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Child health

Child health Letters 3 February 2020 Free

Clinical characteristics of Western Australian children diagnosed with type 2 diabetes before 10 years of age

To the Editor: Over the past decades, the incidence of type 2 diabetes, rarely diagnosed in children and adolescents before the 1990s,1 has been increasing in young people in several populations, including Australia.2,3,4 Early onset type 2 diabetes appears to have a more severe phenotype compared with adult onset type 2 diabetes, and has a high prevalence of complications already present at the time of diagnosis despite the patients’ young age and short duration of the disease.5 We aimed to describe the characteristics of Western Australian children aged less than 10 years diagnosed with type 2 diabetes between June 2000 and June 2017. Demographic and clinical data for children diagnosed with type 2 diabetes during the study period were extracted from the population‐based WA Children's Diabetes Database and via manual review of hospital clinical files. Of the 193 children aged less than 16 years diagnosed with type 2 diabetes in WA during the study period, 12 children were diagnosed at less than 10 years of age, with the youngest aged 6 years and 11 months. These 12 patients had one or both parents diagnosed with type 2 diabetes, 11 children were Aboriginal Australians, one was Māori, 11 were obese (mean body mass index z‐score, 2.38; standard deviation [SD], 0.64); nine were female, and seven had one or more comorbidities. Of the 11 children examined, ten had acanthosis nigricans present on their skin. Three children presented with polyuria and polydipsia, six were unwell with other illnesses and three were asymptomatic. Type 1 diabetes antibodies were negative in seven of eight of the children tested, and the mean glycated haemoglobin level at diagnosis was 75 mmol/mol (mean, 9.0%; SD, 2.4%). Nine patients had one or more diabetes complications present at the time of diagnosis; seven had dyslipidaemia, two had an elevated albumin creatinine ratio, and three had hypertension. Our study describes the common clinical features of early onset type 2 diabetes in young children in WA, such as history of parental type 2 diabetes, Aboriginal heritage, obesity, and female sex, and provides strong evidence for the need to screen children with these risk factors for type 2 diabetes, irrespective of their age. Moreover, the high prevalence of diabetes complications present strongly supports the need for complications screening at the time of diagnosis.

Jacqueline A Curran · Aveni Haynes · Elizabeth A Davis

Mja2 50451
Emergency medicine Research letters 30 September 2019 Free

Clinically important sport‐related traumatic brain injuries in children

The proportion of head injuries that is acutely clinically significant is greater for recreational sports than for contact sports associated with risk of concussion

Nitaa Eapen · Gavin A Davis · Meredith L Borland · Natalie Phillips · Ed Oakley · Stephen Hearps · Amit Kochar · Sarah Dalton · John Cheek · Jeremy Furyk · Mark D Lyttle · Silvia Bressan · Louise Crowe · Stuart Dalziel · Emma Tavender · Franz E Babl

Mja2 50311
Women's health Narrative review 5 August 2019 Free

Infections in pregnancy

Routine and risk-based antenatal screening identifies some vertically transmissible infections that can be prevented or treated in pregnancy

Caitlin L Keighley · Hannah JM Skrzypek · Angela Wilson · Michael A Bonning · Gwendolyn L Gilbert

Mja2 50261
Child health Letters 5 August 2019 Free

Everyone agrees transgender children require more science

To the Editor: Writing recently in The Lancet, Byng and colleagues1 argue that our clinical guidelines on care of transgender children that appeared in the MJA2 use imprecise language, do not consider long term effects, and lack robust evidence. Several points the authors raise are valid and indeed align with what we and others have written about the state of evidence and need for high quality research in the field.3,4 However, it is important to provide additional clarification. First, the phrase “sex assigned at birth” is not intended to mislead as Byng and colleagues have claimed5 but is standard terminology for clinicians who work in transgender health (the guidelines’ primary intended audience).6 Second, the authors fail to acknowledge not only our direct call for more research on the guidelines’ opening page but also the detailed description of the long term effects of hormonal treatment, which is a key component of the guidelines.2 Moreover, in calling for more research, they ignore existing efforts to improve evidence in this field.7 Third, the authors raise the issue of de‐transition, which refers to the observation that some individuals who identify as transgender may eventually return to living as a member of their birth‐assigned sex. This subject has gained attention in mainstream media, which appears to be the authors’ source of information on this topic.5 While more research is needed, existing studies show true de‐transition is uncommon. For example, only 0.4% of 27 715 transgender people surveyed in the United States de‐transitioned because they felt transition was not right for them; more often, de‐transition occurred due to outside pressures (eg, parents, family, religion) and discrimination.8 In summary, Byng and colleagues’ call for more high quality research is not novel and has long been acknowledged by those of us in the field. Moreover, withholding gender‐affirming treatment via wait‐and‐see strategies mentioned by the authors is not without harm,9 and development and ongoing revision of guidelines such as ours will ensure that transgender individuals receive the best care based on up‐to‐date empirical evidence.

Ken C Pang · Carmen C Pace · Michelle A Tollit · Michelle M Telfer

Child health Narrative reviews 11 February 2019 Free

Current thinking in the health care management of children with cerebral palsy

The incidence of cerebral palsy is decreasing and early identification is not only important for families but may help to target treatment. Early interventions with targeted therapies are showing promising results in altering the natural history of cerebral palsy as well as enhancing patient activities. There remain many challenges in the management of a child with cerebral palsy, but there exist a number of interventions with a good evidence base. A child's ability should be viewed in context of their development and current evidence used to guide treatment with what is important for the child and their family. The six Fs framework provides a guide to developing shared goals with families.

David Graham · Simon P Paget · Neil Wimalasundera

Mja2 12106 0
Immune system diseases Narrative review 4 February 2019 Free

Food protein‐induced enterocolitis syndrome: guidelines summary and practice recommendations

Recent international consensus guidelines provide a more rigorous approach to diagnosis, introducing a system of major and minor criteria to facilitate early and accurate diagnosis and to guide diagnostic food challenge. They highlight the need for rapid fluid resuscitation in emergency presentations and the increasing evidence for the use of ondansetron in acute management. Diagnostic challenges should be performed in settings with suitable resuscitation facilities. Action plans and dietary information consistent with this guideline are available via ASCIA.10It is likely that improved understanding of the immunological basis of FPIES will, in the future, facilitate the development of a sensitive and specific biomarker. Until that time, use of standardised diagnostic criteria, improved recognition, timely fluid resuscitation, avoidance of trigger foods, and education form current best practice.

Sam Mehr · Dianne E Campbell

Mja2 12071

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