Background
Emerging evidence suggests that infants who experience significant illness or trauma during the neonatal period—yet do not meet current criteria for high-risk neurodevelopmental follow-up—may also be vulnerable to atypical neurodevelopmental trajectories.
A local audit of children referred for Community Paediatric Assessment with Development Delay showed that approximately 1/3 had a neonatal admission following birth.

Aim
In response, a pilot EiSMART Pathway for infants under 12 months with developmental concerns and an ‘at risk’ neonatal history, was developed to provide timely transdisciplinary assessment and intervention during this critical window of neuroplasticity in early development.

Method
Families received an initial neurodevelopmental assessment with an Occupational Therapists and Physiotherapist, and up to 4 individualised intervention sessions. Outcomes were collected for 1. Parental ratings, using a Likert Scale, of the improvement in their infant’s development, and 2. The need for ongoing neurodevelopmental therapy.

Results
Parental feedback highlighted increased confidence and described the clinics as both practically valuable & emotionally supportive.
Outcomes also showed that almost half of the participating infants were discharged from further neurodevelopmental intervention at this time.

Conclusion
The Ei SMART clinic provided valuable targeted support to families of infants with neurodevelopmental concerns following an atypical neonatal course. This audit indicates the need for further research into the long-term outcomes of specialist neurodevelopmental assessment and transdisciplinary intervention at the earliest opportunity

Introduction: This study compared the accuracy and readability of responses generated by different artificial intelligence (AI) chatbots with recommendations from clinical practice guidelines (CPGs) on motor rehabilitation for children and adolescents with cerebral palsy (CP).
Participants and methods: This cross-sectional study analyzed responses to ten questions derived from three clinical practice guidelines written in Brazilian Portuguese addressing motor rehabilitation in CP. The same questions were submitted to ChatGPT, DeepSeek and Gemini. Responses were assessed for accuracy, readability, and the presence of health-related disclaimers. Accuracy was rated by three independent reviewers using a 6-point Likert scale (1 = completely incorrect, 6 = completely correct) according to CPG alignment. Readability was measured using the Flesch-Kincaid Grade Level, Flesch Reading Ease, and Gunning Fog Index.
Results: Mean accuracy of ChatGPT 4.0, Gemini and DeepSeek were 4.03 (95% CI: 3.55–4.55), 3.80 (95% CI: 3.24–4.35), and 3.73 (95% CI: 3.12–4.33) respectively, with no significant differences among chatbots. Health-related disclaimers appeared in 36% of responses, predominantly from DeepSeek (n=6; 60%). Overall, chatbots provided answers that were ‘average readability’, with a mean of readability of Flesch-Kincaid grade level 13.72 (95% CI: 13.48–13.95), Flesch reading ease 30.15 (95% CI: 29.13–31.16) and Gunning fog index 12.66 (95% CI: 12.64–13.03).
Conclusion: Although chatbot responses moderately aligned with CPGs, their limited accuracy and complex readability may restrict accessibility for families seeking trustworthy rehabilitation information. These findings underscore the physiotherapist’s role in guiding families toward evidence-based resources and critically interpreting AI-generated health content.

Medicine errors are a leading cause of avoidable harm globally. Errors occur at any stage of the medicine process including transcribing: ‘the copying of previously prescribed medicines details to enable their administration’. Once ‘unsafe and unprofessional practice’ only undertaken in exceptional circumstances, transcribing is now an essential task in many community, residential and education settings. Since dedicated guidance is lacking, a framework was established to guide transcribing of large volumes of medicine for children and young people (CYP) with physical disabilities in a residential school and college. The framework incorporates competent transcribers, standardised wording, triangulation of approved evidence and person-centred care.

Annually, over 300,000 prescribed items are administered to our cohort (66% have cerebral palsy; 39% epilepsy; 42% have a gastrostomy) for symptom management (constipation, pain, respiratory difficulties and seizure prevention etc). The framework was evaluated over 4 years: outcomes were measured in terms of medicine errors and qualitative data from satisfaction surveys. This QI initiative is reported using SQUIRE 2:0.

Over this period, medicine errors reaching CYP reduced from 0.13% of total medicines administered, to 0.08%. Over 97% of parents were satisfied staff met their student’s health needs ‘all or most of the time’. 93% of students liked how staff help with their medicines (question tailored to educational level).

Evaluation of the framework indicates a reduction in severity of medicine errors and high levels of satisfaction. This framework may support out of hospital settings to transcribe in a standardised manner facilitating safe administration and person-centred care for CYP.

Introduction
Children and adolescents with cerebral palsy (CP) more often have mental health problems including emotional and behavioural difficulties. Our aim was to explore how common mental health problems were in a population-based group of children with CP and explore associations with communication and motor function and CP type.

Participants and methods
In a study from the CP Register of western Sweden, 232 children, born 1999-2006,
were assessed regarding neuropsychiatric disorders, including the well-established Strengths and Difficulties Questionnaire (SDQ) filled by the parents. All 25 items were completed for 185 children (101 boys, 84 girls; median age 13y, range 9-17y). These were analysed using proposed cut points for possible difficulties.

Results
A total difficulties score of at least 14 indicating possible mental health problems were found in 67 of the 185 children (36%). Indicated difficulties were more common in children with communication restricted to familiar partners (Communication Function Classification System, CFCS, level III-V, p=0.012), but not regarding speech (Viking Speech Scale, p=0.32). No associations were found with level of motor impairment, but indicated difficulties were more common in children with ataxic CP (p=0.022). Children at CFCS level III-V had problems regarding conduct and hyperactivity, while children with ataxic CP more often had peer problems.

Conclusion
Children with CP and communication impairment are at increased risk of developing mental health issues. No association with motor function was found. However, children with ataxic CP are in need of extra attention. Supporting children with communication impairment may reduce future mental health problems.

Background:
Children with spina bifida are at increased risk of vitamin D deficiency and pathological fractures, compounded by comorbidities and medications. International guidelines recommend opportunistic vitamin D testing during routine blood work to identify and treat deficiency, yet this is inconsistently applied. No published studies report outcomes from this approach.

Aim:
To evaluate whether vitamin D levels were measured in line with guidelines, determine prevalence of abnormal results, assess clinical interventions, and identify opportunities to improve care and cost-effectiveness.

Methods:
A quality improvement project using three PDSA cycles:
Audit (March–July 2024): Review of vitamin D testing, supplementation, and dietetic input for patients attending the spina bifida clinic.
Intervention (January 2025): Education session for the multidisciplinary team and introduction of opportunistic vitamin D testing alongside routine bloods (from March 2025).
Re-audit (March–July 2025): Assessment of uptake and clinical outcomes following implementation.

Results:
The initial audit showed 11 patients had bloods taken; none had vitamin D measured.

The re-audit showed 15 patients had bloods taken with 14/15 (93%) having vitamin D tested. Vitamin D status was classified as sufficient 9/14 (64%), insufficient 2/14 (14%), deficient 1/14 (7%), raised 2/14 (14%). Five patients (36%) required changes to supplementation, including initiation, dose adjustments, and adherence assessment.

Conclusion:
Opportunistic vitamin D testing markedly improved compliance with guidelines. Over one-third of patients required management changes, demonstrating clinical value. Future PDSA cycles will embed this approach in additional settings, including inpatient admissions, to ensure consistent identification and treatment of vitamin D deficiency in children with spina bifida.

Individuals with cerebral palsy (CP) often present with cognitive difficulties; however, cognitive assessment is particularly challenging due to motor and sensory limitations that interfere with standardized testing procedures. This study aimed to determine whether the literature: 1) provides sufficient data to identify the instruments used for cognitive assessment of individuals with CP according to functional severity levels, and 2) reports the adaptations made or the reasons for missing use of these instruments.

A literature search was conducted across six databases: PubMed, PsycINFO, CINAHL, ERIC, WOS, and CENTRAL. Original studies were included if they met the following criteria: published from 2010 onwards, involved participants with CP, included standardized cognitive assessments, and considered cognitive functioning as a central focus.

Across the 320 included studies, 206 instruments were used for cognitive assessment. Reporting of functional scales administered to the individuals was inconsistent: 70.6% of studies reported the GMFCS, 30.6% the MACS, 9.4% the CFCS, 5.0% the BFMF, and 5.0% the VSS. Other scales, such as the VFCS, were not reported in any study. Only 18.1% described adaptations, which mainly concerned test presentation, response, and setting. Missing data was inferred in 25.3% of studies, with motor ability (13.6%), intelligence (12.7%), expressive language (10.0%), and visual perception (9.1%) being common reasons.

Current literature provides substantial information on certain functional scales, particularly the GMFCS; however, reporting of other scales, adaptations, and missing data remains limited. Comprehensive reporting is essential to enhance understanding and support the development of cognitive assessment guidelines tailored to the heterogeneity of CP.

Background: Families of children with Autism Spectrum Disorder (ASD) in Ukraine face significant challenges in accessing evidence-based, family-centered care. The WHO CST program is a scalable intervention designed to empower caregivers. This study aims to describe the baseline clinical, functional, and social characteristics of the initial cohort in a trial of the WHO CST in Ukraine.

Participants and methods: We analyzed baseline data from an ongoing implementation-effectiveness study of 48 families. Data included caregiver-reported demographics, service utilization questionnaires, and standardized tools (PEDI, PSS, BPSS, Peds-QL, CBCL). Data were analyzed using descriptive statistics and Spearman correlations.

Results: Children (M=3.9y, SD=1.0) presented with severe functional (PEDI- Social function Median=10.45, IQR: 10–19.8, n=40) and behavioral (CBCL-Total T-score M=68.5, SD=9.7) needs. Caregivers reported moderate stress (PSS M=48.4, SD=10.9, n=26), comparable to global findings. Parental stress was not significantly correlated with child factors but was strongly correlated with parental self-efficacy (Spearman's r = -0.59, 95% CI [-0.79, -0.27], p = 0.001, n=27). 17.02% of families were IDPs

Conclusion: These preliminary findings describe parents of children with severe needs. The data suggests that parental stress level, despite the war, comparable to global findings, is strongly correlated with parental self-efficacy, rather than child-specific factors. This highlights the urgent need for interventions like the WHO CST that directly empower caregivers within Ukraine's unique socio-political context.

Introduction: Upper respiratory tract infections (URTIs) are among the most common diseases in preschool-aged children and are caused by various families of viruses, including rhinoviruses, coronaviruses, respiratory syncytial virus (RSV), adenoviruses, and influenza viruses. In addition to affecting children's well-being, frequent URTIs may also have negative impacts on their families. Therefore, we aimed to investigate the relationship between the frequency of URTIs in preschool-aged children and their mothers’ levels of depression, perceived fatigue and quality of life (QOL).
Participants and methods: This study included nineteen mothers of children with frequent URTIs. The number of URTIs experienced by the children in the last year was recorded. The mothers’ depression level was assessed using Beck Depression Inventory (BDI), perceived fatigue was assessed using Fatigue Severity Scale (FSS) and QOL was assessed using the 36-Item Short Form Health Survey (SF-36).
Results: The number of URTIs experienced by the children was positively correlated with the mothers’ depression level (r=0.568, p=0.011) and perceived fatigue (r=0.470, p=0.042), and negatively correlated with social functioning (r=-0.604, p=0.006), role limitations due to emotional health (r=-0.536, p=0.018), energy-fatigue (r=0.477, p=0.039), and emotional well being (r=-0.590, p=0.008) subscales of SF-36.
Conclusion: This study demonstrates that the frequency of URTIs in preschool-aged children is related to the psychological and social well-being of their mothers. These findings suggest that developing supportive programs may be effective in reducing the negative impact of frequent URTIs on caregivers.