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-A 14-year-old boy with recent antibiotic treatment for tonsillitis, presented to the emergency department with 1-week history of worsening rash and haemorrhagic bullae involving the bilateral legs, trunk and hands (figures 1 and 2). Laboratory results were significant for proteinuria (2+protein) and haematuria (1+, 5-10 red blood cells/high power field); 24 hours urinary protein and renal function were within normal limits. The patient had an inconclusive skin biopsy.edpract;106/6/352/F1F1F1Figure 1Left and right images show palpable purpura with some overlying bullae and vesiculation coalescing into plaques on both lower extremities.edpract;106/6/352/F2F2F2Figure 2Left image shows rash on abdominal wall and right image shows coalesced haemorrhagic bullae on hands. QUESTIONS: What is the most probable diagnosis?Bullous Ig A vasculitisMeningococcemiaBullous impetigoEosinophilic granulomatosis with polyangiitisCryoglobulinemiaWhat is the best test which will establish the diagnosis in this patient?Renal ultrasoundRenal biopsyAbdominal ultrasoundCreatinine clearanceWhat is first line of treatment in this patient?AntibioticsSteroidsSurgical debridementMultispecialty consultationImmunosuppressants such as azothioprineWhat other systems can this condition affect besides the skin?LungsKidneysSpleenNervous systemA, B and D Answers can be found on page 02. [ABSTRACT FROM AUTHOR]

A 12-year-old boy was admitted to the paediatric ward with a 4-month history of worsening pain and bruising to his legs, which had resulted in a progressive reduction in his mobility. He initially had had difficulty weight bearing, which had then progressed further making him wheelchair bound. On examination, there was extensive bruising (figure 1) to his oedematous legs, worse on his right leg compared with his left. His background of autism and 15q13.3 deletion, along with maternal learning difficulties, made deciphering a clear history difficult. However, there was no account of trauma, and he had been afebrile throughout his illness. He had though lost 6 kg in weight but remained clinically stable. He was admitted to the ward for further assessment.edpract;106/6/350/F1F1F1Figure 1Clinical photograph showing bilateral bruises and swellings of the legs. QUESTION 1: What differentials should be considered? QUESTION 2: What investigation is more likely to suggest the diagnosis?Baseline bloods: full blood count-including platelets, albumin and coagulation.Extended bloods: vasculitis screen, erythrocyte Sedimentation Rate, endocrinopathies and iron studies.Doppler ultrasound calves.X-ray legs/hips.MRI tibia and fibula.Initial investigations showed a haemoglobin of 67 g/L, with mean cell volume of 76 fL. Platelet count and white cell counts, including differentials, were all within range. Infection markers, renal function tests, liver function tests and clotting screens were all normal. Leg X-rays were performed and showed no obvious fracture. However, there were some bone changes noted that had not been present 4 months prior during a previous presentation.USS Doppler of his calves were done, excluding deep vein thrombosis.Further investigations as to possible causes of his anaemia and other symptoms were then started, including rheumatology screens, haemaglobinpathy screens, endocrinopathies and viral screens. These results, along with vitamin D levels and bone profile, all came back normal. However, iron studies showed low serum iron and transferrin saturation. He had been empirically treated with a course of intravenous ceftriaxone on admission, which was subsequently stopped in view of lack of any evidence (clinically, radiologically or otherwise) of osteomyelitis, septic arthritis or other infective state.His behaviour on the ward, however, quickly raised some questions; in particular his detailed dietary history showed a very limited range, consisting solely of chicken nuggets, chips and pizza.Therefore, while awaiting results of any definite 'cause' of his immobility, his care was managed holistically. He was started on oral iron therapy and a strict dietary plan, including Ensure supplements. Physiotherapy was started, and various methods to encourage him to mobilise were commenced. His reluctance to engage with these 'treatments' initially caused problems, however through negotiation of 'iPad time' with compliance, they were slowly built up. Along with other professionals, the safeguarding team were also involved in his care at this point.Though a clear diagnosis was still unclear, he clinically improved. Oedema of his legs and bruising reduced, and he was able to mobilise a few steps further each day on the ward. QUESTION 3: What is the most likely action that would help confirm the diagnosis?Bone marrow biopsy.Full-body MRI.Complete nutritional history.Referral to tertiary orthopaedic centre. Answers can be found on page 02. [ABSTRACT FROM AUTHOR]

Improving rates of appropriate skeletal survey use in a district general paediatric emergency department. [ABSTRACT FROM AUTHOR]

Implementation and review of a multidisciplinary Balint group in the paediatric and neonatal units of a busy district general hospital. [ABSTRACT FROM AUTHOR]

The author discusses the need for paediatricians to do more in dealing with male adolescent sexual health. Young people have the right to be informed and access proper health care services about their health, including sexual matters. 35% of annual adolescent health visits did not mention sex at all, according to a recent study by S. C. Alexander et al.

The article presents a case study of a 6-year-old boy who was presented with a 24-hour history of purpuric rash on both of his legs with swelling and ankle pain. The patient had no abdominal pain and examination found a normal urinalysis and normal blood pressure for his age. Diagnosis of Henoch- Schönlein purpura (HSP) was made and was admitted for pain relief provided he was unable to weight bear.

Aims High referral volumes to paediatric orthopaedic surgeons create long clinic waiting lists. The use of extended scope roles for doctors and health professionals is one strategy to address these wait times. We completed a 6-month trial of a non-surgical paediatric orthopaedic physician role ( NSP) to help manage non-urgent referrals to our service from local general practitioners ( GPs). Methods For a 6-month period, the majority of non-urgent GP referrals were assessed by a US-trained NSP. Wait times were compared between this period and the same time period in the previous year. Family and referrer satisfaction was determined through postal surveys. Results Over the trial period, the NSP saw a total of 155 new patient referrals, which represented 49% of all non-urgent GP referrals for the period. Before the trial, only 75% of non-urgent referrals were seen within 131 days (19 weeks) with 10% waiting more than 215 days (31 weeks). By the end of the trial, 75% of referrals were seen within 55 days (8 weeks) and 90% within 61 days (9 weeks). The most common outcome was discharge with management advice. 12% of patients were referred on to an orthopaedic surgeon but only 1% went on to a surgical wait list. Families and referrers reported high levels of satisfaction and only three patients discharged by the NSP were referred back for orthopaedic surgeon review. Conclusion The NSP role was effective at reducing clinic wait times for patients with non-urgent paediatric orthopaedic conditions, while maintaining family and referrer satisfaction. [ABSTRACT FROM AUTHOR]

Although the phrase 'evidence-based medicine' ( EBM) was used for the first time in the medical literature less than 25 years ago, the history of EBM goes back for centuries. What is remarkable is how popular and how globally accepted the EBM movement has become in such a short time. Many famous, past clinicians have played major roles in the disciplines that preceded EBM, particularly 'clinical epidemiology'. It soon became clear to the early EBM champions that 'evidence' was only part of the clinical decision-making process. Consequently, both clinical expertise and the patient's values and preferences were rapidly incorporated into the concept we now know as ' EBM'. The current need for high-quality, easily accessible 'evidence-based summaries' for busy clinicians is now apparent, as traditional EBM requires both considerable time and skill. Consequently, there is a progressive move away from the primary literature (such as randomised controlled trials) to systematic reviews and other 'evidence-based summaries'. The future of EBM will almost certainly involve widespread utilisation of 'clinical (computer)-based decision support systems'. [ABSTRACT FROM AUTHOR]

Since the J ournal of P aediatrics and C hild H ealth was first published, there has been substantial change in the field of autism spectrum disorders ( ASDs) with an exponential increase in the amount of funded and published research. In this paper, we focus on regression in children with ASD, a phenomenon that remains poorly understood. We discuss the implications of what we know about regression in ASD for the way we think about ASD more broadly and for paediatric practice. [ABSTRACT FROM AUTHOR]

We identified 244 relevant articles pertinent to indigenous health (4% of the total) with a steady increase in number since 1995. Most Australian publications in the journal (with a small Indigenous population) have focussed on conditions such as malnutrition, diarrhoeal disease, iron deficiency, rheumatic fever, acute glomerulonephritis and respiratory and ear infections, and in settings where nearly all affected children are Indigenous. In contrast, New Zealand publications (with a large Maori and Pacific Islander population) have addressed important health issues affecting all children but emphasised the over-representation of Maori and Pacific Islanders. Publications in the journal are largely descriptive studies with relatively few systematic reviews and randomised trials. Our review attempts to cover the important Indigenous health issues in our region as represented by articles published in the Journal. The studies do document definite improvements in indigenous child health over the last 50 years. [ABSTRACT FROM AUTHOR]

In this article, we address how general paediatrics has evolved and adapted to change over the past 50 years and speculate on its future directions. We compare the state of general paediatrics with that of general adult medicine. We argue that general paediatrics must continue to have a strong role both in paediatric teaching hospitals and the community. [ABSTRACT FROM AUTHOR]

Aim The diagnosis and management of paediatric chronic fatigue syndrome/myalgic encepnalomyelitis ( CFS/ ME) represent ongoing challenges for paediatricians. A better understanding of current approaches at a national level is important in informing where research and education could improve treatment outcomes. We aimed to examine current diagnosis and management practices for CFS/ ME by Australian paediatricians. Method An online survey was sent to members of the Australian Paediatric Research Network. The primary outcomes of interest included diagnostic criteria used, medical investigations and management practices in paediatric CFS/ ME. Results One hundred seventy-eight (41%) of 430 eligible paediatricians responded, with 70 of the 178 (39%) reporting that they diagnose and manage CFS/ ME as part of their practice. Medical investigations used for diagnosis were variable. Conditions that more than half of the paediatricians reported as commonly co-occurring (i.e. present in >50% of cases) included somatisation disorders, anxiety, depression and fibromyalgia. There was wide variation in behavioural and pharmacological management strategies but most paediatricians commonly engaged a school teacher, physiotherapist and/or psychologist as part of their management. Conclusion The diagnostic and management practices of paediatricians for CFS/ ME within Australia vary widely. This likely reflects a paucity of paediatric-specific guidelines, together with limited evidence to guide best practice and limited training in this area. There is a need for guidance and education for the diagnosis and management of paediatric CFS/ ME in Australia. [ABSTRACT FROM AUTHOR]

Training of general paediatricians in the UK has produced high quality doctors with skills to deliver holistic care to the broad range of children presenting to secondary services with undifferentiated illness. They also play a key role as part of a regional network of care involving deployment of subspeciality knowledge and skills. Current recommendations from the Shape of Training review (Oct 2013) from Professor Greenaway emphasise the importance of the generalist who has important skills to deal with the majority of problems presenting to hospitals and community services and to filter those children requiring expert specialist services and direct them appropriately. There are significant problems with this vision of a shorter training time which coupled with current overproduction of CCT holders and subspecialists means that revision of the balance of training between generalists and subspecialists is needed. Changes in population needs mean that a revision of the current content of general paediatric training is also required. This should include more skills to deal with the rising tide of emotional and mental health problems and skills in the areas of quality improvement, team leadership and system analysis. [ABSTRACT FROM AUTHOR]

Aim To describe the characteristics, circumstances and consequences of dog bite injuries in children in order to inform the discourse concerning preventative approaches. Method A retrospective review of children presenting to the emergency department ( ED) of the Women's and Children's Hospital ( WCH) in South Australia between the years 2009 and 2011 was performed. Results A total of 277 children presented to the WCH with dog bite injuries between 2009 and 2011. Of those, 141(51.0%) were referred for admission. Injury rates were highest in those aged 0-4, declining thereafter with age. In the 0-4 year age group, 89.5% of children presented after being bitten by a familiar dog with 92.5% occurring at home. The head/neck region constituted the most common location for injuries. We found that 67.5% of dog bite injuries were provoked and occurred between the child and a familiar dog (78.0%). Dogs from the bull terrier group (20.0%) and Jack Russell Terriers (11.0%) were the two most documented breeds. Almost half of the children presenting during the specified timeframe required at least one operation under a general anaesthetic. Two children were referred to a psychologist for management of post-traumatic stress. Conclusion Dog bite injuries are common in children and often require admission for inpatient care. This presents as a significant public health burden. For this reason, prevention initiatives need to be implemented on an ongoing basis. [ABSTRACT FROM AUTHOR]

Epidermal nevus syndrome ( ENS) is a rare congenital disorder. It is characterised by epidermal nevi and abnormalities of multiple organs, including central nervous system, skeleton, cardiovascular and genitourinary systems and eyes. Hypophosphatemic rickets-associated ENS has rarely been reported. We report a 46-month-old girl who presented with a classical feature of hypophosphatemic rickets. Examination of skin revealed multiple melanocytic nevi at her trunk, face and both arms with verrucous plaques at both axillae and neck, and yellow plaques at the back along Blaschko's lines. Histopathology of the skin lesions was compatible with epidermal nevi and nevus sebaceous. Therefore, the diagnosis of ENS was made. Apart from typical rickets, the skeletal X-rays interestingly displayed fibrous dysplasia-like lesions along right femur, tibia and fibula. Hypophosphatemic rickets was treated with alfacalcidol and phosphate solution. After 3 months of treatment, clinical improvement of hypophosphatemic rickets was clearly demonstrated. Her blood chemistries were normalised at 5 months following the treatment. In conclusion, hypophosphatemic rickets is a rare presentation of ENS. Our patient also demonstrated an additional abnormal bone finding, fibrous dysplasia-like lesions, associated with rachitic changes. This highlights heterogeneity of this condition and importance of thorough evaluation of patients with ENS. [ABSTRACT FROM AUTHOR]

Aim There are a number of genetic and environmental factors that are associated with an increased risk of developing coeliac disease. Our aim was to determine whether socio-economic deprivation increases or reduces the development of the disease. Methods A cross-sectional study identified all children <16 years old diagnosed with coeliac disease in the same tertiary paediatric centre between January 1995 and December 2011. Data, including age at diagnosis and postcode, were collected and linked with the quintile rank of the Welsh Index of Multiple Deprivation score 2008, a measure of socio-economic status. Results We included 232 patients and identified a graded association between the prevalence of coeliac disease and socio-economic deprivation, which showed a higher rate in children living in more affluent areas. The largest difference was between the lowest deprivation level (rate/1000 = 1.16) and the highest deprivation level (rate/1000 = 0.49). Conclusion In our population, coeliac disease was more common in children in the higher socio-economic groupings. The reasons for this are not clear, but perhaps both the 'hygiene hypothesis' and the health seeking behaviours of parents with high socio-economic status are possible factors in the more frequent diagnosis of coeliac disease in this group. [ABSTRACT FROM AUTHOR]

The large decline in deaths due to the sudden infant death syndrome ( SIDS) in the last 20 years in many countries is largely due to risk-reduction advice resulting from observational studies that examined the relationship between infant care practices and SIDS. Most of this advice remains largely uncontroversial and educators and researchers in this field are in agreement as to the specific recommendations that should be given to parents and health professionals. However, advice surrounding the apparent protective effect of dummies (also known as pacifiers) has been controversial. Several systematic reviews have demonstrated a strong association between the lack of a pacifier being used by the infant for the final sleep and SIDS, but it is not clear how pacifiers confer protection or if this is a marker for something as yet unmeasured. The Epidemiology and Physiology Working Groups of the International Society for the Study and Prevention of Perinatal and Infant Death ( ISPID) are comprised of leading SIDS researchers with an objective to provide evidence-based position statements surrounding the factors associated with SIDS () and risk-reduction strategies. The evidence, discussion and conclusions from these working groups regarding dummies (pacifiers) are described below to help inform this debate and describe the future evidence required so that we might find a common recommendation about dummies (pacifiers) and SIDS. [ABSTRACT FROM AUTHOR]

Aim While it has been widely recognised in Australian and overseas studies that parents tend to underestimate the weight of their overweight or obese child, there is an opportunity for further research within rural populations. The aim of this study was to assess the agreement between a parent's perception of their child's weight category and the child's measured body mass index ( BMI). Methods Cross-sectional pilot study in Dubbo, a large regional centre in western New South Wales in Australia. Ninety-three subjects between the ages of 2 and 17 were recruited from the paediatric inpatient unit of the region's base hospital. Trained nursing staff undertook the anthropometric measurements, while a parent or caregiver was asked to complete a questionnaire assessing their perception of their child's weight category. Results Thirty-two per cent (30/93) of all parents underestimated the weight category of their child, while only 2% (2/93) of parents overestimated their child's weight category. Overall, 66% (61/93) of parents correctly identified their child's measured weight category. Twenty-nine per cent (27/93) of the sample population was overweight or obese, and in these children, 89% (24/27) of parents underestimated the weight category of their child. Conclusion There is a major discrepancy between the child's measured BMI and their parent's perception of their child's weight category. This finding is consistent with similar past research and has important implications for the management of obesity in children. Further qualitative research may be helpful in ascertaining the reasons for this discrepancy. [ABSTRACT FROM AUTHOR]

Aims The primary aim of this study was to determine the frequency of vit D deficiency/insufficiency in an opportunistic sample of Northern Territory ( NT) children. The secondary aim was to evaluate whether: (i) 25( OH)vit D (25( OH) D) levels differ between Indigenous/non- Indigenous children; and (ii) Vit D insufficiency is associated with increased acute/infective hospitalisations. Methods Twenty-five ( OH) D levels were measured in 98 children <16 years between August 2011 and January 2012 (children hospitalised acutely/non-acutely and well children from other studies based in Darwin). Vit D deficiency was defined as 25( OH) D < 50 nmol/L, and insufficiency was postulated to be <75 nmol/L. Demographic data were collected, and computer records were reviewed. Results Median age was 59 months (range 2-161); 3.1% were vit D deficient, 19.4% insufficient. There was no significant difference in mean 25( OH) D level between Indigenous (93.2, standard deviation ( SD) 21.9, n = 42) and non- Indigenous (97.3, SD 27.9, n = 56) children ( P = 0.32). Median number of hospitalisations/year were similar ( P = 0.319) between vit D sufficient (0.34, range 0-12, n = 76) and insufficient (0.22, 0-6, n = 22) children. There was no significant difference between number of infective admissions per year between vit D sufficient/insufficient groups ( P = 0.119). Conclusions Compared with US data (19% deficient, 65% insufficient) fewer NT children are vit D deficient/insufficient. In our limited sample, being vit D insufficient was not associated with increased acute/infective hospitalisations, but a larger unbiased sample of NT children is needed. More information is needed about the optimum level of vit D for non-bone-related health in children. [ABSTRACT FROM AUTHOR]

Aims The study aims to: (i) estimate the prevalence of spinal muscular atrophy type 1 ( SMA 1); (ii) describe what practices characterise end-of-life care of patients with SMA 1; and (iii) ascertain whether a consistent approach to the management of these patients exists in Australia. Methods An audit of the Australasian pathology laboratories offering the diagnostic SMN1 deletion test was conducted for patients diagnosed with SMA in Australia for 2010 and 2011. In addition, a retrospective clinical audit was conducted in eight major Australian paediatric hospitals of the end-of-life care provided to children with confirmed SMA 1 from 2005 to 2010. Results Thirty-five children were included in the clinical audit, accounting for an estimated 61% of children diagnosed with SMA 1 from 2005 to 2010. Twenty-six per cent were ventilated invasively, only two of whom were intubated after the diagnosis was confirmed. No children were ventilated long term (>90 days) or had a tracheostomy performed. Nasogastric tube feeding was a common measure to support adequate nutritional intake. Total parenteral nutrition, gastrostomy and fundoplication were not provided for any children. Conflict over end-of-life care decisions was documented in one instance, without the involvement of a guardianship tribunal. Conclusion There appears to be a consistent approach in the management of children with SMA 1 in Australia, which can be characterised as 'actively managed dying'. This study could contribute to the development of Australian consensus guidelines for the management of these children. These results also highlight a number of ethical issues related to the management of children with SMA 1. [ABSTRACT FROM AUTHOR]

Aim We aimed to characterise the demographic and clinical features of paediatric community-associated Staphylococcus aureus ( CA-SA) infection. We aimed to identify factors associated with methicillin-resistant S. aureus ( MRSA) infection evident at the point of care with the potential to guide antibiotic choice. Methods A retrospective chart review in 2008 of CA-SA infections at the Children's Hospital at Westmead ( CHW), a 300-bed tertiary paediatric hospital in western Sydney, Australia. We calculate rates of MRSA and perform univariate and multivariate analysis for predictors of MRSA. Results Of 431 patients with CA-SA infections, 19.3% were MRSA. In univariate analysis, MRSA was predicted by age greater than 1 year, Aboriginal race, rural/regional residence, previous history of skin and soft tissue infection ( SSTI) or a family history of SSTI, at least 48 h of antibiotics active against methicillin-sensitive S. aureus ( MSSA), invasive infection and abscess formation. In a multivariate analysis factors that independently predicted MRSA in the entire cohort, and in the non-invasive subgroup included abscess formation, a family history of staphylococcal infection or SSTI, Aboriginal ethnicity, at least 48 h of anti- MSSA antibiotics at presentation, presentation during spring and age greater than 1 year. Conclusions One fifth of CA-SA infections at our tertiary paediatric hospital in 2008 were MRSA. Several clinical and demographic factors evident at the point of care were highly significant predictors of CA-MRSA infection. [ABSTRACT FROM AUTHOR]

Aim Sleep problems are more common among children with disabilities. Mothers are likely to provide night-time care. Mothers of children with disabilities are known to experience high levels of stress and mental health issues compared with other mothers. Relationships between a child's sleep problems, and chronic maternal sleep interruption and subjective health have not been researched. Method Cross-sectional mail-out survey with follow-up phone call was used. Instruments included the Short Form 36 version 2 and instruments that measured maternal, child and sleep characteristics. Descriptive statistics examined characteristics of participants and correlation, and Kruskal- Wallis test was used to determine important maternal and child characteristics around sleep issues. Results All mothers ( n = 152) cared for a school-aged child with a developmental disability including autism spectrum disorder ( n = 94) and cerebral palsy ( n = 29). Nearly half (49%) of the mothers were awoken more than 4 nights/week. Three distinct sleep groups were identified: no sleep interruption; sleep interruption once/night, 4 nights/week; and more frequent interruption. Mothers experiencing the most sleep interruptions reported significantly poorer health on six Short Form 36 version 2 dimensions. Night-time caregiving was associated with higher child care needs rather than children's diagnoses. Mothers who experienced more sleep interruption also participated less in health-promoting activities (active leisure, time with socially supportive others) during the day. Conclusion This study identifies a group of mothers with chronic sleep interruption and demonstrates related poor maternal subjective health and lower participation in health activities that may service to support maternal health. Mothers with children with the highest daytime care needs also experienced high night-time care responsibilities. Changes to service provision are recommended to identify mothers in need of additional supports and services. [ABSTRACT FROM AUTHOR]

Aim The utility of screening urinalysis in asymptomatic children has been questioned based on studies done in school-age children or adolescents. The American Academy of Pediatrics ( AAP) recommended to abandon this screening in 2007 but many paediatricians perform it at some point during childhood. Thus, we aimed to investigate usefulness of screening urinalysis during infancy. Methods We retrospectively reviewed results of screening urinalysis done in infants at 6-18 months of age who had regular care since birth at our centre. Infants with an ICD-10 (International Classification of Diseases, Tenth Revision) diagnostic code for routine child health exam ( Z00.1) and a urinalysis requested with this code on the same date were included. Results A total of 683 infants met the inclusion criteria. 44 (6%) had an abnormal urinalysis. The most common abnormality ( n = 39, 5,7%) was pyuria. Of these 39 babies, 5 had a repeat urinalysis only, 18 had a repeat urinalysis with urine culture, and 16 had a urine culture alone. Six patients had positive culture results and were given antibiotic treatment. All six babies who received treatment had normal ultrasound and two patients had a voiding cystourethrography, which were also normal. The other abnormalities ( n = 5) detected were microscopic hematuria and proteinuria. Repeat urinalyses of these patients were normal. Conclusion Screening urinalysis results were abnormal in 6% of the babies, but in 86% of those, abnormalities were transient. Only <1% had positive culture results. These data add to the evidence that screening urinalysis during infancy is unjustified supporting the AAP 2007 recommendations. [ABSTRACT FROM AUTHOR]

The article offers information on three studies which show the positive effect of oral montelukast of reducing extent and severity of eczema. It mentions that the study conducted by A. Y. Pei and colleagues offered detailed methodology while K. L. Hon and colleagues reported a case series with no control group or randomization. Moreover, the double blind study by M. S. Ehlayel and colleagues demonstrate reductions in itching, sleep disturbance, and disease extent with montelukast.

BACKGROUND: Success in a task is not only related to skill, but it is also related to 'self-efficacy', or belief in one's capability to perform that task. No tool currently exists to measure self-efficacy in clinical decision-making in general paediatrics. OBJECTIVE: To develop and provide validity evidence for the General Pediatrics-specific Self-Efficacy (GPedsSE) scale. METHODS: The five-item GPedsSE scale, developed using an expert panel, was matched to the New General Self-Efficacy (NGSE) scale's structure for validity analysis purposes. Thirty-six postgraduate year 1 to postgraduate year 5 paediatric residents of the Montreal Children's Hospital (Montreal, Quebec) completed the GPedsSE and NGSE scales, with items interspersed. RESULTS: The mean (± SD) GPedsSE score was 18.6±2.6 of 25. Total GPedsSE and NGSE scores were moderately correlated (r=0.54, P<0.005). On planned comparison, the GPedsSE score increased with training year (F[1.3]=6.62; P<0.001), while the NGSE score did not (F<0.37). Exploratory factor analysis showed two components, each aligning with a scale. CONCLUSION: The GPedsSE scale contextualizes an existing tool to general paediatrics, a novel concurrent validity approach. [ABSTRACT FROM AUTHOR]

Infantile gastroesophageal reflux is challenging because of the difficulties in differentiating normal developmental physiology from disease, the imprecision of diagnostic tests and the paucity of evidence-based therapies for clinicians to implement. Careful clinical assessment is central to avoidance of inappropriate diagnosis and utilisation of ineffective or dangerous therapies, and at the same time, identification of those infants who warrant intervention. [ABSTRACT FROM AUTHOR]

Nocturnal enuresis (NE) is increasingly seen as part of a heterogeneous phenomenon that at times will include daytime lower urinary tract symptoms such as urgency, frequency and wetting - with reduced bladder storage, usually due to an overactive bladder. In turn, these may be associated with constipation and/or faecal soiling. This paper discusses these considerations in the management of NE. [ABSTRACT FROM AUTHOR]

Aim: Post-circumcision topical steroids may reduce the number of patients with balanitis xerotica obliterans (BXO) who require subsequent meatal dilatation. However, their use has only been investigated in the presence of an abnormal urethral meatus. The aim of this study is to determine if post-operative topical steroids reduce the need for subsequent meatal dilatation in patients with histologically proven BXO independent of the appearance of the urethral meatus. To determine if post-operative topical steroids reduce the need for subsequent meatal procedures in patients with histologically proven BXO. To determine if the appearance of the meatus at circumcision affects the need for subsequent meatal procedure., Methods: We performed a retrospective review of all paediatric patients with histologically confirmed BXO post circumcision. We excluded all those with 'chronic inflammation' or 'early BXO'. Patients were divided into groups based on whether post-operative topical steroids were prescribed. The appearance of the urethral meatus at circumcision was recorded. Primary outcome was progression to subsequent meatal dilatation. Statistical significance was calculated using Fisher's exact test. A P value < 0.05 was considered significant., Results: One hundred and seventeen patients with histologically confirmed BXO were identified between October 2012 and December 2017. Fifty-nine patients were prescribed post-operative topical steroids (50%). Nine patients required subsequent meatal dilatation procedure (8%) and only one of these had been prescribed post-operative topical steroids (P = 0.0165). Abnormal meatus was noted in 24 (21%) patients. Three patients in this group required subsequent meatal dilatation compared with 6 in the group with a normal meatal appearance (P = 0.385)., Conclusions: Post-operative topical steroids can reduce the need for subsequent meatal dilatation in boys with BXO. The appearance of the urethral meatus at circumcision does not predict the need for subsequent meatal dilatation., (© 2022 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Competing Interests: Competing interests: None declared.

Aim The study aims to investigate the prevalence of off-label prescribing in the general paediatric ward at a major teaching hospital in Tasmania, Australia. Method The drug charts and medical records from two groups of 150 consecutive paediatric patients, admitted 6 months apart in July 2009 and January 2010, were studied retrospectively. Patients were required to spend at least one night in hospital and be aged less than 12 years. Each prescribed drug was compared with the approved product information to determine if the usage was off-label. Data concerning documented informed consent and adverse drug reactions were also recorded. Results Three hundred patients were prescribed a total of 887 medicines. Of these, 31.8% were off-label and 57.3% of children received an off-label medication. There was no significant seasonal variation in patient characteristics or prescriptions. Drugs were most commonly off-label due to their dosage or frequency of administration. Of the 106 different drugs used, the use of 51 was off-label on at least one occasion, and for 30 drugs their use was off-label on more than 75% of occasions. The drugs most commonly used off-label were oxycodone, salbutamol and paracetamol. No informed consent documentation was identified, and two of five recorded adverse drug reactions were associated with off-label drug use. Conclusion Off-label use of medicines occurred frequently in paediatric inpatients. The available evidence often supported off-label medication use. An improved system for the revision of approved drug information and an Australian guideline for paediatric prescribing are needed. [ABSTRACT FROM AUTHOR]

Developmental dysplasia of the hip is an important but poorly understood disorder as evidenced by the vast amount of literature published to date on this topic. The precise definition of hip dysplasia is controversial and it encompasses a spectrum of abnormalities, rather than a single condition, which at one end overlap with normal hip maturation. We review the risk factors, clinical examination and radiological imaging of the hip in the infant and young child, the controversies of ultrasound screening for hip dysplasia and the current management, both operative and non-operative, of this condition according to patient age. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the classification of arm circumference (AC) in pre-school children by using National Center for Health Statistics (NCHS/CDC-2000) and World Health Organization (WHO-2006) references. We evaluated 205 children: weight, height and AC were assessed and the body mass index (BMI) was calculated. The BMI values were classified into Z-scores by the WHO referential. The AC was classified into Z-cores by two references, comparing the whole-sample value and among groups (tercis) of BMI Z-score. The correlation was also evaluated between differences of AC with BMI Z-score. The WHO referential classified the AC in Z-scores greater than the NCHS/CDC, which is more specific and less sensitive than the NCHS/CDC for lean children and at the same time more sensitive and less specific for children with overweight. In conclusion, a significant difference in the AC classification occurs according to the referential used. [ABSTRACT FROM AUTHOR]