BMJ Paediatrics Open

Background: Gender-affirming medical care (GAMC) for children and adolescents in Australia has become increasingly politicized, despite care being provided in accordance with latest evidence-based international guidelines. Critics of GAMC claim that current assessment and deliberation processes are insufficient, and that too many young people are accessing medical interventions, no longer identifying as trans, and expressing treatment regret. These claims have led to widespread bans on the provision of paediatric GAMC, despite growing evidence regarding harms caused by such bans. Aim: This study sought to describe the care journeys of the young people attending Australia's largest paediatric gender service, with a focus on reporting the rates at which young people commenced medical interventions, re-identified with their birth-assigned sex, and expressed regret about their treatment. Methods: The Royal Children's Hospital Gender Service (RCHGS) is a statewide service that provides individualised multidisciplinary care to trans and gender diverse young people in Victoria, Australia. An initial extended triage appointment explores the needs and goals of the young person and their family. Some proceed to receive individualised multidisciplinary care (MDC) at RCHGS which can include psychosocial assessment and management, family support, and medical interventions including pubertal suppression (PS) and gender-affirming hormonal therapy (GAHT). We undertook a retrospective file audit of all patients who had attended at least one RCHGS appointment and been discharged between 1/1/2017-31/12/2024. For each person, key data were extracted from their electronic medical record and recorded in REDCap. Results: 1,391 patients were discharged over the 8-year study period and many different care trajectories were observed. 814 (58.5%) did not access ongoing MDC. Of the remaining 577, 353 (25.4% of total cohort) started a medical intervention ((PS: n=64/1391 (4.6%); estradiol: n=97/1391 (7.0%); testosterone: n=244/1391 (17.5%)). For those who started these medical interventions, the median duration and number of sessions from first appointment until commencement of medications was 530 (IQR: 371-693) days and 9 (IQR: 7-13) sessions. 346 of these patients (98.0%) had data on gender identity at discharge and subsequent care pathways. 7 (2.0%) re-identified with their birth-registered sex and stopped treatment: 4 did so after commencing PS (4/61=6.6% of those starting PS), 2 did so after commencing testosterone, and 1 did so after commencing estradiol (3/341=0.9% of those starting GAHT). Just one of these patients, who had been on estradiol for 1 month, expressed treatment regret given concerns about initial breast budding and future fertility. Conclusion: This study highlights varied trajectories of those referred to paediatric gender services, directly challenges claims used to justify restrictions on paediatric GAMC and underscores the importance of a person-centred approach to care.

Importance: Preschool children in care are at high risk for psychosocial health concerns. Population-based evidence is limited. Objective: Estimate prevalence of psychosocial health concerns in children in care and not in care, and assess care-status differences stratified by deprivation. Design: Population-based cross-sectional study using 27-30 Month Health Review data from April 2013 to March 2023. Setting: Universal health review program in Scotland. Participants: 7887 children in care and 445 547 children not in care. Exposures: Care status at review, classified as in care or not. Main Outcomes and Measures: Four outcome categories (emotional, behavioral, and/or attentional; personal and/or social; speech, language, and/or communication; and other developmental concerns) plus an aggregate indicator of any of the four. We estimated adjusted odds ratios between children in care and not in care, including variation with deprivation. Models adjusted for sex, age, ethnicity, and deprivation. Results: Psychosocial health concerns were more common in children in care (2290; 29.0%) than children not in care (77 836; 17.5%; relative risk 1.66). Concerns were more common in children in care across all outcomes. The adjusted odds ratio comparing children in care with children not in care for any recorded concern was 1.86 (95% CI, 1.77-1.96). Adjusted odds ratios varied by outcome from 1.57 (95% CI, 1.49-1.66) for speech, language, and/or communication concerns to 2.49 (95% CI, 2.34-2.66) for emotional, behavioral, and/or attentional concerns. Relative inequities between children in care and not in care decreased with increasing deprivation from aOR of 1.58 (95% CI, 1.45-1.72) in the most deprived fifth of areas to 2.61 (95% CI, 2.25-3.03) in the least deprived fifth. Prevalence of any recorded concern increased with deprivation in both care groups. The relative risk comparing the most deprived with least deprived fifth of areas was 1.46 (95% CI, 1.29-1.66) among children in care and higher at 2.34 (95% CI, 2.29-2.40) among children not in care. Conclusions and Relevance: Psychosocial health inequities are evident at an early age between children in care and not in care, and vary with deprivation. Support for children in care and children living in more deprived areas should be prioritized.

Background Adverse childhood experiences are major determinants of mental disorders, health-risk behaviours and non-communicable diseases across the life course, but evidence from India remains limited. This study aims to estimate the prevalence and patterns of adverse childhood experiences among Indian adolescents, examine their associations with mental health and non-communicable disease risk factors, and evaluate a culturally adapted school-based intervention integrating trauma-informed care and social-emotional learning. Methods A sequential mixed-methods study will be conducted among approximately 1,632 adolescents in 16 public and private schools in Chandigarh and Mohali, India. Phase I is a cross-sectional survey of adverse childhood experiences, mental health, perceived stress, sleep, screen time and behavioural and biological risk factors for non-communicable diseases. Phase II comprises focus group discussions and key informant interviews with students, parents, teachers, counsellors and mental health professionals to inform intervention development. In Phase III, findings from both phases will guide development of the intervention using the ADDIE (Analysis, Design, Development, Implementation and Evaluation) instructional design framework. In Phase IV, adolescents reporting ACE exposure will participate in a school-based intervention delivered over 8-12 weeks by trained psychologists, comprising trauma-informed social-emotional learning sessions, individual counselling sessions for high-risk adolescents (at least six sessions), school-wide awareness activities and parental sensitization. Effectiveness will be evaluated using a quasi-experimental pre-post design. The primary outcome will be change in emotional and behavioural difficulties measured by the Strengths and Difficulties Questionnaire (SDQ). Secondary outcomes will include changes in depressive symptoms (Patient Health Questionnaire-9), perceived stress, sleep quality, school functioning, and behavioural risk factors for NCDs. Recruitment began in April 2026 and is ongoing; data collection is expected to be complete by June 2028, and no results have yet been generated.

Background: Socioeconomic deprivation is associated with childhood morbidity, but nationwide evidence on critical illness and death in a health system with universal insurance coverage is scarce. We assessed the association between area-level deprivation and the population-level incidence of hospital admission, complex intensive care treatment (CICT), and CICT-related mortality in German children, and changes over time. Methods: Population-based analysis of complete German hospital discharge data, 2016 to 2023, covering all cases aged > 28 days to < 18 years. Cases were linked to the German Index of Socioeconomic Deprivation (GISD) via the municipality of residence and grouped into quintiles (Q1 least, Q5 most deprived). Incidence rates were calculated per 100,000 child years. Negative binomial regression adjusted for calendar year, with population as offset, yielded adjusted incidence rate ratios (aIRR) per one-quintile increase in deprivation; sensitivity analyses additionally adjusted for age group. Excess cases were estimated by applying Q1 incidence rates to Q2 to Q5. Results: Of 8,890,103 pediatric cases, 140,509 (1.6 %) received CICT and 3,386 (2.40 %) of these died. Incidence rose with deprivation from Q1 to Q5: admissions 6,191 to 9,255 per 100,000 child years, CICT 97 to 128, mortality 2.54 to 2.96. Each one-quintile increase was associated with higher risk of admission (aIRR 1.10, 95 % CI 1.10-1.11), CICT (1.07, 1.05-1.08), and mortality (1.04, 1.01-1.06); estimates were unchanged after age adjustment. Relative to Q1 rates, Q2 to Q5 accounted for 1,295,896 excess admissions (20.8 %), 11,254 excess CICT cases (12.6 %), and 194 excess deaths (8.7 %). Case fatality among CICT cases was lower in more deprived quintiles (2.35 % in Q5 versus 2.64 % in Q1), as were organ dysfunction and chronic conditions. Disparities in admission and CICT narrowed over time, whereas the mortality gradient persisted. Conclusions: Universal health insurance did not eliminate socioeconomic inequalities in pediatric critical illness. Deprivation increased the population burden of admission, intensive care, and death, but did not worsen outcomes once intensive care had begun, indicating that inequalities arise before pediatric intensive care and that prevention upstream in the care continuum is the primary target.

Background: Early identification of Autism Spectrum Disorder (ASD) is critical for optimizing developmental outcomes, yet community-based screening remains underutilized in Tanzania due to systemic, cultural, and logistical barriers. Purpose: This study explores stakeholder perceptions of the acceptability, feasibility, and potential implementation strategies for culturally adapted autism screening tools in community-based early childhood settings in the Kilimanjaro region, Tanzania. Methods: A phenomenological qualitative study guided by the Socioecological Model (SEM) was conducted across preschools, daycare centers, and rehabilitation facilities in Moshi Municipality and Hai District. Multi-stakeholder participants included daycare center directors, kindergarten teachers, healthcare providers, and parents and guardians of children with ASD and policymakers (10 in-depth interviews, 3 focus group discussions). Data were collected through usability assessments, cognitive debriefing, and semi-structured discussions, and were thematically analyzed using NVivo 15 aligned with SEM domains. Results: Participants reported high perceived acceptability of utilizing the tools, driven by the tools Swahili adaptation, perceived clinical usefulness, and cultural relevance. Key anticipated feasibility enablers included private administration of the tools to mitigate stigma, trained non-specialist screeners, and structured caregiver psychoeducation. Primary barriers included questionnaire length, caregiver stress, and initial resistance. Multi-level implementation strategies emerged: standardized training, consistent home school communication, multidisciplinary care coordination, task-shifting to Community Health Workers, engagement of local and faith leaders, and integration into digital and policy frameworks. Conclusion: Culturally adapted ASD screening tools are feasible and acceptable in Tanzanian community settings when deployed with attention to linguistic accessibility, confidentiality, staff capacity, and cross-sectoral partnerships. Embedding screening within existing early childhood and community health infrastructure, supported by policy alignment and digital outreach, offers a scalable model for improving early ASD identification in low-resource contexts

BACKGROUND: We used anthropometric data from electronic health records (EHRs) of Swiss childrens hospitals to evaluate growth references and estimate centile curves. METHODS: We received EHRs extracted from seven Swiss childrens hospitals and analysed two samples: all children with a height, weight, body mass index (BMI), or head circumference recording, and a subsample restricted to children without diseases potentially affecting growth, weighted to represent the general population. We calculated mean z-scores based on the World Health Organization growth references adopted for Switzerland in 2011 (CH-WHO 2011) and current Swiss growth references (Swiss 2026). We estimated sex-specific centile curves in the subsample using generalised additive models for location, scale, and shape. RESULTS: We included 213,868 children with height, 448,002 with weight, 209,244 with BMI, and 67,397 with head circumference recordings. Mean z-scores in the all children sample were (CH-WHO 2011; Swiss 2026): height (0.10; -0.19), weight (0.16; -0.09), BMI (0.04; -0.07), head circumference (-0.28, -0.28); and in the subsample: height (0.34; 0.00), weight (0.27; 0.01), BMI (0.18; 0.05), and head circumference (0.04; 0.01). The 50th height, weight, BMI, and head circumference centiles of girls and boys in the subsample closely followed those of Swiss 2026, with slightly wider 3rd and 97th centiles in infancy and adolescence. CONCLUSION: Height, weight, BMI, and head circumference centiles aligned well with the Swiss 2026 growth references in Switzerland, demonstrating that hospital EHRs could contribute to future growth references.

Introduction: Health workers (HWs) have a central role in reducing the risk of Sudden Unexpected Infant Death (SUID) through caregiver education and safe-sleep counselling. Yet, awareness and application of evidence-based guidance are inconsistent in primary and maternal-child health settings in low- and middle-income countries (LMICs). This study explored the knowledge, perceptions, and practices of HWs regarding SUID in Uganda. Methods: We conducted a qualitative study with 20 HWs (midwives, nurses, clinicians and medical officers) at three government facilities (two regional referral hospitals and one health centre III) in central Uganda (April-September 2024). Participants were purposively sampled. In-depth interviews were conducted in English or Luganda(a widely spoken local language), audio-recorded, and transcribed into English. Data were analysed thematically using a hybrid inductive-deductive approach supported by NVivo 14. Results: HWs recognized sudden infant deaths but were largely unfamiliar with SUID as a clinical construct. Commonly perceived causes included accidental suffocation, overlay, unsafe sleep positioning and underlying illness, and cultural beliefs. Safe-sleep counselling was infrequent and non-standardized; many HWs recommended prone or side-lying positions to avoid perceived aspiration risk and favoured soft sleep surfaces. Mother infant bed-sharing was considered culturally normative and practical for warmth and monitoring despite acknowledged risks. HWs expressed a need for training and context-adapted guidelines. Conclusion: Participants described gaps and inconsistencies regarding safe sleep and environmental risk factors for SUID. Developing national, context-appropriate safe sleep guidance, integrating pre-service and in-service training, and embedding consistent counselling in maternal-child health services could contribute to risk reduction and consequently prevent infant deaths.

Background: Chronic pain affects approximately 20% of children and youth worldwide and is associated with mental and physical health impacts. Canada-specific data on the prevalence of chronic pain in children and youth are limited, highlighting the need for current high-quality population-based estimates Aims: The aim of this study is to provide national estimates of self-reported chronic pain among Canadian children and youth by pain type (headache stomach ache, backache), sex (female, male), age group (5-11, 12-17 years) and province or territory. Methods: Publicly available data were used from the 2019 Canadian Health Survey on Children and Youth (CHSCY), a population-based survey conducted by Statistics Canada using a nationally representative sample of Canadian children and youth Results: Overall, headaches were the most commonly reported pain type (15.4%), followed by stomach aches (12.5%), and backaches (11.1%). Prevalence was consistently higher among females than males and among youth than children, with youth girls reporting the highest prevalence across all pain types. Prevalence also varied geographically, with some of the highest estimates observed in the Atlantic Provinces. Conclusions: Chronic pain affects substantial proportions of Canadian children and youth with disparities observed by pain type, sex, age, and geography. These findings under score pediatric chronic pain as an important public health issue and highlight the need for equity-oriented approaches that address the needs of populations experiencing the greatest burden.

Background Obtaining uncontaminated urine samples from children can be difficult. Clean catch urine (CCU) is non-invasive but may be slow and lead to a contaminated sample, whereas transurethral bladder catheterisation (TUBC) and suprapubic aspiration (SPA) are invasive. We assessed the feasibility of randomising children to a definitive trial. Methods FROG was a multicentre, randomised feasibility trial with a mixed-methods perspectives study, health-economic analysis and stakeholder consensus meeting. Children under 16 years requiring urine testing for suspected urinary tract infection (UTI) who could not provide a midstream sample were eligible for the feasibility trial. Parents, children and healthcare professionals were eligible for the perspectives study and consensus meeting. Results Of 703 children screened, 170 were offered the study and 99 were recruited. Overall, 64/170 (37.6%) consented to randomisation, exceeding the feasibility threshold (33%); 32 were allocated to CCU and 32 to TUBC. The allocated method was received by 46/64 (71.9%); delays, unsuccessful collection and distress contributed to non-receipt. Among participants with available cultures, contamination occurred in 2/12 (16.7%) allocated CCU and 0/6 allocated TUBC. No participants consented to randomisation involving SPA. The perspectives study included 14 parent interviews, 89 parent questionnaires and 28 staff across 5 focus groups and 1 interview. CCU and TUBC were considered acceptable, although participants balanced speed and accuracy against pain and distress. SPA availability and acceptability were limited. A total of 19 stakeholders attended the consensus meeting; 94% supported recruiting children aged under 18 months and 100% supported comparing CCU with TUBC, without SPA. Accuracy was the highest-ranked outcome. Conclusions A definitive trial comparing CCU-first with TUBC-first in children aged under 18 months is feasible. Its primary outcomes should reflect diagnostic accuracy and clinical consequences of contamination, with successful collection, collection time, pain and distress assessed as key secondary outcomes.

Background Congenital heart disease is the most common congenital anomaly and a major public health concern. No single cause has been identified, and its aetiology is most likely to be multifactorial, determined by a combination of genetic and environmental factors. Congenital heart disease can have a significant and lasting impact on childrens health and development with well documented neurodevelopmental difficulties experienced by some children with CHD. However, evidence linking early environmental factors to developmental outcomes remains limited, despite growing recognition of their importance. The Northern Ireland BabyHearts 2 Study provides an opportunity to investigate these relationships in a longitudinal cohort with extensive prospectively collected preconceptional and antenatal data. Aim To investigate the associations between preconceptional and antenatal environmental factors and the birth outcomes, physical health, neurodevelopment and academic achievement of children with and without congenital heart disease. Methods This is a longitudinal matched cohort follow-up study of children with and without congenital heart disease recruited to the NI BabyHearts 1 case-control study (2014-2017), with controls matched 1:1 by age and sex. Data sources include the existing NI BabyHearts 1 dataset of prospectively collected preconceptional and antenatal environmental exposures, together with linked routine maternity and prescribing data. Follow-up data collected at 8-11 years of age include parental questionnaires assessing child executive function and behavioural development, standardised child-completed assessments of neurodevelopment, language and educational attainment, and clinical information. Impact This study will provide evidence on the long-term health and developmental outcomes in children born with and without congenital heart disease and improve understanding of how early environmental factors influence these outcomes. Findings will inform clinical care and service provision for children with congenital heart disease, strengthen preconception and antenatal guidance, and contribute to public health policy aimed at improving long-term outcomes for children living with congenital heart disease.

Abstract Objective Infant skin is highly susceptible to dermatitis, barrier dysfunction, and infections, necessitating safe and evidence-based skincare. This study assessed perspectives of Indian healthcare professionals (HCP) on infant skincare practices, product recommendations, prescribing behavior, and unmet needs in sensitive skin and atopic dermatitis management. Methods An online multicentric 4 independent cross-sectional survey was conducted involving 358 healthcare professionals across India, including pediatricians, dermatologists, and other clinicians, using structured questionnaires. The survey assessed prescribing behaviors, awareness of parents of the available products, and unmet needs in sensitive skin and atopic dermatitis management. Results The survey findings identified sensitive skin as the most frequently encountered infant skincare concern (91%), followed by eczema/atopic dermatitis (89%), and diaper rash (83%). Emollients were the most preferred first-line management strategy for mild-to-moderate sensitive infant skin (69%), followed by natural skincare products (63%), reflecting a strong preference for barrier-supportive and moisturizing therapies. Most HCPs preferred baby skincare products free from harsh chemicals (92.9%), while more than 90% routinely recommended natural/ayurvedic formulations. Additionally, Most HCPs were aware of cow ghee-based baby skincare products (93.8%) and considered barrier-focused early skincare important in preventing atopic dermatitis and the atopic march (81-87%), with 89% strongly endorsed consistent daily skincare as a key strategy for preventing flares and maintaining long-term control in infant atopic dermatitis. Conclusion Indian healthcare professionals favor preventive, barrier-focused infant skincare, with strong preference for natural and dermatologically safe formulations, while emphasizing the need for stronger clinical evidence in sensitive skin and atopic dermatitis management.

Abstract Background: Having a usual source of care (USC) supports continuity and access to health services. Recent national trends among U.S. children have not been comprehensively characterized. We examined changes in USC prevalence, subgroup heterogeneity, and reported reasons for not having a USC using the 2015-2024 Medical Expenditure Panel Survey. Methods: We analyzed the 2015-2024 Medical Expenditure Panel Survey Household Full-Year Consolidated Data. Annual prevalence rates were estimated for children aged 0 to 17 years overall and by sex, age group, race and ethnicity, and insurance status. The reported reasons for not having a USC were grouped to low perceived need, preference or self-management, access or continuity barrier, and other reasons. The distribution of grouped reasons was analyzed for each study year. Temporal differences in yearly estimates were evaluated using two-sample z-tests between 2015 and 2019 and between 2015 and 2024, and average annual changes were estimated using generalized linear regression. Results: Overall USC prevalence declined from 92.9% (95% confidence interval [CI], 91.9%, 93.8%) in 2015 to 87.2% (95% CI, 85.1%, 89.2%) in 2024. The estimated average annual change was -0.8 percentage points (95% CI, -1.0 to -0.6). Declines were observed across most subgroups and were largest among uninsured children, whose prevalence decreased from 78.4% to 53.6%. Low perceived need remained the most common reported reason for not having a USC, while the proportion reporting access or continuity barriers decreased and the proportion classified as other reasons increased. Conclusions: Estimates based on the Medical Expenditure Panel Survey indicated a substantial decline in the prevalence of having a USC among U.S. children, with notable heterogeneity by insurance status and race and ethnicity. Further research is needed to determine whether the decline reflects changing access, organization and use of pediatric care, survey measurement, or a combination of these factors.

Background Temperature instability during neonatal transport contributes to adverse outcomes in preterm and low birth weight infants. Hypothermia in this population is associated with increased risk of intraventricular haemorrhage (IVH), sepsis, and death. Current transport temperature management is reactive and manually controlled. The Heating On Transport WitH prEtErm and Low birth weight neonates using Servocontrol patient temperature management system (HOTWHEELS) trial aims to determine whether automated, servo-controlled thermoregulation provides superior thermal stability compared to standard care and reduces hypothermia-associated adverse outcomes. Methods This prospective, randomised, superiority trial is conducted by the Newborn Emergency Transport Service of Western Australia. Infants with a gestational age of less than or equal to 34 weeks and/or weight of 1500 g requiring transport are randomised to serve-controlled or standard thermal care. The primary outcome is the proportion of infants with a temperature between 36.5 and 37.5 degrees Celsius on arrival at the receiving neonatal unit. Secondary outcomes include the incidence of IVH in the first 7 days, mortality before discharge, the incidence of moderate (<36.0) and severe (<35.0) hypothermia for greater than 15 minutes and the temperature change during transport. Trial registration: ANZCTR12624000503527. Impact HOTWHEELS is the first randomised trial in neonatal transport to evaluate servo-controlled temperature control. We believe the findings will inform standards of temperature control during transport for preterm and low birth weight infants.

Objective: to estimate reconsultation risk and trajectories after a new episode of musculoskeletal pain in children and young people (CYP), and to determine routinely recorded prognostic factors associated with reconsultation. Design: Population based retrospective cohort study. Setting: Clinical Practice Research Datalink (CPRD) Aurum, 2005-2021. Participants: CYP aged 8-18 years consulting primary care for a new musculoskeletal pain episode (no musculoskeletal consultation in prior 12-months). Main Outcome Measures: Musculoskeletal pain reconsultation within 12-months, and 3-year musculoskeletal reconsultation trajectories derived using latent class growth analysis. Prognostic factors selected from a literature search and two-year symptom histories (sample prevalence >1%) were examined using regression models (conditional logistic; multinomial). Results: Among 313,830 CYP with >12 months' follow-up, 32% reconsulted for musculoskeletal pain within 12 months. Among 240,384 CYP with >3 years' follow-up, three trajectories were observed: single episode (62%), early reconsultation (18%), and persistent reconsultation (20%). Older age; female gender; hip, knee, multisite and back pain on index; previous headache; previous abdominal pain; and analgesic prescribing were associated with higher reconsultation risk. Asian or Black ethnicity, and residing in more deprived areas, were associated with lower recorded reconsultation. Conclusion: Most CYP had no further recorded consultation, but 38% followed early or persistent reconsultation trajectories. Routinely recorded prognostic factors, particularly index pain side and prior pain/symptom history, may differentiate groups who could benefit from proactive follow-up. Lower recorded reconsultation among Asian and Black individuals, and living in more deprived areas, should not imply lower need and warrants equity-sensitive monitoring of access, health-seeking, and coding.

ABSTRACT Breast milk is essential for optimal neonatal nutrition and survival, particularly among preterm and low-birth-weight infants. When a mothers own milk is unavailable, donor breast milk is the recommended alternative. However, Rwanda currently lacks accredited breast milk donation systems and milk banks, and little is known about healthcare providers perspectives on their potential implementation. The main objective of the study was to assess the acceptability of breast milk donation and explore the potential factors that could influence its adoption among healthcare providers in two Rwandan district hospitals. A convergent parallel design with a qualitative-dominant approach was conducted in the neonatology units of Kirehe District Hospital and Ruhengeri Level-II Teaching Hospital, Rwanda. Quantitative data were collected from 41 healthcare providers using structured questionnaires, including a six-item Likert scale (0=strongly disagree to4=strongly agree) to measure acceptability. Scores[&ge;]2.4 were interpreted as indicating high acceptability. Qualitative data were obtained through in-depth interviews with 10 healthcare providers and analyzed using inductive thematic analysis. Quantitative data were analyzed using descriptive statistics and non-parametric tests. The overall acceptability of breast milk donation was high, with 82.9% of healthcare providers expressing agreement (mean score: 2.83{+/-}1.10). Most participants (97.6%) perceived donor breast milk as beneficial for neonatal health. Key barriers included cultural resistance, limited maternal awareness, and inadequate infrastructure, while facilitators were staff training, institutional policies, and community engagement. Qualitative findings highlighted that providers were generally familiar with the concept of breast milk donation but noted the absence of formal programs in Rwanda. They emphasized that cultural concerns often stem from limited knowledge rather than entrenched opposition and strongly endorsed the benefits for infant health and maternal wellbeing. Providers stressed that successful implementation would depend on awareness-raising, trust in safety procedures, and institutional support through training and clear guidelines. Breast milk donation is highly acceptable among healthcare providers in Rwanda, with a mean score of 2.83{+/-}1.10 on the 0-4 Likert scale. Providers strongly recognized its benefits for vulnerable infants. Addressing gaps in awareness, infrastructure, and policy frameworks, alongside culturally sensitive community education, will be critical for successful implementation. These findings support the feasibility of introducing breast milk banking in Rwanda and provide evidence to guide policy and program development.

Background. Refractive error is a leading cause of childhood visual impairment worldwide, yet longitudinal, multi-city data from Vietnam remain scarce, especially for children younger than school age. We aimed to describe the prevalence and secular trends of refractive error in a large urban Vietnamese school health program. Methods. We conducted a retrospective analysis of repeated cross-sectional school health screening data collected from 2021 to 2024 across three major Vietnamese cities (Hanoi, Ho Chi Minh City, and Hai Phong), among children aged 3 to 18 years. The dataset included 141,339 examinations, with a Hanoi sub-cohort of 19,788 examinations that had quantitative autorefractor measurements. We estimated crude prevalence and adjusted prevalence ratios using Poisson regression. Results. The prevalence of any refractive error stayed high throughout the study period, ranging from 53.9% to 57.1% (P for trend < 0.001), and was higher in Hai Phong (68.4%) and Hanoi (61.6%) than Ho Chi Minh City (35.9%), higher in girls than boys (58.5% vs 53.1%), and higher with older age (P < 0.001). In the Hanoi sub-cohort, confirmed myopia prevalence nearly tripled, from 3.7% in 2022 to 11.0% in 2024 (P < 0.001), while hyperopia declined. Conclusions. Refractive error is highly prevalent among urban Vietnamese schoolchildren, and confirmed myopia appears to be rising rapidly at younger ages. These findings support closer surveillance and earlier school-based intervention in Vietnam and similar settings.

Gastrointestinal (GI) conditions are common among children with neurodevelopmental disabilities (NDDs), and are associated with functional impairment, behavioral symptoms, and increased health care utilization. A unique relationship between autism and GI dysfunction has been proposed, leading to a focus on autism in GI research, management guidelines, and clinical tool development. Leveraging >20 years of electronic health record data and a cohort of 42,204 cases with attention-deficit/hyperactivity disorder, autism, cerebral palsy, epilepsy, or intellectual disability and 297,402 controls without NDDs, we quantified associations between NDDs and GI conditions in children. GI conditions were more common in cases than controls across all individual NDDs; intellectual disability and cerebral palsy were most strongly associated with having a GI condition. In this work, clinically recognized GI morbidity was elevated across all NDDs and not unique to autism, suggesting that a broader, transdiagnostic approach to GI dysfunction in children with NDDs is warranted.

Background Pontocerebellar hypoplasia Type 2A (PCH2A) is a rare, autosomal recessive disorder with reduced life expectancy. Clinical features include profound developmental delay, microcephaly, and a dyskinetic movement disorder. Additional symptoms frequently observed are feeding difficulties, vomiting, dystonic attacks, and seizures. Compared to parents of typically developing children, parents of children with PCH2A experience decreased health-related quality of life. The aim of this study was to provide a follow-up on survival, symptoms, and perceived disease burden. Methods Patients were primarily recruited via the German patients' organization (PCH-Familie e.V.). Inclusion required genetic confirmation of PCH2A. Data were collected from 2020-2022 using parent questionnaires and medical reports; uncertainties were clarified during semi-standardized telephone interviews. Statistical analysis was quantitative, appropriate statistical tests were used, depending on the data distribution. Results Sixty-five patients participated, with a median age of 6.4 years and balanced gender distribution. Sixteen patients (25%) died at a median age of 5.5 years. Ten-year survival rate was 71.5%. Feeding difficulties, dyskinesia, and sleep disturbances were common and persistent symptoms. Seizures increased with age, whereas vomiting and dystonic attacks decreased over time. Perceived disease burden differed among families, but most reported overall impaired quality of life. The most burdensome symptoms were restlessness, sleep disorder, and gastrointestinal issues, while seizures/epilepsy were ranked as least impactful. With increasing age, perceived burden from feeding and swallowing disorders, gastrointestinal problems, episodic abdominal pain, and overall quality of life decreased significantly. Conclusions Life expectancy in PCH2A remains limited, but survival appears to have improved in more recent birth cohorts. Most symptoms persist with age, though a few, like reflux and dystonic attacks, improve in tendency. Conversely, respiratory symptoms and seizures tend to worsen. Notably, perceived disease burden generally decreases as patients age. Restlessness proved to be the most burdensome symptom, although it has not been clearly described before.

PurposeTo examine the association between BMI-for-age z-score (BAZ) and BMI status with refractive error prevalence, incidence, subtypes, and quantitative refraction in Vietnamese schoolchildren. MethodsWe retrospectively analyzed body mass index and refractive error data from annual school health checks in three Vietnamese cities, 2022 to 2024. The main analysis set was restricted to children age 6 and older (49,415 examinations, 31,522 children). Refractive error subtypes and quantitative refraction came from a Hanoi autorefractor sub-cohort (13,059 examinations). We used sex-stratified Poisson models with generalized estimating equations, adjusted for age, city, and year, plus linear mixed models for quantitative outcomes. ResultsAny refractive error followed a U shaped curve across BAZ in both sexes, significant in girls (prevalence ratio 1.01 per 1-SD BAZ, p = 0.027) but not boys (p = 0.099). Obesity was associated with higher any refractive error prevalence in girls (adjusted prevalence ratio 1.05, p = 0.017). Astigmatism was associated with BAZ in both sexes (p < 0.001), anisometropia in boys only (p < 0.001), with no association for myopia or hyperopia. Spherical equivalent shifted slightly toward hyperopia, not myopia, with higher BAZ. A supplementary check over 1 to 2 years found no evidence that prior BAZ predicted new refractive error onset (prevalence ratio 1.02, p > 0.6 in both sexes), and the nonlinear pattern did not reappear. ConclusionsAdiposity relates cross-sectionally to refractive error in a nonlinear, sex specific way concentrated in astigmatism and anisometropia rather than myopia, though this did not hold up short term.

INTRODUCTION: Asthma has been associated with obesity in both adults and children. We investigated the association between longitudinal BMI trajectories and asthma at ages 8-9, 12-13, and 16-17 years in a UK cohort of White and South Asian children and adolescents. METHODS: We analysed data from the Leicester Respiratory Cohorts, population-based cohort studies that recruited 0-4-year-old children in 1990 (N = 1650) and 1998 (N = 8700) and followed them up until 2010. Outcome data on asthma came from postal questionnaires throughout infancy, childhood, and adolescence. BMI data came from birth records, well-child visits, questionnaires, and a clinical study visit. We used Group-based trajectory modelling to identify distinct BMI trajectories and used multivariable logistic regression to investigate the association with asthma. RESULTS: Out of 10,350 participants in the Leicester Respiratory Cohorts, we were able to model BMI trajectories for 5571 (54%); 1801 (17%) had information on asthma at 8-9 years of age, 1269 (12%) at 12-13 years, and 575 (6%) at 16-17 years. We identified five BMI trajectories: stable normal BMI (47%), persistent low BMI (30%), early overweight resolving (8%), childhood onset obesity (4%) adolescent onset overweight (11%). The persistent low BMI trajectory was associated with lower odds for asthma at age 8-9 years (0.56 [0.37-0.83]) and 12-13 years (0.38 [0.22-0.63]). Early overweight resolving was very similar to the reference stable normal BMI. The childhood onset obesity trajectory was associated with higher odds for asthma at 16-17 years (5.58 [1.35-24.40]). The adolescent onset overweight trajectory was not associated with asthma. When analysed separately, boys and girls and children of European and South Asian ancestry showed similar associations. CONCLUSION: This study strengthens the current understanding of obesity as a contributing factor in asthma development and highlights that early intervention and management of overweight and obesity in childhood, to achieve a normal BMI, may prevent secondary health impairments such as asthma.