Paediatrics & Child Health

Bisphosphonate therapy is the mainstay of pharmacological intervention in young people with skeletal fragility. The evidence of its use in a variety of conditions remains limited despite over three decades of clinical experience. On behalf of the Australasian Paediatric Endocrine Group, this evidence-based consensus guideline presents recommendations and discusses the graded evidence (using the GRADE system) for these recommendations. Primary bone fragility disorders such as osteogenesis imperfecta are considered separately from osteoporosis secondary to other clinical conditions (such as cerebral palsy, Duchenne muscular dystrophy). The use of bisphosphonates in non-fragility conditions, such as fibrous dysplasia, avascular necrosis, bone cysts and hypercalcaemia, is also discussed. While these guidelines provide an evidence-based approach where possible, further research is required in all clinical applications in order to strengthen the recommendations made.

BACKGROUND Children with medical complexity (CMC), are defined by at least one chronic condition, functional limitation requiring technology support, multiple subspecialist involvement, and high healthcare utilization. A potentially significant social determinant that has yet to be examined in this population is that of “housing need.” According to the Canada Mortgage and Housing Corporation, “housing need” refers to housing that is crowded, unaffordable, or in need of major repairs. Given the known associations between housing and health, we hypothesize that housing need could be particularly relevant in CMC. Population-specific housing considerations may include in-home medical services, housing space, and disability accommodations. OBJECTIVES 1) Determine the prevalence of housing need in families with CMC and 2) Explore the experience and meaning of housing need of caregivers of CMC. DESIGN/METHODS We conducted a mixed methods study using questionnaires and semi-structured inter...

Objectives: To study the relationships between motor type, topographical distribution and gross motor function in a large, population‐based cohort of children with cerebral palsy (CP), from the State of Victoria, and compare this cohort to similar cohorts from other countries.Methods: An inception cohort was generated from the Victorian Cerebral Palsy Register (VCPR) for the birth years 1990–1992. Demographic information, motor types and topographical distribution were obtained from the register and supplemented by grading gross motor function according to the Gross Motor Function Classification System (GMFCS).Results: Complete data were obtained on 323 (86%) of 374 children in the cohort. Gross motor function varied from GMFCS level I (35%) to GMFCS level V (18%) and was similar in distribution to a contemporaneous Swedish cohort. There was a fairly even distribution across the topographical distributions of hemiplegia (35%), diplegia (28%) and quadriplegia (37%) with a large major...

Excessive liquid in airways and/or in distal lung tissue may underpin the respiratory morbidity associated with transient tachypnea of the newborn (TTN). However, its effects on lung aeration and respiratory function following birth are unknown. We investigated the effect of elevated airway liquid volumes on newborn respiratory function. Near term rabbit kittens (30 days gestation; term ~32 days) were delivered, had lung liquid drained and either had no liquid replaced (Control, n=7) or 30 mL/kg of liquid was re-added to the airways (liquid added; LA, n=7). Kittens were mechanically ventilated in a plethysmograph. Measures of chest and lung parameters, uniformity of lung aeration and airway size were analysed using phase contrast X-ray imaging. The maximum peak inflation pressure required to recruit a tidal volume of 8 mL/kg was significantly greater in LA compared to Control kittens (35.0±0.7 vs 26.8±0.4 cmH2O; P<0.001). LA kittens required greater time to achieve lung aeration ...

"Szpitalna piżama" 1 wydaje się frazą poruszającą, ponieważ dotyka naszego -wszakże dość powszechnego -doświadczenia; stawia przed oczyma sytuacje nasze i naszych najbliższych, gdzie owa "piżama" uosabiała specyfikę hospitalizacji i z nią związanych przeżyć. Jednym z nich bywa poczucie depersonalizacji, której sprzyja "rozebranie ze wszystkiego", co na co dzień wyraża naszą rolę społeczną i rodzinną, niejako komunikując światu, kim jesteśmy, czym doniosłym się zajmujemy, "zapracowując sobie na uznanie". W osobie ubranej w piżamę trudno dostrzec (być może emerytowanego) nauczyciela, zabieganą babcię wnukom, ciężko pracującego pracownika budowy czy biznesmena. Nasuwa się refleksja, że niekiedy przydałoby się ubrać schorowane, leżące w szpitalu osoby w garnitury i krawaty, szykowne garsonki, prawnicze lub akademickie togi, aptekarskie kitle bądź inne emblematy ich społecznej aktywności i użyteczności, by choć w ten sposób uzyskać dla nich nieco więcej szacunku. "Ostatnia koszula człowieczeństwa" 2 okazuje się bowiem niewystarczająca.

"Szpitalna piżama" 1 wydaje się frazą poruszającą, ponieważ dotyka naszego -wszakże dość powszechnego -doświadczenia; stawia przed oczyma sytuacje nasze i naszych najbliższych, gdzie owa "piżama" uosabiała specyfikę hospitalizacji i z nią związanych przeżyć. Jednym z nich bywa poczucie depersonalizacji, której sprzyja "rozebranie ze wszystkiego", co na co dzień wyraża naszą rolę społeczną i rodzinną, niejako komunikując światu, kim jesteśmy, czym doniosłym się zajmujemy, "zapracowując sobie na uznanie". W osobie ubranej w piżamę trudno dostrzec (być może emerytowanego) nauczyciela, zabieganą babcię wnukom, ciężko pracującego pracownika budowy czy biznesmena. Nasuwa się refleksja, że niekiedy przydałoby się ubrać schorowane, leżące w szpitalu osoby w garnitury i krawaty, szykowne garsonki, prawnicze lub akademickie togi, aptekarskie kitle bądź inne emblematy ich społecznej aktywności i użyteczności, by choć w ten sposób uzyskać dla nich nieco więcej szacunku. "Ostatnia koszula człowieczeństwa" 2 okazuje się bowiem niewystarczająca.

benefits to the health of Canadian babies while still benefiting infertile couples, and would lead to substantial savings in costs and NICU utilization. Pediatric fuNdoPlicatioNs: too Much of a "Good" thiNG? *s Kupper, Q Zhu, i Bratu university of alberta, stollery children's hospital, edmonton, alberta BACKGROUND: Children with gastro-esophageal reflux disease (GERD) that is refractory to medical treatment may benefit from a fundoplication. Unfortunately, post-operative complications are not uncommon and may result, as shown in the literature, in failure of the fundoplication in up to 25-40% of all cases. The purpose of this study is to elucidate the outcomes of fundoplication including identification of risk factors for abdominal re-operation at our institution. METHODS: Using a retrospective chart review we examine children (age 0 -17 yrs) who had undergone a fundoplication at our hospital from 1987-2007. Data was analyzed using SAS 9.1 with Chi-square test comparing the group of abdominal reoperation versus none, and logistic regression for risk factor analysis where a P value of <0.05 is considered significant. RESULTS: 654 children underwent a fundoplication (98% open Nissen) at a mean age of 2.69 years. 13% of those children are under foster care and 54% are from out of town, requiring pre-operative ward admission in 48% of cases, and pre-operative PICU in 11% of cases. 68% of the children operated are neurologically impaired. Despite only half of the patients having documentation of pre-operative GERD medical treatment and only <30% having had 24 hr pH probe, gastroscopy, or radiological investigations, the majority of indications for fundoplication are: clinical GERD, aspiration pneumonia, and feeding intolerance. 25% of children required PICU post-operatively, with an early 2% mortality rate. Post-fundoplication outcomes include a 16.8% abdominal re-operation rate at a mean 2.4 years later. The abdominal re-operations consist mainly of redo-fundoplications (36%), persistent gastrocutaneous fistula (28%), adhesive bowel obstruction (11%), and esophageal dilations (3.6%). Four patients had an esophago-gastric disconnection. Significant risk factors for abdominal re-operation are: impaired neurological status (odds ratio 1.6) and young age (odds ratio 1.1) at initial fundoplication. At a mean follow-up of 3.2 years, only 50% of patients are GERD free, and 25% are still on GERD medications, regardless if they had the initial fundoplication or re-operation, with an overall mortality of 10%. Over the last 20 years, there has been a significant decline in the number of fundoplications. CONCLUSION: Children, especially those young, and neurologically impaired, who suffer from GERD and undergo fundoplication carry a burden of complex long-term medical and surgical issues that potentially require extensive medical resources. Unfortunately, of those operated on, almost half were not free of GERD. This outcome is reflected in the decrease of fundoplications over the recent years. reach for the toP: Best resideNt aBstract PreseNtatioNs ViseZ le soMMet : les Meilleurs résuMés des résideNts 115 VitaMiN d aNd acute loWer resPiratory iNfectioN iN sasKatcheWaN childreN *Ks leis, Jd McNally, Mr Montgomery, aM rosenberg, K sankaran university of saskatchewan, saskatoon, saskatchewan BACKGROUND: Vitamin D, in addition to being essential to maintain skeletal health, is now recognized as being an important factor influencing

ObjectiveOur purpose was to determine if babies breastfed at 6 months of age were more likely to wake at night and less likely to sleep alone than formula‐fed babies.Patients and MethodsData were drawn from the first wave of The Longitudinal Study of Australian Children, an ongoing, nationally representative study of the growth and development of Australia&#39;s children. The 4507 participants met the criteria for this study. The measures examined infant sleep problems as the outcome and breastfeeding at 6 months of age as the exposure in addition to the demographic data, maternal mental health, infant birthweight and gestational age at delivery.ResultsAfter adjustment for covariates, reports by mothers of infants that breastfed at 6 months of age suggested infants were 66% more likely to wake during the night and 72% more likely to report difficulty sleeping alone. However, breastfeeding had a strongly protective effect on wheezing, coughing, snoring and breathing problems, and it ...

Learning disorders are complex and multifaceted conditions that require early identification, comprehensive evaluation, and a collaborative approach to management. These are neurodevelopmental conditions that affect a child's ability to acquire and process information efficiently, making it difficult for them to perform at expected levels in academic settings. These disorders are not reflective of a child's intelligence but rather their struggle in specific areas of learning, such as reading, writing, mathematics, or language comprehension. Paediatricians play an integral role in recognizing potential learning challenges, guiding families toward appropriate interventions, and supporting ongoing care. With early detection and a tailored treatment plan, children with learning disorders can overcome academic challenges and thrive in both school and life.

Children and young people around the world face challenges to their health and wellbeing. In particular, in low-and middle-income countries they experience a higher burden of disease, exacerbated by global inequity limiting access to quality health care. According to the inverse care law, the availability of quality health care varies inversely to the need of the population, and hardworking health-care professionals in under-resourced countries may face impediments to continued education or subspecialty training. In line with the Sustainable Development Goals, collaborations have been developed between high-income and low-and-middle-income countries to address global disparities in health. These collaborations face challenges of high financial costs, difficulties creating long-term sustainable change, and with the emergence of the COVID-19 pandemic, border closures preventing fly-in volunteers. In this paper, we describe the development of an innovative, paediatric-specific model of care for training and support between high-and low-income countries -Taking Paediatrics Abroad Ltd. Taking Paediatrics Abroad supports the development of mutually beneficial relationships between Australian paediatric health-care professionals and paediatric health-care professionals in developing countries and remote, underserved Australian Aboriginal communities. Since May 2020, there have been over 100 sessions covering a vast array of paediatric specialties. This article explores Taking Paediatrics Abroad's model of care, its implementation and challenges, and opportunities for the future.

Children and young people around the world face challenges to their health and wellbeing. In particular, in low-and middle-income countries they experience a higher burden of disease, exacerbated by global inequity limiting access to quality health care. According to the inverse care law, the availability of quality health care varies inversely to the need of the population, and hardworking health-care professionals in under-resourced countries may face impediments to continued education or subspecialty training. In line with the Sustainable Development Goals, collaborations have been developed between high-income and low-and-middle-income countries to address global disparities in health. These collaborations face challenges of high financial costs, difficulties creating long-term sustainable change, and with the emergence of the COVID-19 pandemic, border closures preventing fly-in volunteers. In this paper, we describe the development of an innovative, paediatric-specific model of care for training and support between high-and low-income countries -Taking Paediatrics Abroad Ltd. Taking Paediatrics Abroad supports the development of mutually beneficial relationships between Australian paediatric health-care professionals and paediatric health-care professionals in developing countries and remote, underserved Australian Aboriginal communities. Since May 2020, there have been over 100 sessions covering a vast array of paediatric specialties. This article explores Taking Paediatrics Abroad's model of care, its implementation and challenges, and opportunities for the future.

AimThis study investigates the prevalence of disturbed eating behaviours in children and adolescents initiating obesity treatment, and how the prevalence varies with age, sex and body mass index (BMI) standard deviation score (SDS). Secondly, it examines whether the presence of disturbed eating behaviours at enrolment is associated with the degree of weight loss after 12 months of treatment.MethodsA total of 3621 patients aged 3–18 years enrolled in a multidisciplinary obesity treatment programme were studied. Follow‐up data after a median of 12.4 months were available for 2055 patients. Upon entry, patients were assessed for the following disturbed eating behaviours: meal skipping, emotional eating, overeating and rapid eating. Height and weight were measured at baseline and follow‐up.ResultsAt enrolment, median age was 11.4 years, median BMI SDS was 2.87, and 82.2% of patients exhibited one or more disturbed eating behaviours. The prevalence of meal skipping, emotional eating and ...

Objective: To determine the incidence, types of organisms and resistance patterns involved in early-onset neonatal sepsis in Canada. Study design: Early-onset neonatal sepsis cases were identified through the Canadian Paediatric Surveillance Program. Neonates were excluded if they were asymptomatic or if intracranial procedures preceded a positive cerebrospinal fluid culture. Results: One hundred and twenty-seven cases were identified (0.17 cases per 1000 live births). Group B Streptococcus accounted for 41.7%, Escherichia coli for 35.4%. Antibiotic resistance was present in 33.9% of all cases. 55.6% of E coli cases were resistant, most commonly to ampicillin. Infecting organism species were associated with gestational age, being very low birth weight, time at sepsis presentation, maternal antibiotic prophylaxis and rupture of membranes lasting over 18 hours. Group B Streptococcus was most common in term and E coli in preterm neonates. Twenty-two per cent of E coli cases presented after 48 hours, compared to 6% of Group B Streptococcus cases. We identify a lower rate of early-onset neonatal sepsis than historically suggested, with differing dominant organisms based on gestational ages and other factors, as well as high rates of resistance especially among E coli cases.

ObjectiveTo evaluate trends in organisms causing early-onset neonatal sepsis (EONS). Congruent with recent reports, we hypothesized there would be an increase in EONS caused by Escherichia coli.Study DesignNational data on infants admitted to neonatal intensive care units from 2009 to 2014 were compared to previously reported data from 2003 to 2008. We report 430 cases of EONS from 2009 to 2014. Bivariate analyses were used to analyze the distribution of causative organisms over time and differences by gestational age. Linear regression was used to estimate trends in causative organisms.ResultsSince 2003, there has been a trend of increasing numbers of cases caused by E coli (P&lt;0.01). The predominant organism was E coli in preterm infants and Group B Streptococcus in term infants.ConclusionsWith the majority of EONS cases now caused by E coli, our findings emphasize the importance of continued surveillance of causative organism patterns and developing approaches to reduce cases c...

BACKGROUND Currently there are limited guidelines for the management of hyperbilirubinemia in preterm infants. Current guidelines are limited to individual sites and are consensus-based opinions. The current decrease in chronic bilirubin encephalopathy in preterm infants is a result of liberal use of phototherapy that are not based on evidence from a large dataset of preterm infants. The pattern of bilirubin levels in preterm is unclear and currently based on clinical judgement. Nomograms in term infants has been proven to be beneficial and effective in reducing unnecessary treatment of hyperbilirubinemia. A nomogram designed for preterm infants would allow health professionals to quantify risk based on evidence based methods and reduce the number of test done on preterm infants. OBJECTIVES The objectives of this study are 1) To determine photherapy thresholds in preterm infants and 2) To determine the normative pattern of bilirubin values in preterm infants. DESIGN/METHODS A multi-...

A male infant was born at 35 weeks' gestational age. A spontaneous rupture of membranes occurred 22 h before delivery. At that time, the mother received three doses of intravenous penicillin. There was no fever during labour. The infant weighed 2.2 kg with an Apgar score of 7 at both 1 min and 5 min. The infant experienced mild respiratory distress at birth and was admitted to the level II neonatal intensive care unit. On admission, the infant's heart rate and respiratory rate were 185 beats/min and 86 breaths/min, respectively. His oxygen saturation was 94% with 30% oxygen and his temperature was 35.2°C. A complete blood count was performed and blood cultures were drawn. Ampicillin and gentamycin were started intravenously. At 4 h of age, the infant deteriorated, with increasing respiratory distress and poor perfusion followed by a drop in blood pressure. His complete blood count revealed a white blood cell count of 4.2×10 9 /L, with 40% neutrophils, 23% bands, 9% metamyelocytes and 4% myelocytes. An arterial blood gas analysis was performed (pH=7.12, PCO 2 =66 mmHg, PO 2 =58 mmHg, bicarbonate = 20 mmol/L, and base excess = -7). Low lung volumes, hazy opacification of both lung fields and air bronchograms were observed on the chest x-ray. At 6 h of age, the infant was intubated and given surfactant. At 20 h of age, the blood culture grew Escherichia coli. On day 2, a lumbar puncture was performed and the cerebrospinal fluid results were the following: three red blood cells, 10 white blood cells and no bacteria seen. Additionally, the cerebrospinal fluid culture revealed no growth. However, the E coli in the blood culture was resistant to penicillin and ampicillin, and sensitive to gentamycin. The infant remained ventilated for four days, treated with gentamycin for 14 days and then discharged home. At the six-month neonatal follow-up, the infant was doing well and developing normally.

BACKGROUND Developmental dysplasia of the hips is a condition that if not detected early and managed properly can lead to lifelong morbidity. The incidence of DDH in most developed countries is reported to be 1.5 to 20 cases per 1000 births. The Canadian Task Force on Preventive Health Care reports fair evidence to include a serial clinical examination of the hips by a trained clinician in the periodic health examination of all infants until they are walking independently. The indications for ultrasound examination are less clear. Guidelines for the clinical exam cite indications of imaging to be unstable hip, hip laxity, hip click and asymmetric skin folds. Given that some of these findings are extremely common it is likely that a large number of normal hips are being imaged unnecessarily. OBJECTIVES The purpose of this project is to determine which clinical findings are most predictive of an abnormal hip on ultrasound. It is hoped that this will assist the paediatrician or family ...

I n December 2004, the Canadian Paediatric Society (CPS) published guidelines (1) for the screening of newborns who were considered to be 'at risk' for neonatal hypoglycemia. The thresholds for hypoglycemia were drawn from three sources -so-called 'normal' values derived from appropriatefor-gestational-age (AGA) term babies, neurophysiological evidence from assumed hypoglycemic babies and follow-up data from preterm infants with transient hypoglycemia. The resulting guidelines were pragmatic, based on evidence that was limited in both level and quality, and recommended further study. With this caveat, the guidelines recommended that AGA newborns did not need routine screening of blood glucose (BG) levels. They also recommended that infants considered to be 'at risk' should be screened at 2 h of age and every 3 h to 6 h thereafter until the risk was minimized (a grade C recommendation, based on level 2 to 4 evidence of limited quality). Infants of diabetic mothers (IDMs), preterm infants (younger than 37 weeks' gestational age), and those who were small for gestational age (SGA -weighing less than the 10th percentile) or large for gestational age (LGA -weighing more than the 90th percentile) were considered to be at risk. The CPS algorithm organized interventions using the 2 h BG level and two initial intervention thresholds (1.8 mmol/L

Medical cannabis (MC) may offer therapeutic benefits for children with complex neurological conditions and chronic diseases. In Canada, parents, and caregivers frequently report encountering barriers when accessing MC for their children. These include negative preconceived notions about risks and benefits, challenges connecting with a knowledgeable healthcare provider (HCP), the high cost of MC products, and navigating MC product shortages. In this manuscript, we explore several of these barriers and provide recommendations to decision-makers to enable a family-centered and evidence-based approach to MC medicine and research for children.

Background: Africa bears one quarter of the burden of disease worldwide, yet has barely 3% of all health workers. A recent WHO 'Call to Action' urged funding agencies to develop research capacity in Africa and recommended that community organisations be included in the research process. However, lack of access to funds has hampered the health research studies needed to improve local quality-of-care. A new model for research funding is desperately needed. The microfinance concept of Muhammad Yunus has generated economic opportunities in developing nations by giving impoverished citizens access to capital to start new small businesses. Borrowing from this principle, micro-research could offer researchers small grants to address relevant, local health research questions; communitybased participatory research (CBPR). oBjective: A pilot program has been launched, between Canadian and Ungandan research organizations and Universities to assess the potential of micro-research to enhance research capacity. The program provides research education (through a face to face workshop and ongoing internet curriculum), mentoring, seed funding ($2-4,000 per project) and ongoing peer-to-peer interaction. The goal of the micro-research approach to CBPR is to build research capacity and foster a culture of inquiry applicable to local health care needs and decision making. Local interdisciplinary groups set the priorities, develop a proposal and assess the outcome of each project. results: A research capacity workshop with 22 participants was completed, a web based curriculum for ongoing support is 75% complete, 2 CBPR projects were started with grant support from peer review process. conclusion: Bureaucracy in micro-research will be kept to a minimum. The major focus will be on the local outcomes: research capacity enhancement, local applied health research questions addressed and health improvements achieved through application of research findings. As with microfinance, spinoffs from micro-research will likely start slowly but, with time, become significant, reaching areas of the world where the need is greatest for improved health.

BACkGrouND: With barely 3% of health care workers (HCW) and over 25% of the global health burden, Sub-Sahara African nations saw an urgent need to build capacity in community focused research in 2008 (WHO Bamako 'Call for Action'). Borrowing from principles of microfinance, MicroResearch (MR) provides training, coaching and small grants for community focused interdisciplinary research (CFIR) and knowledge translation. oBjECtIvES: To assess if MicroResearch addresses the local need for CFIR in East Africa (EA). DESIGN/MEtHoDS: We used targeted on-line surveys to assess health challenges and barriers for EA HCW researchers. In phase 1, questionnaires to assess health care challenges were sent to senior researchers (deans, department heads) and junior HCW engaged in CFIR. In phase 2, we assessed an on-line focus group of community researchers from five academic sites in EA using qualitative analyse of responses to prompted questions. rESultS: In phase 1, 68 questionnaires were distributed, and 40 (59%) responded, 17 from senior and 23 junior HCW researchers. The two groups were pooled since response differences were <3% to most questions. Access to healthcare (36%), social determinants (33%) and health service infrastructure (21%) were the most common healthcare needs identified. Lack of research skills (design, analytic methods, training programs), capacity (coaching, mentoring), and funding were identified, as common research capacity needs. Both groups recommended research funding be directed to community (33%), health system (25%) or epidemiologic research. In phase 2, a focus group of 10 multidisciplinary participants (five female, five male) was formed. There were 16 valid comments with 21 points raised for saturation to be reached. Thematic content analysis and summaries were made at stages of the analysis. The four main thematic areas identified as barriers to health research, listed in order of frequency, were; Knowledge, Finance, Mentorship/Coaching, and Ethical Regulation/clearance, Incentives. CoNCluSIoNS: Healthcare needs and barriers to research for CFIR in EA were identified in surveys of senior and junior East African HCW. Strategies, like MR, are addressing these capacity building issues.

Zawód pedagoga jest niewątpliwie tym, który wymaga szczególnych predyspozycji i umiejętności. Wyzwala też czasami różnorakie mechanizmy w człowieku służące ochronie własnej osoby, własnych granic, a czasami prywatności. Stąd pedagodzy często stosują różne mechanizmy obronne. Niektóre badania wykazały jednak, że szczególnie ważne i skuteczne w pracy wychowawczej są mechanizmy obronne dojrzałe. Stwierdzono na przykład, że pedagodzy charakteryzujący się poczuciem humoru i zadowoleniem ze swojego życia są mniej narażeni na syndrom wypalenia zawodowego 1 . Niniejszy artykuł ma za zadanie ukazać preferencje wartości, zakres potrzeb psychicznych i mechanizmów obronnych w życiu przyszłych pedagogów. W tym celu określone zostaną istotne różnice w nasileniu potrzeb i preferowaniu wartości przez osoby mające duże nasilenie mechanizmów obronnych dojrzałych oraz mające ich małe nasilenie. Następnie zostaną określone związki pomiędzy nasileniem dojrzałych mechanizmów obronnych i intensywnością potrzeb oraz preferowaniem wartości.

Zawód pedagoga jest niewątpliwie tym, który wymaga szczególnych predyspozycji i umiejętności. Wyzwala też czasami różnorakie mechanizmy w człowieku służące ochronie własnej osoby, własnych granic, a czasami prywatności. Stąd pedagodzy często stosują różne mechanizmy obronne. Niektóre badania wykazały jednak, że szczególnie ważne i skuteczne w pracy wychowawczej są mechanizmy obronne dojrzałe. Stwierdzono na przykład, że pedagodzy charakteryzujący się poczuciem humoru i zadowoleniem ze swojego życia są mniej narażeni na syndrom wypalenia zawodowego 1 . Niniejszy artykuł ma za zadanie ukazać preferencje wartości, zakres potrzeb psychicznych i mechanizmów obronnych w życiu przyszłych pedagogów. W tym celu określone zostaną istotne różnice w nasileniu potrzeb i preferowaniu wartości przez osoby mające duże nasilenie mechanizmów obronnych dojrzałych oraz mające ich małe nasilenie. Następnie zostaną określone związki pomiędzy nasileniem dojrzałych mechanizmów obronnych i intensywnością potrzeb oraz preferowaniem wartości.

We would like to thank all Early Childhood Education and Care services and participants involved in this study. We acknowledge that the results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation.

AimGross motor skills are important for children&#39;s health and development. Delays in these skills are a concern for healthy developmental trajectories and therefore early identification of delay is important. This study screened for gross motor delay in children from low‐income communities and investigated potential risk factors associated with gross motor delay.MethodsThis cross‐sectional study involved 701 pre‐schoolers (Mage = 54.1 ± 8.6 months, 52.8% boys) from childcare services in low‐income and remote communities in Australia. Gross motor delay was assessed using the Ages and Stages Questionnaire – third edition. Potential risk factors included: sex, age, birthweight, prematurity status, weight status, childcare service, postcode, parent&#39;s education, parent&#39;s marital status, parent&#39;s employment and family income.ResultsResults showed 4.4% of the children were delayed in gross motor skills and 8.8% were at risk of delay. Logistic regression showed being a boy (...

CASE 2 DIAGNOSIS: BLADDER CALCULUS WITH CHRONIC URINARY TRACT INFECTION Abdominal x-ray and ultrasound revealed a freely mobile, radiopaque calculus in the bladder, measuring 2.8 cm × 2.3 cm × 1.9 cm; there were no signs of hydronephrosis. Serum calcium, urate and parathyroid hormone levels were within normal limits. The patient was begun on intravenous

independent of an ASD diagnosis. Children with ASD and ADHD represent a specific subtype of ASD, with identifiable characteristics. METHODS/ ANALySIS: A retrospective chart review was conducted. Information gathered included sex, age, IQ, communication profile, Autism Diagnostic Observation Schedule, Autism Diagnostic Interview, adaptive skills and Conners Parent Rating Scale subscale scores. Hierarchical linear models were used to estimate the effect of sex and diagnosis on raw Conners index scores, after controlling for age and adjusting for the correlation among individuals of the same family. An interaction between group and sex was introduced into the model in order to estimate within group gender effect and the effect of diagnosis within each gender. RESULTS: Data from 72 children diagnosed with autism were analyzed. Of these, 15 (20.8%) met the DSM-IV criteria for ADHD, with 2 (13.3%) meeting criteria for the hyperactive impulsive profile, 7 (46.7%) the inattentive profile and 6 (40%) meeting the criteria for the combined profile. When using a less conservative cutoff, an additional 39 (54%) children diagnosed with ASD demonstrated at least six symptoms of hyperactivity, impulsivity and or inattention. Only 18 (25%) children diagnosed with ASD displayed no symptoms of ADHD. Girls with ASD were more likely to be hyperactive and impulsive whilst unaffected sibling males were inattentive. SIGNIFICANCE: These data suggest that there are at least three different subtypes to describe the presentation of ADHD symptoms in children diagnosed with ASD. The three subtypes are the asymptomatic, sub clinical and a clinical group. This adds strength to the dimensional approach to classifying and interpreting symptoms in children diagnosed with autism. This challenges the present DSM-IV criteria which fail to recognize the coexistence of ADHD in ASD.

C ommunity-acquired pneumonia (CAP) is one of the most common reasons for hospitalization in otherwise healthy Canadian children. The introduction of effective vaccinations, such as the pneumococcal conjugate vaccines, to the routine immunization schedule, has led to decreased rates of illness and, possibly, changes in the epidemiology of CAP in Canada. Unfortunately, in many children diagnosed with pneumonia, no causative agent can be isolated and up to date local data regarding the most common causes of pneumonia are difficult to obtain. The 2011 national guideline from the Canadian Paediatric Society (CPS) (1) and international guideline from the Infectious Diseases Society of America (2) recommend high-dose amoxicillin as the first-line treatment for otherwise healthy children with CAP who can be treated with oral antibiotics (1,2). This recommendation was initiated before the widespread introduction of the 13-valent pneumococcal conjugate vaccine to immunization schedules, when penicillin-resistant serotype 19A disease was a rising concern. We sought to determine the appropriateness of this recommendation in our setting based on our current local Streptococcus pneumoniae susceptibility patterns.

A newborn girl had, from two weeks on, small bruises on varying body locations, but not on her chest. Her Armenian grandmother easily bruised, too. Her mother was diagnosed with hypermobility-type Ehlers-Danlos-Syndrome (hEDS), an autosomal dominant connective tissue disorder, with a 50% inheritance probability. Referral to a University Medical Center located “Dutch Expertise Center for Child Abuse” resulted (prior to consultation) in physical abuse suspicion. Protocol-based skeletal X-rays showed three healed, asymptomatic rib fractures. A protocol-based Bayesian likelihood ratio guesstimation gave 10–100, erroneously used to suggest a 10–100 times likelier non-accidental-than-accidental cause. Foster care placement followed, even in a secret home, where she also bruised, suggesting hEDS inheritance. Correct non-accidental/accidental Bayes’ probability of symptoms is (likelihood ratio) × (physical abuse incidence). From the literature, we derived an infant abuse incidence between a...

C hildhood maltreatment represents a significant risk factor for the development of a number of mental and physical health outcomes. Individuals who experience childhood maltreatment are at greater risk for depression, post-traumatic stress disorder (PTSD), anxiety disorders, and alcohol and drug dependence (1), as well as cardiovascular disease, gastrointestinal and metabolic disorders, and neurological, musculoskeletal and respiratory problems (2). Converging scientific evidence suggests that early adverse experiences, such as childhood maltreatment, become 'biologically embedded' into multiple systems, altering brain function, neuroendocrine responses to stress and immune system function (3,4) (Figure ). Collectively, these findings indicate that the root of many adult diseases originates in early childhood during sensitive periods of development when biological systems are most susceptible to adverse environmental conditions. Identification of the underlying mechanisms linking childhood maltreatment to poor health outcomes is essential to characterize vulnerability to disease, and to further our understanding and capacity to intervene early. While several recent reviews provide a broad focus on the impact of early adversity on biology, the purpose of the present review is to provide a summary of recent research specifically examining the impact of childhood maltreatment on two biological systems relevant to health outcomes -the hypothalamic-pituitary-adrenal (HPA) axis and the immune system.

Every November 12th, the global health community hosts World Pneumonia Day, and in 2020, on the 11th iteration, we find ourselves once more facing the fact that pneumonia is the leading global cause of infectious mortality amongst children under-5 years old. Many regions are not within sight of the Sustainable Development Goal 3.2 target. And yet, this situation may be less surprising given we are-11 years later-still discussing the basic question of how we define (and count) a child's single breath. The cornerstone of paediatric pneumonia diagnosis in most low-and middle-income country (LMIC) settings, and particularly in primary care, is the evaluation of respiratory rate (RR), as part of the clinical algorithms that constitute the Integrated Management of Childhood Illness (IMCI). The introduction of this standardized syndromic approach through the WHO case management guidelines has resulted in significant pneumonia mortality reductions . The current standard of determining RR is visually counting the number of breaths a child takes over an uninterrupted 60-second period, using a stopwatch or RR counting timer. However, this can be unreliable (especially amongst younger and/ or uncooperative children), challenging in timelimited high-volume settings and often not routinely done by healthcare workers. Additionally, timers are often unavailable . Therefore, the lack of lowcost, accurate and easy-to-use RR tools limits

Aim:  Driveway runover injuries are a frequent cause of paediatric mortality and morbidity throughout the world. Driveway runovers occur as a result of an interaction between human factors (child and driver), vehicle factors (visibility) and environmental factors (driveway design and surroundings). This study investigates the environmental factors involved in these injuries.Methods:  Case control study, Auckland, New Zealand. Cases were the properties where paediatric driveway injuries (age &lt; 7 years) requiring hospital admission had occurred. Control properties were selected from the addresses of children presenting to the emergency department with a non‐driveway injury. Blinded assessment of properties was completed using satellite images, site visits and searches of council records.Results:  Analysis was completed on 88 case properties and 181 controls. The risk of injury was increased by a driveway length greater than 12m (OR = 1.8, 95%CI = 1.1–3.0), exiting the driveway onto...

Objective: to investigate the risk factors and prevalence of suspected cases of developmental delay in a cohort of children born in Pelotas, Brazil, in 1993. Methodology: the Denver II test was used to evaluate development at age 12 months in 1,363 children born in Pelotas, Brazil. The children who failed in two or more items of the test were suspected of having developmental disabilities. A set of independent variables was chosen taking into account the hierarchical relations between risk factors according to the conceptual framework (socioeconomic, reproductive and environmental, birth conditions, child care, nutrition and morbidity). Statistical analysis was carried out using Mantel-Haenszel's chi-square and the multivariate technique through conditional logistic regression, to control for possible confounders. Results: at 12 months of age, 34% of 1,363 children failed in the screening test. After adjustment for confounders, failure was associated with lower family income (OR= 1.5), very low birth weight (OR= 4.0), gestational age of less than 37 weeks (OR= 1.6), more than three siblings (OR= 1.9), less than 3 months of breastfeeding (OR=1.6), or no breastfeeding (OR= 1.9). The risk for failing the Denver II test was 10 times higher in children who presented a weight/age index lower than or equal to -2 z score of the reference population at the 6th month of life. Conclusions: our results support the notion that developmental disabilities have multiple etiologies and the concept of cumulative hazard effect. In this population those who are economically disadvantaged accumulate risk factors (social, economic, and environmental) that determine increased risk for developemental deficit.

While the vast majority of preterm births globally occur in low‐ and middle‐income countries, existing published guidelines relating to the decision‐making and resuscitation of extremely preterm infants (EPIs) largely focus on high‐income countries. In 2018–2019, a working group of the Philippine Society of Newborn Medicine aimed to develop the first national guideline relating to the care of EPIs. The working group reviewed data on the outcomes of EPIs in the Philippines, surveyed paediatricians and neonatologists in the Philippines about current practice and held a consensus workshop. This paper describes the guideline development process and presents a summary of the guidelines. The national guidelines endorse consistency in decision‐making. Health professionals should take into consideration the views and wishes of the infant&#39;s parents and the availability of resources to treat the newborn infant. Active management would be appropriate to provide for potentially viable prete...

AimTo examine the relationship between unsettled infant behaviour and fathers’ depressive symptoms, cognitions surrounding infant sleep (anger, doubt), and personal sleep, in a community cohort.MethodsData were collected from 102 fathers of healthy infants at 4 weeks, 4 months and 6 months of age. Measures included father report of infant sleep and crying problems, depressive symptoms, cognitions about infant sleep and own sleep quality and quantity. Data were analysed using adjusted regression models.ResultsSleep problems at 4 months of age were associated with increased depressive symptoms (adjusted mean difference 2.64 (1.27–4.00)), doubt (adjusted mean difference 1.82 (0.40–3.25)), anger (adjusted mean difference 1.86 (0.51–3.20)), poor personal sleep quantity (adjusted odds ratio (OR) 0.21; 95% confidence interval (CI) 0.09–0.51) and quality (adjusted OR 0.20; 95% CI 0.08–0.51); and at 6 months of age, with increased depressive symptoms (adjusted mean difference 2.56 (1.28–3.84...