Anorexia nervosa has potential to influence the development and function of the gastrointestinal system. We assessed the association between maternal anorexia nervosa and risk of gastrointestinal morbidity in offspring.

We analyzed a longitudinal cohort of 1,269,370 children born in Quebec, Canada, between 2006 and 2022. The exposure was maternal anorexia nervosa. The outcome was hospitalization for pediatric gastrointestinal disorders, including hypertrophic pyloric stenosis, inflammatory bowel disease, and other digestive morbidity. Follow-up ranged from 1 to 17 years. We used adjusted Cox regression models to obtain hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between maternal anorexia nervosa and pediatric gastrointestinal disorders.

A total of 2,447 children (0.2%) had a mother with anorexia nervosa. By age 17 years, the cumulative incidence of gastrointestinal disorders was higher among children whose mothers had anorexia nervosa than other children (165.7 vs. 129.4 per 1,000). Compared with no anorexia, maternal anorexia nervosa was associated with a greater risk of any childhood gastrointestinal disorder (HR: 1.42, 95% CI: 1.26–1.61), particularly hypertrophic pyloric stenosis (HR: 2.51, 95% CI: 1.35–4.66), inflammatory bowel disease (HR: 2.46, 95% CI: 1.67–3.64), and rectal hemorrhage (HR: 3.46, 95% CI: 1.97–6.09). Children whose mothers developed anorexia nervosa after age 20 years or were hospitalized more than once for anorexia had the greatest risk of gastrointestinal morbidity. The associations were not explained by digestive birth defects.

Maternal anorexia nervosa is associated with pediatric gastrointestinal disorders that could potentially be mitigated with psychosocial support, nutritional rehabilitation, and breastfeeding.

We examined cognitive performance in children with complicated mild-severe traumatic brain injury (TBI) versus orthopedic injury (OI) using the National Institutes of Health Toolbox Cognitive Battery (NIH TB-CB).

We recruited children ages 3–18, hospitalized with complicated mild-severe TBI (n = 231) or orthopedic injury (OI, n = 146). Cognition was assessed using the NIH TB-CB at six and twelve months post-injury. We used linear mixed models to assess associations of injury group (TBI versus OI), timepoint (six versus twelve months), and the interaction of injury group and timepoint with NIH TB-CB Total Cognition, Fluid Cognition, and Crystallized Cognition composites, adjusted for sex and socioeconomic status (SES), with Bonferroni correction. We evaluated differences in cognition stratified by injury severity (complicated mild–moderate TBI vs severe TBI) using ANCOVA, adjusting for sex and SES.

Neither injury group nor the interaction of group and timepoint were associated with Total (group: p = 0.50; timepoint*group: p = 0.185), Fluid (group: p = 0.297; timepoint*group: p = 0.842), or Crystallized Cognition (group: p = 0.039; timepoint*group: p = 0.017). However, children with severe TBI performed significantly worse on Fluid and Total Cognition than children with complicated mild–moderate TBI at six months (Fluid: p = 0.004, partial η2 = 0.06, moderate effect, Total: p = 0.012 partial η2 = 0.03, small–moderate effect) and twelve months post-injury (Fluid: p < 0.001, partial η2 = 0.11, moderate–large effect, Total: p = 0.002, partial η2 = 0.06, moderate effect).

The NIH TB-CB detects worse cognitive functioning in children with severe TBI six-twelve months post-injury, largely driven by differences in Fluid Cognition. Our findings suggest the NIH TB-CB may be suitable for monitoring cognition in children with TBI.

Healthy sleep contributes to better cognitive functioning in children. This study sought to investigate the role of pre-injury sleep disturbance as a predictor or moderator of cognitive functioning across 6 months post-injury in children with mild traumatic brain injury (mTBI) or orthopedic injury (OI).

Participants were 143 children with mTBI and 74 with OI, aged 8 – 16 years, prospectively recruited from the Emergency Departments of two children’s hospitals in Ohio, USA. Parents rated their children’s pre-injury sleep retrospectively using the Sleep Disorders Inventory for Students. Children completed the National Institutes of Health (NIH) Toolbox Cognition Battery at 10 days and 3 and 6 months post-injury.

Group differences in both overall performance and reaction time on the Flanker Inhibitory Control and Attention Test varied significantly as a function of the level of pre-injury sleep disturbance as well as time since injury. At the 10 day visit, among children with worse pre-injury sleep, mTBI was associated with slower reaction times relative to OI. Among children with worse pre-injury sleep, those with mTBI improved over time while those with OI did not. Main effects of pre-injury sleep and time since injury were found for several other NIH Toolbox subtests, with poorer performance associated with worse pre-injury sleep and early vs. later timepoints.

These results suggest that pre-existing sleep disturbances and mTBI are jointly associated with poorer executive functioning post-injury. Interventions to improve sleep might help mitigate the effects of mTBI on children’s cognitive functioning.

Methylphenidate (MPH), a commonly used stimulant for the treatment of attention deficit and hyperactivity disorder (ADHD) in children and adolescents, has been associated with adverse effects on weight, height, blood pressure (BP) and heart rate (HR). This study aimed to investigate whether children with ADHD prescribed MPH by a specialist ADHD service showed a change in health data percentiles compared to their pre-treatment measures, and to investigate for any correlation with MPH dose, years prescribed MPH and gender.

In this retrospective observational study health data percentiles (weight, height, BP and HR) were analysed for change between two timepoints: prior to MPH initiation (T1) and at the most recent clinic appointment (T2). Correlations between health data percentile changes and MPH dose, treatment duration, baseline growth centiles and gender were studied.

The cohort consisted of 123 youth (age 5-17.5 years) prescribed MPH (mean dose 0.67 ± 0.32 mg/Kg). Over the treatment period (2.5 ± 2.1 years) weight (P = 0.001) and height (P = 0.007) centiles significantly reduced, BP centiles did not change, while HR centiles increased (P < 0.0001). Weight centile reduction was correlated with higher MPH dose (P < 0.0001) and this effect attenuated with longer duration of MPH treatment (P = 0.005). Height centile reduction was more pronounced in the taller cohort (P = 0.008).

This study supports international guidelines for physical health monitoring of young people prescribed MPH, specifically the conversion of health data to percentiles for accurate monitoring and early identification of concerning trends. Future integration of digital approaches are necessary for rapid and accurate physical health monitoring.

An aspirated foreign body in a child can represent a potentially life-threatening emergency.

This retrospective study, carried out from 2014 to 2024, compares the estimated effective radiation dose children received during ultra-low dose computed tomography (CT) scans with that received with traditional cumulative radiographic investigations.

Of the 44 patients included in the study, 32 were in the radiograph group and 12 were in the CT group. There was a statistically significant reduction in the length of stay and cost in the CT group when compared with the radiograph group (p < 0.01). There was a statistically significant reduction in the cumulative estimated effective radiation dose in the radiograph compared to the estimated effective dose received in the CT group (p < 0.01). No patients required sedation for CT imaging.

Ultra-low dose CT is a safe, cost-effective first-line investigation in stable patients with suspected foreign body aspiration.

Little is known about the diagnostic trajectories following a first psychiatric diagnosis in childhood or adolescence. Such knowledge could aid clinicians in treatment, risk prediction, and psychoeducation. This study presents a comprehensive nationwide overview of diagnostic trajectories in children and adolescents after their first diagnosis in child and adolescent psychiatric hospitals.

Patients aged 0 to 17 years who received their first psychiatric diagnosis between January 1996 and December 2011 were identified through the Danish National Patient Registries. Shifts at the International Classification of Diseases (ICD-10) two-cipher level (F00-F99), grouped into 19 categories, were identified. Subsequent diagnoses during 10 years of follow-up until December 2021 were identified and analyzed using state sequence analysis and Cox proportional hazard regression models.

A total of 77,464 children and adolescents (32,733 [42.26%] girls) were identified with a first-time psychiatric diagnosis. Among these, 46.7% of girls and 37.6% of boys had at least one diagnostic shift after 10 years of follow-up. High entropy and low diagnostic stability were found in first-time diagnoses often presenting in adolescence, such as affective disorders, psychotic illness, and personality disorders, while lower entropy and high diagnostic stability were found in neurodevelopmental disorders and eating disorders. For most categories, girls had higher mean entropy measures than boys (P < 0.05).

Diagnostic shifts are common in child and adolescent psychiatric services, particularly when the first contact occurs in adolescence. Adequate focus on psychoeducation about emerging diagnostic shifts, and on timely detection, particularly in girls, and particularly in adolescence, is warranted.

To compare the international BMI standard/references of the International Obesity Task Force (IOTF), MULT and the WHO and to analyse the association between changes in BMI growth channelling (BMI-GC) during childhood and the risk of being overweight in early adolescence.

Participant data from the Millennium Cohort Study (MCS), young lives (YL) and Generation XXI (G21) cohorts were obtained at three time points. Lin’s concordance correlation coefficient (CCC) and the weighted Kappa coefficient were used to assess the agreement among the BMI standard/references. The relative risk (RR) of being overweight at 9·5–13·5 years, based on an increase in BMI-GC (amplitude ≥ 0·67) between 3·5–6 years and 6·5–9 years, was calculated, with estimates adjusted for sex, ethnicity and socio-economic status.

Ethiopia, India, Portugal, Vietnam and United Kingdom.

Totally, 12 624 participants from the MCS, YL and G21 studies.

The prevalence of overweight across the three ages groups was higher when using the WHO standard/reference (12·8–25·9 %) compared with the MULT (17·1–22·9 %) and IOTF (13·0–19·3 %) references. However, substantial agreement (0·95 < CCC ≤ 0·99) was found among these standard/references. Children who increased their BMI-GC by ≥ 0·67 and < 0·86 were more likely to be overweight at 9·5–13·5 years (MULT-RR = 2·49, 95 % CI: 2·00, 3·09/ WHO-RR = 2·47, 95 % CI: 1·96, 3·12/ IOTF-RR = 2·31, 95 % CI: 1·82, 2·93), compared with those who have stayed in their BMI-GC.

A change in the BMI-GC among normal-weight children during childhood was associated with a significantly higher risk of being overweight at 9·5–13·5 years. These findings suggest that monitoring BMI-GC in children could be a tool to intervene and to prevent overweight in early adolescence.

Otolaryngology/ear, nose and throat conditions are common in clinical practice, yet undergraduate exposure in UK medical schools remains limited. The coronavirus disease 2019 pandemic created opportunities to innovate medical education. This review explores the scope of advance in otolaryngology undergraduate education following the coronavirus disease 2019 pandemic.

A search of MEDLINE, Embase, Cochrane, and Education Resources Information Center databases was conducted. Studies that met inclusion criteria were subject to risk-of-bias assessment and narrative analysis.

Interventions such as mixed reality, cadaveric teaching, and anatomical models improved short-term performance and student satisfaction. Surveys limited advancement in clinical exposure to otolaryngology/ear, nose and throat, when compared to pre-coronavirus-disease literature.

Despite the potential for reform following the pandemic, there has been no significant advancement in the provision of undergraduate medical education in the post-coronavirus-disease era. Standardisation of undergraduate education is needed to mirror recent changes to assessment in undergraduate education in the UK.

Children born very preterm (VPT; ≤32 weeks’ gestation) are at higher risk of developing behavioural problems, encompassing socio-emotional processing and attention, compared to term-born children. This study aimed to examine multi-dimensional predictors of late childhood behavioural and psychiatric outcomes in very preterm children, using longitudinal clinical, environmental, and cognitive measures.

Participants were 153 VPT children previously enrolled in the Evaluation of Preterm Imaging study who underwent neuropsychological assessments at 18–24 months, 4–7 years and 8–11 years as part of the Brain Immunity and Psychopathology following very Preterm birth (BIPP) study. Predictors of late childhood behavioural and psychiatric outcomes were investigated, including clinical, environmental, cognitive, and behavioural measures in toddlerhood and early childhood. Parallel analysis and exploratory factor analysis were conducted to define outcome variables. A prediction model using elastic-net regularisation and repeated nested cross-validation was applied to evaluate the predictive strength of these variables.

Factor analysis revealed two key outcome factors in late childhood: externalising and internalising-socio-emotional problems. The strongest predictors of externalising problems were response inhibition, effortful control and internalising symptoms in early childhood (cross-validated R2=.256). The strongest predictors of internalising problems were autism traits and poor cognitive flexibility in early childhood (cross-validated R2=.123). Cross-validation demonstrated robust prediction models, with higher accuracy for externalising symptoms.

Early childhood cognitive and behavioural outcomes predicted late childhood behavioural and psychiatric outcomes in very preterm children. These findings underscore the importance of early interventions targeting cognitive development and behavioural regulation to mitigate long-term psychiatric risks in very preterm children.

The objectives of this study were to (1) document factors that promoted or hindered the successful implementation of small quantity lipid-based nutrient supplements (SQ-LNS) for children 6–23 months and pregnant and lactating women (PLW) and (2) gather programme staff perspectives on considerations for expanding SQ-LNS programmes in their context.

We used qualitative methods to interview programme staff (n 23), conduct distribution site observations (n 9) and facilitate focus group discussions with caregivers of children 6–23 months (n 9) and PLW (n 6) with 6–8 participants per group across the three countries.

The study was conducted in SQ-LNS programme sites in Honduras, Niger and Somalia.

We found high acceptability of SQ-LNS among caregivers of children 6–23 months and PLW women. However, caregivers and PLW were dissatisfied with the size of the product in Niger and Somalia and PLW disliked the aftertaste of iron in Honduras. In Somalia, PLW referred to high levels of food insecurity. We also found variation in how the partners designed their SQ-LNS programmes (e.g. enrolment and exit criteria), the level of communication around SQ-LNS and problem-solving to support appropriate use of SQ-LNS. Partners tracked anthropometric measurements in all countries and used the information to assess changes and, in some cases, noted improvements in child anthropometry and vaccination rates.

Programmes need to consider several operational factors during implementation, such as securing household food access in highly food-insecure areas, counselling on the use of SQ-LNS and evidence-based criteria for enrolment, exit and supplementation duration.