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The CARe Burn Scales are a portfolio of burn-specific PROMs for people affected by burns, including a Child Form (for children &lt, 8 years (parent-proxy)), a Young Person Form (for young people aged 8–17 years), an Adult Form, and a Parent Form (for parents/carers of children aged 0–17 years). This study aimed to determine the responsiveness and minimal important difference (MID) values of the three scales developed for use in paediatric burn services and research. Participants were recruited by 15 UK Burn Services. Participants completed the appropriate CARe Burn Scale and a set of appropriate comparison validated measures, at three time points: 4 weeks (T1), 3 months (T2) and 6 months (T3) post-burn injury. Spearman’s correlation analysis and effect sizes based on Cohen’s d thresholds were reported and MID values were calculated. At baseline, 250 participants completed the Child Form, 69 completed the Young Person Form, and 320 completed the Parent Form. A total of 85–92% of participants were retained at follow up. The tested CARe Burn Scales were all responsive to change over time. MID values were created for all subscales and ranged from 2 to 11 for the Child Form, 3 to 14 for the Young Person Form and 3 to 10 for the Parent Form. The CARe Burn Scales for children, young people and parents are responsive to change over time. The scales are freely available for clinical and research use.

Background Carer burden amongst carers of youth with an eating disorder is substantial and if not addressed can lead to negative outcomes for the patient, carer and family. The Coronavirus Disease 2019 (COVID-19) pandemic has made caring for youth with an ED even more onerous and preliminary research is beginning to emerge demonstrating the profound negative impact the pandemic is having upon individuals with EDs and their carers. Main In this review, we briefly summarize what is known about carer burden in families where a young person has an ED, consider the additional impact consequent to COVID-19 and highlight the need for interventions aimed at alleviating this. Pre-COVID-19 research identifies high levels of psychological and physical strain amongst those caring for a child with an ED. Themes are beginning to emerge as to why COVID-19 may further exacerbate carer burden: (1) reduced access to ED services; (2) increased physical vulnerability and exacerbation of psychiatric co-morbidity amongst youth with EDs; (3) increased practical demands placed on carers; and (4) social isolation and decreased social support. Conclusion The COVID-19 pandemic poses a specific threat to the mental health of youth with EDs and their carers. Given the salient role families play in caring for youth with an ED, attending to carer burden is imperative. Supporting carers through all phases of their child’s ED journey by offering adaptive and flexible supportive services which accommodate time constraints, geographic barriers and possible COVID-19 spread is essential., Plain English summary Caring for a child with an Eating Disorder (ED) can be difficult at the best of times. Research is beginning to emerge demonstrating the negative impact the Coronavirus Disease 2019 (COVID-19) pandemic is having both on youth with an ED and their carers. In this review, we briefly summarize what is known about carer burden in families where a young person has an ED, consider the additional impact of COVID-19 and highlight the need for further supportive interventions. This review indicates that carer burden is substantial amongst those caring for a loved one with an ED and additional strain has been placed on carers during the pandemic. Key themes have emerged likely contributing to an increase in carer burden during COVID-19: (1) reduced access to ED services; (2) increased physical vulnerability and exacerbation of psychiatric co-morbidity amongst youth with EDs; (3) increased practical demands placed on carers; and (4) social isolation and decreased social support. Findings from this review aim to inspire further research on how best we can support carers of youth with EDs during the pandemic and beyond.

Objective: Adolescence is a critical period for the maturation of neurobiological processes that underlie higher cognitive functions and social and emotional behaviour. However, there are limited studies that investigated brain volumes in healthy adolescents and young persons. The aim of this study was to compare the Grey Matter (GM), White Matter (WM) and some specific brain subcortical volumes such as hippocampus and amygdala between healthy adolescents and young groups by using VolBrain. Material and Methods: Magnetic resonance imaging brain scans were retrospectively obtained from 20 healthy adolescent and young subjects. The mean ages of the adolescent and young persons were 13±1 and 24±2, respectively. Brain parenchyma (BP), GM, WM and asymmetry features were calculated using VolBrain, and the GM and WM volumes of each subjects were compared with those of the both groups. The current study to examine whether regional gray matter (GM), white matter (WM), cerebrospinal fluid (CSF), some brain subcortical structures volumes differed between healthy adolescent and young groups. Also, of the whole brain, hemispheres, and hippocampus, amigdala of adolescent and young subject volumes were measured with an automated method. Results: We have observed that the young group was found to have a 4 % less in volume of GM, when compared with adolescent groups. Conclusion: Our data indicate that quantitative structural Magnetic Resonance Imaging (MRI) data of the adolescent brain is important in understanding the age-related human morphological changes.

Background and ObjectivesSporadic Creutzfeldt-Jakob disease (sCJD) is the most common form of human prion disease and typically occurs in middle to late life. sCJD in early adulthood is extremely uncommon. The purpose of this report is to raise awareness of cases of sCJD in young patients that are not associated with a genetic mutation or acquired prion disease risk factors.MethodsWe describe the clinical presentation, diagnostic workup, and postmortem examination of a 22-year-old man with sCJD.ResultsThe patient presented with a rapidly progressive neurocognitive disorder consisting of early and prominent psychiatric symptoms. CSF real-time quaking-induced conversion (RT-QuIC) was indeterminate, and brain MRI was suggestive of prion disease. Neuropathologic examination and the absence of a genetic mutation and acquired prion disease risk factors resulted in a final diagnosis of sCJD.ConclusionAlthough extremely rare, sCJD can occur in young people and should be considered in the setting of rapidly progressive neuropsychiatric conditions. Postmortem examination is required to diagnose the type of prion disease and remains important to surveil for known and potentially novel acquired prion diseases.

Internationally, increasing numbers of children and adolescents with gender dysphoria are presenting for care. In response, gender-affirming therapeutic interventions that seek to align bodily characteristics with an individual’s gender identity are more commonly being used. Depending on a young person’s circumstances and goals, hormonal interventions may aim to achieve full pubertal suppression, modulation of endogenous pubertal sex hormone effects, and/or development of secondary sex characteristics congruent with their affirmed gender. This is a relatively novel therapeutic area and, although short-term outcomes are encouraging, longer term data from prospective longitudinal adolescent cohorts are still lacking, which may create clinical and ethical decision-making challenges. Here, we review current treatment options, reported outcomes, and clinical challenges in the pharmacological management of trans and gender-diverse adolescents.

The new KIMO guidelines ‘Oral Health Care for Children’ approach caries as a behavioural related disease and unequivocally assign priority to causal caries treatment, emphasising lifestyle and behavioural changes. The 5-step concept of non-restorative caries treatment (NRCT) is recommended as treatment of choice for cavitated dentine lesions in primary dentition. Communicative aspects of NRCT are supported by limited technical interventions, for the purpose of effective oral care. A balance between aetiological and symptomatic treatment is sought for each child individually, in close cooperation with the parents. Technical aspects per tooth range from limited interventions like making cavities accessible for brushing, applying fluoride varnish or SDF, covering the cavity with a layer of glass ionomer cement to treatment like ART restoration or the Hall technique, in cases of necessity. Lifestyle changes lead to sustainable treatment results and enhance the quality of life of the child or young person.De nieuwe KIMO-richtlijn ‘Mondzorg voor Jeugdigen’ beschouwt cariës als een gedragsgerelateerde ziekte en verleent ondubbel­zinnig prioriteit aan causale cariëstherapie met een accent op leefstijl- en gedragsverandering. Het 5-puntenconcept van niet-restauratieve caviteits­behandeling wordt aanbevolen als eerste keuze bij behandeling van gecaviteerde dentinelaesies in melkelementen. Hierbij worden communicatieve aspecten van de zorg ondersteund door beperkte technische interventie ten behoeve van doelmatige mondzorg. Bij ieder kind wordt in goed overleg met de ouders gezocht naar balans tussen causale behandeling en symptoom­bestrijding. De technische middelen per gebitselement variëren van beperkte interventies als het bereikbaar maken van laesies om effectief te poetsen, het aanbrengen van fluoride of zilverdiaminefluoride, de caviteitsbodem bedekken met glasionomeercement tot noodgrepen in de vorm van ART-restauraties of Hall-kronen. Leefstijlverandering zorgt voor een duurzaam resultaat van behandeling en draagt bij aan de kwaliteit van leven van het kind.

The transition is a key step for adolescents with chronic illnesses, as they are at risk of a disruption in care, complications and even mortality. Accompanying this process is based on two axes: autonomization of the young person (acquisition of knowledge and know-how in a perspective of empowerment) and structuring of the care pathway (transition measures, pediatric/adult service coordination).

Background Gilles de la Tourette syndrome (GTS), characterised by motor and vocal tics, has a prevalence of approximately 1% in school-aged children. Commonly encountered comorbidities of GTS include attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive behaviour/disorder (OCB/OCD). Genetic factors play an important part in the aetiology of GTS, and family members may exhibit tics or related disorders such as ADHD, OCB or OCD. Objective The aim of this article is to present a summary of the current evidence to assist the assessment and management of GTS in primary care. Discussion A comprehensive assessment should include exploration of not only tics but also associated features and comorbidities. The stigmatising and impairing nature of tics can have a significant impact on the quality of life of the young person and their parents/carers, as well as on family functioning. Management includes education and explanation, behavioural treatments and (sometimes) medication.

ObjectiveTo gain a better understanding of uncertainty regarding the illness experienced by parents of children with juvenile idiopathic arthritis (JIA).MethodsParents/guardians of a child or young person (aged less than 18 years) diagnosed JIA were recruited in the United Kingdom via the National Rheumatoid Arthritis Society JIA group. Semistructured telephone interviews were conducted with the parents.ResultsTwenty parents took part, including 19 mothers and one father. Their children with JIA were mostly female (n = 15; 75%) with polyarticular arthritis (n = 12; 60%), averaged 8 years of age, and had been diagnosed for a mean of 3.7 (SD 2.3) years. Parents expressed uncertainty in the following five key domains: diagnosis, cause, symptoms, and prognosis; medical management; impact; parenting uncertainty; and awareness of JIA. All participants expressed uncertainty in at least four of the five domains. Although parents’ uncertainty in the early stages of the disease related to lack of information and understanding of JIA, much uncertainty could not be resolved by receipt of information. These included concerns about their child’s future and a lack of support with managing the emotional aspects of living with JIA.ConclusionWe found that parents’ experiences of uncertainty went beyond dealing with the purely medical aspects of JIA. Provision of information about JIA, although essential, is not sufficient to help parents manage the considerable uncertainty they experience about many aspects of their child’s JIA. Identifying ways to incorporate support for coping with uncertainty into routine care will be an important way of supporting parents to care for their child with JIA.

Purpose Data shows that there is an increasing number of young people in the UK needing access to mental health services, including crisis teams. This need has been exacerbated by the current global pandemic. There is mixed evidence for the effectiveness of crisis teams in improving adult functioning, and none, to the authors’ knowledge, that empirically examines the functioning of young people following intervention from child and adolescent mental health services (CAMHS) crisis teams in the UK. Therefore, the purpose of this paper is to use CAMHS Crisis Team data, from an NHS trust that supports 1.4 million people in the North East of England, to examine a young person's functioning following a crisis. Design/methodology/approach This service evaluation compared functioning, as measured by the Outcome Rating Scale (ORS), pre- and post-treatment for young people accessing the CAMHS Crisis Team between December 2018 and December 2019. Findings There were 109 participants included in the analysis. ORS scores were significantly higher at the end of treatment (t(108) = −4.2046, p Practical implications Despite a possibly overly conservative analysis, 15% of patients not only significantly improved functioning but were able to return to a “healthy” level of functioning after a mental health crisis following intervention from a CAMHS Crisis Team. Intervention(s) from a CAMHS Crisis Team are also stabilising as some young people’s functioning did not deteriorate following a mental health crisis. However, improvements also need to be made to increase the number of patients whose functioning did not significantly improve following intervention from a CAMHS Crisis Team. Originality/value This paper evaluates a young person’s functioning following a mental health crisis and intervention from a CAMHS Crisis Team in the North East of England.

OBJECTIVE A suboptimal quality of life (QoL) has been reported in patients with Graves' disease treated in adult life, but long-term QoL in those treated in childhood and adolescence is unclear. We wanted to understand how Graves' disease and its management impact on the physical, psychological and social well-being of young people and their longer-term QoL. DESIGN, PATIENTS AND MEASUREMENTS Two questionnaires were used to assess QoL and patient experience of Graves' disease; PedsQL™ Generic Core Scales and a Graves' disease questionnaire devised for this project. The anonymized questionnaires were sent to young people (

Introduction Whilst it is recognised that cancer may present numerous challenges for the adolescent or young adult during treatment, experiences after this stage as the young person transitions to life without cancer have received little attention. The purpose of this study is to understand the implications of having survived cancer for the young person’s choice of, and participation in, meaningful occupational roles. Method In this qualitative descriptive study, four participants were interviewed on two occasions using semi-structured interviews, with the subsequent interview supplemented with photo elicitation. Participants were male and female, aged 19 and 24 years, and medically cleared of (living beyond) cancer. Thematic analysis was used. Results Three main themes emerged: changes in relationships; moving beyond; and future perspectives. Adolescents and young adults identified the impact of the cancer experience on interpersonal relationships and related occupational roles (for example parenthood), and described how cancer affected their participation in, and the meaning of, occupational roles, and altered present and future occupational priorities. Conclusion Having cancer as an adolescent or young adult has lasting impacts on occupational roles. Understanding the opportunities and challenges this population may face when living beyond cancer can assist in providing enhanced age-aware occupational therapy, potentially optimising outcomes for young people.

Psychotic experiences (PEs) are robustly associated with subsequent non-suicidal self-injury (NSSI) and suicide attempts, but questions remain as to the temporal relation and underlying cause of this association. Most investigations have incorporated only two waves of data, and no study has comprehensively investigated mediating pathways. This study aimed to investigate both the PE-NSSI and PE-suicide attempt association, and their relevant mediators, across three waves of prospective data. Participants were from an Australian prospective longitudinal cohort of 1100 adolescents (12–17 years); data were collected at three time points over 2 years. NSSI and suicide attempts were measured using the Self-Harm Behaviour Questionnaire. Items from the Diagnostic Interview Schedule for Children were used to assess four PE subtypes (auditory hallucinatory experiences [HEs] and three delusional experiences). Potential mediators of interest included: psychological distress, self-reported mental disorders, self-esteem, recent traumatic life events (e.g. bullying, sexual assault), emotion regulation, and impulsivity/other personality traits. Analyses were adjusted for sociodemographics and substance use. Auditory HEs were indirectly associated with future NSSI and suicide attempts via recent traumatic life events, high psychological distress, and low self-esteem, across three waves of data. Other PE subtypes were generally not associated with incident NSSI/suicide attempts at 1- and 2-year follow-up, either directly or indirectly. These findings highlight the importance of screening for auditory HEs when assessing a young person’s self-harm/suicide risk. Clinical assessment would be further enhanced by a comprehensive review of recent interpersonal traumatic events, as well as levels of self-esteem and distress.

Puberty is a life-changing time in the life of a young person, with physical, psychological and social considerations. Amenorrhea is derived from Latin: a—‘not’, men—‘month’ and rhein—‘flow’, meaning absence of monthly flow. In medical terms, it is a symptom describing absence of menstruation. It can be classified as either primary or secondary. This article will focus solely on primary amenorrhea. Primary amenorrhea can induce great anxiety in both the patient and the family and often presents to the general paediatrician. A thorough history and examination and judicious use of investigations is crucial to ensure timely diagnosis and management.

Objective Clinical trial sponsors spend considerable resources preparing informed consent (IC) and assent documentation for multinational paediatric clinical trial applications in Europe due to the limited and dispersed patient populations, the variation of national legal and ethical requirements, and the lack of detailed guidance. The aim of this study was to design new easy-to-use guide publicly available on European Medicines Agency's, Enpr-EMA website for all stakeholders. Methods Current EU legal, ethical and regulatory guidance for paediatric clinical trials were collated, analysed and divided into 30 subject elements in two tables. The European Network of Young Person's Advisory Group reviewed the data and provided specific comments. A three-level recommendation using 'traffic light' symbols was designed for four age groups of children, according to relevance and the requirements. Results A single guide document includes two tables: (1) general information and (2) trial-specific information. In the age group of 6-9 years old, 92% of the trial-specific subject elements can be or should be included in the IC discussion. Even in the youngest possible age group (2-5 years old children), the number of elements considered was, on average, 52%. Conclusion The EU Clinical Trial Regulation (2014) does not contain specific requirements exclusively for paediatric clinical trials. This work is the first to extensively collate all the current legal, regulatory and ethical documentation on the IC process, together with input from adolescents. This guide may increase the ethical standards in paediatric clinical trials. Young people and researchers gathered together to synthesise and rate the advice from all the EU systems they could find about paediatric clinical trials to create a simpler, patient-led, framework for information to aid meaningful trial consent discussions.

Background Practices to support the transition of a young person from the pediatric to the adult health care setting have been examined for many chronic illness populations. However, specific transition practices to support young people with chronic pain have not been examined. Aim The aim of this study was to describe the current nursing practices used in the pediatric and the adult health care to support transition of young people with chronic pain in Canada. Methods An online survey of pediatric and adult chronic pain nurses’ self-reported transition practices was conducted. Results Twenty-two nurses completed the survey, 10 (45.5%) from the pediatric chronic pain setting and 12 (54.4%) from the adult chronic pain setting. Of the pediatric nurses surveyed none reported using a psychometrically valid tool to assess a young person’s readiness of general transition skills; however, one reported using a tool to assess understanding of chronic pain. Most health care facilities in which these pediatric nurses worked offered a general transition clinic, but only one of these facilities also had a chronic pain transition clinic. Nurses in both settings perceived that young people experience increased levels of distress during transition yet most did not report using formal transition practices in their care. Conclusion Nursing practices and clinic resources to support the transition of young people with chronic pain may not meet the needs of this population. Practices may benefit from the use of psychometrically validated tools to assess general transition preparedness. Research is needed to adapt tools and determine best transition practices for the chronic pain population.

The NHS diabetic eye screening (DES) programme is one of the young person and adult NHS population screening programmes that are available in the UK. The various NHS screening programmes identify those people who appear healthy, but could be at increased risk of a disease or condition. Screening is not the same as diagnosis and there will always be a possibility of some false positive and false negative results. This article in the series provides the reader with details about the DES programme. A brief overview of the anatomy of the eye is provided and the screening process is described. The healthcare assistant and assistant practitioner (HCA and AP) have a key role to play in encouraging and emphasising the importance of screening, as well as helping the individual maintain a healthy lifestyle.

Unaccompanied minors are particularly vulnerable due to their pathway marked with multiple bereavements and constant uprooting. They find themselves confronted with the ordeal of mistrust due to administrative contradictions between the need to protect and immigration control. They are particularly at risk of developing psychiatric pathologies. Care must be multidisciplinary and in continuity with the educational support, taking into account the young person's original culture.

We present the first known case of bilateral, acute ruptures of the subscapularis tendons following a bicycle accident in a 43-year-old male. He underwent right shoulder arthroscopic, anatomic subscapularis tendon repair two weeks postinjury, with the left side staged for surgical treatment six weeks after the index procedure. Postoperatively, the patient remained in a sling for 6 weeks before advancing with therapy protocols. The interval between arthroscopic treatments allowed for independence with activities of daily living and focused, early therapy for each shoulder. This approach yielded a right-sided constant score of 89 and subjective shoulder value of 90%; the left side was 87 and 90%, respectively, at 33 months postoperatively. The patient’s only postoperative complaint was slightly diminished external rotation, a near-universal limitation after unilateral repair. This represents a successful outcome that balances functional independence, concentrated rehabilitation, and adherence to safe indications for primary repair. While bilateral traumatic shoulder injuries in a young person is a rare clinical entity, early and staged treatment can lead to good patient outcomes.

Problematic dyspnoea in young athletes is most commonly due to either exercise induced asthma, exercise induced laryngeal obstruction or a breathing pattern disorder. Pathologies that affect the physiological processes involved in the transport of oxygen from ambient air through to the working muscles can also cause dyspnoea. Other factors including psychology, environmental and sport specific factors can contribute. This review highlights the value of a systematic approach to a young person with difficulty in breathing as a result of exercise. A systematic approach commencing with a detailed clinical history and examination and then investigating as appropriate can help with accurate diagnosis and will guide the appropriate management strategy.

Risk assessments that include dynamic risk factors are increasingly being utilized within the youth justice system to predict a young person’s likelihood to reoffend, to assist with case management, and to better inform intervention services. However, most studies to date have relied solely on single-wave cross-sectional research designs that essentially treat dynamic risk factors as static. Thus, it is unclear whether and how putative dynamic risk factors change over time, a question that has significant implications for assessment and case management policy and practice. Using a widely used and validated risk assessment and case management instrument (the Youth Level of Service/Case Management Inventory), the purpose of the present study was to examine whether the dynamic risk factors outlined in the Risk-Need-Responsivity (RNR) model do in fact change over time and, if so, to investigate the effect of youth-specific predictors on these changes. Two hundred youth offenders were tracked from their first risk assessment conducted at probation to their transition out of the youth justice system. Results from generalized linear mixed modelling (GLMM) and latent class growth modelling (LCGM) analyses indicated that most dynamic risk domain scores increased over time, but that there was significant individual variation among youth at initial status and in the rate of change. Even when controlling for youth-specific factors, youth who were lower risk at the time of initial assessment increased in risk at a greater rate than higher-risk youth. Results have implications for the RNR framework, for improving the accuracy of risk assessments, and for informing treatment implementation.

The aim was to investigate the agreement between the ADI-R Deaf adaptation and ADOS-2 Deaf adaptation overall diagnostic categorisation for autism (AUT) and a wider threshold to include autism spectrum (ASD) in a cohort of deaf children with and without ASD. We compared results of the instruments used on their own and when combined and propose standard criteria for the combined use of the ADI-R Deaf adaptation and ADOS-2 Deaf adaptation for use with deaf children. In total, 116 deaf children had a Gold standard NICE guideline assessment; 58 diagnosed with ASD and 58 without ASD, and for both groups a blinded informant based ADI-R Deaf adaptation and direct assessment using the ADOS-2 Deaf adaptation were separately completed. There was moderate agreement between the ADI-R Deaf adaptation and ADOS-2 Deaf adaptation for the wider threshold of ASD (Kappa, 0.433). To achieve the lowest number of false negatives, the most successful assessment tool approach is using the wider threshold of ASD with either ADI-R Deaf adaptation or ADOS-2-Deaf adaptation (95% sensitivity). This compares with 88% for the ADI-R Deaf adaptation alone and 74% for the ADOS-2-Deaf adaptation alone (wider threshold of ASD). To achieve a low number of false positives, the most successful assessment tool approach is a combination of ADI-R Deaf adaptation and ADOS-2- Deaf adaptation (using the narrow threshold of autism for both) (95% specificity). This compares with 83% for the ADI-R Deaf adaptation alone and 81% for the ADOS-2-Deaf adaptation (narrow threshold) alone. This combination is therefore recommended in specialist clinics for diagnostic assessment in deaf children.

Adolescents who menstruate commonly present to acute paediatric services.

Purpose The U.S. Centers for Disease Control and Prevention recommend screening young women for chlamydia but not young men. One reason young men have not been a focus for chlamydia screening is due to the perceived difficulty of accessing these men. Peers are among the most influential people in a young person’s life. We hypothesized that incentivized peer referral (IPR) could assist in increasing enrollment in this screening study. Methods The Check it Program in New Orleans is a community-based screening program for young Black men aged 15–24. Peer referral was monitored between 3/7/2018–11/28/2020. IPR started on 8/29/2020 during which men enrolled in the parent study were offered $5 for each peer they referred and were successfully enrolled in the study. Results Of 1457 men enrolled in the study, 44 were enrolled after IPR was initiated. The percentage of men who said they were referred by a friend was higher in the post-IPR compared to the pre-IPR period (40.9% vs. 20.0%, P Conclusion Incentivized peer referral significantly increased study enrollment and can serve as a method for increasing screening rates in community-based chlamydia screening programs for young Black men who have sex with women.

ObjectiveTo explore feasibility of using child/young person patient-reported outcome measures (PROMs) routinely in practice, using vision-specific instruments and paediatric ophthalmology as the exemplar.MethodsParticipants comprised patients aged 8–17 years, with visual impairment or low vision (visual acuity of the logarithm of the minimum angle of resolution (logMAR) worse than 0.3 in the better eye), attending the Department of Ophthalmology at Great Ormond Street Hospital, London, UK. All participants completed age-appropriate PROMs before attending their outpatient appointment. Half were randomly assigned to completion at home, with the choice of paper-and-pencil or electronic format. The other half were invited to complete PROMs during their hospital appointment, and randomly assigned to completion format. All participants completed a face-to-face survey exploring their attitudes and preferences. Analysis comprised survival analysis, and direct comparisons of proportions, with complementary qualitative data analysis.Results93 patients participated. 48 (98%) completing PROMs at home chose the paper-and-pencil format. Completion at home took longer than at hospital (median=20, vs 14 min, pConclusionPROM completion at home ahead of hospital appointments may be preferable for collecting complete, high-quality datasets. Despite equipoise on preference for format, the majority of those completing at home chose the traditional paper-and-pencil format, despite impaired sight. These findings should inform implementation of child/young person PROMs into routine practice.

Although there has been a rise in reporting of children and adolescents with bipolar disorder over recent years, it remains a controversial diagnosis and has been heavily debated. There are a number of reasons suggested for this increase, including a genuine rise in prevalence, over-diagnosis or an improvement in accurate diagnosis in practice. It is important to note that in the 2013 update of the DSM-5 the criteria for bipolar disorder have been modified from previous versions. Consequently, those who may otherwise have been sub-threshold, as a result of not meeting the full criteria, can now be diagnosed. Early diagnosis, prompt, evidence-based interventions and person-centred care are key factors in helping the young person to manage their illness successfully across their lifespan.

Aims Iliopsoas pathology is a relatively uncommon cause of pain following total hip arthroplasty (THA), typically presenting with symptoms of groin pain on active flexion and/or extension of the hip. A variety of conservative and surgical treatment options have been reported. In this retrospective cohort study, we report the incidence of iliopsoas pathology and treatment outcomes. Methods A retrospective review of 1,000 patients who underwent THA over a five-year period was conducted, to determine the incidence of patients diagnosed with iliopsoas pathology. Outcome following non-surgical and surgical management was assessed. Results In all, 24 patients were diagnosed as having developed symptomatic iliopsoas pathology giving an incidence of 2.4%. While the mean age for receiving a THA was 65 years, the mean age for developing iliopsoas pathology was 54 years (28 to 67). Younger patients and those receiving THA for conditions other than primary osteoarthritis were at a higher risk of developing this complication. Ultrasound-guided steroid injection/physiotherapy resulted in complete resolution of symptoms in 61% of cases, partial resolution in 13%, and no benefit in 26%. Eight out of 24 patients (who initially responded to injection) subsequently underwent surgical intervention including tenotomy (n = 7) and revision of the acetabular component (n = 1). Conclusion This is the largest case series to estimate the incidence of iliopsoas pathology to date. There is a higher incidence of this condition in younger patients, possibly due to the differing surgical indications. Arthoplasty for Perthes' disease or developmental dysplasia of the hip (DDH) often results in leg length and horizontal offset being increased. This, in turn, may increase tension on the iliopsoas tendon, possibly resulting in a higher risk of psoas irritation. Image-guided steroid injection is a low-risk, relatively effective treatment. In refractory cases, tendon release may be considered. Patients should be counselled of the risk of persisting groin pain when undergoing THA. Cite this article: Bone Joint J 2021;103-B(2):305–308.

Quite recently, speaking about diseases of the knee joint, the discussion, as a rule, was about older people, more often, over 60 years old. Problems such as arthritis, arthrosis, acute arthrosis and other diseases arising from wear and tear of the joint during life came to mind. Nowadays, everything has changed since adolescence. Young people at the beginning of the XXI century, in connection with the development of scientific, technical and computer progress, increases physical inactivity, which leads to various diseases of the musculoskeletal system. Today, a very large number of young people suffer from knee diseases, the genesis of which is mainly post-traumatic or mediated by the growth of pathologies of the knee joint tissues. Injuries can occur due to accidents, but some of them can be triggered by the presence in patients of such chronic processes as connective tissue dysplasia. This disease significantly increases the risks of weakening the ligamentous apparatus of the joint. As a result, the likelihood of injury increases. The article presents the author’s complex of physiotherapy exercises for the restoration of the knee joint (A. A. Pantyushina) after injuries and related operations.

A child or young person (CYP) living with a variety of life-limiting, life-threatening, degenerative, congenital or acquired conditions can be considered to have special healthcare needs. This may take the form of illness or impairment from any physical, developmental, mental, sensory, behavioural, cognitive or emotionally limiting condition that requires medical management, healthcare intervention and access to specialised services. Some may have only mild impairment to their day-to-day function, whilst others may have constellations of very complex needs from birth, or which develop over time.

Paediatric Dermatology is a rewarding and challenging speciality, as it involves managing a child/young person with a skin problem within the context of their parents/carers/family circumstances and psycho-social situation.

Eating disorders can have devastating effects on individuals and families. Maddie Burton explains the crucial role practice nurses can play in identifying and supporting patients Children and young people's mental health conditions have continued to increase. The NHS Digital 2017 survey found that 1 in 8 children have a diagnosable mental health condition. During the current COVID-19 pandemic numbers are set to increase. Eating disorders make up a relatively small proportion of these statistics but have some of the most devastating effects on individuals and families. Anorexia nervosa, as discussed here, has the highest morbidity of any mental health condition. The issues are complex and a challenge to understand for both professionals and families, over typically a protracted period of illness. However, all work with children, young people and their families presents a ‘window of opportunity’ in being able to resolve issues within a developmental phase prior to the more concrete adult phase. The risk is highest for young people between the ages of 13 and 17 years. There are several theoretical models that aid understanding of how and why eating disorders emerge and are maintained. Practice nurses in primary care can have a crucial role in early identification and can be found to be less stigmatising than mental health professionals. Practice nurses can have an ongoing role in remaining involved with the young person and their family and as part of the wider specialist support system.

Aims NICE guidance (NG43) recommends that planning for a young person transitioning into adult healthcare should start at 13–14 years. An integral part of transition planning is educating both patient and carers about what is going to happen during transition. We aimed to demonstrate how written information is being distributed and what role it plays on patient experience. Methods A survey about patient experience was co-designed with young people. The survey was delivered by researchers and young people in all outpatient departments in a tertiary paediatric hospital. Patients and their carers were asked to complete a survey about their experience. Staff were surveyed about departmental practice in transition information. Results 556 paediatric patients completed the survey. We found that 13.0% of patients reported receiving transition information (median age 16 years). When patients were asked what would make them feel more prepared for transition, 77% would like more information relating to transition. Patients who received written information reported it as ‘Useful’ or ‘Very useful’ (48/63, 76.2%). Patients who received written information on transition had a better care experience (mean increase 11.3%, p=0.0004), improved self-perceived preparedness (mean increase 32.4%, p The analysis of 271 carer responses is shown. Carers of patients showed similar findings with an improvement in carer care experience (6.2%, p=0.025), a reduction in transition anxiety (31.9% reduction, p Staff were asked if their service handed out information on transition, with 24/58 (41.4%) reporting that their service did give out written information. Conclusions Our study suggests that having written transition information has an association with an improved care experience, reduced transition anxiety and feeling more prepared for the transition in paediatric and carer groups. Information on transition is thus highly effective. However, it is clear that more written information on transition should be provided to empower carer and patient groups about the transition into adult healthcare.

Introduction All post pubertal females presenting with breast lumps were previously sent to the paediatric oncology clinic via the 2 week wait pathway. They would be seen in clinic, examined and when a lump was confirmed an out patient ultrasound was then requested (on a separate day, usually a few weeks later). The young person would then re-attend the oncology clinic to get the results and management plan before finally being discharged. The whole process could take up to 6 weeks. Gp surgeries would usually advise families incorrectly that a scan would take place on the same day. When this then didn’t happen this would lead to additional anxiety on top of the fear that their young person could have cancer (even though that was never the case). Aims To streamline the process so that it resembled the adult one stop process (minus the biopsy) thereby alleviating fears and worries quickly and minimizing hospital visits. Method An average 35 post pubertal females were referred in annually with breast lumps to the paediatric oncology clinic. Two female pediatricians with an interest in oncology met with adult breast surgeon and breast radiologist to agree a one stop pathway. One radiology slot identified at the start of the adult clinic that could be utilized by adolescent if lump identified in new patient clinic slot. Results One stop pathway set up with patient information leaflet (Adolescent focused highlighting benign nature of these type of lumps) sent to families prior to appointment setting out process and likely outcome. Well evaluated by adolescents and families. No loss of income to trust Conclusions An efficient pathway that reduces time to diagnosis and management plan thereby alleviating anxiety and reducing time out from school/off work (parents). Historically GP’s assumed that scans would happen on the same day and so incorrectly advised patients. By matching the adult process this is avoided. Could similar one stop pathways be used for other adolescent conditions and transition pathways as they are in adults?

A pubertal assessment is an important part of the clinical examination of a young person. Clinicians must be empowered to do this confidently and in a sensitive manner. Tanner staging allows an objective measurement of pubertal status, including pubic and axillary hair growth, and breast or genital development. Alongside history, age and growth patterns, pubertal assessment can identify normal, precocious, delayed or arrested puberty and be suggestive of underlying pathology. This article aims to familiarise clinicians with the pubertal assessment, both the examination and interpretation.

This article discusses the treatment of a young person with obsessive-compulsive disorder (OCD) characterized primarily by symptoms of physical and mental contamination, as well as religious obsessions. The treatment was complicated by several factors that will be reviewed and addressed. First, this client had a comorbid diagnosis of attention-deficit/hyperactivity disorder. Second, the young client's mother was also diagnosed with OCD and had a significantly anxious presentation. This impacted treatment in two primary ways. One important way treatment was complicated was that the client frequently attempted to manage her mother's emotions by underreporting her own distress at times. The other implication of the mother's diagnosis was that it became difficult to involve her in the treatment of her daughter and reduce her accommodation of her daughter's symptoms. The manner in which these complicating factors were addressed in the successful treatment of this client by adapting evidence-based practice will be presented as a guide for clinicians facing similar challenges.

Background This first mixed-methods UK trial examined the feasibility and acceptability of a future definitive randomised controlled trial (RCT) to evaluate whether Family Focussed Treatment for Adolescents with Bipolar Disorder (FFT-A) UK version can improve family functioning and well-being as part of the management of Paediatric Bipolar Disorder (PBD). Method The trial used a randomised, parallel group, non-blinded design where participants received FFT-A UK (16 sessions over 6 months) immediately or after 12 months (delayed arm). Measures of family functioning, well-being and quality of life of the young person and the main carer (most commonly a parent) were completed at baseline, 6 and 12-months in both arms. Primary outcome measures included rates of eligibility, consent and retention along with estimates of variability in the measures and assessment of the intervention delivery. Qualitative interviews allowed assessment of participants’ views about FFT-A and the trial processes. Results Twenty-seven of 36 young persons with PBD and their families consented; of these, 14 families were randomised to the immediate and 13 to the delayed arm. Two families from the immediate arm withdrew consent and discontinued participation. Quantitative measures were completed by 22 families (88%) at 6-months and 21 families (84%) at 12-months. Qualitative interviews were conducted with 30 participants (9 young people, 15 parents and 6 other family members). Nine families attended 3 post-trial focus groups. Conclusion It was feasible to recruit and retain to this trial. The results highlighted that trial design and measures were acceptable to participants. A benefit in family relationships was reported by participants which they attributed to the intervention in qualitative interviews. Families recommended that future modifications include definitive trial(s) recruiting participants in the age range 15–25 years as it felt this was the age range with maximum need. Trial registration ISRCTN, ISRCTN59769322. Registered 20 January 2014, http://www.isrctn.com/ISRCTN59769322

Over the last decade, we have seen young people living in an increasingly sexualised society. There has been a growing recognition of behaviours that identify a young person at risk of child sexual abuse (CSA) or exploitation (CSE), emerging evidence indicating that sexually transmitted infections (STIs) in under-16 year olds are a marker of CSE,1 and successful prosecution of high profile CSE cases. These factors, alongside new legislation and policies, have necessitated an update to the UK National Guideline on the Management of Sexually Transmitted Infections and Related Conditions in Children and Young People (2010) . The epidemiology of STIs in young people in the UK is discussed in the Epidemiology section of the guideline. Importantly, rates of STIs continue to be high in 16–19 year olds, with the most …

Background A 12-year-old female with JIA on biologic medication (IV abatacept every three weeks) presented with a first generalised tonic-clonic seizure on background of preceding headache and fatigue. The seizure self-terminated but disorientation and encephalopathy ensued. MRI brain demonstrated lesions with high signal intensity in the left periventricular and right occipital regions. The clinical picture and radiological imaging suggested a broad differential diagnosis including CNS infection, JC virus associated progressive multifocal leucoencephalomalacia (PML), acute disseminated encephalomyelitis (ADEM) and Anti-N-methyl-d-aspartate receptor (NMDAr) encephalitis. She was commenced on IV ceftriaxone, acyclovir and clarithromycin. All bloods including inflammatory markers and infection serology were unremarkable. CSF was acellular and JC virus PCR negative. NMDAr encephalitis was initially considered unlikely (pre-existing immunosuppression, abnormal MRI brain and no evidence of ovarian teratoma on abdominal MRI pelvis). However more classical clinical features developed including further seizures, significant movement disorder, cognitive dysfunction, sleep and speech dysfunction. Anti-NMDAr antibodies in both serum and CSF were positive. She made a good recovery following IV steroids, plasmapheresis and rituximab and was discharged home after a 10-week admission. NMDAr encephalitis developed three years after commencing abatacept treatment. Previous immune modulating treatment included methotrexate (since age 2 years), Etanercept (age 5-8 years) and Tocilizumab (aged 8-10 years). Flares of disease following a period of control necessitated the changes in therapy. Methods A literature review was conducted to explore the relationship between NMDAr encephalitis and biologic medication. A yellow card report and information request to abatacept manufacturer were also submitted. Results No previous cases of NMDAr encephalitis in patients on abatacept or paediatric cases related to biologic therapy are described. There are reports of adults developing NMDAr encephalitis on Adalumimab for Crohn’s disease and etanercept for rheumatoid arthritis. NMDAr encephalitis has also been described in patients on immune checkpoint inhibitors for malignant melanoma (nivolumab and ipilimumab). Known triggers of production of anti-NMDA receptor antibodies include tumours (ovarian teratoma; rarely associated in patients under 12 years) and viral infections. Developing autoimmune disorders on biologic medication is well reported, most notably psoriasis and inflammatory bowel disease. In relation to abatacept specifically, the development of anti-nuclear antibodies (ANA) and psoriasis have been described. However, patients with autoimmune disorders are known to be of increased risk for additional immune disease. A new cohort of patients are emerging who have received multiple biologic medications and the development of autoimmune conditions despite immunosuppression needs to be considered. Conclusion We describe the first case of NMDAr encephalitis occurring in a child on abatacept therapy, and the first case in JIA. We are unable to determine what contribution a history of autoimmune disease or immunomodulating therapy has made on its development in this case. Disclosures R. Close: None. P. Bale: None. K. Gallagher: None. G. Ambegaonkar: None. T. Rossor: None. N. Abbassi: None. K. Armon: None.

Background Prenatal alcohol exposure (PAE) can result in permanent disability, including physical, neurodevelopmental, and cognitive impairments, known as fetal alcohol spectrum disorder (FASD). Individuals with FASD are more likely to engage with the law, including being placed in detention, than individuals without FASD. Young people who were sentenced to detention participated in a FASD prevalence study in Western Australia. The diagnosis of FASD requires a multidisciplinary assessment and confirmation of maternal alcohol consumption during pregnancy. Obtaining accurate assessment of PAE for young people participating in the study was challenging. Methods An interview with the birth mother or other responsible adult for young people sentenced to detention in Western Australia was conducted as part of the FASD assessment. The Alcohol Use Disorders Identification Test consumption subset (AUDIT‐C), other relevant questions, and documentary evidence were used to assess PAE. PAE was categorized according to the Australian Guide to the Diagnosis of FASD: no PAE reported, confirmed or confirmed high‐risk, or unknown. Results Among the 101 participants, information on PAE was unable to be obtained for 13 (13%) young people. Of the remaining 88 participants with information of PAE, 41 reported no PAE and 47 had confirmed PAE. Conclusions Accurately assessing prenatal alcohol consumption is challenging in any setting, but it is exceptionally challenging when assessed 13 to 17 years retrospectively as part of a FASD assessment for a young person sentenced to detention. Recording and recoding detailed qualitative responses was required to provide an accurate assessment of PAE using the AUDIT‐C. Standardized recording of PAE in antenatal and birth records would facilitate later assessments for FASD and provide opportunities for advice and support for women who continue to drink during pregnancy., This study discusses the challenges of assessing prenatal alcohol exposure (PAE) as part of a fetal alcohol spectrum disorder assessment for young people sentenced to detention in Western Australia. PAE was assessed using the AUDIT‐C with the birth mother or another responsible adult who was present during the mother's pregnancy. Recording and recoding detailed qualitative responses was required to provide an accurate assessment of PAE, as recalling prenatal alcohol consumption retrospectively, 13 to 17 years post‐pregnancy, is challenging.

Key Clinical Message The diagnosis of cutaneous metastasis of renal cell carcinoma is challenging in a young person in absence of a prior history of cancer. In such situation, fine needle aspiration alone as a minimally invasive procedure can provide rapid, accurate and cost effective diagnosis, even in case of unknown primary.

Meeting shortfalls in the provision of care to adolescents and young adults with cancer has focused largely on improving outcomes and psychosocial support. A significant percentage of adolescents and young adults with cancer will die of disease because of initial poor prognosis conditions or disease relapse. In adults, progress has been made in the concept of an integrated cancer/palliative care service. In pediatric oncology, the application of this philosophy of care has lagged behind somewhat. In the case of adolescents, particularly those with advanced cancer, the palliative care needs, in a broader sense than only end-of-life care, are often not adequately met, irrespective of whether treatment is delivered in a pediatric or adult cancer service. There are a number of age-specific aspects to palliative and supportive care for adolescents. Complex interactions between clinicians, parents, and patients potentially limit the young person's ability to influence care planning. The wide variation in real or perceived competency at this age, the developmental challenges in relation to behavior, communication, and coping strategy all require particular professional expertise that is not always available.

Neglect is defined as the persistent failure to meet a child or young person's basic physical or psychological needs. Dental caries is explicitly mentioned in guidance on child maltreatment. We discuss the link between dental caries and child abuse in patients presenting to the emergency department.A review of patient medical records was undertaken within the Paediatric Emergency Department at Sunderland Royal Hospital, with the aim to determine whether neglect was considered as a possible contributory factor when a child or young person presented at triage with an "oral cavity" problem.Of the applicable cases with inferences of possible safeguarding concerns, 13% had these concerns documented.Child abuse recognition has become a prominent issue in recent years due to high profile cases. It is clear from this work, which resonates with the reported literature, that there is a lack of recognition of dental neglect being a possible indicator of more systemic abuse.There is likely underreporting of these cases to the relevant authorities.

The adverse impact of skin diseases on an individual's physical and emotional well-being is well recognised, particularly in children as it is reflected in their growth and development. Conversely, the psychological and psychosocial issues that a child or young person may face, can manifest as a skin problem. Cutaneous manifestations of an underlying primary psychiatric problem are a poorly recognised entity amongst paediatricians. Limited knowledge and experience in this realm increases diagnostic and management challenges. The discipline of Psychodermatology attempts to address these problems by relating skin disease to intrinsic and extrinsic mental health factors. This review summarises the current literature on Psychocutaneous conditions with expert opinion from the authors own experience. The importance of a holistic approach in a multidisciplinary setting to manage this vulnerable group of children and young people cannot be over-emphasised.

The manifestation of glenohumeral arthritis in the young adult is a devastating occurrence that can be difficult to manage. This review details the many underlying etiologies including genetic causes, congenital abnormalities, glenohumeral instability, posttraumatic lesions, postcapsulorraphy arthropathy, osteonecrosis, intraarticular pain pump postoperative use, radiofrequency/thermal capsulorraphy treatments, septic arthritis/infection, and inflammatory arthropathies. Although each of these potential causes have been well-studied, their contributions to the development of glenohumeral arthritis in the young person has not been described extensively.

A common presentation to the general paediatric clinic is a child or young person’s difficult bowel habit, which is often a potent source of anxiety for parents and carers. A large proportion of these children will have a functional cause for their symptoms, with unnecessary investigation and non-evidence-based treatments adding to their difficulties. This article aims to explain what encompasses the normal bowel habit in children and young people, reassure where appropriate and identify those patterns that may be suggestive of a disorder or disease requiring treatment. We illustrate both extremes of the spectrum of normal bowel habit in children with two case studies.

Background Fetal Alcohol Spectrum Disorder (FASD) is a condition caused by prenatal alcohol exposure and characterised by lifelong physical, behavioural and cognitive abnormalities. Primary disabilities, such as impairment in memory, attention, cognition, language, executive function, and adaptive function, can lead to young people with FASD becoming engaged with the justice system. Little is known about the extent of FASD in youth detention in Australia, or of the capacity custodial staff have to manage and support young people with FASD. In tandem with a study assessing the prevalence of FASD among youth in detention in Western Australia (WA), this study aims to establish the current knowledge, attitudes, experiences and practices regarding FASD and other neurodevelopmental impairments among youth custodial officers in order to develop training resources for this workforce. Methods We invited youth custodial officers in the only youth detention centre in WA to participate in an online or hardcopy survey. The survey was developed following extensive consultation with the workforce and investigated their knowledge, attitudes, experiences and practices relating to FASD and other neurodevelopmental impairments. This included experience working with young people with FASD and other impairments, and attitudes towards relevant training. Results 112 youth custodial officers (51% of the youth custodial workforce) completed the survey. While many respondents had heard of FASD (77%) and understood it is relevant to the justice system (74%), limited in-depth FASD knowledge existed. Many respondents were unsure or unaware that FASD is permanent brain damage (53%) and cannot be outgrown (57%). Respondents were infrequently informed if a young person in detention had a diagnosis of FASD. Almost all custodial officers indicated motivation to complete training to further understand FASD (92%) and other neurodevelopmental impairments (94%), with particular interest in the application of management strategies appropriate for affected young people. Conclusions A lack of specific knowledge, inadequate training to recognise and manage young people with neurodevelopmental impairments, and inconsistent information-sharing processes reduce the ability of the custodial workforce to care for young people with FASD and other neurodevelopmental impairments. These findings have supported the development and evaluation of training resources targeting the specific needs and requests of the WA youth custodial workforce, and this is now underway.