Bessere Arzneimittel für Kinder

Background

The majority of drugs administered to children today have never been authorized for children. Drugs not tested in children carry increased risks as they may work differently and have different side effects than in adults. Paediatric drug studies have so far been hampered by several hurdles. The EU Paediatric Regulation, in force since 2007, aims to overcome these hurdles and to make more adequately tested drugs available for children. It consists of the requirement for paediatric development of all new drugs by pharmaceutical companies, incentives such as patent extension, and a Paediatric Committee to guide this process.

Current accomplishments

In the last 5 years, the Paediatric Committee has agreed almost 600 paediatric development plans, most of which are still ongoing. Several collateral measures to improve transparency and information and to stimulate paediatric research have already been implemented. As a result of the regulation, some drugs have already received new paediatric authorization, new age-appropriate formulations, or updates of product information with new paediatric data. However, their number is still small because of the short latency.

Conclusion

The Paediatric Regulation has implemented important steps to improve drug development for children. To achieve broad availability of authorized drugs for children will need more time.     

Influenza und Influenzaimpfstoffe für Kinder

Influenza is viral disease with very typical clinical symptoms of sudden onset, high fever, coughing, sore throat, muscle pain and headache. The morbidity is highest for children whereby infants substantially contribute to spreading the disease. Infants and babies are often severely affected and must be hospitalized. The World Health Organization (WHO) now recommends the implementation of routine influenza immunization of healthy children between 6 and 59 months old. As conventional trivalent influenza vaccines (TIV) are not optimal for protection young children more effective vaccines are needed. Since 2011 a live attenuated influenza vaccine has been approved for the age group 2-17 years old which provides children with better protection against influenza than conventional TIV. A further possibility for increased effectiveness is coupling TIV with an adjuvant. A virosomal vaccine is available for children over 6 months old. Antigen enhancement of TIV in infants and young children may lead to better protection rates.     

Rehabilitation für Kinder und Jugendliche

Pädiatrie & Pädologie - Rehabilitation für Kinder und Jugendliche im Indikationsbereich Mobilisierung beinhaltet die Therapie einer Vielzahl von akuten und chronischen...     

Gemeinschaftsverpflegung in Bildungseinrichtungen für Kinder

The routine caring for children in the family is nowadays more and more complemented by institutional caring in day care centers or all day schools. In parallel responsibility for nutrition is also transferred to catering in institutions. At present approximately 3.2 million children aged between 0 and 14 years visit a day care center and another 2 million children an all day school in Germany. Formal regulations for nutritional quality of meals offered in institutional care for children do not exist in Germany. Mealtime-based dietary guidelines deduced from the concept of an optimized mixed diet, e.g. regarding warm lunch, can be used similarly in families and institutions. Children should have one warm meal each day. Commonly available catering systems (e.g. delivery of warm meals from an external kitchen and on-site cooking, including deep frozen food and chilled food from an external kitchen) are equally suitable to offer proper warm meals in institutional nutritional care. Additional offers of cold (bread) meals or snacks could partially compensate for the decreasing participation of older pupils in the warm lunch menu. As part of environmental prevention children having a low quality diet at home in particular would profit from well-balanced institutional nutrition for diet and health.     

Aktuelle STIKO-Impfempfehlungen für Kinder und Jugendliche

The German Advisory Board for Vaccination (STIKO) at the Robert Koch-Institute proposes recommendations to prevent infectious diseases and associated complications through population-based immunization programs. STIKO recommendations focus on vaccination concepts that are of relevance for public health goals (“in public interest”). In addition, STIKO recommendations provide guidance about which vaccinations are indicated for specific risk situations, e.g. related to occupational hazards. Moreover, a comprehensive review on catch up vaccination programs for individuals with incomplete or unknown vaccination status is given. This article reviews the basics of current vaccination practices in Germany and describes the latest STIKO recommendations and its most important innovations.     

Sprechstunde für Kinder psychisch kranker Eltern

Children whose parents suffer from psychiatric illnesses are at a much higher risk of developing psychiatric illness based on the vulnerability-stress-coping model however, resilience may also reduce the risk. Psychoeducation about their parents’ illness, enhancing their self-confidence and self-efficacy may serve as important protective factors. Cooperation between the Departments of Psychiatry and Psychotherapy and Child and Adolescent Psychiatry at the University of Munich has led to an expansion of groups for relatives with consulting hours for children in order to provide support mechanisms for this group at risk. After stabilization of the affected patient and providing support for the partner, information is provided adapted to the child’s level of understanding, with the mother and father integrated into treatment to guarantee support and relief. If the child has additional treatment needs the necessary steps are taken. The integration of relatives and the utilization of support procedures for children under 18 years of age should play an important role in psychiatry. Jointly sharing information between patients, relatives and professionals has the potential to facilitate their coping with the psychiatric illness and to improve quality of family life for all members.     

Update: Impfempfehlungen für Kinder und Jugendliche

Monatsschrift Kinderheilkunde - Die Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut (RKI) haben das Ziel, Infektionskrankheiten und damit assoziierte Komplikationen,...     

Sozialmedizinische Nachsorge für schwer und chronisch kranke Kinder

Coordinated ambulatory aftercare of children and adolescents with severe and chronic conditions will improve the transition from inpatient to outpatient care. Aftercare professionals network within and outside the aftercare team, coordinating services and educating and counselling parents, family members, and professionals. They support adaptation and coping processes, accompany the parents to other welfare and health care services, and empower families to access needed services. Aftercare follows the principles of case management and includes home-based services and home visits. Social medical aftercare is supported by the German health insurances, so care providers must be certified and accredited in order to be reimbursed. The aftercare concept described here, called “Bunter Kreis” (Colourful Circle), has been scientifically evaluated, accredited by the health insurance and health boards, and serves as a model for over 47 aftercare organizations in Germany. These organisations are connected in a quality network, “Qualitätsverbund Bunter Kreis”.     

Robotergestützte Laufbandtherapie für Kinder mit zentralen Gangstörungen

Background. The aims of this study were to test the feasibility of treadmill training with a robotic assisted gait orthosis in children from 4 years of age with central gait impairment and to obtain preliminary results on the efficacy of this intervention. Patients and Methods. A total of 24 patients with central gait impairment aged between 4 and 21 years were included in a clinically controlled trial with a pre-post design. Results. Of the 24 patients, 23 were able to complete the training. There were improvements in velocity, endurance and motor skills such as “standing” and “walking”. Conclusions. Robotic assisted treadmill training in children with central gait impairment is feasible from 4 years of age and leads to significant improvement in velocity, endurance and motor function. This technique may develop to a relevant therapy for regaining motor function.     

Vorsorge- und Rehabilitationsmaßnahmen für Kinder und Jugendliche

As the result of new legislation introduced in 2007 children in Germany enjoy the same rights to prophylaxis and in-patient rehabilitation services as adults. The aim of pediatric rehabilitation is to prevent children from losing their ability to function or participate or to recover lost functions, activities and participation. The best interests of the child are the main consideration. Both preventative and rehabilitative measures may be employed for specific indications, usually following established guidelines. In pediatric rehabilitation, the parents of children under the age of 12 years may also be involved in the medical treatment and health education as “co-therapists”. In contrast, -child treatment programmes focus more on the parents. Based on requirements laid down by the insurer, the main emphasis of these latter programmes is on prevention, psychosocial aspects and parent-child interaction, which is integrated into the treatment plan. Every pediatrician should therefore know the differences between parent-child treatment programmes and approaches directed primarily at the child, in order to help the patients choose the appropriate rehabilitative therapy.     

Schulungsmaßnahmen für neurodermitiskranke Kinder und deren Eltern

Childhood atopic dermatitis (AD) is a common disease with prevalence rates still increasing. Its chronic course with frequent relapses puts a special burden on both children and their parents. To maximise positive long-term outcome in the management of AD it is important to support parents in dealing with the chronic condition of their child in addition to treating symptoms. The present article gives an overview on published programs for the education for parents and children with AD. Results of the evaluation of the Berlin parent education program are presented. Design of the current multicentre study “Modellprojekt Neurodermitisschulung” as well as aims, contents, and structure of the educational program are presented.     

Schulung Obeldicks für adip?se Kinder und Jugendliche

Background

Lifestyle intervention based on diet counseling, exercise, and behavioral therapy is the therapy of choice in childhood obesity. However, predictive factors for outcome are largely unknown. Therefore, the aim of this study was to analyze the impact of participants’ motivation and structured education for therapists on the outcome of the intervention Obeldicks.

Materials and methods

Age, gender, degree of overweight at baseline [as standard deviation score (SDS) of BMI], motivation (proved by participation in exercise groups, filling in questionnaires, and performing dietary records), and training of therapists in a 1-week seminar were correlated with the outcome of the intervention both at end of 1-year intervention and 1?year after end of treatment by multiple linear regression analyses. The intervention was offered at five centers in the Ruhr region in Germany.

Results

At total of 1,083 obese children and adolescents (median BMI 27.9?kg/m²) aged 8–15 years (55% females) were included in the analyses. Forty percent of the participants reduced their SDS-BMI >0.2. The dropout rate was 22%. In multiple linear regression analyses, the reduction of SDS-BMI at end of intervention was associated with motivation (p<0.001), training of therapists (p<0.001), age of participants (p<0.001), and degree of overweight (p=0.026). All these factors were also significantly related to SDS-BMI reduction 1?year after end of treatment.

Conclusion

Since younger age and lower degree of overweight were associated with better outcome, intervention should be offered early in childhood obesity. Patient’s motivation and training of therapists improve the outcome of lifestyle interventions.     

Strukturierte Erfassung der Therapieangebote für adipöse Kinder und Jugendliche

Background

A structured survey of treatment programs for obese children is still missing in Germany. We performed this survey on behalf of the AGA (association for treatment of obesity in children and adolescents) to identify treatment programs and evaluate their success.

Methods

A structured questionnaire was sent to all members of the AGA, children's hospitals, social pediatric centers, public health offices, rehabilitation clinics, and the federation of health insurance providers in Germany (n=1464). In addition, a request for information was published in medical journals and on the home page of the AGA.

Results

A total of 119 outpatient and 56 inpatient treatment centers for obese children and adolescents were identified in Germany. They will be published on the Internet pages of the AGA. The recommendations of the AGA are not met by 51% of the outpatient and 27% of the inpatient therapy plans. Only 16% of the outpatient and 14% of the inpatient therapy institutions evaluate therapy success at the end of the treatment program.

Discussion

This survey demonstrates considerable heterogeneous quality in the therapy of obese children. The efficacy of treatment plans is still unclear since no long-term follow-up data are available. A controlled long-term follow-up study is necessary to improve the quality of treatment programs and to evaluate their efficacy.     

Moderne Behandlungskonzepte für Kinder und Jugendliche mit Diabetes mellitus Typ 1

Diabetes mellitus type 1 is one of the most common chronic diseases in childhood. Acute treatment of diabetic ketoacidosis (DKA) includes treatment of shock, slow and moderate rehydration, correction of electrolyte deficits and substitution of insulin. The most severe complication is brain edema. Associated risk factors are rehydration with large volumes and hypotonic solutions, rapid decrease in serum osmolarity as well as duration and severity of clinical signs of DKA. Insulin therapy in children and adolescents includes the conventional two or multi-injection therapy and also insulin pump treatment. Continuous care of diabetic children and adolescents requires multidisciplinary teams including pediatric diabetologists, diabetes educators and psychologists. Furthermore, collaboration with ophthalmologists, gynecologists and pediatricians is mandatory.