Spanish Paediatric Association Research Articles

Vacunación antigripal en niños

The Vaccine Advisory Committee of the Spanish Paediatrics Association considers that anti-flu vaccination for children >6 months of age not included in risk groups is a recommended measure, because it provides individual protection and improves family and community protection. That is to say, universal anti-flu paediatric vaccination is recommended for children between 6 and 59 months of age; this is also suggested by the World Health Organization (WHO). Healthy children are the main source for spreading flu in the family, because they excrete a higher viral load, and for a longer time than adults. Children who seem to have the highest risk of flu-related complications are those with an underlying medical condition and, therefore, it is necessary to get them vaccinated. For the 2022-2023 season, there are two types of anti-flu vaccines authorized in Spain for <18-year-olds, which are the parenteral inactivated and the inhaled attenuated vaccines. Parenteral vaccines are authorized for >6-month-old children (one of them, for >24-month-old children), and the inhaled vaccine from the age of 24 months. The Interterritorial Council of the National Health System has recently included this vaccination for all children in the 2023-2024 season.

Tuberous Sclerosis: a disease systematically monitored by the Rare Diseases Registries in Spain

Abstract Background Tuberous Sclerosis (TS) is a rare genetic disease that causes hamartomas and neuropsychiatric disorders. Objective to determine the prevalence and its evolution in the Valencian Region in the period 2010-2017. Methods Through the information sources used by the Rare Disease Population-based Registry of the Valencian Region, possible cases of TS were identified with codes 759.5 (International Classification of Diseases -ICD- 9th Revision Clinical Modification version) and Q85.1 (ICD10th Revision, ICD10th Spanish version and ICD10th British Paediatric Association version). Prevalence and mortality rates per year were obtained (by the direct method, using the European Standard Population 2013) and a descriptive analysis of the sociodemographic variables of the confirmed cases was performed. Results 158 possible cases of TS were obtained, which 139 were confirmed (54.7% women and 45.3% men). The lowest prevalence was in the year 2010 with 16.0/1,000,000 (95%CI: 12.7-20.0) and the highest in 2017 with 26.5/1,000,000 (95%CI: 22.0-31.7), identifying an increasing trend along the period. Prevalence in women was higher than in men throughout the period, being in the year 2017 in women (30.3/1,000,000 (95%CI: 23.5-38.4)) and in men (22.7/1,000,000 (95%CI: 17.0-30.0)).The province with the highest prevalence was Castellón (in the north), 34.8/1,000,000 (95%CI: 20.9-55.0) in the year 2017. The median age at diagnosis was 7.2 years. The mortality rate over the period was 0.4/1,000,000 (95%CI: 0.2-0.7), being higher in men (0.5/1,000,000 (95%CI: 0.2-1.0)) than in women (0.3/1,000,000 (95%CI: 0.1-0.7)). Conclusions The prevalence obtained is lower than that estimated by Orphanet, the rare diseases reference portal, (100-500/1,000,000), being in this study the first time it is identified in the Valencian Region. The increasing trend in prevalence may be due to the low mortality of TS and it is being chronic, as well as a good healthcare management of the disease. Key messages The Tuberous Sclerosis is one of the 20 rare diseases systematically monitored by the Rare Disease IPopulation-based Registry of the Valencian Region and in the Spanish Rare Disease Registry. The obtained prevalence and mortality could be used to increase the knowledge of the Tuberous Sclerosis and as a basis for health programs and research.

Recommendations on the clinical management of the COVID-19 infection by the «new coronavirus» SARS-CoV2. Spanish Paediatric Association working group

On 31 December 2019, the Wuhan Municipal Committee of Health and Healthcare (Hubei Province, China) reported that there were 27 cases of pneumonia of unknown origin with symptoms starting on the 8 December. There were 7 serious cases with common exposure in market with shellfish, fish, and live animals, in the city of Wuhan. On 7 January 2020, the Chinese authorities identified that the agent causing the outbreak was a new type of virus of the Coronaviridae family, temporarily called «new coronavirus», 2019-nCoV. On January 30th, 2020, the World Health Organisation (WHO) declared the outbreak an International Emergency. On 11 February 2020 the WHO assigned it the name of SARS-CoV2 and COVID-19 (SARS-CoV2 and COVID-19).The Ministry of Health summoned the Specialties Societies to prepare a clinical protocol for the management of COVID-19. The Spanish Paediatric Association appointed a Working Group of the Societies of Paediatric Infectious Diseases and Paediatric Intensive Care to prepare the present recommendations with the evidence available at the time of preparing them.

Recommendations on the clinical management of the COVID-19 infection by the «new coronavirus» SARS-CoV2. Spanish Paediatric Association working group

El 31 de diciembre de 2019, la Comisión Municipal de Salud y Sanidad de Wuhan (provincia de Hubei, China) informó sobre la existencia de 27 casos de neumonía de etiología desconocida con inicio de síntomas el 8 de diciembre, incluyendo 7 casos graves, con exposición común a un mercado de marisco, pescado y animales vivos en la ciudad de Wuhan. El 7 de enero de 2020, las autoridades chinas identificaron como agente causante del brote un nuevo tipo de virus de la familia Coronaviridae, denominado temporalmente «nuevo coronavirus», 2019-nCoV. El 30 de enero de 2020 la Organización Mundial de la Salud (OMS) declara el brote una Emergencia Internacional. El día 11 de febrero la OMS le asigna el nombre de SARS-CoV2 e infección COVID-19 (Coronavirus Infectious Disease). El Ministerio de Sanidad convoca a las Sociedades de Especialidades para la elaboración de un protocolo clínico de manejo de la infección. La Asociación Española de Pediatría nombra un grupo de trabajo de las Sociedades de Infectología Pediátrica y Cuidados Intensivos Pediátricos que se encargan de elaborar las presentes recomendaciones con la evidencia disponible en el momento de su realización.

Position paper on vegetarian diets in infants and children. Committee on Nutrition and Breastfeeding of the Spanish Paediatric Association

In the last few years, there are an increased number of families following a vegetarian diet, including their children. In order to guarantee child heath, paediatricians need to know the characteristics of this diet and the main foods that are used.There are few data on the medium and long-term health outcomes when removing all animal foods from the child’s diet, especially at younger ages. Nevertheless, new tools have recently become available to facilitate following a vegetarian diet and decreasing the risk of deficiencies.In this document, the group of foods commonly used in vegetarian diets are reviewed, as well as recommendations for each age group. It also mentions the need to use B12 supplements at all ages, as well as other nutrients (iodine, iron, vitamin D3, poly-unsaturated fatty acid n-3), when required.A vegetarian or a vegan diet, as in any other kind of diet, needs to be carefully designed. After reviewing current evidence, even though following a vegetarian diet at any age does not necessarily mean it is unsafe, it is advisable for infant and young children to follow an omnivorous diet or, at least, an ovo-lacto-vegetarian diet.

Exercise as medicine in chronic diseases during childhood and adolescence

Physical activity (PA) and exercise improve the overall quality of life, as well as prevent the onset of diseases in healthy children and adolescents, and as an aid to treat prevalent chronic diseases in childhood. PA and exercise are like medicine, but sedentary lifestyle and inactivity cause disease. In this article, the existing scientific evidence in this field is reviewed and recommendations for professionals involved in child health are updated. A good knowledge of how to prescribe exercise and PA in paediatrics in different diseases is necessary. Interventions to avoid inactivity of children and adolescents must be supported by the appropriate increase in the level of PA, through integration and training programs, which achieve both an overall improvement of the neuromuscular physical condition and also physical, cognitive, and psychosocial performance. The Health Promotion Committee of Spanish Paediatric Association proposes strategies that help to obtain this objective, aiming to improve the health of our patients through the practice of exercise and the increase in PA.

Exercise as medicine in chronic diseases during childhood and adolescence

Physical activity (PA) and exercise improve the overall quality of life, as well as prevent the onset of diseases in healthy children and adolescents, and is an aid to treat prevalent chronic diseases in childhood. PA and exercise are like medicine, while sedentary lifestyle and inactivity cause disease. In this article, the existing scientific evidence in this field is reviewed and recommendations for professionals involved in child health are updated. A good knowledge of how to prescribe exercise and PA in paediatrics in different diseases is necessary. Interventions to avoid inactivity of children and adolescents must be supported by the appropriate increase in the level of PA, through integration and training programs, which achieve both an overall improvement of the neuromuscular physical condition and also physical, cognitive, and psychosocial performance. The Health Promotion Committee of Spanish Paediatric Association proposes strategies that help to obtain this objective, aiming to improve the health of our patients through the practice of exercise and the increase in PA.

Recommendations of the Spanish Society of Paediatric Cardiology and Congenital Heart Disease as regards the use of drugs in attention deficit hyperactivity disorder in children and adolescents with a known heart disease, as well as in the general paediatric population: position statement by the Spanish Paediatric Association

IntroductionApproved drugs for attention deficit hyperactivity disorder (ADHD) in Spain are methylphenidate, lisdexamphetamine, atomoxetine and guanfacine. Due to adverse cardiovascular effects, mainly increased blood pressure and heart rate, its use in patients with known or undiagnosed heart disease may be controversial. ObjectiveTo obtain a consensus document from the Spanish Society of Paediatric Cardiology and Congenital Heart Diseases (SECPCC) and experts from other Agencies and Societies as a guide for the paediatric cardiologist and physicians who treat children and adolescents with ADHD. MethodAn analysis was performed on the bibliography and Clinical Practice Guidelines, technical data sheets approved by the Spanish Agency of Medicines and Health Devices, and the Spanish Ministry of Health Guidelines. A Working Group was formed, with a Coordinator, as well as members of the Clinical Cardiology Working Group and Arrhythmia Group of the SECPCC. This Group produced a preliminary document that was reviewed by a group of external experts (List 1) and a group of internal experts of the SECPCC (List 2) with a consensus being reached on the final document. ResultsThe recommendations of the SECPCC and the group of experts are presented on cardiovascular evaluation prior to treatment in children and adolescents with unknown cardiovascular disease and with known cardiovascular disease.The recommendations of the SECPCC and the group of experts are also presented on the use of medications for ADHD in children and adolescents with cardiological symptoms with no evidence of heart disease, congenital heart disease, cardiomyopathy, Marfan syndrome and other aortic diseases, hypertension, and arrhythmias.

Position paper on vegetarian diets in infants and children. Committee on Nutrition and Breastfeeding of the Spanish Paediatric Association

In the last few years, there are an increased number of families following a vegetarian diet, including their children. In order to guarantee child heath, paediatricians need to know the characteristics of this diet and the main foods that are used. There are few data on the medium and long-term health outcomes when removing all animal foods from the child's diet, especially at younger ages. Nevertheless, new tools have recently become available to facilitate following a vegetarian diet and decreasing the risk of deficiencies. In this document, the group of foods commonly used in vegetarian diets are reviewed, as well as recommendations for each age group. It also mentions the need to use B12 supplements at all ages, as well as other nutrients (iodine, iron, vitaminD3, poly-unsaturated fatty acid n-3), when required. A vegetarian or a vegan diet, as in any other kind of diet, needs to be carefully designed. After reviewing current evidence, even though following a vegetarian diet at any age does not necessarily mean it is unsafe, it is advisable for infant and young children to follow an omnivorous diet or, at least, an ovo-lacto-vegetarian diet.

The Spanish Paediatrics Association: The determining factor in the professional, epidemiological, sociocultural, and environmental changes that impact the health of the children of the country

The Spanish Paediatrics Association: The determining factor in the professional, epidemiological, sociocultural, and environmental changes that impact the health of the children of the country

Statement by the Spanish Paediatric Association in relation to gender diversity in childhood and adolescence: Ethical and legal view from a multidisciplinary perspective

An ethical and legal view of gender diversity in childhood and adolescence is presented from the perspective of the best interest of the child and the principle of protection against vulnerability. The identification of gender diversity in childhood and adolescence is a process that requires support, coordination and a multidisciplinary team that improves care and helps to obtain evidence that is lacking today. Secure, equitable and comprehensive access to care and health care should be guaranteed when required. It is necessary to promote a changing of social outlook, capable of overcoming the stereotypes that lead to discrimination and increase suffering. Respect for gender diversity in childhood and adolescence is a fundamental Human Right. The recognition of a positive value in diversity is an ethical imperative. All of this, without forgetting that we are talking about minors often in contexts of vulnerability, and currently very uncertain, so prudence is the main rule that should guide decision-making.

Views of the Spanish Paediatric Association Bioethics Committee on the refusal of essential and non-essential treatment in minors

The conflicts that arise when minors or their legal representatives refuse to receive medical treatment considered necessary by the paediatrician pose a serious ethical dilemma and also have a considerable emotional impact. In order to adequately tackle this rejection of medical treatment, there is to identify and attempt to understand the arguments of the people involved, to consider the context in each individual case and be conversant with the procedure to follow in life-threatening scenarios, taking into account bioethical considerations and the legal framework.

Immunisation schedule of the Spanish Association of Paediatrics: 2017 recommendations

The Vaccine Advisory Committee of the Spanish Paediatrics Association (CAV-AEP) annually publishes the immunisation schedule which, in our opinion, is optimal for children resident in Spain, considering the evidence available on current vaccines. Pneumococcal and varicella immunisation in early childhood is already included in all of the funded vaccines present in the regional immunisation programmes. Furthermore, this Committee establishes recommendations about vaccines not included in official calendars (non-funded immunisations) such as like rotavirus, meningococcal B, and meningococcal ACWY.As regards funded immunisations, the 2+1 strategy (2, 4, 11–12 months) with hexavalent (DTPa-IPV-Hib-HB), and 13-valent pneumococcal vaccines are recommended.Administration of the 6-year booster dose with DTPa is recommended, and a poliomyelitis dose for children who had received the 2+1 scheme, as well as Tdap vaccine for adolescents and pregnant women between 27 and 32 weeks’ gestation.The two-dose scheme should be used for MMR (12months and 2–4years) and varicella (15months and 2–4years).Coverage of human papillomavirus vaccination in girls aged 12 with a two dose scheme (0, 6months) should be improved. Information and recommendation for male adolescents about potential beneficial effects of this immunisation should also be provided.Meningococcal ACWY vaccine is the optimal choice in adolescents.As regards the recommended unfunded immunisations, the CAV-AEP recommends the administration of meningococcal B vaccine, due to the current availability in Spanish community pharmacies, with a 3+1 scheme. The CAV-AEP requests the incorporation of this vaccine into the funded unified schedule. Vaccination against rotavirus is recommended in all infants.

Calendario de vacunaciones de la Asociación Española de Pediatría: recomendaciones 2017

The Vaccine Advisory Committee of the Spanish Paediatrics Association (CAV-AEP) annually publishes the immunisation schedule which, in our opinion, is optimal for children resident in Spain, considering the evidence available on current vaccines. Pneumococcal and varicella immunisation in early childhood is already included in all of the funded vaccines present in the regional immunisation programmes. Furthermore, this Committee establishes recommendations about vaccines not included in official calendars (non-funded immunisations) such as like rotavirus, meningococcal B, and meningococcal AC.As regards funded immunisations, the 2+1 strategy (2, 4, 11-12 months) with hexavalent (DTPa-IPV-Hib-HB), and 13-valent pneumococcal vaccines are recommended.Administration of the 6-year booster dose with DTPa is recommended, and a poliomyelitis dose for children who had received the 2+1 scheme, as well as Tdap vaccine for adolescents and pregnant women between 27 and 32 weeks’ gestation.The two-dose scheme should be used for MMR (12months and 2-4years) and varicella (15months and 2-4years).Coverage of human papillomavirus vaccination in girls aged 12 with a two dose scheme (0, 6months) should be improved. Information and recommendation for male adolescents about potential beneficial effects of this immunisation should also be provided.Meningococcal ACWY vaccine is the optimal choice in adolescents.As regards the recommended unfunded immunisations, the CAV-AEP recommends the administration of meningococcalB vaccine, due to the current availability in Spanish community pharmacies, with a 3+1 scheme. The CAV-AEP requests the incorporation of this vaccine into the funded unified schedule. Vaccination against rotavirus is recommended in all infants.

Spanish Paediatric Association (2009–2017). Time for accountability

Spanish Paediatric Association (2009–2017). Time for accountability

Solid paediatricians in liquid times: Reviving professionalism

Professionalism is rarely taught formally. It is learned by osmosis through the hidden curriculum: a set of attitudes that each one of us transmits unconsciously to students, medical residents, and colleagues. All of us are a model or counter-model of professionalism through a series of values that have been the pillars of our profession since Hippocrates. Values that do not seem to be strong enough to pass our time. There are specific factors of the 21st century such as the financial crisis, the highly technical nature of medicine, bureaucratisation or trivialisation of the medical process that could explain, but not justify, the decline in the values of our profession: Empathy, integrity, solidarity, the altruism, or confidentiality. That is why, from the Bioethics Committee of the Spanish Paediatrics Association we establish the need to revive professionalism. Building and maintaining the values of our profession by training scientifically competent paediatricians, as well as being excellent from an ethical point of view, is part of our responsibility.

Insomnia in children and adolescents. A consensus document

Insomnia is very common during childhood (30% of children under 5), and causes a serious cognitive and emotional consequence in learning, as well as significant medical comorbidity. It also affects the quality of life, not only of the child, but also of the whole family. Paediatrician training in its diagnosis and treatment is usually poor. For this reason a consensus document is presented on the management of insomnia in children and adolescents. This has been developed by members of the Spanish Paediatrics Association, the Spanish Sleep Society, the Spanish Society of Paediatric Outpatient and Primary Care, the Spanish Adolescent Medicine Society, the Spanish Child and Adolescent Society, and the Spanish Paediatric Neurology Society. The group suggests that diagnosis must be clinical and complementary tests will only be required in doubtful cases or when a differential diagnosis is needed. Likewise, treatment should be mainly based on cognitive-behavioural therapy and the modification of sleeping habits. Using medicines and other substances to make the sleep easier is currently quite common, even although there are no clinical guidelines to support this.

Recommendations for the prevention of foreign body aspiration

The aspiration of a foreign body remains a common paediatric problem, with serious consequences that can produce both acute and chronic disease. Aspiration usually causes a medical emergency that requires a prompt diagnosis and an urgent therapeutic approach as it may result in the death of the child or severe brain injury. It typically involves organic foreign bodies (mainly food or nuts) aspirated by children under 5 years old, and usually at home. In this statement, the Committee on Safety and Prevention of Non-Intentional Injury in Childhood of the Spanish Paediatrics Association provides a series of recommendations, both educational (while eating and playing), as well as legal, to prevent such episodes.

Pediatras sólidos en tiempos líquidos. Reanimando la profesionalidad

Professionalism is rarely taught formally. It is learned by osmosis through the hidden curriculum: a set of attitudes that each one of us transmits unconsciously to students, medical residents, and colleagues. All of us are a model or counter-model of professionalism through a series of values that have been the pillars of our profession since Hippocrates. Values that do not seem to be strong enough to pass our time.There are specific factors of the 21st century such as the financial crisis, the highly technical nature of medicine, bureaucratisation or trivialisation of the medical process that could explain, but not justify, the decline in the values of our profession: Empathy, integrity, solidarity, the altruism, or confidentiality.That is why, from the Bioethics Committee of the Spanish Paediatrics Association we establish the need to revive professionalism. Building and maintaining the values of our profession by training scientifically competent paediatricians, as well as being excellent from an ethical point of view, is part of our responsibility.

Insomnio en niños y adolescentes. Documento de consenso

Insomnia is very common during childhood (30% of children under 5), and causes a serious cognitive and emotional consequence in learning, as well as significant medical comorbidity. It also affects the quality of life, not only of the child, but also of the whole family. Paediatrician training in its diagnosis and treatment is usually poor. For this reason a consensus document is presented on the management of insomnia in children and adolescents. This has been developed by members of the Spanish Paediatrics Association, the Spanish Sleep Society, the Spanish Society of Paediatric Outpatient and Primary Care, the Spanish Adolescent Medicine Society, the Spanish Child and Adolescent Society, and the Spanish Paediatric Neurology Society. The group suggests that diagnosis must be clinical and complementary tests will only be required in doubtful cases or when a differential diagnosis is needed. Likewise, treatment should be mainly based on cognitive-behavioural therapy and the modification of sleeping habits. Using medicines and other substances to make the sleep easier is currently quite common, even although there are no clinical guidelines to support this.