The edition · Paediatrics
A MUAC referral recommendation alone showed no measurable effect near the cut-off; physical activity links weakly to children's cardiometabolic markers
A Burkina Faso regression discontinuity analysis of referral after malnutrition screening, a pooled analysis of accelerometer data in 12,874 young people, and a UK expert consensus on the signs of dysfunctional breathing.
The edition in brief
A regression discontinuity analysis nested in a cluster-randomised trial in Burkina Faso followed 65,554 children aged 6 to 59 months screened for severe acute malnutrition; 226 (0.34%) met the mid-upper arm circumference (MUAC) cut-off of below 11.5 cm for referral at least once. Near the cut-off, eligibility for referral did not change MUAC at the next census (difference 0.21 cm, 95% CI -0.22 to 0.65) or mortality (odds ratio 0.95, 0.03 to 31.37, highly imprecise). Treatment uptake was not measured, so the study cannot judge treatment, only that a referral recommendation alone did not move outcomes in this setting. A harmonised individual-participant-data meta-analysis of 14 cohorts (12,874 children and adolescents, mean follow-up 3.1 years) found moderate-to-vigorous physical activity inversely associated with insulin, LDL cholesterol and triglycerides but not BMI, and positively with systolic blood pressure; associations were weak and sensitive to modelling choices, and sedentary time was not linked to a worse profile. A three-round eDelphi of 39 UK paediatric respiratory professionals agreed on common features of dysfunctional breathing but not on its name; no validated diagnostic tool exists. The pearl covers inhaler technique before escalating asthma treatment.
Physical activity and cardiometabolic markers in children: real but weak associations
Encourage physical activity in children, but frame the cardiometabolic gain as modest, and do not treat screen or sitting time as a major cardiometabolic risk on this evidence.
UK experts agree on the features of dysfunctional breathing in children, but not its name
Consider dysfunctional breathing in a child with unexplained breathlessness once organic causes are excluded; the agreed feature list needs validation before it works as a test.
Before stepping up a child's asthma treatment, check inhaler technique and spacer use
Check technique, spacer use and adherence before increasing asthma treatment in a child.
A recommendation to refer after MUAC screening did not, by itself, change outcomes near the cut-off
Treat a MUAC referral as the start of a pathway: arrange and check that the child reaches nutritional care.
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