Children and screens: Groupe de Pédiatrie Générale (Société française de pédiatrie) guidelines for pediatricians and families.

The Groupe de Pédiatrie Générale (General Pediatrics Group), a member of the Société française de pédiatrie (French Pediatrics Society), has proposed guidelines for families and doctors regarding children's use of digital screens. A number of guidelines have already been published, in particular by the French Academy of Sciences in 2013 and the American Academy of Pediatrics in 2016. These new guidelines were preceded by an investigation into the location of digital screen use by young children in France, a survey of medical concerns on the misuse of digital devices, and a review of their documented benefits. The Conseil Supérieur de l'Audiovisuel (Higher Council on Audiovisual Technology) and the Union Nationale de Associations Familiales (National Union of Family Associations) have taken part in the preparation of this document. Five simple messages are proposed: understanding without demonizing; screen use in common living areas, but not in bedrooms; preserve time with no digital devices (morning, meals, sleep, etc.); provide parental guidance for screen use; and prevent social isolation.

[Assessment and management of gender dysphoria in children and adolescents]. / Évaluation et prise en charge d'une dysphorie de genre chez l'enfant et l'adolescent.

Gender dysphoria, originally called gender identity disorder, is characterized by the dissociation between one's expressed gender and the gender of rearing as assigned at birth, which generates significant clinical distress and social, academic, and other important forms of isolation. This state is also known as transgender or transsexualism and is recognized as a medical disease. Adults with gender dysphoria can benefit from psychological, medical, and surgical care. However, gender dysphoria rarely occurs in adulthood but rather emerges in childhood or adolescence, generating deep social and academic difficulties, especially at puberty. For the last 10years, the management of gender dysphoria in children and adolescents has developed in several countries, specifically in Europe, but remains under-recognized in France. Since 2013, several pediatric psychiatry and endocrinology departments have initiated a multidisciplinary evaluation and management approach for these patients. This article reviews the clinical criteria helping diagnose gender dysphoria and presents the different steps in the assessment and management of these patients in accordance with international guidelines.

Nutri-bébé 2013 Study Part 3. Nutri-Bébé Survey 2013:3/Behaviour of mothers and young children during feeding.

This new study by the Secteur français des aliments de l'enfance (SFAE) (French Agency for Children's Foods) confirms the improvement in the nutritional environment of young children, particularly in sharing family meals. Incorporating the sample of breastfed children is a new feature, although food refusal behavior in infants did not appear to differ greatly whether or not they were being breastfed, and mothers expressed a need to be informed and guided in order for their children to better accept varied foods. We still found long-term continuation of feeding bottles and in parallel excessively early introduction of adult foods and significant and inappropriate viewing of screens for age.

[Cognitive remediation therapy for children and adolescents with anorexia nervosa in France: an exploratory study]. / Évaluation d'un programme de remédiation cognitive au sein d'un groupe d'enfants et d'adolescents anorexiques français: étude exploratoire.

OBJECTIVE: Cognitive remediation therapy (CRT) seems to be increasingly interesting in the treatment of anorexia nervosa for adult patients. We attempted to apply this support to a group of young inpatients, initially to assess its feasibility and acceptability, and then to improve its content for therapeutic application and future research. METHODS: Ten 12- to 17-year-old inpatients with primary DSM-IV diagnosis of anorexia nervosa participated in a 10-week intervention program with a one-hour group session of CRT per week. All 10 patients were assessed before the intervention and those who completed the 10 sessions were assessed after. Assessment included a clinical examination by a psychiatrist, a battery of clinical inventories, and set-shifting tests. Moreover, each patient wrote a letter providing feedback on the intervention for subsequent analysis. RESULTS: Only two patients completed all 10 sessions, the other eight who were discharged from the hospital in the meantime could not attend the sessions for practical reasons. After the 10 sessions, an improvement in BMI and in measured levels of some psychopathological symptoms was observed in our two patients. Most neuropsychological task performances were improved after cognitive remediation. Feedback from the 10 patients was generally positive. CONCLUSION AND IMPLICATIONS FOR PRACTICE: This preliminary investigation suggests that cognitive remediation therapy is acceptable and feasible in this population. Replication of these findings requires a larger sample, improvement of the trial design, more sensitive measures, and another training format to avoid loss of so many participants.

[Cardiovascular risks and management during Attention Deficit Hyperactivity Disorder treatment with methylphenidate]. / Risques cardiovasculaires et conduite à tenir dans le traitement du trouble déficit de l'attention/hyperactivité avec le méthylphénidate.

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common of the pediatric neuropsychiatric disorders. Methylphenidate is an important element of therapeutic strategies for ADHD. Clinicians are interested in the safety of methylphenidate. Because this drug raises heart rate and blood pressure, concerns have been raised about its cardiovascular safety. Concerns were based on case reports of sudden cardiac death in methylphenidate users, plausible pharmacological pathways involving well-established stimulant effects on heart rate and blood pressure. Until recently, data were limited to a number of observational studies too small to examine serious cardiac events. In the past two years, large retrospective, population-based cohort studies were performed. These studies did not show any evidence that methylphenidate was associated with an increase in risk of myocardial infarction, sudden cardiac death, or stroke. Treatment of children with methylphenidate is not significantly associated with an increase in the short term or mid-term risk of severe cardiac events. For many, available data now will be seen as reassuring. But gaps persist in the methodical and comprehensive assessments of the safety of methylphenidate. Analyses cannot be generalized to children with long-term use of stimulants. Furthermore, long-term effects of slight increases in heart rate or blood pressure are unknown. Stimulant administration continues to have a detectable adrenergic effect even after years of treatment. In the MTA study, greater cumulative stimulant exposure was associated with a higher heart rate at years 3 and 8. Although less severe, such adverse cardiac events are nonetheless alarming to patients. This adrenergic effect may have clinical implications, especially for individual patients with underlying heart abnormalities and it deserves further investigation. More research is necessary to optimize a safe use of methylphenidate regarding its cardiovascular effects. In light of the controversies surrounding the increase in the number of children being diagnosed with ADHD, the broad use of methylphenidate in these patients, and cardiovascular concerns about it, this article addresses topics of clinical significance. For ease of use by practitioners, the article summarizes the guidelines stated by the European Medicines Agency over the appropriate pretreatment evaluation and cardiovascular assessment. It advocates a thorough history and physical examination before initiating methylphenidate to treat patients with ADHD, with an emphasis on the identification of risk factors for sudden death. A cardiac sub-specialist consultation is mandatory in case of history or physical examination findings. In other cases, an electrocardiographic screening is recommended in order to check out previously unrecognized heart disease.

[Gender identity disorder in children and adolescents]. / Le concept de trouble de l'identité sexuelle chez l'enfant et l'adolescent. Qu'en savoir ? Que dire ? Que faire ?

There has been an explosion of public interest and concern about children and adolescents who show an interest in changing their gender. And it is an emerging problem for pediatricians, which brings many inquiries about what to do? Both the diagnosis and treatment of gender identity disorder are controversial. But there are a new early treatment using puberty blocking hormones.

[Social media, children and pediatricians]. / Les réseaux sociaux, les enfants et le pédiatre.

Using social media web sites is a common activity for children, and any site that allows social interaction (social network, games, virtual worlds...) is a social media site. Pediatricians are in a position to help families understand the benefits and the risks of these sites, and to diagnose problems in children and adolescents as cyberbullying, depression, and post traumatic disorder.

[Child food refusal: when will we call a child psychiatrist?]. / Le nourrisson qui ne mange pas: quand recourir au pédopsychiatre?

Food refusal is a frequent symptom in infants and toddlers. Many difficulties resolve with pediatric treatment. In some cases of feeding disorders it is necessary to involve child psychiatrist intervention. This indication depends of child characteristics (medical and psychiatric diagnosis, failure to thrive, psycho-affective development) and also of family functioning and parental psychopathology.

[Dangerous games in schoolchildren]. / Jeux dangereux chez l'enfant d'âge scolaire.

Dangerous games inside or outside school are a serious social phenomenon, but unfortunately underrecognized. Aggressive games are a part of school bullying, which is in expansion. Choking games are very dangerous, with many deaths or serious neurologic complications. Pediatricians should be knowledgeable about risky behaviors encountered by their patients, and provide guidance about its dangers.

[Off-label use of psychotropic medications in pediatric wards: a prospective study]. / Utilisation hors autorisation de mise sur le marché (AMM) des psychotropes en pédiatrie: une étude prospective.

PURPOSE: The aim of this study was to investigate the use of psychotropic medications for both labeled and off-labeled indications in a French paediatric teaching hospital. METHODS: A prospective analysis of all psychotropic drug prescriptions was conducted during a 6-month interval. Details were recorded from the computerized prescription order entry system. They included demographic data (sex, age and weight) and psychotropic medications (name, dosage, schedule, route of administration and indication). The physicians specified the indication when prescribing the psychotropic medication. All prescriptions were assessed for off-label use. Off-label prescriptions were defined as: use of a different dose or dose schedule, use for an indication not included in the license or approved for adults only, drug use outside the age range of the product license, use of medicines for which no paediatric information was available, use when the product was contraindicated, use of drug preparations that were manufactured by the hospital pharmacy, use of licensed drugs that were modified by the hospital pharmacy and use of new drugs available under a special manufacturing license. Each prescription was compared with data available in the National French Formulary. RESULTS: A total of 1629 drug prescriptions were written for 472 patients. Sixty-eight percent of all drug prescriptions were for off-label uses: indication not included in the license or approved for adults only in 40%, no paediatric information available in 37%, different dose or dose schedule in 7%, licensed drugs that were modified by the hospital pharmacy in 5%, administration to children outside the age range of the product license in 4%, drug preparations that were manufactured by the hospital pharmacy in 4%, contraindication in 2% and new drugs available under a special manufacturing license in 1%. Sixty-six percent of the patients were prescribed a psychotropic drug in an off-label manner. Over half of the off-label prescriptions were given to adolescents (62%), followed by children (29%), infants (8%) and neonates (1%). The percentage of off-label prescriptions by age was: neonates 91%; adolescents 74%; children 59% and infants 58%. The percentage of off-label prescriptions by medication class are presented in decreasing order of prescription frequency: anxiolytics 65%; antipsychotics 69%; antidepressants 92%; antiepileptics 51%; stimulants 30%; antiparkinsonians 100% and hypnotics 100%. The 5 drugs most commonly prescribed off label were risperidone (12%), clobazam (12%), amitriptyline (11%), hydroxyzine (10%) and diazepam (7%). Nearly half (47%) of all off-label prescriptions were associated with 3 indications: anxiety (24%), disruptive behaviour (12%) and pain (11%). CONCLUSION: The high rates of off-label prescription documented here and elsewhere highlight the need for further controlled clinical trials to evaluate the risks and benefits of psychotropic medication in children and adolescents.

[What's new about hyperactivity disorder in children?]. / Quoi de neuf dans le traitement de l'enfant hyperactif ?

This article presents a review of the treatments for children suffering from attention deficit hyperactivity available in France. Multimodal treatment of French hyperactive child includes psycho stimulant medication (short and long acting methylphenidate) and parent training, speech therapy, psychomotor therapy and academic training.

[Psychopathology of children reared in lesbian families: literature review]. / Psychopathologie des enfants élevés en milieu homoparental lesbien: revue de la littérature.

For several years, a growing number of children raised in lesbian families have been noticed. Even if this number is not really known, it appears clearly that more and more psychiatrists will have to care for children which will present this family configuration. The problem then is to know if this type of education has an incident on the psychopathology of children or not. The purpose of this article is not to give answer or to take side but just to help physicians to make a point of what is known about this subject in international literature.

[Münchhausen syndrome by proxy]. / Syndrome de Münchhausen par procuration.

Münchhausen syndrome by proxy is a factitious disorder, a disease produced or simulated by a parent, the mother in most cases. Clinical presentation is miscellaneous (factitious bleeding, epilepsy, apnea are frequent) and unusual. Physicians participate in the abuse by their therapeutic and diagnostical measures. It is very important to think about this diagnostic in any ambiguous situation in order to evaluate and protect the child.

[Comparison of feeding behaviors in mothers of infants and young children from 0 to 36 months old]. / Comportement alimentaire des nourrissons et jeunes enfants de 0 à 36 mois : comparaison des habitudes des mères.

This article shows the second part of results from the "Behaviour" chapter of fourth edition of Feeding in French infants and young children Survey conducted by SFAE, in 2005, concerning mothers of 713 infants and young children from the age of 1 to 36 months. This survey, conducted every 8 years since 1981, shows that feeding behaviour of young children has improved, especially since 1997, with meals taken in family, postponement of diversification. It confirms that mothers need counselling for feeding their child, and especially from the medical profession. On the other hand, the transition to adult feeding is too fast since 1 year old; an early introduction of certain food as French fries, and cooked pork meat, early television viewing, a lack of sports are observed.

[Evolution of feeding behavior in mothers of infants and young children from 1 to 36 months old in France]. / Conduite alimentaire des nourrissons et jeunes enfants âgés de 1 à 36 mois en France: évolution des habitudes des mères.

The SFAE conducts every eight years since 1981 a national survey on feeding behavior and consumption in children under 3 years old. In 2005, the authors noticed a great improvement of milk feeding behaviour in infants compared to 1982, 1989, and 1997. Infant formulas get more importance compared to cow milk before the age of 1 year, and growth milk takes more and more cow milk's place since 13-18 months old. Feeding diversification is postponed between 5 and 6 months old.

[Medical treatments of hyperactive child: about the new pharmaceutical forms of methylphenidate marketed in France]. / Traitements médicaux de l'enfant hyperactif: à propos des deux nouvelles formes de méthylphénidate commercialisées en France.

Multimodal treatment of hyperactive child includes psychostimulant medication, methylphenidate (MPH) marketed in France in its short-acting form since about ten years. We report our clinical experience about the first fifty methylphenidate responders who received one of the two sustained-release forms available since summer 2004, tablets of oros-methyphenidate (Concerta LP) or microgranule-filled capsules (Ritaline LP).

[Medical treatments of hyperactive child]. / Les traitements médicaux de l'enfant hyperactif.

Treatment of hyperactive child is multimodal, a combination of behaviour therapy and medication. Stimulant drugs are the most often prescribed medications. In France, we use methylphenidate (Ritaline); its efficacy was demonstrated with mild side effects. New formulations of methylphenidate with prolonged action, and non-psychostimulant treatment (atomoxetine) are available in some countries, but not yet in France.