Allergy Immunology

 Allergology International

Dual sublingual immunotherapy with Japanese Cedar Pollen droplets and House Dust Mite tablets

Publication date: Available online 5 April 2019Source: Allergology InternationalAuthor(s): Tomokazu Matsuoka, Satoshi Igarashi, Yuumi Kuroda, Chiharu Fukano, Kensuke Natsui, Katsuyo Doi-Ohashi, Keisuke Masuyama

Allergology International

Sat Apr 06, 2019 16:12

Potential risk factors of adverse reactions to nonionic contrast media in patients with underlying dermatological diseases: An 8-year retrospective survey

Publication date: Available online 4 April 2019Source: Allergology InternationalAuthor(s): Emi Nakauchi, Takeshi Fukumoto, Satoru Takahashi, Nobuyuki Horita, Masahiro Oka, Chikako Nishigori

Allergology International

Fri Apr 05, 2019 14:31

Mark above section as read

 Allergy

Food processing and Occupational Respiratory Allergy ‐ a EAACI Position Paper

AbstractOccupational exposure to foods is responsible for up to 25% of cases of occupational asthma and rhinitis. Animal and vegetable high‐molecular weight proteins present in aerosolized foods during food processing, additives, preservatives, antioxidants and food contaminants are the main inhalant allergen sources. Most agents typically cause IgE‐mediated allergic reactions, causing a distinct form of food allergy (Class 3 food allergy). The allergenicity of a food protein, allergen exposure...

Allergy

Sat Apr 06, 2019 21:58

Supporting allergen‐specific immunotherapy by inhibition of Janus kinases

AbstractAllergen‐specific immunotherapy (AIT) is the only disease‐modifying and curative treatment for allergic diseases. While in selected indications such as Hymenoptera venom allergy the curative success of AIT is impressingly high, in other disease manifestations it only reduces the symptoms to a certain extend in a fraction of patients. Key problems leading to a reduced efficacy of AIT seem to partly depend on local inflammatory processes that are not only causing side‐effects, but additionally...

Allergy

Sat Apr 06, 2019 19:59

Immunological methods for diagnosis and monitoring of IgE‐mediated allergy caused by industrial sensitizing agents (IMExAllergy)

AbstractIndustrial sensitizing agents (allergens) in living and working environments play an important role in eliciting type I allergic disorders including asthma and allergic rhinitis. Successful management of allergic diseases necessitates identifying their specific causes (i.e. identify the causative agent(s) and the route of contact to allergen: airborne, or skin contact) to avoid further exposure. Identification of sensitization by a sensitive and validated measurement of specific‐IgE...

Allergy

Sat Apr 06, 2019 19:59

Towards clinically applicable biomarkers for asthma – An EAACI position paper

AbstractInflammation, structural and functional abnormalities within the airways are key features of asthma. Although these processes are well‐documented, their expression varies across the heterogeneous spectrum of asthma. Type 2 inflammatory responses are characterized by increased levels of eosinophils, FeNO and type 2 cytokines in blood and/or airways. Presently, type 2 asthma is the best‐defined endotype, typically found in patients with allergic asthma, but surprisingly also in non‐allergic...

Allergy

Sat Apr 06, 2019 17:13

Mark above section as read

 Allergy

Comparison of allergic rhinitis outcomes of the Environmental Exposure Unit and Nasal Allergen Challenge Model

Publication date: Available online 6 April 2019Source: Annals of Allergy, Asthma & ImmunologyAuthor(s): Mark W. Tenn, Lisa M. Steacy, Daniel E. Adams, Terry J. Walker, Anne K. Ellis

Allergy

Sat Apr 06, 2019 12:18

The Development and Evaluation of Peer Food Allergy Education Videos for School- Age Youth

Publication date: Available online 6 April 2019Source: Annals of Allergy, Asthma & ImmunologyAuthor(s): Jialing Jiang, Joel Gallagher, Jolanta Szkodon, Maaria Syed, Karina Gobin, Ruchi Gupta, Lucy Bilaver

Allergy

Sat Apr 06, 2019 12:18

Improving Allergy Skin Testing Proficiency

Publication date: Available online 5 April 2019Source: Annals of Allergy, Asthma & ImmunologyAuthor(s): Rachna R. Dave, Catherine M. Hammond, Charles W. Stewart, D.Betty Lew

Allergy

Sat Apr 06, 2019 12:18

Development Of A Progesterone-Specific IgE Assay For Diagnosing Patients With Suspected Progestogen Hypersensitivity

Publication date: Available online 4 April 2019Source: Annals of Allergy, Asthma & ImmunologyAuthor(s): Debajyoti Ghosh, Jonathan Bernstein

Allergy

Fri Apr 05, 2019 13:23

Anti-Eosinophil Therapy is associated with Decreased Body Mass Index in Severe Asthmatics: a Preliminary Retrospective Analysis

Publication date: Available online 4 April 2019Source: Annals of Allergy, Asthma & ImmunologyAuthor(s): Merin Kuruvilla, Meera Patrawala, Joshua M. Levy, Jennifer Shih, Frances E. Lee

Allergy

Fri Apr 05, 2019 13:23

"Early Immunologic Changes During the Onset of Atopic Dermatitis"

Publication date: Available online 4 April 2019Source: Annals of Allergy, Asthma & ImmunologyAuthor(s): Patrick M. Brunner

Allergy

Fri Apr 05, 2019 13:23

Exploring Latent Classes to Identify Prenatal and Early-life Sources of Racial Disparities in Allergic Disease

Publication date: Available online 4 April 2019Source: Annals of Allergy, Asthma & ImmunologyAuthor(s): Ganesa Wegienka, Alexandra Sitarik, Albert M. Levin, Edward M. Zoratti, Dennis Ownby, Christine Cole Johnson, Suzanne Havstad

Allergy

Fri Apr 05, 2019 13:23

Pediatricians underestimate parent receptiveness to early peanut introduction

Publication date: Available online 4 April 2019Source: Annals of Allergy, Asthma & ImmunologyAuthor(s): Michelle Lai, Scott H. Sicherer

Allergy

Fri Apr 05, 2019 13:23

Mark above section as read

 Annals of Allergy, Asthma & Immunology

Mark above section as read

 Autoimmunity Reviews

The 2018 pipeline of targeted therapies under clinical development for primary Sjögren's syndrome: A systematic review of trials

Publication date: Available online 6 April 2019Source: Autoimmunity ReviewsAuthor(s): Renaud Felten, Florence Scher, Jean Sibilia, Jacques-Eric Gottenberg, Laurent ArnaudAbstractTo date, no immunomodulatory drug has proved efficacious in primary Sjögren's syndrome (pSS). In pSS, difficulties in drug efficacy assessment is related to the large spectrum of clinical involvements (glandular/extraglandular involvement), to the lack of correlation between symptoms of dryness and glandular function assessed...

Autoimmunity Reviews

Sat Apr 06, 2019 16:43

Is there a possible correlation between antibodies against lipopolysaccharide, intestinal and blood-brain barrier proteins in IBD subjects?

Publication date: Available online 5 April 2019Source: Autoimmunity ReviewsAuthor(s): Aristo Vojdani

Autoimmunity Reviews

Sat Apr 06, 2019 16:43

Extracellular vesicles in autoimmune vasculitis - Little dirts light the fire in blood vessels

Publication date: Available online 5 April 2019Source: Autoimmunity ReviewsAuthor(s): Xiuhua Wu, Yu Liu, Wei Wei, Ming-Lin LiuAbstractSystemic vasculitis is diverse group of autoimmune disorders which are characterized by inflammation of blood vessel walls with deep aching and burning pain. Their underlying etiology and pathophysiology still remain poorly understood. Extracellular vesicles (EVs), including exosomes, microvesicles (MVs), and apoptotic bodies, are membrane vesicular structures that...

Autoimmunity Reviews

Sat Apr 06, 2019 16:43

Thyroid disorders in patients with systemic sclerosis: A systematic review and meta-analysis

Publication date: Available online 5 April 2019Source: Autoimmunity ReviewsAuthor(s): Qiuming Yao, Zhenyu Song, Bin Wang, Jin-an Zhang, Kaida Mu

Autoimmunity Reviews

Sat Apr 06, 2019 16:43

Systemic rheumatic diseases: From biological agents to small molecules

Publication date: Available online 5 April 2019Source: Autoimmunity ReviewsAuthor(s): Piercarlo Sarzi-Puttini, Angela Ceribelli, Daniela Marotto, Alberto Batticciotto, Fabiola AtzeniAbstractThe development of biologics and small oral molecules has recently changed the scenario of pharmacologic treatment of systemic rheumatic diseases and it has become a real revolution. These drugs have innovative mechanisms of action, based on the inhibition of specific molecular or cellular targets directly involved...

Autoimmunity Reviews

Sat Apr 06, 2019 16:43

Endothelial function features and properties of large vessel behavior in systemic autoimmune diseases: a cross-talk among cardiovascular disease risk factors

Publication date: Available online 5 April 2019Source: Autoimmunity ReviewsAuthor(s): Rafael Giovani Missé, Isabela Bruna Pires Borges, Samuel Katsuyuki Shinjo

Autoimmunity Reviews

Sat Apr 06, 2019 16:43

G-CSF-induced aortitis: Two cases and review of the literature

Publication date: Available online 5 April 2019Source: Autoimmunity ReviewsAuthor(s): Ioannis Parodis, Lara Dani, Antonella Notarnicola, Git Martenhed, Pontus Fernström, Alexios Matikas, Oscar P.B. WiklanderAbstractBackgroundFebrile neutropenia is generally recognised as a complication of myelosuppressive chemotherapy. Recombinant human granulocyte colony stimulating factor (G-CSF) is commonly used as primary or secondary prophylaxis to reduce the degree and duration of neutropenia in patients at...

Autoimmunity Reviews

Sat Apr 06, 2019 16:43

Autoimmune signatures for prediction and diagnosis of autoimmune diabetes in Kuwait

Publication date: Available online 5 April 2019Source: Autoimmunity ReviewsAuthor(s): Mohamed Jahromi, Fahd Al-Mulla, Ebaa Al-Ozairi

Autoimmunity Reviews

Sat Apr 06, 2019 16:43

Corticosteroids and immunosuppressive agents for idiopathic recurrent pericarditis

Publication date: Available online 5 April 2019Source: Autoimmunity ReviewsAuthor(s): Nathan Peiffer-Smadja, Fanny Domont, David Saadoun, Patrice CacoubAbstractRecurrent pericarditis is a frequent and troublesome complication of acute pericarditis. Aspirin or non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine are the mainstay of therapy but few data is available on second-line treatment. We retrospectively analyzed 13 patients, 7 females (54%), median age 40 years, with a median of 4 (IQR...

Autoimmunity Reviews

Sat Apr 06, 2019 16:43

Emerging role of air pollution in autoimmune diseases

Publication date: Available online 5 April 2019Source: Autoimmunity ReviewsAuthor(s): Chan-Na Zhao, Zhiwei Xu, Guo-Cui Wu, Yan-Mei Mao, Li-Na Liu, Qian-Wu, Yi-Lin Dan, Sha-Sha Tao, Qin Zhang, Napoleon Bellua Sam, Yin-Guang Fan, Yan-Feng Zou, Dong-Qing Ye, Hai-Feng PanAbstractAutoimmune diseases (ADs) are a broad spectrum of disorders featured by the body's immune responses being directed against its own tissues, resulting in prolonged inflammation and subsequent tissue damage. Recently, the exposure...

Autoimmunity Reviews

Sat Apr 06, 2019 16:43

Diagnosis of gluten-related disorders: A new and challenging public health problem

Publication date: Available online 5 April 2019Source: Autoimmunity ReviewsAuthor(s): M. Lucia Sur, Loredana Dascăl, Genel Sur, Daniel G. Sur, Emanuela Floca, Cornel Aldea, Iulia Lupan, Gabriel Samasca

Autoimmunity Reviews

Sat Apr 06, 2019 16:43

Does intravenous immunoglobulin therapy in Guillain-Barré syndrome patients interfere with serological Zika detection?

Publication date: Available online 5 April 2019Source: Autoimmunity ReviewsAuthor(s): Anupama Karnam, Emmanuel Stephen-Victor, Mrinmoy Das, Laurent Magy, Jean-Michel Vallat, Francis Bolgert, Etienne Simon-Loriere, Srini V. Kaveri, Anavaj Sakuntabhai, Jagadeesh Bayry

Autoimmunity Reviews

Sat Apr 06, 2019 16:43

Anakinra in idiopathic recurrent pericarditis refractory to immunosuppressive therapy; a preliminary experience in seven patients

Publication date: Available online 5 April 2019Source: Autoimmunity ReviewsAuthor(s): Amir Dagan, Pnina Langevitz, Yehuda Shoenfeld, Ora ShovmanAbstractBackgroundApproximately 5% of idiopathic recurrent pericarditis (IRP) patients are refractory or intolerant to NSAIDs, Colchicine and corticosteroids. The empiric treatment approach for these patients includes immunosuppression with Azathioprine (AZA) or immunomodulation with intravenous human immunoglobulin (IVIG). We assessed the efficacy and safety...

Autoimmunity Reviews

Sat Apr 06, 2019 16:43

Amplifying the concept of psoriatic arthritis: The role of autoimmunity in systemic psoriatic disease

Publication date: Available online 5 April 2019Source: Autoimmunity ReviewsAuthor(s): Maria Sole Chimenti, Francesco Caso, Stefano Alivernini, Erica De Martino, Luisa Costa, Barbara Tolusso, Paola Triggianese, Paola Conigliaro, Elisa Gremese, Raffaele Scarpa, Roberto PerriconeAbstractPsoriatic arthritis (PsA) is a chronic inflammatory arthritis that may be present in near 30% of patients affected by psoriasis (PsO), clinically characterized by inflammation of periarticular (e.g., enthesis) and articular...

Autoimmunity Reviews

Sat Apr 06, 2019 16:43

Mark above section as read

 Current Opinion in Allergy and Clinical Immunology - Published Ahead-of-Print

Editorial introductions

No abstract available

Current Opinion in Allergy and Clinical Immunology - Published Ahead-of-Print

Thu Apr 04, 2019 03:00

Mark above section as read

 International Forum of Allergy & Rhinology

Esophageal IgE, IgG4, and mucosal eosinophilia in individuals with dysphagia

BackgroundEosinophilic esophagitis (EoE) is an inflammatory disease of the esophagus, producing failure to thrive in infants and dysphagia with food impaction in older children and adults. Although most people with EoE manifest atopic/allergic disease, the specific allergens to which immunoglobulin E (IgE) is directed, if any, have not yet been characterized.MethodsMucosal brush biopsy (MBB) and solid tissue biopsy (STB) specimens were prospectively obtained from 25 individuals with dysphagia...

International Forum of Allergy & Rhinology

Fri Apr 05, 2019 11:24

Mark above section as read

 JACI (AOP)

Human BCR analysis of single-sorted, putative IgE+ memory B cells in food allergy

R. Jimenez-Saiz, Y. Ellenbogen and K. Bruton et al. developed a method to identify bona fide IgE+ MBCs in humans, demonstrated their extreme rarity in circulation and cautioned against the clinical utility of their assessment.

JACI (AOP)

Fri Apr 05, 2019 03:00

Fine particulate matter exposure during pregnancy and infancy periods and incident asthma

Both prenatal and postnatal exposures to PM2.5 were associated with the later development of asthma. The vulnerable time windows might be within early- and mid-gestation and the first year after birth.

JACI (AOP)

Fri Apr 05, 2019 03:00

Unneutral Neutrophils in Late Phase Allergic Reactions

JACI (AOP)

Fri Apr 05, 2019 03:00

Mark above section as read

 Journal of Allergy and Clinical Immunology

Allogeneic Hematopoietic Stem Cell Transplant Outcomes for Patients with Dominant-Negative IKFZ1/IKAROS Mutations

Publication date: Available online 6 April 2019Source: Journal of Allergy and Clinical ImmunologyAuthor(s): Erinn S. Kellner, Christa Krupski, Hye Sun Kuehn, Sergio D. Rosenzweig, Nao Yoshida, Seiji Kojima, David Boutbol, Sylvain Latour, Vincent Barlogis, Claire Galambrun, Asbjørg Stray-Pedersen, Hans Christian Erichsen, Rebecca A. Marsh

Journal of Allergy and Clinical Immunology

Sun Apr 07, 2019 15:33

Human BCR analysis of single-sorted, putative IgE⁺ memory B cells in food allergy

Publication date: Available online 5 April 2019Source: Journal of Allergy and Clinical ImmunologyAuthor(s): Rodrigo Jiménez-Saiz, Yosef Ellenbogen, Kelly Bruton, Paul Spill, Doron D. Sommer, Hermenio Lima, Susan Waserman, Sarita U. Patil, Wayne G. Shreffler, Manel Jordana

Journal of Allergy and Clinical Immunology

Sat Apr 06, 2019 13:37

The Skin as an Immune Organ: Tolerance Versus Effector Responses, and Applications to Food Allergy and Hypersensitivity Reactions

Publication date: Available online 5 April 2019Source: Journal of Allergy and Clinical ImmunologyAuthor(s): Emma Guttman-Yassky, Lisa Zhou, James KruegerAbstractSkin is replete with immune-competent cells that modulate signaling pathways to maintain a salubrious immunogenic/tolerogenic balance. This fertile immune environment plays a significant role in the development of allergic responses and sensitivities, but the mechanisms underlying these pathways have been underappreciated and underutilized...

Journal of Allergy and Clinical Immunology

Fri Apr 05, 2019 16:40

Mark above section as read

Aesthetic Plastic Surgery

 British Association of Plastic Surgeons

Quantifying the burden of litigation in UK plastic surgery: A national survey

Publication date: Available online 4 April 2019Source: Journal of Plastic, Reconstructive & Aesthetic SurgeryAuthor(s): Shakeel Rahman, Lilli Cooper, David Thomson, Mark Soldin

British Association of Plastic Surgeons

Fri Apr 05, 2019 16:14

Mark above section as read

 Journal of Plastic, Reconstructive & Aesthetic Surgery

Mark above section as read

 Latest Results for Aesthetic Plastic Surgery

Facial Contouring by Using Dermal Fillers and Botulinum Toxin A: A Practical Approach

Abstract Background The perception of an attractive face is largely subjective. The purpose of this paper is to provide an insight and a practical approach to facial contouring management with hyaluronic acid (HA) implants and botulinum toxin A. Methods This study is presenting the clinical experience of the authors regarding facial contouring. After a careful...

Latest Results for Aesthetic Plastic Surgery

Fri Apr 05, 2019 03:00

Mark above section as read

Archives of Disease in Childhood

Highlights from this issue In Kipling's seminal novel 'Kim', the central premise (literal and metaphorical) is the wresting for power in fin de (19th) siècle South Asia. This attritional confrontation became popularly known as the Great Game and, though ostensibly a children's book, is really more complex. At its core, it is an examination of conflict at multiple levels, part of course of the 'human condition'. The book, is as apposite now as it was in the Bombay and Kabul of Kipling's youth and the theme underpins several of this month's broad ranging papers Disaster preparedness Though one might debate the relative contributions to the change, no one would refute the fact that, as starkly highlighted by the global terrorism index, the world is becoming less stable. Though human beings may always have had this propensity, technological changes have altered the means of expressing this phenotype on both a personal and national scale....

Conflict, candour and reflection There are many challenges to practising medicine well, not least keeping up to date with medical advances, implementing them within the time and financial restraints of ever expanding healthcare and avoiding over or under treatment while keeping the patient safe and avoiding criticism or complaints. In essence, considering the 'whole patient' and managing them using our knowledge, skills and experience which no longer equates to just the medical facts with increased recognition that skills like 'openness', 'listening', 'transparency' and enhanced communication are partly acquired by experience but can also be facilitated by training, mentoring and working in a positive and supportive environment. Multiple new areas of thinking have emerged as priorities—conflict resolution training, the duty of candour, learning from excellence, the need to reflect and active consideration of well being for ourselves, our patients and their families. These concepts need to be embraced as they will help facilitate us...

Quality of life after extremely preterm birth Gire et al examine the quality of life (QoL) of French primary school-age children born extremely preterm (EP), without disabilities.1 EP birth is usually defined as birth <28 completed weeks' pregnancy, and accounts for <1% of all births, and about 5% of all preterm births. Most children born preterm are moderate to late preterm. However, children born EP have been followed up in international cohort studies for many years, and are well recognised as being at high risk of mortality, morbidity and adverse long-term neurodevelopmental and metabolic outcomes. As these children grow into adulthood, a rich body of literature is emerging, describing their self-reported and observer-reported QoL: an important adjunct to the medical and psychological outcome measures that are deemed important by clinicians and researchers. Gire et al report that this cross-sectional multicentre study from five level III neonatal hospitals includes 20% of children born EP in France. Importantly, both...

Research beyond the hospital walls Introduction Reading widely is not only good for children. Although 'publish or perish' has tended to replace 'read or be dull' in academic life, reading beyond the clinical literature gives us grown-ups a better understanding of children's lives and histories as well as our own. This article provides pointers to the kinds of work with something important to say about children's well-being beyond hospital or clinical settings. The more we understand—as medical education reminds us—that bodies are not just a bunch of organs and that medicine is only one of many determinants of good child health, the more fun it can be to see what we might learn from people on whose shoulders we stand, whatever their discipline. Earlier articles in this series discuss the imperative to build on what we know and to ask the kinds of questions that children, parents and healthcare professionals would like to...

Maternal immunisation in pregnancy to protect newborn infants Although maternal tetanus immunisation has been effectively implemented for many years in the developing world,1 there has been a renewed global interest in maternal immunisation programmes over the past several years.2–5 This has been driven partly by the severity of the 2009 H1N1 influenza pandemic in pregnant women and the safety provided by the widespread maternal immunisation programme implemented in response to the pandemic.6 7 It has also been increasingly appreciated that maternal immunisations are an excellent way to provide protection to young infants before their own primary immunisation series would begin. There are several reasons that immunising pregnant women is an attractive vaccination strategy. First, by immunising the pregnant woman there is the potential to prevent the targeted infection in both the pregnant woman and her infant. This approach is often referred to as a 'two-fer' with...

A call to action: attention to paediatric-specific disaster preparedness Natural and man-made disasters have been increasing worldwide. Six hundred natural disasters were documented worldwide in 2016 compared with 200 in 1980.1 The Global Terrorism Index score (which reflects the relative impact of terrorism incidents annually) increased ninefold from 2000 to 2015.2 With this increasing frequency of mass-casualty events globally, hospitals and their healthcare professionals (HCPs) must be ready to receive and manage a large influx of patients. Additionally, these institutions and front-line healthcare workers must be prepared to care for disaster victims of all ages, including the paediatric population, regardless of the hospitals' typical intake patterns. In order to be best prepared, many countries across the world have developed healthcare-related disaster plans. Similar to other countries, France has developed the Organisation de la Réponse du Système de Santé en Situations Sanitaires Exceptionnelles plan to guide the management of mass casualties. However, this specific plan lacks...

Disaster preparedness in French paediatric hospitals 2 years after terrorist attacks of 2015 Objective We aimed to determine paediatric hospital preparedness for a mass casualty disaster involving children in both prehospital and hospital settings. The study findings will serve to generate recommendations, guidelines and training objectives. Design and setting The AMAVI-PED study is a cross-sectional survey. An electronic questionnaire was sent to French physicians with key roles in specialised paediatric acute care. Results In total, 81% (26 of 32) of French University Hospitals were represented in the study. A disaster plan AMAVI with a specific paediatric emphasis was established in all the paediatric centres. In case of a mass casualty event, paediatric victims would be initially admitted to the paediatric emergency department for most centres (n=21; 75%). Paediatric anaesthesiologists, paediatric surgeons and paediatric radiologists were in-house in 20 (71%), 5 (18%) and 12 (43%) centres, respectively. Twenty-three (82%) hospitals had a paediatric specialised mobile intensive care unit and seven (25%) of these could provide a prehospital emergency response. Didactic teaching and simulation exercises were implemented in 20 (71%) and 22 (79%) centres, respectively. Overall, physician participants rated the level of readiness of their hospital as 6 (IQR: 5–7) on a 10-point readiness scale. Conclusion Paediatric preparedness is very heterogeneous between the centres. Based on the study findings, we suggest that a national programme must be defined and guidelines generated.

Reducing healthcare conflict: outcomes from using the conflict management framework Objective To test a new conflict management framework (CMF) to help staff identify and de-escalate conflict between staff and patients/families. Design Before/after study that reports staff quality of life, frequency/severity of conflicts and qualitative interviews on using the framework. Data were collected from May 2017 to September 2017. Setting A paediatric oncology department day-patient and 23-bed inpatient ward. Intervention A two-stage CMF used by staff during daily handovers to identify and then manage conflict cases with families. Results Staff found the CMFto be helpful in identifying and de-escalating conflicts. The number of conflicts reported decreased by 64% from baseline to follow-up. Communication regarding conflict identification improved. Reports of staff burn-out decreased between the two time-points (n=55 at baseline, n=31 at follow-up; p=0.001). Scores on compassion and secondary traumatic stress did not change. Conclusions The CMF substantially reduces the incidence of conflicts and is an acceptable approach for staff. Continued use of the framework would require it to be fully integrated into the working of the ward, which would need to include senior medical buy-in. Further refinements to the framework have been made and will be tested in four UK sites in 2018/2019.

Quality of life of extremely preterm school-age children without major handicap: a cross-sectional observational study Objective To determine the quality of life (QoL) of school-aged children who were born <28+0 weeks of gestation and who have no resultant major disabilities. Design, setting and patients A cross-sectional multicentre study of extremely preterm (EPT) infants born <28+0 weeks, discharged alive and free from severe impairments (cerebral palsy, autism, major cognitive disabilities). Two generic, self-evaluation and hetero-evaluation (by parent) QoL measurement questionnaires (Kidscreen 10/VSP-A) were used and then compared with French population reference. Main outcome measures Clinical examination, an assessment of cognitive functions and QoL between 7 and 10 years of age. Results 40 (7.5%) severely disabled children were excluded. Among those 471 eligible, the lost to follow-up group (169 (36%)) paralleled those 302 (64%) included in the study. The mean gestational age was 26.2 (±0.8), birth weight was 879 (±181) g and the mean age was 8.4 (±0.87) years. 48% of participants had minor or moderate cognitive disabilities based on their Full-Scale Index Quotient. Working memory, attention and mental flexibility scored as low-average. Except for family relationships, the EPT QoL VSP-A and Kidscreen 10 assessment were significantly lower based on the children's and parent's perspectives. Children reported the most significant QoL decline as (1) friends' relationships, (2) self-esteem and (3) leisure, while parents indicated (1) psychological well-being, (2) schoolwork and (3) vitality. Conclusion The QoL of a school-age EPT child without severe impairment was lower relative to a reference population from both the parents' and child's points of view. This evaluation should help to better understand the long-term outcomes and to provide better support for them and their families. Trial registration number NCT01675726, pre-results.

Air pollution and autism It's clear that genetics plays a major role in the aetiology of autistic spectrum disorder (ASD), but the genuine increase in prevalence over recent decades suggests that environmental factors are also responsible. If ASD is considered to be a neurodevelopmental disorder, rather than a social construct, then antenatal influences during early brain development may be important. Potential prenatal causes suggested thus far are many and varied, including paracetamol (Archivist Oct 2016 doi.org/10.1136/archdischild-2016–3 11 708), antidepressant drugs (Archivist March 2016 doi.org/10.1136/archdischild-2016–3 10 462), ultrasound (Archivist Sept 2018 doi.org/10.1136/archdischild-2018–3 15 816), season of conception (Lucina Dec 2016 doi.org/10.1136/archdischild-2016–3 12 102), and obesity, among many others. Several studies have hinted at a link with maternal air pollution exposure, but these have been inconsistent or inconclusive. ASD definitions have been imprecise, exposure indicators not sufficiently localised, and types of pollution lumped together. Importantly, confounding factors need to be accounted for, as families with the highest psychosocial risks for autism may tend...

Highlights from this issue In Kipling's seminal novel 'Kim', the central premise (literal and metaphorical) is the wresting for power in fin de (19th) siècle South Asia. This attritional confrontation became popularly known as the Great Game and, though ostensibly a children's book, is really more complex. At its core, it is an examination of conflict at multiple levels, part of course of the 'human condition'. The book, is as apposite now as it was in the Bombay and Kabul of Kipling's youth and the theme underpins several of this month's broad ranging papers Disaster preparedness Though one might debate the relative contributions to the change, no one would refute the fact that, as starkly highlighted by the global terrorism index, the world is becoming less stable. Though human beings may always have had this propensity, technological changes have altered the means of expressing this phenotype on both a personal and national scale....

Conflict, candour and reflection There are many challenges to practising medicine well, not least keeping up to date with medical advances, implementing them within the time and financial restraints of ever expanding healthcare and avoiding over or under treatment while keeping the patient safe and avoiding criticism or complaints. In essence, considering the 'whole patient' and managing them using our knowledge, skills and experience which no longer equates to just the medical facts with increased recognition that skills like 'openness', 'listening', 'transparency' and enhanced communication are partly acquired by experience but can also be facilitated by training, mentoring and working in a positive and supportive environment. Multiple new areas of thinking have emerged as priorities—conflict resolution training, the duty of candour, learning from excellence, the need to reflect and active consideration of well being for ourselves, our patients and their families. These concepts need to be embraced as they will help facilitate us...

Quality of life after extremely preterm birth Gire et al examine the quality of life (QoL) of French primary school-age children born extremely preterm (EP), without disabilities.1 EP birth is usually defined as birth <28 completed weeks' pregnancy, and accounts for <1% of all births, and about 5% of all preterm births. Most children born preterm are moderate to late preterm. However, children born EP have been followed up in international cohort studies for many years, and are well recognised as being at high risk of mortality, morbidity and adverse long-term neurodevelopmental and metabolic outcomes. As these children grow into adulthood, a rich body of literature is emerging, describing their self-reported and observer-reported QoL: an important adjunct to the medical and psychological outcome measures that are deemed important by clinicians and researchers. Gire et al report that this cross-sectional multicentre study from five level III neonatal hospitals includes 20% of children born EP in France. Importantly, both...

Research beyond the hospital walls Introduction Reading widely is not only good for children. Although 'publish or perish' has tended to replace 'read or be dull' in academic life, reading beyond the clinical literature gives us grown-ups a better understanding of children's lives and histories as well as our own. This article provides pointers to the kinds of work with something important to say about children's well-being beyond hospital or clinical settings. The more we understand—as medical education reminds us—that bodies are not just a bunch of organs and that medicine is only one of many determinants of good child health, the more fun it can be to see what we might learn from people on whose shoulders we stand, whatever their discipline. Earlier articles in this series discuss the imperative to build on what we know and to ask the kinds of questions that children, parents and healthcare professionals would like to...

Maternal immunisation in pregnancy to protect newborn infants Although maternal tetanus immunisation has been effectively implemented for many years in the developing world,1 there has been a renewed global interest in maternal immunisation programmes over the past several years.2–5 This has been driven partly by the severity of the 2009 H1N1 influenza pandemic in pregnant women and the safety provided by the widespread maternal immunisation programme implemented in response to the pandemic.6 7 It has also been increasingly appreciated that maternal immunisations are an excellent way to provide protection to young infants before their own primary immunisation series would begin. There are several reasons that immunising pregnant women is an attractive vaccination strategy. First, by immunising the pregnant woman there is the potential to prevent the targeted infection in both the pregnant woman and her infant. This approach is often referred to as a 'two-fer' with...

A call to action: attention to paediatric-specific disaster preparedness Natural and man-made disasters have been increasing worldwide. Six hundred natural disasters were documented worldwide in 2016 compared with 200 in 1980.1 The Global Terrorism Index score (which reflects the relative impact of terrorism incidents annually) increased ninefold from 2000 to 2015.2 With this increasing frequency of mass-casualty events globally, hospitals and their healthcare professionals (HCPs) must be ready to receive and manage a large influx of patients. Additionally, these institutions and front-line healthcare workers must be prepared to care for disaster victims of all ages, including the paediatric population, regardless of the hospitals' typical intake patterns. In order to be best prepared, many countries across the world have developed healthcare-related disaster plans. Similar to other countries, France has developed the Organisation de la Réponse du Système de Santé en Situations Sanitaires Exceptionnelles plan to guide the management of mass casualties. However, this specific plan lacks...

Disaster preparedness in French paediatric hospitals 2 years after terrorist attacks of 2015 Objective We aimed to determine paediatric hospital preparedness for a mass casualty disaster involving children in both prehospital and hospital settings. The study findings will serve to generate recommendations, guidelines and training objectives. Design and setting The AMAVI-PED study is a cross-sectional survey. An electronic questionnaire was sent to French physicians with key roles in specialised paediatric acute care. Results In total, 81% (26 of 32) of French University Hospitals were represented in the study. A disaster plan AMAVI with a specific paediatric emphasis was established in all the paediatric centres. In case of a mass casualty event, paediatric victims would be initially admitted to the paediatric emergency department for most centres (n=21; 75%). Paediatric anaesthesiologists, paediatric surgeons and paediatric radiologists were in-house in 20 (71%), 5 (18%) and 12 (43%) centres, respectively. Twenty-three (82%) hospitals had a paediatric specialised mobile intensive care unit and seven (25%) of these could provide a prehospital emergency response. Didactic teaching and simulation exercises were implemented in 20 (71%) and 22 (79%) centres, respectively. Overall, physician participants rated the level of readiness of their hospital as 6 (IQR: 5–7) on a 10-point readiness scale. Conclusion Paediatric preparedness is very heterogeneous between the centres. Based on the study findings, we suggest that a national programme must be defined and guidelines generated.

Reducing healthcare conflict: outcomes from using the conflict management framework Objective To test a new conflict management framework (CMF) to help staff identify and de-escalate conflict between staff and patients/families. Design Before/after study that reports staff quality of life, frequency/severity of conflicts and qualitative interviews on using the framework. Data were collected from May 2017 to September 2017. Setting A paediatric oncology department day-patient and 23-bed inpatient ward. Intervention A two-stage CMF used by staff during daily handovers to identify and then manage conflict cases with families. Results Staff found the CMFto be helpful in identifying and de-escalating conflicts. The number of conflicts reported decreased by 64% from baseline to follow-up. Communication regarding conflict identification improved. Reports of staff burn-out decreased between the two time-points (n=55 at baseline, n=31 at follow-up; p=0.001). Scores on compassion and secondary traumatic stress did not change. Conclusions The CMF substantially reduces the incidence of conflicts and is an acceptable approach for staff. Continued use of the framework would require it to be fully integrated into the working of the ward, which would need to include senior medical buy-in. Further refinements to the framework have been made and will be tested in four UK sites in 2018/2019.

Quality of life of extremely preterm school-age children without major handicap: a cross-sectional observational study Objective To determine the quality of life (QoL) of school-aged children who were born <28+0 weeks of gestation and who have no resultant major disabilities. Design, setting and patients A cross-sectional multicentre study of extremely preterm (EPT) infants born <28+0 weeks, discharged alive and free from severe impairments (cerebral palsy, autism, major cognitive disabilities). Two generic, self-evaluation and hetero-evaluation (by parent) QoL measurement questionnaires (Kidscreen 10/VSP-A) were used and then compared with French population reference. Main outcome measures Clinical examination, an assessment of cognitive functions and QoL between 7 and 10 years of age. Results 40 (7.5%) severely disabled children were excluded. Among those 471 eligible, the lost to follow-up group (169 (36%)) paralleled those 302 (64%) included in the study. The mean gestational age was 26.2 (±0.8), birth weight was 879 (±181) g and the mean age was 8.4 (±0.87) years. 48% of participants had minor or moderate cognitive disabilities based on their Full-Scale Index Quotient. Working memory, attention and mental flexibility scored as low-average. Except for family relationships, the EPT QoL VSP-A and Kidscreen 10 assessment were significantly lower based on the children's and parent's perspectives. Children reported the most significant QoL decline as (1) friends' relationships, (2) self-esteem and (3) leisure, while parents indicated (1) psychological well-being, (2) schoolwork and (3) vitality. Conclusion The QoL of a school-age EPT child without severe impairment was lower relative to a reference population from both the parents' and child's points of view. This evaluation should help to better understand the long-term outcomes and to provide better support for them and their families. Trial registration number NCT01675726, pre-results.

Air pollution and autism It's clear that genetics plays a major role in the aetiology of autistic spectrum disorder (ASD), but the genuine increase in prevalence over recent decades suggests that environmental factors are also responsible. If ASD is considered to be a neurodevelopmental disorder, rather than a social construct, then antenatal influences during early brain development may be important. Potential prenatal causes suggested thus far are many and varied, including paracetamol (Archivist Oct 2016 doi.org/10.1136/archdischild-2016–3 11 708), antidepressant drugs (Archivist March 2016 doi.org/10.1136/archdischild-2016–3 10 462), ultrasound (Archivist Sept 2018 doi.org/10.1136/archdischild-2018–3 15 816), season of conception (Lucina Dec 2016 doi.org/10.1136/archdischild-2016–3 12 102), and obesity, among many others. Several studies have hinted at a link with maternal air pollution exposure, but these have been inconsistent or inconclusive. ASD definitions have been imprecise, exposure indicators not sufficiently localised, and types of pollution lumped together. Importantly, confounding factors need to be accounted for, as families with the highest psychosocial risks for autism may tend...

Highlights from the literature I am honoured to take over the role of Lucina; Goddess of Childbirth World-wide estimate of Suicidal ideation in 13-17 year olds An estimate of the prevalence of suicidal ideation, suicide planning, and suicide attempts using data from Global School-based Student Health Survey of schoolchildren aged 13 to 17 years has highlighted some important geographical variation. [Uddin R et al. Lancet (Adolescent and Child Health) DOI:https://doi.org/10.1016/S2352-4642(18)30403-6]. This is a large population-based study of 229, 129 adolescents (mean age 14·6 [SD 1·18] years), from 59 low-income and middle-income countries across six WHO regions collected between 2003 and 2015. Meta-analysis with random effects was used to focus on age based and gender based estimates. The overall prevalence of suicidal ideation was 16·9% (95% CI 15·0–18·8), suicide planning was 17·0% (14·8–19·2), and suicide attempts was 17·0% (14·7–19·3) in the 12 months preceding survey completion. The African region had the highest prevalence of suicidal...

Confused health and nutrition claims in food marketing to children could adversely affect food choice and increase risk of obesity Objectives To investigate the nutritional quality of foods marketed to children in the UK and to explore the use of health and nutrition claims. Design This cross-sectional study was carried out in a wide range of UK food retailers. Products marketed to children above the age of 1 year containing any of a range of child friendly themes (i.e. cartoons, toys and promotions), and terms suggesting a nutritious or healthy attribute such as 'one of 5-a-day', on product packaging were identified both in stores and online. Information on sugar, salt and fat content, as well as health and nutrition claims, was recorded. The Ofcom nutrient profiling model (NPM) was used to assess if products were healthy. Results Three hundred and thirty-two products, including breakfast cereals, fruit snacks, fruit-based drinks, dairy products and ready meals, were sampled. The use of cartoon characters (91.6%), nutrition claims (41.6%) and health claims (19.6%) was a common marketing technique. The one of 5-a-day claim was also common (41.6%), but 75.4% (103) of products which made this claim were made up of less than 80 g of fruit and vegetables. Sugar content (mean±SD per 100 g) was high in fruit snacks (48.4±16.2 g), cereal bars (28.9±7.5 g) and cereals (22.9±8.0 g). Overall, 41.0% of the products were classified as less healthy according to the Ofcom NPM. Conclusion A large proportion of products marketed to children through product packaging are less healthy, and claims used on product packaging are confusing. Uniform guidance would avoid confusion on nutritional quality of many popular foods.

Association between hypotension and serious illness in the emergency department: an observational study Background The value of routine blood pressure measurement in the emergency department (ED) is unclear. Objective To determine the association between hypotension in addition to tachycardia and the Shock Index for serious illness. Design Observational study. Setting University ED (2009–2016). Participants, methods and main outcomes Routine data collected from consecutive children <16 years. Using logistic regression, we assessed the association between hypotension (adjusted for tachycardia) and Shock Index (ratio heart rate/blood pressure [BP]) for serious illness. The predictive accuracy (sensitivity, specificity) for hypotension and Shock Index was determined for serious illness, defined as intensive care unit (ICU) and hospital admissions. Results We included 10 698 children with measured BP. According to three age-adjusted clinical cut-offs (Advanced Paediatric Life Support, Paediatric Advanced Life Support and Paediatric Early Warning Score), hypotension was significantly associated with ICU admission when adjusted for tachycardia (range OR 2.6–5.3). Hypotension showed low sensitivity (range 0.05–0.12) and high specificity (range 0.95–0.99) for ICU admission. Combining hypotension and tachycardia did not change the predictive value for ICU admission. Similar results were found for hospitalisation. Shock index was associated with serious illness. However, no specific cut-off value was identified in different age groups. Conclusions Hypotension, adjusted for tachycardia, is associated with serious illness, although its sensitivity is limited. Shock index showed an association with serious illness, but no acceptable cut-off value could be identified. Routine BP measurement in all children to detect hypotension has limited value in the ED. Future studies need to confirm which patients could benefit from BP measurement.

Acute ataxia in paediatric emergency departments: a multicentre Italian study Objectives To evaluate the causes and management of acute ataxia (AA) in the paediatric emergency setting and to identify clinical features predictive of an underlying clinically urgent neurological pathology (CUNP). Study design This is a retrospective medical chart analysis of children (1–18 years) attending to 11 paediatric emergency departments (EDs) for AA in an 8-year period. A logistic regression model was applied to identify clinical risk factors for CUNP. Results 509 patients (mean age 5.8 years) were included (0.021% of all ED attendances). The most common cause of AA was acute postinfectious cerebellar ataxia (APCA, 33.6%). Brain tumours were the second most common cause (11.2%), followed by migraine-related disorders (9%). Nine out of the 14 variables tested showed an OR >1. Among them, meningeal and focal neurological signs, hyporeflexia and ophthalmoplegia were significantly associated with a higher risk of CUNP (OR=3–7.7, p<0.05). Similarly, the odds of an underlying CUNP were increased by 51% by each day from onset of ataxia (OR=1.5, CI 1.1 to 1.2). Conversely, a history of varicella-zoster virus infection and vertigo resulted in a significantly lower risk of CUNP (OR=0.1 and OR=0.5, respectively; p<0.05). Conclusions The most frequent cause of AA is APCA, but CUNPs account for over a third of cases. Focal and meningeal signs, hyporeflexia and ophthalmoplegia, as well as longer duration of symptoms, are the most consistent 'red flags' of a severe underlying pathology. Other features with less robust association with CUNP, such as seizures or consciousness impairment, should be seriously taken into account during AA evaluation.

Longitudinal analysis of health disparities in childhood Objective Combatting disparities in health outcomes among children is a major public health concern. This study focuses on two questions: (1) To what extent does socioeconomic status (SES) contribute to disparities in health outcomes? and (2) To what extent can social inequalities in health outcomes be explained by differences in children's health behaviours? Design This study included 2-year follow-up data of 1259 children (4–12 years of age) who participated in the 'Healthy Primary School of the Future' project (ClinicalTrials.gov NCT02800616). SES was measured by maternal and paternal education and household income (adjusted for family size). Health outcomes were body mass index (BMI) z-score, health resource use, school absenteeism, health-related quality of life and psychosocial health, measured over 2 years of follow-up (2015–2017). Health behaviours included physical activity, and consumption of fruits, vegetables and sweetened beverages. Associations between SES and baseline health behaviours were examined, and mixed models for repeated measures were used to assess associations between SES and health outcomes over 2 years of follow-up. Results A high socioeconomic background was significantly associated with better health outcomes (all outcomes). For example, children with a low SES had higher BMI z-scores (beta coefficient: 0.42, 95% CI 0.22 to 0.62) and higher consumption healthcare costs (ratio of mean costs: 2.21, 95% CI 1.57 to 3.10). Effects of SES changed very little after controlling for health behaviours. Discussion Our findings strongly suggest that socioeconomic background has a pervasive impact on disparities in child health, but gives little support to the idea that social inequalities in child health can be tackled by means of lifestyle interventions.

Pharmacological management of abnormal tone and movement in cerebral palsy Background The evidence base to guide the pharmacological management of tone and abnormal movements in cerebral palsy (CP) is limited, as is an understanding of routine clinical practice in the UK. We aimed to establish details of motor phenotype and current pharmacological management of a representative cohort across a network of UK tertiary centres. Methods Prospective multicentre review of specialist motor disorder clinics at nine UK centres, collecting data on clinical features and pharmacological management of children and young people (CYP) with CP over a single calendar month. Results Data were collected from 275 CYP with CP reviewed over the calendar month of October 2017. Isolated dystonia or spasticity was infrequently seen, with a mixed picture of dystonia and spasticity ± choreoathetosis identified in 194/275 (70.5%) of CYP. A comorbid diagnosis of epilepsy was present in 103/275 (37.4%). The most commonly used medications for abnormal tone/movement were baclofen, trihexyphenidyl, gabapentin, diazepam and clonidine. Medication use appeared to be influenced separately by the presence of dystonia or spasticity. Botulinum toxin use was common (62.2%). A smaller proportion of children (12.4%) had undergone a previous neurosurgical procedure for tone/movement management. Conclusions CYP with CP frequently present with a complex movement phenotype and comorbid epilepsy. They have multiple therapy, medical and surgical management regimens. Future trials of therapeutic, pharmacological or surgical interventions in this population must adequately encompass this complexity in order to be translatable to clinical practice.

Contained and controlled: a collaborative future Antimicrobial resistance continues to be a major global challenge. The recent Governmental publication from the Department of Health and Social Care in January 2019 reminds of this challenge and attempts to lay out an ambitious plan for the next 20 years; the UK 20-year vision for antimicrobial resistance. Department of Health and Social Care; 2019. https://www.gov.uk/government/publications/uk-20-year-vision-for-antimicrobial-resistance. They comment that "The vision and plan were developed across the government, its agencies and administrations in Scotland, Wales and Northern Ireland, with support from a range of stakeholders. It is supported by the 'UK 5 year action plan for antimicrobial resistance 2019 to 2024'. " It summarises the global issues of antimicrobial resistance (AMR). It challenges not only the medical professions but all stakeholders in public sector and private sector and the public themselves. It reminds us that in the UK that at least 20% of antibiotic prescribed in primary care are...

Can the rotavirus vaccination reduce the incidence of Type 1 diabetes? As the global epidemic of obesity and type two diabetes in children and adults continues to be a major challenge to public health, an intriguing possible 'off-target' effect of the rotavirus vaccine and association with a reduction in the incidence of Type 1 diabetes, has been reported in JAMA Paediatrics. An Australian study from a team in Melbourne, JAMA Pediatr 2019;173(3):280-282. doi: 10.1001/jamapediatrics.2018.4578) and is the first report of epidemiological evidence of this possible and fascinating association. Nearly 20 years ago it was recognised the rotavirus may have an effect on islet cells auto immunity (Diabetes 2000;49(8):1319–1324. doi:10.2337/diabetes.49.8.1319). Rotavirus vaccination was introduced in Australia in 2007. The team examined the incidence of type 1 diabetes, 8 years before the introduction of the vaccine and compared the incidence to the 8 years after introduction. They hypothesised that the rotavirus vaccination may reduce the incidence of the disease over time. National coverage of the vaccination...

Falling admissions to hospital with febrile seizures in the UK Objectives There was a reduction in febrile seizure admissions in Scotland after 2008. Our hypothesis was that a similar trend would be seen in other countries. Methods We obtained the number of febrile and non-febrile seizure admissions in England and Scotland 2000–2013 and the incidence of all seizure admissions 2000–2013 in European countries. We compared the incidence of admission for febrile seizure (Scotland and England) and all seizures (all countries) between 2000–2008 and 2009–2013. Results The incidence of febrile seizure admissions per 1000 children in 2009–2013 was lower than 2000–2008 in Scotland (0.79 vs 1.08, p=0.001) and England (0.92 vs 1.20, p<0.001). The incidence of all seizure admissions (but not non-febrile seizures) was lower in 2009–2013 compared with 2000–2008 in Scotland (1.84 vs 2.20, p=0.010) and England (2.71 vs 2.91, p=0.001). Across 12 European countries (including the UK), there was no difference in all seizure admissions after 2008. We explored the possibility that the fall was related to the introduction of routine pneumococcal vaccination in 2006 but there were insufficient data. Conclusion A fall in admissions for febrile (but not afebrile) seizures after 2008 in Scotland and England explains a fall in all emergency admissions for seizure. A fall in all seizure admissions has not occurred in other European countries, and more research is required to understand the different outcomes in the UK and non-UK countries.

Age-related gait standards for healthy children and young people: the GOS-ICH paediatric gait centiles Objective To develop paediatric gait standards in healthy children and young people. Methods This observational study aims to address the lack of population standards for gait measurements in children. Analysing gait in children affected by neurological or musculoskeletal conditions is an important component of paediatric assessment but is often confounded by developmental changes. The standards presented here do not require clinician expertise to interpret and offer an alternative to developmental tables of normalised gait data. Healthy children aged 1–19 years were recruited from community settings in London and Hertfordshire, UK. The GAITRite walkway was used to record measurements for each child for velocity, cadence, step length, base of support and stance, single and double support (as percentage of gait cycle). We fitted generalised linear additive models for location, scale and shape (gamlss). Results We constructed percentile charts for seven gait variables measured on 624 (321 males) contemporary healthy children using a gamlss package in R. A clinical application of gait standards was explored. Conclusion Age-related, gender-specific standards for seven gait variables were developed and are presented here. They have a familiar format and can be used clinically to aid diagnoses and to monitor change over time for both medical therapy and natural history of the condition. The clinical example demonstrates the potential of the Great Ormond Street Institute of Child Health Paediatric Gait Centiles to enable meaningful interpretation of change in an individual's performance and describes characteristic features of gait from a specific population throughout childhood.