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Please look at my baby

Lucina has always been concerned about the technical progress of medicine overtaking the ethical and moral aspects; just because you can intervene, doesn’t mean you should. Golda Grinberg [N Engl J Med 2023;388:486–487 DOI: 10.1056/NEJMp2213031] gives a very personal account of their journey progressing towards palliative care, with their child who has severe chronic neurodevelopmental issues. Should he have a tracheostomy or not?

What was happening to mental health presentations in the emergency department before COVID?

Cushing AM et al [JAMA Pediatr 2023;177(2):168–176. doi:10.1001/jamapediatrics.2022.4885] have examined a cohort of over 200 000 children (aged 3–17 years) seen at 38 US children’s hospitals over five years. Interestingly these data were collated before the COVID epidemic (end of data collection was February 2020). There were 308 264 mental health ED visits from 217 865 unique patients, and 13.2% of patients had a mental health revisit within 6 months. Mental health visits increased by 8.0% annually (95% CI, 4.5%–11.4%), whereas all other ED visits increased by 1.5% annually (95% CI, 0.1%–2.9%). Factors associated with mental health ED revisits included psychiatric comorbidities, chemical restraint use, public insurance, higher area measures of child opportunity, and presence of an inpatient psychiatric unit at the presenting hospital. Patients with psychotic disorders (hazard ratio [HR], 1.42; 95% …

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