L'article du mois des Archives de Pédiatrie

Retrouvez ici l'article du mois des Archives de Pédiatrie

Article du mois d'Avril 2025

Nous vous proposons la lecture de l'article "Behavioral parenting intervention for parents of preschool-aged children born moderately and late preterm: An experimental study"
G. Maigret, E. Gentaz, F. Lejeune

Background: Prematurity can be associated with difficulties in emotional and behavioral regulation in children, leading to short- and long-term impacts on parental dynamics. However, moderate-late preterm children and their parents rarely receive follow-up care.
Objectives: The aim of this current study was to evaluate a Behavioral Parenting Intervention (BPI) specifically developed for parents of preschool-aged moderate-late preterm children, to prevent their potential difficulties in emotional and behavioral regulation.
Method: Thirty-eight families participated in a program consisting of 7 therapy sessions. Each experimental group was matched with a control group; the control group would become the experimental group in the following session. Parents completed questionnaires one week before the start of the program (T1) and at the end of the 7th therapy session to measure immediate effects (T2). Social validity measures were also added to this study to assess the feasibility and acceptability of our program.
Results: We primarily observed positive effects on the Parental Stress Index total (PSI) in the population 1. For the control group, there was no significant difference between PSI Total scores at T1 (M = 101.1, SD = 22.2) and T2 (M = 101.5, SD = 19.8). In contrast, the experimental group showed a significant reduction in PSI total scores from T1 (M = 105, SD = 23.2) to T2 (M = 93.3, SD = 21.3), with p < .001. Similar effects were observed for both the Parent Distress and the Difficult Child subscales.
Conclusion: While our results are modest, the measures of social validity and our high satisfaction rates indicate the importance and necessity of a parenting intervention aimed at moderately preterm children beyond the initial phase of early development. Future research should aim to facilitate access and increase family engagement to improve the effectiveness of this type of intervention.

Article du mois de Mars 2025

Nous vous proposons la lecture de l'article "Child victims of intrafamilial sexual abuse: A retrospective study at the Forensic Unit"
A. Tchouprikoff, L. Tuchtan, E. Bosdure, V. Bresson, C. Borrione, M.-D. Piercecchi-Marti, C. Delteil

Background: Reports of sexual abuse of minors are increasing, highlighting the important public health problem of child maltreatment with its long-lasting medical, forensic, emotional and social repercussions. The aim of this work was to document epidemiological data on children who were victims or suspected victims of intrafamilial sexual abuse and who were referred to a forensic unit, in order to help prevent abuse and to ipmrove our practice in detection, diagnosis and medical, forensic, psychological and social management.
Method: This was a historical observational descriptive and analytical study carried out in the Forensic Unit of La Timone, part of the Assistance Publique des Hôpitaux de Marseille, France, over a 2-year period.
Results: One hundred and ninety perineal examinations were performed on young children (average age 9 years), 67% of whom were more than a month old. Lesions were described in only 30 children (all girls), all of them old. Twenty-one children received psychological or psychiatric follow-up.
Conclusion: This study leads us to call into question our practice for overall management of child victims of sexual abuse and for forensic expert reports, with disappearance of lesions and low information yield from samples taken for genetic identification. There is a need for multidisciplinary management of these children and for specific training in obtaining their testimony. The paediatric units for children in danger (UPAD) can provide unity of time and place with multidisciplinary management.

Article du mois de Février 2025

Nous vous proposons la lecture de l'article "From pediatric emergency department to pediatric intensive care unit: a retrospective stuy in a French Tertiary University hospital"
E. Riche, A. Morand, S. Fruscione, F. Michel, A. Boutin, V. Bremond, V. Arnoux, P. Minodier

Objective: The management of a child presenting with a critical method or surgical condition is a scarce event in the pediatric emergency department (PED). In this one year retrospective study, we have tried to better characterize the profile and care pathway of children who had been transferred to the neonatal or pediatric inteisve care or critical care units (PICCU) after a visit to the PED, or died in PED.
Methods: Retrospective study of children who has been transferred to PICCO from the two PED of Marseille's University Hospital from the 1st of January 2022 until the 31st of December 2022.
Results: Among the 82,962 children who consulted the two PED of Marseille's University Hospital in 2022, 260 (0,3%) were transferred to PICCU or died in PED. The mean age was 42 months. There were 17% newborns and 12% infants aged 1 to 3 months old. The main reasons for referral was respiratory troubles (bronchiolitis 27.3%, asthma 21.9%), and neurological impairment (14.6%). Thirty percent of children were previously followed for a chronic illness. In 45%, a critical intervention was required: non-invasive or controlled ventilation, extracorporeal membrane oxygenation, use of amines and/or blood transfusion, surgery, and/or external cardiac massage. Two children died in the PED and six during the hospitalization. The mean duration of hospitalization in PICCU was 4.2 days.
Conclusion: In Marseille, during 2022, the occurrence of a critical child in PED was estimated at one every 300 children. These children were generally young and presented with respiratory or neurological pathologies. Care might require extensive resources or simple surveillance. Mortality was low (2.3%).

Article du mois de Janvier 2025

Nous vous proposons la lecture de l'article "Impact of the first COVID-19 lockdown on domestic accidents in children in France"
M.-P. Chaffard Luçon, N. Beltzer, A. Rigou, I. Claudet

Introduction: In March 2020, several countries, including France, implemented a total lockdown policy to combat the spread of the COVID-19 epidemic, involving the closure of schools. This measure required children to stay at home for an extended period of time. Several studies have shown an increase in the number or proportion and severity of domestic accidents in children during this period. Santé Publique France and the paediatric emergency department of Toulouse University Hospital conducted a study on the impact of the first lockdown in children under 15 years of age in France.
Methods: The study was conducted using data from nine French emergency departments participating in the Enquête permanente sur les accidents de la vie courante [Permanent Survey on Home and leisure injuries] (EPAC), which involves the exhaustive collection of data on emergency admissions following home and leisure injuries. The frequencies and characteristics of emergency department admissions due to domestic accidents were analysed over the period from 17 March to 11 May 2020, and compared to those over the same period in 2016-2019.
Results: During the lockdown period, an increase in the proportion of emergency department admissions due to domestic accidents is observed in boys and children aged 2-5 years. This study showed an increase in the proportion of hospital admissions during this period. These accidents were mainly falls in outside living spades (balcony, patio, garden, etc.). The results showed an increase in admissions for fractures and upper limb injuries.
Conclusion: This study shows that health policies must take into account the collateral effects of certain measures put in place to manage an epidemic. Prevention messages for parents of young children need to be strengthened and their attention drawn to the risk of certain kinds of accidents, such as falls.

Article du mois de Novembre 2024

Nous vous proposons la lecture de l'article "Endocrine management of transgender adolescents: Expert consensus of the french society of pediatric endocrinology and diabetology working group"
F. Brezin, . Busiah, C. Leroy, E. Fiot, C. Bensignor, C. Amouroux, M. Caquard, A. Cartault, S. Castets, C. Delcour, M. Devernay, E. Feigerlova, M. Hoarau, B. Lebon-Labich, A.-S. Lambert, S. Rouleau, M.-A. Trouvin, V. Vautier, L. Martinerie

Abstract: 
Introduction: Requests for hormonal transition in minors are increasing. To date, there is no national recommendation to guide these practices in France. Therefore, the SFEDP (French Society of Pediatric Endocrinology and Diabetology) has commissioned a group of experts to draft the first national consensus on this topic.
Method: Each chapter was prepared by one to three authors who conducted a literature review, and it was then reviewed and revised by the group as many times as necessary to achieve a consensus position. The final document was reviewed by a group of external experts.
Results: A consensus position was reached regarding the multi-professional nature of support for trans youth, the prescription of molecules aimed at inhibiting endogenous hormone secretion, and the use of gender-affirming hormone therapies, as well as the importance of offering gamete preservation. Non-hormonal aspects of support and various considerations, including ethical ones, were also discussed.
Conclusion: This work constitutes an initial set of recommendations for professionals involved in the hormonal transition of trans youth. Additional recommendations under the auspices of the French High Authority for Health would be worthy of being drafted, involving all relevant stakeholders to establish comprehensive official national guidelines that would secure the support and rights of these young individuals, especially those under 16 years old, as well as the professionals involved in their care.

Article du mois d'OCTOBRE 2024

Nous vous proposons la lecture de l'article "Paradigm shift in France in the medical care of children with genital development variations: Medical care for children with genital development variations in France"
C. Bouvattier, L. Duranteau, T. Verdelet, M. Joly, C. Le Roux, L. Brunet

Abstract: In 2021, for the first time, a legal framework organizing the care of children with a variation in genital development (VGD), sometimes referred to as "intersex children" or "children with differences in sex development" (DSD), was introduced in France (article L. 2131-6 of the Code of Public Health). It should be immediately apparent that the chosen term, "variation" rather than "anomalies" or "disorders" - which was previously used in the medical world - reflects a political will to renew both the way of thinking and the medical practices in this field. The aim of the new legal framework is to guarantee optimum care for children with VGD by requiring the systematic involvement of expert centers (to establish diagnoses and therapeutic proposals), providing the most comprehensive information possible to their families and seeking the minor's consent. Among the possible medical care options, the law explicitly mentions "therapeutic abstention," reflecting a paradigm shift aimed at curbing the too-frequent recourse to treatments whose sole objective is the conformation of the genitalia. An order was subsequently issued on 15 November 2022 to provide the necessary details for the implementation of the changes introduced by the law.

Article du mois d'Août 2024

Nous vous proposons la lecture de l'article "Indications for extensively hydrolyzed cow's mil protein in the neonatal period"
V. Rigourd, A. Heneay, A.-L. Virlouvet, A. Basset, E. Herry, B. Jacquemet, M. Bellaiche, A. Lapillonne, P. Tounian

Abstract: A large proportion of prescriptions for extensively hydrolyzed cow's milk protein (CMP) in newborns are not based on any scientific data justifying the indication. Many of these prescriptions are old habits or are based on incomplete data. The aim of this article is to analyze these practices and propose recommendations. The following points are covered: (a) indications for extensively hydrolyzed formula based on studies demonstrating their benefits in these situations - newborns with a proven allergy to CMP and occasional prescription of supplements to breastfeeding; (b) possible indications not based on a high level of evidence-re-initiation of feeding due to necrotizing enterocolitis, short bowel syndrome, re-initiation of feeding of newborns following intestinal surgery, and laparoschisis if neither the mother's own milk nor milk from a lactarium is available; (c) unjustified indications - newborns at risk of atopy, prematurity, severe neurological pathologies, newborns who are hemodynamically unstable and/or have congenital cardiopathy, neonatal hypoxic-ischemic encephalopathy treated with hypothermia, and newborns with esophageal atresia or diaphragmatic hernia. By following this classification, the prescriber will be guided to use the milk best suited to the pathology, bearing in mind that each situation must be adapted individually and the tolerance and effectiveness of the food reassessed from a nutritional and functional point of view.

Article du mois de mai 2024

Nous vous proposons la lecture de l'article "Guiding and supporting parents: Practical aspects and pending questions"
A. Nuytten, J. Andreu-Gallien

Parenting is a subject that has been increasingly discussed in the media in recent years from various angles: television, radio, podcasts, and social media. In France, the topic sparks debates and often renders caricatured positions, urging the audience to "pick a side." The pressures on parents are numerous, leading to anxiety and guilt, and they are not always provided with concrete support in their role as parents. While discussions on educational matters are not new, it is essential to note that they are happening at a time when our knowledge about child development, particularly in the emotional and social aspects, has significantly evolved in recent years.
[...]
 

ARTICLE DU MOIS D'Avril 2024

Nous vous proposons la lecture de l'article "Diagnosis and management of congenital hypopituitarism in children"
S. Castets, C. Thomas-Teinturier, C. Villanueva, J. Amsellem, P. Barat, G. Brun, E.B. Quoc, J.C. Carel, G.P. De Filippo, C. Kipnis, L. Martinerie, J. Vergier, A. Saveanu, N. Teissier, R. Coutant, J. Léger, R. Reynaud

Abstract: Hypopituitarism (or pituitary deficiency) is a rare disease with an estimated prevalence of between 1/16,000 and 1/26,000 individuals, defined by insufficient production of one or several anterior pituitary hormones (growth hormone [GH], thyroid-stimulating hormone [TSH], adrenocorticotropic hormone [ACTH], luteinizing hormone [LH], follicle-stimulating hormone [FSH], prolactin), in association or not with diabetes insipidus (antidiuretic hormone [ADH] deficiency). While in adults hypopituitarism is mostly an acquired disease (tumors, irradiation), in children it is most often a congenital condition, due to abnormal pituitary development. Clinical symptoms vary considerably from isolated to combined deficiencies and between syndromic and non-syndromic forms. Early signs are non-specific but should not be overlooked. Diagnosis is based on a combination of clinical, laboratory (testing of all hormonal axes), imaging (brain magnetic resonance imaging [MRI] with thin slices centered on the hypothalamic–pituitary region), and genetic (next-generation sequencing of genes involved in pituitary development, array-based comparative genomic hybridization, and/or genomic analysis) findings. Early brain MRI is crucial in neonates or in cases of severe hormone deficiency for differential diagnosis and to inform syndrome workup. This article presents recommendations for hormone replacement therapy for each of the respective deficient axes. Lifelong follow-up with an endocrinologist is required, including in adulthood, with multidisciplinary management for patients with syndromic forms or comorbidities. Treatment objectives include alleviating symptoms, preventing comorbidities and acute complications, and optimal social and educational integration.

ARTICLE DU MOIS DE FéVRIER 2024

Nous vous proposons la lecture de l'article "Parents' participation in collegial meetings to discuss withholding or withdrawing treatment for their newborn: Working to improve information-sharing"
P. Boize, Y. Garner, E. Neaud, S. Borrhomee

Aim: The role of parents in decision-making concerning their child's end-of-life care is not clearly defined. Their participation is encouraged by ethical reflection, in particular by the CCNE (French National Ethics Advisory Committee), but laws are limited to imposing a duty to provide information to doctors. Decisions are taken at the end of a collegial meeting (CM) intended to better inform the child's referring physician (RP) who is in charge of the final decision following the French law. The aim of this study was to describe the support provided to bereaved families after they had been invited to attend a CM concerning their child, if they so wished. Additional aims were to determine the differences resulting from their acceptance or their refusal to participate as regards their perception of their child's history and as regards their grieving process.

Matérial and method: We conducted a retrospective study of all CMs held between November 2016 and May 2021, drawing a distinction between proposals made or not made to parents and their decision to accept or refuse.

Results: In total, 49 CMs concerning 46 children were held during the study period. The proposal was not made to the parents in three cases; the parents chose to be present in 28 cases. The psychological follow-up (15/28 parents attending, 10/16 parents absent) illustrated that their presence enabled them to reflect on their child's death after having listened to and understood the reasons why it happened. They did not dispute the teams' approach or decisions taken.

Conclusion: It is possible to include parents in CMs if they so wish. It would appear more beneficial than merely providing them with the information required. Studies must be carried out to ensure potential long-term benefit.

Article du mois de Janvier 2024

Nous vous proposons la lecture de l'article "Childminder knowledge of shaken baby syndrome and the role played by childminders in prevention: An observational study in France"
V. Fortin, A. Romero De Avila Ortiz, A.-D. Marq, E. Mostermans, M. Marichal, M. Bailhache

Background: Shaken baby syndrome (SBS) triggers negative short- and long-term outcomes. In France, registered childminders are the principal source of daycare. They may encounter SBS imparted by caregivers or simply excessive infant crying. The aim of the study was to explore childminder knowledge on SBS, the source of information, the responses to infant crying, how childminders perceived their roles in terms of caregiver SBS prevention, and the factors associated with a good knowledge of SBS.

Methods: The participants were registered childminders working in the French department of Gironde who had email accounts. This observational study employed an anonymous online questionnaire distributed by the maternal and child health services unit of the Gironde department over 5 weeks from 16 September 2021. Data on childminder characteristics, knowledge on SBS, responses to infant crying, and perceptions of their roles in SBS prevention were collected. The knowledge score ranged from 0 (all wrong answers) to 30 (all correct answers).

Results: A total of 779 registered childminders participated; 43.9 % had learnt about SBS during their initial training and 75 % before (other training) or after initial training. The median knowledge score was 19/30 (interquartile range [16; 21]). A higher educational level, previous other professional experience, training on SBS, and responsibility for few children were associated with higher scores. Ten reported that they did not advise caregivers who complained of infant crying.

Conclusion: Childminders require training on SBS and SBS prevention.