Atoms
It was only when the whispering became deafening As is so often the case, it started with a half glance: maybe even less. As so often ensues, that first contact built up its own head of steam, a delirious, all-engulfing momentum that consumed both (let’s call them) parties. Keen as mustard to etch contracts in stone, the febrile milieu obfuscated... It obfuscated some ‘issues’, issues the parties hadn’t entertained or, at least, had chosen not to air. The aphorism about being open to discussion, to a wide-angle lens, has never been more appropriate. Succeeding to thrive Growth monitoring is rightly a cornerstone of global child health surveillance policy, as concrete as routine vaccination. But even the best ‘tests’ can be misinterpreted, at least if the instructions are not heeded. Charlotte Wright and Tim Cole expand an earlier hypothesis based on infant weight data to the toddler...
>> Read More

How can parents experience of child death reviews be improved?
When my sister died through suicide—as an adult, but still my little sister—I, my parents and our family and friends all grappled with that persistent but elusive question, ‘Why?’ We were grieving, coping with the pain of our loss, and trying to make some sense of what had happened. When it finally arrived, the coroner’s verdict confirmed the facts and conclusion on the cause of death that we already knew. The lack of any personal contact from any professionals was something we accepted. It may not have made any difference to our understanding of her death, but it might have allowed us to tell her story—our story, to ask our questions, and to take some further steps in our grieving journey. Reflecting on that time, I am struck by how our experience mirrors that of so many families I have met after the death of their child. I have...
>> Read More

Gender medicine and the Cass Review: why medicine and the law make poor bedfellows
In April 2024, the final report of the Cass Review, an independent review chaired by Dr Hilary Cass, was published, offering recommendations to improve gender identity services for children and young people in the UK. The core purpose of the Review was to improve care for children and adolescents. Commissioned by National Health Service England, the Review identified a weak evidence base for medical endocrine interventions and recommended that these treatments be provided within a structured research framework. The Review received widespread support from the clinical community. However, in July, the British Medical Association Council, without consulting its own members, unexpectedly passed a motion calling for a public critique of the Review, citing concerns over methodological weaknesses - a position it then softened following public criticism from members, concluding that their review would come instead from a position of neutrality. The original motion was based on two non-peer-reviewed online papers, prominently the work of McNamara et al—a paper which was written for a primarily litigious, rather than academic, purpose. We critically examine these sources and analyse the wider legal context in which they have been applied. We conclude that these sources misrepresent the Cass Review’s role and process (specifically, by mistakenly comparing the Review to clinical practice guideline development), while many of the methodological criticisms directed at the Cass Review, including its use of evidence appraisal and systematic reviews conducted by University of York (UK), are unfounded. These misunderstandings, based on flawed and non-peer-reviewed analyses intended for legal (rather than clinical) purposes, jeopardise the implementation of crucial reforms in the care of gender dysphoric youth. The UK clinical community should move beyond these critiques and focus on the Cass Review’s recommendations to establish a safer, more holistic and evidence-based service model for children and young people experiencing gender identity issues.
>> Read More

Research exposure in UK paediatric training: how do we address the gaps--experience from the London REACH network
Trainee-led Research Networks (TRNs) can mitigate against the lack of in-training academic opportunities by offering research experience, support and shared learning for paediatricians. The London Research, Evaluation and Audit for Child Health (REACH) Network, founded in 2021, has grown to involve a diverse group of 190 volunteer members at 28 London hospitals. Planning and delivery of a range of multisite projects bring not only many challenges but also a wealth of learning opportunities relating to research and quality improvement as well as leadership, management, education and fostering an accessible and equitable research culture. TRNs are an effective and valuable tool in improving the experience of trainees.
>> Read More