Paediatrics & Child Health

A secure attachment relationship with at least one healthy adult is essential for a child to develop optimal coping abilities. Primary care providers like paediatricians and family physicians can help by supporting parents in practice settings. Every clinician encounter is an opportunity to ask parents about children's relationships and their behaviour, daily routines, and overall family function. This statement, which focuses on children aged 0 to 6 years, describes basic principles in support of positive parenting and recommends in-office practices to promote secure parent-child relationships, engage families and build trust with parents...

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Introduction: Steadily increasing emergency department (ED) utilization has prompted efforts to increase resource allocation to meet demand. Little is known about the distribution and characteristics of patient arrivals by time of day. This study describes the variability and patterns of ED resource utilization related to patient, acuity, clinical, and disposition characteristics over a 24-hour period. Methods: Retrospective cross-sectional study of all visits to a tertiary children's hospital over a 1-year period...

Objectives: Recent studies suggest that same-day discharge is safe for the paediatric population after various laparoscopic procedures. Same-day discharge is increasingly common after laparoscopic surgery for uncomplicated appendicitis although it is not standard practice. This prospective study aims to assess parental satisfaction with same-day discharge after laparoscopic appendectomy for uncomplicated appendicitis. Methods: At our institution, 849 patients with uncomplicated acute appendicitis underwent laparoscopic appendectomy in 2016; of which, 382 were discharged on the same calendar day...

Background: Surfactant delivery via a thin endotracheal catheter during spontaneous breathing, a technique called minimally invasive surfactant therapy (MIST), is an alternative to intubation and surfactant administration. There is paucity of data regarding the administration of high-volume surfactant using this technique. Methods: We conducted a retrospective cohort study to review the safety, efficacy, and procedural details pertaining to the delivery of 5 mL/kg of BLES® via MIST approach...

Objectives: To describe variations in the monitoring, treatment, and discharge of children hospitalized with bronchiolitis among physicians across Canadian paediatric teaching hospitals. Methods: We conducted an electronic survey of paediatricians with experience in the management of inpatient bronchiolitis at 20 Canadian paediatric teaching hospitals. Only physicians who worked a minimum of 6 weeks on their hospital inpatient unit in the 2015 calendar year were eligible to participate in the study...

There is a growing focus in the medical community on de-escalating medical treatments where appropriate; however, specific efforts to reduce medication burden in patients with polypharmacy has largely been targeted toward adult populations. Polypharmacy increases the risk of adverse drug reactions in children, and that risk may be further increased by the use of off-label drugs. The paediatric prescribing community should explore pharmacovigilance strategies and deprescription initiatives that prioritize patients with polypharmacy...

Health care workers often talk about 'karma' regarding how busy a clinical service will be when a certain physician is on service. While often lighthearted, this construction of karma might have some undesirable implications by shifting our focus from our patients to ourselves.

A 16-month-old previously healthy child with normal development presented with decreased level of consciousness, apneas, and seizure requiring intubation and treatment for status epilepticus. Investigations revealed no evidence of infection or trauma, normal head CT scan, and urine positive for tetrahydrocannabinol (THC) and negative for other substances. This report outlines the clinical presentation, approach to treatment, and potential seriousness of THC intoxication in young children. Mandatory reporting and monitoring of THC intoxication in children is recommended...

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No abstract text is available yet for this article.

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No abstract text is available yet for this article.

Although acute and subacute lead toxicity requiring active treatment is rare in Canada, paediatricians need to be aware of new evidence linking lower lead levels to neurodevelopmental deficits. Health Canada has identified potential exposures occurring prenatally, in infancy and during early childhood from food and water, household dust, soil, and mouthing products that contain lead. Children with neurodevelopmental problems who live in older housing and newcomers to Canada may be at greater risk. Symptoms may be latent, subtle, and chronic...

This practice point provides guidance for clinicians caring for immunocompromised children, with focus on preventing or managing infection risks associated with a range of activities and exposures. The consequences of these infections depend on numerous factors, including but not limited to the nature of the child's immunocompromised state, general health, and the virulence of the organism involved.

Infants born at ≤32+6 weeks gestation are at higher risk for intracranial ischemic and hemorrhagic injuries, which often occur in the first 72 hours postbirth. Antenatal strategies to reduce the incidence of acute brain injuries include administering maternal corticosteroids and prompt antibiotic treatment for chorioamnionitis. Perinatal strategies include delivery within a tertiary centre, delayed cord clamping, and preventing hypothermia. Postnatal strategies include empiric treatment with antibiotics when chorioamnionitis is suspected, the cautious use of inotropes, the avoidance of blood PCO2 fluctuation, and neutral head positioning...

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Objective: To determine if there was a significant increase in Endocrine consultations postinitiation of the more stringent 2015 guidelines for persistent neonatal hypoglycemia. Methods: A retrospective chart review was conducted using data from November 2011 to October 2016. All infants with persistent hypoglycemia past 72 hours of life were included. Data included age, critical sample values, anthropometric measures, and maternal health. Descriptive statistical analyses were performed as was an interrupted time series analysis assuming a Poisson distribution...