Abstract Objectives This study aimed to gather examples of how paediatricians use complex adaptive systems theory and complexity in their practice. Methods Semistructured interviews were conducted, using a descriptive exploratory approach. Participants Paediatricians practising in British Columbia participated in the study. Results Participants told rich stories about their care of children with complex illness and how they interacted with other care providers. Aspects of their stories aligned with elements of systems theory and complexity theory. Conclusion Examples of complex care illustrated by these stories may promote better understanding and enable more widespread use of the theory, thus improving care.
Abstract Background Youth living in out-of-home care face physical, mental, and developmental challenges. Homebridge Youth Society aims to provide living facilities in Nova Scotia for youth who are in care when alternative placements cannot be identified. Objectives This mixed methods study sought to characterize the health-seeking behaviours and health care challenges of youth residing at Homebridge Youth Society. Methods Semi-structured interviews with youth and staff were analyzed using thematic analysis. A chart review was conducted to determine demographics and health care utilization the year prior and the year post the initiation of a paediatric clinic at Homebridge Youth Society. Results The quantitative study captured 220 youth (mean age 13.9) of which 52% were male. Twenty-three per cent resided over 200 km from their home community and 29% had no primary care provider. Fifty-four per cent were diagnosed with a neuro-developmental disorder, 47% had a diagnosis of ADHD, 46% had a mood disorder, and 33% had a substance use disorder. Thematic analysis revealed barriers to health care. Mental health was identified as a critical unmet need. Youth expressed deep mistrust in health care settings and many voiced a desire for immediate, flexible access to care, paired with autonomy over health care decisions, with adult support when necessary. Conclusion Youth in care living at Homebridge Youth Society face complex health care needs. Integrating health care delivery within residential facilities could mitigate many of the barriers faced by youth. Paediatricians and other health care providers are well positioned to advocate for resources to support this population.
Abstract Objectives The Early Motor Clinic (EMC) was established in Manitoba following international recommendations for early diagnosis of cerebral palsy (CP). Clinical experience suggested that the EMC was capturing children with a wide variety of diagnoses other than CP. This study aimed to (1) assess the percentage of primary diagnoses other than CP made at the EMC, (2) determine the proportion of children referred to genetics/neurology following EMC assessment, and (3) describe other diagnostic testing conducted thereafter. Methods Retrospective chart review of all children ≤2 years of age referred for motor delay as a primary developmental concern, and who were assessed at the EMC between November 2019 and December 2023. Data collected included referral sources, subspecialty consultations, diagnostic testing, and primary diagnoses. Outcomes were analyzed using descriptive statistics. Results Among 142 children included, 78/142 (54.9%) were referred by family physicians, and 45/142 (31.7%) by paediatricians, the median age at referral was 16 months (IQR 10 to 24), and the median age at assessment was 20 months (IQR 16 to 31). Other than CP (diagnosed in 37/142 [26%] children), 83/142 (58.5%) were identified/suspected to have a genetic/metabolic condition, and 32/142 (22.5%) were diagnosed with autism. Among those tested for suspected genetic/metabolic conditions, 31/72 (43%) had a positive finding. Overall, 56.3% had associated global developmental delay. Following EMC assessment, 72/142 (50.7%) were referred for genetic/metabolic evaluation, and 49/142 (34.5%) were referred to neurology. Conclusion Early motor delay may be associated with diverse neurodevelopmental conditions and requires a multidisciplinary approach. Its association with autism warrants further study.
Abstract Background Point-of-care ultrasound (POCUS) is increasingly used in many disciplines, but its role in paediatric hospital medicine (PHM) remains less well defined. There is growing interest in POCUS integration into PHM practice; however, there are limited data on current practices in Canada. This study aimed to assess the current landscape of POCUS use in PHM across Canada and inform curriculum development by identifying clinical applications of interest, barriers to implementation and training needs. Methods We conducted a cross-sectional national survey of Canadian paediatricians practicing in inpatient settings. The survey was adapted from existing needs assessments and distributed electronically via the Canadian Paediatric Society Section on Hospital Paediatrics and through section chiefs of PHM at Canadian children's hospitals. Descriptive statistics were used to analyze responses. Results A total of 59 responses were received. Only 19% of respondents reported prior POCUS training, and 8% reported using POCUS in their current clinical practice, with 44% expressing interest in additional POCUS training. The applications of POCUS perceived as most useful in PHM included lumbar puncture guidance (63%), pleural effusion assessment (49%) and peripheral IV insertion (41%). Key reported barriers included limited training opportunities (49%), lack of equipment (42%) and absence of quality assurance processes (34%). Conclusions Canadian PHM physicians report limited current use of POCUS but demonstrate interest in training, particularly with procedural guidance. Addressing educational and system-level barriers may support broader POCUS integration into inpatient paediatric care.
Abstract Objectives First Nations and Métis children are disproportionally affected by chronic diseases due to ongoing impacts of colonial policies. This study evaluated rates of hypertension and associations with biopsychosocial risk factors and potential protective factors associated with lower blood pressure (BP) in at-risk Indigenous youth. Methods This cross-sectional study included normoglycemic First Nations and Métis youth, aged 10 to 25 years, with BMI>85th percentile from the iCARE (improving renal complications in adolescents with type 2 diabetes through research) cohort. Hypertension was determined using 24-h ambulatory BP monitoring (ABPM) or average of five measures from a BpTRU device. Metabolic, psychosocial, and physical activity measures were compared between youth with and without hypertension. Univariate linear regression analyses assessed associations between covariates and mean daytime systolic and diastolic BP. Results The cohort included 120 youth (mean age 14.8 years; 55.3% female; mean BMI z-score 3.27+/−0.26). A total of 25.8% met criteria for daytime hypertension (16/52 assessed by ABPM; 15/68 by BpTRU). An additional 17 youth had isolated nocturnal hypertension on ABPM. Hypertensive youth had higher HbA1c, ALT, cholesterol, and triglycerides, without differences in age, sex, BMI z-score, rural residence, or income quintile compared to normotensive youth. Lower systolic BP was associated with a lower perceived stress score (β = 0.13; P = 0.009), while lower diastolic BP was associated with more vigorous-intensity physical activity (β = −0.002; P = 0.015). Conclusion First Nations and Métis youth with elevated BMI display high rates of hypertension associated with increased perceived stress and lower physical activity. These observations could inform potential prevention strategies to improve cardiovascular health in youth at risk for T2D.
Résumé À l’adolescence, les diètes sont monnaie courante. Les cognitions et les comportements qui y sont liés peuvent avoir de profondes répercussions pendant cette période critique du développement, lorsque les adolescents éprouvent une sensibilité aiguë envers leur apparence et forment activement leur image corporelle. Les adolescents sont particulièrement susceptibles d’internaliser les multiples messages contradictoires sur la « santé » véhiculés par les médias généraux, les réseaux sociaux, les interactions entre camarades, les dynamiques familiales, les systèmes scolaires et les rencontres médicales. Ces messages peuvent avoir une influence sur leur perception de ce qui constitue un corps « normal » ou « en santé » et motiver des régimes alimentaires visant à changer de poids ou de forme (ou les deux).
Résumé Les prestataires de soins aux enfants jouent un rôle essentiel auprès des enfants ayant un retard global du développement et un trouble de développement intellectuel. Ce rôle englobe la détection précoce des problèmes de développement, l’orientation des familles tout au long du processus diagnostique, la coordination des soins avec d’autres prestataires de soins aux enfants et avec les enseignants et les mesures pour garantir l’accès aux interventions appropriées. Une évaluation approfondie de l’histoire médicale, un examen physique approfondi et l’amorce d’une exploration génomique, en fonction des indications cliniques et des ressources disponibles, sont les piliers de l’évaluation de ces enfants. Les tests métaboliques ne sont recommandés que dans des situations particulières, qui sont décrites brièvement.
Abstract This article presents tools for the pediatric resident doing developmental evaluation after developmental surveillance has detected a problem. Crucial skills with prompts developmental attainments charts and succinct tables provide a practical and structured approach to figuring out what the child’s developmental disorder might be. Charts include wording for history and observations on physical exam, as prompts. ‘Crucial skills’ content is novel and holistic to meet the standards of modern developmental care when providing parenting guidance and determining diagnoses. Skills are placed in the chart according to oldest age of attainment, signalling that the skill will have been attained by most children of that age. The teaching tools in this article will equip residents to subdue complex presentations into manageable cases, to enjoy as satisfyingly simple.
Abstract The paediatric health care provider (HCP) plays a pivotal role in the care of children with global developmental delay (GDD) and intellectual developmental disorder (IDD). This role encompasses early detection of developmental concerns, guiding families through the diagnostic process, coordinating care with other HCPs and educators, and ensuring that appropriate interventions are accessed. A comprehensive review of the medical history, completion of a thorough physical assessment, and the initiation of a genomic investigation—depending on clinical indications and available resources—are the mainstays for assessing children with GDD/IDD. Metabolic testing is only recommended in specific circumstances, which are briefly described.
Abstract The rise in opioid-related hospitalizations and deaths continues to profoundly impact Canadian children, youth, and families. Take-home naloxone (THN) programs provide an evidence informed harm reduction intervention that equips individuals with naloxone kits and overdose response training. Despite the known benefits of THN, children and youth impacted by substance use are often overlooked. Moreover, there is a critical lack of evidence informing the implementation of THN programs in pediatric settings. This commentary highlights the impact of the opioid crisis on Canadian children and youth; identifies the need for expanded youth focused harm reduction efforts and calls on stakeholders to prioritize the integration of THN initiatives into paediatric clinical settings.
Objectives Newborn screening (NBS) for hemoglobinopathies continues to grow in Canada. This study aims to describe the current diagnostic rates of hemoglobinopathies and hemoglobinopathy carriers through NBS programs in Canada, which has never been reviewed comprehensively across the country.Methods We requested collaboration from provincial or territorial NBS programs in Canada on this cross-sectional study which included screening data from January 1, 2020 to December 31, 2023, inclusive. The data collection encompassed screening for hemoglobinopathies (including sickle cell disease, thalassemia, and other variants), hemoglobinopathy carriers, and relevant laboratory information.Results 90% of Canadian newborns were screened for hemoglobinopathies by NBS between the study dates. On average, 1 in 2000 newborns is diagnosed with a hemoglobinopathy by NBS across Canada. Sickle cell disease (SCD) (including HbS/S, HbS/C, HbS/beta 0, HbS/beta+, and HbS/HPFH) was the most common outcome, affecting 1 in 2700 newborns. Thalassemia (including Hb beta 0/beta 0, HbE/E, HbE/beta 0, and HBH) is diagnosed by NBS at a rate of 1 in 10,000 newborns. NBS additionally identifies 1 in 72 newborns as a carrier of a hemoglobinopathy. Sickle cell trait is identified in 1 in 118 newborns.Conclusion This study established hemoglobinopathy and carrier identification rates among children born in Canada essential in establishing the epidemiology of SCD, Thalassemia, and other hemoglobinopathies. When compared with previous publications, the findings of this study suggest an increase in the incidence of SCD in Canadian newborns over time.
Abstract Strong evidence demonstrates that specific multi-strain probiotics substantially reduce the incidence of necrotizing enterocolitis and all-cause mortality in preterm infants. While many high-income nations have access such preparations into routine neonatal practice, Canadian preterm infants do not currently have access to this therapy following the discontinuation of the only high-quality multi-strain probiotic previously available for this population. Consequently, Canadian preterm infants are now placed at a disadvantage, lacking access to regulated and clinically validated products. This is a significant public health concern regarding neonatal care in Canada. In this call for action, we underscore the urgent need for a coordinated national strategy to re-establish access to safe, regulated, multi-strain probiotic formulations, ensuring Canadian preterm infants are no longer denied a preventive therapy with proven benefits.
Abstract Understanding how armed conflict impacts children and adolescents in wartime helps their care providers take the necessary time and space to attend to, and address, the unique exposures and health needs of newcomer families to Canada. This statement examines the direct, indirect, and remote effects of armed conflict on those disproportionately affected by violence, disruption, and displacement. Young people whose educational, socially supportive, and health service structures are seriously compromised or destroyed by armed conflict often experience huge gaps in access to care and live with long-unmet physical and mental health needs. Based on Canada's obligations under the United Nations Convention of the Rights of the Child, this statement offers strategies and resources that care providers can use to better recognize, appreciate, and address the effects of armed conflict—and migration experiences—as part of essential quality care.
Résumé Le présent point de pratique s’applique aux enfants et aux adolescents qui consultent à l’urgence à cause d’une migraine aiguë. Les recommandations actuelles de prise en charge tirées d’études pertinentes sont résumées en vue de réduire les variations aux pratiques des professionnels de la santé et d’éviter les préjudices potentiels aux patients. La métoclopramide est le traitement de première intention des crises migraineuses aiguës, tandis que les blocs des grands nerfs occipitaux et la lidocaïne par voie intranasale peuvent être utilisés en deuxième intention. Les opioïdes sont à éviter pour le traitement de la migraine.
Hyperbilirubinemia is a common condition and is usually benign in term and late preterm newborns. Developing a standardized approach for all newborns to prevent, identify, and manage those with clinically significant hyperbilirubinemia will minimize the potential risks of long-term neurological sequelae from acute bilirubin encephalopathy and kernicterus. This statement provides recommendations on universal screening, risk factors assessment, and approaches to hyperbilirubinemia treatment, investigations, and monitoring.
Résumé L’athérosclérose, qui se manifeste pendant l’enfance, est directement liée à la présence et à la gravité des facteurs de risque cardiovasculaires, y compris la dyslipidémie. La détection et la prise en charge rapides de la dyslipidémie pendant l’enfance peuvent ralentir l’évolution de l’athérosclérose et réduire le risque de future maladie cardiovasculaire, particulièrement chez les enfants atteints d’un trouble génétique qui les prédispose à la dyslipidémie (p. ex., l’hypercholestérolémie familiale qui, souvent, demeure non diagnostiquée). Les stratégies de dépistage existantes peuvent permettre de détecter les cas de dyslipidémie avec efficacité en pédiatrie, mais devraient être à la fois plus globales et adoptées plus tôt. Il est essentiel d’évaluer les causes secondaires de la dyslipidémie chez les enfants, y compris la prise de médicaments et les troubles systémiques. Les traitements de première ligne sont axés sur les modifications au mode de vie et à l’alimentation en fonction du phénotype de la dyslipidémie. Les indications relatives à la médication dépendent de la gravité de la dyslipidémie et de l’évaluation du risque cardiovasculaire individuel.
Résumé La maladie de Kawasaki est une vasculite systémique qui doit être traitée rapidement pour éviter des anévrismes coronaires et les complications cardiaques qui en découlent. Le présent point de pratique propose des directives pour diagnostiquer la maladie de Kawasaki et la prendre en charge, y compris dans les scénarios de maladie grave et de risque marqué d’anévrisme coronaire qui justifient des consultations en surspécialité.
Abstract Objectives Given the limitations of body mass index (BMI), current guidance recommends combining BMI with a waist-based indicator to assess excess adiposity when adiposity cannot be pragmatically evaluated. We compared the prevalence of (1) excess adiposity and (2) clinical evidence of cardiovascular, hepatic, and/or metabolic dysfunction across different approaches to measuring excess adiposity in children and adolescents classified as having obesity based on BMI. Methods This cross-sectional study included 549 children (2 to 17 years) with BMI >97th percentile followed at a paediatric obesity management clinic. The prevalences of (1) excess adiposity and (2) greater than or equal to one manifestation(s) of alterations in blood pressure, liver enzymes, and/or metabolic alterations affecting glucose homeostasis and plasma lipids were compared across six approaches to assess adiposity: (1) BMI >97th percentile, (2) waist circumference (WC) ≥90th percentile, (3) waist-to-height ratio (WHtR) >0.5, (4) BMI + WC, (5) BMI + WHtR, and (6) WC + WHtR, using logistic regressions. Results Statistical differences in excess adiposity prevalence were found between some approaches: BMI (100.0%) >WHtR and BMI + WHtR (99.7%) >WC and BMI + WC (98.4%) and WC + WHtR (98.0%) (P = 0.0001). However, the prevalence of children having greater than or equal to one cardiovascular, hepatic, and/or metabolic dysfunction(s) was similar across the six approaches (minimum: 65.8% with BMI + WHtR; maximum: 66.6% with BMI + WC; P = 1.00). Conclusion In this sample of children with obesity, we found no evidence that the adiposity assessment method led to clinically significant differences in detecting excess adiposity or cardiovascular, hepatic, and/or metabolic alterations. When anthropometric measurements are warranted, it is reasonable to prioritize, on an individual basis, the least stigmatizing approach.
RÉSUMÉ L’échographie au point d’intervention est un outil d’évaluation clinique portatif d’appoint qui, entre les mains de cliniciens formés, peut contribuer au diagnostic différentiel, éclairer les options thérapeutiques et améliorer les interventions clés. En situation d’urgence à l’unité de soins intensifs néonatals, elle peut sauver des vies lorsqu’elle est utilisée en temps réel pour l’examen d’une tamponnade cardiaque, d’un épanchement pleural ou d’un pneumothorax. Puisque l’intérêt pour ce type d’examen augmente, des stages postdoctoraux structurés sur le sujet ont été créés en médecine d’urgence et en soins intensifs au Canada, et de nombreux établissements nord-américains ont commencé à l’intégrer. Le présent document de principes porte sur l’état actuel de l’échographie néonatale au point d’intervention, y compris les difficultés à la déployer, propose un parcours de formation et contient des conseils d’utilisation axés sur les diagnostics et les diverses interventions.
