Explore humanitarian healthcare professionals’ (HCPs) perceptions about implementing children’s palliative care and to identify their educational needs and challenges, including learning topics, training methods, and barriers to education.

Humanitarian HCPs were interviewed about perspectives on children’s palliative care and preferences and needs for training. Interviews were transcribed, coded, and arranged into overarching themes. Thematic analysis was performed using qualitative description.

Ten healthcare workers, including doctors, nurses, psychologists, and health-project coordinators, were interviewed. Participants identified key patient and family-related barriers to palliative care in humanitarian settings, including misconceptions that palliative care was synonymous with end-of-life care or failure. Health system barriers included time constraints, insufficient provider knowledge, and a lack of standardized palliative care protocols. Important learning topics included learning strategies to address the stigma of serious illness and palliative care, culturally sensitive communication skills, and pain and symptom management. Preferred learning modalities included interactive lectures, role-play/simulation, and team-based case discussions. Participants preferred online training for theoretical knowledge and in-person learning to improve their ability to conduct serious illness conversations and learn other key palliative care skills.

Palliative care prevents and relieves serious illness-related suffering for children with life-threatening and life-limiting conditions; however, most children in humanitarian settings are not able to access essential palliative care, leading to preventable pain and suffering. Limited palliative care knowledge and skills among HCPs in these settings are significant barriers to improving access to palliative care. Humanitarian HCPs are highly motivated to learn and improve their skills in children’s palliative care, but they require adequate health system resources and training. These findings can guide educators in developing palliative care education packages for humanitarian HCPs.

Caring for children with solid tumors (STs) can impact caregiver’s physical and mental health. Caregiver mastery, which influences psychological well-being, is vital in improving outcomes for both caregivers and children. The study aimed to investigate the relationship between caregiver mastery, anxiety, depression, fear of disease progression (FoP), caregiver burden, and the quality of life (QOL) of children with ST.

This cross-sectional study was conducted from June 2022 to April 2023 at a Grade A tertiary hospital in Shandong. Family caregivers of children with ST completed several validated measures, including the Pediatric Quality of Life Inventory (PedsQL) 3.0 Cancer Module, the Fear of Progression Questionnaire-parent version (FoP-Q-SF/PR), the Zarit Burden Interview Scale (ZBI), the hospital anxiety and depression scale (HADS), and the Caregiver Mastery Scale. Multiple linear regression analyses assessed the relationships between FoP, caregiver burden, anxiety, depression, caregiver mastery, and children’s QOL. Results were expressed as β and 95% confidence intervals (CIs).

A total of 454 caregivers participated. Caregiver mastery was positively correlated with children’s QOL (β = 0.80, 95% CI: 0.20 to 1.39). Depression (β = −0.64, 95% CI: −0.83 to −0.45), anxiety (β = −0.67, 95% CI: −0.85 to −0.49), caregiver burden (β = −1.20, 95% CI: −1.60 to −0.80), and FoP (β = −0.04, 95% CI: −0.05 to −0.03) were negatively related to children’s QOL. Caregiver mastery moderated the associations between depression, caregiver burden, FoP, and children’s QOL, while also improving the effect of mild anxiety on QOL.

The study underscores the importance of fostering caregiver mastery to mitigate the negative impact of caregiver distress on children’s QOL and improve outcomes for both caregivers and children with solid tumors.

Caregiver mastery moderates the effects of anxiety, depression, FoP, and caregiver burdenon children’s QOL. Supporting caregiver mastery can alleviate caregiver burden and enhance both caregiver and child well-being.

To assess the prevalence of obesity and investigate any changes in body mass index in children with CHD compared to age-matched healthy controls, in Southwestern Ontario.

The body mass index z-scores of 1259 children (aged 2–18) with CHD were compared with 2037 healthy controls. The body mass index z-scores of children who presented to our paediatric cardiology outpatient clinic from 2018 to 2021 were compared with previously collected data from 2008 to 2010. A longitudinal analysis of patients with data in both cohorts was also completed.

In total, 21.4% of patients with CHD and 26.6% of healthy controls were found to be overweight or obese (p < 0.001). The 2018–2021 cohort of CHD patients and controls had significantly higher body mass index z-scores compared to the 2008–2010 cohort (p < 0.001). Longitudinal analysis showed that body mass index z-scores significantly increased over time for CHD patients with data in both cohorts (2018–2021: M = 0.59, SD = 1.26; 2008–2010: M = −0.04, SD = 1.05; p < 0.001).

The prevalence of obesity in all children, irrespective of CHD, is rising. The coexistence of obesity and CHD may pose additional cardiovascular risks and complications.

The Wolff–Parkinson–White pattern is a delta wave frequently detected in school-based cardiovascular screening programs in Japan. Although most children with Wolff–Parkinson–White pattern are asymptomatic, initial symptoms may include syncope or sudden death, necessitating accurate diagnosis and management. Delta waves can also indicate a fasciculoventricular pathway, which poses no risk and does not require management.

We reviewed the medical records of patients referred to our hospital between April 2008 and March 2022 to evaluate the electrocardiographic signs of the Wolff–Parkinson–White pattern. The existence of Wolff–Parkinson–White syndrome and fasciculoventricular pathway were determined based on atrioventricular block and QRS waveform changes after adenosine administration during sinus rhythm.

The study cohort included 127 children (65 males; median age: 12.8 years, resting heart rate: 75 beats/min, PR interval: 109 ms, and QRS duration: 101 ms). The adenosine administration test revealed a fasciculoventricular pathway, Wolff–Parkinson–White syndrome, and indeterminate findings in 64, 54, and 9 children, respectively. More than 60% of children with a QRS duration ≤ 120 ms had a fasciculoventricular pathway. Age ≤ 12 years, QRS duration >120 ms, and type A category (children with R/S ratios >1 in lead V1) were identified as independent risk factors for Wolff–Parkinson–White syndrome. No adverse events were observed in any child.

The adenosine administration test is safe and feasible for differentiating Wolff–Parkinson–White syndrome from fasciculoventricular pathways and can reduce the unnecessary management of children with fasciculoventricular pathways.

This study evaluated the impact of 2015/2016 prescribing guidance on antidepressant prescribing choices in children.

A retrospective e-cohort study of whole population routine electronic healthcare records was conducted. Poisson regression was undertaken to explore trends over time for depression, antidepressant prescribing, indications and secondary care contacts. Time trend analysis was conducted to assess the impact of guidance.

A total of 643 322 primary care patients in Wales UK, aged 6–17 years from 2010–2019 contributed 3 215 584 person-years of follow-up. Adjusted incidence of depression more than doubled (IRR for 2019 = 2.8 [2.5–3.2]) with similar trends seen for antidepressants. Fluoxetine was the most frequently prescribed first-line antidepressant. Citalopram comprised less than 5% of first prescriptions in younger children but 22.9% (95% CI 22.0–23.8; 95% CI 2533) in 16–17-year-olds. Approximately half of new antidepressant prescribing was associated with depression. Segmented regression analysis showed that prescriptions of ‘all’ antidepressants, Fluoxetine and Sertraline were increasing before the guidance. This upward trend flattened for both ‘all’ antidepressants and Fluoxetine and steepened for Sertraline. Citalopram prescribing was decreasing significantly pre guidance being issued with no significant change afterward.

Targeted intervention is needed to address rising rates of depression in children. Practitioners are partially adhering to local and national guidance. The decision-making process behind prescribing choices is likely to be multi-factorial. Activities to support implementation of guidance should be adopted in relation to safety in prescribing of antidepressants in children including timely availability of talking therapies and specialist mental health services.

This study assessed the association between baseline sociodemographic variables, body composition and 4-year changes in the intake of food groups, including sugar-sweetened beverages (SSB) among children, after the implementation of the health promotion levy.

Prospective cohort study.

Ten schools in North West Province, South Africa.

950 children aged 5–9 years at baseline and data of 672 children at follow-up. The frequency of intake from healthy and unhealthy food groups was assessed by questionnaire. Anthropometric and sociodemographic information were collected; BMI-for-age z-scores were calculated. The health promotion levy was implemented after baseline and follow-up measurements were done after 4 years. A random intercept generalised linear mixed model analysis was applied to investigate the time effect of the weekly intake of the foods adjusting for BMI-for-age z-scores and sociodemographic characteristics of the children.

The weekly frequency of intake from most food groups remained unchanged at follow-up. The frequency of SSB intake decreased significantly over 4 years. Decreased intake of SSB was not linked to increased intake of healthy foods. Changes in intakes from SSB were not associated with household income, parental education or BMI-for-age z-score categories. A decreased frequency of intake from SSB was observed following the implementation of the health promotion levy after baseline, in line with reports of national decreases in SSB sales in South Africa since 2017.

The decreased frequency of SSB intakes following the implementation of the health promotion levy in South Africa may indicate that health policies can promote healthier dietary habits.

To describe the economic, lifestyle and nutritional impact of the COVID-19 pandemic on parents, guardians and children in Malaysia, Indonesia, Thailand and Vietnam.

Data from the SEANUTS II cohort were used. Questionnaires, including a COVID-19 questionnaire, were used to study the impact of the pandemic on parents/guardians and their children with respect to work status, household expenditures and children’s dietary intake and lifestyle behaviours.

Data were collected in Malaysia, Indonesia, Thailand and Vietnam between May 2019 and April 2021.

In total, 9203 children, aged 0·5–12·9 years, including their parents/guardians.

Children and their families were significantly affected by the pandemic. Although the impact of lockdown measures on children’s food intake has been relatively mild in all countries, food security was negatively impacted, especially in Indonesia. Surprisingly, in Malaysia, lockdown resulted in overall healthier dietary patterns with more basic food groups and less discretionary foods. Consumption of milk/dairy products, however, decreased. In the other countries, intake of most food groups did not change much during lockdown for households based on self-reporting. Only in rural Thailand, some marginal decreases in food intakes during lockdown persisted after lockdown. Physical activity of children, monthly household income and job security of the parents/guardians were negatively affected in all countries due to the pandemic.

The COVID-19 pandemic has significantly impacted societies in South-East Asia. To counteract negative effects, economic measures should be combined with strategies to promote physical activity and eating nutrient-adequate diets to increase resilience of the population.

Cognitive therapy for PTSD (CT-PTSD) is an efficacious treatment for children and adolescents with post-traumatic stress disorder (PTSD) following single incident trauma, but there is a lack of evidence relating to this approach for youth with PTSD following exposure to multiple traumatic experiences.

To assess the safety, acceptability and feasibility of CT-PTSD for youth following multiple trauma, and obtain a preliminary estimate of its pre–post effect size.

Nine children and adolescents (aged 8–17 years) with multiple-trauma PTSD were recruited to a case series of CT-PTSD. Participants completed a structured interview and mental health questionnaires at baseline, post-treatment and 6-month follow-up, and measures of treatment credibility, therapeutic alliance, and mechanisms proposed to underpin treatment response. A developmentally adjusted algorithm for diagnosing PTSD was used.

No safety concerns or adverse effects were recorded. Suicidal ideation reduced following treatment. No participants withdrew from treatment or from the study. CT-PTSD was rated as highly credible. Participants reported strong working alliances with their therapists. Data completion was good at post-treatment (n=8), but modest at 6-month follow-up (n=6). Only two participants met criteria for PTSD (developmentally adjusted algorithm) at post-treatment. A large within-subjects treatment effect was observed post-treatment and at follow up for PTSD severity (using self-report questionnaire measures; ds>1.65) and general functioning (CGAS; ds<1.23). Participants showed reduced anxiety and depression symptoms at post-treatment and follow-up (RCADS-C; ds>.57).

These findings suggest that CT-PTSD is a safe, acceptable and feasible treatment for children with multiple-trauma PTSD, which warrants further evaluation.

This study aimed to explore the multifaceted experiences of families with children and adolescents enrolled in the pediatric palliative care (PPC) program, with a particular emphasis on understanding their perspectives regarding the quality and effectiveness of care provided. Our goals included exploring emotional, social, and practical caregiving dimensions within the PPC context to address gaps and find areas for improvement. The objectives encompassed an exploration of the perceived effects on physical, emotional, social, and spiritual dimensions, an investigation into pre-PPC inclusion experiences, and an identification of limitations and potential areas for enhancement within the program.

Using a qualitative descriptive approach with a phenomenological lens, we engaged 6 primary caregivers through semi-structured interviews, employing theoretical convenience sampling. Analysis involved meticulous transcription, alphanumeric coding, and thematic categorization using Atlas.ti 8.0® software.

Consistently echoed across interviews were the positive impacts on family dynamics, characterized by a sense of tranquility, enhanced patient care, and substantial caregiver support. Emotional well-being improvements were marked by elevated mood, reduced anxiety, and a restored sense of normalcy. Noteworthy challenges identified encompassed communication gaps among health-care professionals, limited-service availability, and perceived constraints in home care.

The study underscores the profound positive influence of the PPC program on the perceived quality of life for families navigating the complexities of caring for children with life-limiting illnesses. The findings underscore the paramount importance of holistic, family-centric care and underscore the imperative to address caregiver needs comprehensively to mitigate the risk of burnout. The identified challenges serve as signposts for refining communication strategies, expanding service provisions, and augmenting support structures within the PPC program. Overall, the study highlights the profound positive impact of the PPC program on family well-being, while also identifying areas for program enhancement, particularly in communication and service availability.