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Latest & greatest articles for children
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on children or other clinical topics then use Trip today.
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Methylphenidate remains first-choice drug treatment for children and young people with ADHD Methylphenidate remains first-choice drug treatment for children and young people with ADHD Discover Portal Discover Portal Methylphenidate remains first-choice drug treatment for children and young people with ADHD Published on 6 November 2018 doi: The stimulant methylphenidate has the best balance of effectiveness against side effects in children and young people with attention deficit hyperactivity (...) disorder. Amphetamines are more effective, but also more likely to be stopped for a reason other than side effects. This large, NIHR-funded systematic review compared a range of drugs against each other through a network meta-analysis. Effectiveness and tolerability were assessed at about 12 weeks of treatment. Other second-line drug treatments were also effective and well-tolerated, including modafinil which is currently not licensed for children in the UK. There were some quality issues due to risk
Sodium thiosulfate reduces hearing loss in children treated with chemotherapy Sodium thiosulfate reduces hearing loss in children treated with chemotherapy Discover Portal Discover Portal Sodium thiosulfate reduces hearing loss in children treated with chemotherapy Published on 6 November 2018 doi: Treatment with sodium thiosulfate alongside cisplatin chemotherapy can reduce hearing loss in children with a liver tumour called hepatoblastoma. The risk of hearing loss was reduced by 48 (...) % in children who had the combination treatment compared with those who had cisplatin only. This phase 3 trial involved 109 children with standard-risk hepatoblastoma and tested the addition of sodium thiosulfate six hours after cisplatin treatment. The additional drug caused few major side effects, and there was no difference in event-free or overall survival between treatment groups after three years. Although small, the study adds to growing evidence that this well tolerated, cheap treatment might reduce
Adding emollients to the bath unlikely to help children with eczema Adding emollients to the bath unlikely to help children with eczema Discover Portal Discover Portal Adding emollients to the bath unlikely to help children with eczema Published on 7 August 2018 doi: Adding emollients to children’s bath water does not significantly improve their eczema. Prescriptions should focus on emollients applied directly to the skin or used as a soap substitute. Using emollients to lock in moisture (...) is the standard treatment for childhood eczema. These can be applied in a number of ways, but there is uncertainty surrounding their use as a bath additive. This NIHR-funded year-long trial included 482 children, mostly with mild eczema. It found there was little change in skin-related outcomes or quality of life between those that did or did not have emollients poured into their bath. Share your views on the research. Why was this study needed? Eczema often starts in childhood, affecting between 10 to 30
Ultrasound shows potential for confirming the diagnosis of pneumonia in children Diagnosis of pneumonia in children may be confirmed by ultrasound Discover Portal Discover Portal Ultrasound shows potential for confirming the diagnosis of pneumonia in children Published on 24 July 2018 doi: Ultrasound scans of the lungs can be more accurate than chest X-rays for diagnosing pneumonia in children in some circumstances. A review of the published evidence found that lung ultrasound was more (...) sensitive (missed fewer cases) and about as specific (gave about the same number of false alarms) as chest X-ray, when used to confirm suspected community-acquired pneumonia in children. While pneumonia is a clinical diagnosis, X-ray is often used for confirmation. Ultrasound also spares the child from the radiation associated with X-ray imaging. Many emergency departments already use ultrasound, so it might be practical to train paediatric staff to use it as a first-line test. However, the study found
General hospital care for children with learning disabilities has scope for improvement General hospital care for children with learning disabilities has scope for improvement Discover Portal Discover Portal General hospital care for children with learning disabilities has scope for improvement Published on 18 September 2018 doi: Less than half of NHS staff surveyed said they were routinely informed that a child has learning disabilities through a dedicated flagging system on admission. Many (...) general hospital staff lack confidence and organisational support in providing care for children and young people with learning disabilities. In an NIHR national hospital staff-awareness survey, staff were uncertain or unaware of local policy and practice. Only half of the children’s hospitals had a learning disability nurse, and where they did exist, there was disparity in the status and importance attributed to the role. This is likely to prevent the needs of these children being fully met
Vaccination likely to reduce flu in healthy children Vaccination likely to reduce flu in healthy children Discover Portal Discover Portal Vaccination likely to reduce influenza in healthy children Published on 22 May 2018 doi: In healthy children aged two to 16, vaccines are likely to reduce laboratory-confirmed cases of influenza and may reduce the risk of influenza-like illness compared to placebo. Seven children need to receive the live vaccine to prevent one case of confirmed influenza (...) . Twenty children need to be vaccinated to prevent one case of influenza-like illness. This updated Cochrane review included 41 trials of either live attenuated (weakened) or inactivated influenza vaccines, with over 200,000 participants. The evidence gave a moderate to high level of certainty about their effects on influenza, but only a low certainty about the effect on influenza-like illness due to problems in reporting and data capture. The finding supports the benefits of the existing vaccination
School-based self-management interventions for asthma in children and adolescents: a mixed methods systematic review. Asthma is a common respiratory condition in children that is characterised by symptoms including wheeze, shortness of breath, chest tightness, and cough. Children with asthma may be able to manage their condition more effectively by improving inhaler technique, and by recognising and responding to symptoms. Schools offer a potentially supportive environment for delivering (...) interventions aimed at improving self-management skills among children. The educational ethos aligns with skill and knowledge acquisition and makes it easier to reach children with asthma who do not regularly engage with primary care. Given the multi-faceted nature of self-management interventions, there is a need to understand the combination of intervention features that are associated with successful delivery of asthma self-management programmes.This review has two primary objectives.• To identify
Association of Matched Sibling Donor Hematopoietic Stem Cell Transplantation With Transcranial Doppler Velocities in Children With Sickle Cell Anemia. In children with sickle cell anemia (SCA), high transcranial Doppler (TCD) velocities are associated with stroke risk, which is reduced by chronic transfusion. Whether matched sibling donor hematopoietic stem cell transplantation (MSD-HSCT) can reduce velocities in patients with SCA is unknown.To determine the association of MSD-HSCT with TCD (...) velocities as a surrogate for the occurrence of ischemic stroke in children with SCA.Nonrandomized controlled intervention study conducted at 9 French centers. Patients with SCA were enrolled between December 2010 and June 2013, with 3-year follow-up ending in January 2017. Children with SCA were eligible if younger than 15 years, required chronic transfusions for persistently elevated TCD velocities, and had at least 1 sibling without SCA from the same 2 parents. Families agreed to HLA antigen typing
Postoperative epidural analgesia versus systemic analgesia for thoraco-lumbar spine surgery in children. Spine surgery may be associated with severe acute postoperative pain. Compared with systemic analgesia alone, epidural analgesia may offer better pain control. However, epidural analgesia has sometimes been associated with rare but serious complications. Therefore, it is critical to quantify the real benefits of epidural analgesia over other modes of pain treatment.To assess (...) the effectiveness and safety of epidural analgesia compared with systemic analgesia for acute postoperative pain control after thoraco-lumbar spine surgery in children.We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and Cumulative Index to Nursing and Allied Health Literature on 14 November 2018, together with the references lists of related reviews and retained trials, and two trials registers.We included all randomized controlled trials performed in children
Obesity in children Obesity in children - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search Obesity in children Last reviewed: February 2019 Last updated: January 2019 Summary Behavioural and environmental factors are primarily responsible for the dramatic increase in obesity in the past two decades, although genes play an important role in regulation of body weight. Calculating body mass index (BMI) is the most widely (...) accepted method of screening for obesity in children. Abnormal BMI cut-offs in children are determined by age- and sex-specific percentiles. The dramatic increase in childhood obesity has led to a marked increase in the diagnosis of impaired glucose tolerance and type 2 diabetes mellitus in children. Preventing excessive weight gain in children is of paramount importance in confronting the obesity epidemic, as obesity is difficult to treat at all ages, and obese children tend to become obese adults
Chest physiotherapy for pneumonia in children. Pneumonia is a lung infection that causes more deaths in children aged under five years than any other single cause. Chest physiotherapy is widely used as adjuvant treatment for pneumonia. Physiotherapy is thought to help remove inflammatory exudates, tracheobronchial secretions, and airway obstructions, and reduce airway resistance to improve breathing and enhance gas exchange. This is an update of a review published in 2013.To assess (...) the effectiveness of chest physiotherapy with regard to time until clinical resolution in children (from birth to 18 years) of either gender with any type of pneumonia.We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 1), which includes the Cochrane Acute Respiratory Infections Group Specialised Register, MEDLINE (22 February 2018), Embase (22 February 2018), CINAHL (22 February 2018), LILACS (22 February 2018), Web of Science (22 February 2018), and PEDro (22 February 2018
Effects of fascia iliaca compartment block combined with general laryngeal mask airway anesthesia in children undergoing femoral fracture surgery: a randomized trial Postoperative agitation after general anesthesia is a common complication in children; however, pain or uncomfortable feeling is the main reason of emergence agitation. Here, we have investigated the effects of fascia iliaca compartment block (FICB) combined with general laryngeal mask airway (LMA) anesthesia in children undergoing (...) femoral surgery.Eighty children undergoing femoral surgery were randomly divided into two groups: FICB + LMA group and control group (n=40). The FICB + LMA group received FICB combined with general LMA anesthesia, and the control group received tracheal intubation general anesthesia alone. Anesthesia was maintained with nitrous oxide and sevoflurane. Hemodynamic parameters were monitored, and pain was assessed by verbal numeric score within 24 hours postoperatively. Time to extubation, time
Regional Analgesia Added to General Anesthesia Compared With General Anesthesia Plus Systemic Analgesia for Cardiac Surgery in Children: A Systematic Review and Meta-analysis of Randomized Clinical Trials The aim of this systematic review was to compare the effects of regional analgesic (RA) techniques with systemic analgesia on postoperative pain, nausea and vomiting, resources utilization, reoperation, death, and complications of the analgesic techniques in children undergoing cardiac (...) neurological or infectious complications related to the RA techniques. One trial reported 1 transient ipsilateral episode of diaphragmatic paralysis with intrapleural analgesia that resolved with cessation of local anesthetic administration.Compared to systemic analgesia, RA techniques reduce postoperative pain up to 24 hours in children undergoing cardiac surgery. Currently, there is no evidence that RA for pediatric cardiac surgery has any impact on major morbidity and mortality. These results should
Clinical Practice Guideline: Maintenance Intravenous Fluids in Children Maintenance intravenous fluids (IVFs) are used to provide critical supportive care for children who are acutely ill. IVFs are required if sufficient fluids cannot be provided by using enteral administration for reasons such as gastrointestinal illness, respiratory compromise, neurologic impairment, a perioperative state, or being moribund from an acute or chronic illness. Despite the common use of maintenance IVFs (...) from 28 days to 18 years of age who require maintenance IVFs. This guideline applies to children in surgical (postoperative) and medical acute-care settings, including critical care and the general inpatient ward. Patients with neurosurgical disorders, congenital or acquired cardiac disease, hepatic disease, cancer, renal dysfunction, diabetes insipidus, voluminous watery diarrhea, or severe burns; neonates who are younger than 28 days old or in the NICU; and adolescents older than 18 years old
The Effect of a Parental Visitation Program on Emergence Delirium Among Postoperative Children in the PACU. The purpose of this study was to examine the effects of parental presence on the incidence of emergence delirium (ED) of children in the postanesthesia care unit (PACU).A quasi-experimental pretest and post-test study with nonequivalent and nonsynchronized control groups.About 93 children aged 3 to 6 years undergoing general anesthesia for tonsillectomy were divided into two groups (...) : parental presence and absence. ED was recorded using the Pediatric Anesthesia Emergence Delirium Scale at 0, 10, 20, and 30 minutes after PACU admission.ED score at each time point in the experimental group was lower than the control group, but not statistically significant. ED score in the experimental group significantly decreased over time (F = 6.98; P = .010).Parental visitation programs could be effective on the degree of ED in children in the PACU setting. This result may contribute
Placebo vs Amoxicillin for Nonsevere Fast-Breathing Pneumonia in Malawian Children Aged 2 to 59 Months: A Double-blind, Randomized Clinical Noninferiority Trial Pneumonia is the leading infectious killer of children. Rigorous evidence supporting antibiotic treatment of children with nonsevere fast-breathing pneumonia in low-resource African settings is lacking.To assess whether treatment with placebo for nonsevere fast-breathing pneumonia is substantively less effective than 3 days of treatment (...) with amoxicillin.This double-blind, 2-arm, randomized clinical noninferiority trial with follow-up of 14 days screened 1343 HIV-uninfected children aged 2 to 59 months with nonsevere fast-breathing pneumonia at outpatient departments of hospitals in Lilongwe, Malawi, Africa, between June 2016 and June 2017.Placebo or amoxicillin dispersible tablets administered twice daily for 3 days.The primary end point was the proportion of children failing treatment by day 4 with a relative noninferiority margin of 1.5 times