Category: Paediatrics

Categories : General Interest PaediatricsTags :

Horses Work ‘Magic’ for Children with Disabilities

On By ModernMedia
Children with disabilities enjoy free riding lessons at the South African Riding for the Disabled Association in Durban. Photo: Nokulunga Majola

GroundUp reports on the South African Riding for the Disabled Association, which provides 50 rides a week for children with disabilities near Durban.

“You make the world of difference one day of the week in the lives of the Browns Pre-Primary children, and for this I thank you,” Browns School teacher Fiona Muhl tells the volunteers at the South African Riding for the Disabled Association (SARDA) in Durban.

Based in Assagay on the outskirts of Durban, SARDA has been offering free therapeutic horse-riding lessons since 2007 for children with disabilities. They see about 50 children a week, aged five to 16.

From the minute the children arrive at the Ridgetop Equestrian Centre to the moment they leave, their day is filled with thrills. Children giggle on their horses in the riding arena as volunteers play with them and teach them riding.

Each child is allocated a suitable pony. Once they are all mounted, the lesson begins. There are obstacle courses and various activities, such as throwing a ball into a hoop, to encourage coordination, flexibility and cognitive development.

A SARDA volunteer said one child is still completely non-verbal at school, but laughed right through a riding session and at the end gave a cowboy style “Yeehaw”. What is happening at the riding school is magic, she said.

Susan Warrington, a volunteer at SARDA, said it is one of the most rewarding things she has ever done. “The joy on their faces, the often first words an autistic child speaks, and knowing that these little souls had a good day is the reason we do this,” said Warrington.

Libby Durk, chairperson of SARDA Durban, said children come from Browns School in Pinetown, Ethembeni School in Inchanga, West Park School in Malvern and the Open Air School in Glenwood.

The riding school depends on donor funding.

“We currently lease six ponies from Ridgetop Equestrian Centre and also pay a lease for the use of the property. Other costs include vet fees, farrier fees, dentist fees, insurance, cost of equipment, training days for volunteers, and training and therapy of our horses,” said Durk.

Three volunteers are also needed per child in addition to the instructor of the day – two side walkers and a leader for the horse.

“Our ponies are an integral part of our programme and require special training to become a therapeutic riding pony. The cost of keeping and caring for the horses is our main expense,” said Durk.

Written by Nokulunga Majola

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Categories : Metabolic Disorders PaediatricsTags :

Dulaglutide Achieves Glycaemic Control in Diabetic Youths

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Photo by Towfiqu Barbhuiya on Unsplash

A trial testing dulaglutide in children and adolescents with diabetes found that it was effective in achieving glycaemic control. The findings, reported in the New England Journal of Medicine, suggest that dulaglutide may be a more convenient pharmacological treatment for youths.

The incidence of type 2 diabetes mellitus is increasing among youths, and metformin has shown high treatment failure against a backdrop of greater insulin resistance and deterioration in β-cell function than in adults. Daily liraglutide and weekly exenatide, glucagon-like peptide-1 receptor agonists, are available, but have complicated administration and exenatide is available only at a single dose level, making it harder to escalate glycaemic control. The researchers sought to determine whether once-weekly treatment with dulaglutide was effective with regard to glycaemic control in youths with type 2 diabetes.

In a double-blind, placebo-controlled, 26-week trial, 154 participants (aged 10–17; body-mass index [BMI], >85th percentile) being treated with lifestyle modifications alone or with metformin, with or without basal insulin, were randomised in a 1:1:1 ratio to receive once-weekly subcutaneous injections of placebo, dulaglutide at a dose of 0.75mg, or dulaglutide at a dose of 1.5 mg. Participants were then included in a 26-week open-label extension study in which those who had received placebo began receiving dulaglutide at a weekly dose of 0.75mg.

At 26 weeks, the mean glycated haemoglobin level had increased in the placebo group (0.6%) and had decreased in the dulaglutide groups compared to placebo (–0.6% in the 0.75mg group and −0.9% in the 1.5mg group). At 26 weeks, a significantly higher percentage of participants in the pooled dulaglutide groups than in the placebo group had a glycated haemoglobin level of less than 7.0% (51% vs 14%), which was a secondary endpoint. The fasting glucose concentration increased in the placebo group (17.1mg/dL) and decreased in the pooled dulaglutide groups (−18.9mg/dL), and BMI did not change between groups. More gastrointestinal adverse events were reported in dulaglutide therapy than with placebo, and dulaglutide’s safety profile was consistent with that reported in adults.

Overall, the researchers concluded that dulaglutide at a once-weekly dose of 0.75mg or 1.5mg was superior to placebo in improving glycaemic control through 26 weeks among youths with type 2 diabetes (with or without metformin or basal insulin), without an effect on BMI.

Categories : COVID PaediatricsTags :

Children’s Nasal Epithelium Protective against Older COVID Variants

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Photo by Kelly Sikkema on Unsplash

An Australian study published in PLOS Biology suggests the nasal epithelium of children inhibits infection and replication of the ancestral strain of the SARS-CoV-2 virus and also the Delta variant, but not the Omicron variant.

Children are in general less susceptible to COVID, with a lower infection rate and milder symptoms than adults. However, the factors driving this apparent paediatric resistance to COVID infections remained unknown.

In order to better understand infection and replication of SARS-CoV-2 in children, Kirsty Short at University of Queensland, and colleagues, obtained samples of primary nasal epithelium cells from twenty-three healthy children aged 2–11 and fifteen healthy adults aged 19–66 in Australia. They exposed the cells of adults and children to SARS-CoV-2 and then observed the infection kinetics and antiviral responses in children compared to adults.

The researchers found that ancestral SARS-CoV-2 replicated less efficiently and was associated with a heightened antiviral response in the nasal epithelial cells of children. This lower viral replication rate was also observed with the Delta variant, but not the Omicron variant.

Study limitations included a small sample size, so future clinical studies will be needed to validate these preliminary findings in a larger population and to determine the role of other factors, such as antibodies in protecting children from SARS-CoV-2 infection. Additionally, paediatric protection from emerging variants has yet to be quantified.

The authors wrote, “We have provided the first experimental evidence that the paediatric nasal epithelium may play an important role in reducing the susceptibility of children to SARS-CoV-2. The data strongly suggest that the nasal epithelium of children is distinct and that it may afford children some level of protection from ancestral SARS-CoV-2.”

Short added, “We use nasal epithelial cells from children and adults to show that the ancestral SARS-CoV-2 and Delta, but not Omicron, replicate less efficiently in paediatric nasal epithelial cells.”

Source: Science Daily

Categories : Ethics and Law PaediatricsTags :

UK Children’s Gender Identity Clinic to Close after Controversies

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Photo by Sharon McCutcheon on Unsplash

Following a highly critical independent report and accusations of inadequate and unsafe care, the UK will shut down the Tavistock gender identity clinic for children – the only one in the country. It will be replaced by a number of smaller facilities with closer links with mental health care.

The Tavistock and Portman NHS Foundation Trust clinic, named the Gender Identity Development Service (GIDS), had faced complaints of both long waiting lists for a burgeoning number of referrals, as well as rushing to assign puberty-blocking drugs and cross-sex hormones to children experiencing gender dysphoria.

Concerns had been voiced as early as 2005, when a nurse working at the clinic said that patients were being assessed too quickly and giving in to pressure from interest groups. Nevertheless, demand for its services skyrocketed in later years, from less than 100 per year in 2010 to nearly 2500 by 2018. In 2018, concerns were raised anew, with staff going on to make serious public accusations.

In July 2019, Dr Kirsy Entwhisle, a psychologist at GIDS Leeds hub, said that staff misled patients and made decisions about young people’s “bodies and lives” without “robust evidence”. Some of the children had suffered “very traumatic early experiences” which had not been addressed by the staff. The trust’s safeguarding lead, Sonia Appleby, won a claim from an employment tribunal after trust managers tried to stop her from carrying out her role when staff raised concerns.

One of the loudest critics of Tavistock Centre is Keira Bell, who at 16 was assigned puberty blockers, then cross-sex hormones at 17, and had a double mastectomy at 20 before later de-transitioning.

The former patient, who said she was suffering from anxiety and depression at the time she received treatment, said medics should have considered her mental health issues, “not just reaffirm my naïve hope that everything could be solved with hormones and surgery”.

Along with the unnamed parent of an autistic girl at the clinic, she won a ruling against the NHS assigning cross-sex hormones to children under 16 – but was overturned on appeal.

Helen, a parent of a patient at the clinic, welcomed its closure, but expressed concern for the future of her son’s treatments, according to LGBT site Pink News. While she said her son was treated quickly and received puberty blocking drugs, “From that point on, it felt like it was a little bit like they were winging it,” she said.

During therapy sessions at Tavistock, she said her son was asked a lot of questions and treated “almost like a little bit of an academic curiosity”. She criticised the fact that the same staff evaluated children for medical interventions and also offered therapy session, creating “a fear that they would stop access to medical support”. In contrast to the legal claims of Keira Bell’s and the unnamed patient, she said that GIDS refused to even discuss cross-sex hormones.

Dr David Bell (no relation to Keira Bell) welcomed the closure of Tavistock, telling the BBC: “Some children have got the double problem of living with the wrong treatment, and the original problems weren’t addressed – with complex problems like trauma, depression, large instances of autism.”

Categories : PaediatricsTags :

No Consensus on a Definition for ‘Growing Pains’

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Photo by Monstera from Pexels

The phrase ‘growing pains’ is often used by people to describe muscle or joint pain in young people and health professionals also use the term. However a broad review of medical literature has found there is no consistent medical definition of the condition behind a diagnosis.

Researchers from the University of Sydney found there is no agreement in the literature on what growing pains really are, what they mean, how they are defined, and how they should be diagnosed.

Growing pains may be a medical misnomer, the researchers said – more than 93% of studies did not refer to growth when defining the condition. Similarly, age was not mentioned in more than 80% of studies’ definitions.

The findings have prompted the researchers to recommend the term growing pains not be used by clinicians and other researchers as a stand-alone diagnosis, until a clear definition backed by evidence has been established.

Growing pains are considered to be one of the most common causes of recurring musculoskeletal pain in children and adolescents. Some studies suggest up to a third of children experience the condition at some point in their life.

The term first arose in 1823 in a book called ‘Maladies de la Croissance’ (‘diseases of growth’).

“Thousands of kids are diagnosed with growing pains by their healthcare professional, but we were curious – what does that diagnosis really mean?” said lead author Dr Mary O’Keeffe from Institute for Musculoskeletal Health at the University of Sydney. 

In order to see how researchers defined the term, and if there were any detailed criteria that led to a diagnosis, the reviewers examined 147 studies that mentioned growing pains. The medical literature spanned many types of research, including systematic reviews, editorials, observational studies, case-control studies, and theses.

“What we found was a little concerning: that there is no consistency in the literature on what ‘growing pains’ means,” said Professor Steven Kamper, at the University of Sydney.  

“The definitions were really variable, vague and often contradictory. Some studies suggested growing pains happened in the arms, or in the lower body. Some said it was about muscles while other studies said joints.”

Only seven studies, less than 10% of the studies examined, mentioned growth related to the pain. More than 80% of the studies did not mention a young person’s age at the time ‘growing pains’ occurred.

There was no widespread agreement or detail on where the pain was located or when the pain happened.

Half of the studies referenced ‘growing pains’ as being located in the lower limb, while 28% reported specifically in the knees.

As for time of occurrence, 48% of studies reported the ‘growing pains’ happens during the evening or night and 42% reported it was recurring.

“What this study uncovered was while ‘growing pains’ is a very popular label used to diagnose musculoskeletal pain, it means very different things to different people,” said senior author Professor Steve Kamper.

“This level of uncertainty means clinicians don’t have a clear guide or criteria to know when the label ‘growing pains might be appropriate for a patient’.”

The study questioned whether growing pains are connected to growth itself in bone or muscle.

“There is a lack of evidence or inconsistent information on growing pains as a condition – and how it is associated with growth, or even the cause of the pain,” said Dr O’Keeffe.

“There is a real opportunity to understand this condition – given how widespread the use of the term is, or whether there is even a need to use this term.”

Source: EurekAlert!

Categories : PaediatricsTags :

Evidence for Widespread Overprescription of Specialised Infant Formula

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New research published in Clinical and Experimental Allergy reveals that prescriptions of specialised infant formula have increased in recent years in England, Norway, and Australia, with rates over 10 times what would normally be expected for the number of children with milk allergies.

Increasing specialised formula use has been interpreted as evidence for milk allergy overdiagnosis, leading to the use of specialised formula for managing common infant symptoms. This is because there is little evidence in high-income countries for a change in milk allergy incidence to explain rises in specialised formula prescription. While specialised formula is reasonably well tolerated by most infants, and supports infant nutrition and growth, there are significant differences from standard cow’s milk-based infant formula or human breastmilk. In specialised formula products, the lactose found in breastmilk or cow’s milk is partially or completely replaced by alternative carbohydrate sources, often free sugars such as glucose or sucrose.

Soya milk alternatives were prevalent in the 1990s, but in the 2000s were displaced by amino-acid formulations after health concerns emerged over soya milk use in infants. Prescribed amounts of specialised formula for infants rose 2.8-fold in England from 2007–2018, with similar trends in other regions of the United Kingdom. Amounts rose 2.2-fold in Norway from 2009–2020 and 3.2-fold in Australia from 2001–2012.

In addition to added expense (specialised formula costs an average of US117 extra per birth in England), these findings are of particular concern due to their higher levels of sugar, which may promote tooth decay and obesity in young children.

“These data suggest high levels of milk allergy over-diagnosis and mark an important shift in early child nutrition,” the authors wrote.

Source: Wiley

Categories : PaediatricsTags :

A Prescription-only Video Game to Treat ADHD in Children

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Doctors in the US have been prescribing a unique new treatment for attention deficit hyperactivity disorder (ADHD) in children – a video game.

Designed in conjunction with neuroscientists, EndeavorRx, known in clinical trials as AKL-T01, is the first FDA-approved video game designed to treat ADHD in children. It is currently only available in the US by prescription but its creators are hoping to have it approved in other countries.

The game, which involves controlling a little alien racing across different environments to complete tasks, specifically trains users to concentrate on multitasking and to block out distractions – cognitive areas which often need a boost in ADHD.

In a randomised controlled trial published in The Lancet Digital Health, 348 patients, aged 8–12 years old and not receiving medication for ADHD, were randomised to receive the game intervention or a control.

For a control, the clinical trial made use of a different game specifically designed as a digital word game which did not target areas involved with ADHD.

Over four weeks, participants were instructed to play the intervention or placebo game for five minutes, five times a day, five days a week.

The trial found that compliance was high, with 83% of treatment session being played. Treatment-related adverse events were mild and included frustration (5 [3%] of 180) and headache (3 [2%] of 180).

ADHD was measured by Test of Variables of Attention (TOVA) Attention Performance Index (API). The mean change from baseline on the TOVA API was 0·93 in the AKL-T01 group and 0·03 in the control group.

An extension of the trial found that EndeavorRx also worked as an adjunct treatment in children with ADHD who were also receiving stimulant treatment for their condition. One hundred and thirty were enrolled in the On Stimulants cohort, and 76 in the No Stimulants cohort. Despite severe comorbidities being exclusionary, around 20% of the included participants still presented with at least one DSM-listed comorbidity. The trial involved a four week treatment period, a four week pause, and another four week treatment period. Improvements for both groups were found from the first treatment period, and continued into the pause and into the second treatment period, suggesting continuing and lasting gains.

Eddie Martucci, chief executive of Akili which produced the game, told the BBC that EandeavorRx offers something that pharmaceuticals currently cannot. “It is something that’s very difficult to get through molecular means, like taking a pill. But it turns out that sensory stimuli can actually directly stimulate parts of the brain controlling cognitive function.”

Categories : Paediatrics Respiratory DiseasesTags :

Hospital Readmissions for Children with Asthma on The Increase

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Hospital readmissions for asthma are increasing among children, likely stemming from COVID lockdowns reducing immunity to common respiratory viruses. These are the findings of a new study published in the Journal of Asthma. The finding highlights the gaps in health care for this most common of chronic paediatric illnesses.

The Australian study, led by the Murdoch Children’s Research Institute, found about one in three children, mostly pre-schoolers, are readmitted to hospital for asthma compared to one in five a decade ago.

Most asthma hospital presentations were preventable, Murdoch Children’s Dr Katherine Chen said, which emphasises the need for a holistic evaluation of each child’s asthma management to prevent future readmissions.

The study involved 767 children, aged three to 18 years, who were admitted to three hospitals in Victoria state between 2017-2018 with a diagnosis of asthma. It found that 34.3% were readmitted to hospital for asthma, with those aged three to five years accounting for 69.2%. Of the 767 participants, 20.6% were readmitted once, and 13.7% had two or more readmissions in 12 months. 

“Our study highlighted gaps in the children’s asthma care,” Dr Chen said. Over a third of children hadn’t had a review of their inhaler technique, and only about a quarter were prescribed a preventer or asked to continue using it.

“Almost three quarters were discharged without a preventer medication, and over 80 per cent did not have a follow-up clinic booked at the hospital, often reserved for children with difficult-to-control asthma. Most families, therefore, need to navigate their child’s asthma follow-up with their GP.”

Recently, said Dr Chen, asthma admissions had spiked due to the rise in respiratory infections and children lacking immunity to common viruses as a result of COVID lockdowns.

Professor Harriet Hiscock at MCRI said that the findings confirmed the important role of GPs in paediatric asthma management and how targeted interventions at each hospital could reduce readmissions.

“Less than 10 per cent were readmitted within 30 days suggesting the importance of ongoing community care and longer-term asthma control,” she said. The need to regularly review overall asthma management, minimise risk factors, arrange follow-up, and support optimum care in the community are key.

“Interactive digital symptom monitoring with specialist nurse support, home-based education and a culturally tailored education program could also help.”

Prof Hiscock said linked datasets were important to objectively measure the burden of asthma cases on health services.

“Our current dataset cannot verify whether the follow-up appointment was attended, whether caregivers had arranged follow-up post-discharge and if the medications were used as prescribed,” she said. “Integrating datasets such as health services and medication use into clinical care will improve the clinician’s understanding of the child’s asthma control and medication adherence and would assist in providing targeted treatments.”

Asthma is the most common chronic paediatric illness in industrialised countries, affecting 8–10% of children.

Source: Murdoch Children’s Research Institute

Categories : PaediatricsTags :

ADHD Overdiagnosis Common and Racially Skewed, US Study Finds

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Children in classroom
Photo by CDC

A study in the Journal of Learning Disabilities examining overdiagnosis of attention-deficit/hyperactivity disorder (ADHD) found that diagnoses are common in children who are functioning well, and that there is a racial bias.

ADHD overdiagnosis and subsequent overtreatment poses needless potential harm to children. It also contributes to scepticism toward those who do have moderate or severe symptoms and significant impairments, resulting in less supportive care.

Yet which sociodemographic groups of children are overdiagnosed and overtreated for ADHD is poorly understood. As a proxy for overdiagnosis, researchers selected elementary schoolchildren who had displayed above-average levels of independently assessed behavioural, academic, or executive functioning the year prior to their initial ADHD diagnoses and who did not have prior diagnostic histories. This suggested they were unlikely to have ADHD.

The researchers conducted descriptive and logistic regression analyses of a population-based subsample of 1070 elementary schoolchildren.

Among these children, (a) 27% of White children versus 19% of non-White children were later diagnosed with ADHD and (b) 20% of White children versus 14% of non-White children were later using medication. In adjusted analyses, White children are more likely to later be diagnosed (odds ratio [OR] range = 1.70–2.62) and using medication (OR range = 1.70–2.37) among those whose prior behavioural, academic, and executive functioning suggested that they were unlikely to have ADHD.

The findings also skewed toward older children, and differences in diagnoses according to race was not linked to socioeconomic status. The authors acknowledge limitations such as a small sample size as well as not being able to account for English-speaking versus non-English speaking families, but note that their results are significant for 9 out of the 10 tests used.

The researchers suggest that greater overdiagnosis in White children may be in part explained by greater access to better-resourced schools more likely to pick up (or attempt to pick up) ADHD in children. Non-White children may also need to display behaviours more consistent with ADHD to be referred for evaluation and treatment.

Cultural misconceptions about ADHD are less likely to be prevalent in non-White families, and there is evidence to suggest that ADHD overdiagnosis is being used to gain academic achievement.

They concluded: “Preventing or reducing ADHD overdiagnosis and overtreatment should contribute to more appropriate care, limit increasing ADHD prevalence, increase the academic and behavioural functioning of elementary schoolchildren being diagnosed with ADHD but who are displaying few or mild symptoms, reduce unnecessary exposure to adverse side effects of medication use, and better allocate limited mental health resources.”

Categories : COVID PaediatricsTags :

Chinese Study Finds Children More Likely to Spread COVID

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By gaining access to a high quality COVID transmission data from a northern Chinese city which enforced stringent lockdowns, scientists concluded that young people were most responsible for an increase in direct and secondary infections, and also determined that county-wide lockdowns proved effective in limiting the virus’s spread.

The research study, led by Professor of Sociology Zai Liang at University of Albany, was given rare access to patient profiles and contact tracing data from every case accompanying the outbreak of the virus in Shijiazhuang from January to February in 2021. “Because of universal testing and digital tracing, the data are of high quality,” said Prof Liang, who was assisted by Sociology PhD student and lecturer Han Liu. Liu is from Shijiazhuang and has connections with that city’s CDC research centre, which enabled them to get the data.

The two UAlbany researchers, joined by two colleagues from China, published their findings in the Journal of Urban Health.

Prof Liang wrote that while individual-level contact tracing studies on the virus’s transmission and mitigation efforts have been growing, “because of limited testing capacities and risks of infringing on privacy, surveillance data used in individual-level research usually have limited representativeness.” His Shijiazhuang study, whose analysis included 99.52 percent (1028 of 1133) of the transmitted cases in Shijiazhuang, is designed “to fill this gap in the literature.”

The research examined sociodemographic factors including age, gender and socioeconomic status, postulating that “certain sociodemographic characteristics may facilitate the spread of germs by exposing the host to more social contacts.” This would include children interacting in the classroom, females having more contact with their relatives than do males, and less affluent workers working or living in overcrowded settings.

Among the study’s results are:

  • Children 0–17 years old had fewer close contacts than adults, but these led to more secondary infections: 32.1% infected children, 67.9% adults
  • Close contacts of children were 81% more likely to be infected than the contacts of those 18–49
  • Peasant workers, compared to non-manual workers, had 40% more secondary cases from the same neighbourhoods.

Prof Liang wrote, “While children have a low probability of having severe symptoms after being infected by COVID, they can seed the spread in the larger society by infecting their household members and other adults living in their neighbourhoods. These adults can then transmit the disease to their own social contacts. Future studies on how to control within-school infections are therefore urgently needed.”

Another major conclusion of the Shijiazhuang study is that timely non-pharmaceutical interventions, including restrictions on gatherings and school closures, effectively contained further infections via contact reduction, especially when implemented in small areas with the highest caseloads. Liang acknowledged that school closures did have negative ramifications for children’s education and socialisation.

Serendipitous data collection

How did Prof Liang and colleagues obtain comprehensive data not yet publicly available to others? “We heard of this COVID outbreak in this part of northern China early last year, when I was working on a proposal to study COVID. I asked Han Liu if we had connections in that city. It turned out that he is originally from Shijiazhuang and has connections with that city’s CDC research centre.

“The two researchers who collected the data agreed to join us in this effort. I am lucky to ask the right question at the right time.”

Source: University at Albany