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A programme of universal rather than targeted Healthy Start vitamin D supplementation for pregnant and lactating women and young children has led to a substantial decrease in cases of symptomatic vitamin D deficiency in a high-risk population. Supplementation was also started at a younger age than in the national programme. This approach has implications for the delivery of vitamin D supplementation programmes in similar populations.

ObjectivesTo determine any change in referral patterns and outcomes in children (0–18) referred for child protection medical examination (CPME) during the COVID-19 pandemic compared with previous years.DesignRetrospective observational study, analysing routinely collected clinical data from CPME reports in a rapid response to the pandemic lockdown.SettingBirmingham Community Healthcare NHS Trust, which provides all routine CPME for Birmingham, England, population 1.1 million including 288 000 children.ParticipantsChildren aged under 18 years attending CPME during an 18-week period from late February to late June during the years 2018–2020.Main outcome measuresNumbers of referrals, source of disclosure and outcomes from CPME.ResultsThere were 78 CPME referrals in 2018, 75 in 2019 and 47 in 2020, this was a 39.7% (95% CI 12.4% to 59.0%) reduction in referrals from 2018 to 2020, and a 37.3% (95% CI 8.6% to 57.4%) reduction from 2019 to 2020. There were fewer CPME referrals initiated by school staff in 2020, 12 (26%) compared with 36 (47%) and 38 (52%) in 2018 and 2019, respectively. In all years 75.9% of children were known to social care prior to CPME, and 94% of CPME concluded that there were significant safeguarding concerns.ConclusionsSchool closure due to COVID-19 may have harmed children as child abuse has remained hidden. There needs to be either mandatory attendance at schools in future or viable alternatives found. There may be a significant increase in safeguarding referrals when schools fully reopen as children disclose the abuse they have experienced at home.

The occurrence of non-epileptic hyperkinetic movements in the context of developmental epileptic encephalopathies is an increasingly recognized phenomenon. Identification of causative mutations provides an important insight into common pathogenic mechanisms that cause both seizures and abnormal motor control. We report bi-allelic loss-of-function CACNA1B variants in six children from three unrelated families whose affected members present with a complex and progressive neurological syndrome. All affected individuals presented with epileptic encephalopathy, severe neurodevelopmental delay (often with regression), and a hyperkinetic movement disorder. Additional neurological features included postnatal microcephaly and hypotonia. Five children died in childhood or adolescence (mean age of death: 9 years), mainly as a result of secondary respiratory complications. CACNA1B encodes the pore-forming subunit of the presynaptic neuronal voltage-gated calcium channel Ca v 2.2/N-type, crucial for SNARE-mediated neurotransmission, particularly in the early postnatal period. Bi-allelic loss-of-function variants in CACNA1B are predicted to cause disruption of Ca 2þ influx, leading to impaired synaptic neurotransmission. The resultant effect on neuronal function is likely to be important in the development of involuntary movements and epilepsy. Overall, our findings provide further evidence for the key role of Ca v 2.2 in normal human neurodevelopment.

Objectives: In line with a national policy to move care 'closer-to-home', a specialist children's hospital in the National Health Service in England introduced consultant-led 'satellite' clinics to two community settings for general paediatric outpatient services.Objectives were to reduce non-attendance at appointments by providing care in more accessible locations, and to create new physical clinic capacity. This study evaluated these satellite clinics to inform further development and identify lessons for stakeholders.Methods: Impact of the satellite clinics was assessed by comparing community versus hospital-based clinics across the following measures 1) non-attendance rates and associated factors (including patient characteristics and travel distance) using a logistic regression model; 2) percentage of appointments booked within local catchment area; 3) contribution to total clinic capacity; 4) time allocated to clinics and appointments; 5) clinic efficiency, defined as the ratio of income to staff-related costs.Results: Satellite clinics did not increase attendance beyond their contributing to shorter travel distance, which was associated with higher attendance. Children living in the mostdeprived areas were 1.8 times more likely to miss appointments compared with those from least-deprived quartile. The satellite clinics' contribution to activity in catchment areas and to total capacity was small. However, one of the two satellite clinics was efficient compared with most hospital-based clinics.Conclusions: Outpatient clinics were relocated in pragmatically chosen community settings using a "drag and drop" service model. Such clinics have potential to improve access to specialist paediatric healthcare, but do not provide a panacea. Work is required to improve attendance as part of wider efforts to support vulnerable families. Satellite clinics highlight how improved management could contribute to better use of existing capacity.

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SUMMARYA case is described of near fatal aspiration of a child's dummy. This caused extensive injuries to the mouth and pharynx and acute respiratory embarrassment necessitating admission to a paediatric intensive care unit, and multi-disciplinary assessment. A design fault in the dummy is discussed, and it is recommended that the British Standards specification for dummies be changed. Finally, the issue of non-accidental injury is discussed, with the suggestion that injuries to the soft tissues of the mouth and pharynx be treated with the same degree of suspicion as any other childhood injury.