This guidance sets out the full process that follows the death of a child who is normally resident in England. It builds on the statutory requirements set out in Working together to safeguard children and clarifies how individual professionals and organisations across all sectors involved in the child death review should contribute to reviews.
The guidance sets out the process in order to:
improve the experience of bereaved families, and professionals involved in caring for children
ensure that information from the child death review process is systematically captured in every case to enable learning to prevent future deaths
NHS England will issue guidance for the bereaved, ‘When a child dies: a guide for parents and carers’, setting out the steps that follow the death of a child.
The collation and sharing of the learning from reviews will be managed initially by NHS Digital and then by the National Child Mortality Database when it becomes operational on 1 April 2019. It will be handled through the use of standardised forms. Guidance on the transitional arrangements has been published.
The epilepsies of childhood are a markedly heterogeneous group of diseases with different presentations, outcomes and aetiologies. There is no single, gold-standard investigation that will unequivocally diagnose an epilepsy. The range of aetiologies includes genetic, structural brain malformations and metabolic; in many, there may be a combination of causes. Despite major advances in neuro-imaging and genetics, a cause will not be identified in approximately 40% of all children with epilepsies. This article outlines the available investigations and provides a practical and structured approach on their most effective use in the childhood epilepsies.
Trauma patients in a Level I Pediatric Trauma Center may undergo CT of the abdomen and pelvis with concurrent radiograph during initial evaluation in an attempt to diagnose injury. To determine if plain digital radiograph of the pelvis adds additional information in the initial trauma evaluation when CT of the abdomen and pelvis is also performed, trauma patients who presented to an urban Level I Pediatric Trauma Center between 1 January 2010 and 7 February 2017 in whom pelvic radiograph and CT of the abdomen and pelvis were performed within 24 hours of each other were analyzed. A total of 172 trauma patients had pelvic radiograph and CT exams performed within 24 hours of each other. There were 12 cases in which the radiograph missed pelvic fractures seen on CT and 2 cases in which the radiograph suspected a fracture that was not present on subsequent CT. Furthermore, fractures in the pelvis were missed on pelvic radiographs in 12 of 35 cases identified on CT. Sensitivity of pelvic radiograph in detecting fractures seen on CT was 65.7% with a 95% confidence interval of 47.79-80.87%. Results suggest that there is no added diagnostic information gained from a pelvic radiograph when concurrent CT is also obtained, a practice which exposes the pediatric trauma patient to unnecessary radiation.
This is an update of the original Cochrane review first published in Issue 1, 2003, and previously updated in 2009, 2012 and 2014. Chronic pain, defined as pain that recurs or persists for more than three months, is common in childhood. Chronic pain can affect nearly every aspect of daily life and is associated with disability, anxiety, and depressive symptoms.
Psychological treatments delivered predominantly face‐to‐face might be effective for reducing pain outcomes for children and adolescents with headache or other chronic pain conditions post‐treatment. However, there were no effects at follow‐up. Psychological therapies were also beneficial for reducing disability in children with mixed chronic pain conditions at post‐treatment and follow‐up, and for children with headache at follow‐up. We found no beneficial effect of therapies for improving depression or anxiety. The conclusions of this update replicate and add to those of a previous version of the review which found that psychological therapies were effective in reducing pain frequency/intensity for children with headache and mixed chronic pain conditions post‐treatment.
Naloxone, a specific opioid antagonist, is available for the treatment of newborn infants with cardiorespiratory or neurological depression that may be due to intrauterine exposure to opioid. It is unclear whether newborn infants may benefit from this therapy and whether naloxone has any harmful effects.
The existing evidence from randomised controlled trials is insufficient to determine whether naloxone confers any important benefits to newborn infants with cardiorespiratory or neurological depression that may be due to intrauterine exposure to opioid. Given concerns about the safety of naloxone in this context, it may be appropriate to limit its use to randomised controlled trials that aim to resolve these uncertainties.
Tics are considered to be benign but often cause great distress to the child and family, especially when there is a lack of understanding about their nature and the related conditions. This article is a clinical guide to assessment, diagnosis and management; with focus on practical aspects, caveats and catches and most importantly recognising and managing developmental and psychiatric co-morbidities in Tourette Syndrome and other Tic conditions.
Stratified medicine in paediatrics is increasingly becoming a reality, as our understanding of disease pathogenesis improves and novel treatment targets emerge. We have already seen some success in paediatrics in targeted therapies such as cystic fibrosis for specific cystic fibrosis transmembrane conductance regulator variants. With the increased speed and decreased cost of processing and analysing data from rare disease registries, we are increasingly able to use a systems biology approach (including ‘-omics’) to screen across populations for molecules and genes of interest. Improving our understanding of the molecular mechanisms underlying disease, and how to classify patients according to these will lead the way for targeted therapies for individual patients. This review article will summarise how ‘big data’ and the ‘omics’ are being used and developed, and taking examples from paediatric renal medicine and rheumatology, demonstrate progress being made towards stratified medicine for children.