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Position paper of the Federal Association of German Hospital Pharmacists, the nutrition committees of the German and Austrian Societies of Pediatrics and Adolescent Medicine and the working group on intestinal failure of the Society of Pediatric Gastroenterology and Nutrition. In 2019 the German Federal Institute for Drugs and Medical Devices (Bundesinstitut fur Arzneimittel und Medizinprodukte, BfArM) launched a “doctors letter” (Rote-Hand-Brief) recommending light protection of all parenteral nutrition (PN) solutions during administration for preterm infants, term infants and children less than 2 years of age. The aim of the present paper is to review the available evidence and provide evidence-based recommendations for hospital and home PN light protection in children. The Federal Association of German Hospital Pharmacists, the nutrition committees of the German and Austrian Societies of Pediatrics and Adolescent Medicine and the working group on intestinal failure of the Society of Pediatric Gastroenterology and Nutrition recommend in accordance with the recommendations of the ESPGHAN, ESPEN, ESPR and CESPEN guidelines on pediatric parenteral nutrition: 1. Lipid emulsions and/or vitamins containing PN solutions should be protected from light during administration (bags and tubing) to prevent the generation of oxidants. 2. There is no conclusive evidence for recommending light protection for PN solutions without lipid emulsions and without vitamins during administration (solutions containing, e.g. amino acids, glucose, electrolytes, or trace elements). In addition, in home PN non-light-protected spiral tubing may be used because validated light-protected spiral tubing is currently not available, given that spiral tubing improves the range of motion and safety in infants and young children.

This paper presents research results concerning developmental data (ET 6-6 and SSV) in the context of community based prevention of disruptive behavior. The analysis included data from 61 children between 3 and 6 years of age. The research aimed to analyze associations between SDQ behavior ratings and the scores of developmental tests. In addition evaluation data of the PEP quality management are illustrated. Moreover, recommendations concerning the need of follow-up treatment were evaluated. Significant reduction of disruptive behavior and the total problem behavior score as well as enhancement of prosocial behavior are reported. The purpose of the screening was to identify associations between the appearance of behavioral dysfunction and developmental disorders. Therefore, a regression analysis was performed including the parental SDQ ratings and the results of developmental tests which showed significant associations between developmental disorders and behavioral dysfunction. For the ET 6-6 developmental dimensions body awareness, gross motor and expressive language, substantial correlations with the SDQ prosocial scale and the SDQ problem scales could be found.

Based on guidelines and recommendations of experts this paper describes how depression in children and adolescents can be recognized and managed in primary care. Depression in school age children often presents as diminished attention and somatic complaints, such as sleep problems or tiredness and in adolescents as loss of drive and depressed mood. Interviews with children, adolescents and parents aim at establishing a relationship and identifying depressive symptoms. It is difficult and challenging to achieve simultaneous contact with children and parents. Rating scales help the physician to structure an assessment of behaviour. Questions on indications of dangerous behaviour must be documented. Physicians showed much more competence in psychosocial issues in 5 min training interviews than they were aware of. A supportive and trustful relationship, counseling and monitoring constitute the core competency in primary care. If depressive symptoms last longer or are severe psychotherapy and antidepressive medication are indicated. Consultation of a child and adolescent psychiatrist is needed immediately if a suicidal tendency is suspected and quickly for suspected additional psychiatric problems. The availability of specialists is an indicator of the quality of cooperation. Basic knowledge of psychiatric problems in children, skills in interviewing and a supportive attitude are the essential instruments to feel comfortable in the role of counselor in primary care.