Category: Paediatrics

Categories : Lab Tests and Imaging PaediatricsTags : Leave a comment

How Paediatric Radiology Gives Answers when Children Cannot

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Children are NOT small adults. They experience and express illness and injury very differently from adults. Which is why paediatric diagnostic imaging is a highly specialised field of medical imaging and is specifically designed for children, from birth to adolescence.

Dr Ebrahim Banderker, a paediatric radiologist at Red Cross War Memorial Children’s Hospital (RXCH), explains why children need a different approach to imaging and the role of radiology in children. He also talks about the success of a public-private initiative with SCP Radiology where he is a consulting radiologist.

Why is paediatric imaging so important?

Children are often unable to, or struggle to describe the nature of their discomfort, pain or symptoms clearly. Imaging helps doctors understand what is happening inside the body, when language and understanding are limited.

When we diagnose early, we are often preventing future pain, disability or developmental issues as well as reducing the anxiety of the family. 

What should parents know or understand about paediatric radiology?

Paediatric imaging is designed with the needs, safety and the specific conditions of children in mind. It is a tool for clarity, reassurance and early care. Our goal is to care for the child in their imaging journey and provide their doctors and families with clear answers they can trust.

How is paediatric radiology different from adult radiology?

  • The choice of the method of imaging is primarily based on how safe it is. The effects of radiation from X-rays and CT scans have a greater risk for a child than an adult – so ultrasound and MRI are preferred where possible.
  • Children are often afraid, unsettled because of pain and anxiety and may require sedation or anaesthesia to make them comfortable during the imaging process.
  • Paediatric imaging equipment, anaesthetic apparatus, monitoring and emergency equipment have to be adapted to children of different ages.

Do paediatric radiologist work directly with children and their parents?

Paediatric radiologists interact with the child and their caregivers far more often than adult radiologists interact with their patients. It is one of the most rewarding aspects of our work. Parents are generally more involved and can help the radiologist by confirming the history and symptoms. The radiologist in turn can reduce parent anxiety, explain the procedure and obtain consent where needed.

Please can you talk about radiation and safety in children – we know that one of the issues both parents and other adults have is safety and radiation?

Children have rapidly developing cells and tissues, often tightly packed together in small bodies and are considered to be 10-15 times more sensitive to radiation.  

The guiding principle of all radiation safety is ‘ALARA,’ which stands for ‘As Low As Reasonably Achievable’ or as we say, ‘when benefit clearly outweighs the risk.’  Ultrasound and MRI do not use radiation and these should be used where possible.

What injuries are commonly seen in children that require imaging?

Common injuries include those from motor vehicle accidents and particularly pedestrian accidents, fractures from falls or playing sport and unfortunately, increasingly from child abuse which is sometimes first identified by the radiologist.

Children’s bones are different from adults and have areas where the bone is still growing. These are called growth plates. Injuries to the growth plates require special care because they can affect how a bone develops and this impacts the overall growth of the child. 

Outside of injuries, paediatric imaging also looks at chest infections, abdominal pain, appendicitis, urinary tract problems and hip development in infants. Brain imaging may be used for seizures, headaches or developmental concerns. In essence, imaging can help us rule out serious causes quickly, which brings enormous reassurance to families.

Even for adults, radiology can be stressful and frightening – for children it must be worse.  How are children supported during scans?

Radiographers and radiologists are trained to work gently and calmly with children and parents are encouraged to be involved and ask questions. For example, when a child needs to be sedated for an MRI, the parent will stay with them until they are asleep. When children feel safe, the scan is quicker, easier and more accurate. The team ensures the child is warm and comfortable and the environment is child friendly with toys and reading material to distract patients and to keep them happy and engaged.

What developments in paediatric radiology do you feel are the most important – especially over the 5 years?

  • Digital radiography allows for digital manipulation of images improving image quality and accuracy. Retakes are reduced so there is less radiation involved
  • Ultrasound machines have improved in-depth visualisation of body parts, disease processes and blood vessels
  • CT scanners are faster and offer lower radiation dose options. There are scanners which can scan the entire body of a child in less than a second.  There is not even time to wriggle…
  • MRI imaging is developing at a galloping pace with faster scanning techniques and finer image detail
  • Functional MRI and the ability to do tissue sampling in cancer imaging, is opening many exciting new avenues. 

The scope of interventional radiology techniques (treating not just diagnosing) is expanding rapidly to make less invasive treatment possible, with less complications for patients and much shorter recovery times. Paediatric radiology increasingly includes minimally invasive procedures (image-guided drainages, biopsies, nephrostomies, angiography), which can shorten hospital stays and reduce surgical burden. 

Categories : HIV PaediatricsTags : Leave a comment

Triple-dose Regimen May Permanently Clear HIV in Infected Newborns

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OHSU-led discovery in animal model could advance quickly to clinical trials in people

Research from the lab of Jonah Sacha, PhD, at OHSU, has identified a one-time regimen of therapies for newborns with HIV that, if given within three days of birth, could permanently clear the virus. The research team hopes to use the animal model results to move into a human clinical trials. (OHSU/Christine Torres Hicks)

Every year, more than 120 000 newborns worldwide contract HIV, a global health burden that requires lifelong treatment for millions of people – assuming they have access and can afford it. New research led by Oregon Health & Science University suggests another possibility: a one-time regimen of therapies given to newborns within three days of birth to permanently clear the virus. The research was published in the journal Nature Microbiology.

“The really exciting part is that it could go to clinical trials immediately to eliminate HIV infection in newborns,” said co-lead author Jonah Sacha, PhD, professor and chief of pathobiology and immunology at OHSU’s Oregon National Primate Research Center and Vaccine and Gene Therapy Institute. “The next step after that is to test if this can work in newly exposed adults.”

The research involved many collaborators and nonhuman primates at both the Oregon and California national primate research centres.

Researchers tested three distinct treatments that were delivered for a few weeks: neutralising antibodies, standard antiretroviral therapy, and an experimental monoclonal antibody known as leronlimab.

Each of the individual treatments has been tried previously and failed to permanently clear the virus – and Sacha wasn’t convinced combining them would work any better. Sacha has worked for years to develop leronlimab, which is designed to block HIV from entering immune cells through a surface protein called CCR5. His longtime OHSU colleague and coauthor Nancy Haigwood, PhD, thought combining existing therapies with leronlimab might be effective.

The study that published today shows she was correct.

Haigwood, a former professor and ONPRC director, is a virologist and immunologist who has specialised in HIV antibody research for decades. “We were astounded and overjoyed, actually,” Haigwood said. “It’s a remarkable result.”

Antiretroviral therapy has already been approved in people, whereas broadly neutralising antibodies and leronlimab are both being tested separately in clinical trials. This new discovery of a one-time, three-part regimen to clear the virus in newborn babies would first need to be tested in clinical trials in people – most likely in newly exposed adults initially – before it would be widely available to constrain an HIV epidemic that continues to kill 600 000 people worldwide each year.

Researchers say they are optimistic, given the anatomical similarity between nonhuman primates and people.

“There was no reason to think this would completely clear the virus,” Sacha said. “It’s one of those things where you test it and, holy cow, it works and you’ve discovered something new.”

Exactly how this approach worked remains unclear, but Sacha and Haigwood said it appears that the combination of therapies is far more potent and effective than each therapy alone. The key appears to be leronlimab’s ability to block HIV from entering immune cells through the surface protein CCR5.

“For reasons we don’t understand, HIV really wants to use CCR5 receptors to infect cells,” Sacha said. “By blocking access, it’s like you’ve kept fuel away from the fire.”

Haigwood uses a slightly different analogy:

  • Turning off the faucet: Antiretroviral therapy doesn’t eliminate HIV altogether, but it minimises its ability to replicate.
  • Mopping up: Neutralising antibodies effectively corral HIV so there is less virus circulating in the body’s blood supply.
  • Sealing off: Leronlimab blocks what’s left of the virus from infecting immune cells – the equivalent of sealing off the room with a water-tight valve.

Haigwood believes the combination appears to be especially potent early in the infection.

“There’s a lot more going on during the first week of infection than we previously thought,” she said. “From this experiment, it looks like there’s a dynamic interaction between the virus and antibodies that takes place as the virus begins to spread.”

Researchers are eager to see whether the combined regimen can be effective beyond 72 hours of the initial infection.

“We only tested out to three days,” Sacha said. “Could it work a week after infection? Two weeks? How far can you go after infection, and still purge the virus?”

By Erik Robinson

Source: Oregon Health & Science University

Categories : Exercise PaediatricsTags : Leave a comment

More Screen Time Since Childhood Linked to Better Cognitive Processing in Adolescence

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Photo by Steinar Engeland on Unsplash

A study conducted at the Universities of Jyväskylä and Eastern Finland, found the surprising result that more screen time since childhood was associated with better cognitive processing in adolescence. According to one of the researchers, we should not regard screen time solely as harmful. The most important thing is to find a balance between physical activity and screen time that promotes active thinking.

Adolescents’ scarce physical activity is a major challenge in terms of public health. Sedentary lifestyle has been shown to decrease school achievement, while physical activity is known to promote brain functions especially for adults. However, there is little research evidence about the connections of physical activity and sedentary time in childhood and adolescence with regard to cognitive processing in adolescence, although these life stages are pivotal for brain development. Various factors that influence cognitive processing in childhood and adolescence can be reflected far into adulthood also in terms of educational choices and working life. 

The study investigated how physical activity, sedentary behaviour and screen time from childhood to adolescence are associated with cognitive processing in adolescence and whether there are any sex differences in these connections. In addition, the researchers also examined the role of the intensity of physical activity in this respect. 

Screen time can support thinking and learning 

According to the findings, higher amount of screen time since childhood were connected to better cognitive processing in adolescence.  

“The findings suggest that screen time can support children’s and adolescents’ cognitive processing. Presumably, the essential point here is what kind of things they do in their screen time. Teachers and parents should encourage children to use devices and screens in such ways that promote active thinking, problem-solving, creativity and learning,” states Doctoral Researcher Petri Jalanko from the University of Jyväskylä. 

“We should not regard screen time solely as harmful but seek balance between physical activity and screen time that promotes active thinking,” Jalanko summarises. 

Physical activity and sedentary time associated in complex ways with cognitive processing 

In girls, the higher amount of light-intensity physical activity since childhood was associated with better working memory in adolescence. In boys, then again, higher amount of guided physical activity from childhood to adolescence was associated with better working memory in adolescence. 

Surprisingly, lesser self-reported unsupervised physical activity was connected to better cognitive processing in adolescence. Instead, physical activity or sedentary time as measured by a heart rate and movement sensor were not associated with cognitive processing. The differences may be explained by the fact that the heart rate and movement sensors cannot tell what a person is actually doing during the physical activity and sedentary periods. 

“Our study indicates that the connections of physical activity and sedentary behaviour to cognitive processing are complex and depend on the sex, the type and assessment method of physical activity and sedentary time. Moreover, boys and girls may benefit from different types of physical activity in view of brain health, Jalanko adds. 

“However, we need more intervention studies to find out causal relations and sex differences in this respect. Moreover, it is important to examine more specifically the effects of the intensity of physical activity on changes taking place in cognitive processing.”

The findings are based on an eight-year follow-up of the PANIC study on children’s physical activity and nutrition. The current study involved 124 girls and 136 boys, whose average age was 15.8 years. Physical activity and sedentary behaviour were measured by a device that combined heart rate and movement measurements and also by a survey questionnaire. Learning, attention and working memory were assessed by means of the CogState test battery. The research article is published in the Pediatric Exercise Science journal. 

Source: University of Finland

Categories : Paediatrics Respiratory DiseasesTags : Leave a comment

Early Flu Antiviral Reduces ICU Admissions in Hospitalised Children

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Sudy finds early treatment was associated with a 31% lower likelihood of ICU admission

Photo by Andrea Piacquadio on Unsplash

A new US study finds antiviral treatment is linked to fewer intensive care unit (ICU) admissions and shorter hospital stays for children hospitalised with influenza. The study, published in JAMA Pediatrics and led by experts at the University of Colorado Anschutz, is one of the most comprehensive real-world evaluations of antiviral treatment in paediatric influenza to date.

The research found that children who received early treatment with antiviral treatment, in this case oseltamivir, were 31% less likely to be admitted to an ICU and had shorter hospital stays than those who did not receive the antiviral.

The findings come as use of antiviral medications among hospitalised children with influenza has declined despite national guidelines recommending treatment for suspected or confirmed cases.

“After one of the most severe influenza seasons in the past two decades, these findings reinforce the importance of treating children with influenza who are hospitalised. Our findings show that oseltamivir treatment can decrease the risk of needing critical care, even if started beyond the first two days of the start of the illness,” said the paper’s senior author Suchitra Rao, MD, professor in the department of paediatrics at the University of Colorado Anschutz School of Medicine and infectious disease specialist at Children’s Hospital Colorado.

One of the largest and most rigorous real-world evaluations

The researchers looked at data from more than 7000 paediatric hospitalisations captured through a FluSurv-NET, a CDC-supported surveillance network that captures laboratory-confirmed influenza hospitalisations. The data spanned 13 states and eight influenza seasons.

Unlike many earlier observational studies, this research accounted for when symptoms began and when antiviral treatment started, providing stronger real-world evidence on the effectiveness of oseltamivir in hospitalised children.

“Earlier studies were often missing key information about when children became sick or whether they started antiviral treatment before being hospitalised, making it harder to evaluate the medication’s effectiveness. By capturing those details and using advanced statistical methods, we were able to produce stronger real-world evidence to inform the care of children hospitalised with influenza,” adds Rao.

The findings reinforce current national recommendations that children hospitalised with suspected or confirmed influenza receive an antiviral medication as soon as possible.

Source: University of Colorado Anschutz

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Earlier Discharge for Children with Severe Pneumonia After Switching to Oral Antibiotics

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Children hospitalised with severe pneumonia can safely switch from injectable to oral antibiotics once they begin to recover, allowing many to return home sooner and complete treatment outside hospital, according to a major clinical trial involving 13 hospitals in Southern Africa.

The new results were published in The Lancet. The trial involved partners across Europe and Africa and was led with researchers at City St George’s, University of London.

Pneumonia remains one of the leading infectious killers of children worldwide, particularly in low- and middle-income countries. Current World Health Organization (WHO) guidelines recommend five days of injectable antibiotics for children hospitalised with severe community-acquired pneumonia, often requiring them to stay in hospital even after they have already substantially improved.

Longer hospital stays are more expensive, placing a higher burden on already pressurised healthcare systems and facilities, whilst increasing the risk of hospital-acquired antibiotic-resistant infections and impacting the wellbeing of the children and their families.

The PediCAP trial is one of the largest studies to assess antibiotic treatment for severe childhood pneumonia in Africa. The study enrolled 1101 children aged two months to six years with community-acquired pneumonia that developed outside hospital but was severe enough to require hospital treatment. Thirteen hospitals across South Africa, Uganda, Zambia, Zimbabwe and Mozambique contributed to the study.

All children in the trial began treatment with a WHO-recommended injectable antibiotic. Some were assigned to switch to either oral amoxicillin or oral amoxicillin-clavulanate when their condition had improved, as confirmed by a healthcare worker. Researchers compared these children to those who received the WHO-recommended injectable treatment for the full five days.

Children who switched to oral antibiotics recovered just as well as those who remained on injectable treatment for five days. Rates of hospital readmission or death within 28 days were similar across all groups – 6% for oral amoxicillin, 7% for oral amoxicillin-clavulanate and 6% for injectable antibiotics – showing that an early switch to oral treatment is a safe and effective strategy.

The standard amoxicillin performed just as well as the broader-spectrum antibiotic amoxicillin-clavulanate, supporting the use of a treatment that is cheaper and widely available.

Researchers also compared how well children recovered with different durations of antibiotic treatment, ranging from four to eight days in total. A total antibiotic course of four to five days was as effective as longer courses of seven or eight days, suggesting many children can be treated successfully with substantially less antibiotic exposure than is often used in practice.

Children who switched to oral antibiotics left hospital around one day earlier compared to those who remained on injectable treatment for the full five days.

Co-lead author Dr Michelle Clements, based at UCL Innovative Clinical Trials Unit, said: “PediCAP is the first large-scale study to use an innovative multi-arm trial design, which we developed here at UCL, to evaluate different antibiotics and treatment durations at the same time. Rather than simply comparing one short course with one longer course, this approach allowed us to establish that the shortest studied treatment strategy was effective and safe, while also helping us to understanding the relationship between treatment length and effect.

“By generating robust evidence more efficiently, this trial design has helped answer questions that we hope will support changes to global treatment guidelines and improve care for millions of children with pneumonia worldwide.”

Co-lead author Professor Julia Bielicki, from City St George’s, University of London, said: “Every year millions of children around the world are admitted to hospital with severe pneumonia. Our study shows that once a child is clinically improving, it is safe to switch from injectable to oral antibiotics, and complete treatment at home.

“This simple change could help children get back to their families sooner, reduce pressure on busy hospitals, lower healthcare costs and avoid sometimes catastrophic financial impacts on families from lost caregiver earnings. Because amoxicillin is affordable and widely available, these findings have the potential to change clinical practice and improve care for children around the world.”

The trial was funded by the European Union’s EDCTP2 programme and sponsored by the Penta Foundation.

Source: University of London

Categories : Dentistry PaediatricsTags :

Brush-on Treatment Could Halt Cavities and Prevent Fillings

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Photo by Hush Naidoo Jade Photography on Unsplash

Every year, untreated tooth decay sends thousands of young children to emergency departments for dental problems doctors can’t treat. Many eventually undergo surgery under general anaesthesia, while others endure pain and infection.

A simple, inexpensive liquid called silver diamine fluoride, or SDF, could spare many of those children. Applied to a cavity with a tiny sponge-tipped applicator in about a few second’s time per tooth, SDF arrests decay without drilling, shots or sedation.

Dentists have used SDF successfully for decades in many countries, and off label in the United States since 2014, when it was approved as a medical device to treat tooth sensitivity. However, it has lacked the large US population clinical trials for efficacy and safety that are needed for FDA approval as a drug to treat cavities.

Now, a University of Michigan-led clinical trial has produced that evidence.

Published in JAMA Pediatrics, the Phase III trial enrolled 830 children under age 6 who were recruited through dental offices, pediatric medical practices, Head Start and Early Head Start programs in Michigan, New York and Iowa.

Researchers found that 38% SDF arrested tooth decay in more than half of children’s affected baby teeth when treated at 6-month intervals. Unlike conventional treatment, which removes part of the tooth before placing a filling, SDF is simply painted onto the cavity.

“This is a very effective and safe treatment – even in children as young as 1,” said Margherita Fontana, professor of dentistry at the University of Michigan School of Dentistry and the study’s lead investigator.

Tooth decay is the most common chronic disease of childhood, affecting more than 40% of US children. Left untreated, cavities can cause severe pain, infection, difficulty eating and sleeping, missed school and repeated medical visits.

SDF may be especially valuable for very young children, older adults, people with developmental or physical disabilities, patients with severe dental anxiety, and others who cannot easily tolerate or access conventional dental treatment, Fontana said.

Its primary drawback is cosmetic, she said. The silver permanently darkens the decayed portion of the tooth.

“If we want more children and families to benefit from this treatment, we need rigorous evidence showing both that it works and that it’s safe. From a public health perspective, if we want broader implementation across the United States, including in medical settings, we need carefully collected data in U.S. populations, and we now have that,” Fontana said.

The study began in 2018 and progressed even with the challenges of the COVID-19 pandemic.

“In medicine, clinicians want high-quality evidence before changing practice,” Fontana said. “It is important to have data they can refer to because young children often see paediatricians years before they ever visit a dentist, broader acceptance could allow many more cavities to be treated while a referral to a dental home is successful, and before they become painful, infected or require surgery.”

The product used in this trial, Advantage Arrest 38% SDF, was provided by Elevate Oral Care.

Amr Moursi, professor of paediatric dentistry at New York University College of Dentistry, said the study provides important data for broadening use of SDF.

“Our results support FDA approval of SDF for managing arrest of tooth decay in young children. Removing SDF from off-label status would be an important innovation which could lead to increased utilisation by providers, enhanced payments by insurers and more consistent product quality,” said Moursi, a co-principal investigator on the study.

For some children, reapplying SDF every few months may be all that’s needed until the baby tooth naturally falls out. For adults, it may serve as a long-term treatment or as a bridge until restorative procedure is affordable or practical.

“For almost anyone, this can arrest the decay and stop the infection and the pain it causes,” Fontana said. “This could benefit many people.”

Source: University of Michigan

Categories : PaediatricsTags :

Kids Do Feel the Cold. So Why Won’t They Wear a Jumper?

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Zachary Kadolf/Unsplash

Joshua Pate, University of Technology Sydney

It happens just when you need to leave. Bags are packed. Shoes are on. Then your child decides a jumper is impossible.

You say, “put your jumper on”.

They say, “I’m not cold”.

Do kids really not feel the cold like adults do? Or are they just expressing their independence? And when should you insist?

A clue from pain research

I study how children experience pain, and pain research offers one clue about this jumper battle.

A child may scrape their knee during a game and barely notice until the game stops. The scrape was there throughout, but chasing a friend or reaching the next base kept winning their attention.

Cold can slip into the background in a similar way. A child’s fingers may be cooling while the playground remains far more compelling. Then the game ends.

Their attention returns to their hands at around the same time their moving muscles stop producing so much heat. Suddenly, the jumper may seem like a better idea.

So “I’m not cold” can mean, “I can feel it and I’m comfortable”.

It can also mean, “the jumper feels worse” or “I want to keep playing”. Sometimes it means, “I am four years old and this has become a matter of principle”.

Similarly, when parents ask, “but aren’t you cold?” we’re often asking several questions at once.

Will you still be warm when you stop running? What if the wind picks up? How about later, when we’re standing still on the sideline at the soccer field?

Children report the present moment, and parents factor in the forecast.

What cold actually feels like

Your skin contains sensory nerve endings that respond as its temperature changes.

One cool-sensitive channel, called TRPM8, helps convert cooling at the skin into electrical activity in sensory nerves.

This is the same channel that menthol activates, which is why mint can make your mouth feel cool even when there’s no real temperature change.

And as you know with mint, a strong cooling sensation can sometimes become uncomfortable or even painful. Other factors such as wind, wetness, contact with cold surfaces, movement, and how much time we’re outside can all influence how we experience temperature.

For example, a parent who is standing still in a playground, clutching a coffee, may be acutely aware of the gap in their coat where the icy wind is sneaking in.

But children tend to run, climb and jump in bursts – and moving muscles produce heat.

Children also differ from adults in body size, body composition, metabolism and how their circulation responds to cold.

One 2024 laboratory study, done indoors, looked at children aged six to nine. It found their sedentary metabolic rates (how much energy you’re burning when you’re resting) were around 39% higher compared to adults in the study.

Their skin was also warmer over parts of their torso, and the skin on their hands recovered temperature and bloodflow faster than adults after being exposed to the cold.

So it’s not that kids don’t feel cold at all, but they may have a quite different experience from an adult standing in the same air.

Bodies prepare for what comes next

We often learn about thermoregulation – how the body maintains its core temperature – as though the body were simply a thermostat. The body detects a temperature change, then bloodflow changes, and sweating or shivering bring it back towards the middle.

But our movement and behaviour also play an important role in maintaining this balance. When we’re cold we may walk into sunshine, curl up, or add a layer; when we’re hot we take one off. A child who keeps running may already be generating the warmth they need.

Bodies also prepare for expected demands. Researchers use the term allostasis to describe this wider process of how the body maintains stability through change.

Some adjustments happen automatically. For example, before we exercise, our heart rate and breathing begin adjusting for the work ahead. Others involve choices, such as moving into the sun, seeking shelter or reaching for warmer clothing.

But young children outsource some of this forecasting to adults.

Kids supply the live report from inside their body. We add the weather forecast and the schedule. We pack snacks for hunger that has yet to arrive, spare clothes for puddles yet to be found, and jumpers too.

What the jumper itself feels like

A jumper creates its own sensations. It may feel scratchy, bulky or restrictive. It can make climbing harder, then become hot and sweaty as soon as the child starts running.

Tags, seams and some fabrics can feel intensely unpleasant, especially for children with tactile sensitivities. Clothing tags and light touch, for example, can cause marked discomfort for some autistic children.

A child may genuinely prefer mildly cold skin over an irritating texture.

So it’s worth asking whether “aren’t you cold?” is the right question. Others may work better:

are you comfortable?

will you be running or sitting still?

would you rather wear the jumper or carry it?

These questions help children connect what they feel now with what they may need later.

When should parents insist?

Parents should be firmer when a child is very young, wet, unwell, exposed to strong wind or likely to remain outside for a long time.

Persistent shivering or numbness means it is time to get warm. Increasing clumsiness, unusual drowsiness, confusion or reduced responsiveness can indicate hypothermia, where the body’s core temperature has fallen dangerously low. Hypothermia is a medical emergency.

But for ordinary winter outings, flexible layers allow the plan to change. A jumper can be carried, added when activity slows, and removed when the child warms up again.

Your child reports the weather inside their body. You keep an eye on the weather outside it. A jumper in the bag lets your child feel heard, lets you keep the forecast in view, and lets everyone finally get out the door.

Joshua Pate, Associate Professor of Physiotherapy, University of Technology Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Categories : PaediatricsTags :

Parents’ Socioeconomic Status is More Important than Prenatal Behaviours to a Future Child’s Health

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Socioeconomic status had greater effects on child health than parental smoking or alcohol consumption

Photography by Drew Hays on Unsplash

Family socioeconomic position may be a more important determiner of children’s health than parental behaviours such as smoking, drinking or caffeine consumption, according to a study published July 23rd in the open access journal PLOS Medicine by Gemma Sharp from the University of Exeter, UK, and colleagues.

According to the Developmental Origins of Health and Disease (DOHaD) hypothesis, prenatal and early childhood environmental exposures can affect a child’s health long-term. Most research, however, has focused on maternal behaviours and has not included fathers, the environment in which the parents live, and other factors. To better understand how environmental influences might impact child health, the authors of this study analysed data from four large studies of parents and children in the United Kingdom and Norway, including more than 230 000 participants, running several models to produce high confidence in the results. They looked at parental health behaviours including smoking, drinking, and caffeine consumption, as well as their socioeconomic position. They associated these variables with 72 different child health outcomes measured at six different time points, including size at delivery, body mass, hyperactivity, social communication, aggression, depressive symptoms, and more.

The authors found that maternal behaviours did not have larger effects than those of their partners. While 6% of the results found links between smoking and child health, 3% showed links for alcohol and 0.4% for caffeine, 15% of the child health effects were associated with the socioeconomic position of the child’s family. While the results are associations and based on observational data of families in the United Kingdom and Norway, the authors note that efforts to improve child health might be more effective if they are aimed at socioeconomic inequalities, rather than individual parent behaviour.

Gemma Sharp adds, “Our study suggests that the social and economic circumstances children grow up in may have a greater influence on their health than specific parental behaviours during pregnancy. By analysing data from more than 230 000 participants across four long-term studies, we found that socioeconomic disadvantage was more consistently linked to poorer child health outcomes than smoking, alcohol, or caffeine use by either parent.”

“One of the most interesting findings was that we didn’t see consistently stronger effects for mothers than for fathers. We often assume that a mother’s behaviours during pregnancy will have a larger impact on child health because of direct effects on the developing baby. However, we found that mothers’ and fathers’ smoking, alcohol, and caffeine use showed remarkably similar patterns of association with child health outcomes. This also points towards the importance of the wider family environment and social circumstances, rather than pregnancy-related behaviours alone, in shaping children’s health.”

Provided by PLOS

Categories : Antibiotics PaediatricsTags :

Last-line Antibiotics at Risk as Children’s Resistance Rises

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Photo by Ben Wicks on Unsplash

Antimicrobial resistance in children is rising globally and will worsen over the next decade, threatening the effectiveness of life‑saving antibiotics, according to a world-first monitoring platform.

The findings, led by Murdoch Children’s Research Institute (MCRI) in collaboration with the University of Sydney, Clinton Health Access Initiative (CHAI) and The Chinese University of Hong Kong, analysed more than 106 000 infection samples from children, aged up to 18 years, across 82 countries, discovering that antibiotic resistance increased in every region between 2004 and 2022. Babies and children in intensive care and countries with fewer healthcare resources were the most affected.

Published in JAMA Pediatrics, the research found the increase is being driven largely by Gram-negative bacteria responsible for severe infections such as sepsis and pneumonia. Resistance rose most sharply to critical ‘Watch’ and ‘Reserve’ antibiotics, which the World Health Organization (WHO) classifies to limit overuse and help preserve their effectiveness when first-line treatments fail.

MCRI Associate Professor Penelope Bryant said the findings highlighted a widening gap between recommended antibiotic use and real‑world effectiveness, reinforcing the urgent need for improved surveillance, targeted antimicrobial stewardship and better access to effective antibiotics for children.

Forecasting future antimicrobial resistance

The newly launched AMR in Kids website, created by the study team, allows clinicians, researchers and policymakers to explore antibiotic resistance by country, bacteria and antibiotic class. It also provides region and pathogen-specific forecasts to 2035, helping researchers to identify emerging threats, inform treatment decisions and help guide public health planning.

MCRI and University of Sydney Dr Yanhong Jessika Hu said by combining almost two decades of global data with forecasting, the platform could identify where resistance was likely to emerge before it becomes an even greater clinical challenge.

Antimicrobial resistance occurs when bacteria evolve to withstand antibiotic treatment. As resistant bacteria emerge and spread through communities, infections become harder to treat. Children are especially vulnerable as they experience high rates of bacterial infections and have fewer antibiotic options than adults. In 2021, about 840,000 deaths in children under five years were associated with antimicrobial resistance.

“Antimicrobial resistance is one of the biggest threats to children’s health globally, but until now we haven’t had a clear picture of how it’s changing specifically in children,” Dr Hu said. “The AMR in Kids platform addresses a major gap by developing region and pathogen-specific forecasts for the next decade.”

Forecast modelling by the platform suggests that by 2035, some of the most dangerous pathogens could become highly resistant to last‑line treatments.

CHAI Senior Clinical Director Associate Professor Joseph Harwell said, “Better data is essential, but children can’t wait for perfect data. We need to use the best available evidence to guide action now.”

The research found two types of Gram-negative bacteria were driving antimicrobial resistance globally. Acinetobacter baumannii, which commonly causes hospital acquired bloodstream infections and pneumonia, showed the highest overall resistance. Klebsiella, causing urinary tract infections and liver abscesses, recorded the fastest increase, particularly in Southeast Asia, Eastern Europe and the Western Pacific. Alarmingly, resistance to last‑line carbapenem antibiotics is projected to rise substantially by 2035, reaching 82 per cent and 35 per cent, for each superbug, respectively.

Turning data into global action

Associate Professor Bryant said despite facing unique treatment challenges, children had been overlooked in global antibiotic resistance surveillance.

“Rising resistance to first- and now second-line drugs is the clinical reality for children,” she said. “Making antibiotic resistance in children visible, through AMR in Kids, is the first step towards changing its trajectory. By understanding where resistance is emerging and how it’s changing, we can better protect children now and preserve the effectiveness of antibiotics into the future.”

But Associate Professor Bryant said more action was needed on the global stage and measures specifically targeted towards children.

“In low-income countries we need to address unregulated antibiotic use and poor sanitation,” she said. “These countries need better access to diagnostic techniques and first-line antibiotics. Encouraging, Australia’s Department of Foreign Affairs and Trade has brought together experts including from the University of Melbourne and the WHO to develop solutions in the Western Pacific.

“In high-income countries, antibiotic overuse must be tackled across farming, veterinary, primary care and hospital settings, while infection control remains critical.

“We also need child-friendly antibiotic formulations, clearer dosing guidance and funding for trials on safely reducing antibiotic use. Consumers can help by talking with their GP about the risks of overprescribing antibiotics.”

Source: Murdoch Children’s Research Institute

Categories : Paediatrics Respiratory DiseasesTags :

New Clues Raise Hopes for Better Treatment of RSV in Babies

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Future therapies for respiratory syncytial virus (RSV) must target both the virus and its immune response to ensure babies get the best possible outcomes, finds a new study by researchers at UCL and Great Ormond Street Hospital for Children (GOSH).

RSV is the biggest cause of serious illness in babies, with over three million hospital admissions worldwide because of the virus every year. It causes wheezing and breathing difficulties, and in the worst cases babies end up in intensive care. Despite this, treatment options for infants who develop severe disease remain extremely limited.

As part of the new study, published in Nature Communications and funded by Animal Free Research UK and UK Research and Innovation (UKRI), researchers built a new lab model of baby lungs to show why RSV makes infants so much sicker than adults and allow them to test new treatments before they reach patients.

The miniature model of a baby’s airways was created using real infant airway cells, blood vessel cells and neutrophils (a type of white blood cell that acts as the immune system’s primary response to infection).

To compare with an adult response to RSV, the research team also made a model of an adult’s airways.

Dr Claire Smith (UCL Great Ormond Street Institute of Child Health), who led the study, said: “This model allows us to watch early immune responses unfold and study them in a human setting that reflects the infant airway. That’s something animal models often struggle to capture, especially when it comes to age-specific effects.”

When the models were infected with RSV, the team found that baby airway cells attracted far more white blood cells than adult airway cells did. This influx can block babies’ small airways and make it harder for them to breathe.

Neutrophils normally circulate in the blood but enter lung tissue in response to infection. In the baby airway model, researchers found that the neutrophils that entered the lung tissue were more activated and triggered a stronger inflammatory reaction than in the adult model.

This effect depended on the immune cells physically moving through the infected tissue, not just responding to chemical signals released by it, making this type of model essential for studying it.

This suggests it’s the infant airway itself, not just the virus, that ramps up the immune response and causes damage to the lungs.

First author, Dr Machaela Palor (UCL Great Ormond Street Institute of Child Health), said: “These findings help explain why RSV is often much more severe in infants than in adults. The paediatric airway actively shapes how immune cells behave during the infection.”

The researchers then tested two antiviral drugs (remdesivir and RSV604). Both stopped the virus from multiplying, but only RSV604 also calmed the overactive immune response, reducing levels of a key inflammatory protein released by white blood cells – high levels of which are linked to more severe RSV disease in babies.

Remdesivir had no effect on this, suggesting that not all antivirals are equal when it comes to protecting the infant airway from immune-driven damage.

This suggests that treating severe RSV in babies may require more than just stopping the virus – it may also be important to calm an overactive immune response.

The researchers hope their findings and the new approach to research on RSV will accelerate the development of treatments better tailored to infants.

Dr Smith said: “Our model gives us a way to assess both sides of the problem at once. We can not only ask whether the drug stops the virus but also whether it helps control immune response in the infant airway.

“This work reinforces the idea that age matters in respiratory infection. Understanding how infant airways shape immune responses will be key to designing safer and more effective RSV treatments.”

Source: University College London