online health information instead of going to the doctor. Parents who trusted their child's doctor were more likely to follow the doctor instead of online health information when it contained conflicting advice. Most parents (91%) wanted health‐care professionals' help in searching for online health information. Conclusion: Almost all parents search for online health information, but most do not act on it. Parents' trust in their child's doctor influences how parents use online health information. Thus, clinicians could recommend trustworthy websites with information that complements their advice to ensure parents access reliable online health information. [ABSTRACT FROM AUTHOR]

Aims: To identify how the COVID‐19 pandemic influences parents' use of the internet, including social media, when seeking health‐related information about the pandemic relevant to their children. Methods: This study employed semi‐structured interviews to explore the factors affecting parents of young children when information‐seeking online about their children's health related to the COVID‐19 pandemic. Parents of children with and without chronic health conditions were interviewed in July and August 2020. Interviews were audio‐recorded and transcribed verbatim, then analysed using theoretical thematic analysis, based on Social Cognitive Theory. Results: Through interviews with 13 parents, we identified a myriad of factors that affected parents' internet searching. The decision to access online health information and the regulation of its usage was multifaceted and relied upon the interactions between environmental triggers and parents' information needs, personal attitudes, and circumstances. Overall, parents felt supported by online health information during the COVID‐19 pandemic, and the majority were confident in their ability to navigate the plethora of online health information. However, parents of children with chronic conditions had unmet information needs in relation to COVID‐19 and their children's condition. Conclusions: Understanding parents' attitudes and behaviours when seeking online health information that is relevant to their children during a global pandemic can inform the optimisation of online health content delivery to parents. [ABSTRACT FROM AUTHOR]

Aim: Health literacy is the ability to understand and interpret health information and navigate the health‐care system. Low health literacy is associated with poorer health knowledge and disease management, increased chronic illness, underutilisation of preventative health services and increased hospitalisations. The aim of the study is to review the available literature on the relationship between parental health literacy and health outcomes for children with chronic disease in high‐income countries (HIC) and low‐ and middle‐income countries (LMIC). Methods: We systematically searched Medline, EMBASE and Web of Science, and assessed study quality using the Newcastle Ottawa Scale. We reviewed all relevant studies, and identified themes using thematic analysis. Results: Of 1167 studies assessed, 49 were included in the review. All studies were of adequate quality. Twenty‐two were from LMIC and 27 from HIC. Six themes were identified: Parental health literacy, parental education, socio‐economic conditions, identity and culture, family factors, and health behaviours. In both HIC and LMIC, lower parental health literacy was associated with poorer child health outcomes. Disease‐specific knowledge was found in a number of papers to directly impact parent health behaviour and child health outcomes, and may mitigate the effects of low parental health literacy. Conclusion: There is a clear link between parental health literacy, health behaviour and health outcomes for children with chronic disease. Disease‐specific knowledge as a target for health‐care interventions holds promise for application in low‐resourced settings with parents (particularly mothers) who have lower health literacy, where disease‐specific education may improve child health outcomes, although more research is required to determine how we can best facilitate these programmes. [ABSTRACT FROM AUTHOR]

Aims: Recent years have seen an exponential increase in the proportion of parents searching for online health information on their child's medical condition. We investigated the experiences, attitudes and approaches of paediatricians interacting with parents who search for online health information and the impact on the doctor–parent relationship. Methods: This qualitative study was conducted utilising semi‐structured interviews with 17 paediatric physicians, surgeons, anaesthetists and trainees working in an Australian children's hospital. Data were analysed through deductive and inductive thematic analysis using line‐by‐line coding. Results: Three key themes were identified: paediatricians' experiences with, and attitudes towards, parents using online health information; paediatricians' communication approaches; and the perceived impact on the doctor–parent relationship. These themes demonstrated that most paediatricians acknowledged the information parents found and directed parents to reliable websites. Following discussions with Internet‐informed parents, a few changed their management plans and a few reported discouraging parents from further searching online. Conclusions: Our results indicate that paediatricians predominantly used patient‐centred communication strategies to care for patients in partnership with parents. Paediatricians contextualising online health information can contribute to a quality partnership with parents and facilitate shared decision‐making, potentially fostering better health outcomes for children. Our conclusions may inform clinicians' communication approaches when interacting with Internet‐informed parents and stimulate research about more effective doctor–parent communication approaches. In a digital age, paediatricians may benefit from employing more time‐efficient approaches to manage increasing workloads with their new role of digital stewardship of parents. [ABSTRACT FROM AUTHOR]

A systematic review is a type of study that synthesises research that has been conducted on a particular topic. Systematic reviews are considered to provide the highest level of evidence on the hierarchy of evidence pyramid. Systematic reviews are conducted following rigorous research methodology. To minimise bias, systematic reviews utilise a predefined search strategy to identify and appraise all available published literature on a specific topic. The meticulous nature of the systematic review research methodology differentiates a systematic review from a narrative review (literature review or authoritative review). This paper provides a brief step by step summary of how to conduct a systematic review, which may be of interest for clinicians and researchers. [ABSTRACT FROM AUTHOR]

Aim: The internet has rapidly developed to become a default information source for parents when searching for information about their child's medical condition. This study aims to understand how parents use, search for and appraise the relevance and credibility of online information relating to children's health. Methods: This research involved a practical task with parents of in‐patients with subacute health conditions at The Children's Hospital at Westmead. Each was presented with a scenario detailing symptoms of a paediatric health condition and asked to search for online health information on their mobile device. Participants' search was video‐recorded. A semi‐structured interview was then conducted to explore participants' use, search and appraisal of online health information. Interview audio recordings were transcribed verbatim and analysed using inductive thematic analysis. Videos of practical tasks were analysed using an observation checklist. Results: Twenty‐two parents participated. Four themes were identified: Wide spectrum of online health information utilisation, techniques in searching for online health information, appraising relevance and appraising credibility. Most parents used online health information flexibly in conjunction with consultations with health professionals, depending on assumptions about the severity of their child's condition, availability of health professionals and relationship with their child's doctor. Most focused on website titles and descriptions more than website sources when selecting a website. Conclusion: Most parents exhibited a wide use of online health information utilisation, from minimal to extensive. There are disparities between parents' perceived knowledge and performance during search and appraisal, emphasising the need for education to improve parents' eHealth literacy. [ABSTRACT FROM AUTHOR]

Aim: To explore associations between weight and type/frequency of urinary incontinence (UI) in children presenting to a tertiary hospital incontinence clinic.Methods: We retrospectively reviewed medical records of children who first attended the incontinence clinic at The Children's Hospital at Westmead between January 2004 and December 2014. A random sample of 1000 children was selected from 2022 patient records, and data were collected on weight, height, age, gender, UI parameters, bowel habits and medical history. Associations between predictors (weight categories, gender, snoring, constipation, faecal incontinence) and outcomes (daytime urinary incontinence (DUI) and nocturnal enuresis (NE)) were examined using χ2 tests and logistic regression analysis.Results: A total of 862 children were included in the study; 54% were male, and 28% were overweight/obese. No evidence of difference was found between the underweight/normal and overweight/obese weight children with NE (34 vs. 39%), DUI (7 vs. 9%) or combined NE and DUI (58 vs. 52.1%), P = 0.23. The frequency of NE (83 vs. 82%, P = 0.56) and DUI (52 vs. 58%, P = 0.20) was similar between the weight groups.Conclusion: In a large cohort of children presenting to a tertiary incontinence clinic, weight was not associated with the type or frequency of UI. [ABSTRACT FROM AUTHOR]

Aim: Studies of published clinical trials involving children have shown frequent omissions in key aspects of design and conduct, but these problems may be artefactual and due to editorial processes and space limitations. To determine actual design and conduct, we analysed the completeness of key domains in trial protocols involving children submitted to Human Research Ethics Committees.Methods: The ethics committees of all eight children's hospitals in Australia were invited to participate. De-identified trial protocols submitted for review in 2012 were evaluated using a checklist derived from Consolidated Standards of Reporting Trials, the Cochrane Risk of Bias Tool and Good Clinical Practice guidelines.Results: Four ethics committees agreed to participate, and 69 protocols were analysed. The domains almost always reported were clustered around the background and trial plan (planned interventions for each group (99%), specific objectives (97%) and scientific background (96%)). Risk-of-bias domains such as random sequence generation and blinding of participants were often reported (75-90%). Domains least reported were clustered around the statistical analysis plan (66%), specified intention-to-treat analysis (54%), the justification for the proposed trial based upon a systematic review (48%) and age-specific outcomes (48%).Conclusions: Protocols of trials involving children assessed by ethics committees generally include details on background and basic design, but many key domains in trial design and conduct are not covered. Despite widespread recognition of how problems in the design and conduct of trials may lead to unreliable results, investigators still appear to be omitting key elements in trial protocols. [ABSTRACT FROM AUTHOR]

Aim: The internet has enabled parents to become informed medical consumers and take an active role in their child's treatment. We aimed to determine parents' online medical information-seeking behaviour about their child's health. This included sources of information, reasons for searching, use and assessment of information and whether parents wanted assistance with searching and assessing information.Methods: A questionnaire was distributed to 331 parents and carers of inpatients and outpatients at Children's Hospital at Westmead in 2015. Most questions involved tick-box responses and a few free-text responses. Responses were tabulated and described by frequencies and percentages. Associations between participant demographics and responses were examined using chi-square tests.Results: In all, 308 (93%) questionnaires were returned. Most participants (90%) reported searching for medical information about their child's health. Of these, 96% searched the internet, and of these, 63% used a smartphone. The most common reason for searching before seeing the doctor was to prepare questions. The most common reasons for searching after seeing the doctor were to know more and because participants had more questions. Only half (57%) ascertained whether an information source was reliable. Most wanted guidance on searching (69%) and assessing reliability (77%).Conclusions: Almost all parents search for online information about their child's health, but most are unsure whether the information they find is trustworthy and are hesitant to act on or present it to their child's doctor. Health professionals could discuss this with parents during consultations to dispel potential misunderstandings and provide guidance on searching and assessing. [ABSTRACT FROM AUTHOR]

Enuresis (bedwetting) is common in school-aged children and can impact health, psychosocial well-being and quality of life. Although effective treatment is available, treatment resistance is encountered in about 50%. This paper discusses the management of treatment-resistant enuresis from a multidisciplinary perspective. Causes of treatment resistance include lower urinary tract problems, constipation, incorrect alarm training techniques, sleep disorders including sleep apnoea and psychological comorbidities. Practical suggestions to address treatment resistance are offered utilising expertise from clinicians from different disciplines. [ABSTRACT FROM AUTHOR]

Aim: To describe the prevalence and consultation characteristics of enuresis in Australian paediatric practice and assess for changes over a period of 5 years.Methods: Data collected prospectively by paediatricians (outpatient settings) in 2008 and 2013, as part of the Children Attending Paediatricians Study. Consultations on children aged 5 years or over were included. Consultations in each cohort (2008 and 2013) categorised as either listing or not listing enuresis. Characteristics of the 'enuresis' versus 'non-enuresis' subgroup in each cohort were compared as were the enuresis subgroups 2008 versus 2013.Results: Of 4175 and 4181 consultations in 2008 and 2013, enuresis was reported in 178 (4.3% - 2008) and 193 (4.6% - 2013). Constipation and encopresis were more prevalent in the enuresis versus non-enuresis subgroups (46 (25.8%) vs. 136 (3.4%) for constipation and 25 (14%) vs. 65 (1.6%) for encopresis in 2008; 52 (26.9%) vs. 160 (4%) for constipation and 25 (13%) vs. 78 (2%) for encopresis in 2013, both P < 0.001). The enuresis subgroup had more referrals to multidisciplinary teams (19 (10.7%) vs. 148 (3.7%) - 2008 and 21 (10.9%) vs. 163 (4.1%) - 2013, both P < 0.001) and allied health professionals (29 (16.3%) vs. 230 (5.8%) - 2008; 27 (14%) vs. 178 (4.5%) - 2013, both P < 0.001).Conclusion: The overall frequency of presentation of children for management of enuresis was low. Prevalence/Consultation characteristics of enuresis were comparable over 5 years. Constipation and encopresis were significantly more prevalent in the enuresis subgroups. [ABSTRACT FROM AUTHOR]

This paper reviews the literature on the impact of social media on the health of children and young people. Relevant papers were identified from Medline, Embase and PsycINFO databases. The studies identified that the health impact of social media on children and young people was greatest on mental health and specifically in the areas of self-esteem and well-being, with related issues around cyberbullying and 'Facebook Depression', with an association between the use of social media and self-esteem and body image. However, it is difficult to determine the cause and effect, which is likely to be related to the nature of the young person. There is little work on the impact of social media on younger children. More research is needed to identify those most at risk of harm from social media and risk mitigation strategies to assist health-care professionals to provide essential education for parents and young people. [ABSTRACT FROM AUTHOR]

The busy clinician is constantly faced with clinical questions regarding patient care. It is easy to feel overwhelmed by the large amount of health information available electronically. This article offers one easy approach for searching the electronic database. It is intended for the busy clinician who is unsure how to conduct an electronic search. It provides guidance on where to search and how to search using the PICO search method. It also provides a list of useful resources to help clinicians critically appraise the articles found to determine its relevance. [ABSTRACT FROM AUTHOR]

Background/Hypothesis: Teaching hospitals affiliated with universities are now common sites for research higher degree supervision. We hypothesised that the hospital environment poses unique challenges to supervision compared with the traditional university research institute setting. Aims: This study aimed to identify and rank important supervision issues in a clinical setting from the students' perspective. Methods: Using the Delphi method to explore issues and facilitate consensus, small group discussions were conducted with 10 research doctoral students from a tertiary teaching hospital. Results: We identified supervision issues that are unique to the hospital-based context. These include the demands placed on supervisors combining clinical and supervisory roles, the challenges of academic medical/scientific writing and career issues for students who are already established in their professions. Other issues identified, common to all doctoral students, include differing expectations between students and supervisors (with students wanting support for their career plans, training in research skills and increasing autonomy and responsibility), supervisor access, quality and frequency of meetings, lack of training in writing and dealing with conflicts. Conclusion: Our research identified that postgraduate students of supervisors who combine clinical and supervisory roles report significant issues with supervision, some of which are unique to the clinical setting. Clinician researchers who supervise postgraduate students need to balance clinical and supervisory responsibilities, identify and negotiate student expectations early in candidature and provide career counselling to students who are already highly experienced. Furthermore, clinician supervisors should undertake postgraduate supervisor training programme tailored to the hospital setting to better support their students. [ABSTRACT FROM AUTHOR]

Lower urinary tract symptoms, particularly urgency, frequency and incontinence are common in school-aged children but are often overlooked. They may cause considerable physical, social and psychological difficulties to children and their families, and usually are manifestations of underlying non-neurogenic voiding disorders. The differential diagnoses include overactive bladder syndrome, dysfunctional voiding and vaginal reflux as well as less common conditions like giggle incontinence, voiding postponement, pollakiuria and diabetes insipidus. In this paper, we discuss an evidence-based approach to the management of conditions causing daytime urinary incontinence and lower urinary tract symptoms in children from a general paediatrician's perspective. [ABSTRACT FROM AUTHOR]

Paediatric research is essential for improving health outcomes of children. Waiting for adult studies before conducting paediatric studies will prolong the denial of effective treatment for children. If we rely on information from adult studies rather than conducting studies with children, we risk causing harm to children. In this paper, we identify and examine ethical issues unique to conducting research with children. These include the function and the value of a child's assent and the criteria that should guide a proxy in making decisions about a child's involvement in research, offering payment to children for research participation and acceptable levels of risk for paediatric research. Justice demands that children not be denied the benefits of research, and it is the role of the paediatric medical community to advocate not only for more research for children but also to ensure that the research conducted is of the highest quality. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to determine whether there is a match between the health problems that children face and the clinical trials that are being conducted, especially in low- and middle-income countries (LMICs).Methods: All trials on the World Health Organisation International Clinical Trials Registry Platform registered from 2005 to 2013 were reviewed. The disease-specific focus of registered trials for children was compared to the global burden of disease for 2011 using World Health Organisation disability-adjusted life-year data.Results: Children account for 34% of the global disease burden, but were represented in only 15% (29 899/203 726) of registered trials. Although the number of trials in children registered annually has increased over time (from 3174 in 2005 to 3392 in 2013), the proportion of trials involving children has decreased (from 18 to 13%). LMICs account for 98% of the disease burden among children world-wide, but only 22% of trials. More trials were registered in high-income countries than in LMICs for the majority of the disease categories. There was moderate correlation between the number of trials and the burden of each disease within each region (Spearman's correlation r = 0.6, P = 0.007 and r = 0.55, P = 0.02 in LMICs and high-income countries, respectively).Conclusion: Overall, children continue to be under-represented in clinical trials, particularly children from LMICs where disease burden is greatest. Clinical trial activity correlates moderately with disease burden among the world's children. A more evidence-informed approach for prioritising trials to specifically address the health-care needs of children is required. [ABSTRACT FROM AUTHOR]

The article focuses on the importance of telehealth consulations for pediatrics. It states that telehealth video consultations utilize videoconferencing to carry on medical consultations in real time. It notes that telehealth is another way where specialist care can be provided and offers an alternative to face to face consultations. Moreover, telehealth consultations are helpful for assessment, clarification of diagnosis, and recommendations for treatment and review.

A letter to the editor is presented in response to the article "Writing Well" by D. Isaacs.