Child under nutrition project

A report about the current undernourishment of children in England | Patients Association

The project was undertaken by the Patients Association and funded by a non-restricted education grant from Abbott. A cross-section of health and care staff in four sites – Bradford, Cornwall, Tower Hamlets and Birmingham – were interviewed. Parents were also interviewed in Bradford and Cornwall.

The findings reveal examples of positive efforts in working with children and families across agencies, particularly by public health teams, community and acute health staff; but many are overstretched and unable to meet demand for the types of information and guidance that people need. The report’s recommendations include:

  • Awareness of under-nutrition should be raised among both professionals and the public
  • New and existing training and guidance for professionals should include the identification and treatment of under-nutrition
  • National guidance and a care pathway should be developed specifically for undernutrition.

The full report is available here

The paediatrician’s role in mental health

Mental health is increasingly acknowledged as an integral part of a paediatrician’s work. This article aims to cover six important areas that will be useful to the general paediatrician | Paediatrics and Child Health

In the first part of the article I will tackle: why mental health is an important part of paediatric care, what kind of mental health difficulties do children encounter and how should paediatricians initially approach emotional and behavioural problems? In the second part I will describe the emotional problems encountered in paediatric services, how to understand behavioural problems and how to manage both of these in paediatric practice. Practical approaches and advice are provided in each section.

Full reference: Davie, M. (2017) The paediatrician’s role in mental health. Paediatrics and Child Health. Published online: 28 July 2017

Risk Stratification in Pediatric Acute Respiratory Distress Syndrome

This study aims to describe the epidemiology of patients with PARDS across Asia and evaluate whether the Pediatric Acute Lung Injury Consensus Conference risk stratification accurately predicts outcome in PARDS | Critical Care Medicine

Objectives: The Pediatric Acute Lung Injury Consensus Conference developed a pediatric specific definition for acute respiratory distress syndrome (PARDS). In this definition, severity of lung disease is stratified into mild, moderate, and severe groups. We aim to describe the epidemiology of patients with PARDS across Asia and evaluate whether the Pediatric Acute Lung Injury Consensus Conference risk stratification accurately predicts outcome in PARDS.

Measurements and Main Results: Data on epidemiology, ventilation, adjunct therapies, and clinical outcomes were collected. Patients were followed for 100 days post diagnosis of PARDS. A total of 373 patients were included. There were 89 (23.9%), 149 (39.9%), and 135 (36.2%) patients with mild, moderate, and severe PARDS, respectively. The most common risk factor for PARDS was pneumonia/lower respiratory tract infection (309 [82.8%]). Higher category of severity of PARDS was associated with lower ventilator-free days (22 [17-25], 16 [0-23], 6 [0-19]; p < 0.001 for mild, moderate, and severe, respectively) and PICU free days (19 [11-24], 15 [0-22], 5 [0-20]; p < 0.001 for mild, moderate, and severe, respectively). Overall PICU mortality for PARDS was 113 of 373 (30.3%), and 100-day mortality was 126 of 317 (39.7%). After adjusting for site, presence of comorbidities and severity of illness in the multivariate Cox proportional hazard regression model, patients with moderate (hazard ratio, 1.88 [95% CI, 1.03-3.45]; p = 0.039) and severe PARDS (hazard ratio, 3.18 [95% CI, 1.68, 6.02]; p < 0.001) had higher risk of mortality compared with those with mild PARDS.

Conclusions: Mortality from PARDS is high in Asia. The Pediatric Acute Lung Injury Consensus Conference definition of PARDS is a useful tool for risk stratification.

Full reference: Wong, J, J-M. et al. (2017) Risk Stratification in Pediatric Acute Respiratory Distress Syndrome: A Multicenter Observational Study. Critical Care Medicine. Published online: July 26 2017

 

Very preterm birth not associated with mood & anxiety disorders

Do very-preterm or very-low-weight babies develop anxiety and mood disorders later in life? Researchers have concluded a study to answer this question | ScienceDaily

The team studied nearly 400 individuals from birth to adulthood. Half of the participants had been born before 32 weeks gestation or at a very low birth weight (less than 3.3 pounds), and the other half had been born at term and normal birth weight. They assessed each participant when they were 6, 8 and 26 years old using detailed clinical interviews of psychiatric disorders.

“Previous research has reported increased risks for anxiety and mood disorders, but these studies were based on small samples and did not include repeated assessments for over 20 years,”

Their results? At age 6, children were not at an increased risk of any anxiety or mood disorders, but by age 8 — after they had entered school — more children had an anxiety disorder. By 26, there was a tendency to have more mood disorders like depression, but the findings were not meaningfully different between the two groups.

This study is the first investigation of anxiety and mood disorders in childhood and adulthood using clinical diagnoses in a large whole-population study of very preterm and very-low-birth-weight individuals as compared to individuals born at term.

The team also found that having a romantic partner who is supportive is an important factor for good mental health because it helps protect one from developing anxiety or depression. However, the study found fewer very-preterm-born adults had a romantic partner and were more withdrawn socially.

‘Eating for two’ pregnancy myth

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The Royal College of Obstetricians and Gynaecologists (RCOG) has highlighted the publication of a survey, to understand women’s perceptions of how much they should eat during pregnancy.

The survey, commissioned by the National Charity Partnership, a partnership between Diabetes UK, the British Heart Foundation (BHF) and Tesco, found 69 per cent of women are unaware of how many extra calories they need to consume during pregnancy. 63 per cent report feeling under pressure from others to eat larger meals than normal with 14 per cent of pregnant respondents saying that this pressure is constant.

The RCOG is working with the National Charity Partnership to bust the ’eating for two’ myth and make it easier for people to understand how to make healthy choices during pregnancy to avoid unhealthy weight gain.

Read more via RCOG

 

 

Preventing depression in low-income mothers

It is well-established that women in low-income households have an increased risk of developing mental health problems, in particular depression | The Mental Elf

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Studies have found that these women are around twice as likely to develop the disorder compared with those from higher-income households (Hobfoll et al, 1995). Low-income women are also less likely to seek and receive appropriate treatment, in part because of the associated costs (Lennon et al, 2001).

For women who are mothers, this is especially consequential: parental depression has been linked with developmental, emotional and mental health problems in children (McDaniel et al., 2013). In the United States this has been highlighted as a public health concern, and it is increasingly being recognised that community-based services offer valuable opportunities to reach those for whom help is less accessible.

Head Start is a US government-funded service aimed at families at or below the federal poverty level with young children under five. They use a case-management structure to establish a healthy family environment in order to look after the child’s development and wellbeing. Depression affects almost half of the mothers at Head Start. A recent study by Silverstein et al. (2017) examines the efficacy of embedding a depression prevention strategy in the Head Start program.

Themes emerging from State of Child Health

This current report is very well produced and clearly lays out the state of child health in the four countries of the UK highlighting a life course approach with key conditions and services emphasised | Archives of Disease in Childhood

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Some 20 years ago, it was suggested to the relatively newly established Royal College that it might be advisable to develop a regular report on the health of children of Great Britain. At the time, a Working party was set up, chaired by Aidan Macfarlane, and a wide membership of stakeholders was gathered together and a Delphi carried out as to which topics should be covered. The driving principles of that report were stated as giving added value to existing reports and should emphasise evidence-based interventions which might improve child health outcomes. A draft was produced but the Council rejected it on the basis that it was not a priority or core business for the new College at the time and there were insufficient resources to support its appropriate development (RCPCH Council Minutes and personal correspondence Blair 1999).

However, this current report is very well produced and clearly lays out the state of child health in the four countries of the UK highlighting a life course approach with key conditions and services emphasised. The report has come at an opportune time with the spotlight clearly on children from a number of key reports including those of the Chief Medical Officers. Some of the drivers have included the lack of progress the UK is making compared with other countries, particularly in mortality statistics, and the pernicious effects of social inequalities on children’s lives and well-being. If we were to select a number of themes which run through the report, they are as follows:

  • Better integrated data collection is required
  • Non-communicable diseases need cross-sectoral solutions
  • Implementation of guidance
  • Strengthening early years services
  • Well-being

Full reference: Blair, M. & Hiscock, H. (2017) Themes emerging from State of Child Health: UK and Australia. Archives of Disease in Childhood. Published Online: 22 July 2017