Safeguarding children – understanding the roles of Named and Designated Professionals

Safeguarding is everyone's responsibility. To be able to discharge these responsibilities there needs to be a robust and supportive multi-agency safeguarding system to ensure children and young people reach their optimum potential and best outcomes. Designated and Named Professionals are key parts of such a system. This paper describes the roles and responsibilities of Designated and Named Professionals, how they support the system and safeguarding as well as the key attributes they require to undertake these roles. It describes the challenges they face but also the rewarding aspects of their involvement. The readers are urged to reflect on why a career in this field is intellectually stimulating and worth considering. Both authors have enjoyed their roles as Designated Doctors in Safeguarding Children.     

Association between caregivers’ anxiety and depression symptoms and feeding difficulties of preschool children: A cross-sectional study in rural China

PurposeTo investigate the prevalence of feeding difficulties in preschool children and explore the association between caregivers’ anxiety and depression symptoms and preschool children's feeding difficulties.MethodsThis cross-sectional study was conducted between June 2017 and January 2018 in rural areas of Anhui province, China. A total of 2231 preschool children and their caregivers were interviewed. Feeding difficulties of preschool children were reported by caregivers using the adapted Identification and Management of Feeding Difficulties (IMFeD) tool. Anxiety and depression symptoms of caregivers were evaluated via the Self-Rating Anxiety Scale (SAS) and the Self-Rating Depression Scale (SDS).ResultsIn total, 54.1% of preschool children were reported to have feeding difficulties by their caregivers. Among all children, when the caregivers had symptoms of anxiety or depression, the children had a higher risk of feeding difficulties. Specifically, for caregivers’ anxiety symptoms, the odds ratios (ORs) of feeding difficulties in all children, left-behind children (LBC), and non-LBC were 1.91 (95% confidence interval [CI]: 1.42–2.57), 2.04 (95% CI: 1.34–3.09), and 1.86 (95% CI: 1.21–2.87), respectively; for caregivers’ depression symptoms, the ORs of feeding difficulties in all children, LBC, and non-LBC were 1.86 (95% CI: 1.46–2.39), 1.76 (95% CI: 1.24–2.51), and 2.08 (95% CI: 1.45–2.97), respectively. In addition, when caregivers who were parents or grandparents had anxiety or depression symptoms, their children had a higher risk of feeding difficulties. Specifically, for parents and grandparents with anxiety symptoms, the ORs of feeding difficulties were 1.84 (95% CI: 1.14–2.98) and 2.17 (95% CI: 1.46–3.22), respectively; for parents and grandparents with depression symptoms, the ORs of feeding difficulties were 2.03 (95% CI: 1.40–2.95) and 1.93 (95% CI: 1.37–2.73), respectively.ConclusionCaregivers’ anxiety or depression symptoms are positively associated with feeding difficulties in children.     

The conundrums of human development – implications for the study of child and adolescent disorder

The conundrums inherent in the study of child and adolescent development are likely never far from the minds of the readers of JCPP. The complexity of development is flagged clearly in this issue. Included papers remind us that the link between associations (here maternal depression and child internalising problems) can change over short time periods. Even when the magnitude of associations stay consistent over time (here between the home environment and depression), there may be different aetiological processes underlying these links. Going forward, we should not lose sight of the significance of small changes in study designs, whether concerning the age range of participants, stipulated reporting periods and data analysis decisions (such as combining data from different age groups). The value of longitudinal data in addressing these questions remains paramount.     

Management policies for children with renal transplantation in the Netherlands,Belgium and Germany – Report from the RICH-Q study

Tijdschrift voor Kindergeneeskunde -     

Hospital stay and short-term follow-up of children of drug-abusing mothers born in an urban community hospital – a retrospective review

In order to assess the current use of medical and social services of children of drug-abusing mothers in regard to their short term outcome in a Swiss urban community hospital, we compared hospital, private paediatricians and home nursing records of 37 of these children with 37 matched control children from birth to 18 months of age. Children of drug-abusing mothers (CDAM) experienced a longer neonatal hospital stay than control children with a median (25%–75%) of 26 days (10.5–52.5 days) versus 5 (5–6) days (P < 0.001), a substantial part of which, 8 days (3.5–26 days) versus 0 days (0–1 day) (P < 0.001) was not motivated by any specific medical treatment or nursing care. Before discharge, CDAM were referred to out of hospital nursing and social services for further management, but only 13% were effectively followed. More than 50% were lost to follow-up by their initial paediatrician after 1 year of life. Conclusion New ways to ensure better co-ordination between paediatricians and the social services (inside and outside the hospital) should be developed to shorten the neonatal hospitalisation period and improve the quality of follow-up. Received: 14 September 1999 and in revised form: 19 January, 25 February and 16 March 2000 Accepted: 24 March 2000     

The role of mother-child relationship in the association between maternal parenting stress and emotional and behavioral problems in preschool children北大核心CSCD

Objective To study the moderating effect of mother-child relationship in the association between maternal parenting stress and emotional and behavioral problems in preschool children, and to provide reference for the prevention and control of emotional and behavioral problems in preschool children. Methods Using a stratified cluster sampling method, 2 049 preschool children were surveyed from November to December 2021, who sampled from 12 kindergartens in Wuhu City, Anhui Province. The emotional and behavioral problems of preschool children were assessed with the Strength and Difficulties Questionnaire. Pearson correlation analysis was used to evaluate the relationship of maternal parenting stress and mother-child relationship with children's emotional and behavioral problems. The PROCESS Macro was used to analyze the moderating effect of conflicted and dependent mother-child relationships in the association between maternal parenting stress and emotional and behavioral problems in these preschool children. Results Among these preschool children, maternal parenting stress was positively correlated with the scores of emotional symptoms, conduct problems, hyperactivity, and peer problems subscales and total difficulty scores (P<0.001); intimate mother-child relationships were negatively correlated with the scores of conduct problems, hyperactivity, and peer problems subscales and total difficulty scores (P<0.001); conflicted and dependent mother-child relationships were positively correlated with the scores of emotional symptoms, conduct problems, hyperactivity, and peer problems subscales and total difficulty scores (P<0.001). After controlling for relevant confounding factors, conflicted mother-child relationship (β=0.05, P=0.001) and dependent mother-child relationship (β=0.04, P=0.012) were found to have a moderating effect on the association between maternal parenting stress and total difficulty scores in these preschool children. Conclusions Negative mother-child relationships play a moderating role in the association between maternal parenting stress and emotional and behavioral problems in preschool children. Prevention of emotional and behavioral problems in preschool children should focus on reducing maternal parenting stress and improving negative mother-child relationships. © 2023 Xiangya Hospital of CSU. All rights reserved.     

Prematurity and school readiness in a nationally representative sample of Australian children: Does typically occurring preschool moderate the relationship?

Objective

This study aims to examine the relationship between indicators of prematurity and children's cognitive and behavioral school readiness in a nationally representative sample and to investigate whether typically occurring preschool enrollment moderates this relationship, particularly for children from disadvantaged families in Australia.

Methods

The Longitudinal Study of Australian Children is a nationally representative prospective sample of two cohorts of children with sequentially obtained indicators of child health and developmental outcomes. We analyzed information on 8060 children aged 4–5 years who had complete data on birth weight, gestational age, prenatal risks, social factors, and cognitive and behavioral outcomes of school readiness. Multivariate regressions were used to relate three indicators of prematurity (low birth weight, preterm birth, and small for gestational age) to cognitive and behavioral school readiness.

Results

Children born preterm, small for gestational age, or with low birth weight have significantly lower cognitive school readiness after controlling for social factors and prenatal risks. None of the premature indicators were associated with behavioral school readiness. All children benefited from attending preschool. Yet, preschool enrollment did not moderate the relationship between prematurity and school readiness. The only exception is for small for gestational age survivors with low educated mothers. Preschool enrollment was associated with an increase in cognitive school readiness skills.

Conclusions

Prematurity was associated with lower cognitive school readiness skills. Typical occurring preschool did not eliminate this association. Findings suggest that simply expanding the preschool enrollment is inadequate to address the developmental needs of premature children from disadvantaged backgrounds.     

Burden of otitis media and pneumonia in children up to 6 years of age: results of the LISA birth cohort

Infections play an important role in childhood. For Germany, few data are available on the epidemiology of infectious diseases such as otitis media and pneumonia in children. We therefore described the prevalence, first episode proportions and recurrence of these childhood infection diseases in selected regions of Germany in children up to 6 years of age. The analysis was based on data from the LISA Study, a prospective population-based birth cohort study including 3,097 full-term infants. Information was collected by parent questionnaire. The first episode proportions for the first 6 years of life were high for otitis media (66.7%; 95%CI 0.65–0.69) and pneumonia (13.5%; 95%CI 0.12–0.15). The annual first episode proportions for otitis media ranged from 7.3% to 25.6% and for pneumonia from 1.4% to 3.4%; both peaked during the second year. The average number of otitis media episodes was 2.2 (SD 2.0) episodes per child within the first 2 years. During the first 2 years of life, hospitalisations due to otitis and pneumonia occurred in up to 7.8‰ and 3.0‰ of the children, respectively. On average, 50.6% of the children with otitis media were treated with antibiotics during the first year of life. In conclusion, this analysis shows that infectious diseases, especially otitis media, are very frequent childhood diseases in Germany. Thus, parents and physicians should not per se worry about a high frequency of otitis media during early childhood.     

Immunogenicity and safety of the quadrivalent meningococcal serogroups A, C, W-135 and Y tetanus toxoid conjugate vaccine (MenACWY-TT) in 2–10-year-old children: results of an open, randomised, controlled study

In Europe, the introduction of monovalent meningococcal serogroup C (MenC) conjugate vaccines has resulted in a significant decline in MenC invasive disease. However, given the potential for strain evolution and increasing travel to areas of high endemicity, protection against additional serogroups is needed. In this study, the immunogenicity, measured by a serum bactericidal activity assay using rabbit complement (rSBA), and the safety of a quadrivalent meningococcal serogroups A, C, W-135 and Y tetanus toxoid conjugate vaccine (MenACWY-TT) were compared to that of a licensed monovalent MenC conjugate vaccine (MenC-CRM₁₉₇) in children 2–10 years of age. Children were randomised (3:1) to receive a single dose of either MenACWY-TT or MenC-CRM₁₉₇. Non-inferiority of the immunogenicity of MenACWY-TT versus MenC-CRM₁₉₇ in terms of rSBA-MenC vaccine response was demonstrated. Exploratory analyses suggested that rSBA-MenC geometric mean titres adjusted for pre-vaccination titres were lower in children vaccinated with MenACWY-TT compared to MenC-CRM₁₉₇. Nevertheless, at 1 month post-vaccination, ≥99.3 % of the children who received MenACWY-TT had rSBA titres ≥1:128 for each of the four vaccine serogroups, which is the more conservative correlate of protection. The reactogenicity and safety profile of MenACWY-TT was clinically acceptable and no serious adverse events considered related to vaccination were reported throughout the study. Conclusion: When administered to European school-age children, MenACWY-TT has a clinically acceptable safety profile and, when compared with MenC-CRM₁₉₇, the potential to broaden protection against meningococcal disease caused by serogroups A, W-135 and Y while maintaining protection against MenC. This study has been registered at www.clinicaltrials.gov NCT00674583.     

Concordance between school outcomes and developmental follow-up results of very preterm and/or low birth weight children at the age of 5 years

Introduction Long-term follow-up studies have revealed a high frequency of developmental disturbances in preterm survivors of neonatal intensive care who were formerly considered to be non-disabled. These developmental disturbances interfere with the acquisition of everyday skills and, in particular, with normal school functioning. Methods Developmental and school outcomes of 355 children, age 5 years at the time of the study, who had a mean gestational age of 30.2 weeks (SD: 1.95) and a mean birth weight of 1272 g (SD: 326) were investigated. Children with severe handicaps were excluded from the study. Perinatal data, information from a parental and school questionnaire and data from standardized developmental tests were used to explain the differences. Results An agreement of 72% was found between developmental follow-up and school outcomes. Normal developmental results but problematic school outcomes were found for 15% of the children tested. There were more boys than girls in this latter group as well as small-for-gestational-age children with relatively poor motor or language development. The schools had not identified problems in 13% of the children, whereas their developmental outcomes were problematic. These children had less neonatal morbidity and relatively higher IQ’s than children who also had problematic developmental outcomes but who had been signalled as problematic by their schools. Conclusions Schools have a good insight in the school functioning of children who are developing well and of children with the lowest developmental scores and the most complicated neonatal histories. How school and developmental outcomes interrelate in the in-between groups remains a challenging question that could be answered by following these children throughout their school career. The study was supported by a grant of the Praeventiefonds, project no. 28-2756 and Zorg Onderzoek Nederland (ZON), project no. 10010004-20.     

Where are the opportunities for an earlier diagnosis of primary intracranial tumours in children and young adults?

BackgroundChildhood brain tumours have some of the longest time to diagnosis. A timely diagnosis may have a role in reducing anxiety in waiting for a diagnosis and subsequent morbidity and mortality. We investigated where the opportunities for an earlier diagnosis were, and for which anatomical locations this strategy will most likely to be effective.MethodsA record-linkage cohort study of patients diagnosed aged 0–24 years with a primary intracranial tumour between 1989 and 2006 in England, using records from the National Cancer Registry linked to hospital admission records from Hospital Episode Statistics (HES, 1997–2006) and primary care consultation records from Clinical Practice Research Datalink (CPRD, 1989–2006). Relevant neurological presentations were extracted from HES and CPRD. Temporal changes in presentation rates were estimated in generalised additive models.ResultsFrequency of presentation began to increase six months before diagnosis in primary care and three months before diagnosis in hospital. Supratentorial and midline tumours had the longest presentation history before diagnosis. Peri-ventricular tumours presented frequently in hospital (rate ratio = 1.29 vs supratentorial tumours; 95% CI = 1.12–1.48) or as an emergency (1.24; 1.01–1.51), and in primary care (1.12; 0.62–1.85).ConclusionsOpportunities for an earlier diagnosis are greater in supratentorial, midline or cranial nerve tumours, which have a longer presentation history than peri-ventricular, cerebellar or brainstem tumours. Common features before diagnosis include headache, convulsions, and growth or endocrine disorders. Focal neurological deficits are uncommon and emerge late in the pre-diagnosis period.     

Can urodynamic studies be dispensed with in the initial urologic management of children with meningomyelocele? A study of 30 cases and review of the literature

ObjectiveTo identify whether a relationship exists between information gathered from voiding patterns, neurological status and radiological findings, and the actual dysfunction seen on cystometry in children with spina bifida.Patients and methodsThirty consecutive children with spina bifida underwent clinical evaluation, urinary tract imaging and cystometry. The clinical and radiological data were correlated with actual bladder dysfunction.ResultsCystometry was abnormal in 87% with overactive detrusor in 77%. Seventeen patients (57%) had significant residual urine of whom all had neurological or voiding abnormalities. Irrespective of radiological findings (abnormal in 53%), 90% of these patients had detrusor overactivity and 10% an underactive detrusor. In the group with insignificant residual urine (n = 13), upper tract was abnormal in six (46%) of which four had neurological/voiding abnormalities and detrusor overactivity. The other two patients with normal neurologic status and voiding pattern had normal cystometry, but their upper tract damage was inexplicable. Of the patients with insignificant residual urine and normal upper tracts (n = 7), four had neurologic/voiding abnormalities, three with an overactive detrusor and one underactive detrusor, and of the other three, one had an overactive detrusor.ConclusionsPatients with significant residual urine can be presumed to have detrusor overactivity and may be initially managed with clean intermittent catheterization and bladder relaxants. Cystometry is indicated if upper tract shows deterioration. In patients with insignificant residual urine and abnormal clinical evaluation or radiology, detrusor overactivity can be presumed and urodynamic studies deferred. Patients with insignificant residual urine, normal radiology but abnormal clinical findings must undergo initial cystometry.     

Associations between Arab Mothers’ Self-Efficacy and Parenting Attitudes and their children’s Externalizing and Internalizing Behaviors: Gender Differences and the Mediating Role of Corporal Punishment

In this study we examined the association between Arab mothers’ self-efficacy and parenting attitudes and their children’s internalizing and externalizing behaviors, and whether these associations are mediated by the use of corporal punishment. Further, we examined whether the child’s gender moderates these associations. We included 2380 mothers of kindergartners who answered a questionnaire assessing levels of self-efficacy, attitudes on corporal punishment, use of corporal punishment, and their children’s internalizing and externalizing behaviors. Using structural equation modeling we tested for the mediation by corporal punishment of the association between self-efficacy, attitudes on corporal punishment and children’s behaviors. We further tested possible moderation by gender of the model. Results supported the hypothesized mediation effect of corporal punishment. Results suggest that mothers’ low self-efficacy and attitudes supporting corporal punishment were associated with elevated likelihood of use of corporal punishment which, in turn was associated with elevated levels of child’s internalizing and externalizing behaviors. No moderation by gender of this pathway was found, suggesting that boys and girls react similarly to the use of corporal punishment by their mothers. Interventions aimed at helping Arab mothers understand the impact of their behavior and guide them toward effective disciplinary strategies are suggested.