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Abstract To engender safer medication practice the Government of Canada encourages families to, “Ask your doctor about your child’s medication.” Medicines for Children (MFC) was established in 2006 when the U.K.’s Royal College of Paediatrics and Child Health (RCPCH), Wellchild charity, and the Neonatal and Paediatric Pharmacy Group (NPPG) listened to parents’ concerns that they needed better information on children’s medicines. Each one of the >200 information sheets available on the website has gone through a standardized, audited development. When launched in 2009 there were 10,500 hits by 7000 unique users which has grown to 4.5 million hits from 3.6 million individuals in 2022. Although the UK has the largest number of users; its worldwide importance is demonstrated by the fact that there are 430,000 users in Canada. For parents of a child who needs to take medicines safely, MFC provides high-quality, reliable family-centred information accessible 24/7 across the globe.

The NHS recommends that children aged 4 years and below avoid any food and beverages with added sugar.1 We audited against this with a survey. This study aimed to evaluate parental awareness on added sugar intake during complementary feeding. A survey was created with 21 questions covering the child’s demographics, advice parents were given, their source of information, importance of minimising sugar to parents, use of store-bought baby food, identifying food with added sugar, and dental questions. A pilot survey was done with five parents to achieve clarity. 128 parents with children under 5 years old were approached, of these 12 declined, 15 did not complete the survey and one could not speak fluent English. Of the remaining 100 children:•50 were boys and 50 were girls.•38% of the children were the first child.•The age groups were as follows: under 1 year old (21%), 1-year old (20%), 2-years old (19%), 3-years old (22%) and 4-years old (18%).•33% were breast fed, 33% were formula fed, 32% combination fed and 2% fed using selected other methods.•Most parents (80%) were given advice on when to start complementary feeding.•63% of the parents followed the recommended age to start complementary feeding, which is 6-months old;•31% did it earlier than the recommended age, whereas 6% did it later;•77% of the parents followed the advice given to them on the time to start complementary feeding•Only 25% of parents said they had all the information needed about complementary feeding.•The main sources of information about complementary feeding were: 4% doctor; 55% health visitor; 22% websites and online resources; 2% social media; 4% friends and relatives; 13% other•Most parents (81%) considered minimising sugar intake when introducing solids.•43% of parents said reducing sugar intake was a very important factor to them;•90% of parents said they were aware of ‘added sugar’ and that they should avoid it during complementary feeding;•Most parents described added sugar as ‘extra artificial sugar not originally present in food’;•Some parents (14%) used store-bought baby food on a daily basis, while 33% used it few times a week. Most parents failed to identify the products with added sugar (Fig 1). 70% of parents were aware that they should start brushing their child’s teeth as soon as the first tooth had erupted. For the 60% of children who had had their dental check-up, 78% of them had it when they were 1 year old and below. •Parents with multiple children have better complementary feeding knowledge;•Most parents claimed to know what added sugar is and to avoid it when complementary feeding; however, most were unable to recognise products with added sugar;•Parents had a wide variety of sources of information about complementary feeding;•Most parents had a general understanding of added sugar.

BackgroundAnaphylaxis is a severe life-threatening allergic reaction; the treatment of choice is adrenaline(epinephrine). The most common UK adrenaline auto-injector is the EpiPen. Primary school children (under 11 years) will have this administered by a parent/carer or teacher if in school. Secondary school aged children (11–18) are supposed to carry their EpiPens themselves for self-administration, however many do not.ObjectivesPilot survey exploring the reasons that secondary school aged children do not carry their EpiPens and rating suggestions for how to improve this.MethodsA questionnaire was devised exploring these issues asking:Do they have an EpiPen?Their knowledge of EpiPens? (sliding bar range: 0 bad to 10 good)Were they concerned about adolescents not carrying their EpiPens?Which of the following did they think were factors for teenagers not carrying their EpiPens? (Multiple responses accepted).Nowhere to put themForgottenExpiredDon’t expect them to be neededDon’t realise they have toOther (asked to specify)Rate the following in effectiveness to increase teenagers carrying EpiPens; Smaller Pens; Better education; Better ways to carry them(Likert scale: 1 not good to 5 ideal).The questionnaire was approved by the school as part of a sixth form Welsh Baccalaureate project. It was sent digitally as a convenience sample to members of the sixth form, Girl Guides and an adult from each family to complete via SurveyMonkey®. Comparative statistical tests comparing adults and teenagers results were performed(p<0.05 taken as significant).ResultsThe survey was sent to 82 teenagers; there were 61 respondents, 35 teenagers and 26 adults.Q1) Only 2 children had EpiPens.Q2) EpiPen knowledge: Overall mean score4.4 (SD 2.8). Teenagers mean 4.0 (SD 2.5): adults mean 5.0 (SD 3.1): students t-test t-value 1.43 p=0.079.Q3) Concerned about EpiPen carriage: Overall yes 47(77.1%), no 3(4.9%), don’t know 11(18.0%). Teenagers yes 30(85.7%), no 1(2.9%), don’t know 4(11.4%): adults yes 17(65.4%), no 2(7.7%), don’t know 7(26.9%). Chi-square1.1132 p=0.29.Q4) Factors for teenagers not carrying their EpiPens n(%) Nowhere to put them 27(44%) Forgotten 37(61%) Expired 7(11%) Not expected to be needed 45(74%) Don’t realise they have to 17(28%) Other 9(15%) Q5) Methods to improve carriage Mean rating(1–5) Mann-Whitney U value P value Overall score Adults Teenagers Smaller Pens 3.5 3.6 3.5 418.5 0.84 Better education 4.1 3.9 4.3 359.0 0.24 Better ways to carry them 3.7 3.6 3.9 376.5 0.36 ConclusionsThere was a wide range of self-reported knowledge scores about EpiPens and most respondents were concerned that EpiPens were often not carried. They felt the reasons for this included; not expecting them to be needed, forgetting them and not having anywhere to carry them due to their size. Almost all respondents felt that education and an improved, smaller design for both EpiPens and their carrycases would increase carriage rates. In this pilot survey no differences between adults and children were demonstrated.Sixth form student projects may enable teenagers’ perspectives on medical topics to be assessed through a non-threatening peer evaluation. Post-Covid this peer based digital technique may warrant further exploration.

ObjectiveTo investigate awareness and implementation of the Spare Pens (ie, adrenaline auto-injectors (AAIs)) scheme in primary and secondary schools in two regions in Wales.DesignA cross-sectional pilot study employing a mixed research methods approach was carried out.Setting and participantsState primary and secondary schools within Swansea and Pembrokeshire regional authorities were invited to take part. For geographical context, Swansea is the second largest city in Wales and is situated in the southwest of the country. Pembrokeshire is located in West Wales, with a large rural population outside of its main towns.Main outcome measuresAwareness and implementation of the Spare Pens in Schools scheme. Additionally, compliance with national guidance was measured by administering a questionnaire capturing data on registers, procedures, storage and training in the use of AAIs.Results35 schools (30 primary, 5 secondary) participated, with 11% and 6% reporting awareness and implementation of the scheme, respectively. No significant differences in awareness or implementation of the scheme were revealed for school type or region. Secondary schools reportedly stored more AAI devices compared with primary schools. The location of stored AAIs varied by school type, with 46.7% of primary schools storing AAIs in the classroom while 80% of secondary schools stored AAIs in the school office. Procedures for accessing AAI training differed, with 83% of primary schools receiving training by school nurses and 60% of secondary schools accessing training via an allergy team.ConclusionsThe overall poor awareness of the Spare Pens in Schools scheme has resulted in a worrying lack of implementation of generic AAI devices. An urgent review of information dissemination regarding the scheme is required.

ObjectivesTo estimate the incidence, characteristics and outcomes of 10-fold or greater or a tenth or less medication errors in children aged <16 years in Wales.DesignPopulation-based surveillance study July 2017 to June 2019. Cases were identified by paediatricians and hospital pharmacists using monthly electronic Welsh Paediatric Surveillance Unit (WPSU) reporting system.Patients‘Definite’ incident occurred when children received all or any of the incorrect dose of medication. ‘Near miss’ was where the prescribed, prepared or dispensed medication was not administered to the child.Main outcome measuresIncidence, patient characteristics, setting, drug characteristics, outcome, harm and enabling or preventive factors.ResultsIn total, 50 10-fold errors were reported; 20 definite and 30 near miss cases. This yields a minimum annual incidence of 1 per 3797 admissions, or 4.6/100 000 children. Of these, 43 were overdoses and 7 underdoses. 33 incidents occurred in children <5 years of age. Overall, 37 different medications were involved with the majority, 31 cases, being administered enterally. Of these 31 enteral medication errors, all definite cases (10) had received liquid preparations. Temporary harm occurred in 5/20 (25%) definite cases with one requiring intensive care; all fully recovered.ConclusionsIn this first ever population surveillance study in a high-resource healthcare system, 10-fold errors in children were rare, sometimes prevented and uncommonly caused harm. We recommend country-wide improvements be made to reduce iatrogenic harm. Understanding the enabling and preventive factors may help national improvement strategies to reduce these errors.

ObjectiveTo examine if the weight of a child determines adverse events following oral antibiotics prescription.DesignPopulation respective cohort using linked general practice (GP), hospital data and linkage with the Welsh Demographic Service for demographic information. Data linkage was performed using Wales health data, extracted from the SAIL (Secure Anonymised Information Linkage) databank.InclusionChildren (0–12 years) prescribed oral antibiotics by their GP in Wales.ExposureAntibiotic prescription (penicillins, cephalosporins, macrolides, dihydropyrimidines, nitroimidazoles, nitrofurans, lincosamides).OutcomeAdverse event as defined by; patients’ death within 5 days, records of emergency admission within 5 days and GP records of adverse drug reactions or prescription of another antibiotic within 14 days.AnalysisLogistic regression of adverse events versus no adverse events at follow-up time.ResultsThere were 139 571 prescriptions of the selected antibiotics and 71 541 children (51.39% male) included with follow-up data of which there were 25 445 (18.23% of all prescriptions) children experienced adverse outcomes. There was higher odds of adverse events for lower weight children and those who were younger, female, of Asian origin or deprived.ConclusionThe findings support the hypothesis that smaller children for their age (eg, low weight, female, Asian) are more likely to experience adverse events following antibiotics prescription. This work suggests child weight, in addition to age, should be used when prescribing antibiotics to children in primary care.

AimsTo establish the incidence and characteristics of tenfold or greater and a tenth or less medication errors in children <16 years in Wales to help inform patient safety on a population level.MethodPopulation-based incidence study in Wales, UK, from June 2017 - May 2019 (24 months). Cases were reported from paediatricians and hospital pharmacists using the monthly Welsh Paediatric Surveillance Unit (WPSU).Results46 confirmed incidents in 44 children from 63 notifications were identified. Cases came from 8 hospitals in Wales with 29 (63%) from the sole tertiary hospital. Median age was 1.7 (range 1 week to 15) years and weight 10 kg (0.6 to 59).39 (85%) were overdosing (up to 1000x fold error) and 7 underdosing. 40 different medications were involved, 16 (37%) intravenous. Of 29 cases involving enteral medication, 26 (90%) were liquid formulations. Three cases were discharge medication prescribed or dispensed incorrectly and administrated at home. Stage of errors were primarily in prescribing 37 (80%), administration 7 (16%) and dispensing 2 (4%).18 (42%) cases reached the patient, 10 from prescribing. Seven cases were spotted after multiple doses were given. Six errors resulted in harm, three which required intensive care treatment. No deaths or permanent disabilities were reported. Half (23/46) of all errors reported and two-thirds (12/18) of cases that reached the child occurred in <10 kg children.Several human factor themes were identified: Prescribing confusion between gram milligram and microgram (none reached patient, n=7), confusing between mg and mg/kg (n=6 including 3 underdosing errors), leading zero errors (e.g. 0.1 vs 0.001 mg, n=6) and prescribing reconciliation errors where admitting doctor attempted to prescribe chronic medication in mg by reversing calculating liquid dosage expressed in mL (n=4).During this study period 164,000 hospital admissions occurred in children <16 years in Wales. Our data estimates a tenfold error incidence of 1:3600 paediatric admissions, with drug reaching the child in 1:9000 admissions.ConclusionIn this unique first ever population surveillance study, tenfold errors in children occurred at every stage of medication process and in the full range of care settings. Errors found were very different from those obtained from tertiary hospital single centre study and UK National Reporting and Learning System (NRLS). Strategies for error reduction will be more productive if designed across a whole national healthcare system.