Atoms
Sox It’s not as if the clues weren’t there. Once the cache of documents (many calligraphically etched) were disinterred from the mahogany box under cobweb-veiled trapdoor beside the ever-penumbral fork in the forest trail, events moved quickly. The chronology, ultimately unchallenging, left no doubt that earlier intervention (C’s animus and D’s parsimony were both surely modifiable) and the matter (in the police vernacular) ‘resolved’? ‘Prevention’ became the new mantra, billboards to this effect even appearing at Red Sox games. The rest, as they say is up to you. Global child health: early child development You won’t have failed to notice the emphasis (a deliberate one) on ECD recently. This month, Zahra Hoodbhoy at the Aga Khan University, Karachi, demonstrate the excess risk associated in all domains of fetal growth restriction using antenatal doppler data (exposure) and the validated Malawi tool (outcome). Neatly following this trajectory, Karen...
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Review and future directions for PIMS-TS (MIS-C)
Paediatric multisystem inflammatory syndrome temporally associated with COVID-19 Paediatric multisystem inflammatory syndrome temporally associated with COVID-19 (PIMS-TS), also known as multisystem inflammatory syndrome in children (MIS-C), is a novel hyperinflammatory condition that shares features with Kawasaki disease (KD) and toxic shock syndrome (TSS).1–3 The median age of children with PIMS-TS is approximately 8 years with male sex, obesity and black or Asian ethnicity associated with an increased risk.1 2 Children with PIMS-TS typically have a history of SARS-CoV-2 infection in the weeks preceding presentation.1 2 The clinical phenotype varies and includes fever, gastrointestinal symptoms, cardiac manifestations, conjunctivitis, polymorphous rashes and respiratory failure.1–3 Figure 1 and table 1 report the diagnostic criteria for PIMS-TS and the common features seen in children with the disease. Children with...
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Giving a voice to the voiceless: end of life second opinions
As modern medicine can achieve greater than ever prolongation of life, the difficult issue of whether it is right as opposed to possible to continue with intensive treatment has become ever more important, not least in light of recent high-profile cases where professionals and parents have been unable to agree. The Royal College of Paediatrics and Child Health (RCPCH) has published an ethical framework setting out in rigorous, scholarly and humane documents the principles by which life-sustaining treatment may be withheld or withdrawn from a child,1 2 and important principles for giving a second opinion have also been published.3 This Viewpoint is set within the framework of previous guidance and relates to the practicalities of giving a second opinion when such a course of action is contemplated; it does not seek to challenge any aspect of the RCPCH principles, nor unfortunately does it...
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Restrictive eating disorders in children and young people: the role of the paediatrician and paediatric ward
Introduction It will not have escaped any paediatrician that the COVID-19 pandemic has seen a marked rise in presentations of children and young people with restrictive eating disorders. The surge has spilled onto paediatric wards, with young people in distress often admitted for weeks at a time awaiting more specialist care.1 In some centres in the UK, however, admission rates have been lower through closer collaboration between paediatricians and eating disorder teams who offer a different, more pre-emptive approach to the medical management of affected young people and their families. We discuss how paediatricians and the proactive paediatric admission, sanctioned and supported by the eating disorder team, can influence the journey to recovery of a young person with a restrictive eating disorder. Another way? Restrictive eating disorders are an important cause of lifetime morbidity and mortality, with much of the risk attributable to complications...
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