Paediatricians, and society in general, often feel very uncertain about trajectories of gender questioning in children. Gender-questioning children have not historically been referred to paediatricians, but the new National Health Service England referral pathway as of September 2024 is that those who don’t also meet criteria for Child and Adolescent Mental Health Service referral will be seen by general paediatrics before referral to regional services.1 The Cass review of gender identity services also recommended that paediatricians with a special interest will be part of regional gender identity services.2 Paediatric endocrinologists may have an important role in considering puberty blockers or hormonal treatments. In all these ways and as leaders in child health you are important advocates for gender-questioning and transgender children’s best interests. As a parent, I wanted to tell you my child’s story so far. Not because I have any easy answers or simple actions to recommend. But

With the centralisation of paediatric intensive care services in England in the late 1990s, the development of transport services to transfer critically ill children from their local hospital to a tertiary centre became essential. To begin with, many of these services were provided by teams within those same regional paediatric intensive care units (PICUs), but over time specialist paediatric critical care transport services developed. The study by Ramnarayan et al 1 describes how the development of a national database collecting data over a 10-year period across the UK and Ireland has been able to track more recent changes in provision, such that all areas are now covered by specialist paediatric critical care transport teams, along with a doubling in the number of transports led by an advanced nurse practitioner. At the same time, as well as having separately staffed transport teams, the auditing of performance has led to improvements in the speed at which teams mobilise for a transf

Objective To determine the efficacy of addition of melatonin or triclofos to sleep deprivation as compared with sleep deprivation with placebo for conduct of successful sleep electroencephalogram (EEG) among children between 6 months and 12 years of age. Design, setting and Patients 486 children aged between 6 months and 12 years who were uncooperative or referred for sleep EEG were enrolled for this double-blind, placebo-controlled randomised trial between 30 June 2022 and 31 March 2023. Intervention On the day of sleep EEG, participants were sleep deprived by 25% of their regular sleep duration and then randomly assigned to receive either triclofos (50 mg/kg), melatonin (weight ≤15 kg=3 mg; weight >15 kg=6 mg) or placebo. Outcome Primary outcome was the conduct of a successful sleep EEG. Results 486 children were randomly assigned to intervention with triclofos (n=165), melatonin (n=161) or placebo (n=160). Sleep EEG success (p<0.001) with different interventions was: triclofos=145/1

Aims To explore short-term weight variability in young children; (1) how it relates to expected weight gain and (2) how it is affected by age, time of day and dietary intakes and outputs. Methods Twenty healthy infants aged 2–10 months and 21 healthy toddlers aged 12–35 months were weighed at home by their parents six times over 3 days. The toddlers’ parents also recorded whether they had eaten, drunk, urinated or passed stool in the previous 2 hours. The primary outcome was ‘noise’: the within-subject weight SD pooled separately for infants and toddlers, compared with their expected weight gain over 4 or 8 weeks. Analysis by successive pairs of weights was used to assess the extent of short-term weight gain and loss associated with time of day and eating, drinking and excretion. Results In infants, noise (117 g) was much less than the expected weight gain over 4 weeks (280–1040 g) but in toddlers, noise (313 g) was higher than the expected gain over 4 weeks (180–230 g) and around thre