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Background: There is minimal research and no formal written guidance for speech and language therapists (SLTs) managing children eating and drinking with acknowledged risks (EDAR). Many SLTs lack confidence due to the complexity of these cases medically, ethically and emotionally. Guidance is recommended to aid paediatric EDAR management. Aims: To establish consensus amongst expert paediatric SLTs regarding core components of a care bundle guiding the management of children who are EDAR. Methods & Procedures: A two‐round online modified Delphi technique was used. An expert panel of UK SLTs working across paediatric settings (education, hospital, community) were recruited using snowball sampling. Both rounds comprised 36 statements related to potential components of a care bundle, which participants rated on a 7‐point scale (strongly agree to strongly disagree), and one open‐box question. Consensus was calculated using predetermined criteria (percentage, median and interquartile range) and the final list was ranked by level of importance (mean). Outcomes & Results: A total of 35 participants completed round 1, with 31 completing round 2 (88.6% response rate). Thirty out of 36 statements achieved high to very high consensus. The nine statements reaching very high consensus covered topics such as documentation, capacity, safeguarding and person‐centred care. Conclusion & Implications: There is a high level of consensus amongst SLTs about core components for a paediatric EDAR care bundle. This study provides a useful starting point for the future development of a care bundle to manage children who are EDAR. WHAT THIS PAPER ADDS: What is already known on the subject: There is limited research and guidance for SLTs managing children who are EDAR. In adult populations, care bundles have been introduced with positive effects (e.g., better patient outcomes, increased standardisation of care and clinician confidence) and are seen as a promising avenue for paediatrics. What this study adds to the existing knowledge: To the research team's knowledge, this is the first published Delphi study on SLT opinion around a care bundle for paediatric EDAR. There were high levels of consensus amongst UK SLTs and the results highlighted documentation, capacity, safeguarding and person‐centred care as key areas in practice. Finally, the results provide a ranked list of components UK SLTs felt are important for developing a care bundle. What are the practical and clinical implications of this work?: This study could be a useful starting point for creating a care bundle to support the management of children who are EDAR. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion Paediatricians using instant messaging phone apps for informal medical discussions poses ethical and legal risks. We filled a gap in the research, by assessing the use of apps and the possible risks.A national, cross‐sectional, questionnaire study was conducted in Israel from 11 August to 20 November 2019. The frequency of informal discussions, clinical details and recommendations were compared to the paediatricians' expertise and work settings. The discussions included work and private phones, consultation with the parents of patients and advice to the paediatricians' friends and families.The 305 paediatricians who responded had a median age of 37 (range 27–74) years: 42% were residents and 58% were specialists. The majority (99%) had carried out informal discussions using a messaging app in the last week and 65% had used them for 1–5 discussions. Specialists were more likely to use apps for more than 10 discussions per week than residents (24% vs. 5%, p < 0.001) and recommend treatment via apps (35% vs. 22%, p < 0.001). A third failed to provide disclaimers about the risks of app‐based discussions.Using instant messaging apps for informal medical discussions was common, but ethical and legal aspects were not always fully considered. [ABSTRACT FROM AUTHOR]

Aim: This pilot study examines how rural and remote junior doctors' career decisions are influenced by collegial relationships within the discipline of general paediatrics. Methods: Social network analysis (SNA) was undertaken by structured interviews with 10 paediatricians working in regional towns in Western Australia. UNICET software was used to determine the interactions between individual networks to look for overlap and common influencers. Results: Ten rural paediatricians were interviewed. An individual was found to have key measures of centrality at the core of the entire social network of rural general paediatricians. This included a high degree of 'betweenness' (connections within social networks), and a high broker index (connections between separate areas of a network or between networks) demonstrated by that person combining three disconnected networks into a single coherent network. This central individual was a recently appointed consultant with links to senior paediatricians, peers and junior trainees, and may be instrumental in recruitment and retention in the rural paediatric workforce. Conclusion: Improving understanding of the impact of social networks, and decision‐making processes that influence rural career choices, can inform innovative solutions to develop sustainable strategies for recruiting and retaining the rural paediatric workforce. Applying this model on a larger scale may provide more data to support evidence‐based programmes that enable this within the Australian context. [ABSTRACT FROM AUTHOR]

Aim: To provide guidance for follow‐up and monitoring of children and adolescents identified as positive to islet autoantibodies (IA) in the general population screening for type 1 diabetes (T1D) in Italy. Methods: Detection of IA helps to diagnose pre‐symptomatic T1D, prevent diabetic ketoacidosis (DKA) and identify persons for new therapies to delay symptomatic diabetes. Italy recently became the first country to approve by law a general autoantibody screening program for T1D and celiac disease in all children and adolescents (age 1‐17yr). A pilot study is currently underway in four Italian regions addressing feasibility issues to be used in the scale up to nationwide screening. Meanwhile, a group of experts developed guidance recommendations for follow‐up and monitoring of identified IA positive persons. Results: Ten key components have been identified: establishment of a registry for children and adolescents at risk; close collaboration with the national network of family paediatricians; creation of T1D centers with expertise in follow‐up and monitoring; educational measures; assurance of solid IA tests; identification of appropriate metabolic tests; feed‐back feasibility and acceptability questionnaires; potential access to available therapeutic interventions; valuable outcome measures including DKA incidence; costs monitoring. Distinctive features of this program include single (in addition to multiple) IA antibody‐positive persons in follow‐up and the use of CGM to assess risk progression, rather than the cumbersome OGTT. Conclusion: It is expected that the proposed follow‐up and monitoring program will be effective, affordable and acceptable to children and families identified in general T1D screening in Italy. [ABSTRACT FROM AUTHOR]

Background: Depressive moods and behaviors are developmentally normative, yet potentially impairing, in preschool‐aged children. In addition to frequency, duration of behavior is an important parameter to consider when characterizing risk for worsening mood dysregulation. The goal of this study was to identify the duration and severity of depressive moods and behaviors and associations with impairment in a large community sample of preschool‐aged children using an online parent‐report daily diary. Methods: Primary caregivers (N = 900) of 3–5‐year‐old children reported the daily duration of each instance of seven depressive moods and behaviors for 14 days. We used item response theory analyses to examine duration item characteristics. Results: Moods and behaviors occurred at specific durations to be considered psychometrically severe/rare; for example, instances of sadness had to last an average total of 32 min per day or more, irritability at least 38 min, tantrums at least 30 min, and tearfulness/sensitivity at least 35 min. Longer durations of mood and behavior were associated with daily impairment, as well as older child age and less parental education. Conclusions: To our knowledge, this is the first study to delineate specific duration ranges for depressive moods and behaviors in preschool‐aged children. These data, coupled with information about the frequency of mood‐related behaviors, can assist child practitioners in differentiating normative patterns from less normative mood problems to evaluate which children may be at risk. Future work should identify the duration of depressive moods and behaviors in early childhood that predict clinically significant psychopathology over time. [ABSTRACT FROM AUTHOR]

Aim: Sudden unexpected postnatal collapse is a life‐threatening event and may occur in any newborn infant. Safe skin‐to‐skin contact, and awareness of sudden unexpected postnatal collapse are key to its prevention. The aim of this study was to survey the presence of skin‐to‐skin contact and/or sudden unexpected postnatal collapse protocols in the 70 perinatal centres in the Netherlands. Methods: We performed a survey among Dutch paediatricians to examine the safe skin‐to‐skin contact and sudden unexpected postnatal collapse protocols. Results: We received data from 59/70 (85%) perinatal centres. At least one case of sudden unexpected postnatal collapse was reported in 35/59 (59%) of these centres. Nearly half the centres had safe skin‐to‐skin contact and/or sudden unexpected postnatal collapse protocols. Ultimately, 16 protocols were available for analysis. They showed considerable differences in the type of perinatal care provided. Most protocols lacked recently published insights on safe skin‐to‐skin contact. Besides, protocols failed to incorporate awareness of and knowledge on how to prevent sudden unexpected postnatal collapse. Conclusion: This study underlines the importance of drawing up uniform, multidisciplinary guidelines containing recommendations for the prevention of sudden unexpected postnatal collapse in the Netherlands. [ABSTRACT FROM AUTHOR]

Background: Children with chronic medical conditions and their families have significant emotional health concerns, yet paediatricians are often ill‐equipped to address these needs. The American Board of Pediatrics launched the Roadmap Project to better support emotional health as part of routine care. We present pilot work in paediatric training programmes to test educational approaches and explore lessons learned. Approach: Four institutions implemented Roadmap tools into their paediatric training programmes, either incorporating them into existing educational structures or embedding them into the clinical workplace. One programme utilised an existing longitudinal curriculum, and another incorporated into a block rotation. Two programmes embedded training for residents into a larger programme for the healthcare team within the clinical space, one in outpatient clinics and one in an inpatient service. Evaluation: Evaluation strategies at each site matched the intended outcomes. Sites working within education programmes evaluated learners, demonstrating increases in resident skills and confidence on pre‐/post‐self‐assessments. Sites embedding tools into the practice context measured changes in the clinical practice of the healthcare team. Despite variability in implementation, all approaches improved trainee skills; sites embedding education into a clinical setting saw greater changes in clinical practice. Implications: Our pilot provided structure yet allowed for flexibility, and all sites improved trainee skills. Engaging the entire healthcare team within practice settings appears advantageous, thus embedding education into clinical practice may be preferable to a separate education programme. Similar to outcomes found in interprofessional education (IPE), educating clinical teams together may be more impactful for cultural shifts needed for changing clinical practice. [ABSTRACT FROM AUTHOR]

Background: Administration of live vaccines following liver transplant (LT) has historically not been recommended due to concerns regarding risk of vaccine‐attenuated disease. However, there is evidence suggesting that in select transplant recipients live vaccinations can be administered safely. Studies in other regions have indicated that despite this evidence many clinicians remain hesitant to administer live vaccinations. Method: A REDCap survey was distributed to gastroenterologists, pediatricians, and infectious diseases physicians at pediatric centers across Australia and New Zealand via email between September and November 2023. The survey included a series of questions regarding live vaccine and varicella postexposure prophylaxis (PEP) practices in pediatric LT recipients and barriers to live vaccine administration in this cohort. Results: There was a total of 16 responses to the survey, from 10 different pediatric centers, including 10/11 pediatric gastroenterology centers and all four pediatric LT centers in the region. Only 31% (5/16) of respondents (from 3/10 different centers) offer live vaccines. The main barrier to live vaccine administration was clinician reluctance and the main reason for not offering live vaccines was insufficient safety data. Sixty‐nine percent (11/16) of respondents take vaccination status and/or serology into account when deciding whether to offer varicella PEP to this cohort. Respondents universally offer varicella zoster immunoglobulin as PEP, though 31% (5/16) also offer antiviral medication. Conclusions: Many clinicians in our region remain hesitant to provide live vaccines to pediatric LT recipients, with concerns regarding insufficient safety data. Updated local guidelines may help to address this. [ABSTRACT FROM AUTHOR]

Background: Children and young people (CYP) with complex neurodisability experience multiple physical, communication, educational and social challenges, which require complex packages of multidisciplinary care. Part of the holistic care required includes supporting the families and parents/caregivers. The aim of the wider study was to introduce a new programme ('Ubuntu') to parents/caregivers and healthcare professionals (HCPs) in order to test the feasibility and acceptability of the concept and content, with the goal of potential adaptation for the UK in mind. Data collection and analysis uncovered rich data on caregiving journeys, navigation of health services, and perceived service gaps. This paper focuses solely on these topics. Further papers will report on the feasibility and adaptation data. Methods: Two rounds of semi‐structured interviews were conducted with 12 caregivers of CYP with complex neurodisability and six HCPs from a variety of disciplines, recruited from a community child health service in London Borough of Newham, UK in 2020. The interviews included open‐ended questions to explore caregiving journeys, experiences of navigating health services and perceived service gaps. Transcripts were analysed using a data‐driven inductive thematic analysis. Results: Three themes were identified that related to the aim of understanding caregivers' experiences and unmet needs relating to current service provision. These were (1) Caregiver Mental Health, (2) The Information Gap and (3) The Need for Holistic Support. Mental health difficulties were reported, particularly around the period of diagnosis. Priority needs included the provision of clear information about the diagnosis and services offered, opportunities to forge peer support networks and for services across the community to collaborate. Conclusions: The delivery of health services for CYP with neurodisability should encompass the broad needs of the family as well as meeting the clinical needs of the CYP. [ABSTRACT FROM AUTHOR]

The article discusses the ethical responsibility of healthcare professionals, specifically pediatricians, to communicate the risks of air pollution to children and their families. It highlights the detrimental effects of air pollution on children's health, including non-communicable diseases and mortality. The article argues that withholding this information from families is paternalistic and goes against children's rights. It emphasizes the importance of engaging with children and families, advocating for actions that protect children's health, and working towards improving air quality in communities. The article also mentions the broader negative effects of climate change on children and the need for medical organizations to be transparent with patients. [Extracted from the article]

Antibiotic overprescription in China has long been considered a problem on the supply side, linked to the financial incentives of physicians. Based on the conversation analysis of 187 video‐recorded naturally occurring medical consultations in Chinese paediatric primary care settings, this study finds that the driving force behind the problem of antibiotic overprescription in China has changed. Physicians use a low‐authority communication style to recommend treatment, displaying a low level of medical authority and a willingness to accommodate caregivers' preferences in antibiotic prescribing decisions. The problem is now attributed to physician–caregiver interaction, doctor–patient relationship and the antibiotic‐saturated prescribing culture. Practice implications involve deepening the understanding of the evolving nature of the antibiotic overprescription problem in China, building trust between physicians and patients/caregivers in order to facilitate the physicians' role as the gatekeeper of antibiotics and providing training programmes to help physicians develop effective communication skills. [ABSTRACT FROM AUTHOR]

Severe vision impairment and blindness in childhood have a significant health burden on the child, family and society. This review article seeks to provide a structured framework for managing the apparently blind child presenting in the first year of life, starting from a comprehensive history and examination. Different investigation modalities and the increasingly important role of genetics will also be described, in addition to common causes of severe vision impairment. Crucially, a systematic approach to the blind infant is key to correct diagnoses and timely management. Incorrect diagnoses can be costly to all involved, however it is important to note that diagnoses can change with ongoing follow‐up and investigations. Furthermore, the modern age of ophthalmology requires a multi‐disciplinary approach and close collaboration with specialists including paediatricians, neurologists and geneticists, in addition to rehabilitation and low vision services, to ensure the best care for these vulnerable infants. [ABSTRACT FROM AUTHOR]

Background: Moisturizers are designed to maintain skin health and treat dermatological conditions associated with impaired skin barrier function. However, differences in their composition account for the differences in their effect. Aims: This narrative review aims to discuss the role of barrier repair moisturizers, highlight the role of different components in a moisturizer and their role in impaired skin conditions (e.g., dry, itchy, inflamed, sensitive skin, atopic eczema), and thereby empower dermatologists and pediatricians in selecting the right moisturizer. Methods: PubMed, Embase, and Scopus electronic databases were searched from January 2000 to June 2023 for publications on skin barrier repair and use of barrier repair moisturizers for the treatment of dry, itchy, inflamed, sensitive skin, or atopic eczema. Studies conducted in humans, published in English for which full texts were freely available were included. Results: The structure and composition of lipid lamellae within the stratum corneum play an important role in maintaining an effective skin barrier and protecting the body from various external assaults. Endocannabinoid mediators play an active role in maintaining skin barrier function. Moisturizers containing physiological lipids and functional ingredients (e.g., endocannabinoids such as palmitoylethanolamide [PEA]) and based on the principles of biomimic technology are demonstrated to be beneficial for the management of conditions associated with a disrupted skin barrier. Conclusions: Moisturizer based on the innovative biomimic formulation has good cosmetic efficacy and is generally well tolerated, and the addition of PEA might represent a new generation of compounds that may be beneficial for long‐term management of impaired skin conditions. [ABSTRACT FROM AUTHOR]

Background: There exists strong evidence for the early introduction of peanut to at‐risk infants for the primary prevention of peanut allergy. There is a need for educational initiatives to assist in dissemination and implementation of updated clinical guidelines on peanut allergy prevention. Approach: The aim for this project was to create an innovative curriculum for paediatricians on peanut allergy prevention. The Intervention to Reduce Early Allergy (Peanut) in Childhood (iREACH) study was leveraged to recruit paediatricians for a needs assessment. Materials from the iREACH study, including an educational YouTube video and knowledge survey, were evaluated. Applying findings from the needs assessment, an innovative curriculum was developed, and updated knowledge survey questions were developed. Evaluation: The iREACH YouTube video had suboptimal viewing behaviours, and iREACH participants had high baseline knowledge scores that did improve after viewing the video. The majority of respondents to the needs assessment felt that all paediatricians needed access to an effective educational module on peanut allergy prevention, and they wanted a broadly accessible curriculum that incorporated quality media and content segmentation. An online, interactive curriculum was developed that includes clinical cases and games, and updated knowledge questions were created with associated internal structure and reliability evidence, as well as relation to other variables evidence. Implication: The next steps of this project will focus on curriculum implementation and evaluation through a randomised, prospective study with the aim to serve as an educational model for how to integrate specialty‐specific guidelines into broader clinical practice through education. [ABSTRACT FROM AUTHOR]

Background: Pediatricians are often the first point of contact for children in Primary Care (PC), but still perceive gaps in their allergy knowledge. We investigated self‐perceived knowledge gaps and educational needs in pediatricians across healthcare systems in Europe so that future educational initiatives may better support the delivery of allergy services in PC. Method: A multinational survey was circulated to pediatricians who care for children and adolescents with allergy problems in PC by the EAACI Allergy Educational Needs in Primary Care Pediatricians Task Force from February to March 2023. A 5‐point Likert scale was used to assess the level of agreement with questionnaire statements. Thirty surveys per country were the cut‐off for inclusion and statistical analysis. Results: In this study, 1991 respondents were obtained from 56 countries across Europe and 210 responses were from countries with a cut‐off below 30 participants per country. Primary care pediatricians (PCPs) comprised 74.4% of the respondents. The majority (65.3%) were contracted to state or district health services. 61.7% had awareness of guidelines for onward allergy referral in their countries but only 22.3% were aware of the EAACI competencies document for allied health professionals for allergy. Total sample respondents versus PCPs showed 52% and 47% of them have access to allergy investigations in their PC facility (mainly specific IgE and skin prick tests); 67.6% and 58.9% have access to immunotherapy, respectively. The main barrier to referral to a specialist was a consideration that the patient's condition could be diagnosed and treated in this PC facility, (57.8% and 63.6% respectively). The main reasons for referral were the need for hospital assessment, and partial response to first‐line treatment (55.4% and 59.2%, 47% and 50.7%, respectively). Learning and assessment methods preference was fairly equally divided between Traditional methods (45.7% and 50.1% respectively) and e‐learning 45.5% and 44.9%, respectively. Generalist physicians (GPs) have the poorest access to allergy investigations (32.7%, p =.000). The majority of the total sample (91.9%) assess patients with allergic pathology. 868 (43.6%) and 1117 (46.1%), received allergy training as undergraduates and postgraduates respectively [these proportions in PCPs were higher (45% and 59%), respectively]. PCPs with a special interest in allergology experienced greater exposure to allergy teaching as postgraduates. GPs received the largest amount of allergy teaching as undergraduates. Identifying allergic disease based on clinical presentation, respondents felt most confident in the management of eczema/atopic dermatitis (87.4%) and rhinitis/asthma (86.2%), and least confident in allergen immunotherapy (36.9%) and latex allergy (30.8%). Conclusion: This study exploring the confidence of PCPs to diagnose, manage, and refer patients with allergies, demonstrated knowledge gaps and educational needs for allergy clinical practice. It detects areas in need of urgent improvement especially in latex and allergen immunotherapy. It is important to ensure the dissemination of allergy guidelines and supporting EAACI documents since the majority of PCPs lack awareness of them. This survey has enabled us to identify what the educational priorities of PCPs are and how they would like to have them met. [ABSTRACT FROM AUTHOR]

Background/Aim: Pediatricians play an essential role in managing pediatric oral emergencies; hence, they should have accurate information on dental injuries. This study aimed to assess the knowledge level of pediatricians regarding traumatic dental injuries (TDI) and their awareness of the ToothSOS mobile application. Materials and Methods: A survey comprising 10 questions was created on Google forms, and the links were sent to the participants via electronic mail and a mobile application. The demographic characteristics and the knowledge level of pediatricians about TDI and their awareness of the ToothSOS mobile application were evaluated. The questions were prepared by following similar studies and the current guidelines of the International Association of Dental Traumatology. Results: A total of 229 pediatricians (74.2% female) participated in this study. The correct answer rates revealed statistical differences in terms of profession and experience on the following issues: the most frequently traumatized tooth, the preference of the antibiotic agent, and the management of avulsed primary tooth (p <.05). The decision to consult a dentist revealed statistical differences in the profession (p =.001). The correct answers on the correlation between the age group and dental trauma accompanied by soft tissue injuries showed statistical differences in experience (p =.005). Although none of the participants knew the ToothSOS application, 91.7% of them preferred using this tool in future practices. This rate was statistically higher in participants with an experience of more than 10 years (p =.013). Conclusions: The knowledge level of pediatricians regarding dental trauma was found to be sufficient, except for the questions on avulsion injuries. However, the fact that the participants were unaware of the ToothSOS mobile application was the most considerable result of the study, and this finding highlighted the importance of informing pediatricians dealing with oral injuries regarding the latest updates on dental traumatology. [ABSTRACT FROM AUTHOR]

Clemens Freiherr von Pirquet, an innovative paediatrician, basic researcher, and teacher, made significant contributions to the fields of paediatrics, immunology, bacteriology, and allergology. He was born in 1874 in Vienna, Austria, and began his medical studies at the University of Vienna. Pirquet's research on infectious diseases and allergies led to the development of the smallpox vaccine and the identification of hypersensitivity reactions. Despite being nominated for the Nobel Prize multiple times, Pirquet was never awarded the prize. He received other honors and held important positions in academia, but tragically, he and his wife died by suicide in 1929. [Extracted from the article]

Provider‐to‐provider outpatient pediatric dermatology eConsultation services increase access to care, but barriers exist that may prevent eConsult implementation and survival. We deployed cross‐sectional surveys to referring pediatric primary care physicians and consulting pediatric dermatologists participating in our eConsult program to identify barriers to utilization and sustainability. Our data suggest that eConsultation increases access to care and offers iterative educational opportunities for primary care providers, which may ultimately reduce office referrals for common outpatient skin issues. Sustainability of eConsult services requires simple order templates, clear representative photos, concise submission reports, and provider reimbursement. [ABSTRACT FROM AUTHOR]

Aim: Hypernatraemia typically reflects dehydration, yet in rare instances may be caused by salt poisoning. Identifying these rare cases is a difficult challenge. Making the diagnosis of salt poisoning can have severe consequences, such as the removal of the child from its home or even prison sentences for the implicated carer. It is therefore imperative to get the diagnosis right. Guidelines for the assessment of hypernatraemia emphasise the importance of the fractional excretion of sodium to distinguish between dehydration and salt poisoning, but no generally accepted cut‐off value exists. Opinions about the diagnosis of salt poisoning in some cases consequently may differ. Here, we aim to highlight the challenges and stimulate discussion on how to improve the tools for the assessment of hypernatraemia. Methods: Report of a case of unexplained hypernatraemia in which the treating paediatrician raised the suspicion of salt poisoning. Results: Two consulted experts made opposing judgements about the aetiology of the observed hypernatraemia. Conclusion: Clear diagnostic criteria for the diagnosis of salt poisoning are lacking and more data are needed for their establishment. Without this, victims may experience further harm and carers are at risk of devastating, yet potentially erroneous accusations. [ABSTRACT FROM AUTHOR]

Aim: We examined physicians' perspectives on the mental capabilities of pediatric patients with unresponsive wakefulness syndrome (UWS) and their attitudes towards limiting life‐sustaining treatment (LST) in an international context. Method: A questionnaire survey was conducted among 267 neuropediatricians, practicing in 65 countries. Comparisons were made according to the Human Development Index (HDI) of the countries. The Idler Index of Religiosity was applied to determine religiosity. Results: Participants from countries with a very high HDI were generally more favorable to limiting LST (p < 0.001), specifically cardiopulmonary resuscitation (p = 0.021), intubation/ventilation (p = 0.014), hemodialysis/hemofiltration (p < 0.001), and antibiotic therapy (p < 0.001). Treatment costs that were too high had a weaker influence on their decisions (p < 0.001). Participants who found it never ethically justifiable to limit LST had a higher mean Idler Index of private (p = 0.001) and general (p = 0.020) religiosity and were less satisfied with treatment decisions (p < 0.001) and the communication during the process (p = 0.016). Interpretation: The perspectives towards limiting LST for pediatric patients with UWS are markedly different between physicians from countries with very high and lower HDIs. [ABSTRACT FROM AUTHOR]

Aims and Objectives: Studies in adult medicine have shown that physicians base testing decisions on the patient's clinical condition but also consider other factors, including local practice or patient expectations. In pediatrics, physicians and parents jointly decide on behalf of a (young) child. This might demand more explicit and more complex deliberations, with sometimes conflicting interests. We explored pediatricians' considerations in diagnostic test ordering and the factors that influence their deliberation. Method: We performed in‐depth, semistructured interviews with a purposively selected heterogeneous sample of 20 Dutch pediatricians. We analyzed transcribed interviews inductively using a constant comparative approach, and clustered data across interviews to derive common themes. Results: Pediatricians perceived test‐related burden in children higher compared with adults, and reported that avoiding an unjustified burden causes them to be more restrictive and deliberate in test ordering. They felt conflicted when parents desired testing or when guidelines recommended diagnostic tests pediatricians perceived as unnecessary. When parents demanded testing, they would explore parental concern, educate parents about harms and alternative explanations of symptoms, and advocate watchful waiting. Yet they reported sometimes performing tests to appease parents or to comply with guidelines, because of feared personal consequences in the case of adverse outcomes. Conclusion: We obtained an overview of the considerations that are weighed in pediatric test decisions. The comparatively strong focus on prevention of harm motivates pediatricians to critically appraise the added value of testing and drivers of low‐value testing. Pediatricians' relatively restrictive approach to testing could provide an example for other disciplines. Improved guidelines and physician and patient education could help to withstand the perceived pressure to test. [ABSTRACT FROM AUTHOR]

In July 2020, Corinth School District was the first in Mississippi to return to the classroom setting. Coronavirus disease 2019 (Covid‐19) protocols were developed to maintain the safety of students. These included mandatory masking, seating charts, desk spacing, sanitizing protocols, lunch within classrooms, alteration of extracurriculars, cancellation of assemblies, and quarantine policies. Temperature screenings were also performed. Students registering as febrile would undergo Covid‐19 testing. To evaluate the efficacy of temperature scanning as a surveillance method for Covid‐19 in the school setting, deidentified data was obtained from the Corinth School District. Overall incidence and grade level incidence of Covid‐19 were calculated in children attending school from July 27, 2020 to September 25, 2020. Data were examined for a correlation between documented fevers and Covid‐19 positivity. Reports provided by the school district were investigated for positive test groupings signifying a school‐related outbreak. Of 28 children with fevers at school, zero tested positive for Covid‐19. Twenty‐six children tested positive for Covid‐19; none were febrile at school. The incidence of Covid‐19 in our population during the study period was 1.03%. Incidence in elementary students was 0.34%, 0.93% in middle school, and 2.51% in high school students. There were no school outbreaks during the study period. Both relative risk and odds ratio were calculated as equal to zero (0.00). Temperature scanning is not a sensitive screening method for Covid‐19 in school children. Key points: In the pediatric population temperature screening was not found to be a reliable means of coronavirus disease 2019 (Covid‐19) screening and detection.Fever is often not the primary presenting symptom of Covid‐19 within the pediatric population.Covid‐19 screening and outbreak prevention methods within pediatrics must take into account differing presentations to effectively prevent outbreaks. [ABSTRACT FROM AUTHOR]

Objectives: Testicular torsion (TT) is a pediatric surgical emergency that requires prompt treatment. This study investigated the feasibility of point‐of‐care ultrasound (POCUS) for diagnosing TT in the pediatric emergency department (ED). Methods: We retrospectively reviewed the medical records of patients, aged 18 years or younger, who visited a university‐affiliated hospital pediatric ED with acute scrotal pain without trauma history and underwent diagnostic ultrasounds between January 2010 and October 2022. Results: This study included 731 patients (median age: 9 years), Of these, 315 (43%) were in the POCUS‐performed group: 188 in the POCUS‐only group, and 127 in the POCUS‐and‐RADUS group. The other 416 patients (56.9%) were in the RADUS‐only group. In total, 45 patients (6.2%) were diagnosed with TT (19 in the POCUS‐performed group and 26 in the RADUS‐only group). The sensitivity, specificity, and positive and negative predictive values of POCUS for diagnosing TT were 94.7%, 92.9%, 46.2%, and 99.6%, respectively. The median time to perform POCUS was shorter than RADUS (23 versus 61 minutes, P <.001). The POCUS‐performed group had a shorter ED length of stay than the RADUS‐only group (93 versus 170 minutes, P <.001). Among the patients diagnosed with TT, performing POCUS first did not significantly delay the ED process, including time to operation (250 versus 205 minutes, P =.142). Conclusions: For patients with acute scrotal pain, evaluation performed by pediatric emergency physicians using POCUS performs well in screening TT, and can decrease length of stay in the ED. Access the CME test here and search by article title. [ABSTRACT FROM AUTHOR]

In this paper, the authors introduce the Triadic Model of Pediatric Care, an innovative conceptual framework for pediatric practice with transgender and gender diverse children. The Triadic Model of Pediatric Care consists of three experts—pediatricians, primary caregiver(s), and children—who each possess unique insights, knowledge, and decision‐making power. This model guides pediatricians to provide gender‐affirming care that acknowledges children as experts of their own experience and worthy of bodily autonomy, while also working to ensure primary caregiver(s) have the information and support necessary to provide a safe and nurturing developmental environment for their child. The authors provide a recommendation for how the Triadic Model of Pediatric Care might be applied in a pediatric healthcare setting and conclude with a summary of the model's implications, limitations, and future directions. [ABSTRACT FROM AUTHOR]

This article discusses the life and achievements of Madeleine Brès, a French pediatrician who paved the way for female doctors in France during the late 19th century. Brès faced societal discrimination and had to overcome numerous obstacles to pursue her dream of becoming a doctor. She specialized in mother and child relationships and hygiene, focusing on the benefits of breastfeeding. Brès also established a free daycare center and authored books on childcare and pediatric nursing. Despite her contributions, she faced poverty and blindness in her later years. Brès received several awards and honors for her work, and her legacy is commemorated through schools, nurseries, and streets named after her. [Extracted from the article]

Problem: Building rapport and trust between healthcare professional and patient/parents would improve satisfaction of patient/parents. The purpose of this study was to develop "The Pediatric Provider Communication Skills Assessment Scale" in this study. Methods: A trial form, with linguistic and psychometric validation and consisting of 44 statements, was administered to a sample of 325 individuals. Data were collected between January 20 and October 22, 2021. The validity of the scale was concluded after examining its construct validity and internal validity. "Exploratory factor analysis" was used for determining construct validity, and "comparison of lower‐upper groups" for internal validity. "Cronbach's α reliability coefficient" and "split half test consistency coefficient" were calculated for testing the reliability of the scale. Findings: The Pediatric Provider Communication Skills Assessment Scale that we developed consists of one dimension and 20 items, and the variance it can explain was calculated as 62.3%. The Cronbach α reliability coefficient of the scale was calculated as 0.90, indicating high reliability. Conclusions: According to the findings, "The Pediatric Provider Communication Skills Assessment Scale" is a scale with features that can measure in a valid and reliable way, with high variance and a low number of items. The study aims to develop the "The Pediatric Provider Communication Skills Assessment Scale," and present it to the literature as a validated and reliable new objective measurement tool. This study will enable us to understand more about the complex communication processes involved in pediatric care and how these may influence care delivery. [ABSTRACT FROM AUTHOR]

Background: There are wide variations in the gender makeup of speakers at national pediatric emergency medicine (PEM) conferences with no significant change in recent years. Objective: Gender disparities exist among national speakers and award recipients. PEM represents the intersection of pediatrics, a female‐dominated specialty with approximately 58% women, and emergency medicine, a male‐dominated specialty. We describe the proportion of women speakers and award recipients at two national PEM conferences, the American Academy of Pediatrics (AAP) Section on Emergency Medicine (SOEM) and the Advanced PEM Assembly (APEMA), to the AAP National Conference & Exhibition (NCE), a national pediatric conference. Methods: Data from SOEM and APEMA, obtained from 2016 to 2021 were compared to the 2021 NCE. Invited speakers, abstract presenters, and award recipients were identified. Gender was determined by searching each individual's name for self‐identification. Gender proportions were compared across conferences, speaker type, and year. Results: Compared to the NCE, a significantly smaller proportion of women were invited speakers at APEMA (NCE 59.9% vs. APEMA 38.8%, p < 0.001), but similar proportions of women were invited speakers (53.9%, p = 0.178) and awardees at SOEM (50% vs. 50%, p = 1.0). A larger number of women were SOEM abstract presenters than invited speakers (63.3% vs. 53.9%, p = 0.041). Between 2016 and 2021, the proportion of women invited speakers (SOEM, p = 0.744; APEMA, p = 0.947) or abstract presenters (SOEM, p = 0.632) did not significantly change. Conclusions: Compared to NCE, women are underrepresented as speakers at APEMA, but not at SOEM. Abstract presenters are more likely to be women compared to invited speakers. While awards appear equally distributed, recipients do not mirror the proportion of women in PEM. Conference organizers and leaders in PEM should ensure gender equity in national recognition. [ABSTRACT FROM AUTHOR]

Introduction: Epidemiologic studies of physical activity among pediatric hemodialysis (HD) patients are lacking. A sedentary lifestyle in End‐Stage Kidney Disease is associated with a higher cardiovascular mortality risk. In those patients receiving HD, time spent on dialysis and restrictions on physical activity due to access also contribute. No consensus exists regarding physical activity restrictions based on vascular access type. The aim of this study was to describe the patterns of physical activity restrictions imposed by pediatric nephrologists on pediatric HD patients and to understand the basis for these restrictions. Methods: We conducted a cross‐sectional study involving US pediatric nephrologists using an anonymized survey through Pediatric Nephrology Research Consortium. The survey consisted of 19 items, 6 questions detailed physician characteristics with the subsequent 13 addressing physical activity restrictions. Findings: A total of 35 responses (35% response rate) were received. The average years in practice after fellowship was 11.5 years. Significant restrictions were placed on physical activity and water exposure. None of the participants reported accesses damage or loss that was attributed to physical activity and sport participation. Physicians practice is based on their personal experience, standard practice at their HD center, and clinical practices they were taught. Discussion: There is no consensus among pediatric nephrologists about allowable physical activity in children receiving HD. Due to the lack of objective data, individual physician beliefs have been utilized to restrict activities in the absence of any deleterious effects to accesses. This survey clearly demonstrates the need for more prospective and detailed studies to develop guidelines regarding physical activity and dialysis access in order to optimize quality of care in these children. [ABSTRACT FROM AUTHOR]

Pediatric Failure To Thrive (FTT), commonly presented in young infants, is often not diagnosed on time or missed. Lack of timely infants' diagnosis can adversely affect their growth and development. We have developed and successfully tested FTTell—a model‐based system for diagnosing FTT during common pediatric follow up. FTTell is an executable model‐based diagnostic tool for diagnosing FTT. We use Object‐Process Methodology extended with Methodical Approach to Executable Integrative Modeling, enabling qualitative considerations and quantitative parameters of the problem to be modeled jointly, enabling FTT diagnosis. The validity of FTTell is demonstrated on data collected from 100 infants. For each child, FTTell calculates a score indicating FTT presence and severity. We compared the systems' outcomes to a pediatric gastroenterologist expert severity assessment. Of the 100 infants, the system initially yielded 82% validity. Reassessment improved it to 87% validity. Pediatricians may miss infants with FTT, especially in borderline cases. FTTell can effectively serve as a FTT diagnosis tool, boosting pediatricians' correct diagnosis and proper investigation. Our cloud‐based system can be continuously updated with the latest research findings. FTTell can diagnose FTT and its severity in infants with 87% accuracy. Pediatricians can use this model‐based standardized approach to improve their FTT diagnosis and provide appropriate timely intervention when needed. Model‐based diagnosis is a novel application of conceptual models, and OPM ISO 19450 is especially fit for this purpose. The model‐based diagnosis approach can be extended beyond medicine to diagnosing problems with engineered, technological, and socio‐technical systems. [ABSTRACT FROM AUTHOR]

Aim: We suggest the top ten tips that any clinician working in a pediatric emergency department should always keep in mind. Methods: A literature review was conducted using, as a starting point, the previously published Ten Commandments for Emergency Medicine, Pediatric Emergency Medicine, and Perinatal Medicine. Results and Conclusion: A standard curriculum for pediatric emergency physicians is lacking. These ten commandments should be considered as advice for physicians who practice this profession every day and not as unbreakable rules established from above. [ABSTRACT FROM AUTHOR]

This article discusses the use of sedation or general anesthesia (A/S) in pediatric patients undergoing radiation therapy and the implications it has for the child, their family, and the healthcare system. The article highlights the need for interventions to reduce distress and anxiety in pediatric patients during radiation therapy, and suggests approaches such as cognitive-behavioral therapy, therapeutic play, and virtual reality. The article also emphasizes the importance of a child-friendly environment and effective communication with both children and their parents. However, the article notes that there is a lack of robust research in this area and calls for further studies to test interventions and improve outcomes for pediatric patients undergoing radiation therapy. [Extracted from the article]

Background: Although pediatric residents frequently order blood products, transfusion medicine (TM) education is both limited and unstandardized during postgraduate training. Using Delphi methodology, this study aimed to identify and prioritize which pediatric TM curricular topics are most important to inform postgraduate training in TM for general pediatricians and pediatric subspecialists. Methods: A national panel of experts iteratively rated potential curricular topics, on a 5‐point scale, to determine their priority for inclusion within a TM curriculum. After each round, responses were analyzed. Topics receiving a mean rating <3/5 were removed from subsequent rounds and remaining topics were resent to the panel for further ratings until consensus was achieved, defined as Cronbach α ≥ 0.95. At conclusion of the Delphi process, topics rated ≥4/5 were considered core curricular topics, while topics rated ≥3 to <4 were considered extended topics. Results: Forty‐five TM experts from 17 Canadian institutions and 12 subspecialties completed the first Delphi round and 31 completed the second. Fifty‐seven potential curricular topics were generated from a systematic literature review and Delphi panelists. Two survey rounds were completed before consensus was achieved. Seventy‐three topics in six domains reached consensus: 31 core curricular topics and 42 extended topics. There were no significant differences in ratings between TM and non‐TM specialists. Discussion: A multispecialty Delphi panel reached consensus in identification of curricular topics for pediatric resident physicians. These results set the stage to develop a pediatric TM curriculum that will be foundational for pediatric trainees to enhance learning and improve transfusion safety. [ABSTRACT FROM AUTHOR]

Background: General emergency physicians provide most pediatric emergency care in the United States yet report more challenges managing emergencies in children than adults. Recommendations for standardized pediatric emergency medicine (PEM) curricula to address educational gaps due to variations in pediatric exposure during emergency medicine (EM) training lack learner input. This study surveyed senior EM residents and recent graduates about their perceived preparedness to manage pediatric emergencies to better inform PEM curricula design. Methods: In 2021, senior EM residents and graduates from the classes of 2020 and 2019 across eight EM programs with PEM rotations at the same children's hospital were recruited and surveyed electronically to assess perceived preparedness for 42 pediatric emergencies and procedures by age: infants under 1 year, toddlers, and children over 4 years. Preparedness was reported on a 5-point Likert scale with 1 or 2 defined as "unprepared." A chi-square test of independence compared the proportion of respondents unprepared to manage each condition across age groups, and a p-value < 0.05 demonstrated significance. Results: The response rate was 53% (129/242), with a higher response rate from senior residents (65%). Respondents reported feeling unprepared to manage more emergency conditions in infants compared to other age groups. Respondents felt least prepared to manage inborn errors of metabolism and congenital heart disease, with 45%-68% unprepared for these conditions across ages. A heat map compared senior residents to recent graduates. More graduates reported feeling unprepared for major trauma, impending respiratory failure, and pediatric advanced life support algorithms. Conclusions: This study, describing the perspective of EM senior residents and recent graduates, offers unique insights into PEM curricular needs during EM training. Future PEM curricula should target infant complaints and conditions with lower preparedness scores across ages. Other centers training EM residents could use our findings and methods to bolster PEM curricula. [ABSTRACT FROM AUTHOR]

Among the medical parameters used for infants, the grasping force is particularly important because it indicates their musculoskeletal and neurological development. Although several grasping force measuring devices have been developed for infants, their accuracy and reliability are limited owing to their direction‐dependent sensing mechanisms. It is challenging to calculate the direction and area of the ambiguous forces applied by infants, and pediatricians cannot control the grasping method used by them. In this study, a direction‐independent grasping force measuring device is proposed that features a high resolution (0.1 kPa), cyclic stability (20 000 cycles), and linear sensitivity (21.73 µV kPa−1), and high accuracy and reliability. The grasping forces (average, minimum, and maximum) of the left (normal state) and right (injection needle inserted: uncomfortable state) hands of a 1‐day old infant can be successfully analyzed using the proposed device. It can be used to obtain the standard grasping force data of infants, which can contribute toward understanding the correlation between the grasping force and neurological diseases. The proposed device can be used to quantitatively measure the grasping force of not only infants but also the elderly; therefore, additional studies may report that the grasping force can be a discriminable parameter for identifying neurological diseases. [ABSTRACT FROM AUTHOR]

Background: The induction of anesthesia in children poses a challenge for the anesthesiologist, the parent and child. Anxiety and negative behaviours and strategies that effectively mitigate should be documented accurately and be available for future patient encounters. To address the need for a structured and standardized electronic documentation tool. Aims: Our aim was to develop a comprehensive electronic tool to capture and report behaviours during induction of anesthesia. Methods: We performed a literature search on existing validated tools for documenting behaviours during anesthesia induction. We used the nominal group technique to achieve agreement on the components to include. We used Agile software development techniques to design and review the integrated electronic tool. Twelve international hospitals informed the development of the tool. Results: We developed an electronic tool, the Standardized Anesthesia InductioN Tool (SAINT). SAINT incorporates validated scales for documenting key stages of the anesthesia induction journey (separation from caregivers, mask acceptance, induction behaviour, parental presence, the use of adjuncts and their effectiveness). In addition, the standardised data elements used in SAINT allow for local reporting, quality metrics and can assist in data across multi‐centre trials. To date the tool has been adopted by 133 institutions across four countries and is freely available. Conclusion: We show that collaborative development and rapid adoption of the comprehensive induction tool SAINT has led to its rapid adoption in the routine practice of pediatric anesthesiology across several countries. Further studies on how the SAINT is being used for quality improvement or research are warranted. [ABSTRACT FROM AUTHOR]

How pioneering paediatrician Andrés Martínez Vargas (1861-1948) improved child health in Spain in the late 19th and early 20th centuries These were attended by healthy wet nurses and were the precursors of Spanish breast milk banks.[1] Vargas believed in nipology, which is the sub-discipline of paediatrics that studies physical and mental development, diseases and nutrition in early childhood. The early history of Spanish paediatrics can be traced back to the 15th-17th century. [Extracted from the article]

This article provides an overview of advanced therapies for the management of inflammatory bowel disease (IBD) in children, with a focus on the Australasian perspective. The rates of IBD in Australasian children have been increasing, and early diagnosis and optimal management are crucial for their well-being. The article discusses different therapeutic interventions, including nutritional, medical, and surgical options. It also highlights the unique needs of children with IBD and the challenges they face in accessing advanced therapies. While there is promise in these therapies, access for children and adolescents with IBD is currently limited, particularly in Australasia. The article concludes by emphasizing the importance of ongoing research and the development of local data and experience in the use of advanced therapies for children with IBD. [Extracted from the article]

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]

Rationale, Aims, and Objectives: While paediatric clinician‐scientists are ideally positioned to generate clinically relevant research and translate research evidence into practice, they face challenges in this dual role. The authors sought to explore the unique contributions, opportunities, and challenges of paediatric clinician‐scientists, including issues related to training and ongoing support needs to ensure their success. Method: The authors used a qualitative descriptive approach with thematic analysis to explore the experiences of clinician‐scientist stakeholders in child health (n = 39). Semi‐structured interviews (60 min) were conducted virtually and recorded. Thematic analysis was conducted according to the phases outlined by Braun and Clarke (2006). Results: The analysis resulted in the creation of three themes: (1) "Walking on both sides of the fence": unique positioning of clinician‐scientists for advancing clinical practice and research; (2) the clinician‐scientist: a specialized role with significant challenges; and (3) beyond the basics of clinical and research training programmes: essential skill sets and knowledge for future clinician‐scientists. Conclusions: While clinician‐scientists can make unique contributions to the advancement of evidence‐based practice, they face significant barriers straddling their dual roles including divergent institutional cultures in healthcare and academia and a lack of infrastructure to effectively support clinician‐scientist positions. Training programmes can play an important role in mentoring and supporting early‐career clinician‐scientists. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to evaluate whether a neurology outreach teaching programme delivered via video‐teleconferencing (6 × 60 min live sessions every 6–8 weeks) is acceptable, contributes to understanding and meets the neurology learning needs of Australian paediatricians from metropolitan, rural and remote areas. Methods: A sample of six NSW sites that joined the neurology outreach programme between 2017 and 2019 (Arm 1) and six interstate sites from QLD, WA and TAS who commenced the programme in 2020 (Arm 2) participated. A mixed‐methods survey explored participants' learning needs and value of the programme. Results: Forty‐six participants submitted programme evaluation surveys (26 arm 1, 20 arm 2); 9 were removed due to insufficient data (n = 37). Quantitative and qualitative data showed the programme was acceptable in format, relevant to practice, appropriate for clinician learning needs, and engaging. Clinicians reported improvement in understanding and confidence. Participants felt more connected/less isolated and up‐to‐date. Participants reported a positive impact from the programme on approach to neurological problems and ensuing consults, and more differentiated and appropriate paediatric neurology referrals. Conclusion: This study validates the live video‐teleconference outreach model as an acceptable, effective and important means of providing continuing neurology education for Australian paediatricians. [ABSTRACT FROM AUTHOR]

Allergy diagnosis, allergy treatment, education, healthcare, learning methods, primary care, primary care pediatricians Keywords: allergy diagnosis; allergy treatment; education; healthcare; learning methods; primary care; primary care pediatricians EN allergy diagnosis allergy treatment education healthcare learning methods primary care primary care pediatricians 1 4 4 01/31/23 20230101 NES 230101 Pediatricians are often the first point of contact for children in primary care (PC). [Extracted from the article]

Background: Diversity management has gained traction in Japan. The Pediatric Rheumatology Association of Japan (PRAJ) has an Advisory Committee for Diversity Promotion with a broader focus on promoting diversity. The objectives of this study were to better understand the problems faced by PRAJ members regarding the work environment, childcare and nursing care, and work‐life balance. Methods: A web‐based questionnaire was administered to members of the PRAJ and 79 responses were evaluated. Results: Of the respondents, 73% were male and 27% were female. A total of 14% worked for more than 12 h on weekdays, and 22% worked for more than 60 h per week and 38% had fewer than 4 days off per month. Regarding childcare, 54% of the respondents were raising preschool children and 83% had taken parental leave for less than 1 year. A total of 17% of participants had family members in need of care. For both childcare and caregiving, the burden was greater for women. Only 18% of the respondents reported a well‐balanced work‐life balance, and the most common reasons for a lack of balance were not having enough time, heavy workload, and heavy housework load. Conclusions: The working hours of the respondents were long, and female members had a greater burden of childcare and caregiving, which was considered a barrier to the career development of women. In the future, there will be a need to promote a sense of equality in diverse human resources, develop support for family life, and shorten working hours. [ABSTRACT FROM AUTHOR]

Aims: Recent years have seen an exponential increase in the proportion of parents searching for online health information on their child's medical condition. We investigated the experiences, attitudes and approaches of paediatricians interacting with parents who search for online health information and the impact on the doctor–parent relationship. Methods: This qualitative study was conducted utilising semi‐structured interviews with 17 paediatric physicians, surgeons, anaesthetists and trainees working in an Australian children's hospital. Data were analysed through deductive and inductive thematic analysis using line‐by‐line coding. Results: Three key themes were identified: paediatricians' experiences with, and attitudes towards, parents using online health information; paediatricians' communication approaches; and the perceived impact on the doctor–parent relationship. These themes demonstrated that most paediatricians acknowledged the information parents found and directed parents to reliable websites. Following discussions with Internet‐informed parents, a few changed their management plans and a few reported discouraging parents from further searching online. Conclusions: Our results indicate that paediatricians predominantly used patient‐centred communication strategies to care for patients in partnership with parents. Paediatricians contextualising online health information can contribute to a quality partnership with parents and facilitate shared decision‐making, potentially fostering better health outcomes for children. Our conclusions may inform clinicians' communication approaches when interacting with Internet‐informed parents and stimulate research about more effective doctor–parent communication approaches. In a digital age, paediatricians may benefit from employing more time‐efficient approaches to manage increasing workloads with their new role of digital stewardship of parents. [ABSTRACT FROM AUTHOR]

Aim: According to the Italian national statistical institute, severe bacterial infections (SBI) in Italy are responsible for 1.7% of mortality under 5 years of age and their recognition is often challenging, especially in the first stages of the disease. We tried to estimate the prevalence of SBI in our target population and to identify signs and symptoms that could guide in the initial evaluation of a child with a possible SBI. Methods: We designed a prospective, multicentre study and enrolled patients aged 0–14 years at the first evaluation to the emergency department with an acute illness lasting a maximum of 5 days. The presence of variables suggestive of SBI was collected for every enrolled patient. One week after the enrolment, every patient was followed up by telephone. Results: SBI is more likely to be detected with the 'gut feeling' in both univariate and multivariate models (univariate OR: 7.16, 95% CI: 4.08–12.56; multivariate OR: 5.34, 95% CI: 2.78–10.25), while abnormal breathing pattern resulted significative only in univariate model (OR 3.83, 95% CI: 1.98–7.40). Nevertheless, their associated sensitivity is low. Conclusion: SBI is uncommon in the absence of paediatricians' gut feeling and abnormal respiratory pattern. [ABSTRACT FROM AUTHOR]

Aim: Paediatricians and child psychiatrists review children with complex comorbidity, noting similarities between tertiary Child Development Service (CDS) and Child and Youth Mental Health Service (CYMHS) cohorts. Mental health comorbidity is common in developmental services. Developmental comorbidity in mental health cohorts is uncharacterised. The study aimed to describe CDS and CYMHS cohorts using measures of child development, mental health, physical health and psychosocial risk. Methods: A questionnaire was completed by parents of CDS and CYMHS new clients aged 4–11. It included measures of mental health symptoms, child development, physical health, stressful life events, family functioning, parent mental health and socio‐economic variables. Sample rates were compared to population norms. CDS and CYMHS cohorts were compared. Results: The study population had elevated rates of psychosocial risk, family dysfunction, physical illness, developmental risk and mental health symptoms. CDS had higher levels of developmental risk and family dysfunction. Most CDS clients (81%) had mental health difficulties. CYMHS clients were older, and had more mental health symptoms, stressful life events and child safety contact; 81% of CYMHS clients demonstrated developmental risk. CDS and CYMHS had similar socio‐demographic profiles and parent mental health difficulties, and similarly high rates of physical health problems. Conclusions: Consideration should be given to mental health screening and support in CDS, and to developmental screening in CYMHS. Both services support at‐risk children with complex developmental, mental health and physical co‐morbidity necessitating shared approaches to clinical and population health, including care integration, and collaborative cross‐disciplinary models of service provision and training, and advocacy. [ABSTRACT FROM AUTHOR]

Aim: Most acute appendicitis (AA) patients present first to physicians who are not paediatric surgeons. The aim of this study was to investigate whether there is a relationship between the speciality of the first physician and delays in diagnosis and morbidity in AA. Methods: The study was planned prospectively. Patients who were operated on between 15 June 2017 and 2018 due to abdominal pain were included. Demographic data of the patients, speciality of the doctors who examined them and postoperative complications were recorded. The patients were divided into three groups: those who were diagnosed at the first examination, those who were diagnosed at the second examination and those who were diagnosed after three or more examinations. Results: A total of 414 patients were included in the study. There were 255 (61.6%) patients in group 1, 135 (32.6%) patients in group 2 and 24 (5.8%) patients in group 3. The mean age of the patients in group 3 was lower (P < 0.05). Postoperative complications and hospital stay were higher in group 3 (P < 0.05). While 91.8% of the patients in group 1 were examined by a paediatrician, this rate was significantly lower in the other groups (P < 0.05). Conclusions: If children presenting with abdominal pain are evaluated primarily by paediatricians, consultation with paediatric surgeons is faster. The awareness of doctors of other specialities should be increased through regular periodic training. [ABSTRACT FROM AUTHOR]

Background: Evaluating the effectiveness of pediatric emergency medicine training is essential to ensure that emergency physicians and emergency medicine residents have sufficient knowledge, skill, and confidence in optimizing care for acute pediatric visits. Although the field of pediatric emergency medicine has experienced phenomenal growth in past decades, it still faces challenges in how to best implement the curriculums in emergency medicine residency training programs. Objectives: Exploring emergency physicians' and emergency residents' perspectives on pediatric emergency medicine training in emergency residency training programs in Taiwan through a nationwide survey. Methods: The survey was distributed to 1281 emergency physicians and emergency medicine residents in 43 teaching hospitals. The survey inquired about demographic data, hospital type, rank of proctored trainers and assessors, and the setting of pediatric emergency medicine training. Participants' confidence in managing acute pediatric visits and their satisfaction and reflections of their pediatric emergency medicine training were explored. Results: In all, 258 responses were received from 117 residents and 141 emergency physicians. Seventy-seven percent reported working in medical centers. Clinical supervision was primarily performed by pediatric attending physicians and emergency physicians. Fifty-eight percent of participants felt satisfied with their pediatric emergency medicine training. However, only 52.3% felt confident managing acute pediatric visits, which was attributed to inadequate exposure to pediatric patients. Residents noted lack of confidence in managing newborns, infants, and clinical procedures. Therefore, simulation training and point-of-care ultrasound learning were considered advantageous. Conclusion: The pediatric emergency medicine training in emergency medicine residency programs is diverse in intensive care training, supervisors, and assessors. Surveys demonstrate that learning experience in pediatric wards and emergency department rotations is associated with overall satisfaction with pediatric emergency medicine training; inadequate exposure to pediatric patients contributed to learners having less confidence. Emergency medicine residency program reform might focus on adequate hands-on pediatric patient care. [ABSTRACT FROM AUTHOR]

Aim: Drowning is the leading cause of unintentional injury death for children 1–4 years of age in the USA. Texas, a southeastern state, is disproportionately burdened by paediatric drowning. The aim of this project was to increase drowning prevention counselling provided during well‐child visits to families with children aged 0–10 years. Methods: We developed and implemented a water safety counselling programme for paediatricians to impart to families during well child, urgent care and ED visits for 0–10 year age group. Physicians completed and self‐reported demographic, pre‐ and post‐intervention, counselling rate and project evaluation surveys, while caregivers completed post‐intervention surveys only. Both physicians and caregivers were surveyed on evidence‐based drowning prevention strategies (four‐sided fencing of pools, touch supervision, life jackets and swim/cardio‐pulmonary resuscitation classes). Results: Thirty‐three physicians and 1934 caregivers participated in the project. Physicians demonstrated statistically significant improvement in discussing drowning prevention with patients (3.5 vs. 4 on Likert scale; P = 0.002) in 2018 versus 2019. The counselling frequency in primary care settings increased from 54% to 70% from year 1 to 2. 100% of physicians correctly identified the best drowning prevention strategy and 80.6% of caregivers reported learning new water safety information in 2019 versus 68.8% in 2018 (P value < 0.001). Conclusions: This water safety education programme demonstrated increased drowning prevention counselling during well‐child visits. The counselling was effective as demonstrated by increased caregiver acquisition of new water safety information. Paediatricians had adequate drowning prevention knowledge; an efficient counselling strategy helped them impart this knowledge to their patients. [ABSTRACT FROM AUTHOR]

This article discusses the challenges and considerations in choosing the best kidney for pediatric kidney transplant recipients. The longevity of the graft is often threatened by the development of donor-specific antibodies and rejection, leading to graft loss. Factors such as HLA matching, age of the donor, and the choice between living and deceased donors are explored. The article also discusses the potential benefits of utilizing kidney exchange programs. While more research is needed, this symposium has provided valuable insights into selecting the best kidney for pediatric transplant recipients. [Extracted from the article]

Background: Pediatric Rome IV criteria are used to diagnose childhood functional gastrointestinal disorders (FGIDs). This study of pediatric gastroenterology physicians measured their agreement in (1) Making a pediatric Rome IV FGID diagnosis; and (2) Diagnostic testing for patients with FGIDs. Methods: Pediatric gastroenterologists and pediatric gastroenterology fellows at two medical centers completed a survey containing clinical FGID vignettes. For each vignette, raters identified the most likely Rome IV diagnosis(es) and selected which diagnostic test(s) (if any) they typically would obtain. The survey was re‐administered within 3 months. Inter‐rater and intra‐rater weighted percent agreement was determined. Linear mixed modeling identified sources of variability in diagnostic testing. Key Results: Thirty‐four raters completed the initial survey of whom thirty‐one (91%) completed the repeat survey. Overall inter‐rater agreement on Rome IV diagnoses was 68% for initial and repeat surveys whereas intra‐rater agreement was 76%. In contrast, overall inter‐rater agreement on diagnostic testing was <30% for both initial and repeat surveys and intra‐rater agreement was only 57%. Between‐physician differences accounted for 43% of the variability in the number of tests selected. Rater identified use of Rome criteria in clinical practice was associated with 1.1 fewer diagnostic tests on average (95% CI 0.2–2.0, p = 0.015). Higher intra‐rater agreement was noted for diagnostic testing in faculty when compared to fellows (p = 0.009). Conclusions & Inferences: In a multicenter evaluation among pediatric gastroenterology physicians, pediatric Rome IV diagnostic agreement was higher than that reported for previous Rome versions, and higher than agreement on diagnostic testing. [ABSTRACT FROM AUTHOR]