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This practice point provides a framework for initiating investigation in children suspected of having infection with Mycobacterium tuberculosis (Mtb). Some areas in Canada have a high burden of tubercular disease, with Indigenous populations being most at risk. Tuberculosis (TB) can present either as an acute or subacute illness and both primary or reactivation infection can cause pulmonary or multisystem disease. Tuberculin skin tests and interferon-γ release assays can be used to support a suspected diagnosis. TB elimination in Canada is possible but requires improving social determinants of health, one of the major factors contributing to the spread of TB in populations at risk. [ABSTRACT FROM AUTHOR]

Recreation, globalization, migration, and families visiting friends and relatives (VFRs) overseas have increased the frequency of international travel and potential exposures to tropical diseases. Young infected patients can present a diagnostic challenge to clinicians when they return to Canada, with significant consequences if untreated. High-quality guidelines for screening and diagnosis exist, but care providers need to know where to access them. This practice point highlights key points in the management of fever in the returning child traveller and provides links to detailed resources on this topic. [ABSTRACT FROM AUTHOR]

Significant changes are occurring in Canada's health care system regarding physician-hastened death (PHD). In the Netherlands, where the Groningen Protocol is in place, euthanasia in now legal for infants and children. The present article considers whether PHD should be applied to young children in Canada and how these paediatric cases differ from adult cases. The discussion analyzes and critiques the underlying assumptions necessary to believe that PHD is good. The role of worldviews in the deliberation of any moral question and the importance of recognizing personal bias are highlighted. The authors present common issues regarding PHD, including suffering, parental autonomy and future quality of life, and examine the basic assumptions on which these arguments are made. Finally, they conclude that the assumptions required are incorrect and that PHD should not be allowed in the case of children. Instead, policies should continue to strive for the protection and promotion of health in all children. [ABSTRACT FROM AUTHOR]

A response from the author of the article "Preventing hospitalizations for respiratory syncytial virus infection" in the August/September 2015 issue is presented.

A letter to the editor is presented in response to the article "Preventing hospitalizations for respiratory syncytial virus infection" in the August/September 2015 issue.

Concerns about vaccine safety make some parents hesitant about immunization. Health care providers are pivotal in helping parents understand that Canada is a leader in vaccine safety. The present practice point provides an update on the eight components of Canada's vaccine safety system: (1) an evidence-based pre-license review and approval process; (2) strong regulations for manufacturers; (3) independent evidence-based vaccine use recommendations; (4) immunization competency training and standards for health care providers; (5) pharmacovigilance programs to detect and (6) determine causality of adverse events following immunization (AEFIs); (7) a program for vaccine safety and efficacy signal detection; and (8) the Canadian Immunization Research Network's special immunization clinics for children who have experienced serious AEFIs. [ABSTRACT FROM AUTHOR]

An abstract of the article "Enhancing the quality of palliative care for children with cancer: A nation-wide train-the-trainer educational initiative educational initiative" by Kimberly Widger and colleagues is presented.

The article focuses on effective treatment for children with tuberculosis (TB) in Canada. Topics covered include the description of childhood TB, decline in TB rates in the country and delays in diagnosis of patients. Also mentioned are the effective ways to manage and detect the health condition in children.

The article discusses the impact of pacifier use in increasing breastfeeding duration among healthy term infants. Jaafar and colleagues and Jenik and colleagues are the two systematic reviews that investigated pacifier use by young infants as a marker of breastfeeding difficulties. On pacifier use, the Canadian Paediatric Society recommends health care providers recognize the use of pacifier as a parent's choice determined by their individual child's needs.

The authors comment on the challenges and intricacies experienced by individuals that furnished clinical care to the youth and children in Canada. They believed that clinical care personnel should understand them to prevent their problems from getting worse. They mentioned the need to fathom the effects of migration, culture and status on the children and families new to the country.

The author addresses the paediatric mental health concerns in Canada. He discusses the notable exceptions of mental health among children in the country including attention deficit-hyperactivity disorder and autism, health care providers' awareness and less public sphere. It also examines the global mental health conditions among children according to the World Health Organization (WHO) that accounts almost two-thirds of the global burden in the paediatric community.

Les véhicules tout-terrains (VTT) sont largement utilisés au Canada dans le cadre des loisirs, du transport et du travail, tel que l'agriculture. En qualité de véhicules automobiles, ils peuvent être particulièrement dangereux lorsqu'ils sont utilisés par des enfants et des jeunes adolescents qui ne possèdent pas les connaissances, la taille physique, la force et les compétences cognitives et motrices nécessaires pour les conduire en toute sécurité. La magnitude du risque de blessures pour les jeunes conducteurs est exposée de manière explicite dans les avertissements figurant dans le manuel du conducteur et sur les étiquettes des modèles les plus récents. Elle est également et démontrée par le nombre important d'hospitalisations et de décès pédiatriques attribuables à des traumatismes liés aux VTT. Cependant, le port du casque est loin d'être universel chez les jeunes conducteurs, et les comportements de conduite non sécuritaires demeurent courants, tels que la conduite sans supervision ou avec des passagers. Malgré les avertissements de l'industrie et l'éducation publique qui font ressortir l'importance de comportements sécuritaires et les risques de graves blessures chez les enfants et les adolescents, on continue de recenser des blessures et des décès liés aux VTT. Tant que des mesures n'auront pas été prises pour réduire ces blessures de manière substantielle et efficace, il est essentiel de limiter la conduite par des jeunes, notamment ceux de moins de 16 ans, afin de réduire le fardeau des traumatismes liés aux VTT chez les enfants et les adolescents. Le présent document remplace le document de principes de la Société canadienne de pédiatrie publié en 2004. [ABSTRACT FROM AUTHOR]

The author discusses aspects of the Canadian Paediatric Surveillance Program (CPSP). It describes several surveillance studies that illustrates the importance of collecting national data to have a better comprehension of the rare childhood disease and to better inform preventive measures. It notes that the program initiated a multiphase online reporting process that might provide new opportunities for improving the collection of data from northern communities that have Internet access.

The author observes that the Canadian federal government has adopted a narrow definition of the Jordan's Principle stating that when a dispute arises regarding public services for a First Nation child, the government of first contact pays for the service and addresses payment disputes later. She informs that the narrow definition has been found to be unlawful by the Federal Court of Canada and the Human Rights Tribunal. She also mentions that First Nations children experience service delays.

Administration of inactivated trivalent or quadrivalent influenza vaccines is now believed to be safe for individuals with egg allergy. Unless children have experienced an anaphylactic reaction to a previous dose of influenza vaccine, they can and should be immunized with a full dose of trivalent or quadrivalent inactivated vaccine. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Caring for Kids New to Canada," by Charles Hui and Tony Barozzino.

La majorité des blessures dont sont victimes les enfants et les adolescents sont évitables. Le présent document de principes contient des renseignements généraux, des conseils et une déclaration d'engagement à l'égard de la prévention des blessures au Canada. Il sert de base sur laquelle construire en s'attardant d'abord aux définitions, à l'étendue et aux priorités en matière de prévention des blessures. Il contient également une description du fardeau et du profil des blessures non intentionnelles, de même que les principes d'interventions de prévention efficaces. La version intégrale renferme une liste de ressources en vue d'obtenir des données et de l'information probante (www.cps.ca). Enfin, le présent document de principes peut être utilisé pour la défense généralisée de la prévention des blessures. [ABSTRACT FROM AUTHOR]

All-terrain vehicles (ATVs) are widely used in Canada for recreation, transportation and occupations such as farming. As motorized vehicles, they can be especially dangerous when used by children and young adolescents who lack the knowledge, physical size, strength, and cognitive and motor skills to operate them safely. The magnitude of injury risk to young riders is reflected in explicit vehicle manual warnings and the warning labels on current models, and evidenced by the significant number of paediatric hospitalizations and deaths due to ATV-related trauma. However, helmet use is far from universal among youth operators, and unsafe riding behaviours, such as driving unsupervised and/or driving with passengers, remain common. Despite industry warnings and public education that emphasize the importance of safety behaviours and the risks of significant injury to children and youth, ATV-related injuries and fatalities continue to occur. Until measures are taken that clearly effect substantial reductions in these injuries, restricting ridership by young operators, especially those younger than 16 years of age, is critical to reducing the burden of ATV-related trauma in children and youth. This document replaces a previous Canadian Paediatric Society position statement published in 2004. [ABSTRACT FROM AUTHOR]

The majority of child and youth injuries are preventable. This statement provides background, direction and a statement of commitment to the issue of child and youth injury prevention in Canada. It acts as a foundation to build upon by focusing first on definitions, scope and priorities for injury prevention. It also describes the burden and patterns of unintentional injury, and the principles of effective intervention for prevention. A list of resources for obtaining data and evidence-based information is included in the full-text version of this statement (www.cps.ca). This statement can also be used for broad-based injury prevention advocacy. [ABSTRACT FROM AUTHOR]

The article presents a case study of a four-year-old Canadian-born child presented with left knee pain and swelling of two months' duration. The musculoskeletal examination revealed presence of large effusion and radiograph showed growth disturbance suggestive of hyperemia, epiphyseal overgrowth and a small effusion. An intra-articular injection of corticosteroid revealed only transient mild improvement.

Historically, children have been 'therapeutic orphans'. Many drugs have not been studied or labelled for use in children and adolescents, making the development and definition of optimally safe and effective drug therapies for the paediatric age group an ongoing challenge. Over the past decade, networks have developed in the United States and Europe to enhance drug research for this group, while no comparable evolution has occurred in Canada. The present statement provides context for the Canadian situation and makes recommendations that address two pressing needs: for more drug research focused on Canadian children and adolescents, including dedicated support for such research; and for increasing human capacity to undertake targeted studies. These initiatives should be undertaken collaboratively, nationally and internationally, and include strategic, innovative approaches to the unique problems and ethical issues posed by drug research in this population. [ABSTRACT FROM AUTHOR]

All Canadian provinces and territories have had routine immunization programs for one-dose varicella vaccination since 2007, a strategy that has reduced varicella disease rates dramatically. However, breakthrough cases still occur, and some cases are severe. There is increasing evidence that immunity to one dose of the vaccine can wane in a vaccinated population, and the disease may be shifting to an older age group that can experience more severe disease and more complications. This statement presents the rationale for a two-dose immunization strategy in Canada, as well as recommendations for a routine two-dose varicella vaccine schedule for all Canadian children. Children who have received one dose of varicella vaccine and have not had breakthrough infection should receive another dose of varicella vaccine. [ABSTRACT FROM AUTHOR]