Early integration of pediatric palliative care (PPC) offers significant benefits for children with cancer, yet referrals often occur late in the child’s cancer trajectory.

As part of a larger project looking at barriers and facilitators to early integration of PPC, this study explored the perspectives of healthcare providers (HCPs) on the pros and cons of a universal referral system where all children with cancer are referred to PPC at diagnosis.

Using the grounded theory method, semi-structured interviews were conducted with 66 oncology and PPC providers across 4 tertiary cancer centers in Canada. Interviews were coded line-by-line to explore patterns and themes across the dataset.

Three key benefits emerged that included: reducing stigma and normalizing PPC as standard care, fostering early relationship building with patients and families, and minimizing HCP subjectivity in making PPC referrals. Cons included the idea that universal referral was a poor use of resources, particularly for children with curable cancers, and that this system lacked usefulness for patients and families.

Universal referral can promote equitable, timely, and family-centered integration of PPC in pediatric oncology. However, these types of referral systems face substantial challenges, particularly around resources. There was also wide variation of opinions and acceptability of universal referral among providers. The adoption of standardized or tiered referral criteria, guided by disease risk, prognosis, or symptom burden, may represent a practical middle ground. Future work should evaluate the impact of such criteria-based referral models on patient and family outcomes, provider experiences, and healthcare resource use.

Practice guidelines for Australian primary health professionals (PHPs) highlight their crucial role in preventive care. However, PHPs report a lack of knowledge and skills regarding early childhood obesity prevention. This study aimed to identify the training needs of Australian PHPs – including child and family health nurses (CFHNs), general practitioners, general practice nurses and other community-based health professionals – to support early childhood health promotion and obesity prevention.

From August 2022 to July 2023, PHPs were recruited to participate in an online survey and semi-structured interviews. Quantitative data was analysed descriptively and qualitative data analysed using reflexive thematic analysis.

227 PHPs returned a survey (46% CFHNs) and 28 were interviewed (13 CFHNs). Almost a quarter (23%) of participants had not received any continuing education regarding early childhood health behaviours and obesity prevention, with general practice professionals less likely to have participated in such education. PHPs identified a need to develop skills in growth assessment and working with children at risk of obesity. Digital and visual parent-facing resources were required to support PHPs’ discussions of child health behaviours. Important components of education were case studies, self-paced learning, and live interactive discussions (37–46% of PHPs rated as highly important). PHPs sought interactive education activities from reputable service providers and reported time and cost were barriers to education.

Australian PHPs require access to evidence-based education and resources to support early childhood health promotion and obesity prevention. Professional education providers should prioritize interactive and flexible modes of delivery.

In the Netherlands, around 750 children (0–21 year) die annually from potentially palliative conditions. The majority of these children reside at home, receiving care from hospital services and primary care. This study aims to examine general practice utilization for pediatric palliative care patients in the last 2 years of life.

A retrospective cohort study was performed using the routine healthcare database of the Julius General Practitioners’ Network. The main outcome for general practitioner (GP) utilization was the number of GP consultations for children in the last 3 months of life. Participants were included who were children (0–21 years), and deceased in the period 01-01-2013 to 31-12-2022 from an underlying chronic condition. Data were analyzed using descriptive statistics and tested for differences in provided care between children who died in hospital and who died at home.

Forty-eight children from 32 GP practices met inclusion criteria. Median age was 10.0 years (interquartile range [IQR] 1.5–17.1). Common diagnoses were oncological (29%), congenital (29%), and metabolic conditions (23%). Ninety-six percent of children had contact with their GP in the last 3 months (median 7 consultations, IQR 3.0–10.0), i.e. 26 children who died in hospital had median 3.5 GP consultations compared to 20 children who died at home median 9.5 GP consultations (p < 0.001). Thirty-five percent of children were documented as being palliative, with 54% having some form of advance care planning discussions documented.

These results demonstrate that GPs are highly involved in providing pediatric palliative care. The palliative nature of these children and advance care planning discussions are not routinely documented and/or performed by GPs. Further insights into guidance that supports GPs, in collaboration with other healthcare professionals, in providing palliative care for children at home and their families are needed.

To evaluate food marketing techniques used in Canadian recreation and sport facilities and assess the healthfulness of foods and beverages marketed by the techniques.

Cross-sectional content analysis of photographed food marketing instances coded for marketing techniques according to Health Canada’s Monitoring Protocol, developed for monitoring food marketing techniques across settings, supplemented with new inductively identified codes and sport-related marketing techniques. Healthfulness was classified as ‘of concern’ or ‘not of concern’ according to cut-offs of sodium, sugar and saturated fat established by Health Canada.

Recreation and sport facilities in Canada

134 facilities with 2576 food marketing instances

91·4 % of food marketing instances included at least one general marketing technique. Branded infrastructure, displays and furniture was the most prevalent (87·9 %) and appeared with another technique half of the time. Sport-related marketing appeared in 12·2 % of marketing instances, with most referring to sponsors. Most (86·5 %) marketing instances were ‘of concern’. Food marketing instances with sport-related marketing (97·6 %) were significantly more likely to be ‘of concern’ than without sport-related marketing (84·6 %) (χ2 = 20·54, P < 0·001). Three new indicators – appeals to taste, appeals to emotion, and cross-channel references – captured persuasive elements not addressed by the current monitoring protocol.

This study highlights the presence of food branding and the use of sport-related marketing to promote unhealthy products/brands in recreation and sports facilities. Monitoring protocols may underestimate exposure to persuasive food marketing by overlooking subtle, symbolic and cross-channel techniques. Future research can be improved by including subtle techniques and reinforced messages across marketing channels.

Internet-delivered parent-led interventions can be useful for treating anxiety in children and adolescents, and they also help increase access to services while reducing time and cost.

This review aimed to investigate the effects of internet-delivered parent-led interventions on reducing anxiety in children and adolescents.

A search of PubMed, PsycArticles, Cochrane Library, and Google Scholar databases identified 13 studies published between 2013 and 2024, which examined internet-delivered, parent-led interventions targeting anxiety in children.

Internet-delivered parent-led interventions had overall positive effects on reduced anxiety in children and adolescents that could be maintained through follow-up. Interventions directly targeting anxiety symptoms had significant treatment effects.

Internet-delivered parent-led interventions may be effective in reducing anxiety symptoms in children and adolescents, particularly when the intervention directly targets anxiety rather than focusing solely on parenting approaches. Interventions supplemented with therapist support, such as telephone consultations, appear to enhance treatment outcomes and help maintain effects over time. Two-thirds of the included studies had a moderate risk of bias, and one-third had a serious risk of bias. Further studies using rigorous methodologies are needed to strengthen the evidence base.

This study aims to identify the factors affecting the development of complications and to present the necessary data to the literature in order to reduce the frequency of complications as a result of some measures that can be taken against them.

This retrospective study included 609 patients between the ages of 0 and 18 who underwent cardiac catheterisation between 2012 and 2020 by our Department of Paediatric Cardiology. The patient’s demographic data, cardiac catheterisation-related data, laboratory results, and all data in the post-procedure records are scanned and evaluated.

Of the patients aged between 0 and 216 months (mean 67.1 ± 55.8 months), 371 were female (60.9%). Interventional catheterisation was performed in 419 (68.4%) of the patients, and diagnostic catheterisation was performed in 193 (31.6%). Complications were detected in 39 patients (6.4%). The most frequent complications were vascular complications in 16 patients (41%), bleeding in 5 patients (12.8%), anaemia in 4 patients (10.3%), and arrhythmia in 3 patients (7.7%). Mortality occurred in 2 patients (0.3%). Risk factors for the development of complications were determined as <10 kg (p = 0.001) and <1 year of age (p = 0.002).

The most common complications were vascular complications, followed by bleeding and anaemia. Low body weight (<10 kg) and being under 12 months of age are risk factors for the development of complications. Considering that most studies only include certain age groups or certain types of procedures, our study will make a significant contribution to the literature as it includes a larger scale and different types of procedures.

This study aimed to evaluate patients with beta thalassaemia major using the cardiac electrophysiological index of balance, a new electrocardiography parameter, and to predict ventricular arrhythmias.

In this study, 60 beta thalassaemia major and 60 healthy children were included. All patients were evaluated with echocardiography. P-wave dispersion, repolarisation times, repolarisation dispersion times, and cardiac electrophysiological balance index were measured using 12-lead electrocardiography. Heart rate variability parameters were evaluated with a 24-hour Holter electrocardiography.

Left ventricular functions were similar between the groups. Although repolarisation times (QT, JT, and JTp) were significantly lower in the beta thalassaemia major group, heart rate-corrected repolarisation times were similar. Except for Tpe/QT, which is one of the repolarisation dispersion parameters, the other parameters were similar. The heart rate-corrected cardiac electrophysiological index of balance ratio was significantly higher in the beta thalassaemia major group. QRS duration and QRS-dispersion duration (QRS-d) were similar between the groups. There was a correlation between blood ferritin levels and LVmass-i, Tpe/QT, Tpe/QTc, QTc/QRS ratio, and QT, JT, and JTp values.

Patients with beta thalassaemia major are at high risk for ventricular arrhythmia due to a high QTc/QRS ratio, despite normal left ventricular systolic, diastolic, and autonomic function in the early period. We believe that there is a moderate correlation between blood ferritin levels and the QTc/QRS ratio and that the QTc/QRS ratio can provide important information for the follow-up and evaluation of patients with beta thalassaemia major.

Despite normal early ventricular function in the beta thalassaemia major group, they were at high risk of ventricular arrhythmias.

Paediatric septoplasty remains a contentious topic due to concerns about its potential impact on midfacial growth and the landscape in the UK has been largely unexplored to date. We aimed to describe the current attitudes and practice patterns surrounding paediatric septoplasty practice in the UK.

A survey was distributed to independently practising ENT surgeons across the UK. Statistical analysis and qualitative thematic analysis were performed.

A total of 103 responses from all UK regions were analysed. Opinions on septoplasty in children were polarised. Rhinologists, as well as consultants with more than 10 years’ experience, were more likely to offer surgery. Qualitative thematic analysis identified six themes within free-text responses, reflecting the diversity of current practice.

Paediatric septoplasty is being offered in the UK, but attitudes remain divided and practice is highly variable. Prospective longitudinal studies are needed to clarify long-term outcomes.

This study compared health status and developmental skill acquisition of children aged 3–5 years with and without CHD and identified predictors of special education or early intervention plan.

Data were analysed from the 2022 National Survey of Children’s Health using complex weighted survey data procedures. Chi-square tests compared health status and developmental skill acquisition of children aged 3–5 years with and without CHD. Multivariate logistic regression identified predictors of the need for special education or early intervention plan.

11,097 National Survey of Children’s Health responses pertained to children aged 3–5 years. Children aged 3–5 years with CHD were more likely than heart-healthy peers to be born prematurely, have special healthcare needs, have parent-reported health as “fair” or “poor,” be diagnosed with anxiety, depression, or a developmental disorder, and receive special education or an early intervention plan. Children aged 3–5 years with CHD were less likely to have acquired communication, fine motor, personal social, and problem-solving skills than comparators at the time of the survey, even after adjustment for special healthcare needs. Having public plus private insurance, special healthcare needs designation, and a developmental disorder predicted children aged 3–5 years needing special education or an early intervention plan.

Children with predictors of receiving special education or an early intervention plan may benefit from early identification and support. Further research should investigate the impact of systemic disparities on developmental skill acquisition in children with CHD.

To explore the effect of parental presence on the recovery period of paediatric patients undergoing general anaesthesia for snoring surgery.

Forty-two paediatric patients who underwent snoring surgery were randomly divided into control and observation groups. The control group received routine nursing intervention, while the observation group allowed either the father or mother to enter the recovery room immediately after the child was awake and extubated, in addition to the routine nursing intervention.

Paediatric anaesthesia emergence delirium score during the recovery period was significantly lower in the observation group than the control group. The Face, Legs, Activity, Cry, Consolability score during the recovery period was also significantly lower in the observation group. Parental satisfaction with nursing was significantly higher in the observation group.

Immediate parental presence can effectively alleviate insecurity, reduce pain, decrease crying and restlessness of paediatric patients, and improve parental satisfaction with nursing.

To evaluate the effectiveness and safety of endoscopic interventions for managing paediatric subglottic stenosis.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and the Cochrane Handbook, we systematically searched four databases from inception to August 2024. Studies reporting outcomes of endoscopic management of paediatric subglottic stenosis were included. The primary outcome was procedural success; secondary outcomes were recurrence, decannulation and complications.

Forty-three studies involving 1088 children were included. The pooled success rate of endoscopic treatment was 79.2 per cent. Carbon dioxide and potassium titanyl phosphate laser achieved success rates of 79.9 and 100 per cent, respectively. Balloon dilatation and rigid dilatation had success rates of 79.9 and 82.4 per cent, whereas cold knife alone had a lower rate of 47.2 per cent. The recurrence rate was 36.8 per cent and balloon dilatation showed the highest recurrence at 42.2 per cent. The pooled decannulation rate was 60.4 per cent and complications occurred in 3.0 per cent of cases.

Endoscopic interventions are effective for paediatric subglottic stenosis, but recurrence remains common.

Eustachian tube balloon dilation is increasingly recognised as a minimally invasive option for middle ear effusion. However, its role in children with cleft lip and palate remains under-explored.

We prospectively evaluated 14 cleft lip and palate children (28 ears) with middle ear effusion. Group 1 (intervention) comprised 14 ears that underwent Eustachian tube balloon dilation with intranasal corticosteroids, while Group 2 (control) included 14 ears treated with intranasal corticosteroids alone. Tympanometry, pure-tone audiometry and Eustachian Tube Dysfunction Questionnaire-7 were administered before and six weeks after intervention.

Eustachian tube balloon dilation significantly improved hearing thresholds (p = 0.03) and air-bone gap (p = 0.04), with favourable tympanometric changes (p < 0.05) and a significant reduction in Eustachian Tube Dysfunction Questionnaire-7 scores, indicating symptom improvement. No major complications occurred.

Eustachian tube balloon dilation is a safe, well-tolerated and potentially effective adjunctive procedure for cleft lip and palate children with middle ear effusion. Larger randomised controlled trials are needed to validate these findings.