The edition · Paediatrics
Adolescent mental health crises: home and family-based care as an alternative to admission
A systematic review of 15 crisis interventions for suicidal and severely depressed young people. Also today: what late-night phone use does to measured sleep, videolaryngoscopy for infant nasal intubation, and five years of Zika-related microcephaly.
The edition in brief
A systematic review of 15 studies of crisis services for children and adolescents with severe depression, suicidal ideation or self-harm found brief structured interventions, family-focused programmes and community linkage services were associated with fewer suicidal thoughts, emergency visits and admissions, though the evidence is largely observational and heterogeneous. In 425 US adolescents with phone-tracked use and Fitbit-measured sleep, nights with more phone use after 10 pm than usual were linked to falling asleep about an hour later and sleeping about 20 minutes less. In a US multicentre trial of 673 infants needing nasotracheal intubation for cardiac procedures, videolaryngoscopy raised first-attempt success from 75% to 83% without more complications. A Brazilian cohort of 181 children with Zika-related microcephaly found 62% were admitted to hospital within five years, a third had swallowing problems, and more than half had strabismus.
Zika-related microcephaly at five years: high rates of dysphagia, eye disease and admission
Give children with congenital microcephaly early swallowing, eye, hearing and seizure assessment, and recheck head circumference after birth.
More phone use after 10 pm meant later, shorter sleep on the same night
Advise families to set a device-off time, ideally by 10 pm, with phones charged outside the bedroom.
Videolaryngoscopy improved first-attempt nasal intubation success in infants
Consider videolaryngoscopy as the first-line device for infant intubation where equipment and training exist.
Asking a teenager about suicide does not put the idea there
Ask every adolescent with low mood directly and privately about suicidal thoughts.
Crisis services for suicidal and severely depressed young people may reduce admissions
For a young person in a mental health crisis, consider a written safety plan, family involvement and rapid follow-up before defaulting to admission.
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