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A review of growth hormone deficiency

Paediatrics and Child Health - Tue, 06/11/2019 - 00:00
Growth hormone deficiency (GHD) is a rare but important cause of short stature in children. It is treatable. However, diagnosis is challenging and often requires referral to a specialist paediatric endocrinologist to facilitate testing and the interpretation of results. Careful history and examination with meticulous auxology data are critical components of the initial evaluation in clinic. Thereafter, further investigations are required to exclude other causes of short stature, and to establish the diagnosis.
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Von Willebrand disease: diagnosis and management

Paediatrics and Child Health - Mon, 06/10/2019 - 00:00
Von Willebrand Disease is a common cause of excessive bruising and bleeding in children. This short article gives advice on diagnosis and management for paediatricians. Given its prevalence and presenting symptoms, VWD should always be considered in the assessment of children suspected of non-accidental injury. Its diagnosis can be challenging, not only because of the various subtypes of the disorder but because of the considerable overlap between VWD and normal individuals. Laboratory diagnosis requires a range of quantitative and qualitative tests of the VWF protein, with targeted gene analysis increasingly used to confirm the diagnosis of type 2 and type 3 VWD.
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Medical Marijuana in the Pediatric Population With Epilepsy—What You Should Know

Journal of Pediatric Health Care - Sat, 06/01/2019 - 00:00
This article discusses the controversial but promising topic of medical marijuana (MM) use in the pediatric population with epilepsy. Included is the importance of MM throughout history, the pharmacodynamics and pharmacokinetics, and a literature review that provides anecdotal evidence of the positive effect MM has on children suffering from seizures. From this literature review, dosage for treatment and management is provided. Also discussed is the recent FDA-approved pharmaceutical grade CBD product, Epidiolex, for treatment of two pediatric-onset seizure syndromes, Lennox-Gastaut and Dravet.
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Management of haemophilia in children

Paediatrics and Child Health - Sat, 06/01/2019 - 00:00
Haemophilia is an inherited bleeding disorder associated with a reduction or absence of coagulation factor VIII or IX. In severe haemophilia, recurrent, spontaneous bleeding occurs into joints, without treatment this leads to crippling joint deformity. Haemophilia is an X-linked disorder yet there is no family history in approximately one third of cases where haemophilia arises as a result of a new genetic mutation. Without treatment, the prognosis is poor but the development of factor concentrates and ‘non-factor replacement therapy’ has transformed the outlook.
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Editorial Board

Paediatrics and Child Health - Sat, 06/01/2019 - 00:00
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A simple model for understanding the causes of paediatric wheeze

Paediatrics and Child Health - Fri, 05/31/2019 - 00:00
Wheeze is one of the most common paediatric presentations. While there are only a few possible reasons for a child to develop wheeze, there is often diagnostic uncertainty between common causes such as bronchiolitis, viral wheeze and asthma. The evidence shows that these conditions respond differently to the treatments available. This means that better differentiation should have a beneficial effect through more appropriate and targeted disease management. This article describes my personal model for understanding why these three conditions occur at different ages and respond to different treatments.
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Perceived Needs for Adolescent Mental Health in an Urban Community

Journal of Pediatric Health Care - Thu, 05/30/2019 - 00:00
Stressors in urban communities are detrimental to adolescents’ psychological health. Key factors for success are a community–academic partnership in which researchers and stakeholders in the community work together on program development and research practices. This study elicited students’, parents’, and teachers’ perceived needs for psychological well-being in urban-dwelling adolescents.
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Effects of Early Initiation of Breastfeeding on Exclusive Breastfeeding Practices of Mothers in Rural Haiti

Journal of Pediatric Health Care - Thu, 05/30/2019 - 00:00
Rates and relationships of early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) of mothers in rural Haiti were examined. Prelacteal and complementary feedings were identified.
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A practical approach to recurrent epistaxis in children

Paediatrics and Child Health - Mon, 05/20/2019 - 00:00
Recurrent epistaxis (nose bleeds) are common in children. The vast majority of nose bleeds are self-resolving and do not require medical input. Clinicians get involved in cases where the nose bleeds are more severe, frequent and take a longer time to resolve. Emergency management involves basic resuscitation and first aid measures. A holistic approach is required, when dealing with non-emergency cases of frequent nose bleeds, including the exclusion of systemic illness. In this article we outline the basic history, examination, investigation and management aspects of evaluating a paediatric patient with epistaxis.
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Fifteen-minute consultation: Chickenpox vaccine--should parents immunise their children privately?

Sebastian J Gray
May 17, 2019; 104:120-123
BEST PRACTICE AND FIFTEEN-MINUTE CONSULTATIONS
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How to use C-reactive protein

Emma M Dyer
May 17, 2019; 104:150-153
Interpretations
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Fifteen-minute consultation: Polydipsia, polyuria or both

Mark Mahon
May 17, 2019; 104:141-145
BEST PRACTICE AND FIFTEEN-MINUTE CONSULTATIONS
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Managing headache

Paediatrics and Child Health - Thu, 05/16/2019 - 00:00
Managing headache involves being able to make a positive diagnosis of the headache type, reassuring the family that there is no serious underlying cause and enabling self-management. Resisting the urge to investigate is also important.
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Assessing tall stature

Paediatrics and Child Health - Tue, 05/14/2019 - 00:00
Children and adults are considered ‘tall’ when their height is above 98th centile for age i.e. 2 standard deviations (SD) above the mean. Tall stature is familial in most cases. In assessing children with tall stature the mid-parental height centile should always be calculated and this article gives advice on how to proceed with investigation and management for children who are unexpectedly tall. Other common causes of tall stature are obesity or early normal puberty. Precocious puberty, hyperthyroidism and GH excess are less common but these will also cause rapid height velocity at any age and precocious puberty should be excluded in every child presenting with tall stature.
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The 'Pink herring

Siew Cheng Foong
May 9, 2019; 0:archdischild-2018-316682v1-edpract-2018-316682
Epilogue
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Checklists in action in neonatal medicine: improving breastfeeding rates

Paediatrics and Child Health - Wed, 05/08/2019 - 00:00
Checklists were initially used within the aviation industry before being extrapolated into a number of other industries and arriving much later to medicine, where they are used as tools to improve patient safety. Checklists improve reliability, reduce variation and standardise care, ensuring that staff can review their tasks and confirm compliance before moving on to the next step. They have flexibility in application and are used in both within the acute care setting, in addition to service planning and delivery.
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Graves’ disease

Paediatrics and Child Health - Tue, 05/07/2019 - 00:00
Graves' disease develops when pathogenic thyroid receptor antibodies stimulate the thyroid gland resulting in excessive thyroid hormone production. Children and adolescents with Graves' disease can present in a variety of ways to many different clinical teams with a diverse range of underlying symptoms and signs. Graves' disease is usually managed initially with the anti-thyroid drug (ATD) carbimazole. However, only 20–25 % of young patients remit (remaining euthyroid when the ATD is stopped in the longer term) after a 2 year course of ATD treatment.
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Management of teenagers with polycystic ovarian syndrome

Paediatrics and Child Health - Tue, 05/07/2019 - 00:00
Polycystic ovary syndrome (PCOS) is a common, complex endocrine and metabolic disorder with a prevalence of 20%. It is variable in aetiology, clinical presentation and prognosis, making it a challenging disease to understand and manage in teenagers. It results from a defect in steroidogenesis, leading to excess luteinising hormone and hyperandrogenism. PCOS is also associated with insulin resistance and compensatory hyperinsulinism. The Rotterdam criteria are the most widely used criteria for diagnosing PCOS, however it is typically challenging to diagnose in teenage girls due to the overlap of symptoms with normal pubertal changes.
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Editorial Board

Paediatrics and Child Health - Wed, 05/01/2019 - 00:00
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