tubes (NGT) due to sensory processing difficulties. Despite reinsertions under general anaesthesia, he would remove them as soon as he woke up.Due to potential metabolic risks, he was transferred to intensive care (PICU) to be managed under sedation for a period of time. Low dose antipsychotic medication was started, to manage procedure-related agitation that worsened rumination. He learnt to tolerate the NGT upon gradual weaning of sedation. The severity of rumination improved and his weight stabilised. He was transferred back to his local hospital on a weaning sedation plan. However, rumination recurred with discontinuation of his medications.He was readmitted to PICU and rumination was re-stabilised under IV sedation. Following multidisciplinary team discussion (involving liaison psychiatry, general paediatrics, intensive care, gastroenterology and surgery) a gastrostomy was placed to break the cycle. Eight weeks on parenteral nutrition and gastrostomy feeds gave his upper gastrointestinal tract time to recover. He is currently feeding orally with minimal rumination. The gastrostomy is being used for medications and fluids. He has returned to his premorbid level of functioning, and his weight is stable. Conclusion Gastrostomies have been used in children with intellectual disability and 'avoidant and restrictive food intake disorder' linked to autism. This case, however, presented additional challenges due to the severity of rumination with sensory processing difficulties, and tested the ethical limits of intensive care. Management in these cases must be multidisciplinary, with the adolescent's best interests at the centre of decision-making.Background NICE has produced recent guidelines for the management of Cerebral Palsy in the under 25 s. It recommends every 'child or young person and their parents or carers [should be] provided with information, by a professional with appropriate expertise, about fertility and contraception, sex and sexuality, parenting and menstruation relevant to them that is tailored to their individual needs. Aim To audit our practice according to the NICE guidelines. To determine whether young people with Cerebral Palsy and their families are being provided with this information and whether they would want further information related to their sexual and reproductive health. Method A survey was sent to all young people older than 11 years seen in our hospital's movement disorder clinic. The survey asked whether, in a healthcare setting, they had been spoken to about their sexual and reproductive health. The survey also asked whether the young people and their families would find an information leaflet on these topics useful. Results Forty-two young people were identified to fulfil the criteria, with GMFCS ranging I-V. 40% of questionnaires were completed. Only two respondents (12%) had been asked about some aspect of their sexual or reproductive health in a
The vulnerability of children with disabilities to human rights abuses, including in health care, is well documented. Medical professionals can too often breach rather than fulfil the rights of children with disabilities, often through misunderstandings about the law, an inevitable consequence of, as identified by the United Nation's Committee for the Rights of the Child, medical professionals too often not receiving systematic and effective training in children's rights. This paper explores some key rights vital to the health and well‐being of children with disabilities and shows how the guidance known as General Comments published by the United Nation's Committee on the Rights of the Child can assist medical professionals in ensuring the rights of children with disabilities in their care are fulfilled. It will also outline the human rights model of disability and explain how adopting this model in day‐to‐day practice, as required by international law, will empower medical professionals to help fulfil the human rights of children with disabilities. Suggestions are also made as to how training in human rights for medical professionals might be facilitated.
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