A 10-year-old boy with spastic quadriplegic cerebral palsy (CP) was admitted into the hospital with a lower respiratory tract infection. His parents complained that he had a problem with excessive drooling of saliva; they had tried different treatments but to no avail. There was no formal guidance on the management of drooling in CP in the hospital. This raised the question regarding the effectiveness and safety of different interventions in the management of drooling in children with CP.
In a child with CP (patient), which is the treatment with maximum effectiveness and minimum adverse effects (intervention) to reduce sialorrhoea (outcome)?
MEDLINE, Embase, PsychINFO, AMED, PubMed, CINAHL, Cochrane Library and Google Scholar were searched from 1 January 1980 to 23 January 2020 and reference lists also scoured. Searches used synonyms of ‘drooling’ (sialorrhoea, hypersalivation, ptyalism, slobbering), ‘cerebral palsy’, ‘children’ and management/intervention/therapy. Two hundred and twenty-one unique records were screened (online supplementary figure 1) and 14 studies with 510 participants were included (table 1). Six studies evaluated the efficacy of botulinum toxin type A (BoNT-A) and one evaluated botulinum toxin type B (BoNT-B). Five trials examined pharmacological interventions: benztropine, glycopyrrolate and hyoscine. Three studies evaluated non-pharmacological non-invasive interventions: kinesio taping, oromotor exercises, functional chewing training and behavioural techniques. One randomised controlled trial (RCT) compared BoNT-A with submandibular duct ligation. No RCTs or controlled clinical trials could be retrieved on acupuncture or intraoral devices.
### Supplementary data
[archdischild-2020-319309supp001.pdf]
View this table:
Table 1
Summary of included studies
CP describes a group of permanent …
Sujata Khajuria, Khuen Foong Ng, Rosalind J Jefferson
Background Shiga-toxin-producingEscherichia colihaemolytic uraemic syndrome affects ~100 United Kingdom children each year. Around half need dialysis, a quarter develop serious complications with long-term consequences and ~3% die. No effective intervention is known; however, some studies report eculizumab, effective in atypical haemolytic uraemic syndrome, may be effective. Objectives To determine whether the severity of Shiga-toxin-producingEscherichia colihaemolytic uraemic syndrome is less in those given eculizumab. Design Randomised, double-blind, placebo-controlled, parallel-group trial with internal pilot phase and nested mechanistic laboratory studies. Setting Paediatric nephrology units in 12 United Kingdom hospitals. Participants Children aged 6 months to < 19 years weighing ≥ 5 kg, with presumed Shiga-toxin-producingEscherichia colihaemolytic uraemic syndrome, including ‘injury’ or ‘failure’ category of the acute kidney injury paediatric risk/injury/failure/loss/end criteria. Intervention Participants were randomised in a 1 : 1 ratio to receive intravenous eculizumab or placebo on day 1 and 8. All received meningococcal vaccination and prophylactic antibiotics. Main outcome measures The primary outcome measure was a multidomain clinical severity score, reflecting morbidity until day 60. Secondary outcome measures included survival, duration of renal replacement therapy, persistent neurological defect (day 60) and presence of chronic kidney disease at 1 year. Mechanistic studies assessed complement activation and vascular endothelial growth factor profiles in plasma ± urine samples. In vitro cell co-culture work assessed the effect of Shiga toxin on endothelial cells. Results Thirty-six participants from 10 sites were randomised: 17 to eculizumab and 19 to placebo. The target sample size was 134 participants – recruitment stopped early due to low recruitment (factors included reduced incidence and limited out-of-hours research infrastructure) and the COVID-19 pandemic. The mean clinical severity score for participants randomised to eculizumab was 11.5 (standard deviation 8.4) compared to 14.6 (standard deviation 7.7) for participants randomised to placebo (adjusted mean difference: −2.5, 95% confidence interval −7.8 to 2.8,p= 0.3). Five participants (three eculizumab, two placebo) experienced an adverse event; there were seven serious adverse events in six participants (five eculizumab, one placebo). Urinary complement factor H and vascular endothelial growth factor levels were high initially and subsequently normalised. Shiga toxin caused a podocyte-dependent decrease in endothelial cell factor H levels. Conclusions and limitations There was no significant difference in mean clinical severity score between eculizumab and placebo groups – since the trial was underpowered, this cannot be interpreted as evidence of no effect. No significant safety concerns were observed. With further validation, the Eculizumab in Shiga-toxin-producingEscherichia coliHaemolytic Uraemic Syndrome clinical severity score may be an outcome measure for future trials. Our results imply that Shiga toxin causes complement-dependent glomerular endothelial cell injury through its action on podocytes and subsequent cellular cross-talk. Future work We will continue to investigate cross talk between podocytes and endothelial cells after exposure to Shiga toxin and further develop plasma/urine biomarkers for diagnosis of Shiga-toxin-producingEscherichia colihaemolytic uraemic syndrome. Trial registration This trial is registered as EudraCT-2016-000997-39 and ISRCTN89553116. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Efficacy and Mechanism Evaluation (EME) programme (NIHR award ref: 14/48/43) and is published in full inEfficacy and Mechanism Evaluation; Vol. 11, No. 11. See the NIHR Funding and Awards website for further award information.
Natalie J. Ives, Rebecca L. Woolley, Moin Ahson Saleem et al.
The article presents a brief overview of the main directions of legal regulation using the social networks from the standpoint of ensuring proper protection of the children’s rights and legitimate interests. The objective of the scientific article is to highlight the main arguments “for” and “against” giving children the opportunity to use social networks such as Facebook, Instagram, etc. Comparative legal review and comparative legal analysis that were used by author allow identifying two directions of legal regulation: determining the procedure for a child’s access to a social network and the procedure for its use by a child. The legal issues concerning the need to introduce an age threshold, special requirements for the registration of a child’s account, and the development and legislative implementation of special safety standards for children’s accounts aimed at minimizing online risks are proposed for further discussion. In conclusion, the author proposes combining these methods: since the doctrine and current legislation consider a child to be a full-fledged subject of law that implies the need to retain his access to social networks, but with additional guarantees to ensure the protection of the child when using a social network.
The focus is on psychological and legal aspects of the well-being and safety of children who are socially vulnerable, including: children who are victims of violence and abuse; children separated from their parents due to the deprivation of parental rights; young people who are graduates of organizations for orphans and foster families; and children living in the territory of military conflicts.
Cyberbullying is associated with considerable negative mental and psychosocial consequences in children and young people, making it a serious public health concern. To review the highest level of available evidence, a systematic mapping review was conducted to identify systematic reviews that investigated the relationship between cyberbullying and mental and psychological outcomes in young people. Topic-relevant bibliographic databases and online resources were searched to identify reviews published since 2007. Data were extracted using a coding tool developed for this study. Methodological quality of included reviews was assessed using AMSTAR criteria. Nineteen systematic reviews satisfied the inclusion criteria and they reported a strong negative association between cyberbullying and mental health outcomes in young people. Meta-analysis was performed in 11 reviews and narrative synthesis in 8 reviews. Data were derived from predominantly cross-sectional studies and a clear causal relationship between cyberbullying and mental outcomes cannot be established. Two-third of the included reviews were classified to be of low or unclear quality, due to the lack of quality assessment of the primary studies included in individual reviews. This systematic map consolidates available evidence at review level and confirms the existing gaps in longitudinal and qualitative evidence synthesis. Closer examination of the moderating factors influencing cyberbullying behaviors in future research can advance our understanding and inform the development of tailored programs of intervention to mitigate the negative impact of this phenomenon.
Irene Kwan, Kelly Dickson, Michelle Richardson et al.
AIM: Several countries, such as Norway and Sweden, have not implemented universal varicella vaccination. We present data for Norway and Sweden that were generated by a paediatric multi-country Phase III study over a 10-year period. This assessed the efficacy, antibody persistence and safety of two varicella vaccines containing the same Oka strain. METHODS: This was an observer-blind, controlled trial conducted in 10 European countries. Children aged 12-22 months (n = 5803) were randomised 3:3:1 and vaccinated between 1 September 2005 and 10 May 2006. The two-dose group received two tetravalent measles-mumps-rubella-varicella vaccine doses. The one-dose group received one monovalent varicella vaccine dose after a measles-mumps-rubella vaccine dose. Control group participants received two measles-mumps-rubella vaccine doses. Main study outcomes were vaccine efficacy against confirmed varicella cases and incidence of adverse events. RESULTS: Vaccine efficacy in the two-dose group was ≥92.1% in both Norwegian and Swedish children compared to 72.3% in Norway and 58.0% in Sweden in the one-dose group. Incidences of adverse events and serious adverse events were similar in the Norwegian and Swedish study populations. CONCLUSION: Consistent with overall study results, high efficacy against varicella and acceptable safety profiles of the two varicella vaccines were observed in Norwegian and Swedish populations. These findings highlight the benefits of varicella vaccines, particularly when administered as a two-dose schedule.
G. Casabona, Md. Ahsan Habib, Michael Povey et al.
In an increasingly digital world, it is essential for children and young people to develop online safety skills. Konstantina Martzoukou, Elaine Allan and Melanie Hayward discuss the use of the ‘Maddie is Online’ resources within the SCPHN School Nurse curriculum to ensure school nurses are equipped to help them acquire those skills.
Abstract Background The COVID-19 pandemic necessitated an almost overnight shift in mental healthcare from in-person to remote delivery. However, the feasibility of online therapy for children and its potential as a long-term fixture remain underexplored. Objective This study aimed to explore the advantages, disadvantages, and suitability of online therapy for children, as perceived by pediatric clinicians delivering remote psychological interventions during the COVID-19 pandemic. Method Six qualified child psychologists with limited pre-pandemic online therapy experience were surveyed about their perspectives on online therapy for children using a qualitative descriptive approach. Data was analyzed using thematic network analysis. Results Analysis revealed themes relating to: issues encountered in the areas of technology, resource availability, and therapeutic alliance; perceived advantages in children being digital natives, and online therapy’s wide accessibility; and (un)suitability of specific client profiles and therapeutic techniques. Conclusions Psychological interventions delivered via videoconferencing are not suitable for all children, but can be greatly beneficial for some. Client- and intervention-specific findings from this study can be used to guide future research aimed at clinical practice, developing tailored approaches, and informing policy for improving access to pediatric mental healthcare.
The article examines the extent to which International Labour standards (ILS) have contributed to combating child labour. Child labour is regarded as an impediment to children’s development and their human rights. The ILO’s endeavour to improve labour relations and eradicate child labour globally has seen the organisation engaged in adopting Conventions and Recommendations focusing on current critical issues in the labour environment. The idea that the International labour Organisation is a necessity which the world has been waiting for years (Thomas, 1921: p. 5, 22) is underpinned by the working mechanisms that are well accepted among member states. More significantly, the optimism of the founders and their desire to thrive were the driving forces necessary to put the ILO on the track to longevity. Hence, the article evaluates the working mechanisms of the organisation which facilitate the materialisation of its approaches to various labour issues. The approach taken is a textual analysis and justification of the International Labour Standards (ILS). The article concludes that the ILO has the legitimacy to set international labour standards and that its standards are fit for purpose. Indeed in the light of its focus, its working mechanism, and its efficient approach to labour issues, the ILO cannot be denied the status of “most adequate institution” in addressing child labour issues with a view to eradicating the phenomenon worldwide.
Abstract The “traditional view” on the historical decline of child labour has emphasised the role of the approval of effective child labour (minimum working age) laws. Since then, the importance of alternative key driving factors such as schooling, demography, household income or technology has been highlighted. While historically leading countries such as England and industrial labour have been studied, peripheral Europe and a full participation rate also including agriculture and services have received limited research attention. The contribution of this paper is to provide a first empirical explanation for the child labour decline observed in a European peripheral country like Portugal using long historical yearly data. For doing so, we use long series of Portugal’s child labour participation rate and several candidate explanatory factors. We implement cointegration techniques to relate child labour with its main drivers. We find that not only factors related to the “traditional view” were important for the Portuguese case. In fact, a mixture of legislation, schooling, demography, income, and technological factors seem to have contributed to the sustainable fall of Portugal’s child labour. Hence, explanations for observed child labour decline seem to differ by country and context, introducing a more nuanced view of the existing literature.
Pedro Vaz Goulart, Nuno Sobreira, Gianluca Ferrittu et al.
