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Patient-reported outcome measures place the patient at the centre of his/her care. There are calls to introduce child-reported outcome measures to mental health services. We aimed to (a) develop an age-appropriate patient-reported outcome measure for children's mental health, and (b) validate this in a primary school and Child and Adolescent Mental Health Service (CAMHS).A list of items to measure children's mental health was proposed (Draft 1) and revised to 14 items following focus group and user consultation (Draft 2). A colourful, cartoon and emoji version was created in consultation with children (Draft 3); a professional cartoon artist created the final 'My Feelings Form' (MFF), with usability feedback (Draft 4). The MFF was tested by 317 children aged 4-13 years from one mixed-gender primary school at two time points in 1 day, and 25 children aged 4-13 years from CAMHS. Results were analysed using test-retest reliability and exploratory factor analysis; a receiver operator characteristic curve was constructed.The CAMHS group scored significantly higher than the school group for the mean total score (23.5 ± 11.3 vs. 16.1 ± 6.2) and for 10 items. Test-retest reliability was acceptable (correlation = 0.74, p .001). Exploratory factor analysis using 10 informative items identified two factors - emotional factor (Cronbach's alpha = 0.74) and function factor (Cronbach's alpha = 0.59). The revised 10-item form has a Cronbach's alpha of 0.77; a cut-off of 12 has a sensitivity of 80% and specificity of 60%, indicating that it correctly identified 80% of those who were attending CAMHS and gave 60% of the schoolchildren a negative result.The colourful MFF was co-produced with children, and preliminary data suggest that it is a useful patient-reported outcome measure for children's mental health.

A previously well 6-year-old girl was referred to clinic with a 5-month history of an ulcerated lesion on her left forearm after sustaining an insect bite in Iraq, having recently emigrated to the UK. The lesion was initially painful and later became ulcerated, pruritic and inflamed. She previously received treatment with topical corticosteroid with no improvement. There were no systemic symptoms of fever, weight loss or night sweats. She had no significant medical history, no allergies or regular medication. Her vaccinations were up to date including BCG. There was no known exposure to tuberculosis and no other family members were affected. Examination revealed a well-grown child with height and weight >25th centile. Systems examination was unremarkable with no lymphadenopathy or organomegaly. An ~2×3 cm erythematous plaque on the left dorsal forearm was noted (figure 1). Initial investigations revealed a normal Full Blood Count, Urea & Electrolytes and Liver Function Tests and negative tests for HIV and Hepatitis B & C. Mantoux was 0 mm, Quantiferon (IGRA) negative and chest X-ray was normal. Figure 1 Initial clinical findings demonstrating an erythematous plaque with central ulceration and crusted scab on the left dorsal forearm. 1. Which of the following …

Food allergy is common, it can lead to significant morbidity andnegatively impacts on quality of life; therefore, it is vitally important we get the diagnosis right. However, making the diagnosis can be complex. Clinical history is the most important diagnostic tool and subsequent investigation may help confirm the diagnosis. The investigations available to most paediatric departments are skin prick testing and specific IgE so we will focus on these. Within this article we explore the evidence related to targeted testing and how to interpret these within the clinical context.

Art therapy and art psychotherapy are often offered in Child and Adolescent Mental Health services (CAMHS). We aimed to review the evidence regarding art therapy and art psychotherapy in children attending mental health services. We searched PubMed, Web of Science, and EBSCO (CINHAL®Complete) following PRISMA guidelines, using the search terms (“creative therapy” OR “art therapy”) AND (child* OR adolescent OR teen*). We excluded review articles, articles which included adults, articles which were not written in English and articles without outcome measures. We identified 17 articles which are included in our review synthesis. We described these in two groups—ten articles regarding the treatment of children with a psychiatric diagnosis and seven regarding the treatment of children with psychiatric symptoms, but no formal diagnosis. The studies varied in terms of the type of art therapy/psychotherapy delivered, underlying conditions and outcome measures. Many were case studies/case series or small quasi-experimental studies; there were few randomised controlled trials and no replication studies. However, there was some evidence that art therapy or art psychotherapy may benefit children who have experienced trauma or who have post-traumatic stress disorder (PTSD) symptoms. There is extensive literature regarding art therapy/psychotherapy in children but limited empirical papers regarding its use in children attending mental health services. There is some evidence that art therapy or art psychotherapy may benefit children who have experienced trauma. Further research is required, and it may be beneficial if studies could be replicated in different locations.

Background: An increase in weight is a risk factor for cardiovascular disease and cancer. This increased risk may be mediated by inflammation, but no long-term data are available on the effect of weight gain on systemic inflammation. Objective: We tested the hypothesis that weight gain is associated with an increase in systemic inflammation during a 9-y period. Design: In 1991 data on body weight and a blood sample were collected from a random sample of 2425 randomly selected adults from a community-based cohort in Nottingham, United Kingdom. In 2000, these measures were repeated in 1301 of these participants. The main outcome measure was change in systemic inflammation as measured by serum C-reactive protein (CRP) from the 1222 participants who provided paired samples. Results: The mean change in weight from 1991 to 2000 was 2.9 kg (95% CI: 2.6,3.2 kg). The geometric mean of CRP in 1991 was 1.22 mg/L (95% CI: 0.03, 125.0 mg/L), and it increased to 1.76 mg/L (95% CI: 0.09, 62.0 mg/L) in 2000 (P < 0.001). A linear association was observed between increase in weight and serum CRP, with a I-kg increment in weight being associated with an additional increase in CRP of 0.09 mg/L (95% CI: 0.02, 0.16 mg/L) during this time period. Conclusion: During a 9-y period, an increase in weight is associated with an increase in systemic inflammation. This provides a mechanism that may explain some of the previously reported association of weight gain with an increased risk of both cancer and cardiovascular disease.