GCF Chan

Paediatricians take care of not only complicated diseases of children and adolescents, but also many child health and family related problems. That is why the Royal College of Paediatricians of United Kingdom adopted her name as Royal College of Paediatricians and Child Health. This issue of our journal illustrates vividly how we should pay attention to this spectrum of problems.

Good parenting is a major determinant for the psychological wellbeing of a growing child. However, when a child suffers from a complicated medical condition and requires sophisticated care, that is not an ordinary person can handle. The healthcare team should not overlook the importance of assisting the parents to overcome the difficulties that they encountered. Type 1 diabetes mellitus (T1DM) is an example of complicated medical condition for T1DM treatment involving injection at home, tedious monitoring process including frequent blood examinations, and meticulous dietary restrictions. These are all problematic both for the children and their parents. Before we render any help, we should have an idea of what the problems are and how can they be solved. Bolu S et al evaluated the parents' depression and anxiety status using various assessment tools and found that parents, especially the mother, of children with T1DM are at risk of developing anxiety and depression. Healthcare workers should provide focused education and psychological support to reduce their stress and anxiety so they can take care of their children appropriately.

With the improvement of socioeconomical status, the experience of the developed societies showed us that a new set of healthcare problems emerged. As shown in the cross-sectional study of secondary school students by Oktay G et al, 22.8% were overweight or obese, and 32.3% were suspected to have hypertension. And these 2 problems are probably correlated for the frequency of abdominal obesity and hypertension increased as the body mass index increased. Similar trends were also observed in Hong Kong. Based on the 2022 to 2023 survey by student health service, the prevalence of overweight or obesity among primary and secondary school students were 19.5 percent and 20.5 percent respectively. However, the visual impairment in this study was relatively low (13.3%) as compared to our local prevalence. The problem of myopia was found in 18% of 6-year-old students and increases to about 62% in 12-year-old students. Both genetic and environmental factors may contribute to such differences. Even not as common, the hearing impairment was found in 5.4% in this study so such issue should not be overlooked. Many studies suggest the change in lifestyle from outdoor physical activities to sedentary indoor electronic games is a major factor for such epidemiology changes. How to identify the root causes and to establish effective preventive means to circumvent these issues are the imminent challenge for us as the child health advocates.

In a retrospective study by Tong ASW, it showed the alarming high numbers of children with ADHD or/and ASD related disorders. 8639 were diagnosed to have ADHD or/and ASD related disorders within just a 2-year period of 2012 to 2013. Among them, 65.8% of ADHD related disorders and 91.3% of ASD children were subsequently referred to the Child Psychiatric Clinic in Hospital Authority for long-term follow-up and management. It was found that the comorbidity of these 2 conditions was common. With limited child psychiatry service available, how can these children be managed on-time will be a big issue. For a long time, effectively mobilize the existing clinical manpower to cope with children with ADHD or/and ASD disorders has been repeatedly discussed. One suggestion is to allow family physicians and paediatricians to take care of the mild to moderate ADHD or/and ASD, but such practice was not carried out effectively. The golden period of early training may be missed. Early training and interventions remain the most effectively way to improve their behaviour and learning. All the involved parties must work together to solve this service gap.

Finally, Kawasaki disease as a common autoimmune disorder in oriental children, the diagnosis and disease monitoring has been depending on clinical features mainly. In recent years, with the advancing knowledge in molecular biology, a large group of previously ignored "non-coding RNA" were found to have clinical significance. They may serve as diagnostic markers or even therapeutic targets. Dong T, et al summarised the recent data on the association between various forms of non-coding RNA and vascular complications of Kawasaki disease. Many of these non-coding RNAs serve as immune genes expression modifiers which reflects the underlying immune dysregulation mechanisms of Kawasaki disease. Whether some of these non-coding RNAs will eventually be utilised clinically await further evaluation. Of note, in this year which marks the 100 years birthday of the late Dr. Tomisaku Kawasaki, change in the treatment paradigm was made by the Taiwan group. Using a randomized control trial, they showed that with the treatment of high dose IVIG, high dose aspirin does not have any additional benefit in preventing the occurrence of coronary artery disease (Kou HC et al, JAMA Open 2025). This will change our standard practice in the future.

In training the newer generation of paediatricians, they should be equipped with the skills and knowledge to handle a wide spectrum of issues, from child health related problems to complicated systemic illnesses (most of them are rare), and care of the sick children's family. The curriculum of training should be updated to include all these elements. But while we add new items, we should also judiciously remove some out-dated requirements so the core training will not become too laborious and redundant. All those seniors involve in training should also receive additional update training themselves so effective supervision can be conducted.