Recent years have seen a surge in demand for neurodevelopmental assessments across the UK and internationally, driven by multiple factors, including increased awareness, reduced stigma, and deeper understanding of diverse presentations. With service capacity remaining largely static, wait-times often exceed two years, leaving families in a "vacuum of support" that causes psychological distress. This article advocates for holistic, whole-system approaches, focused on needs-led support while waiting for neurodevelopmental assessment. The proposed framework focuses on "waiting well"; the provision of interventions based on needs rather than waiting for a formal diagnostic label to unlock care. Central to this approach is robust clinical triage and risk stratification. While formal diagnostic assessment remains vital, particularly for accessing evidence-based medical treatments like medication for ADHD, a needs-led model ensures that environmental and behavioural supports are implemented at the point of recognition. By decoupling support from diagnosis, clinicians can mitigate many of the negative impacts of prolonged wait times. Whilst our proposals are not intended as substitute for initiatives aimed at reducing waiting time, this article provides a practical structure for managing increasingly lengthy neurodevelopmental waiting lists, moving toward an integrated ecosystem that prioritises immediate needs and promotes better long-term outcomes for children and families.
Vision is essential in a child's development, affecting everything from learning and behaviour to emotional growth and social interactions. However, congenital and developmental eye conditions can impair sight in children, delaying development and leading to long term challenges. Many of these conditions require early detection and intervention to reduce or prevent vision loss. Gene therapy has emerged as a cutting-edge treatment, offering hope for potentially curing or significantly improving vision in children with genetic eye conditions. It is essential for paediatricians to be aware of risk of systemic associations, available treatments and working jointly with ophthalmology colleagues in delivering care and supporting patients and their families.
Lyme disease (LD) is the most common vector-borne infection in Europe and North America. LD is caused by Borrelia burgdorferi and transmitted through bites from infected Ixodes spp. ticks. Children are at risk if they spend time outdoors, since they are close to the ground. A history of a recognised tick bite is not always present, and the erythema migrans rash may be atypical or difficult to identify, particularly on the scalp or along the hairline. Incidence in the United Kingdom is low, but the distribution of ticks is expanding. Clinicians may therefore encounter LD more often than previously. Early diagnosis is important; timely treatment with appropriate antibiotics is highly effective and can prevent dissemination and longer-term complications. Clinicians should include LD in the differential diagnosis of target-like or unexplained expanding skin rashes, facial palsies, lymphocytic meningitis, carditis, or arthritis, especially in the summer and autumn, even when tick exposure is uncertain. Diagnosis is clinical in early disease. Laboratory tests are helpful if LD is disseminated. Improving awareness among paediatric and primary care clinicians is key to reducing diagnostic delay and preventing complications.
Status epilepticus (SE) is the commonest neurological emergency in children and may occur in the context of epilepsy or secondary to an acute cause. It requires prompt recognition and urgent management to avoid potential complications and further neuronal damage. Over time, there have been several changes to the emergency management in children and recent research played a pivotal role in influencing emergency algorithms. This article aims to provide a concise summary on the approach to paediatric SE, focusing on the emergency management, clinical evaluation and a review of recent research.
