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Diabetes mellitus is a common long-term childhood condition, which paediatricians, allied healthcare professionals and paediatric trainees will encounter frequently. General or acute paediatric trainees will be involved in treatment initiation, requesting appropriate investigations and continued management. The vast majority of children with diabetes have type 1 diabetes mellitus (T1DM) and the minority have type 2 diabetes mellitus (T2DM) or monogenic causes (also known as maturity-onset diabetes of the young). Individuals with T1DM tend to present more acutely and may be unwell with diabetic ketoacidosis. Those with T2DM and MODY usually present less acutely. However, there is considerable overlap in the clinical features, which may lead to diagnostic uncertainty. It is essential to clarify the subtype of diabetes mellitus as this allows tailored management including education, lifestyle modifications, medication and appropriate family counselling. In this review, we consider three adolescents presenting with symptoms and signs of diabetes, highlight the key features of different types of MODY and consider their differential diagnoses.

Objective: To understand software tasks aimed at improving cognitive abilities in school-aged children born pre-term to determine if paediatric clinic advice on manual exercises can be given if the software is inaccessible. Method: Exploration of software tasks and linking these to results of seminal experiments on cognitive ability. Outcome: It may be possible to performing some of these software tasks manually to improve working memory, however some further research on the efficacy of these techniques with school-aged children born pre-term are required.

You are seeing an 11-year-old boy in a general paediatric clinic referred with short stature. His height is below the 0.4th centile. The mid-parental height is on 50th centile. Baseline investigations, including renal and liver function, coeliac screen and thyroid function tests are normal. You have a suspicion of growth hormone deficiency. Should you check an insulin-like growth factor-1 level or proceed with a growth hormone provocation test? The current paper will aim to give an overview of these tests and factors to consider when interpreting the results.

AIM To investigate the implementation of a plan of action for treatment of childhood obesity, and the effect after 2 years of treatment. METHODS Children aged 6-12.9 years who started obesity treatment between 2008 and 2015 in a paediatric clinic in Stockholm County were included. The treatment model included staff education and support and group activities for parents and children separately followed by individual sessions to a multidisciplinary team. The main outcome was change in body mass index standard deviation score (BMI SDS), in comparison to a matched control group. RESULTS In the intervention group, 1334 children (52% boys) with an average age of 9.3 years and BMI SDS of 2.7 and 3012 children in the control group were included. The intervention group decreased their BMI SDS more after two years compared with the control group, (-0.31 vs -0.23, P

3-year-old Susie has been referred to the medical paediatric clinic by her general practitioner with sweating at night; her parents change Susie’s pillowcase whilst she is asleep at around 11pm as her hair looks wet with sweat. Her mother has searched ‘ sweating overnight ’ on the internet and is worried that her child has cancer. What should you do? Night sweats are a common complaint in young children in the general paediatric clinic, either as the presenting complaint or as a symptom mentioned in the context of other concerns. Despite this, available literature on the subject is scarce.1 2 How do we limit over-investigating these children and mitigate parental anxiety, while ensuring timely detection of serious pathologies such as malignancy or infection? This article aims to provide a structured approach to the management of paediatric night sweats. ### How are night sweats defined? Night sweats are subjective reports (often parental) involving an exaggeration of the normal circadian temperature rhythm. They are defined as sweating that occurs solely or predominantly at night.1 The clinical significance of night sweats, particularly within the paediatric population, remains controversial. Although severe night sweats can be both distressing and disruptive to sleep, in most cases the child is completely unaffected, apyrexial, and awoken by a worried parent.3 4 Conversely, night sweats may be the presenting clinical manifestation of certain serious medical conditions (including malignancy, infection, autoimmune disease and obstructive sleep apnoea).1 It is important to be aware of the red flag features to look out for. ### What are the underlying physiological mechanisms responsible for sweating? The autonomic nervous system has an essential role in human thermoregulation. The skin’s blood vessels and sweat glands are innervated by sympathetic nerve fibres.2 Regulation of sweating involves both complex thermoregulatory and non-thermoregulatory mechanisms.5 Core body temperature (Tc) decreases as a result of sweating. The preoptic anterior hypothalamic region …

BACKGROUND Understanding the emotional changes in children during dental treatment is necessary for providing stress-free care. AIM To objectively assess the stress associated with dental treatment in children, based on the autonomic nervous activity and the electroencephalogram (EEG). DESIGN Twenty-two children aged 4-9 years were recruited from outpatients of a paediatric clinic. Electrocardiogram and EEG were recorded throughout the treatment to analyze the autonomic nervous activities and the powers of brain waves, respectively. Changes in these measurements during each treatment process were evaluated in two age groups: 4-6 years and 6-9 years. RESULTS Elevations in sympathetic activities accompanied by decreased parasympathetic activities induced by stress were observed during rubber dam setting (RD) in the age group of 4-6 years and during infiltration anesthesia (IA), RD, and cavity preparation with a dental turbine (CP-T) in the age group of 6-9 years. Stress-related beta wave increments in EEG were observed during IA and CP-T in the age group of 6-9 years but not in the age group of 4-6 years. CONCLUSION Monitoring the autonomic nervous activities during treatments is useful in assessing stresses in a wide age of young children, whereas EEG monitoring is applicable only to children older than 6 years.

A 26-year-old female presented to the paediatric clinic at 11 years of age with poor growth. The detection of delayed puberty, anosmia, coloboma and hearing impairment led to a diagnosis of CHARGE syndrome. This was confirmed by a heterogenous de novo pathogenic variant c.6955C >T:p.(Arg2319Cys) detected in the CHD7 gene. Detailed assessment, including olfaction, ophthalmic and auditory examination should be part of the evaluation framework in children with delayed growth and puberty.

Objectives When caring for children in a hospital setting, tablets are often manipulated at the ward to obtain the right dose. One example is manipulation of tablets containing the slightly water-soluble substance aspirin, used in paediatric care as an antiplatelet agent. The evidence base, however, for choosing certain tablet formulations and manipulation methods over others for extraction of proportions is lacking. The aim of this study was to investigate the effect of tablet formulation and manipulation technique on the dose accuracy and precision attained when dispersing different commercially available aspirin tablets and extracting a small proportion suitable for children. Methods The manipulation methods investigated simulated those observed in the paediatric clinic. Four tablet formulations—one chewable, one conventional and two dispersible—were dispersed in 10 mL water in a medicine measure. On (1) passive dispersion, (2) mixing by stirring with the syringe, or (3) stirring and pumping the dispersion in and out of the syringe, respectively, proportions (1 mL or 2 mL) were extracted and the doses recovered were determined using a validated UHPLC (ultra high-pressure liquid chromatography) method. Results Fractions from the four different dispersed aspirin tablet formulations varied from 99% to 3% of that intended with the lowest degree of mixing, and from 96% to 34% of that intended with the highest degree of mixing. Only the dispersible tablets gave average doses within 20% of the intended dose. Conclusions Fraction extraction from dispersed aspirin tablets only gave doses within 20% of intended for the dispersible tablets, and then only for some of the manipulation methods: ‘passive dispersion’ for the 75 mg dispersible tablet and ‘stirring and pumping’ for the 300 mg dispersible tablet. The tablets not intended for dispersion gave unsatisfactory results, outside 20%, regardless of manipulation method. The findings underline the importance of considering both tablet formulation and dose extraction technique when manipulations are required.

Despite the very high burden of malaria among children in Borno state, the proportion of those who receive standard treatment has been very low. This study aimed to determine malaria knowledge, attitude towards prevention, and health care seeking behaviours of parents or caregivers of children presenting with fever at the paediatric clinic of a secondary-level hospital in Maiduguri, Borno state, Nigeria. A cross-sectional study design was used to obtain information from the respondents. Data were collected using a structured questionnaire, from the parents or caregivers of children presented to the Paediatric clinic with history of fever, and analysed in SPSS. A total of 331 respondents were finally recruited into the study. The ages of the children ranged from one to fourteen years. Some of them (15.3%) were internally displaced persons (IDPs). As many as 90.7% and 91.9% of the respondents believed that malaria is a life-threatening illness, and ITNs could prevent malaria, respectively. Less than a half of them (42.3%) had immediately brought their children to the hospital once they detected the fever. At the hospital, only 202 (60.7%) of the children had had malaria parasite test done on them, of which 89.1% tested positive. Permanent residents were more likely to promptly take their children to the hospital, one they detected fever, compared to IDPs (Χ2=12.401, df =1, p=0.002). There is the need for promoting early presentation of febrile children to health centres, and also promoting routine malaria tests for febrile persons.

A 14-years-old girl presented to Paediatric clinic after an aggressive recurrence of ingrown toenail 6 months...

Kinderkliniken werden als ein klassisches Handlungsfeld Klinischer Sozialer Arbeit erachtet. Diese Forschungsarbeit stellt einen anfänglichen Versuch dar, dieses für die Klinische Soziale Arbeit noch kaum erforschte Gebiet mit dem Fokus Kinderschutz zu untersuchen. Damit wird das Ziel verfolgt, wertvolle Informationen für die Weiterentwicklung der Klinischen Sozialen Arbeit im Kontext Kinderschutzarbeit an Kinderkliniken zu erhalten. Für die Beantwortung der Forschungsfrage wurden mit elf Klinischen Sozialarbeiter*innen aus acht unterschiedlichen Kinderkliniken in Österreich leidfadengestützte Interviews geführt und anschließend mit der Inhaltsanalyse nach Kuckartz ausgewertet. Mit dem Fokus auf den Beitrag der Klinischen Sozialen Arbeit in Bezug auf die Kinderschutzarbeit an österreichischen Kinderkliniken wird die Rolle der Klinischen Sozialen Arbeit aus Sicht der Klinischen Sozialarbeiter*innen dargestellt. Die Ergebnisse zeigen, dass die Klinische Soziale Arbeit, auf unterschiedlichen Ebenen, an einer professionellen und umfassenden Kinderschutzarbeit beteiligt ist. Die Klinischen Sozialarbeitenden gehen der Berücksichtigung und Behandlung der sozialen Risikofaktoren für Kindeswohlgefährdungen nach. Mit diesem Einsatz bei unmittelbaren bzw. möglichen Kinderschutzfälle strebt die Klinische Soziale Arbeit auf eine ganzheitliche Behandlung von Kindeswohlgefährdungen an. Zusätzlich setzen sie sich für die Weiterentwicklung und Verbesserung der klinikinternen Kinderschutzarbeit ein. Children's hospitals are considered a classical field of action for clinical social work. This research paper represents an initial attempt to examine this area, which has hardly been explored yet in regard to clinical social work, with a focus on child protection. The aim is to obtain valuable information for the further development of clinical social work in the context of child protection work at children's hospitals. In order to answer the research question, guideline-based interviews with eleven clinical social workers from eight different children's hospitals in Austria were conducted and subsequently analysed using the content analysis according to Kuckartz. Focusing on the contribution of clinical social work in relation to child protection work at Austrian children's hospitals, the role of clinical social work is presented from the perspective of clinical social workers. The results show that clinical social work, at different levels, is involved in professional and comprehensive child protection work. Clinical social workers follow up the consideration and treatment of risk factors for child welfare hazards which can be related to family lifestyles and living conditions. In addition, they stand up for further development and improvement of the clinic's internal child protection work. vorgelegt von: Stefanie Stockinger Wien, FH Campus Wien, Masterarb., 2021

With the outbreak and spread of the novel coronavirus (SARS-CoV-2), there has been a significant increase in the number of children infected, and some severe infection cases and neonatal cases have been reported. The parents or other family members who come to our paediatric clinic inevitably experience panic, tension and anxiety. The generation of these emotions has seriously affected the normal order of outpatient treatment and has led to many children not receiving an accurate diagnosis or proper treatment. This situation is not conducive to the control of the epidemic or the children's physical and mental health. Through summarizing parents' behaviours and emotional characteristics during the epidemic period, we hope to develop relevant coping and nursing strategies to ensure better control of the epidemic and to protect the physical and mental health of children.

Aims There is growing appreciation of the evolving difficulties for children placed in adoptive/special guardianship order (SGO) families, and the need for specialist input. Previous local service review identified 7/51 children adopted with no initial developmental difficulties recognised who were subsequently re-referred to community paediatrics. Consequently, an innovative service was established to enable review by a consultant with expertise in adoption and looked after children. This evaluation aimed to examine parental perspectives on the value of this service. Methods 27 parent/guardian questionnaires were posted following clinic review and initial actions. Parents were asked to report on a 5-point scale (‘strongly agreed’ to ‘strongly disagreed’) if being reviewed in the clinic: a) helped their child, b) benefited from seeing a professional with adoption expertise, or c) offered opportunities to discuss concerns. Free text responses were also encouraged to ascertain what was helpful, and suggestions for improvement. 12 families were additionally asked to complete PedsQL and SDQ forms. Results A high proportion of questionnaires 16 (59%) were returned. Of these, 13 (81%) agreed/strongly agreed the clinic had helped their child. 13 (81%) agreed/strongly agreed their child benefitted from review with a professional with expertise in adoption. 16 (100%) agreed/strongly agreed that they, as parents, benefitted from discussing concerns with an adoption professional. 14 questionnaires had additional comments, thematic analysis of which revealed that parents largely appreciated the consultation style and professional understanding of the different complex aspects of their child’s life. Suggestions for improvement included: direct liaison with school, and the ability to have direct consultant contact. Conclusion This evaluation demonstrated positive parental experience from this innovative clinic for children and young people following adoption/SGO. This value is especially important given the unmet need in this group around unidentified developmental difficulties, the complexity/heterogeneity of these issues, and the need for improved information gathering. These findings will be used to advocate for increased resources locally and may provide evidence for other services to offer a similar pathway.

A 14-month-old boy with Dandy-Walker malformation and absent corpus callosum with a ventriculoperitoneal shunt (VPS) in situ presented to paediatric clinic. An increase in head circumference (figure 1) was noted but there was no history or clinical signs demonstrating raised intracranial pressure suggesting a partial CSF obstruction. He was also noted to have a new onset right-sided hydrocele, with a tortuous structure palpable alongside the testis. An ultrasound demonstrated a migrated VPS in …

Aim We aimed to introduce a low-cost combined online referral and immediate appointment selection system (CORIAS) to empower referrers and parents by allowing them to schedule an appointment at a time and location of their choosing in conjunction with the referrer at the time of referral. This was because an unacceptably high rate of reported lost referrals, combined with a high rate of failure to attend initial appointments (FTAs), was noted at a six-site community paediatric clinic service. We aimed to analyse the impact of CORIAS on important outcomes including timely appointment scheduling, attendance, loss of referrals, user acceptance, overall cost and administrative burden. Methods For 3-month periods before and after the implementation of CORIAS, data were collected regarding all new referrals received and initial appointments scheduled, as well as reports of lost referrals. The number of attended initial appointments, FTAs, failures in successfully scheduling appointments, referrer background, CORIAS cost and qualitative feedback received from relevant parties was collated and analysed. Results The proportion of referrals reported lost was 6% following the implementation of the combined online system in comparison to 17% pre-implementation. The FTA rate for scheduled initial appointments pre-implementation was 16%; post-implementation, the FTA rate was 9%. Qualitative benefits included a decrease in the administrative burden associated with appointment scheduling and increased service access for culturally and linguistically diverse families. Conclusion Appropriately designed and implemented novel online systems may improve timely and equitable access to health care by providing secure, reliable pathways for referrers and by empowering and improving communication with patients and families.

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.

Introduction. The unsatisfactory results of the survival in patients with acute lymphoblastic leukemia (ALL) until 2000 in our center have led us to improve the approach of diagnosis and therapy. Since 2003 in all patients the following have been performed: flow cytometry, conventional genetic diagnosis, FISH (fluorescent in situ hybridization), and molecular biology. Objectives. Our aims were to identify solutions to increase patients’ survival. Patients and method. It is a single-center, retrospective study of 136 patients with ALL treated at 3rd Pediatric Clinic of Timisoara, over a period of 10 years (2003-2012), where survival was assessed. Results. Morphologically, 86% of the patients were L1 type, 13% L2 type and 1% L3 type. Flow citometry revealed that 68% were ALL with B precursors, and 19% with T immunophenotype. Acute leukemia with mixed phenotype (biphenotypic) was identified in 2.3% of patients and 10.7% of the forms were acute leukemia with myeloid markers. In 27.7% of patients, mutations were detected by the RT-PCR method, the most commonly identified was TEL-AML1 (ETV6- RUNX1) accounting for 12.7% of the cases. Relapse-free survival at 5 years for the entire group was 59%, and for the group treated between 2008 and 2012 it was 72%. Conclusion. Our analysis confirms the decisive value of laboratory investigations for the prognosis and improvement of supportive therapy.

Background: Febrile convulsion is a common emergency encountered in Paediatric practice. Inadequate knowledge could result in parental anxiety, apprehension and improper home management. Aim: To determine the knowledge, attitude of mothers, and home management of febrile convulsion in Uyo. Methods: A fourteen-itemed questionnaire bordering on knowledge, attitudes and home management of febrile convulsion was completed by mothers who brought their children to the Children’s Outpatient Clinic of the University of Uyo Teaching Hospital, Uyo. Results: of the one hundred and sixty-five respondents, 154 (93.4%) were married, 162 (98.2%) were Christians and 110 (66.7%) had tertiary education. Majority (84.2%) knew that febrile convulsion occur as a result of fever, 25 (15.2%) believed that febrile convulsion is caused by evil spirit and 5(3.0%) by black magic. Significantly more mothers whose children had febrile convulsion believed that febrile convulsion is caused by evil spirit (p=0.04). Various treatments agreed by respondents include application of palm oil on the body -23(13.9%), rushing the child to the hospital -153(92.7%), insertion of spoon into the mouth–51(30.9%), instillation of onions juice into the eyes –19(11.5%), cow’s urine concoction -4(2.4%). Mothers with children with febrile convulsion preferred the application of palm oil on the body during seizure episode (p=0.03). Conclusion: There is good knowledge of febrile convulsion among mothers attending the paediatric clinic of the university of Uyo teaching hospital. Public health education on this subject should be intensified to cater for the mothers with poor knowledge of the cause, treatment and prevention of febrile convulsion.

BACKGROUND Evidence has shown neurocognitive problems often exist among human immunodeficiency virus (HIV)-infected children. There are limited data for children in Nigeria. METHODS This was a cross-sectional study of 100 school-aged perinatally HIV-infected children seen in the paediatric HIV clinic and age/sex-matched controls from the general paediatric clinic. Neuro-cognitive functioning was assessed using the Raven's progressive matrices (RPM) that has been adapted for the Nigerian population. RESULTS The mean RPM score of subjects was 22.97 ± 11.35 compared with 32.93 ± 15.71 among controls (p < 0.001). Twenty-two percent of subjects in the HIV-infected group vs. 56% of controls were in the above-average intelligence group on the RPM. Thirty-four percent had average scores, while 22% were in the below-average scoring range. Neuro-cognitive functioning of the subjects was significantly affected by immunologic staging and socio-economic status. CONCLUSIONS Neurocognitive functioning of the HIV-infected children was significantly lower than those of their un-infected counterparts. Neurodevelopmental evaluation should be part of standard care in HIV-infected children in Nigerian setting.

Objectives: To determine the consumer awareness and acceptability of bambara groundnut as a protein source and to assess its potential for use in complementary feeding.Design: Cross-sectional study using a mixed-methods approach.Setting: The study took place at Gcumisa Clinic located at Swayimane, uMshwathi Municipality, in the UMgungundlovu District, KwaZulu-Natal province.Subjects: Black African female outpatients attending the Gcumisa paediatric clinic participated in the consumer-awareness survey (n = 70), consumer-acceptability tests (n = 64) and focus-group discussion (n = 16).Outcome measures: Consumer awareness of bambara groundnut and consumer acceptability of pureed samples made from bambara groundnut and common dry bean (reference) were assessed using questionnaires. A focus-group discussion was also held with some of the consumer acceptability test participants.Results: The survey participants were not familiar with bambara groundnut and its preparation methods. The sensory attributes, including overall acceptability, of the brown bambara groundnut puree compared well with that of the reference. Grain colour significantly influenced overall acceptability of the bambara groundnut puree (p < 0.05). Fifty caregivers (71%) expressed willingness to use the bambara groundnut in complementary feeding if it was accessible, affordable, and beneficial to health.Conclusion: Bambara groundnut is not a familiar legume in KwaZulu-Natal and utilisation is seemingly limited due to poor market availability and knowledge of cooking methods. However, there is potential for its use as a protein source in complementary foods. An improvement in the market availability and nutrition education to highlight the nutritional benefits of bambara groundnut are required to increase utilisation.Keywords: bambara groundnut, complementary foods, consumer awareness

ObjectiveTo describe the presentation and management of children with suspected or confirmed female genital mutilation (FGM) referred to a specialist paediatric clinic.MethodsData collected included referral source, age, ethnicity, circumstances of FGM and clinical findings in accordance with the WHO FGM classification.ResultsBetween September 2014 and January 2019, 148 children attended the clinic of whom 55 (37.2%) had confirmed FGM. Police or social care referred 112 (76%) children. The proportion of looked-after children (LAC) was significantly higher in the group with confirmed FGM (17/55, 31%) compared with children where FGM was not confirmed (5/93, 5%). In almost all children where FGM was confirmed, FGM was initially disclosed by the child or family (53/55, 96%) and of these 48/55 (87%) underwent FGM prior to UK entry. The remaining seven cases were British children, potentially meeting legal criteria under the FGM Act, and one resulted in a successful prosecution.ConclusionsThe number of children with FGM was significantly lower than expected based on UK prevalence estimates. Most children had undergone FGM prior to UK entry, and the majority of cases were initially disclosed by the child or family themselves. These results reflect the lack of large-scale proof of the practice of FGM in the UK and are consistent with growing evidence of the abandonment of FGM among communities after migration.

Clinical bottom lines A 7-year-old girl is seen in paediatric clinic for review of her alopecia areata (AA). Topical corticosteroids have thus far proven ineffective at stimulating hair regrowth and the consultant is considering other possible treatments for her. He mentions that oral corticosteroids may be a possibility; however, he is unsure of the evidence supporting their use. In children suffering from alopecia areata (AA; patients), does the use of oral corticosteroids (intervention) stimulate prolonged hair regrowth (outcome)? Cochrane Library: ‘alopecia areata’ AND ‘oral corticosteroid’)—1 result, 1 relevant. PubMed: ‘alopecia areata’ AND ‘oral corticosteroids’—45 results, 13 relevant. 1 relevant result irretrievable and excluded. Searches conducted in December 2018. AA is a chronic, autoimmune, non-scarring alopecia …

Aims To review healthcare needs as identified during initial health assessment of unaccompanied asylum seeker children (UASC). Methods Initial health assessment (IHA) records of unaccompanied asylum seeker children were collected from system one software in community Paediatric Looked after children (LAC) clinic between 01/10/2017 to 30/09/2018. Necessary permission was obtained from lead Paediatrician for Looked after children and ethical clearance was obtained from the trust ethics committee. Microsoft Excel was used to collect data and analyse. Methods Total 41 UASC were seen in LAC clinic in between the abovementioned period out of which 37 are male and 4 are female. Majority of children (56.09%) are from African countries followed by Middle Eastern (29.28%) and South East Asian (14.63%) countries. Only 41.46% of them were registered to NHS services at the time of their initial health assessment. Significant health issues identified during assessment were Tooth decay (87.8%), emotional problems (73.17%), sleep difficulty (43.9%), body pain and injuries (41.46%) and sexual abuse during journey (9.75%). There was history of sexual abuse in 50% of girls and 5.41 % of boys. None of them could provide any immunization history so immunization as per UK schedule and tuberculosis screening was recommended for all of them (100%). Conclusions The authors concluded that Unaccompanied asylum seeker children go through enormous physical and mental trauma during their journey to Europe and to the UK. They need to have early access to healthcare for both their physical and emotional wellbeing. Tooth decay, emotional problems, sleep difficulty, body pain and injuries, history of sexual abuse and risk of infections because of incomplete immunization were common in these children. They should have early and easy access to sexual health clinic to prevent/treat sexually transmitted disease.

Aim There has been an increase in referrals to paediatric cardiology clinics, at the same time concerns have been raised on the clinical skills related to cardiological examination. This retrospective study aimed to evaluate the cardiovascular examinations (CVE) documented on patients attending general paediatric outpatient clinics. Methods We retrospectively reviewed the healthcare records of new patients attending general paediatric clinics in a DGH during a one month period. Data gathered included patient demographics, presenting complaint (PC), CVE performed and referral for cardiovascular services. A questionnaire was also circulated to the consultant staff related to their views on the symptoms that would need such an assessment. Results 86/137 (62.8%) children received a CVE, consistent with the expectations gathered from the clinicians survey. There was no statistically significant association between PC (p=0.078), patient age (p=0.703), consulting clinician (p=0.488), and the completion of a CVE. Cardiovascular symptoms formed the presenting complaint in 7/137 (5.1%) of children, only one of whom received a full CVE. All these children received a CVE, but only one child received a full examination. However, it is reassuring that these 7 children received a more complete examination (4.43/8 aspects assessed) than the rest of the study group ( Conclusion Only two thirds of children attending a general paediatric clinic received any form of cardiovascular examination, and only one child out of 4 received a full assessment prior to referral to the cardiac service. A standardized paediatric clinical examination template for the outpatient clinics would help to improve the situation. However, Clinicians must also weigh-up the benefits of performing an extensive CVE within the time constraints of a busy clinic

Historical and recent data demonstrate that off-the-shelf infant formulas are heavily contaminated with aluminium. The origin of this contamination remains to be elucidated though may be imported via ingredients, packaging and processing. Specialised infant formulas exist to address health issues, such as low birth weight, allergy or intolerance and medical conditions, such as renal insufficiency. The aluminium content of these prescription infant formulas is measured here for the first time. We obtained 24 prescription infant formulas through a paediatric clinic and measured their total aluminium content by transversely heated graphite furnace atomic absorption spectrometry following microwave assisted acid/peroxide digestion. The aluminium content of ready-to-drink formulas ranged from 49.9 (33.7) to 1956.3 (111.0) &mu, g/L. The most heavily contaminated products were those designed as nutritional supplements for infants struggling to gain weight. The aluminium content of powdered formulas ranged from 0.27 (0.04) to 3.27 (0.19) &mu, g/g. The most heavily contaminated products tended to be those addressing allergies and intolerance. Prescription infant formulas are contaminated with aluminium. Ready-made formulas available as nutritional supplements to aid infant growth contained some of the highest concentrations of aluminium in infant formulas measured in our laboratory. However, a number of prescription infant formulas contained the lowest concentrations of aluminium yet measured in our laboratory. These higher cost specialist preparations demonstrate that the contamination of infant formulas by aluminium is not inevitable. They represent what is achievable should manufacturers wish to address the threat posed to health through infant exposure to aluminium.

Down’s syndrome (DS) is the most common chromosomal abnormality seen in live born children and it is the most common genetic cause of intellectual disability. It is associated with abnormalities in many body systems, some of which can cause life threatening complications. This article aims to cover the important aspects to cover when seeing children with DS for their routine follow-up in the neurodevelopmental or general paediatric clinic.

AIM In Finland, specialist paediatrics training is led by university hospitals, but half of it is carried out in regional central hospitals. We audited the training provided by four regional central hospitals in the tertiary care area covered by Tampere University Hospital, in 2003, 2008 and 2015. METHODS The audits comprised hospital visits and discussions with the chief doctor of the paediatric clinic, the trainees and the specialists who trained them. A modified version of the European Union of Medical Specialists 1997 protocol was used, and the key areas that performed poorly in the audits were followed up. RESULTS In 2008 and 2015, most of the key follow-up issues had improved, but two main areas in need of further development were identified in 2015. These were that educational objectives should be clarified, and their implementation systemically followed up, and that trainees should spend more time working in outpatient settings. CONCLUSION Since 2003, a marked improvement had taken place in the paediatric training provided by regional central hospitals, partly because of the increase in paediatric specialist resources. This study underlines the importance of repeat audits and the need for co-opera-tion between the university hospital and regional hospitals, including regular visits.

Avoidant Restrictive Food Intake Disorder (ARFID) and Anorexia Nervosa (AN) cause significant underweight in children and young people (CYP). The association of low bone mineral density (BMD) and underweight CYP in AN is well established, but less is known about BMD in ARFID.Retrospective case-note review and analysis of BMD measures by DXA on underweight patients referred to a paediatric clinic for eating disorders between 2014 and 2019. Indications for BMD measurement were age 5 years and underweight for at least 6 months.Of 134 cases where BMD was measured, 118 (88%) had AN and 16 (12%) ARFID. Age range was 6-19 years. 19% were males. ARFID cases were more likely to be male, have lower Body Mass Index (BMI), BMI z-score (BMIz), and longer underweight duration. For all cases, BMI and BMIz were positively associated with BMD z-score (BMI: coefficient 0.13,95%CI 0.04 to 0.22, p = 0.01; BMIz: coefficient 0.34, 95%CI 0.17 to 0.51, p 0.001) and bone mineral areal density z-score (BMI: coefficient 0.12, 95% CI 0.01 to 0.23, p = 0.04 and BMIz: coefficient 0.27, 95% CI 0.05 to 0.49, p = 0.02). However, there were no associations of BMD with diagnosis (ARFID vs AN). Paired t-testing of 13 age, sex and pubertally matched pairs from AN and ARFID cases also showed no difference in standardized BMD scores.Low BMD in our sample of underweight AN and ARFID cases was associated with BMI but not diagnosis. BMD may be as important in ARFID as AN. Further research should examine mechanisms and potential interventions.

Background: Disclosing a positive Human Immunode ciency Virus (HIV)-infection status to a child pose major challenges to caregivers for various reasons. Objective: This study aims to determine the prevalence, pattern and effect of disclosure among HIV-infected adolescents attending a tertiary hospital in Nigeria. Materials and Methods: A cross-sectional study among adolescents attending the HIV Paediatric clinic at the University of Abuja Teaching Hospital, Gwagwalada. A questionnaire was administered after ethically age-appropriate consent and assent had been obtained from the adolescents or adolescent/caregiver pairs. Blood was also drawn for CD4 count and viral load assay. Results: One hundred and forty-five adolescents participated in the study. Eighty (55.2%) were males, 78(53.8%) aged 10-13 years while 91(62.7%) had secondary level of education. Fifty-nine (40.7%) adolescents had been disclosed to. The mean age of disclosure was 14.6±2.2. Disclosure was mostly by mothers (n = 32; 22.1%), at home (n = 43; 29.7%) and their status revealed by 14 (23.7%) of the adolescents to mainly their siblings (n = 10; 6.9%). At disclosure, 19 (13.1%) felt bad/sad while 18 (12.4%) were indifferent. The preferred age for disclosure was 14–16 years (n = 33; 22.8%). There was a statistically significant relationship between disclosure and; adolescents' age (P =

Introduction: Mouth guards are devices used to prevent injuries during sports activities. Objetive: The aim of this study is to evaluate the knowledge about mouth guards of paediatric patients and their guardians. Methods: Paediatric patients from 9 to 15 years old, who sought care in the Paediatric Clinic of the Dentistry School and their guardians were invited to participate. Their knowledge about mouth guards was collected through a two-part questionnaire with open and closed questions. The first part of the questionnaire contained some sociodemographic questions and a main question about what a mouth guard is. The second part was solely about mouth guards and was applied immediately after an explanation about mouth guards at the end of the first part. All data collected were tabulated and analysed descriptively. Results: A total of 122 guardians were interviewed, 39.3% had children who practised some type of sports activity, and 32% reported a trauma episode. Most (54.9%) did not know what a mouth guard is, but after explanation, 57.4% had seen someone using one. A total of 33 paediatric patients were interviewed, 60.6% of whom practised some sport and 27.3% of these had already suffered some type of dental trauma during the activity. None of the interviewees use a mouth guard during sports activity, although 97% believe that using a mouth guard is important and 78.8% believe that the protector does not interfere with the activity. Conclusion: In conclusion, guardians and paediatric patients have little knowledge about mouth guards. Introdução: Os protetores bucais são usados ??para prevenir lesões durante atividades esportivas. Objetivo: O objetivo deste estudo é avaliar o conhecimento sobre os protetores bucais dos pacientes pediátricos e seus responsáveis. Métodos: pacientes pediátricos de 9 a 15 anos, que procuraram atendimento na Clínica Pediátrica da Faculdade de Odontologia e seus responsáveis ??foram convidados a participar. Seu conhecimento sobre protetores bucais foi coletado através de um questionário em duas partes com perguntas abertas e fechadas. A primeira parte do questionário continha algumas questões sociodemográficas e uma questão principal sobre o que é um protetores bucais. A segunda parte era apenas sobre protetores bucais e foi aplicada imediatamente após uma explicação sobre os protetores bucais no final da primeira parte. Todos os dados coletados foram tabulados e analisados ??de forma descritiva. Resultados: um total de 122 guardiões foram entrevistados, 39,3% tiveram crianças que praticavam algum tipo de atividade esportiva e 32% relataram um episódio de trauma. A maioria (54,9%) não sabia o que é um protetor bucal, mas após a explicação, 57,4% tinham visto alguém usando um. Um total de 33 pacientes pediátricos foram entrevistados, 60,6% praticaram algum esporte e 27,3% deles já sofreram algum tipo de trauma dental durante a atividade. Nenhum dos entrevistados usa um protetor bucal durante a atividade esportiva, embora 97% acreditem que usar um protetor bucal é importante e 78,8% acreditam que o protetor não interfere com a atividade. Conclusão: Em conclusão, os guardiões e pacientes pediátricos têm pouco conhecimento sobre os protetores bucais.

Aims To explore any glycaemia changes from paediatric to young adult transition; non-attendances to young adult clinics and impact on diabetes related admissions. Methods Data on adolescents with diabetes who went into young adult service from January to December 2016 was reviewed. HbA1c at the last paediatric clinic (PC), transition clinic (TC) and first young adult clinic (YAC) appointments were collected. Comparison between group means was done by ANOVA and paired t-test; the differences between frequencies/proportions by chi-square test and for statistical significance P value of Results Demographics of the cohort (n=23): males 43%; Caucasian 100%. Age when diabetes diagnosed 8.0±4.5 years (mean ±sd). Age at last PC and the first YAC: 17±0.3 and 18.1±0.4 years respectively. HbA1c at PC correlated significantly with the HbA1c in the YAC (r=0.78, r2=0.61; p=0.001). HbA1c was higher at YAC compared to that at the last PC visit (88.4 vs. 79.4 mmol/mol; p=0.001) but not significantly different to that in TC. Non-attendance rate in YAC was 56.5% and diabetes related admission (DKA, Hypoglycaemia) occurred in 30.4%. HbA1c at YAC was significantly higher in those hospitalised (113 vs. 76 mmol/mol; p=0.007). Comparing those with non-attendances vs. those who attended the YAC their HbA1c 99.8 vs. 78.4 mmol/mol (p=0.13). There were no differences in the age, age diagnosed diabetes and BMI in those with or without admissions for diabetes and those with DNA compared to non-attendances. Non-attendances to the YAC had higher rates of admission (38.5% vs. 28.6%). Discussion Non-attendance to young adult clinics is associated with higher rates of hospitalisations for diabetes related complications and possibly associated poor glycaemia. In the transition from paediatrics to young adult diabetes services and change in responsibility from parents to child, patients may struggle to deal with compliance and service attendance.

This chapter describes the implementation phase of the project and the major challenges in deciding about relevant content, methods and procedures as well as methods of evaluation. The chapter describes some experiences and principles linked to enhancing communication in clinical settings. Various models of implementation are described including profession-specific models, team-training models and enhancing communication through performing arts. Case examples are offered for each, with a range of practical suggestions such as the use of drama techniques and evidence from a trial site and a paediatric clinic. A site-specific team-training model based on local contextual evidence is recommended, and some guidelines are offered for realistic measurement of the impact of such interventions on broader communication processes.

The aims of this work were to assess dental age using the Demirjian system and to evaluate the discrepancy between chronological and dental age among children residing in Western Australia. Forty panoramic radiographs of 5- to 11-year-old children taken at the paediatric clinic of a dental hospital in Western Australia were selected. The developmental stage of each left permanent mandibular tooth excluding the third molar was assessed by three trained examiners. Estimated dental age using the Demirjian system was compared with the chronological age of each child. The accuracy of the Demirjian system in this group of children was 42.5%. The difference between chronological age and dental age was significant (t = 4.066, df = 39, p < 0.001). Dental age estimation for Caucasian children had greater accuracy (χ2 = 5.013, df = 1, p = 0.025). Gender and orthodontic concerns were not related to the accuracy of the Demirjian system (p ≥ 0.481). The discrepancy between chronological and dental age using the Demirji...

Summary Objectives We examined whether aromatherapy involving inhalation of yuzu (Citrus ichangensis × Citrus reticulata) oil was effective in decreasing mothers' anxiety for her sick child receiving an infusion at a paediatric clinic. Design Controlled clinical trial. Setting Mothers of sick children who arrived at the hospital were asked to complete an anonymous questionnaire. After a doctor examined the child and confirmed the necessity for infusion, the mothers who agreed to participate in our study were allocated to an aromatherapy or a control group. Interventions A diffuser was filled with yuzu oil before the subjects entered the aromatherapy room. The mother was shown how to use the aromatherapy diffuser while the child was receiving an infusion in the same room. Fifteen minutes after entering the room, the mothers were asked to complete an another questionnaire. Main outcome measures We measured the mother's anxiety with the state anxiety score from the State-Trait Anxiety Inventory. Results There were 60 subjects in the aromatherapy group and 61 in the control group. Both groups were well balanced in terms of demographic characteristics. Using analysis of variance, we demonstrated a significant difference in two-factor interactions between the control and aromatherapy groups. Maternal state anxiety was significantly lower in the aromatherapy than in the control group. Conclusions Inhalation of yuzu oil was shown to decrease maternal anxiety for a sick child. A multicentre randomized controlled trial or double-blind study is necessary to obtain objective evidence of this benefit of aromatherapy.

Sir,In the present journal, the emergence of OXA-162-producing Klebsiella pneumoniae at a Hungarian paediatric clinic was recently reported as the first isolation of OXA-48-like carbapenemase-produ...

Purpose According to the CDC, in 2014, paediatric unintentional falls were the leading cause of paediatric nonfatal injury in ages 0–4 nationwide. Likewise, in Georgia, the highest burden of admission and ER visits for paediatric falls exists in the 0–4 age group. The purpose of this study was to identify population characteristics, mechanisms of injury, and injuries sustained from falls among those ages 0–4 in Georgia. Methods Data from Georgia Central Trauma Registry (GCTR) was examined for all patients ages 0–4 from Level 1 and Level 2 Trauma Centres with an ICD-9/ICD-10 E-code diagnosis for unintentional falls from January 1, 2014-December 31, 2015 (n=1,058). Additionally, Children’s Healthcare of Atlanta (CHOA) Trauma Registry data, a subset of the GCTR data, was reviewed from CHOA inpatient records. Results The majority of falls were males (56.9%: 602/1,058), from a height of Conclusions Unintentional falls remain a significant burden of injury in the youngest population. To further reduce risk, falls prevention education should be offered to families in settings outside the paediatric clinic including emergency departments, community centres, and daycare facilities. Significance The results of this study provide new information regarding the mechanism of falls injury for the 0–4 population in Georgia. Current paediatric guidelines for falls prevention parent education only include ages 0–18 months. The research results support expanding falls prevention education for parents with children through age 4.

Introduction One of the major advantage of procalcitonin compared to other parameters is its highly and early increase in response to bacterial infection. The increased procalcitonin levels can be observed 3 to 6 hours after infectious challenge. It is a parameter that made a significant contribution to the clinical diagnosis, severity of infection and in the same time procalcitonin kinetics cand be used to assess the effectiveness of treatment. Methods A single- centre observational study consecutively enrolled 70 preschool children with lower respiratory tract infections who were hospitalised in Paediatric Clinic Hospital of Sibiu between January 2013 and January 2017. Procalcitonin, were measured on admission, after 48–72 hours and after 24–48 hours without fever. Results The majority of hospitalised children were male (64,7%) coming from urban areas (70,58%) aged between 3 and 4 years (76,47%). Criteria for antibiotherapy were: fever, the value of procalcitonin above 2 ng/mL, the increase of other inflammatory markers and modified chest radiography (interstitial pneumonia, bronchopneumonia). Procalcitonin serum decreased on average after five days of antibiotic treatment and most children required hospitalisation lasting between 5 and 10 days (58, 82%). Only 17% of cases had complications, like pleurezia and they required a longer length of hospital stay. Conclusion Procalcitonin allows the fast identification in children who need antibiotics. This study allows a more individualised approach for each patient, a shorter use of antibiotics and a shorter stay in the hospital.

In the last two decades, there has been registered a constant decrease in the number of breastfed infants and in the duration of breastfeeding. Our paper is aiming at pointing out the rate of breastfeeding in a group of infants correlated with mothers’ demographic profile, the ways to give birth, the time until the initiation of breastfeeding, breastfeeding counselling, and the mothers’ educational level. The study had a prospective development, analysing the answers provided by the mothers of breastfed infants, who filled in some anonymous questionnaires given by family doctors and the 2 nd Paediatric Clinic of the Emergency County Hospital Craiova. The study comprised 110 mothers, with an average age of 20–25 years, 69% of them coming from an urban environment. 56% of the cases were first born children (only 9% being the third born child or more). In 60% of the cases, children were born by caesarian section. 42% of the mothers had a higher education level, 29% having highschool education, while the rest of them having primary and secondary school education. The moment they filled in the questionnaires, 47.3% of the mothers were breastfeeding their infants of 4 months of age, on average. 49% of the infants had an early breastfeeding, while 60% of the mothers needed counselling offered by nurses or neonatologists. 14.5% of the mothers declared they were never explained the breastfeeding technique. Nearly 75% of the mothers were never monitored during their breastfeeding process, at home. Birth by caesarian section, lack of breastfeeding monitoring, and mothers’ lack of education may be the causes of the low rate of breastfeeding in infants.

Early diagnosis of scoliosis is important for a good orthopaedic treatment. Paediatrician is fondamental in first scoliosis recognising and sending to the specialist. This protocol is a simple instrument for a quick, safe an uniform metod to recognise and treat scoliosis in paediatric clinic. Medical history Genetic syndrome with malformations………………………2 points Familiar history of scoliosis………………………………….……1 point Statural growth≥5 cm in last 6 months………………1 point Peri-puberty period ……………………………………………...…..1 point Physical examination Dorsal hump…………………………………………..3 points Lumbar rotation……………………………….3 points Cut triangles asymmetry……………………2 points Shoulder asymmetry……………………………….…1 point Pelvic asymmetry………………………………………1 point Hyperkyphosis…………………………………………..1 point Hyperlordosis…………………………………1 point Scapular winging………………………………………….1 point Marfanoid aspect……………………………….1 point Skin caffe-latte spots………………………………….1 point Treatment 0–2 points: clinical monitoring (4–6 months) 3–4 points: spine x-ray -scoliosis in x-ray: send to specialist - no scoliosis in x-ray: clinical monitoring (4–6 months) ≥5 points: send to specialist with spine x-ray

Introduction Neutropenia is the decrease of neutrophil count in the blood. It is classified as mild, when the Absolute Neutrophil Count (ANC) is 1000–1500 cells/µL, or Aim Incidence and causes of neutropenia in hospitalised children in our Paediatric Clinic during the year 2016. Methods All the hospitalised children from 01-01-2016 to 31-12-2016 were screened for the presence of neutropenia during their hospitalisation. The type of neutropenia, the causes and the other blood cells counts were recorded for every neutropenic child. Results Among 784 children hospitalised during 2016, 35 were found to be neutropenic (4,46%). None of these children had known neutropenia in their history. Viral infections were the first cause of neutropenia, with the second cause (14%) being the use of antimicrobial drugs. The majority of neutropenias were mild to moderate (83%), whereas 6 children presented with severe neutropenia. Among them, three patients were diagnosed with viral infections, two had autoimmune diseases and the other remained undiagnosed. A percentage of 8,5% had also reduction in other blood cells. Conclusion The most common form of neutropenia in hospitalised children is mild-moderate neutropenia of viral aetiology, which resolves itself. However, major systematic diseases should always be excluded.