Persons with sickle cell disease (SCD) are particularly susceptible to infection. Infants and very young children are especially vulnerable. The ‘Co-operative Study of Sickle Cell Disease’ observed an incidence rate for pneumococcal septicaemia of 10 per 100 person years in children under the age of three years. Vaccines, including customary pneumococcal vaccines, may be of limited use in this age group. Therefore, prophylactic penicillin regimens may be advisable for this population. This is an update of a Cochrane Review first published in 2002, and previously updated, most recently in 2014.
This guideline covers recognising and responding to abuse and neglect in children and young people aged under 18. It covers physical, sexual and emotional abuse, and neglect. The guideline aims to help anyone whose work brings them into contact with children and young people to spot signs of abuse and neglect and to know how to respond. It also supports practitioners who carry out assessments and provide early help and interventions to children, young people, parents and carers.
Clinical features of abuse and neglect (including physical injury) are covered in NICE’s guideline on child maltreatment. Recommendations relevant to both health and social care practitioners appear in both guidelines.
The technology described in this briefing is Thora‑3Di for assessing respiratory function in children with asthma.
The innovative aspects are that the measurements are taken non-invasively without the need for special breathing manoeuvres, and provide information on right-versus-left lung function.
The intended place in therapy would be instead of spirometry in secondary care in children for conditions such as asthma.
The main points from the evidence summarised in this briefing are from 5 prospective, observational studies including a total of 129 patients and 139 healthy controls (young people and children) in secondary care. They show that Thora‑3Di may be as effective as spirometry in assessing asthma respiratory parameters in children and young people.
Key uncertainties around the evidence or technology are that it is not clear which of the breathing parameters measured by Thora‑3Di are specific to assessing asthma, and that there is limited evidence comparing these measures with spirometry.
The cost of Thora‑3Di is £25,000 per unit (exclusive of VAT). The resource impact is unclear, but using the device could save costs through quicker testing.
Obese children and adolescents can lose up to seven pounds over six to 12 months when they engage in at least 52 hours of behaviour-based lifestyle interventions. Minimal benefit was seen with shorter contact time, with less than 25 hours ineffective. The control group gained weight.
Rising obesity in the young is a global concern, which may lead to high rates of obesity-related diseases in adulthood. This review identified trials covering various weight management strategies. Lifestyle-based-interventions with sufficient contact time – as recommended by UK guidelines – showed clear benefits with no evidence of harms.
Investing in effective strategies to manage child obesity will ultimately save healthcare costs. Behaviour-based support should now be assessed for long-term weight loss and maintenance.
The evidence is still lacking whether universal child screening for obesity should be performed in the UK.