[A new challenge: post-COVID syndrome in teenagers]. / Nouveau défi : syndrome post-Covid à l'adolescence.

Post-COVID syndrome (or long COVID) is a set of persistent symptoms occurring after a documented SARS-CoV-2 infection. Children and adolescents are also affected, with similar symptoms than adults. To date there is no clinical or biological parameter allowing to confirm the diagnosis, which relies on the presence of typical symptoms associated with a suggestive temporality, in the absence of any other explanation. These persistent symptoms can have a strong impact on the quality of life and schooling. In our specialized consultation for pediatric post-COVID syndrome, we offer a global and multidisciplinary follow-up to patients and their families, supporting them progressively resuming physical and mental activity, and pursuing school attendance to avoid dropout.

Le syndrome post-Covid est un ensemble de symptômes persistants après une infection à SARS-CoV-2 documentée. Cette affection touche aussi les enfants et les adolescents, avec des symptômes similaires à ceux des adultes. Il n'existe à ce jour aucun paramètre clinique ou biologique pour confirmer le diagnostic qui repose sur la présence de symptômes typiques et d'une temporalité suggestive, en l'absence d'autre explication. Ces symptômes persistants peuvent avoir un fort retentissement sur la qualité de vie et la scolarité. Au sein de notre consultation multidisciplinaire dédiée au syndrome post-Covid pédiatrique, nous proposons un suivi global aux patients et à leurs familles, en les accompagnant dans la reprise progressive d'une activité physique et mentale, et en soutenant la poursuite de la scolarité pour éviter la rupture scolaire.

Does age influence self-perception of the soft-tissue profile in children?

INTRODUCTION: Appreciation of the soft-tissue profile is important in orthodontic diagnosis and treatment. However, are the patients themselves aware of their profile appearance? We aimed to evaluate if age influences self-perception of the soft-tissue profile in children. METHODS: The study population for this prospective cross-sectional investigation consisted of 3 groups of 60 patients, classified according to age (<12 years; 12-15 years; >15 years). Each subject's right-sided facial profile was photographed to obtain a silhouette. Facial profile silhouette templates were created to represent the local population. Each subject's photograph was inserted into the corresponding template, and the subjects were asked to identify themselves. Facial profile self-recognition was recorded as a binary variable (yes or no). Other recorded variables included age, sex, and sexual maturity rating (using Tanner staging). Chi-square tests were used to analyze facial profile self-recognition between different subgroups, and stepwise multiple regression was used to predict the probabilities of facial profile self-recognition, with age, sexual maturity rating, and other recorded variables as independent variables. RESULTS: Eighty percent of subjects aged >15 years recognized their own profile, compared with only 55% and 50% of subjects aged 12-15 years and <12 years, respectively. Subjects aged >15 years were significantly more likely to recognize their profile than younger subjects (P = 0.001). Similarly, subjects with the most advanced sexual maturity rating (stage V) were significantly more likely to recognize their profile (85% self-recognition) than those in groups I-IV (P <0.001). Girls were more likely to recognize their profiles than boys (P = 0.028). When using multiple regression analysis, sexual maturity rating appears to be the only significant predictor for facial profile self-recognition (R2 = 0.25; P <0.001). CONCLUSIONS: Facial profile self-recognition seems to improve with age and sexual maturity (sexual maturity rating stage V). Because orthodontic treatment planning takes possible soft-tissue changes into account, it is important to evaluate the degree of self-perception of the patients to adapt our goals and treatment discussions.

[The range of adolescent medicine]. / Bandbreite "Adoleszentenmedizin"

Adolescent medicine is situated "in between" and "on the borders of" different areas of medical specialisations: psychiatry, gynaecology, preventive medicine, paediatrics and internal medicine (and their respective subspecialties).The specificity of adolescent medicine is the evaluation of clinical situations with a particular consideration of the successive stages of the adolescent bio-psycho social development (puberty, identity construction, modifications of the relations to the peer-groups and the family). A special interest goes also to preventive aspects, especially concerning experimental and risk behaviours. The medical approach to adolescents requires a particular attention to psychosocial aspects when confronted with somatic complaints and inversely a good somatic evaluation in front of adolescents suffering from complexes psychosocial situations.

[At the crossover of adolescent and alcohol]. / Lorsque les chemins de l'alcool et de l'adolescence se croisent.

These last ten years, we observed an increased number of alcohol abuse among young adolescents in Swiss Hospitals. The Pediatric Department of Geneva has established a brief intervention program for adolescents brought to the emergency unit for acute alcohol intoxication (one night at the emergency unit followed by an ambulatory consultation within ten days). In these consultations, we evaluate their psychosocial situation and risk behaviors. If necessary these adolescents are referred to psychiatric or addiction units for special care. Adolescents were informed about the risks of alcohol abuse (secondary prevention) and the parents were counseled in their educational function. This program seems to answer to a real need since 88% of adolescents came to the followup evaluation. The parents also felt reassured by this interventional program.

Female genital mutilation and its prevention: a challenge for paediatricians.

Female genital mutilation (FGM) is defined as an injury of the external female genitalia for cultural or non-therapeutic reasons. FGM is mainly performed in sub-Saharan and Eastern Africa. The western health care systems are confronted with migrants from this cultural background. The aim is to offer information on how to approach this subject. The degree of FGM can vary from excision of the prepuce and clitoris to infibulation. Infections, urinary retention, pain, lesions of neighbouring organs, bleeding, psychological trauma and even death are possible acute complications. The different long-term complications include the risk of reduced fertility and difficulties during labour, which are key arguments against FGM in the migrant community. Paediatricians often have questions on how to approach the subject. With an open, neutral approach and basic knowledge, discussions with parents are constructive. Talking about the newborn, delivery or traditions may be a good starting point. Once they feel accepted, they speak surprisingly openly. FGM is performed out of love for their daughters. We have to be aware of their arguments and fears, but we should also stress the parents' responsibility in taking a health risk for their daughters. It is important to know the family's opinion on FGM. Some may need support, especially against community pressure. As FGM is often performed on newborns or at 4-9 years of age, paediatricians should have an active role in the prevention of FGM, especially as they have repeated close contact with those concerned and medical consequences are the main arguments against FGM.

[Consultations for adolescents: which setting?]. / La consultation avec un adolescent: quel cadre proposer?

Consultations with adolescents have their specificities, there is a triangular situation between the adolescent patient, his parents and the physician. The setting of the consultation has to take into consideration the developmental stages of adolescence for to give an appropriate response to the expectations and needs of the patient and his parents. Questions about confidentiality are fundamental and has to be openly discussed. The condition for medical confidentiality for an adolescent is his capacity for exercising autonomous choices; on the other hand the parents have the right to be informed about the health of their child. We are confronted with an ethical and legal dilemma. The physician can take the role of a mediator: he has to support the autonomy of the adolescent with regard to the parental role.