We are thrilled to be returning to a face-to-face conference next year, and we hope you can join us.
Taking place in Liverpool from Tuesday 28 to Thursday 30 June, this is a great opportunity to network with colleagues once again. Hear from leading voices and catch up on the latest innovations in child health at a wide range of specialty sessions.
Whether you’re sick from COVID or more likely, sick of COVID, cautious murmurs are surfacing of light at the end of the tunnel. Lengthening days strengthen growing hope and College members have been extremely active contributing to another jam-packed Milestones edition with something to get the heart racing for everyone.
Whether it’s learning new words (“obliviobesity”), our resident baker raising the bar with a healthconscious bake, resonating nocturnal poetry or hearing about great projects, perspectives or people, we’ve got you covered. Take a deep breath – it’s time to be inspired by all the different activities and exercises our members partake in.
As always, this is a magazine for members by members so if you have an idea or would like to write something, please get in touch with any of the editorial team on Twitter (you'll find our handles in the small print below) or email milestones@rcpch.ac.uk We’d love to hear from you!
#RCPCHMilestones
Dr Seb Gray General Paediatric Consultant Salisbury NHS Foundation Trust
Copyright of the Royal College of Paediatrics and Child Health. All rights reserved; no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means – electronic, mechanical, photocopying, recording, or otherwise – without prior permission of the publishers. The views, opinions and policies expressed in Milestones do not necessarily reflect those of the College. While all reasonable efforts have been made to ensure the accuracy of the contents of this publication, no responsibility can be accepted for any error, inconsistency or omission. Products and services advertised in Milestones are also not recommended or endorsed by the College. Readers should exercise their own discretion and, where necessary, obtain appropriate independent advice about their suitability. Royal College of Paediatrics and Child Health is a registered charity in England and Wales (1057744) and in Scotland (SC038299). Registered address: 5-11 Theobalds Road, Holborn, London WC1X 8SH. Head of Design: Simon Goddard Project manager: Lizzie Hufton Publisher: James Houston. Milestones is published four times per year on behalf of the Royal College of Paediatrics and Child Health by James Pembroke Media, 90 Walcot Street, Bath, BA1 5BG. T: 01225 337777. Advertising: Alex Brown, Head of Corporate Partnerships advertising@rcpch.ac.uk
I LOVE SPRING and so it gives me great pleasure to welcome you to our first edition of Milestones in 2022! Just when the darkness and gloom of winter is starting to feel too much, it is so heartening to notice the earliest signs of life with the first shoots on trees and the odd bulb beginning to pop up above ground. It’s been such a tough few months and so the opportunity to celebrate the beginning of the end of winter, and to think optimistically about the future, is important.
Every one of us will have developed strategies to cope with the uncertainty and stresses of the pandemic. For many of us, developing a routine that includes exercise has been crucial for our health and wellbeing. I am a great one for finding excuses not to go for a run! However, how often doesn’t one come home after a trip to the gym or a long walk, and feel just that bit more
upbeat about life? I am so delighted that this edition of Milestones focuses on exercise and the importance of activity for all of us.
The importance of exercise is fundamental to the health of children too. We have a skateboard park on the common near my home in South London. I love walking past and seeing all ages of children and young adults showing off their skills, cheering each other on and generally hanging out together even on the coldest of days. There’s something about exercise that binds all sorts of people together and the spin-offs for both physical and mental health are priceless.
I trust that, despite how stressed and stretched our whole workforce is feeling, some of the ideas and inspirations in this edition of Milestones will bring a smile to your face and may even give you some new ideas of ways to stay active. My huge thanks to the editorial team for once again bringing together a really energising and action-packed edition.
With my best wishes to you all, Camilla
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Community and Neurodisability Paediatrician Nottingham Children’s Hospital RCPCH Treasurer @lizmarder
OVER 3,000 OF you took the time to share your views despite significant competing pressures, and the feedback is particularly valuable as we embark on our new three-year strategy. Overall, member satisfaction has decreased slightly from last year, with levels being similar to those seen in previous member surveys.
Archives of Disease in Childhood continues to be the benefit that members value most, along with the Child Protection Companion. We were really heartened to see how aware our members are of our work to improve equality, diversity and inclusion, and of the forthcoming changes to UK paediatric training through Progress+.
Whilst members generally remain positive about the benefits of College membership, we cannot be complacent and need to respond to emerging challenges and adapt to continually improve what we offer.
This includes the following priorities:
Taking a stand on important issues which are impacting on child health, such as climate change and child poverty
Addressing the workforce crisis through robust evidence and effective campaigning Developing communities of members to provide lifelong learning and ensure paediatrics is a fulfilling career for current and future generations
The College has made significant investment to deliver better services for members so look out for announcements as we continue to deliver our ambitious strategy for 2021-24.
Read the survey findings in full www.rcpch.ac.uk/member-survey-2021
With spring just around the corner, what better time to get outdoors and get active?
I’M REALLY EXCITED to take on the role and work with some incredible aspiring paediatricians across the UK, although I have some big shoes to fill following on from our previous Presidents.
UKAPS promotes paediatrics as a career to medical students and foundation doctors. We have events throughout the year including revision talks, mock interviews and our annual conference. This year, I’m looking forward to working alongside the Paediatric Foundation Conference Committee to enable us to help host a second conference aimed at foundation doctors. We’re also looking to work on our website and social media to have regular blog posts and revision questions for medical students and people sitting MRCPCH exams. We’re always looking for new ideas and ways to encourage the next generation of paediatricians and I’d love to hear your thoughts.
RCPCH CEO @8jorevPERHAPS, LIKE ME, you were able to dive into a book this month to escape from the constant news cycles. I recently read the scientist Carlo Rovelli’s Seven Brief Lessons on Physics, a short bestseller which eloquently describes everything from particles to deep matter, but also raises the question of our place as knowledge of the universe expands. Describing how we relate to the nature around us, he writes: “Our reality is made up of our societies, of the emotion inspired by music, of the rich intertwined networks of the common knowledge which we have constructed together.”
This made me think about how we as a College describe our reality. Most of our discussions centre around how we might better use and share our data, knowledge and insights to improve the lives of children, but also how we might better tap into the stores of knowledge that you possess to shape our work and strengthen communities. Our reality is that paediatrics is composed of so many different societies and networks. For example, we bring together 50 different groups through our Specialty Board that meets regularly representing many of you, but of course, there are many other groups we could reach.
One visible means of building communities happens at Annual Conference each year and this June will be the first for two years that has taken place in person (and with a virtual package for those who cannot make it). This will be an important moment for us, and we’ll be discussing the challenges as we seek to recover services that were lost or battered during the pandemic, but also to help networks to thrive and to do more to enable the transfer of knowledge, ideas and data. This should be easier through digital means but meeting together for discussions has always held a central place in the development of the specialty. I hope you enjoy this edition of Milestones and with warm wishes, Jo
IT HAS BEEN 23 years since my family moved into our earth-sheltered ecohome in Hockerton, a small village in Nottinghamshire. Life at Hockerton Housing Project has been my sanctuary, my sanity and a wonderful place for our children to grow up whilst I continued to progress my paediatric career. Mostly I kept the two lives separate. You could tell by my shoes who I was; high heels or wellies?
After the birth of our grandson I was galvanised to act for him and my patients in terms of the climate crisis and I realised that I could achieve more as Dr Clements with my management hats on than I could out of hours as an activist. It made sense for me to join the College’s Climate Change Working Group and lead the College Building and Resources workstream as I have spent a long time thinking about low carbon buildings, food, water and transport in my other life.
The workstream has already come up with a detailed work plan. This year we plan to commission a detailed carbon audit of the College building in addition to all of the other work of the College that contributes to its carbon footprint, including publications, exams, events and travel. We’ve also already supported a major College change: this year, copies of our journal Archives of Disease in Childhood will be an opt in to receive on paper rather than an opt out. This will give us a measurable carbon saving!
We are on a journey and it has been exciting to see the start of this. Paediatricians have an important role to play within the NHS and beyond to make the clinical case for climate action. We will lead the way through the actions of our members and through the College leadership, including a firm commitment to be a net-zero organisation by 2040.
For more information about the RCPCH Climate Change Working Group www.rcpch.ac.uk/climatechange
Dr Sanjay Patel Consultant in Paediatric Infectious Diseases and Immunology Southampton Children’s Hospital @doctorsanjay
THE WHO HAS declared that antimicrobial resistance (AMR) is one of the top 10 global public health threats facing humanity. It is predicted that the number of deaths directly attributable to AMR will rise from 700,000 per year at the present time to 10 million per year by 2050. However, many clinicians and policy makers still assume that AMR has very little impact on children. Unfortunately, the changing nature of paediatrics over the past decade, with increasing numbers of extremely premature babies being managed on neonatal intensive care units (NICUs) and increasing numbers of children with chronic health conditions, disability and life-limited illness being looked after on general paediatric wards and paediatric intensive care units (PICUs), has resulted in AMR becoming a major cause of mortality and morbidity in these groups of children. Ensuring robust antimicrobial stewardship (AMS) and infection prevention and control (IPC) practices is essential. It is encouraging that the College has recognised this threat; it recently supported a meeting hosted by the British Society for Antimicrobial Chemotherapy (BSAC) on AMR and AMS in children and has supported the inclusion of the UK paediatric AMS network (UK-PAS) as a special interest group within the College. Various College specialty groups have supported the development of national common infection pathways that promote AMS and UK-PAS is supporting educational activities on AMS and AMR within the College. I encourage anyone who is interested in AMS or just wants to know more about it to join the UK-PAS network.
Visit uk-pas.co.uk
Dr Michael McKean Consultant in Respiratory Paediatrics Great North Children’s Hospital
@DrMikeMckean
IT IS A REAL honour to be elected as your Vice President for Health Policy. I feel a great sense of pride as well as good fortune to be asked to take a more hands on role within the College and I hope I can represent you to the best of my abilities as we take forwards many important policies.
We face unprecedented times. The full effects of the pandemic are not yet realised and the looming dark cloud of the climate crisis is filling many people with anxiety. Add to this increasing number of UK children living in poverty, now 4.1 million (RCPCH State of Child Health), and it is very understandable that we should be worried for the future of our children.
The NHS is currently restructuring with a focus on organisational partnerships to deliver better integrated care. This laudable aim may bring opportunities to tackle some of the challenges our children face. I look forwards to working with the College’s policy team in providing leadership and guidance in this and other endeavours and I hope my experience to date will be of help. I have worked as a paediatric respiratory consultant for 20 years, have been clinical director of the Great North Children’s Hospital in Newcastle for seven years, and have set up and established a regional Child Health and Wellbeing Network, focused on promoting integrated care, early interventions and bringing together children and young people with those many professionals who make up ‘the children’s workforce’.
There are a number of threats to children’s future health and wellbeing
Education & Professional Development Coordinator
I JOINED THE Professional Development Team in July 2015, having previously worked in the exams team at the RCGP. Before this, I worked in residential social care management and as a pharmacy technician before that, so it’s fair to say that healthcare has been at the centre of my various career paths!
During my time in this role, I have been proud to be part of the transformational changes in the College’s CPD services, having worked on the migration of the CPD Diary tool and over 10,000 user accounts to the ePortfolio, which was no small undertaking. I was also involved in revamping the CPD guidelines for paediatricians, emphasising educational ‘quality over quantity’ and broadening opportunities for continued learning for paediatricians. I have also been involved in the digitalisation of the PaedCCF (Parent and Carer feedback tool) and currently look after the College’s online learning platform, Compass.
In addition to the CPD Diary and Compass, I also manage the College’s CPD approvals and endorsement services, which quality assures and supports the educational activities delivered by our members and external bodies and ensures high-quality educational provision for our doctors.
I am most proud of the commitment to exceptional customer service provided by our team. This is the foundation of our work, and we constantly endeavour to go above and beyond to support our doctors and service users. Outside of work, I have a two year old who keeps me busy, and with that said, my current hobbies would technically be den building and robot/ dinosaur arts and crafts!
I AM HUGELY excited and honoured to be joining the College in this newly created post. Firstly, let me introduce myself. I am a consultant paediatrician at University Hospital of Derby and Burton NHS Trust as well as a training programme director within the East Midlands and prior to this a College Tutor. This new role has been developed to provide two-way communication between the College and the trainers across the four nations. We really want to know what challenges and difficulties trainers are currently facing but also know about the brilliant ideas and excellent training that is being undertaken. This is where my role comes in! This role will be particularly important over the next few years as we implement Progress+ and support trainees and trainers in understanding the new curriculum and the change in training that comes with it.
One of my first tasks is to support College Tutors in the amazing work that they do. As a previous College Tutor, I understand the role and the challenges it brings on a day-to-day basis; the constant juggling between the various educational needs of trainees and the trainers, as well as the requirements of service provision and rotas. Having the correct support, educational resources and training for College Tutors is therefore paramount to provide consistent and high-quality training.
These are really exciting times within paediatric training, and I can’t wait to start working with great people both within and outside the College with the common aspiration of delivering high quality training for the paediatricians of the future.
Explore Progress+ www.rcpch.ac.uk/progressplus
CHILDREN AND YOUNG people have experienced significant harm from the COVID pandemic, despite not being at risk of medical harm from COVID-19 itself. In the UK, schools and playgrounds have been closed and social interaction with other children severely restricted. In other parts of the world the effect has been more severe.
BMJPO has a special collection of papers on the theme of ‘Young voices in the time of COVID-19’. The main aim of this special collection is to capture the experiences, needs and strengths of diverse populations of children and young people during the pandemic. It is important as health professionals that we listen to young people and understand their concerns. Some of the articles have been written by young people themselves. Others are qualitative research which include quotes from young people. Worth reading!
THE LARGER THE VESSEL, the slower it turns… There’s one important aspect of research that hasn’t traditionally appeared in the ‘brochure’, though it is arguably the single most important.
Irrespective of the breathtaking standard of your about-to-be-unleashed randomised controlled trial, positive effects beyond imagination. Notwithstanding the high impact factor of the journal providing the platform for dissemination. Despite mouthwatering cost effectiveness figures. All these factors pale into insignificance when put into the context of implementation.
Translation of findings to policy are complex. History is littered with examples of non-completion of the research mission: Ensuring the right audience is presented with the data and motivated to meet the bottom lines potential costs and expend the efforts required to change policy, breaking with the ‘if it ain’t broke, why fix it?’ stance.
Whose responsibility is this? The reality is that it’s shared. We have to make our presence felt and voices unignorable to budget holders and policy makers to effect innovation where needed. As a group, we should be rightfully proud of our role as advocates for children – this is simply an extension.
We have a wide range of pieces in the pipeline with implementation implications. Think about these as you absorb and discuss them: change is never a single person’s task…
Enjoy !
IT IS A GREAT honour to be elected as Vice President for Science and Research. I am currently working as Professor of Child Health, Consultant in Paediatric Endocrinology and Director of Research and Innovation at Sheffield Children’s Hospital. In my position at the National Institute for Health Research (NIHR) as Clinical Research Network National Children’s Specialty Lead over the last six years, I am sure that the knowledge, experience and contacts that I have acquired have prepared me well for my future work as VP. I hope to add a new dimension to the VP role
as a leader in child health technology. In 2014, I led on the development of the UK’s first child health technology network – Technology Innovation Transforming Child Health and went on to develop the NIHR Children and Young People MedTech Cooperative. Given the exciting and evolving landscape of innovation, I aim to work with colleagues at the College to understand how we can advance paediatric healthcare and training through digital innovation and technology development.
I look forward to dealing with some significant challenges. For
too long, child health research has been underfunded. Through my collaboration with Innovate UK, child health research is now a focus; I aim to work with other national funders to achieve the same. I also want to ensure that we focus on equality, diversity and inclusion to ensure equitable opportunities for those conducting and participating in research. I firmly believe that by working across multiple professional stakeholder groups we will be stronger together, to ensure that through research, we develop the world’s best healthcare for the children we care for.
AS CLINICIANS IN modern healthcare we work collaboratively in highly skilled multi-professional teams, with evidence consistently demonstrating that multiprofessional team working delivers improved outcomes for our patients with enhanced efficiencies.
In 2017, NHS Improvement, NHS England and Health Education England (HEE), worked together to develop a national framework for Advanced Clinical Practice (ACP), to ensure
consistency and understanding about advanced level practice across the NHS workforce. For paediatrics and child health, this offered an opportunity for our College to support future workforce developments, and following national engagement workshops and stakeholder consultations, HEE approached the College to develop a modular, learning outcomes-based, curricular framework for advanced clinical practice in paediatrics and neonates.
A core multi-professional writing group was established, resulting in the development of the Paediatric and Child Health ACP Curricular Framework (PCHCF), detailing a road map for the training and education of paediatric advanced clinical practitioners, not limited by job role, title, professional group, or clinical setting. The PCHCF has 11 domains,
Find
to comprehensively underpin the care of infants, children and young people in clinical practice, whilst explicitly addressing the remaining three pillars of the national HEE advanced clinical practice framework, namely leadership and management, education and research. Each of these domains has been designed with illustrations, to ensure that learning outcomes and key capabilities can be demonstrated in an individual trainee’s clinical area of practice, whilst ensuring structural alignment to the established RCPCH Progress curriculum.
A first draft of the PCHCF went through a consultation with existing ACPs, employers and higher education institutions in 2021. The project is ongoing, pending further consultations, with the aim of publication in early summer.
In the long run Meet Dr Beth Pascall, who is a professional ultra-runner alongside her paediatric role
p30
Interview with Fiona Fox, Chief Executive of Science Media Centre
Keeping children in school and the COVID-19 vaccine
Listed below are some of the up and coming online courses and events. We will continue to add to this list over the coming months, so don’t forget to keep an eye on our website.
Statement and report writing – Northern Ireland (Level 3) 17 May
Senior Members’ Day – Windermere 94 years on 25 May
Statement and report writing – England/ Wales (Level 3) 9 June
How to Manage: Paediatric Allergy Training (PAT2) 21 June
Diabetes Quality Programme 05 – Improving clinic experience
Climate action in paediatrics and child health
Paediatric sepsis
The RCPCH &Us Climate Change Group update us on their youth action project and how they’ve been collecting the views of children and young people on the climate emergency
IT’S FANTASTIC THAT the College has made climate change a priority, given that it is one of the biggest problems affecting children and young people’s health now and in the future. This will help to spread awareness about the climate emergency in health and especially how the College has prioritised the voice of children and young people, ensuring that our views are embedded across all the College’s priorities.
The College understands that young people need to be part of conversations about the climate emergency and have incredible creativity and energy to bring when thinking about solutions, and it has committed to help us along the way. The fact that the College is also taking a note of the ideas and perspectives of young people is great as it allows our voices and opinions to be heard and it makes children and young people feel like they are truly making a change.
The climate crisis is not just an environmental crisis, it is also
a healthcare and disability justice crisis, so it is especially important to have a wide range of voices, views and opinions with a health perspective to support change.
The RCPCH &Us Climate Change Group have started to collect the views of children and young people across the UK, delivering interactive roadshows in schools, hospital youth forums and youth parliament groups, getting a wide range of views from so many children and young people including those with long term health conditions.
The roadshows helped us to find out the different views and opinions that they have about climate change and health. We wanted to gain as much information as possible so that it would help us to identify the key themes that mattered most to children and young people and to map across their views into the College’s climate change work.
We wanted to find out what ideas children and young people had that would make a difference and that would help our youth action project. As a group, it is our hope to
change the declining environment and improve life for all by helping the NHS become as sustainable and climate friendly as possible, keeping our future children, young people and adults safe, before it’s too late. We will do this by creating environmentally sustainable paediatric healthcare through innovative carbon-neutral and patient-focused solutions to heal our patients and our planet.
To find out how we are getting on, email us at and_us@rcpch.ac.uk
RCPCH &Us: The Children and Young People’s Engagement Team delivers projects and programmes across the UK to support patients, siblings, families and under 25s, and gives them a voice in shaping services, health policy and practice. RCPCH &Us is a network of young voices who work with the College, providing information and advice on children’s rights and engagement.
Children can help to bring about change
BACK IN 2018 we celebrated the 70th birthday of the NHS and pondered on a present to give the NHS. Via Twitter, a few NHS colleagues discussed how being a bit more active to reduce our reliance on the NHS would make a great gift, we wondered if we could encourage others to do the same and join in the challenge. The plethora of research advocating the physical and mental benefits of being active is overwhelming, from reducing the risk of obesity, strengthening muscles and bones, managing blood glucose levels, decreasing the risk of cardiovascular disease and cancers, along with increasing the quality of sleep and sense of wellbeing. The demands of juggling our work commitments with home life means
that all too often exercise is lower down the priority list. And of course, over the past two years with the pandemic, it’s been made even harder! Yet the #NHS1000miles challenge is standing the test of time and each year on 1 January, we reset the clock on the miles and start afresh with an ever-growing number of enthusiasts totting up the miles!
So 2022 sees us embrace the fifth year of the #NHS1000miles community, it’s made up of multi-disciplinary members from across the NHS and some patients too! All setting a goal of covering 1,000 miles over the period of a year, monitoring and sharing progress by tweeting updates on a Sunday evening at 7.30pm along with pictures to inspire others to be active too. Every Sunday evening, Twitter lights up with encouraging tweets using the hashtag #NHS1000miles, willing people onwards.
All methods count in covering the miles. To be honest, we’re not too precious about the
rules as the focus is about being encouraging and inclusive. It’s a personal challenge, providing a bubble of support from a kind, encouraging and generous community.
We’re always seeking new members to join us so feel free to ‘tweet in’ and find out more about the challenge: kathevans.com/2021/11/29/nhs1000miles-2022-calls/
#NHS1000MILES:
We all know the benefits both physically and mentally of being active and exercising. With busy lives however, this isn’t always so easy. This spring, how can you start taking steps to be more active? Some members tell us what they’ve done and how you can do it too!Kath Evans clocking up her #NHS1000miles
Kath Evans Director of Children’s Nursing Barts Health NHS TrustDr Niall Donaldson ST1 Paediatrics Royal Hospital for Children, Glasgow @niall_donaldson
LET’S GET PHYSICAL! A song by Dua Lipa or something that’s mentioned at every wellbeing seminar? The gym is a big part of my life now, but for many years it was a will they, won’t they relationship that any romcom would be proud of.
The perfect storm brewed; the pandemic, lockdown and working in COVID times. No outlet for stress, no exercise and many packets of mint buttons later, I was the heaviest I’ve ever been. Committing to the gym wasn’t a walk in the park but seeing the improvements in myself kept me going.
The obvious benefit has been I’ve lost weight and improved my fitness, but for me the improvement in my mental health has been the greatest. For me nothing beats de-stressing after a shift by deadlifting or a spin class post nights (I know this sounds like hell to some of you!). If you’ve never tried the gym before I’d encourage you give it a go. I know it can be a daunting place so here’s some tips for getting started.
1. Do what you can: don’t set unrealistic goals, as it’ll make you more likely to skip.
2. Find exercises/ equipment you like.
3. Don’t get intimidated (everyone starts somewhere!)
4. Watch YouTube tutorials, so you’re more comfortable using equipment.
5. It’s not for everyone; there’s plenty other ways of keeping active, find yours!
Dr Tony Waterston Retired Paediatrician Newcastle upon TyneI AM 77 and have cycled near to every day of my life for the last 50 years – I feel jaded if I don’t have a pedal. But I’m not a MAMIL (middle aged man in Lycra) and I cycle mainly to get somewhere – the shops, to the hospital or clinic when I was at work, and to the countryside when I can. It’s ‘just’ a form of transport but makes it so much more fun getting places. I cycle because I love it, despite the polluted air and angry drivers –
the perspective from the saddle is a special one, the parking is so much quicker, and it’s usually faster to reach my destination. And I attribute my good health and longevity to daily cycling. Every summer I usually have a cycling holiday either in the UK or Europe and this adds another dimension, especially seeing how cycle friendly many other countries are. I’m also a cycle campaigner locally and a climate activist and was privileged to be part of the Ride for their Lives from London to Glasgow for COP26. Cycling is one of the best ways to show a commitment to reducing carbon emissions: it’s carbon neutral, causes no pollution, doesn’t cause child deaths and is THE transport mode for the future! Cycle to work, you’ll never look back!
Pete Donnelly Community Programme Development Manager UK Leonard Cheshire @LeonardCheshirePARALYMPIAN OLIVIA BREEN has codesigned a series of home workouts to inspire young people to exercise and challenge their friends to #ShowMeYouCan. The Leonard Cheshire ambassador, who is a two-time Paralympian, and the charity’s Community Engagement Team, have developed an introductory toolkit to stay active at home.
The fun and engaging pack features a week of workouts combining circuits, yoga,
dance, balance, and co-ordination exercises to make you fitter while improving your mental health. #ShowMeYouCan will also invite friends to challenge each other and spread the word across their networks and Leonard Cheshire will be encouraging residents across their services to join in too! Disabled people and people with long-term health conditions are twice as likely to be inactive as those without. The effects of the pandemic have further exacerbated these inequalities and made accessing sport even more difficult.
Access the toolkit and #ShowMeYouCan: www.leonardcheshire.org/ShowMeYouCan
classes can be a great way to de-stressDr David Watkin Clinical Fellow in General Paediatrics Birmingham Children’s Hospital @tweediatrics
I’VE ALWAYS LOVED the outdoors, ever since I was a child. I feel free in the mountains, free from stress, free from noise, and free from phone signal and the work WhatsApp group!
We’re lucky in the UK to have so many interesting peaks accessible from the big cities; whether that’s the Peak District in the Midlands, the Brecon Beacons in South Wales, the Cairngorms in Scotland or the Lake District in Northern England. Depending on where you live, the mountains
can be an afternoon jaunt or a low-fuss weekend away.
Climbing hills and mountains is a wonderfully flexible past-time. It’s easy to choose your peak according to the amount of time you’ve got, your fitness (or lack thereof!), your equipment or abilities. All of these things can fluctuate, but there’ll always be the right hill waiting for you somewhere.
I don’t usually hike alone; I find that a
Dr Marty Hanna ST7 Paediatric Trainee Royal Belfast Hospital for Sick Children @martyha09
“GOLF IS DECEPTIVELY simple and endlessly complicated; it satisfies the soul and frustrates the intellect. It is at the same time rewarding and maddening – it is without a doubt the greatest game mankind has ever invented.”
This quote from one of the game’s most iconic figures, Arnold Palmer, sums golf up perfectly. I have definitely experienced the madness, the reward, the satisfaction and the frustration, often all in the same 18 holes.
The reward for me is the sense of peace and enjoyment when playing a round of golf with friends. We all know it can be difficult to switch off and to leave our worries at the hospital doors. I find my Saturday morning round of golf the perfect way to relax, even when the ball has a mind of its own. Scenic surroundings,
gentle exercise, friendly competitiveness and a coffee afterwards always make up for a busy week in work.
Once seen as a sport for the wealthy, golf is now becoming increasingly accessible. Many clubs and driving ranges offer introductory packages or group lessons which are the perfect way to start playing. I would encourage anyone with an interest to pick up a club. You won’t regret it!
long climb is often when I have the best conversations with friends and family. Where else do you get someone’s undivided attention for so long? Add in a good cardiovascular workout, some incredible views and a glowing sense of achievement, and you’ve got the perfect weekend activity. If you’ve never tried, do; at worst you’ll have tired legs and great photos. At best, you’ll have created some of your best future weekends.
PEM Registrar Leicester Royal Infirmary @ChrisDadnam1
FIRSTLY, ENJOY THE exercise that you do, in my case almost everything including HIIT (high intensity interval training), rowing, cycling or playing a game of badminton or squash.
Secondly, get yourself in the mood. I find listening to gym music on the commute from work really gets me going. If you reached home before this it’s too late! This however leads me onto point three –mix things up! Exercise doesn’t have to be boring or something you dread just to keep you healthy. It can be going out for walks with the family or cycling whilst listening to your favourite podcast, even a 20 minute YouTube HIIT session whilst waiting for food in the oven! Keeping the body guessing and trying new things will help keep you motivated and actually enjoy exercising!
Alongside this, mix up your surroundings. If COVID has taught us anything, it’s to get
Helen
Foster
Co-Chair, Paediatric Global Musculoskeletal Task Force Emerita Professor Paediatric Rheumatology Newcastle University @paedmskglobal
MANY OF US appreciate the benefits of walking, especially outdoors, as a source of solace, mental wellbeing and healthy exercise. Walking as a form of regular exercise brings many benefits including healthy weight control and prevention of many non-communicable chronic diseases. Unfortunately, many children and young people (CYP) are not able to experience the pleasures and benefits of walking with huge implications for a child’s physical and mental health
as well as impacting on school and social interactions. There is massive unmet need to improve musculoskeletal (MSK) health for children around the globe.
The Paediatric Global MSK Task Force, set up in 2017, is a virtual global community, open to all with representatives from Africa, Asia, Americas, Australasia and Europe to emphasise our multi-professional, multidisciplinary and multi-cultural MSK world. We believe that all CYP around the globe have the right to walk in a safe environment and to achieve their optimal MSK health. All professionals engaged in the care of children can promote walking, MSK health and wellbeing through advice and encouragement about healthy lifestyle choices (e.g. diet, safe exercise, avoidance of sport and other injury).
As we launch into 2022, the Paediatric
Global MSK Task Force is planning our WALK campaign (World Action for All Kids). Our strategy is to identify and share exemplar models of care to promote walking, optimise MSK health and to identify CYP with MSK conditions and facilitate access to right care. Working better together with wide engagement, partnership and collaboration has to be the right way forward.
some gym equipment at home and those free YouTube channels are gold dust! I use a mix of Joe Wicks, Tabata and GCN cycling network – all free. I don’t invest in expensive equipment, a pair of kettlebells, dumbbells and mid-range cardio equipment is good enough. Working out with a friend or colleague will also give you extra motivation. Always remember to stretch/ cool down, keep hydrated, take rest days and eat well to avoid pesky injuries.
Bottom line, working out shouldn’t be another stress in your life. For me it helps to de-stress after a tough shift, refocus on things other than work and get me into a better mindset whilst feeling good about how I’ve physically improved.
Platt Paediatric Advanced Clinical Practitioner Royal London Hospital @BeckyPlatt3I’M A NICER person when I run regularly. Nicer to other people and nicer to myself. Simple as that. It’s not always easy to find time to run, but I’ve learned that the times I feel I have least time for it are the times I need it the most. That’s when I remind myself of the reasons why:
Being outdoors gives me a fresh perspective, a sense of the bigger picture
The rhythm calms me
The physical challenge allows my mind to wander and to problem-solve effortlessly
It makes me feel virtuous!
I have never regretted going for a run. Here’s how I make it happen:
STEP 1: Treat it as an appointment Running is a diary entry. It’s an
appointment with myself and sometimes with others. Therefore, it happens. Running kit out in advance; alarm set; trainers by the door; no excuses. I make it as easy as I can for myself to do it.
STEP 2: Involve others
For me, this is two-fold. It means that my family remind me that I know I’ll feel better for it. Often it means going with a group so that the momentum will pull me along.
STEP 3: Praise yourself
Sometimes just getting out of the door is a big ask. Other times I feel I could run forever. However far I have run, however fast or slow, I try to bank that as an achievement. I know that sometimes (most times) I will enjoy the process, other times I will just enjoy the results. It all matters. And obviously, if it’s raining, everything counts double!
Supervisor, who has adequate time in their job plan to provide such supervision.
Trainees expect to get meaningful feedback on their performance, delivered in an appropriate manner.
Trainees expect to have access to free, high quality and personalised career guidance, either locally or by signposting them to resources at a regional level.
Trainees expect to be released to attend relevant local and regional teaching, leaving staffing at weekend levels to cover the clinical work where necessary. Attendance at teaching must be audited and an effective plan for resolution or mitigation must be in place if poor attendance is common or recurring.
Trainees expect high quality, relevant and varied teaching locally and that this should be bleep-free for all trainees (except in the case of emergencies).
Trainees expect to be provided with their rota at least six weeks before they start their job and that the rota is always provided six weeks into the future.
Trainees expect to be facilitated in taking annual leave and study leave provided six weeks’ notice has been given and adequate cover is available.
Trainees expect to be supported to undertake accurate exception reporting or hours monitoring (if they are on the 2016 or 2002 contract terms and conditions respectively).
Trainees expect intelligent rota design to
contracts and British Medical Association (BMA) recommendations.
Trainees expect education on healthy lifestyle, sleep and risks of fatigue to be a part of their inductions and education programmes.
Trainees expect training units to provide appropriate rest facilities for trainees working resident on-call night shifts, in line with BMA fatigue and facilities recommendations, and to facilitate interim measures whilst undertaking changes within the department.
Trainees expect that those who are working long, late or night shifts have access to adequate rest facilities following their work if they do not feel safe to travel home. Colleagues should take a duty of care to ensure their co-workers are both safe to work and to travel.
Trainees expect a positive culture towards taking contractual rests and breaks during shifts, including night shifts, and should be encouraged to raise non-adherence with their supervisors.
Trainees expect to be able to access hot food and hydration on all shifts that they are expected to work.
Trainees expect that LTFT trainees will have the same balance of daytime and out of hours working as full time trainees.
Trainees expect to be provided with timetables for educational opportunities in sufficient time to allow LTFT trainees to plan their work pattern to maximise exposure to teaching and training.
Trainees
a positive working environment for them to work alongside the multi-professional team.
Trainees expect to be given opportunities to reflect in a supported environment and access psychological support as necessary.
Trainees expect that when a suitable opportunity to undertake a Supervised Learning Event is identified, that this is facilitated and completed on the electronic Portfolio in a timely fashion.
Trainees expect training units to hold and minute regular junior-senior meetings, support regular junior doctor meetings and involve trainees in monitoring and improving educational quality within the department. The training unit will be accountable to deliver on the recommendations made in the junior-senior meetings.
Trainees expect to have adequate time within their work schedule to complete Supporting Professional Activity, for example QI (quality improvement), audit, leadership, ePortfolio. If this needs to be complete outside of rostered hours, trainees should be encouraged to exception report. It is recommended that this is a minimum of eight hours a month for ST1-3 trainees and 16 hours a month for ST4 and higher trainees, pro rata for LTFT trainees. This is in addition to departmental teaching and clinical admin time.
Trainees expect that training units, in conjunction with the Heads of School and Training Programme Directors, will ensure that they have access to a breadth of different training environments and opportunities across each level of training, which trainees can use to evidence each curriculum domain in RCPCH Progress.
expect training units will foster
1. Educational supervision take account for adequate rest and recovery during and between shifts, in line with their
This Charter outlines what trainees expect from every training unit in the UK. We hope that training units will strive to achieve these aims and that the Charter will be a hallmark of high quality local training.
Paediatric ST6
Birmingham Women’s and Children’s NHS Foundation Trust
RCPCH Chair of the Trainees’ Committee
@lauramkelly
THE TRAINEECHARTER originally came to be after the Trainees’ Committee had surveyed all UK paediatric trainees and found inconsistencies in the training experience across the UK. The Trainee Charter sought to bring together what trainees should expect of a training unit and to serve as a hallmark of high quality local training.
The Trainee Charter has seven domains and is not a reinvention of standards but rather brings together standards from areas such as the Gold Guide, the GMC, Statutory
Education Bodies and terms and conditions of employment to create a defined set of standards that training units should be achieving as a marker of high quality training. Where no specific standard exists for paediatric trainees, the Charter also hopes to make this clear and adopt standards in line with other specialties and with the support of Heads of School.
The Trainees Committee aims to review the Trainee Charter every three years to ensure it still accurately reflects paediatric training needs. It was pleasing to see that it had largely stood the test of time. We did find one area where change needed to happen, specifically around ‘Supporting Professional Activity’ (SPA) time for trainees, to bring our College in line with others. So following approval by the Trainees’ Committee, Heads of School
and the College’s Training and Quality Board, the recommendation was updated within the Charter such that ST1-3 trainees should receive a minimum eight hours a month of SPA time within their rota and ST4-8 trainees should receive a minimum 16 hours per month, pro-rata for LTFT. SPA time should be used for activities such as QI, audit, leadership opportunities and completing ePortfolio for example.
It has been really pleasing to see that increasingly many regions use the Trainee Charter as the basis of regional surveys and audits to help highlight where training is high quality, but also to help uncover where issues may be arising. I am certain that supporting local training units to deliver high quality training will be key to investing in the recruitment and retention of trainees.
Dr Cathryn Chadwick Consultant
Paediatrician
Northampton General Hospital
RCPCH VP for Training and Assessment
@cathrynchadwic1
IHOPE THAT IT is self-evident that trainees’ working and training lives should be of a good standard. We are proud to endorse and promote the Trainee Charter, which outlines the standards expected.
There are many reasons to support the Charter, but the bottom line is that the standards represent a safe, humane and sustainable way to treat our colleagues in training and mirror what we all need from our working and learning environments. Training is about so much more than ‘learning on the job’. While experiential learning is important, that
needs to be underpinned by access to formal teaching and good supervision including time and input for supervised learning events and safe spaces to reflect.
The clinical workload is full on for us all, but particularly for trainees who are often the backbone of the acute service; without time for supporting professional activity, trainees will struggle to develop capabilities in QI or leadership and management and to maintain their portfolios. The change in the Trainee Charter to advocate eight to 16 hours a month for professional development time acknowledges the importance of these activities and that we should not be expecting trainees to do this work in their own time; we are encouraging trainees to exception report when they are unable to complete this vital part of their training in work time, and hope that this is seen positively.
Quite rightly, workplace conditions are part of the Charter. Trainees who have good rest facilities, access to hot food and due attention to breaks will be in a better place to provide safe care and to learn at the same time.
There are challenges in the implementation of the Charter, largely around time and workforce, and a little around changing the culture. I hope that using the Charter to audit trainee experience and to benchmark will be a driver for change. I also hope that units will be proud to implement the Trainee Charter.
Today’s trainees are our consultant colleagues of tomorrow. They should have a rounded training and a sustainable work life balance wherever they are based.
Download the Trainee Charter www.rcpch.ac.uk/trainee-charter
To mark three years since it came into being, our Chair of the Trainees Committee and VP for Training and Assessment outline the importance of the RCPCH Trainee Charter and its role in delivering a high standard for trainees and their working livesDr Laura Kelly
We hear from Dr Clare Smith on the evidence review which led to the first globally complete national cohort of CYP affected by COVID-19 and PIMS-TS
CHILDREN
(CYP) have experienced a huge breadth of challenges in the COVID-19 pandemic, impacting mental and physical health, education, development, opportunities and experience. This has been felt even more so by those who were required to shield. Initial government advice was based on criteria adapted from adults, leading to approximately 90,000 CYP being on the ‘shielding list’. Over time, it became apparent that COVID-19 had a different impact on CYP and therefore there was an urgent need to ensure national policy was evidence-based.
In January 2021, NHS England and NHS Improvement National Clinical Director for Children and Young People was commissioned by the Chief Medical Officer to undertake an evidence review to understand the CYP that are likely to be at risk. I had just joined the team as a National Medical Directors Clinical Fellow, and I was asked to get involved in the whole project and lead a review of CYP who died with a positive COVID-19 test.
This was a hugely challenging project. We brought together a number of experts in different areas to plan just how we were going to do this. We worked remotely and we didn’t ever meet up in person – which proved problematic for providing a team photograph! One of the biggest successes
was enabling national datasets to talk to each other, to enhance data quality and to enable different pieces of the puzzle to be put together. This enabled us to produce the first globally complete national cohort of CYP affected by COVID-19 and PIMS-TS (population c.12 million), including complete mortality data (both hospital and community deaths). One of the biggest challenges was ensuring we shared the data and information in the best way possible for national policy makers and the general public – including a national press conference.
We structured the work into three main areas:
1. A systematic review of all published national and international literature to understand more about what is already known about CYP at risk of severe illness and/or death following SARS-CoV-2 infection.
2. A review of all hospital admissions in CYP with a positive SARS-CoV-2 test to understand the demographic and comorbidity profile of that cohort.
3. A review of all CYP who died with a positive SARS-CoV-2 test to identify if they died of SARS-CoV-2 or if they died of an alternative cause with a coincidentally positive SARS-CoV-2 test.
Findings across the three studies were broadly consistent:
Severe illness and death from COVID-19 is extremely rare in CYP.
Around 90,000 CYP were required to shield
Vulnerable groups have slightly higher risk – but even in these groups, risk remains very low.
Established adult COVID-19 risks extend into CYP (age, non-white ethnicity, obesity, comorbidity). This consistency has not been recognised before because severe disease is so rare in CYP.
CYP at highest risk from COVID-19 are those known to be at risk from any winter virus or other illness, for example those with complex disabilities and comorbidities.
COVID-19 appears to amplify these risks, with risks higher than for influenza, for example.
This piece of work was my full-time job for six months as an out-of-programme Clinical Fellow at NHS England and Improvement. It hugely contrasted clinical work, challenged me in my verbal and written communication skills, taught me the power of kindness and has undoubtedly made me a better clinician. Opening our eyes to the bigger picture has to be a tool in our skill set to enable us to deliver the best care that we can to children, young people and their families.
Obesity represents one of the greatest threats to children and to the future of our nation. What does anaesthesia have to do with it?
Dr Zoë Burton Consultant Paediatric Anaesthetist Sheffield Children’s NHS Foundation Trust @drzoeburton
trainee, I noticed an anecdotal increasing trend of obesity amongst children presenting to our tertiary children’s hospital for surgical procedures. Following a local snapshot audit, I led a NIHR portfolio study investigating PErioperAtive Childhood obesitY (PEACHY) involving 102 hospitals nationally. The study was delivered by the Paediatric Anaesthetic Trainee Research Network and included >4,000 children. 1 in 4 UK children undergoing general anaesthesia were overweight or obese, with 5% severely obese (>99.6th centile). The prevalence of obesity also rose with age.
So, why should childhood obesity concern anaesthetists? Perioperative management of obese children presents several challenges. They are practically more difficult to anaesthetise and more likely to suffer critical airway complications e.g. PEACHY showed a six-fold incidence of difficult face mask ventilation. Obese children also suffer with adult comorbidities, more pain and poorer surgical outcomes. However, perioperative childhood obesity is now so commonplace that it is considered the ‘new normal’. The term ‘oblivobesity’ describes obliviousness to obesity and its associated risks.
Critically, obese children are five times more likely to become obese adults. During their lifetime, an obese child costs the NHS five to seven times that of a healthy weight child. Surely, every healthcare professional has a wider public health responsibility to “make every contact count” and play a part in addressing the burden of childhood obesity?
Perioperatively, can we play a role in exerting a positive influence on the future trajectory of these children’s lives? UK anaesthetists care for around 120,000 overweight/ obese children annually, representing an extraordinary missed opportunity. Further, the perioperative period constitutes a ‘teachable moment’; an event or scenario during which individuals are highly motivated to adopt positive behavioural change.
At Sheffield Children’s Hospital (SCH), we have set up a novel preoperative care obesity service. The aim is to promote healthy lifestyles, identifying and optimising comorbidities preoperatively, whilst simultaneously taking advantage of longer surgical waiting times imposed by COVID-19.
Children attending SCH clinics should have their height, weight and BMI calculated. We encourage all surgeons to refer obese children at the time of booking for surgery. They are then contacted by preoperative care practitioners trained in delivering weight management and lifestyle advice, with onward referral to structured local weight management programmes. Severely obese children attend my consultant-led clinic where they are screened for comorbidities of obesity and offered assessment by both an
This can be a minefield –focus on low hanging fruit!
exercise therapist and sleep specialist nurse. Amongst post-pubertal children, fatty liver disease and insulin resistance are common. Fortunately, I have excellent support from my paediatric colleagues in helping with subsequent management of these problems.
• Lack of documentation of height, weight, BMI and calculation of the child’s age/sexspecific centile. PEACHY found that this was routine in <10% of hospitals. At SCH, this has been facilitated by an electronic growth chart as part of our electronic medical record system.
• Whilst we have local weight management programmes in Sheffield, in some regions where patients fall into commissioning vacuums, it is increasingly difficult to find suitable services.
Ensuring adequate training in starting conversations about weight is critical so that this can be managed sensitively and positively. I loosely structure health promotion around the triad of “Eat well, move well, sleep well”.
For example no fizzy drinks, water before meals, cut out highsugar and ultra-processed foods, three meals/day with snacks limited to fruit/vegetables, portion control
Signpost to ‘sugar swaps’ (www.sheffieldissweetenough.org) and healthy recipes (www.change4life.com)
WELL Physical activity (PA)
What activities does the child already enjoy? What prevents them doing more?
How the family might increase PA as part of their daily routine? Can they spend more time outside?
Moving Medicine website for excellent PA consultation guides (movingmedicine.ac.uk/consultation-guides)
Difficult to manage weight if sleep quality is poor
Limit screen time for at least one hour before bed – suggest audiobooks/music
Encourage relaxation, mindfulness e.g. Headspace app No late-night snacking, ensure sleep environment conducive to sleep, e.g. dark, quiet/white noise
Dr Laura Wood from VITA, a clinician-led organisation advancing the health response to modern slavery, shares some thoughts on Trauma-Informed Care (TIC)
Dr Laura Wood Research Director / Child & Family Modern Slavery Lead VITA Training @VITA_Network
ID YOU KNOW that pre-pandemic, almost 50% of all UK children and young people (CYP) had experienced at least one form of childhood adversity including abuse, neglect and major household dysfunction? It’s possible this percentage is even higher now, with COVID-19 and its ‘shadow pandemic’ of violence and other major disruptions to children’s lives.
TIC begins with the knowledge that adversity and trauma are prevalent in society, and that CYP use amazing subconscious and conscious methods to respond to the problem of danger and to survive. TIC recognises that behaviour is communication, and strategically seeks to understand what CYP are really trying to express to us through their body, mind and actions, especially when talking about trauma is too hard. Healthcare is provided in an environment of physical and psychological safety, building upon safe relational connection, collaboration and empowerment. TIC doesn’t just happen with patients; it’s curating a system-wide approach that values and benefits all the diverse humans within it.
Psychological trauma is complex, but in everyday practice it can be helpful to think of it as a response to chronic or acute situations of terror plus helplessness
Many things can cause a CYP to feel terrified, helpless and overwhelmed. Sometimes causes of trauma are more obvious, such as abuse. Other triggers can
Dbe more unique to individuals, including medical procedures, identity rejection, or an unplanned pregnancy.
CYP interpret what is happening to them from their child-perspective, often lacking much of the wider context adults can see. Many CYP conclude they must have caused the abuse or problem and may believe this into adulthood. The ensuing painful emotions, including guilt, shame, self-disgust, lack of self-worth and fear of rejection, can cause huge interruption to healthy development, and unhealthy decision making that is logical in the light of negative beliefs. CYP’s resilience can be phenomenal and adversity can lead to a legacy of healing and strength, but, sadly, without loving support and, for certain children, specialist professional input, trauma can risk negative impacts on whole person health.
TIC means that we recognise, respond to and advocate for CYP demonstrating trauma responses, whether or not we know the full history yet. We bring wisdom and compassion to the aggressive adolescent instead of frustration. We look deeper at the much-praised, desperately obedient schoolchild who never says “no”. We consider trauma as a differential or factor when CYP are referred with query ASD or ADHD behaviours. We advocate for the asylumseeking CYP in legal limbo with non-specific body pain. TIC also understands why we might be seen as a threat by a CYP who has been lied to or hurt before.
At work let’s consider – what would help CYP feel safer (ask them!)? How can we reduce fear in this family? What could we do to support this CYP’s agency, autonomy and choice? How can we work more holistically with families in the context of their lives? We can aim to reduce fear and helplessness, helping to reduce risks of trauma and re-traumatisation.
TIC is a growing area of research and practice, and an exciting field at the intersection of neuroscience, human rights and healthcare. Do take the time to learn more about becoming a Trauma-Informed paediatrician – it encourages greater work satisfaction too!
FIGHT: Be aggressive and show your strength towards the danger
FLIGHT: Try and get away from the danger
FREEZE: Stay still or numb, hopefully the danger might not harm you
APPEASE: By pleasing the dangerous person or threat, you might protect yourself from serious harm
SUBMIT: If you do what the danger or dangerous person demands, making yourself small and compliant, you might protect yourself from serious harm
Dr Zoë Johnson tells us about the importance of taster weeks in encouraging foundation doctors to #ChoosePaediatrics
Dr Zoë Johnson Junior Clinical Fellow Noah’s Ark Children’s Hospital, Wales @zoejohnson__
TASTER WEEKS ARE encouraged during the foundation programme to allow new doctors to try specialties that they might not otherwise experience during their two years rotation after graduation.
For those who do not have a job in paediatrics, taster weeks are a chance to sample work in child health and as paediatricians, they are prime opportunities to show foundation doctors why they should choose paediatrics. Importantly in recent years, for foundation doctors who have had their training altered by the pandemic, taster weeks are a great way to encourage interest in child health when they may have had an unusual journey through the first two years of being a doctor.
When COVID-19 prevented my rotation onto my paediatric FY1 job and instead left me working in a surgical job for eight months, I used my time on tasters to experience a week in paediatric palliative care and a week in paediatric intensive care in South Wales. Confident that I wanted to pursue a career in child health, these weeks were an opportunity to nurture specialist interest, meet role models already in training and develop communication and clinical skills that I would not otherwise have gained during my FY1 and FY2. My taster weeks were some of my best experiences during my foundation training,
and in fact I was so inspired by the time spent on mine, I applied for a clinical fellow post in the hospital where I did my taster and now proudly work alongside the doctors who inspired me during those important weeks. Without my taster weeks, I do not think I would be as confident discussing challenging issues or have met so many mentors to help me through my application to paediatric training. I am now working with the foundation team in Wales to establish a formal taster week programme in paediatrics nationally so many more doctors can have the amazing experiences that I did. So why are taster weeks important for foundation doctors and how can we as paediatricians support them? Here are my top tips for how you can encourage engagement in taster weeks in your department:
1. Advertise – many foundation doctors simply don’t know where to start with organising a taster week, so it is important to make it easy! If you feel you could host an FY1/2 for a few days and show them why paediatrics is amazing, contact your local foundation school and offer your email as a contact.
2. Motivate – if you have a foundation doctor doing their taster week in your department, make sure to get them involved in the day to day working of a paediatric trainee so they can see what the job is all about and tell them about opportunities to come and engage with the department including projects and FY3 years.
One of Zoë’s patients painted a rainbow for her because she was “sunny and lovely”
3. Welcome – for some departments, they do not regularly have doctors on taster weeks and so some teams do not know how to interact with them, or what they are there to do. Accept and learn from their varied knowledge and relish the opportunity to teach them about paediatrics as there is nothing worse than feeling like a department wasn’t expecting you or doesn’t understand your role.
4. Inspire – taster weeks are designed to inspire the next generation of paediatricians. Show them the best parts of your job, offer help with applications and allow them to become part of the team and I hope many more people will be encouraged to choose paediatrics.
#ChoosePaediatrics www.rcpch.ac.uk/choose-paediatrics
TAKING
What is International Adolescent Health Week (IAHW)?
Dr Ngozi Oketah Consultant Paediatrician
IAHW Special Interest Group member
Royal Belfast Hospital for Sick Children
@EngozyO
The International Adolescent Health Week is a grass roots initiative for young people developed by a special interest group within the Society of Adolescent Health and Medicine (SAHM). It started as a Teen Health Week in Philadelphia in 2016 and quickly became a global celebration in 2018 and has continued to grow. It is usually celebrated annually in March as a health campaign of dynamic participatory events and is aimed at inspiring adolescents and their communities to advocate for a successful transition into adulthood.
IAHW has three main goals of increasing recognition of the unique health issues facing adolescents worldwide by both adults and adolescents, increasing the engagement of adolescents in their own health decisions and stimulating events worldwide that highlight issues facing adolescents and ways to address them. The theme changes from year to year focusing on different aspects of care.
The official colour of IAHW is
lime green, which represents health, happiness, and the high energy and passion of adolescents.
The theme for the 2022 celebrations is ‘Transitions’ and will focus on support for young people in multiple transition areas of their lives including but not limited to transitions from childhood to adulthood, physically and mentally; from a pre-pandemic life into a life shaped by a pandemic; from dependence to independence; and from leadership of older generations to a younger generation.
Over the course of the week, activities focus on adolescent health issues which are relevant in specific communities, including youth-focused policies addressing healthy and safe communities, socioeconomic determinants of health, adolescents’ rights, as well as specific preventative, physical and mental health issues.
2020 saw the IAHW special interest group launch the youth ambassadors’ (YA) programme initiative which has had tremendous success. Last year 250 applications were received from 16 to 22 year olds, representing 44 countries! A final selection of 33 were made. The selected youth ambassadors were charged with suggesting a broad theme for IAHW
2021 celebrations focusing on health topics affecting teenagers. They participated in monthly interactive meetings with IAHW senior leaders who provided guidance through preparation for and the celebration of IAHW.
Anyone! IAHW encourages participation from individuals or organisations who deal with young people including parents, healthcare professionals, schools, hospitals, charities and community centres. IAHW can be celebrated with special events, social media campaigns, health and physical education classes, advocacy work, community events, sponsorship events, competitions, school campaigns and other events.
It focuses on small actions by many people to create a change globally. The more people that are involved the stronger the impact made to benefit adolescents.
Why does everyone in paediatrics need to know about adolescent health?
Currently there are about 11.7 million young people aged 10-24 in the UK of which about 7.4 million are 10-19 year olds. While adolescence is generally a period of good health, it is also a period when 60% of mental health problems and
many long-term conditions emerge. There is evidence that young people do not always have access to the services they require, and health inequalities remain widespread during the time of transition, especially between the ages of 16 and 18, when they often fall between paediatric and adult services.
Adolescence is a period of dynamic brain development in which the interaction with the social environment can shape the capabilities an individual takes into adult life and a time to reinforce positive habits for managing chronic health conditions. It’s a time where effective interventions by paediatricians can support their physical, cognitive, emotional and social wellbeing, which will form the foundation for later life health and wellbeing.
The effects of poor healthcare can last well into the future and have grave consequences. This investment not only brings benefits now, but also for the next generation and decades
to come and our health systems must be transformed to keep pace with the social and cultural changes adolescents face.
Individuals can work alone or with their organisations. The formation of IAHW special interest groups within hospitals to organise week-long activities has been very successful across the UK and Ireland.
I strongly encourage all paediatricians to be a part of this, working closely with other healthcare professionals like play therapists, youth workers/social workers, psychologists and other professionals who work very closely with and understand teenagers.
Adolescent Health Week logos can be put on banners and hung on walls throughout buildings and activities advertised on your organisation’s website in support of young people throughout IAHW.
Activities can include a plan for all staff to wear lime green ties, scarves, T-shirts, or other lime green attire during Adolescent Health Week, and distribution of lime green giveaways to teenage patients (toothbrushes, key-holders, T-shirts, water bottles, health packs, etc).
You can also consider writing to the editor of your local paper to highlight an adolescent health issue or share educational materials.
Coverage of your participation during Adolescent Health Week can be promoted on local newspapers, television, or radio.
You can reach out to local media to set up an interview to share information about adolescent health issues in your practice or share good practice on what you have done to improve adolescent health.
Send a message of support to young people Participation in IAHW sends a strong message of support to young people. We know that the global pandemic has had a negative mental health impact on many teenagers, now more than ever we need to support and motivate young people showing them that we are here to support them as they transition.
If you have a keen interest in adolescent health then why not consider joining YPHSIG (the Young Person’s Health Special Interest Group), an RCPCH-affiliated multiprofessional group aiming to raise the profile of young people’s health and promote the development of high quality services in the UK. Find out more at www.yphsig.org.uk
Promote IAHW this year by posting events on social media using #IAHW2022 and follow IAHW on:
@IAHW2022
@adolescent_health_week
@internationaladolescenthealthweek
internationaladolescenthealthweek.org
“Effective support by paediatricians can support their physical, cognitive, emotional and social wellbeing”Activity packs can be distributed to patients Show your support by wearing lime green You can plan activities around particular issues
We’d love to hear from you, get in touch through our channels
Twitter @RCPCHTweets Facebook @RCPCH Instagram @RCPCH milestones@rcpch.ac.uk
ASTHMA REMAINS THE most prevalent long-term childhood disease and one of the most common reasons for urgent admissions to hospital in England. However, the goal of freedom from asthma symptoms is still not being met for many children and young people (CYP). Proper asthma education is crucial and is associated with reduced morbidity and hospitalisation.
Therefore, with help from CYP, the Whittington Health NHS Trust and Asthma Innovation Research (AIR), we co-created a patient information booklet called Asthmanauts. This interactive comic involves the child enrolling at ‘Nasthma HQ’ before they embark on
IMPROVING CHILDREN’S UNDERSTANDING of asthma is crucial to maintain their health, and this is where Asthmanauts comes in. Asthmanauts is a captivating, creative booklet aimed at children aged four to 10.
It delivers clear, concise information on the causes and prevention of asthma and on inhaler technique. Asthmanauts is an easy read, with interactive
their space cadet training to become an Asthmanaut and defeat the evil space villains (asthma triggers) with help from Commander Brown (beclomethasone) and Captain Blue (salbutamol). We are pleased to announce that with the help and support of Public Health Camden, Public Health Islington and NHS England, we are currently launching the newest version. Packed full of updates, fun additions and new characters, the booklets, along with additional resources, are all available to download for free. If you would like more information or help with your own launch, Nasthma HQ is ready and waiting.
activities and engaging information. As well as being well-presented and brightly coloured, the information is in sections and clearly laid out. It provides easy-to-find and accessible information, giving clearer and better knowledge than most materials currently given to parents or patients. It is still funny and amusing, making it enjoyable to read and interesting for young children, something that is often lacking in booklets or leaflets aimed at children. I highly recommend it and I wish I had it when I was younger.
IT IS NEVER too early to start on the retirement journey. I began mine with the birth of my children, soon after my appointment as a consultant. Money is the boring part, but I wanted to calculate just how early I could afford to retire, calculating when my children would no longer need financial support.
I spent many enjoyable years in training roles at the College, standing down as VP for Training and Assessment a year before retirement. What do you want to achieve in your professional life? You are probably only ever going to retire when you think you have done those things.
Many of us would like to retire gradually, perhaps giving up the on-call or going half time. This was not possible for me, but relinquishing the College work and just doing my clinical job did feel like going part time and enabled me to wind down gradually. Ask yourself: “what do I love about the job of being a paediatrician?” Is it the clinical work, the great variety of people we meet every day, or the academic stimulation of always learning? Plan for activities that will replace those things. But remember, serendipity can trump no end of planning. Fate led me to the door of Bristol University and enrolling for an MA in English Literature. I certainly got academic stimulation and met lots of new and interesting people. Instead of adorning my “lean and slippered pantaloons”, I became rejuvenated. Many of us in retirement wonder how we ever managed to find time to work. Retirement is to be celebrated, never feared.
LIKE MANY OF the best ideas, it all started with a pint of beer. Well, a stein. A few steins. A boozy evening in a Berlin pub in 1967. The issue – all the physiology knowledge on the body under exertion at the time was adult knowledge.
This was about to change. One of the drinkers was Prof Joseph Rutenfranz – an expert on shiftwork, who set up a conference looking into what happened to children when exercising.
They realised that nobody really knew what normal was for different ages. The drive to understand the impact of exercise on children had begun! This was the first time that it was demonstrated that there was no impact on academic achievement, and that regular physical activity as a child made it more likely that healthy habits would be formed as an adult.
The research matured and looked at aerobic capacity, heat tolerance and bone mineralisation, and showed that children were not only as resilient to exertion as adults, but that exposure to impact exercise whilst growing had huge benefits long into adulthood. Children with conditions ranging from cystic fibrosis to muscular dystrophy and obesity to cerebral palsy were found to benefit in multiple ways from exercise in managing their symptoms. This was all groundbreaking – it was presumed that children, especially those with long term conditions would be less robust. Instead, the case for exercise has been well and truly made.
The conference is now a biennial event – being held around the globe from Israel to Canada, Estonia to Portugal. The next Paediatric Work Physiology Conference is being held in Wales in 2023!
Dr Ashish Patel ST7 Paediatric Nephrology & Sim Fellow Birmingham Children’s Hospital @DrKidneyAsh
WE ALL AIM to eat healthily and follow the advice we give daily to our patients, but this can be a challenge in our line of work, especially on a busy on-call shift. Here’s a simple and healthy plan you can all stick to – homemade breakfast bars! Breakfast is arguably the most important meal of the day. I struggle to find time in the mornings to sit down and have a proper breakfast. I prefer having mine on the go (also giving me that extra 10 minutes in bed). Luckily, these breakfast bars are quick and easy to make and will provide you with a batch for the whole week. Or you can share them among your team at the morning handover. Enjoy and continue to spread the love of baking!
Instructions
1. Preheat your oven to 130 °C/110 °C for a fan assisted oven. Line a 9 x 13inch baking tray with baking paper.
2. Warm the condensed milk in a saucepan – don’t let it burn.
3. In a large mixing bowl, weigh out and mix all the other ingredients. Add the warmed condensed milk and combine to a sticky mixture.
4. Spread the mixture into the baking
Ingredients
1 can of condensed milk (397g) 250g rolled oats
75g desiccated coconut 100g dried cranberries
125g pumpkin/sunflower seeds 125g roughly chopped nuts – use any you like, peanuts, pistachios, almonds etc
tray and push down the mixture so it is well packed and level.
5. Bake in the oven for at least 1 hour (it might need a bit longer). Remove from the oven, let it cool for about 15 minutes before slicing into 12 bars and then leave to cool completely. Store in an airtight container.
6. The beauty of these bars is that you can adapt them to add whatever dried fruit, nuts or seeds you want.
Paediatrics Neonatology Registrar Barnet Hospital @pepemac27
Some nights are fine
Some nights are sing-alongs and stickers and bubbles
Some nights are “it’s just viral” and baby cuddles
Some nights are quiet, calm, and cool Some nights are team Dominoes on Deliveroo
Some nights are rashes, coughs, and tiny sneezes
Some nights are easy, total breezes
Some nights are toddler smiles and happy mums and dads Some nights are simply not that bad.
But not “one of those nights”
Those nights are a burden in the centre of your chest Those nights your heart weighs heavy as a green lead vest
Those nights you’re the messenger of hideous truths Those nights bringing pain that can’t be soothed
Those nights are “I’m so sorry, the results aren’t good” Those nights are “I’m so sorry, we did all we could”
Those nights of that child’s unforgettable name Those nights you question why you got into this game
Those nights handing over tissues, instead of screaming babies Those nights the emotional fatigue gets you hazy
Those nights hearing yourself say things you don’t want to say Those nights of “I’m sorry we are meeting in circumstances so grave”
Those nights are “maybe we should consider redirection of care” Those nights are “what are we actually able to achieve here?”
But,
Those nights are fewer and farther between Those nights and their darkness give the good nights their gleam
Those nights you’re left holding broken hope and hearts in your hands
Those nights aren’t all nights, in fact they’re just that Those nights are just some nights and, at least when they’re done, Those nights all end with the light of the sun.
PAEDIATRICS IS A WONDERFUL SPECIALTY, but it can be psychologically hard to deal with sometimes. This is influenced by the day-to-day pressures we are under, but also by what we are going through in our personal lives.
I found myself working in a tertiary neonatal unit whilst pregnant, both as a level 1 trainee and now, three years later, in my registrar rotation. We look after the sickest babies in the province, some of them inevitably pass away. We see normal pregnancies go terribly wrong last minute, having a lifelong impact on the babies and their families. I would often wonder what would I do if I was the parent. Would I be able to cope?
I really had to pull back and develop some coping strategies.
1. SPEAK TO YOUR LOVED ONES about your worries – we feel we are protecting our closest ones by internalising our fears, which simply isn’t true.
2. ENGAGE WITH YOUR ANTENATAL CLASSES
– we may think we know everything, but we have so much to learn from our midwifery colleagues. Antenatal classes are also a reminder that the majority of deliveries are normal and have good outcomes.
3. CONTINUE GENTLE EXERCISE
…if you can. Nothing clears your head like it, with the bonus of giving you the amazing feeling that you’re doing the best for yourself and the baby.
4. TAKE A BREAK. Don’t feel bad about nipping off for some food or water.
5. LET GO OF THE GUILT. Feelings of guilt for having a healthy pregnancy might appear when surrounded by sick babies. But remember you do deserve a normal pregnancy, and no one would wish you anything different.
6. MAKE SPACE FOR SELF CARE. Whether that be a bath, some meditation, exercise, crafting or just a doughnut!
Pregnancy is a time of your life like no other, so enjoy it for what it is.
Paediatric Advanced Clinical Practitioner, King’s College Hospital @lolotteyaya
1) Describe your job in three words. Scary, exciting, rewarding.
2) After a hard day at work, what is your guilty pleasure?
Nutella and a glass of red.
3) What two things do you find particularly challenging?
Finding room for an ACP service. Believing in myself.
4) What is the best part of your working day?
When the children say thank you for whatever we put them through.
5) What is the best advice you have received as a trainee?
You know more than you think you do.
6) Who is the best fictional character of all time, and why?
Le Petit Prince, because he saw the world as it should be.
7) What three medications would you like with you if you were marooned on a desert island filled with paediatric patients?
Pain relief, ondansetron and alimemazine.
8) If you were bitten by a radioactive gerbil, what would you like your superpower to be, and why?
To go back in time, to be able to say thank you to all the people who have left us too early.
9) What is the single, most encouraging thing that one of your colleagues can do to make your day?
Buy me coffee and give me a hug.
10) How do you think you and your colleagues can inspire the next generation of ACPs?
We all have so much to bring to paediatric health. Change is coming and it’s going to be good!
Paediatric Advanced Clinical Practitioner, King’s College Hospital @messig86
1) Describe your job in three words. Laughter, tears, challenging.
2) After a hard day at work, what is your guilty pleasure?
Anything involving salted caramel. Debrief at the pub.
3) What two things do you find particularly challenging?
Defining the ACP role, this hybrid model of being a nurse with advanced additional skills sitting within the medical team. Additional responsibility with imposter syndrome!
4) What is the best part of your working day? A smile or cheeky grin – even after a not nice procedure.
5) What is the best advice you have received as a trainee?
You CAN do this.
6) Who is the best fictional character of all time, and why?
Captain Planet. He taught me at a young age that pollution was a bad thing: “He’s our hero, gonna take pollution down to zero.”
7) What three medications would you like with you if you were marooned on a desert island filled with paediatric patients?
Chloral hydrate, paracetamol, sunscreen.
8) If you were bitten by a radioactive gerbil, what would you like your superpower to be, and why? The ability to enable anyone to see the world through the eyes of a child. The world would be a much kinder place.
9) What is the single, most encouraging thing that one of your colleagues can do to make your day?
Take and give five minutes of non-work-related time to chat about how we really are feeling, not necessarily trying to fix anything, just listening.
10) How do you think you and your colleagues can inspire the next generation of ACPs?
It’s not about me, it’s about the patients and their families – they are the inspiration. A child with eyes full of tears, who smiles and says thank you after a smooth procedure is my inspiration.
@drshilpashah
IN THIS BOOK Betsy offers us a brief overview of what constitutes childhood trauma, its impact and ways adults can support and promote recovery. “Trauma,” says Betsy, “shatters our safety, stability, trust and innocence.” It can have profound short- and long-term impacts on behaviour, emotions, learning and relationships. Recurrent exposure to trauma in childhood in the absence of a supportive adult carer to help process the events, can result in maladaptive compensatory behaviour patterns such as deliberate self-harm, feelings of intense guilt, sadness and rejection.
Trauma can take various forms – be it witnessing an abusive parental relationship, living with an adult struggling with mental illness or being subjected to physical, sexual and emotional abuse. Despite its sombre tone, this book offers hope. “They can recover,” says Betsy. As adults and carers, we need to create and maintain an environment of nurture, consistency, predictability and, above all, kindness: ingredients of a life where a child can blossom and prosper. You will rarely come across a book that imparts so much wisdom in so few pages!
Dr Delan Devakumar
Clinical Associate Professor in Child and Adolescent Health Institute for Global Health, University College London
@DJDevakumar
THE COLLEGE’S SPECIAL interest group, the International Child Health Group (ICHG), launched the Global Health Lives podcast last year.
In this, we explore some of the most important issues in global health from the perspective of the people working in it. We discuss the lives of the guests, what influenced them and the challenges they face, both professionally and personally. In the first series we talk about topics such as newborn mortality, early child development, climate change, racism and xenophobia, HIV and child marriage.
Dr Nick Schindler
General Paediatric Consultant
Norfolk and Norwich University Hospitals NHS Foundation Trust
@DrNickTwit
AS YOU MIGHT ALREADY KNOW, I quite like Twitter. I joined during RCPCH Conference in 2014 so I could ‘follow’ one of the speakers on global health, and my phone turned into a gateway to a myriad of wonderful and inspiring colleagues.
If you’ve ever used social media, you’ll know it isn’t all harmony and enlightenment though. One such moment led a friend and I to discuss the pitfalls, which in turn led to this article. I’ve been told more than once to “be careful” about my use of Twitter by a variety of people, and I find it about as helpful as when I tell my three year
old to “be careful” during whatever precarious activity he is currently embroiled in. So, what is helpful?
Doctors are a delightfully heterogenous group, which makes #MedTwitter a fun and interesting place to be. You can promote your education events, discuss research, learn to bake for your colleagues, play video games with them, or just tease cardiologists about doughnuts. If something interests you, I promise you’ll find another doctor of like mind on Twitter either by chance or by talking about your passions and drawing them in.
Unlike my son when he is balancing
on the back of the sofa, we don’t get to directly see the reaction our tweets provoke in others and modify our behaviour accordingly. In fact, we don’t get to modify those 280 characters at all. You can add to them, but you can never really take them back. This means that perhaps some things require a little more careful consideration about when to balance, and when to sit this one out.
Overall, I think we can learn a lot from children. Tweet about the things that bring you joy, even the precarious ones, but if you fall off the sofa, apologise and don’t do it again.
The healthcare system in Mauritius is a twotier system comprising of a public health service and a private health service. The public health service is entirely free to all Mauritian citizens and residents. It is in fact modelled on the NHS. In addition, anybody can have access to private healthcare, which evidently has a cost.
As far as paediatrics is concerned, the public health service provides free, comprehensive childhood immunisations to all, well-baby clinics and school health checks. We do not have a dedicated children’s hospital but there are dedicated paediatric outpatient services for acute and chronic childhood illnesses provided by all the five regional public hospitals; and each regional hospital also has a children’s ward for inpatients.
Paediatric private healthcare comprises paediatricians offering consultations in stand-alone practices, which means anyone can have direct access to a paediatrician, as opposed to the British system where you have to be referred to a paediatrician by your GP.
My passion for neonatal medicine started when I was a fourth year medical student doing my posting in paediatrics at St Mary’s Hospital in Manchester. This was in the late 1980s, when bespoke neonatal ventilation as a treatment modality was revolutionising the care of preterm babies.
The only treatment available in Mauritius for preterm babies at the time was oxygen and if they did not improve, no escalation of
treatment was possible. It was heartbreaking for me to see a 34-week gestation baby, struggling to breathe, and not showing any improvement with oxygen and knowing that the outcome would be disastrous because of the lack of facilities. This was when the dream of setting up a neonatal intensive care unit in Mauritius started and when I decided to specialise in paediatrics.
I returned to Mauritius towards the end of 1998 where I was employed by the Ministry of Health to set up a neonatal intensive care unit on the island. At that time, the infant mortality rate (IMR) in Mauritius had been stagnating around 19 per 1,000 live births for years. The first neonatal intensive care unit was set up in 1999 and I was responsible for setting up the second one in 2001. In the following few years, the IMR drastically came down and it now fluctuates between 12 to 14 per 1,000 live births.
Despite Mauritius being a tropical island, we do not see as many tropical diseases as one would see in mainland Africa. Malaria and TB are exceedingly rare. Our uptake of childhood immunisation is pretty high and Mauritius is considered to be polio free.
We did however have a major outbreak of measles in 2018. Under the guidance of the WHO, steps were taken by our Department of Public Health, namely a change in the
timing of both the first and second dose of the MMR, and the epidemic was brought under control within a year.
We tend to see the same childhood pathology as middle-income countries such as asthma, eczema, nephrotic syndrome, type 1 diabetes, epilepsy, childhood malignancies etc. We also have our fair share of congenital disorders such as thalassaemia, sickle cell anaemia, congenital heart disease and congenital surgical malformations.
One of the main challenges in paediatrics is the lack of subspecialty services. Besides a handful of paediatricians with an interest in neonatology or PICU or neurology and one paediatric/neonatal surgeon, we do not have any other paediatric subspecialty services in Mauritius. We rely very much on adult specialists to look after children with diabetes/endocrine problems, gastro-intestinal problems, neurosurgical problems etc. Most children with complex pathology that cannot be treated in Mauritius, such as those with congenital heart disease or malignancies, are sent to India for further management.
We do have many young newly-qualified and motivated paediatricians and we hope that one day we will be able to have a convention with a country, whereby our paediatricians could do a masters programme in a paediatric subspecialty, so that we can provide better care to the children of Mauritius.
We hear from Dr Faeza Soobadar on what it’s like to provide care to children on a tropical islandDr Faeza Soobadar Senior Consultant Wellkin Hospital by C-Care Faeza with the nursing staff of the NICU at Wellkin Hospital by C-Care
I became a paediatrician because I took a year out in the middle of medical school and spent several months volunteering in a hospital in rural Zambia. I was sent to work on the children’s ward because they were in desperate need of help. With over 100 children on a 30-bed ward, many dying daily from malaria and other infectious diseases, I quickly learnt how to help with what limited treatments we had available. I could save lives on a daily basis. It was the most rewarding thing I had ever experienced. The work just seemed so important. Even though paediatrics in the UK is very different, after this experience I couldn’t imagine pursuing any other career.
My typical working day involves coffee (I’m a self-confessed coffee snob), a lot of food, and variety. I get to work at 8am (to beat the traffic!) and spend an hour doing admin before handover at 9am. After handover, I help with the general paediatric ward round, either seeing patients independently or the most complex patients with a consultant. I try to get some of the most urgent tasks (procedures, referrals etc) done before lunch. Lunch is usually eaten whilst at some sort of teaching session or clinical meeting. In the afternoon, I will either be in the general paediatric clinic or helping out on the wards and reviewing the new admissions. Assuming I’m not the unlucky person working a long day, I leave work around 5pm.
The most difficult part of my job is switching off when I leave work. I have always been a ‘thinker’ and I often find myself dwelling over a decision I’ve made at work whilst I’m out for a run in the evening, or in the middle of the night. I’m working on this!
The best part of the job is the satisfaction I get from making good decisions. As a trainee when I started to work more independently, the responsibility was daunting at first, but with that comes greater reward when things go well. It’s those moments when you see you’ve made a difference that make the job worthwhile. Also, working in such an enthusiastic and supportive department! I feel very fortunate.
My most memorable moment was as an ST1 in my first neonatal job. I attended the delivery of a 23/40 preterm; she had a stormy course on NICU followed by several months on PICU. It happened that my NICU job was followed by PICU so I ended up looking after her for the first five months of her life. When she was eventually discharged home, it was a joyous and emotional moment.
…run! In fact, this is what I do before work as well. Alongside my job in paediatrics, I am a professional trail runner for the Salomon International team. I usually train for about 20 hours a week (runs might be 6-8 hours long on my days off), and if I include all other runningrelated activities (media, content creation, research and development with brands) there is very little time for anything else! I love travelling all over the world to race, but also the platform it gives me to inspire others to exercise in nature. Follow me on Instagram
@beth_pascall or at
www.bethpascall.com
When I’m finished working I like to...Beth is also a professional trail runner Beth was inspired to become a paediatrician after volunteering in Zambia
Slenyto, the first and only licensed melatonin indicated for the treatment of insomnia in a paediatric ASD population¹ (2 to 18 years where sleep hygiene measures have proved insufficient)2
SLENYTO® PROLONGED-RELEASE TABLETS 1mg and 5mg
PRESCRIBING INFORMATION: Please refer to Summary of Product Characteristics (SmPC) before prescribing. ACTIVE INGREDIENT: Melatonin 1mg or 5mg. INDICATIONS: Insomnia in children and adolescents aged 2-18 years with Autism Spectrum Disorder and / or SmithMagenis syndrome, where sleep hygiene measures have been insufficient. DOSAGE AND ADMINISTRATION: Dose titration: Recommended starting dose is 2mg once daily. If an inadequate response is observed, increase the dose to 5mg, with a maximal dose of 10mg. Data are available for up to two years treatment. Monitor at regular intervals (at least every 6 months) to check that Slenyto is still the most appropriate treatment. After at least 3 months, evaluate treatment effect and consider stopping if no clinically relevant treatment effect is observed. If a lower treatment effect is seen after titration to a higher dose, consider a down-titration to a lower dose before deciding on a complete discontinuation of treatment. Administration: Once daily 0.5-1 hour before bedtime with or after food. Swallow whole, do not crush, break or chew. To facilitate swallowing, tablets may be put into food such as yoghurt, orange juice or ice-cream and then taken immediately. CONTRAINDICATIONS: Hypersensitivity to the active substance or to any of the excipients. SPECIAL WARNINGS AND PRECAUTIONS: Use caution in patients with renal insufficiency. Not recommended in patients with hepatic impairment. Children under 2 years: not recommended. Slenyto may cause drowsiness, therefore use with caution if the effects of drowsiness are likely to be associated with a risk to safety. Not recommended in patients with autoimmune disease. Patients with rare hereditary problems of galactose intolerance, total lactase deficiency or glucose-galactose malabsorption should not take this medicine. INTERACTIONS: Concomitant use with fluvoxamine, alcohol, thioridazine, imipramine, benzodiazepines and non-benzodiazepine hypnotics should be avoided. Use caution with 5or 8-methoxypsoralen, cimetidine, oestrogens, CYP1A2 inhibitors, CYP1A2 inducers, NSAIDs, beta-blockers and with smoking. FERTILITY, PREGNANCY, LACTATION: Avoid use of melatonin during pregnancy. Consider discontinuation of breastfeeding or discontinuation of melatonin therapy taking account of the benefit of breastfeeding for the child and the benefit of therapy for
the woman. No known effects on fertility. DRIVING: Melatonin has a moderate influence on the ability to drive and use machines. UNDESIRABLE EFFECTS: Very common: None. Common: Mood swings, aggression, irritability, somnolence, headache, sudden onset of sleep, sinusitis, fatigue, hangover. Consult SmPC in relation to other adverse reactions. PHARMACEUTICAL PRECAUTIONS: Do not store above 30°C. LEGAL CATEGORY: POM. MARKETING AUTHORISATION HOLDER: RAD Neurim Pharmaceuticals EEC SARL, 4 rue de Marivaux, 75002 Paris, France. Marketed in the UK by Flynn Pharma Limited, Hertlands House, Primett Road, Stevenage, Herts, SG1 3EE, Tel: 01438 727822, E-mail: medinfo@flynnpharma.com
Product
Slenyto 1mg £ 41.20 60 tablets PLGB 52348/0003 EU/1/18/1318/001
Slenyto 5mg £ 103.00 30 tablets PLGB 52348/0004 EU/1/18/1318/003
Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk/. Adverse events should also be reported to RAD Neurim Pharmaceuticals EEC Limited Medical Information e-mail: regulatory@neurim.com
DATE OF REVISION OF PRESCRIBING INFORMATION: June 2021
1. BNF for Children. https://bnfc.nice.org.uk/drug/melatonin.html#indications AndDoses [Accessed January 2022]. 2. Slenyto SmPC [Accessed January 2022].
Date of preparation January 2022 UK/SLY/2021/1857
