Amputation is an infrequent but devastating outcome of meningococcal septicemia. We assessed daily living functions and quality of life in a cohort of children and young people, 3 to 5 years after limb amputations following severe meningococcal disease. All participants lived with their families in the community, with minimal assistance. Participants used effective strategies to compensate for motor impairment and generally had good quality of life, despite ongoing health problems (predominantly musculoskeletal). The degree of amputation did not predict the functional outcome. The surprisingly good outcomes we report should discourage clinicians from withdrawing intensive care support because of presumed poor outcomes after multiple amputations in severe meningococcal disease.

Background The isolated finding of an unexplained chronic subdural haematoma in an infant may suggest non-accidental head injury (NAHI). The authors report a previously undescribed cause of multifocal chronic subdural haematoma in infancy which could result in a misdiagnosis of previous NAHI. Methods Two infants, aged 3 and 4 months of age, presented with progressively increasing head circumference measurements from birth. There was no history of encephalopathy. Retinal haemorrhages were not present. CT and MRI demonstrated bilateral subdural fluid collections over the frontal regions that were consistent with either chronic subdural haematomas or haemorrhagic subdural effusions. In view of the possibility of NAHI, child protection investigations were initiated. Findings In neither case did the child protection investigations raise concerns. Comprehensive investigations for known haematological and metabolic disorders associated with subdural haematomas or effusions in infants were all normal. In both cases the infant's mother had a history of Sjögren's syndrome and both infants had positive anti-Ro antibody at presentation. Conclusions Transplacental acquisition of anti-Ro antibodies has been associated with external hydrocephalus. External hydrocephalus has been recognised as a predisposing factor for subdural haemorrhage. These are the first reported cases linking the presence of anti-Ro antibodies and external hydrocephalus with subdural fluid collections in infancy.

Background Women lacking social support during pregnancy often have worse mental health, but we know little about the influence of social support on child development, or the impact for migrant women. We aimed to investigate the association between maternal social support during pregnancy and child development using the Born in Bradford birth cohort. Methods Social support was evaluated using a composite score of items from the baseline pregnancy questionnaire. Outcomes were Communication and Language and Personal, Social and Emotional development school-readiness assessments from the Early Years Foundation Stage Profile (EYFSP, age 4–5 years) and the Strengths and Difficulties Questionnaire (SDQ, age 7–11 years), with associations tested using logistic and linear regression models. We explored the modifying effect of maternal migrant status. Results 3257 and 1413 cohort participants had EYFSP and SDQ outcomes, respectively. Higher levels of social support were associated with better EYFSP outcomes and SDQ scores. One SD higher social support score was associated with 13% lower odds of missing any EYFSP communication and language target (95% CI 0.79 to 0.95); 17% lower for EYFSP personal, social and emotional development (95% CI 0.75 to 0.92) and 0.65 (95% CI −0.98 to –0.32) lower overall SDQ scores, after adjustment for all variables. There was some evidence that maternal migrant status modified associations with SDQ, but not with EYFSP outcomes. Conclusions Greater attention to the role of social support in pregnancy, and its social and cultural context, may be helpful in developing and implementing interventions aiming to improve early childhood development.

Background Children born to migrant parents have higher rates of language difficulties, intellectual disability and autism. This study explores the relationship between migration, ethnicity and reasons for early years referrals to community paediatrics in a diverse multi-cultural population in a city in south west England. Methods Observational retrospective study from a community paediatric service serving a multi-cultural urban population from June 2012 to February 2016. We tested associations of ethnicity and parental birth origin with reason for referral (developmental or non-developmental) for children under 5 years old and estimated crude rate ratios for referrals using population census data. Results Data were available for 514 children (52% white or mixed race, 16% Asian, 21% African diaspora, and 11.5% Somali); 53% had two UK-born parents while 22% had two migrant (non-UK-born) parents. Referrals were for developmental reasons in 307 (60%) including 86 for possible autism. Parental birth origin and ethnicity were associated with reason for referral (p < 0.001). Children from African diaspora, Asian or Somali backgrounds had more than twice the rate (rate ratio [RR] 2.37, 95% CI 1.88-2.99, p < 0.001) of developmental referrals compared with white or mixed-race children. Children of Somali or African diaspora ethnicity were, respectively, six-times (RR 5.99, 95% CI 3.24-10.8, p < 0.001) and four times (RR 4.23, 95% CI 2.44-7.29, p < 0.001) more likely to be referred for possible autism spectrum than their white or mixed-race peers. Developmental referral as a proportion of all referrals was twice as high among children with one migrant parent (20.4%) and three times as high among children with two migrant parents (29.5%), compared with children whose parents were both UK-born (10.7%). Conclusions This study supports the importance of ethnicity and parental migration as factors in young children experiencing developmental difficulties, especially concerns about social communication or autism.