Children and adolescents are no longer a priority in the most recent European Programme of Work (EPW) 2020-2025 of the World Health Organization (WHO) Regional Office for Europe. In this position statement we provide arguments for why we think this population should be explicitly addressed in this important and influential document. We firstly emphasize the persistent health problems and inequalities in access to care for children and adolescents that are challenging to solve, and thus require a continuous focus. Secondly, we urge the WHO to prioritize children and adolescents in their EPW due to the new and emerging health problems related to global issues. Finally, we explain why permanent prioritization of children and adolescents is essential for the future of children and of society.

Abstract Background one can assume that toilet use by young people is not a problem in the Netherlands because there are sufficient toilets available at all schools. However, international research shows that a substantial number of young people avoid school toilets. It is unknown to what extent Dutch young people avoid school toilets. Methods from spring 2023 we recruited young people between the ages of 16 and 25 (all school levels) throughout the Netherlands. Young people who agreed to participate in the study were asked to complete an online questionnaire with questions about their toilet visits during their secondary school period (did they avoid school toilets or not), reasons for avoiding school toilets and the absence/presence of physical, mental and concentration problems during their secondary school period. We analysed our findings. Data will be analysed descriptively by means of a regression analysis. Results results are not yet available, but we expect - based on previous study - that at least one in four young people avoid using the toilet at their secondary school period, that girls avoid school toilets more than boys and that older teenagers avoid school toilets more than younger teenagers. We expect the following reasons for avoiding school toilets: feeling unsafe in the school toilets, lack of toilet hygiene, lack of privacy, limited access to the toilet during classes and shame. We also expect that young people that avoid school toilets have more physical, mental and concentration problems than young people that don’t avoid school toilets. Discussion We will give insight into the extent to which avoiding school toilets is also relevant in the Netherlands. We will advise schools on how they can adapt schools so that young people use school toilets more often. In addition, this study may show the need for general practitioners, paediatricians, and youth health care physicians to be aware of health problems related to this public health problem.

Background Point-of-care-tests (POCTs) have been advocated to optimise care in patients with infections but their actual use varies. This study aimed to estimate the variability in the adoption of current POCTs by paediatricians across Europe, and to explore the determinants of variability. Methods and findings A cross-sectional survey was conducted of hospital and primary care paediatricians, recruited through professional networks. Questions focused on the availability and use of currently available POCTs. Data were analysed descriptively and using Median Odds Ratio (MOR) to measure variation between countries. Multilevel regression modelling using changes in the area under the receiver operating characteristic curve of models were used to assess the contribution of individual or workplace versus country level factors, to the observed variation. The commonest POCT was urine dipsticks (UD) which were available to >80% of primary care and hospital paediatricians in 68% (13/19) and 79% (23/29) countries, respectively. Availability of all POCTs varied between countries. In primary care, the country (MOR) varied from 1.61 (95%CI: 1.04-2.58) for lactate to 7.28 (95%CI: 3.04-24.35) for UD. In hospitals, the country MOR varied from 1.37 (95%CI:1.04-1.80) for lactate to 11.93 (95%CI:3.35-72.23) for UD. Most paediatricians in primary care (69%, 795/1154) and hospital (81%, 962/1188) would use a diagnostic test in the case scenario of an infant with undifferentiated fever. Multilevel regression modelling showed that the country of work was more important in predicting both the availability and use of POCTs than individual or workplace characteristics. Conclusion There is substantial variability in the adoption of POCTs for the management of acute infections in children across Europe. To inform future implementation of both existing and innovative tests, further research is needed to understand what drives the variation between countries, the needs of frontline clinicians, and the role of diagnostic tests in the management of acute childhood infections.

Abstract There are many societal developments in The Netherlands that have or will have an impact on Dutch paediatric care. These developments both reveal potential risks in paediatric care and require future improvement of paediatric practices to achieve the best possible outcomes for Dutch children. To realise this, the Dutch Paediatric Society decided in their renewed vision to have a closer focus on prevention and on building partnership with public health, by implementing a building block ‘Interprofessional Collaboration between Paediatricians and Other Health Care Providers’. This building block formulates the wish of the Dutch Paediatric Society to work together in networks with other domains of care, such as public health. Preferably, it will be a flexible network in which the disciplines involved align the needs of the specific child. In order to develop and participate in such a network, pediatricians and public health professionals actively have to invest in connecting, establishing, and further developing professional networks (including patient societies). A first precondition for the development and successful functioning of such a network is the implementation and use of a joint electronic medical record in which all diagnostics, treatment plans and positive health aspects of the child are collected, and which is accessible to all professionals involved. A patient record which guarantees a barrier-free exchange of medical and non-medical information between paediatricians and public health professionals within the framework of the current privacy legislation. A second precondition regards an improvement of the paediatric training curriculum in which the paediatrician of the future will gain knowledge of positive health and integrative medicine. The future paediatrician must be trained to function in networks and to make connections. In this presentation we present an update of the implementation of this building block: what is already realised and how.

To improve medical care for young people in the Netherlands, various professional groups representing physicians who provide medical care to children have developed a vision called ‘strengthening medical care for young people’. The purpose of this viewpoint is to reflect on the implementation of proposals to augment cooperation and coordination between the professional groups involved. Our reflection demonstrates that additional action regarding cooperation and coordination is still necessary to strengthen this care for young people. First, regarding the practical implementation of collaboration, the guidelines are unclear, and many are out-of-date. Second, adequate structured interdisciplinary training and intervision are lacking for physicians frequently collaborating in the care of young people. Third, interdisciplinary access to patient files is too complex and time-consuming. We recommend structured monitoring of the implementation of all improvement proposals, regarding both processes and outcomes. In addition, we recommend collaboration with physicians treating mentally disabled individuals to improve medical care for this group.

There are many societal developments in The Netherlands, such as a rising and changing demand for care and support and a paradigm shift from curation to prevention, that currently-and in the near future-will have an impact on paediatric care. These developments both reveal potential risks in paediatric care and affect practices that require future improvement. In this viewpoint, we first present the most pressing developments for paediatrics, and we demonstrate why and how Dutch paediatricians have renewed their vision on paediatric care in order to cope with a changing society. It is a vision towards the year 2030 that gives children and paediatric care the right place in the Dutch healthcare landscape to guarantee accessible, high-quality, and effective care for every child at the right time. Realising this renewed vision requires however not only an adjustment from paediatricians and paediatricians in training, but also from professionals who work with them and from the Government that can facilitate or accelerate the implementation of the renewed vision in various ways.

Objectives: After childcare and schools have been closed in March 2020 to prevent the spread of COVID-19, they were open again in most European countries after the summer holidays till early autumn. Aim of this study is to give an overview and to compare COVID-19 childcare and school containment policies in 19 European countries.Methods: We collected data on containment measures among delegates of the European Academy of Pediatrics (EAP), through an online, closed questionnaire in the second half of October 2020.Results: Most policy has been formulated for secondary education. In all three settings policy was most often formulated for individual hygiene, cleaning of surfaces, exclusion of sick children, ventilation, distance between children and between children and teachers. In secondary schools, policy is formulated on face masks in and outside the class. School closure, cancellation of physical education and class size reduction are measures for which the fewest countries have formulated national policies.Conclusion: We recommend to accompany the opening of children’s facilities and schools by surveillance studies that further clarify questions about control measures implemented to halt COVID-19 pandemic.

Compared to other European countries, the Netherlands does not collect enough data on the health of its youth. There is still room for improvement there.

We explored the collateral harm in Dutch children and adolescents during the COVID-19 pandemic from experience of paediatricians via an open question distributed via the website of the Dutch Paediatric Society. From the end of March till the first week of July, we received 51 reports of collateral harm involving mostly very young children with mainly acute physical problems but also social problems. In older children, several cases of diabetic ketoacidosis were reported. Our results show that delaying care can lead to seriously ill children, life-threatening situations and that in some cases it can even lead to death. If we want to avoid such a delay at a possible second peak of Corona, general care providers and paediatricians have to join forces and find new ways of working. Systematic data collection of collateral harm in children is needed to be able to intervene adequately.

Abstract It is an interesting debate whether young (and incapacitated) children shouldn't be protected from the irresponsible behavior of their parents. In many European countries it is a legal obligation to use special seats when transporting a young child in a car. And if you don't, you will be fined. This measure exists in order to protect children from dangerous behavior of adults. In fact, it is hard to understand why we find it so difficult to apply the same attitude regarding parents who put their children deliberately at risk when not vaccinating their children. They not only put their own children at risk but also children who are too young or too vulnerable to be vaccinated. The degree of vaccination differs largely between the European countries. In some countries we see a good and safe degree of vaccination, in other countries it's extremely low. In the latter situation, especially vulnerable children are at risk of contracting potentially lethal infections. As a result, there is a wide range of options that health care professionals, politicians and policymakers are discussing about. In many European countries we see a lively discussion about the issue of mandatory vaccination. It is a political and often emotional debate. The question is: does mandatory vaccination help? And what exactly does it imply? In this presentation the advantages and disadvantages of the various mandatory policies will be discussed along with the question how changes in vaccine legislation may influence vaccine acceptance.

Background: Despite the fact that vaccines save 2-3 million lives worldwide every year, a percentage of children are not getting appropriately vaccinated, thus leading to disease outbreaks. One of the major reasons of low vaccine uptake in Europe is vaccine hesitancy, contributing to the recent measles outbreaks. Monitoring of vaccine hesitancy is valuable in early identification of vaccine concerns. Methods: We performed an eighteen country European survey on parents' attitudes and behaviors regarding their children's immunization. Parents having at least one child 1-4 years old were mostly recruited by primary care paediatricians to reply to a web-based questionnaire. The questionnaire was developed by the European Academy of Paediatrics Research in Ambulatory Setting Network steering committee, based on similar surveys. An individual level hesitancy score was constructed using the answers to 21 questions, and correlations of the score with socio-demographic characteristics and types of providers were explored. To assess inter country differences, a country level self -reported confidence was defined. Results: Fifty six percent and 24% of 5736 respondents defined themselves as "not at all hesitant", and "somewhat hesitant", respectively. Parents who consulted general practitioners were more hesitant than parents who consulted pediatricians (p < 0.05). Consultation with homeopathists was associated with the highest reported hesitancy (p < 0.05). Vaccine confidence was highest in Portugal and Cyprus, and lowest in Bulgaria and Poland. Conclusion: The majority of parents in Europe believe in the importance of childhood vaccination. However, significant lack of confidence was found in certain European countries, highlighting the need for continuous monitoring, awareness and response plans. The possible influence of different types of healthcare providers on parental decisions demonstrated for the first time in our survey, calls for further research. Monitoring and continuous medical education efforts aimed mostly at those professionals who might not be likely to recommend vaccination are suggested. (C) 2019 Elsevier Ltd. All rights reserved.

Abstract Children treated in different European countries continue to have very variable outcomes. Among several factors that might affect these outcomes, organisation of primary care services for children and training programmes for primary care clinicians are likely to be important factors. Children have an unquestionable right to health, safety, and wellbeing. Children have the right to access the highest possible standards of health-care services and facilities, both in primary health care and when they need specialised care. Any restriction of provision of appropriate care would contradict article 24 of the UN Convention on the Rights of the Child. Paediatric primary care is an academic and scientific discipline dealing with all issues affecting the health and wellbeing of infants, children, and adolescents from birth to adulthood in the context of their family, community, and culture. The primary clinician, ideally a paediatrician, is the first contact for children until they reach adulthood and is thus responsible for provision of comprehensive and continuing care throughout infancy, childhood, and adolescence. Paediatric care in both primary care and hospital settings needs special knowledge, ethics, empathic behaviour, and access to services, including disease prevention and health promotion. These aspects are therefore mandatory for all paediatric training both for paediatricians and family doctors. There should be a structured and accountable paediatric training programme for all doctors providing first-line care to children in primary care. When family doctors provide primary health care close collaboration with paediatricians and adequate continued training in both paediatrics and primary care is advised. Moreover, all children need timely access to professional paediatric advice.

European children and paediatricians rely heavily on the fair, complete and timely publication of data obtained from paediatric randomised controlled trials (RCTs). Selective publication and reporting of paediatric RCTs is common practice. Industry-sponsored trials are more likely to remain unpublished, and take longer to get published compared with trials sponsored by others. However, also academic sponsors contribute to inefficiencies in publishing clinical data. Publication bias violates the ethical obligation that investigators have towards study participants, leads to considerable inefficiencies in research and a waste of financial and human resources, and has the potential to distort evidence for treatment approaches.CONCLUSION:The European Academy of Paediatrics (EAP) therefore actively supports initiatives that increase the public dissemination of paediatric clinical trial data. The EAP will raise awareness about the guidelines for Good Publication Practice among European paediatricians and subspecialty societies.

The European Academy of Paediatrics (EAP) is the paediatric section of the European Union of Medical Specialists (UEMS). The UEMS is responsible for the supervision and approval of training programmes in paediatrics and in its subspecialties. This implies also that EAP has the responsibility to address the training of all professionals working with children, to ensure that their paediatric competences and skills are adequate when dealing with children. The EAP has developed syllabi for paediatricians that provide standards of practice, and criteria for the assessment of competencies in trainees and training centres across Europe. The EAP recommends that all health care professionals working with children should have an officially approved training in child health in addition to formal qualifications in their own field. Moreover, the existing paediatric workforce must maintain their knowledge and skills with relevant continuous professional development and medical education in child health.CONCLUSION:There is a need to reassess the training of all health care professionals caring for children, ensuring that it supports new models of integrated and multidisciplinary care and focuses on the needs of the child and the family. A standardised, competency-based minimum paediatric training programme/curriculum should be part in the specialty curriculums.

A common mantra is “as little as possible and as much as necessary.” This perception can be applied to all kinds of different projects in everyday life in order to help achieve a good outcome. It also applies to medicine, for example, “as little antibiotics as possible and as much/many antibiotics as necessary.” However, does this “rule” also apply to the pediatric workforce, that is, “as few pediatricians as possible and as many pediatricians as necessary”? How can we develop a sustainable pediatric workforce to meet the healthcare needs of children? We previously offered different equations for calculating the needed numbers of annually trained pediatricians to keep the actual number of pediatricians in a country stable in view of variable working conditions such as full-time or part-time working equivalents1Ehrich J. Pettoello-Mantovani M. Never ending stories: the loop in pediatrics. How many pediatricians need to be trained in European countries to keep the pediatric workforce stable?.J Pediatr. 2018; 196: 332-333Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar, 2Ehrich J. Fruth J. Jansen D. Gerber-Grote A. Pettoello-Mantovani M. The loop in pediatrics: how to calculate the risk of shortage and surplus of pediatric workforce?.J Pediatr. 2018; 199: 286-287Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar and weekly working hours and night shifts.3Machtey E. Ehrich J. Somekh E. Regulations of night shifts of pediatric residents: review of responses to a European survey.J Pediatr. 2018; 201: 302-303Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar We now describe pediatric workforces in 2013-2018 in 16 European countries, 11 European Union and 5 non-European Union countries. National child healthcare systems are embedded in the underlying political and economic systems such as capitalistic, liberal, monarchic, socialistic, or social market system. National pediatric workforces can be analyzed according to the triangle of need–supply–demand. Our analysis neither intended to compare national pediatric workforces with the underlying political systems nor did it investigate the role of different types of health insurance systems, for example, financed by levies to insurance funds (Bismarck system) or by taxes (Beveridge system). We also tried to avoid a single-sided view of pediatricians whose understandable aim is to defend their own needs and to improve working conditions. Instead, we wanted to look at the child healthcare services through the eyes of families and their children. The priority of families is to have an available, adequate/appropriate, affordable, and easily accessible healthcare service provided by highly qualified personnel on all levels ranging from generalists to specialists. Families wish to have a well-functioning and competent child healthcare system that—if fragmented—should be well-coordinated. Different bodies and institutions involved in the care of children should communicate and cooperate well, reaching a consensus wherever and whenever possible. The factors that must be taken into account in the process of calculating the pediatric workforce include geography, population density, transport links, relationship between child health centers, political readiness for change, and cooperation between different types of clinicians. Critical to the discussion is the number of children requiring community care, hospital care, and public healthcare by pediatricians to adapt the different competences of pediatrics to the needs of young patients and their families. Responses to a questionnaire on national pediatric workforce were received from pediatricians (see author list) of 16 European countries and subsequently analyzed (data on individual countries will be published in an upcoming European Paediatric Association article). Results were also compared for the 3 subgroups of child healthcare systems as described by Katz et al4Katz M. Rubino A. Collier J. Rosen J. Ehrich J.H. Demography of pediatricprimary care in Europe: delivery of care and training.Pediatrics. 2002; 109: 788-796Crossref PubMed Scopus (80) Google Scholar and the World Health Organization5Weber M. Backhaus S. Chukwujana O. Fenski F. Henking G. Schatte L. et al.Pädiatrische Versorgungskonzepte in Europa.Monatsschrift Kinderheilkunde. 2018; 166: 131-140Crossref Scopus (4) Google Scholar: pediatric system = 6 countries (Croatia, Czech Republic, Germany, Israel, Russia, Spain), mixed care system = 6 countries (Armenia, Austria, France, Italy, Switzerland, Turkey), and general practitioner system = 4 countries (Bulgaria, Ireland, The Netherlands, Romania). In the 16 countries there were 95 559 853 children <14 years of age and the total number of pediatricians was 116 840, a ratio of 818:1. The mean percentage of primary care pediatricians was 41%; hospital pediatricians equaled 56%, and other types of pediatricians 3% (eg, working in public healthcare services). The mean proportion of trained and accredited pediatric subspecialists was 27%. The median of lifelong working years was 36 years. The median percentage of pediatricians working part time equivalents was 17%; 71% were female and the mean percentage of female pediatricians currently in training was 76%. Eight countries reported an increase of pediatricians from 2013 to 2018 ranging from 1% to 10%; 5 countries reported no change and 2 a decrease. No data were available for 1 country. In 6 of the 16 countries, the number of pediatricians leaving the national workforce and migrating exceeded the number of immigrating physicians; in 3 countries there was an equal balance of incoming and outgoing pediatricians, and there was a surplus of immigrating physicians in 5 countries; no data were available for 2 countries. Data on the influence of new medical technologies or increasing multidisciplinary care by other caregivers than pediatricians on the numbers of pediatricians were unknown. The annual number of active pediatricians leaving child healthcare services for other professions was negligible in all but 1 of the 16 countries. From 2013 to 2018, the mean number of annually trained pediatricians per country was 319. In 2018, there will be 347 trainees, reflecting the accuracy of the equations used when compared with 339 as predicted by using our previously published equations.1Ehrich J. Pettoello-Mantovani M. Never ending stories: the loop in pediatrics. How many pediatricians need to be trained in European countries to keep the pediatric workforce stable?.J Pediatr. 2018; 196: 332-333Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar, 2Ehrich J. Fruth J. Jansen D. Gerber-Grote A. Pettoello-Mantovani M. The loop in pediatrics: how to calculate the risk of shortage and surplus of pediatric workforce?.J Pediatr. 2018; 199: 286-287Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar In 2013, the presidents of national pediatric societies had been asked to predict the future numbers of pediatricians in their countries. Eight of the 16 presidents correctly predicted the number of pediatricians. The median ratio of children <14 years per pediatrician in 6 countries with a pediatric system was 722:1. This ratio was 1342:1 for primary care pediatricians and 1446:1 for hospital pediatricians. When comparing the mixed care system with the pediatric system, higher numbers of children were treated by 1 pediatrician working in a mixed system, 860:1 vs 722:1 for all pediatricians, 1625:1 vs 1342:1 for primary care pediatricians, and 2540:1 vs 1446:1 for hospital pediatricians. There were no major differences between these 2 groups concerning lifelong working years of pediatricians and percentages of subspecialists, primary care pediatricians, and hospital pediatricians. Countries with the general practitioner system had the highest percentage of hospital pediatricians (90%) and subspecialists (31%), and the highest mean ratio of children per pediatrician, namely 2250:1. What is the best model for testing how to calculate the ideal number of children in the community who should be cared for by a single pediatrician? We may be naive when using the existing statistics on numbers of pediatricians of 16 European countries as indicators for solving the challenges of a highly complex service system also including other caregivers for children.