Migrant children's health problems, care needs, and inequalities: European primary care paediatricians' perspective.

BACKGROUND: Primary care paediatricians' perception of migrant children's health in Europe has not been explored before. Our aim was to examine European paediatricians' knowledge on migrant children's health problems, needs, inequalities, and barriers to access health care. METHODS: European primary care paediatricians were invited by the European Academy of Paediatrics Research in Ambulatory Setting Network country coordinators to complete a web-based survey concerning health care of migrant children. A descriptive analysis of all variables was performed. RESULTS: The survey was completed by 492 paediatricians. Sixty-three per cent of the respondents reported that the general health of migrant children is worse than that of nonmigrants, chronic diseases cited by 66% of the respondents as the most frequent health problem. Sixty-six per cent of the paediatricians reported that migrant children have different health needs compared to nonmigrant children, proper oral health care mentioned by 86% of the respondents. Cultural/linguistic factors have been reported as the most frequent barrier (90%).to access health care. However, only 37% of providers have access to professional interpreters and cultural mediators. Fifty-two per cent and 32% do not know whether one or more of the family members are undocumented and whether they are refugees/asylum seekers, respectively. Updated guidelines for care of migrant children are available for only 35% of respondents, and 80% of them have not received specific training on migrant children's care. CONCLUSIONS: European primary care paediatricians recognize migrant children as a population at risk with more frequent and specific health problems and needs, but they are often unaware of their legal state. Lack of interpreters augments the existing language barriers to access proper care and should be solved. Widespread lack of guidelines and specific providers' training should be addressed to optimize health care delivery to migrant children.

Síndrome de munchausen en la infancia y la adolescencia: de la hiperfrecuentación de consultas al maltrato / Munchausen syndrome in childhood and adolescence: from very frequent visits to the doctor´s office to maltreatment

Los autores exponen el concepto actualizado de síndrome de Munchausen por podres. Caracterizan de forma actualizada y detallada: 1. Formas clínicas del síndrome de Munchausen. 2. Factores de riesgo familiar (en ambas figuras parentales y en el niño). 3. Características evolutivas. 4. Funcionamiento del sistema sanitario: hiperfrecuentados de servicios sanitarios. 4. Bases para la intervención terapéutica: primera etapa en los servicios pediátricos de Atención Primaria y segunda etapa en los servicios de Salud Mental de la Infancia. Se destaca la importancia de las técnicas de interconsulta y enlace desde los Servicios de Pediatría y Psiquiatría Infantil para el tratamiento del síndrome de Munchausen por poderes (AU)

The authors present an approach to the Munchausen´s Syndrome by Proxy. Focusing on the clinical features including psychopathological and psychosocial profile. Authors consider also family risk factors- both the parenting and the children, developmental characteristics and Health Care Services delivery its relationship with the impact on the clients attendance. The therapeutic interventions was implemented in tow phases: the first phase Primary Care Paediatric setting, and the second phase in Child Psychiatry Services. Authors emphasize the relevance of the liaison-consultation between Paediatrician and Child Psychiatrist as a key procedure to approach Munchausen´s Syndrome by Proxy treatment (AU)