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Aim: The continuing existence of 'teaching by humiliation' of medical students and junior doctors in Australia has recently been highlighted in a number of research publications and media reports. This study investigates medical students' experiences of being intimidated or humiliated during their clinical rotations in Australian hospitals in paediatrics and adult medicine.Methods: From factors identified in earlier research, a two-page survey was developed for administration at two Australian medical schools. Administered in Semester 2 of 2014, students were invited to add their own free-text comments at the conclusion of 17 closed questions. Using thematic analysis of the qualitative data, the researchers identified the common themes in the students' free-text comments, which are reported in this paper.Results: We found five main themes in the qualitative data: a spectrum of interpretations of and responses to 'teaching by humiliation', an accepted means of enculturating the young, teachers' techniques for asking questions, the victims and perpetrators of mistreatment and the variance of prevalence in different contexts.Conclusion: Research shows the persistence of 'teaching by humiliation', even in paediatrics, particularly when doctors are questioning students in ways that shame them for their lack of knowledge. Given the many personal and professional costs of these practices, this cycle of mistreatment needs to be brought to an end. There is a need for students' reports of intimidation and humiliation to be acknowledged; the offending practices need to be interrupted, and more effective and respectful approaches to teaching need to be adopted. [ABSTRACT FROM AUTHOR]

Aim: In New Zealand, there is a paucity of information on children with chronic conditions and disabilities (CCD). One reason is that many are managed in hospital outpatients where diagnostic coding of health-care events does not occur. This study explores the feasibility of coding paediatric outpatient data to provide health planners with information on children with CCD.Methods: Thirty-seven clinicians from six District Health Boards (DHBs) trialled coding over 12 weeks. In five DHBs, the International Classification of Diseases and Related Health Problems, 10th Edition, Australian Modification (ICD-10-AM) and Systematised Nomenclature of Medicine Clinical Terms (SNOMED-CT) were trialled for 6 weeks each. In one DHB, ICD-10-AM was trialled for 12 weeks. A random sample (30%) of ICD-10-AM coded events were also coded by clinical coders. A mix of paper and electronic methods were used.Results: In total 2,604 outpatient events were coded in ICD-10-AM and 693 in SNOMED-CT. Dual coding occurred for 770 (29.6%) ICD-10-AM events. Overall, 34% of ICD-10-AM and 40% of SNOMED-CT events were for developmental and behavioural disorders. Chronic medical conditions were also common. Clinicians were concerned about the workload impacts, particularly for paper-based methods. Coder's were concerned about clinician's adherence to coding guidelines and the poor quality of documentation in some notes.Conclusion: Coded outpatient data could provide planners with a rich source of information on children with CCD. However, coding is also resource intensive. Thus its costs need to be weighed against the costs of managing a much larger health budget using very limited information. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the attitudes and practices of Australian general practitioners (GPs) regarding infant gastro-oesophageal reflux disease (GORD) diagnosis and management.Methods: A national cross-sectional survey, involving a random sample of currently practising Australian GPs (n = 2319) was undertaken between July and September 2011. GPs attitudes and management of infant GORD were surveyed via an online and paper-based 41-item questionnaire.Results: In total, 400 responses were analysed (17.24% response rate). The majority of GPs employed empirical trials of acid-suppression medication and/or lifestyle modifications to diagnose infant GORD. GPs frequently recommended dietary modification despite the belief that they were only moderately effective at best. In addition, GPs frequently prescribed acid-suppression medication, despite concerns regarding their safety in the infant population. Other GP concerns included the lack of clinical guidelines and education for GPs about infant GORD, as well as the level of evidence available for the safety and efficacy of diagnostic tests and treatments.Conclusion: Despite the important role Australian GPs play in the diagnosis and management of infant GORD, high-level evidence-based guidelines for GPs are lacking. Consequently, GPs engage in diagnostic and management practices despite their concerns regarding the safety and effectiveness. [ABSTRACT FROM AUTHOR]

This paper provides specific guidelines on the management of tuberculosis infection and disease, covering general principles, recommended drug regimens and discuss the evidence to support these. It also covers use of corticosteroids, intermittent therapy, directly observed therapy and an approach to the management of a patient with drug-resistant tuberculosis. [ABSTRACT FROM AUTHOR]

Aim: We describe the experience of a new paediatric heart transplant (HT) centre in Australia. New South Wales offers quaternary paediatric cardiac services including comprehensive care pre‐ and post‐HT; however, perioperative HT care has previously occurred at the national paediatric centre or in adult centres. Internationally, perioperative HT care is highly protocol‐driven and a majority of HT occurs in low volume centres. Establishing a low volume paediatric HT centre in New South Wales offers potential for quality HT care close to home. Methods: Retrospective review of programme data for the first 12 months was undertaken. Patient selection was audited against the programme's intended initiation criteria. Longitudinal patient data on outcomes and complications were obtained from patient medical records. Results: The programme's initial phase offered HT to children with non‐congenital heart disease and no requirement for durable mechanical circulatory support. Eight patients met criteria for HT referral. Three underwent interstate transfer to the national paediatric centre. Five children (13–15 years, weight 36–85 kg) underwent HT in the new programme. Individual predicted 90‐day mortality was 1.3–11.6%, with increased risk for recipients transplanted from veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) and with restrictive/hypertrophic cardiomyopathies. Survival at 90 days and for duration of follow‐up is 100%. Observed programme benefits include mitigation of family dislocation and improved continuity of care within a family‐centred programme. Conclusion: Audit of the first 12 months' activity of a second paediatric HT centre in Australia demonstrates adherence to proposed patient selection criteria and excellent 90‐day patient outcomes. The programme demonstrates feasibility of care close to home, providing continuity for all patients including those requiring increased rehabilitation and psychosocial support post‐transplantation. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to evaluate whether pre‐recorded video‐based lectures (VBLs) covering a range of paediatric topics are an acceptable means of providing ongoing education for consultant and trainee paediatricians in Australia. Methods: Previous participants (paediatric consultants and junior medical officers) of a neurology outreach teleconference programme offered by a paediatric neurologist between 2017 and 2020 were invited to participate in a multi‐specialty pre‐recorded video‐based education programme. Acceptability was explored by assessing relevance, likelihood of utilising VBL's in the future, uptake and learning activity preferences. The impact of VBLs on confidence, currency and practice was also explored. Additional data including topics of interest, preferred video format, duration, viewing method and frequency of delivery were captured, to better understand participant preferences to inform future efforts. Results: A total of 135 consented; 116 returned baseline; 94 returned follow‐up surveys. Preferred learning activities included a live/interactive component. Videos were considered relevant. Preferences for pre‐recorded videos improved from ninth to sixth most preferred learning activity post‐intervention. VBL convenience and accessibility were valued. Practice was altered in: approach to management, use of treatments, confidence in decision‐making, and discussion with families and patients. The average view duration was 16 min. Longer videos yielded slightly lower audience retention rates. For future offerings, the majority endorsed a preference for a 'mixed' video format and duration of 20–40 min, offered monthly. Conclusion: Video‐based medical education is an appealing and sustainable alternative, given the convenience of unrestricted accessibility, in meeting ongoing learning needs of Australian paediatricians and trainees. [ABSTRACT FROM AUTHOR]

Aim: Establish the incidence, burden and characteristics of paediatric safeguarding concerns in rural Australian emergency department practice. Methods: Retrospective cohort study of burns, injury and poisoning presentations across 16 months involving 1472 paediatric cases. Results: Five per cent of presentations had confirmed safeguarding concern. These were highest during the 2200–0600 staffing period. Mean age was 7.7 years, 43.8% were female. Multivariable regression models show age 2–6 years (odds ratio (OR), 3.27; 95% confidence interval (CI), 1.35–7.93); delayed presentation (OR, 2.3; 95% CI, 1.47–3.59); and police accompaniment (OR, 9.46; 95% CI, 2.61–34.26) are associated with increased safeguarding concerns. Most concerns (91.8%) related to injuries, largely musculoskeletal, wounds and head injuries. Thermal burns were more common than chemical and electrical. Conclusion: Children aged 2–6 are at higher risk for harm than previously recognised and children aged 0–2 years were over‐represented in staff‐suspected concerns. Those accompanied by police had significant association with confirmed safeguarding concerns which were under‐suspected by staff or assumed to have been already reported. In rural practice, 'unreasonable delay' was found to be a better measure of concern than a discrete time value. Transient family arrangements, unsecured accommodation, geographical isolation, cultural safety and unique home environments must be taken into when completing injury assessments. For regional health services to successfully identify children at risk, interagency collaboration, staff education and local patterns of concern should be targeted. Rostering changes should increase after‐hours assessment capacity by specialty paediatric staff. [ABSTRACT FROM AUTHOR]

The author comments on pediatric trainees taking the Fellowship of the Royal Australasian College of Physicians (FRACP) Written Examination in Australia. As many viewed the two major categories used as pass marks for the examinations to be unfair for candidates, the author emphasizes how education help them to qualify for the second category which is criterion-reference approach in which candidates whose clinical competence satisfies the examiners, can pass the examination.

Sick and injured children, like combatants wounded by shot and shell in war, are disproportionately represented in the tallies of both man-made and national disasters. Paediatricians have a particularly proud heritage of military service, a nexus dating in Australia from the early 19th century. This paper traces this link between service to children in peacetime and the care of servicemen, women and children in times of war and disaster. The extraordinary record of Australian 'paediatric' doctors who also served in the Gallipoli Campaign (1915) is documented as an illustration of this duality. Paediatricians who serve in the Defence Reserves and in civilian non-government organisations which respond to disasters and civil wars have special credentials in their advocacy for the protection of children enmeshed in conflict or disaster. Such applies particularly to the banning of the recruitment and use of child soldiers; support for children caught up in refugee and illegal immigrant confrontations; and continued advocacy for greater international compliance with the Ottawa Convention to ban the use of anti-personnel landmines. Volunteering for such service must occur in cold 'down time', ensuring that paediatricians are trained in disaster and conflict response, when such challenges inevitably confront the paediatricians of the future. [ABSTRACT FROM AUTHOR]

This paper provides a general overview of the literature investigating the nexus between education and health; discussing the relationship between these domains at individual, family and community levels. We then briefly examine the programme and research implications of such a framework for interventions aimed at improving education and health, with specific reference to young Indigenous Australians. We find that while education and health are inextricably linked, throughout the life course and at different levels of influence, there is less empirical work exploring this relationship in an Indigenous context. Given the gravity of literacy and numeracy failure rates in school-based education and its potential impact on Indigenous health, we assert an urgent case for rigorous research into interventions that address the barriers to effectiveness in implementing quality educational experiences and opportunities for Indigenous children. [ABSTRACT FROM AUTHOR]

Aim: To explore the socio-demographic factors and other maternal characteristics that influence breastfeeding initiation rates. In particular, this paper aims to (i) estimate the rate of breastfeeding by maternal socio-demographic factors and other maternal characteristics at first well-baby visit; and (ii) investigate the relationship between breastfeeding rates and these maternal factors. Methods: Cross-sectional data were obtained for 9618 babies in south-western Sydney in New South Wales from the Ingleburn Baby Information Systems database from January 2000 to June 2004 and included information on breastfeeding status, socio-demographic factors and other maternal characteristics. Results: At first visit, 59.8% of mothers were breastfeeding. The factors that increased the risk for NOT breastfeeding on multivariate analysis were being Australian-born (OR = 1.67, 95% CI 1.45–1.89, P < 0.001), unmarried (OR = 1.79, 95% CI 1.52–2.11, P < 0.001), living in disadvantaged accommodation (OR = 1.90, 95% CI 1.60–2.26, P < 0.001), having lower levels of education (OR = 1.88, 95% CI 1.38–2.54, P < 0.001) and current smoking (OR = 1.72, 95% CI 1.51–1.96, P < 0.001). Conclusion: The results from this large population-based study suggest that breastfeeding rates are significantly influenced by socio-demographic factors and maternal characteristics. Consequently, subgroups of the population ‘at risk’ for not breastfeeding can be identified and targeted for further strategies to promote breastfeeding. [ABSTRACT FROM AUTHOR]

The article comments on the issues concerning the specialty status of medical practice in community child health in Australia. The author believed that community child health will continue to grow and will lead to factions and fractionalization. The author further suggested that continued action is needed to promote developmental health.

Aims: COVID-19 is now a global pandemic. At the time of survey, fewer than 150 children in Australia and New Zealand had documented infection. The aim of this study was to assess attitudes, readiness and confidence in the early stages of the COVID-19 pandemic through an online survey of paediatric physicians and sub-specialists across Australia and New Zealand.Methods: Multiple email list groups were used to contact paediatric physicians to undertake an online Likert scale survey between 17 and 24 March. Respondents' specialty, experience and work setting were recorded. Ordinal logistic regression was used to determine respondent factors.Results: There were 542 respondents from across Australia and New Zealand: an estimated 11% of the paediatric physician workforce. A minority (36.6%) agreed that their national response had been well coordinated; the majority (92.7%) agreed that senior-level hospital administrators were taking the situation seriously. Most reported a good understanding of the natural history of COVID-19 in children, and knowledge of where to find local information. A large proportion of physicians (86.1%) were worried about becoming infected through their work; few (5.8%) reported that they would not come to work to avoid infection. Closure of school and childcares would reduce the ability to continue work at current capacity for 23.6% of respondents.Conclusion: Despite limited experience in pandemics, most paediatric physicians felt informed. Concern about exposure at work is common; most were willing to work regardless. The closure of schools and daycares may have an impact on staffing. Coordination and leadership will be critical. [ABSTRACT FROM AUTHOR]

Aim: Tonsillectomy procedures are a core element of paediatrics; however, perioperative management differs. This study aimed to describe tonsillectomy management, including the burden of pain, nausea and delayed recovery.Methods: A prospective cohort study was undertaken through an audit of tonsillectomy perioperative practice and recovery and survey interviews with family members 7-14 days post-surgery. The study was undertaken at an Australian tertiary referral paediatric hospital between June and September 2016.Results: The audit included 255 children undergoing tonsillectomy, with 127 family members interviewed. Most participants underwent adenotonsillectomy (n = 216; 85%), with a primary diagnosis of obstructive sleep apnoea (n = 205; 80%) and a mean age of 7 years (standard deviation; 3.9). A variety of intra-operative pain relief and antiemetics was administered. Pain was present in 29% (n = 26) of participants at ward return, increasing to 32-45% at 4-20 h and decreasing to 21% (n = 15) at discharge. A third of the children (32%; n = 41) had moderate to severe pain at post-discharge interview, and 30% (n = 38) experienced nausea at home. Most parents (82%; n = 104) were still giving regular paracetamol at 7 days post-operatively, and 31% (n = 39) had finished their oxycodone. Of the participants, 14% (n = 26) presented to the emergency department within 7 days of discharge; 8% (n = 20) of the total cohort were re-admitted.Conclusions: There was variety in perioperative and post-discharge care. Pain scores were infrequently documented post-tonsillectomy, and parents are generally dissatisfied with the management of post-operative pain and nausea. Further research is needed to provide a more consistent approach to perioperative management to promote recovery. [ABSTRACT FROM AUTHOR]

Aim: To investigate paediatricians' understanding of, and approaches to, the diagnosis and treatment of functional abdominal pain (FAP) and irritable bowel syndrome (IBS) in children.Methods: This study used an electronic survey of doctors subscribing to a popular Australian-based paediatrics email forum. Responses about investigation and management in two clinical vignettes were correlated with respondent demographic data, practice setting, attitudes and knowledge.Results: The 327 respondents were mostly female (60.3%), aged <45 years (54.5%), general paediatricians (53.5%), working in public outpatient clinics (50.5%). Awareness of Rome III diagnostic criteria was low (37.2%) but associated with confidence in diagnosing FAP/IBS in the vignettes. Respondents who lacked confidence in diagnosing FAP/IBS requested more investigations (P < 0.05), although most acknowledged they would not be helpful. Most (70.5%) believed that families are unlikely to accept an FAP diagnosis without investigations requested. Fewer than 1 of 3 were aware of clear evidence for the effective therapy of FAP or IBS, although awareness did not influence management options selected. Two-thirds of respondents believe that FAP is a psychological rather than a medical problem, while few (8.8%) believe the same about IBS (P < 0.001). Parental pressure to find an immediate cure was cited as the most frequent challenge to successful management in both FAP (86.6%) and IBS (75.9%).Conclusions: Awareness of the Rome criteria was associated with greater confidence in diagnosing FAP and IBS. Attitudes to FAP and IBS being diagnoses of exclusion are prevalent among paediatricians and associated with more investigations requested. There is a lack of awareness of evidence-based therapies for FAP and IBS. [ABSTRACT FROM AUTHOR]

Aim: To evaluate a paediatric clinical ethics service incorporating both normative and empirical analysis.Methods: Section 1: Review of consensus guidelines to identify emerging standards for clinical ethics services (CES) and evaluation of the service in relation to these. Section 2: Description of service activity data. Section 3: Feedback from clinical staff involved in clinical ethics consultations was collected using a web-based survey.Results: Four guideline documents were reviewed, and clear emerging consensus standards were identified. Our service fulfils identified knowledge and skill core competencies and at least partially fulfils all of the identified service-level standards. Clinicians report that clinical ethics consultation decreases their moral distress.Conclusions: There is emerging consensus for staff competencies and service-level standards for CES. The role of CES in staff well-being needs to be explored. Collaborative, multi-modal research to develop standards and evaluate CES is needed. [ABSTRACT FROM AUTHOR]

Aim: To estimate the non-medical out-of-pocket costs for families with a child in hospital.Methods: This study was a survey of 225 parents of paediatric inpatients on nine wards of an Australian public paediatric teaching hospital on two separate days. Our primary outcomes were the costs associated with: (i) time taken off work to care for the child in hospital; (ii) time off work or contributed by family and friends to care for other dependents; and (iii) travel, meals, accommodation and incidental expenses during the child's stay. Demographic data included postcode (to assess distance, socio-economic status and remoteness), child's age, ward and whether this was their child's first admission.Results: Mean patient age was 6.5 years (standard deviation 5.2). On an average per patient day basis, parents took 1.12 days off work and spent 0.61 (standard deviation 0.53) nights away from home, with 83.8% of nights away at the child's bedside. Parents spent Australian dollars (AUD)89 per day on travel and AUD36 on meals and accommodation. Total costs (including productivity costs) were AUD589 per patient day. Higher costs per patient day were correlated with living in a more remote area (0.48) and a greater travel distance to the hospital (0.41). A higher number of days off work was correlated (0.69) with number of school days missed.Conclusion: These results demonstrate the considerable time and financial resources expended by families caring for a child in hospital and are important inputs in evaluating health-care interventions that affect risk of hospitalisation and length of stay in paediatric care. [ABSTRACT FROM AUTHOR]

Aim: Penetrating head injuries (pHIs) are associated with high morbidity and mortality. Data on pHIs in children outside North America are limited. We describe the mechanism of injuries, neuroimaging findings, neurosurgery and mortality for pHIs in Australia and New Zealand.Methods: This was a planned secondary analysis of a prospective observational study of children <18 years who presented with a head injury of any severity at any of 10 predominantly paediatric Australian/New Zealand emergency departments (EDs) between 2011 and 2014. We reviewed all cases where clinicians had clinically suspected pHI as well as all cases of clinically important traumatic brain injuries (death, neurosurgery, intubation >24 h, admission >2 days and abnormal computed tomography).Results: Of 20 137 evaluable patients with a head injury, 21 (0.1%) were identified to have sustained a pHI. All injuries were of non-intentional nature, and there were no gunshot wounds. The mechanisms of injuries varied from falls, animal attack, motor vehicle crashes and impact with objects. Mean Glasgow Coma Scale on ED arrival was 10; 10 (48%) had a history of loss of consciousness, and 7 (33%) children were intubated pre-hospital or in the ED. Fourteen (67%) children underwent neurosurgery, two (10%) craniofacial surgery, and five (24%) were treated conservatively; four (19%) patients died.Conclusions: Paediatric pHIs are very rare in EDs in Australia and New Zealand but are associated with high morbidity and mortality. The absence of firearm-related injuries compared to North America is striking and may reflect Australian and New Zealand firearm regulations. [ABSTRACT FROM AUTHOR]

Aim: Variation in the management of fever and neutropenia (FN) in children is well described. The aim of this study was to explore the current management of FN across Australia and New Zealand and highlight areas for improvement.Methods: A practice survey was administered to paediatric health-care providers via four clinical and research networks. Using three clinical case vignettes, we explored risk stratification, empiric antibiotics, initial investigations, intravenous-oral switch, ambulatory management and antibiotic duration in children with cancer and FN.Results: A response was received from 104 participants from 16 different hospitals. FN guideline compliance was rated as moderate or poor by 24% of respondents, and seven different fever definitions were described. There was little variation in the selected empiric monotherapy and dual-therapy regimens, and almost all respondents recommended first-dose antibiotics within 1 h. However, 27 different empiric antibiotic combinations were selected for beta-lactam allergy. An incorrect risk status was assigned to the low-risk case by 27% of respondents and to the high-risk case by 41%. Compared to current practice, significantly more respondents would manage the low-risk case in the ambulatory setting provided adequate resources were in place (43 vs. 85%, P < 0.0001). There was variation in the use of empiric glycopeptides as well as use of aminoglycosides beyond 48 h.Conclusion: Although the antibiotics selected for empiric management of FN are appropriate and consistent, variation and inaccuracies exist in risk stratification, the selection of monotherapy over dual therapy, empiric antibiotics chosen for beta-lactam allergy, use of glycopeptides and duration of aminoglycosides. [ABSTRACT FROM AUTHOR]

Aim: The aims of this study were to investigate clinicians' knowledge, and barriers they perceive exist, relating to the identification and measurement of dyskinesia (dystonia/choreoathetosis) in children with cerebral palsy (CP) and to explore educational needs regarding improving identification and assessment of dyskinesia.Methods: This was a cross-sectional online survey of clinicians working with children with CP. Data analysis was descriptive, with qualitative analysis of unstructured questions.Results: In total, 163 completed surveys from Australian clinicians were analysed. Respondents were allied health (n = 140) followed by medical doctors (n = 18) working mainly in tertiary hospitals and not-for-profit organisations. Hypertonia subtypes and movement disorders seen in children with CP appear to be identified by clinicians, although limited knowledge about dyskinesia and access to training were reported as significant barriers to accurate identification. Despite knowledge of available measurement scales, only a small percentage were used clinically and reported to be only somewhat useful or not useful at all. Barriers identified for use of scales included limited training opportunities and knowledge of scales and lack of confidence in their use.Conclusion: A lack of confidence in identifying and measuring movement disorders in children with CP was reported by Australian clinicians. It was identified that a greater understanding of dyskinetic CP and the tools available to identify and measure it would be valuable in clinical practice. The results of this survey will inform the development of a 'Toolbox' to help identify, classify and measure dyskinetic CP and its impact on activity and participation using the framework of the International Classification of Functioning, Disability and Health. [ABSTRACT FROM AUTHOR]

Aim: To determine (i) the proportion of different referral sources for new referrals to paediatric specialist outpatient clinics and (ii) any association of referral source with utilisation of additional health services.Methods: Survey of parents presenting with their child at five paediatric specialist outpatient clinics at two Melbourne public hospitals.Results: Just over half (52%) of the respondents were referred by a general practitioner (GP). The remainder were referred by a paediatrician (27%) at hospital discharge (16%) or from the ED (6%). Most respondents (71%) reported that their child also has a referral to see another specialist for the same health concern but had not yet had the consultation; 44% had consulted another doctor for the same health concern between receiving the referral and the appointment. Paediatrician referrals were more likely to see another specialist for the same health concern compared to other referral sources (P = 0.032).Conclusion: Only half of the referrals of new patients to paediatric specialist outpatient clinics come from GPs. Future research should investigate whether multiple referral sources have a negative impact on the co-ordination and cost of paediatric health care. [ABSTRACT FROM AUTHOR]

Aim: To examine the psychological and psychosocial service needs of mothers of children with craniofacial anomalies (CFAs).Methods: Mothers (n = 55) of children from newborn to 6 years with CFA completed self-report measures of psychological distress, quality of life and perceived social support.Results: Mothers' psychological distress levels were significantly higher than those in a normative population. Mothers reported lower quality of life than the normative sample. Social support mediated the relationship between quality of life and psychological distress. While most mothers reported a willingness to receive formal psychological support for issues relating to their child's CFA, few had been offered such services.Conclusions: Mothers of children with CFAs may experience increased psychological distress in comparison with the general population. Increased social support may reduce the risk of psychological distress, thus enhancing quality of life among such mothers. The majority of mothers of children with CFAs in Australia may not be routinely offered psychological support services in spite of their elevated psychological risk. [ABSTRACT FROM AUTHOR]

Aim: Telehealth is a useful method of providing specialist consultation to a geographically diverse population. Canadian studies of telehealth for paediatric surgery demonstrate good accuracy, but have low numbers of cryptorchid patients in their cohorts. Our aim was to confirm Canadian studies for our cohort and to assess accuracy regarding cryptorchidism.Methods: We conducted a cohort study of patients seen via paediatric surgical telehealth over a 12-month period, to determine accuracy of telediagnosis with respect to face-to-face diagnosis and plan.Results: A total of 183 children had 224 videoconferences, resulting in 74 surgical bookings. There was high diagnostic concordance, except for undescended testes. One discharged patient, and two patients booked for review, have subsequently required an orchidopexy (false negatives). Of 15 patients booked for surgery, three did not require an operation (false positives). Other patients had their procedures upgraded (from open to laparoscopic) or downgraded (from laparoscopic to open) due to inaccuracies in far-end assessment.Conclusion: Telehealth for paediatric surgery is accurate for most conditions seen, but for cryptorchidism there are significant concerns. [ABSTRACT FROM AUTHOR]

Aim: In adult medicine, rates of investigation and prescribing appear to be increasing. Such information is lacking for paediatrics. We audited Australian paediatricians' practices in 2013 to determine changes since 2008 in: (i) conditions seen; (ii) consultation duration; (iii) imaging and pathology ordered; and (iv) prescribing.Methods: This is a patient-level prospective audit of paediatricians' secondary care practice. Between November and December 2013, members of the Australian Paediatric Research Network were invited to complete standardised forms for 100 consecutive patients or all patients seen over 2 weeks, whichever was completed first.Main Measures: diagnoses, consultation duration, pathology and/or imaging investigations ordered, rate of medication prescription.Analyses: hierarchical linear modelling clustered at the paediatrician level.Results: One hundred and eighty paediatricians (48% of those eligible) contributed 7102 consultations. The proportion of developmental/behavioural conditions rose from 48% (SD 31%) to 60% (SD 30%) in new and 54% (SD 28%) to 66% (SD 28%) in review consultations in 2013 compared with 2008. More paediatricians reported diagnoses of autism spectrum disorder (39-56%, P = 0.002), attention-deficit/hyperactivity disorder (47-55%, P = 0.05) and intellectual disability (18-36%, P = 0.001) in first consultations. Mean consultation duration and pathology/imaging ordering rates were stable. Prescribing rates increased from 39 to 45% of consultations for the top 10 new diagnoses and from 57 to 68% of consultations for the top 10 review diagnoses.Conclusions: Paediatricians are seeing more children with developmental-behavioural conditions, prescribing more and demonstrating wide variation in their practice. The latter suggests both over- and under-treatment. [ABSTRACT FROM AUTHOR]

Aim: Concurrence between parents' information needs and clinicians' practice when diagnosing autism is unknown but may influence families' uptake of management and adjustment. We aimed to compare parents' experience and preferences with paediatrician report of (i) diagnosis delivery and (ii) information given at diagnosis and identify types and usefulness of resources accessed by families post-diagnosis.Methods: The design used for the study are parent and paediatrician surveys. Participants are parents of children aged 1.5-18 years, diagnosed with autism between 01 January 2010 and 30 September 2012 and their paediatricians who are members of the Australian Paediatric Research Network. Study-designed quantitative and qualitative questions about diagnosis delivery and information given at diagnosis (written and spoken vs. neither) and parent perceived importance and harms of information accessed post-diagnosis.Results: Paediatricians (53/198 (27%)) identified 1127 eligible families, of whom 404 (36%) participated. Parents were more likely to report receiving adequate time to discuss diagnosis than paediatricians (71 vs. 51%). Parents (98%) rated information about accessing allied health professionals and the meaning of diagnosis as most important, yet paediatricians offered written or spoken information about each infrequently (allied health: 22%; diagnosis: 42%). Post-diagnosis, allied health was the most important source of information (83%). Harmful resources conveyed helplessness or non-evidenced-based therapies, but few parents (14%) reported this.Conclusions: Parents want more information than can be conveyed in a single diagnostic consultation. Developing a tailored 'autism action plan' with written materials could improve parents' understanding of and satisfaction with children's autism diagnoses. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study is to characterise ambient sound levels of paediatric and neonatal intensive care units in an old and new hospital according to current standards.Methods: The sound environment was surveyed for 24-h data collection periods (n = 80) in the Neonatal and Paediatric Intensive Care Units (NICUs and PICUs) and Special Care Nursery of the old and new Royal Children's Hospital Melbourne. The ambient sound environment was characterised as the proportion of time the ongoing ambient sound met standard benchmarks, the mean 5-s sound levels and the number and duration of noise events.Results: In the old hospital, none of the data collection periods in the NICU and PICU met the standard benchmark for ongoing ambient sound, while only 5 of the 22 data collection periods in the new hospital met the recommended level. There was no change in proportion of time at recommended Leq between the old and the new Special Care Nursery. There was strong evidence for a difference in the mean number of events >65 dBA (Lmax ) in the old and new hospital (rate ratio = 0.82, 95% confidence interval: 0.73 to 0.92, P = 0.001). The NICU and PICU were above 50 dBA in 75% of all data collection periods, with ventilatory equipment associated with higher ongoing ambient sound levels.Conclusions: The ongoing ambient sound suggests that the background sound environment of the new hospital is not different to the old hospital. However, there may be a reduction in the number of noise events. [ABSTRACT FROM AUTHOR]

Aims: In a sample of newly diagnosed children with attention-deficit/hyperactivity disorder (ADHD), the aims were to examine (1) paediatrician assessment and management practices; (2) previous assessments and interventions; (3) correspondence between parent-report and paediatrician identification of comorbidities; and (4) parent agreement with diagnosis of ADHD.Methods: Design: cross-sectional, multi-site practice audit with questionnaires completed by paediatricians and parents at the point of ADHD diagnosis.Setting: private/public paediatric practices in Western Australia and Victoria, Australia.Main Outcome Measures: paediatricians: elements of assessment and management were indicated on a study-designed data form. Parents: ADHD symptoms and comorbidities were measured using the Conners 3 ADHD Index and Strengths and Difficulties Questionnaire, respectively. Sleep problems, previous assessments and interventions, and agreement with ADHD diagnosis were measured by questionnaire.Results: Twenty-four paediatricians participated, providing data on 137 patients (77% men, mean age 8.1 years). Parent and teacher questionnaires were used in 88% and 85% of assessments, respectively. Medication was prescribed in 75% of cases. Comorbidities were commonly diagnosed (70%); however, the proportion of patients identified by paediatricians with internalising problems (18%), externalising problems (15%) and sleep problems (4%) was less than by parent report (51%, 66% and 39%). One in seven parents did not agree with the diagnosis of ADHD.Conclusions: Australian paediatric practice in relation to ADHD assessment is generally consistent with best practice guidelines; however, improvements are needed in relation to the routine use of questionnaires and the identification of comorbidities. A proportion of parents do not agree with the diagnosis of ADHD made by their paediatrician. [ABSTRACT FROM AUTHOR]

Aim: Autism spectrum disorder (ASD) is a neurodevelopmental disorder with reported prevalence of more than 1/100. In Australia, paediatricians are often involved in diagnosing ASD and providing long-term management. However, it is not known how paediatricians diagnose ASD. This study aimed to investigate whether the way Australian paediatricians diagnose ASD is in line with current recommendations.Methods: Members of the Australian Paediatric Research Network were invited to answer questions about their ASD diagnostic practice in a multi-topic survey and also as part of a study about parents needs around the time of a diagnosis of ASD.Results: The majority of the 124 paediatricians who responded to the multi-topic survey and most who responded to the parent needs survey reported taking more than one session to make a diagnosis of ASD. Most paediatricians included information from preschool, child care or school when making a diagnosis, and over half included information from speech pathology or psychology colleagues more than 50% of the time. The main reasons for not including assessment information in the diagnostic process were service barriers such as no regular service available or long waiting lists. More than 70% reported ordering audiology and genetic tests more than half of the time.Conclusion: Not all paediatricians are following current recommendations for diagnosing ASD more than 50% of the time. While there are good reasons why current diagnostic approaches may fall short of expected standards, these need to be overcome to ensure diagnostic validity and optimal services for all children and their families. [ABSTRACT FROM AUTHOR]

Aim: An estimated 1.1% of Australian adults are infected with hepatitis C virus (HCV). Many develop chronic liver disease, and some develop liver failure or hepatocellular carcinoma. HCV infection in Australian children is poorly defined. We aimed to determine the reported incidence, clinical and epidemiological features of newly diagnosed HCV infection in Australian children presenting to paediatricians.Methods: We undertook prospective active national surveillance, using the Australian Paediatric Surveillance Unit, of incident HCV cases in children aged <15 years between 1(st) January 2003, and 31(st) December 2007.Results: There were 45 confirmed cases of newly diagnosed HCV infection over five years (<1 per 100,000 children aged <15 years per year). Median age at diagnosis was 2.9 years. Positive maternal HCV serostatus was the most frequent reported risk factor for HCV infection in children (40/45). Three children (all aged > 14), were exposed through their own IV drug use. No children were co-infected with HIV and only one child was co-infected with HBV. All children were asymptomatic at diagnosis, although many had minor elevations in liver transaminases. Many clinicians reported difficulties with follow-up.Conclusions: Childhood HCV infection is uncommon in Australia, although our data likely underestimate the incidence. Only a small number of children aged <18 months was identified, despite known perinatal exposure. Opportunistic investigation of children at risk for HCV, improved education regarding vertical transmission for health care providers, and increased coordination of childhood HCV services are required to improve recognition and management of children with HCV. [ABSTRACT FROM AUTHOR]

Aim This study aims to identify the health needs of children placed in out-of-home care in regional Queensland and to compare them with the needs of similar children in metropolitan Queensland. Methods Retrospective chart review and subsequent analysis of data from the first assessments of the children placed in care from January 2005 to April 2011. Health needs based on assessment recommendations were then compared with needs and recommendations from a similar clinic in metropolitan Brisbane. Results Two hundred thirty-nine first assessments were reviewed. The average number of health referrals arising out of each assessment was 2. 72% children were between 2 and 12 years of age and accounted for 76% of the health referrals made. The 10-13% of the children needed referrals for medical and surgical specialties, audiology, speech pathology, dental, and ophthalmology/optometry, each. A percentage of 30 needed ongoing paediatric care. The 15% needed immunisation catch up, 35% counselling and behaviour management, and 15% formal mental health referrals. These were comparable to the health needs identified in out-of-home care children residing in metropolitan Queensland. Conclusion Children in care who live in a regional setting have similar health-care needs compared with urban children. Given restricted health services in regional settings, there is difficulty in accessing services to meet these needs. [ABSTRACT FROM AUTHOR]

The authors discuss the training in clinical communication skills of paediatrics. The authors state that learning by doing is the most effective approach of communication skills training. They mention that Australia and New Zealand have been catering communication skills couses for medical practitioners who take up specialty training. They add that communication skills training can also bring essential benefits to the patients and families of the participants.

Aim Acute gastroenteritis ( AGE) has been a significant component of the clinical load in the short stay unit ( SSU) at the Royal Children's Hospital ( RCH) since its establishment in 2004. Since the introduction of routine rotavirus immunisation in Australia in 2007 there has been a clinical impression of a substantial reduction in AGE managed in the SSU. This study aimed to examine changes in the epidemiology of AGE in the SSU, and RCH overall, between 2005 and 2009 and explore whether this reflects a change specifically in AGE due to rotavirus. Methods Discharge coding data for AGE from all inpatient wards, the SSU and emergency department ( ED) at the RCH were examined. Stool virology results for the same period were analysed. Results Since 2007 there has been a 58% reduction in AGE admissions to the SSU. The median age of patients admitted to the RCH with rotaviral enteritis has increased from 1.3 years to 3.8 years. Presentations to the ED for AGE have fallen from 53 to 34 cases per 1000 attendances between 2004 and 2009, and admission rates from the ED have fallen from 23 to 13% of AGE presentations. Detection rates of rotavirus fell from 13.1 to 6.7% between 2005 and 2009. Conclusion A marked decrease in AGE-related clinical activity and reduction in rotavirus detection at the RCH has occurred since the introduction of routine rotavirus immunisation in Australia. This has significant resource planning implications for units based on short stay models of care. [ABSTRACT FROM AUTHOR]

Aim Primary chilblains are an idiopathic cold-induced vasculopathy affecting the soft tissues of the hands and feet. Secondary chilblains occur in different forms of vasculitis and chronic autoimmune connective tissue disorders. Idiopathic chilblains are rarely reported in children and may generate significant anxiety to doctors and patients. We describe a cluster of idiopathic chilblains encountered over the winter of 2010 in Perth, Western Australia. Methods This is a retrospective review of patients identified from a prospectively compiled database of all new cases seen in our department. Data on history, examination, investigations, prescribed treatments and outcomes were collected. Results Thirty-two patients with isolated idiopathic chilblains were included, including 20 females and 12 males with a median age at onset of 13.5 years. Lesions were papular with signs of peripheral vasoconstriction causing acrocyanosis, and uncomfortable due to pain and/or pruritis in most. Thickening of the small joints was common where lesions involved these areas. Ulceration of lesions also occurred in some. One patient required hospitalisation for secondary bacterial infection. Most received some form of treatment including non-steroidal anti-inflammatory drugs, prednisolone or nifedipine. Most patients improved spontaneously with warmer weather or responded to cold protection advice. All had resolved completely by late spring ( November). Conclusion Our cluster of chilblains was associated with an unusually cold winter in Perth 2010. It is the largest series reported in the literature, suggesting that chilblains may be more common than previously thought. Chilblains are almost always benign in nature and patients are systemically well and usually need no further investigation and only symptomatic treatment. Prompt recognition can avoid excessive investigation and anxiety, allowing appropriate simple advice and treatment. [ABSTRACT FROM AUTHOR]

Following research highlighting high levels of health need in New South Wales children in out-of-home care, this study aimed to quantify health need in a sample of Queensland children in care based on multidisciplinary child health assessments. The study also sought to examine the concordance between foster carers' health concerns for children for whom they are providing care and health need as established through referrals made as a result of health assessment. Children entering out-of-home care in the north Brisbane area within the previous month were referred for baseline child health assessment. Child health was assessed by paediatricians and clinical nurses utilising a pro forma-based methodology. Analysis of initial carer concerns, health referrals and immunisation status in the sample was undertaken. Of the 63 children assessed, 70% were found to require multiple referrals to various health services. The most frequently made referrals included paediatrician follow-up (41% of children), counselling services (30%) and audiology (26%). Only 68% of the sample was found to be fully immunised. A discrepancy was noted between foster carers' child health concerns and level of referral need established during assessment. Queensland children in care have high health needs similar to those evidenced by children in care in other areas of Australia. Foster carers appear to underestimate the health needs of children in their care, demonstrating the necessity of multidisciplinary health screens and foster carer training in order to detect child health problems in this population. [ABSTRACT FROM AUTHOR]

Contemporary paediatric practices of Australian Aboriginal men and women, in more than 100 Aboriginal Language Groups, comprise a living discipline whose origins predate Western medicine by tens of millennia. The history of paediatrics acknowledges this surviving continuum of the world's oldest child-care practices. Because of the inextricable nexus between Aboriginal men and women and the land in which they live, medical ethnobotany forms a major part of the medical aspects of Aboriginal child care. Traditional tribal healers, called‘Nungungi’ in some language groups of Central Australia, are identified as such whilst still young children and are given special education in the healing arts, especially that of medical ethnobotany, by older healers. Distinct from this specialized role, all Aboriginal men and women (and in particular grandmothers) in traditional communities use a sophisticated botanicalmateria medicain the treatment of sick and injured children.In cultures in transition, medical ethnobotanical practices may persist long after the local use of flora as sources of traditional food, weaponry, totemic identity and religious rites have disappeared. Some selected botanical‘cures’ were adopted by early European settlers and a number of such relict uses have become part of mainstream Western life today, particularly as this applies to self-medication. Drugs and medicaments used in the treatment of children are obtained from leaves, bark, roots and flowers, usually as fresh preparations. They are prepared as infusions, decoctions and macerations and may be enjoined with emollients such as emu or kangaroo fat for topical application. Botanical drugs and medicaments are usually prepared fresh for each administration and are rarely stored. Contemporary Australian ethnobotany exploits the medicinal properties of more than 100 genera– using such extracts as antiseptics, analgesics, astringents, antipyretics, sedatives, hypnotics, expectorants and carminatives. Their widespread use, by the world's oldest surviving cultures, reflect perhaps 50 millennia of acute observation and clinical interpretation, trial and error, serendipidity and experimentation.Australian medical ethnobotany generally, and that used specifically for children, is characterized by several features including (i) the multipurpose or‘broad-spectrum’ use of many floral species; (ii) a paradigm of the use of botanical material to treat symptoms and symptom-complexes rather than disease-based treatment; (iii) the widespread and universal medical knowledge of botanical remedies byallmembers of local Aboriginal communities, not only traditional community or tribal healers and (iv) the use of botanical material in the context of preventive medicine. Seventy per cent of the world's population uses traditional herbal remedies in the treatment of sick or injured children. In this context, the detailed and extensive ethnobotanical pharmacopoeia of the Aboriginal Peoples of Australia holds an important place. [ABSTRACT FROM AUTHOR]

In Australia acute idiopathic thrombocytopenic purpura (ITP) is mainly treated by paediatricians (either general paediatricians or paediatric haematologists/oncologists). A survey was conducted to gauge the current practice of treating children with acute ITP in Australia.All practising Australian paediatricians registered by the Royal Australasian College of Physicians were surveyed regarding their intended management of children with acute ITP. The questionnaire, adapted from a study of paediatric haematologists/oncologists in North America, presented four clinical scenarios of children with acute ITP with a platelet count of 3000 × 109/L, with and without mucosal bleeding (wet and dry purpura, respectively). Questionnaires were returned by mail or filled in online at a dedicated webpage.Five hundred and sixty-three of 1097 (51%) paediatricians responded to the survey. Data from 140 who had treated at least one child with ITP in the previous 12 months were analysed. Respondents indicated that children with acute ITP are usually or always hospitalised (58−92%) and that 48% would be given active treatment, even with dry purpura. Various regimens of i.v. immunoglobulin or corticosteroids are used when treatment is administered. In comparing Australian and North American management of acute ITP there were many similarities, although Australian paediatricians were less likely to arrange a bone marrow aspirate if corticosteroids were prescribed.There is great variation in the intended management of children with acute ITP in Australia. Previously published management recommendations regarding investigation and treatment have had little impact on intended practice. Prospective studies are required to evaluate hypotheses so as to produce evidence-based recommendations for treatment of patients with acute ITP. [ABSTRACT FROM AUTHOR]

To describe the clinical effects of spider bites in a paediatric population and compare to bites in an adult population. Prospective follow up study of children with definite spider bites where the spiders were immediately collected and expertly identified. Cases were recruited from Australian emergency departments and poison information centres and followed up. Data were collected on circumstances of bites and clinical effects, and compared with similar data from adult spider bites. There were 163 cases (62% male, 38% female; age <16, median age 7 years, interquartile range (IQR): 3−11 years). The median duration of effects was 2 h (IQR 0.25−12 h). The commonest spiders were Huntsman spiders ( Sparassidae) and Orb weavers ( Araneidae), and comparatively few bites by theridiid spiders, including Red-back spiders. Pain or discomfort occurred in all bites and was severe in 20%. Local effects included puncture marks/bleeding (36%) and red mark/redness (73%). Systemic effects occurred in only 6% of cases. There were no necrotic lesions or ulcers as a consequence of any spider bites (0%; 97.5% CI 0.0−2.2%) and no early allergic reactions or secondary infections. The median duration of clinical effects was shorter than adults, the frequency of severe pain was less than adults and systemic effects were less common in children. Paediatric spider bite causes minor effects in the majority of cases, and is unlikely to cause necrotic ulcers, allergic reactions or infection. The severity and duration of effects differ from adults. [ABSTRACT FROM AUTHOR]

Objective: To identify determinants of the initiation and duration of breastfeeding amongst Australian women.Methods: A prospective cohort study of 556 women in Perth, Western Australia and 503 women from the Darling Downs area, Queensland, Australia.Results: Breastfeeding at discharge was most strongly associated with perceived paternal support of breastfeeding with an adjusted odds ratio of 9.13 (95% CI 4.83-17.26), using multivariate logistic regression analysis. Duration of breastfeeding was most strongly associated with the length of time a mother intended to breastfeed with an adjusted relative risk of 4.18 (95% CI 2.81-6.22) for > or = 4 months relative to < 4 months.Conclusions: Interventions which aim to increase the length of time a woman intends to breastfeed, and which highlight the role of the father in successful breastfeeding, are recommended to help achieve recommended targets for breastfeeding initiation and duration. [ABSTRACT FROM AUTHOR]

Objective: The Royal Australasian College of Physicians has conducted periodic workforce censuses of Fellows practising paediatric medicine in Australia since 1981. The aim of this study was to document trends in the supply of paediatricians and to project these trends into the early 21st century.Methodology: Time series analysis using least squares regression.Results: The paediatric consultant workforce in Australia increased in a linear manner from 374 in 1981 to 777 in 1997. If this trend persists, the number of paediatricians will grow by 62% to 1255 in 2016. The ratio of population aged 0-14 years per paediatrician fell from 9960:1 in 1981 to 5040:1 in 1997. The projected national decline in the child population will result in a ratio of 3050 children per paediatrician in the year 2016. The proportion of women in the paediatric workforce was 22.4% in 1997 and is projected to rise to at least 36% by 2016. The proportion aged 50 years and older rose from 22% in 1981 to 33.6% in 1997 and is projected to be 45% by the year 2016. The average total weekly working hours fell from 58.2 in 1984 to 53. 4 in 1997. The proportion practising in regional centres rose from 12 to 17.9%.Conclusions: The paediatric workforce in Australia has grown rapidly over the past 16 years. If this trend continues, the ratio of child population per paediatrician will continue to fall, acccentuated by the projected decline in the child population. The trends towards an ageing workforce with an increasing proportion of women, declining working hours and rising proportion practising in regional centres are expected to continue unless workforce intake or retirement change dramatically. [ABSTRACT FROM AUTHOR]

The author discusses whether it is now time for paediatrics to form its own college. Professor Frank Oberklaid had debated that paediatrics and child health in Australia and New Zealand is ready to transition to a new age where paediatricians regulate their own fate, take responsibility for binational policy development and establish standards of training in postgraduate paediatrics and child health.

The article comments on the needs of community child health practice in Australia. The claim that training in community child health lacks quality control is not supported by evidence. Also, there is no evidence supporting the claims that research funding in community child health is comparatively poor. Instead, the existing structure is well-placed to respond to the emergence of high prevalence conditions.

The authors reflect on the cases of female genital mutilation (FGM) observed by western paediatricians and those working in Refugee Clinics. Topics include the partial or complete removal of the clitoris and labia minora, the countries practicing FGM including Africa, the Middle East, and India, and the relationship between health-care practitioners and families.

Aim: To determine the accuracy of emergency department (ED) paediatric anaphylaxis diagnosis, and to identify factors associated with misdiagnosis.Methods: Retrospective chart review of children aged 0-18 years with allergic presentations to three Victorian EDs in 2014. Cases were included if an ED diagnosis of anaphylaxis was recorded, or the presentation met international consensus criteria for anaphylaxis.Results: Of the 60 143 paediatric ED presentations during the study period, 1551 allergy-related presentations were identified and reviewed. One hundred and eighty-seven met consensus criteria for anaphylaxis, and another 24 were diagnosed with anaphylaxis without meeting criteria. Of the 211 presentations, 105 cases were given an ED diagnosis of anaphylaxis and 106 cases were given an alternative diagnosis in ED. ED assessment had a sensitivity of 43.2% (95% confidence interval (CI) 36.1-50.7%) and specificity of 97.9% (95% CI 96.9-98.7%) for anaphylaxis. Multiple logistic regression demonstrated that an ED anaphylaxis diagnosis was associated with previous anaphylaxis (odds ratio (OR) 3.20; 95% CI 1.52-6.75), arrival by ambulance (OR 2.80; 95% CI 1.36-5.74), a high-acuity triage category (OR 4.51; 95% CI 2.20-9.25) and presentation to a tertiary hospital (OR 2.86; 95% CI 1.44-5.67). ED diagnosis of anaphylaxis was less likely in those with resolution of symptoms and signs in at least one organ system prior to arrival (OR 0.27; 95% CI 0.12-0.62).Conclusion: In children with allergic presentations, ED assessment has a low sensitivity but high specificity for anaphylaxis. Attention to resolved pre-hospital symptoms and awareness of diagnostic criteria are important considerations for accurate ED diagnosis of anaphylaxis. [ABSTRACT FROM AUTHOR]

Aim: Chromosomal microarray (CMA) is an important diagnostic test for children with multiple congenital anomalies or certain developmental behavioural problems suggestive of an underlying genetic diagnosis. However, there are medical and ethical complexities to its use and few Australian policies to guide practice. We aimed to describe the current practice of Australian paediatricians in relation to CMA testing. We hypothesised that there are knowledge gaps in their use of CMA.Methods: Online survey completed between September 2015 and January 2016 by paediatricians in secondary care settings. Participants were members of the Australian Paediatric Research Network. One hundred and sixty five (43%) of 383 active members responded. Our main outcome measures comprised: (i) the indications for which paediatricians request CMA; (ii) their approach to consent; (iii) their interpretation of results; and (iv) their understanding of the impact on patient management.Results: A significant proportion of paediatricians (21-52%) did not regularly use CMA for conditions with established evidence of diagnostic yield. Paediatricians under-estimated the potential for CMA findings to alter patient management. There was wide variability in paediatricians' approach to consent, and low use of consent forms and fact sheets. Paediatricians reported difficulties interpreting CMA results, with high rates of referral to clinical genetics services.Conclusions: The reported practice of Australian paediatricians is not consistent with international standards on CMA. Australian practice could be improved by a standardised approach to ordering CMA, consenting patients and interpreting results. We provide resources for CMA ordering and make recommendations about preparation for next generation sequencing. [ABSTRACT FROM AUTHOR]

Aim: This study describes clinical staff opinions on the availability and suitability of resources to provide trauma care to children and their families and any perceived strengths, gaps and potential interventions to strengthen care.Methods: A mixed-method study was conducted in five Australian paediatric trauma centres. The trauma coordinator at each site participated in a structured interview to determine models of care and trauma activity at their site. This informed the development of an electronic survey, which sought staff opinion on child and family access to services and perceived gaps in care.Results: Five trauma coordinators were interviewed, and 214 clinicians (medical, nursing, allied health) from New South Wales, Victoria, South Australia and Queensland completed the survey. Each site had a trauma director and coordinator, and there was variance in resource availability. Almost all survey participants (92.5%) considered their hospital met the physical needs of injured children, 68.2% thought that the psychosocial needs of children were met and 82.1% thought that the needs of families were met. The least accessible services reported were clinical psychology/family counselling, mental health and behaviour management services. No routine follow-up support services post-discharge for the child or their families were identified.Conclusion: Staff providing care for injured children report that physical needs are better met than psychosocial needs. There is variability in resource levels across paediatric trauma centres. A coordinated model of care that provides psychosocial care both during hospitalisation and post-discharge could reduce this gap in care for injured children and their families. [ABSTRACT FROM AUTHOR]

The article comments on the developments in the community child health in Australia. It is indicated that the medical practice have grown from being a soft issue to an assertive influence on specialty areas in pediatrics. Significant changes occurred in training strategies developed, child health research, and college support programs.

The article discusses about health of refugee children in Australia. The health of children of Australia appears fairly robust but not all are doing so well. The prenatal death rate and child mortality for indigenous children is double that of other Australian children. Whilst refugee children have a special set of circumstances, they highlight the issues for all health care providers, but particularly pediatricians. The challenge for pediatricians is to ensure they are well trained in order to enhance the effectiveness of their role and ensure their capacity to make a difference.

Discusses the issues concerning the increasing presentation of aggressive children and adolescents to pediatric emergency departments in Australia. Risk factors of mental health disorders; Impetus to the limitations in the medical follow-up of the patients; Measures for promoting mental health.

Editorial. Focuses on psychotropic medication for children. Appropriate use of stimulant medication in children.

Focuses on the resurgence of rheumatic heart disease among Australian children during the 1990s. Factors attributing to the decline in the incidence of rheumatic fever since World War II; Conditions that have possibly caused the persisting high rates of rheumatic heart disease in Australian Aboriginals; Characterization of the disease condition.