The impact of age, disease severity, and BMI on bone health and growth in children and young people with Crohn's disease.

Objectives: The objective of this study was to explore the correlation between paediatric Crohn's disease (CD) characteristics, bone health and growth parameters at diagnosis and follow-up. Methods: Retrospective data was collected for 47 children aged 4-16 who were newly diagnosed with CD between January 2018 and December 2019. Mean follow-up time was 2.5 years. Results: Eleven (24%) children had growth delay at diagnosis, which persisted in 4 (44%) of 9 recorded children at follow-up. Of the 35 children tested, 20 (57%) had inadequate Vitamin D levels (<50 mmol/L) at diagnosis. Thirty-seven (79%) children had a dual-energy X-ray absorptiometry scan at diagnosis, with 20 of them having at least 1 low Z-score. Children with poorer bone mineral density and bone mineral concentration Z-scores for age had a younger age at diagnosis (p = .042 and p = .021), more severe disease (p = .04 and p = .029) and a lower BMI (p < .001) at diagnosis. Children diagnosed with CD ≥11 years had a lower-than-expected height velocity (p < .0001 and p < .001). Multivariate regression analysis demonstrated an older age of diagnosis was a significant predictor of a lower height velocity at follow-up. Conclusion: Disease severity and age of diagnosis are important CD-related factors that influence bone health and growth. Vitamin D is an accessible component that if optimised can improve all three factors. Monitoring and optimising each aspect systematically has the potential to enable children to achieve their bone health and growth potentials.

Paediatric shadowing: a student-led initiative to increase medical student interest in paediatric careers.

INTRODUCTION: Clinical exposure to paediatrics increases student interest in the specialty. However, the paediatric placement is relatively short and usually falls towards the end of medical school in the UK. A student-led shadowing scheme was developed to provide opportunities for medical students, including those at an early stage, to experience clinical paediatrics. METHODS: Paediatric society members could apply for a shadowing day in the scheme run in 2022 and 2023. Feedback was collected following the day. Free text answers on learning points and the impact of shadowing on views of paediatrics were analysed using a framework approach. Knowledge of the role of a paediatrician and consideration of a career in paediatrics were rated on a 5-point Likert scale before and after the shadowing day. RESULTS: 66 and 37 students completed shadowing days in cycles 1 and 2, respectively. Students' knowledge of the role of the paediatrician and consideration of a career in paediatrics increased significantly after the shadowing scheme. The key themes that participating year 1-2 students gained from the scheme were: increased interest in paediatrics, increased knowledge about the specialty, challenges and decision-making in paediatrics, variety within paediatrics, communication skills, working with families, improving practical skills and some overwhelming first clinical experiences. DISCUSSION: A student-run shadowing scheme is a novel and sustainable way to provide early exposure to paediatrics in medical school. This will help to develop interest in paediatrics from the start of medical school, as clinical exposure is a key factor in choosing paediatrics once qualified.