Background In the UK, more than one in five children are overweight on starting school. An elevated body mass index (BMI) in childhood increases the likelihood of developing many health and social issues. The Lifestyles, Eating and Activity for Families (LEAF) programme is a weight management service for clinically obese children under the age of 7 years and their families. This study evaluates the effectiveness of the LEAF programme by measuring BMI z‐score change, the reduction in calorific beverage consumption and user satisfaction. Methods Data were collected over 6 years from 2012 and children who met the local weight management pathway criteria were recruited. Contact time was typically 20 h over 12 months and included home and clinic‐based assessment by the multidisciplinary team and community‐based intervention through six group sessions. This study compared baseline and post‐intervention BMI z‐scores (zBMI) for 65 children, as well as daily total calorific intakes from beverages for 41 children, and, in addition, 20 parents completed user satisfaction questionnaires. Results There was a highly significant reduction in both mean zBMI (0.5; p < 0.001) and mean total calories from beverages (199; p < 0.001) across the intervention period. There was no significant correlation between zBMI and beverage calorific trends. Families who completed user satisfaction questionnaires reported that they had changed their dietary habits and 90% would recommend the programme to others. Conclusions This initial evaluation indicates that the LEAF programme was effective in reducing the zBMI of a group of clinically obese young children. Keywords obesity epidemic, young children, intervention, multidisciplinary

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deficiencies and insufficient/unsafe levels of staffing. The associated declining self-respect, frustration, and guilt cause work-dissatisfaction, burnout, turnover, and consequently, diminished patient care. In this survey study, perceived appropriateness of care and levels of moral distress were evaluated across time. We also determined if respondents' background predicted moral distress levels. Methods After baseline assessment (background, moral distress, ethical climate), nurses and physicians of our level-III NICU evaluated day-levels of perceived appropriateness of care, the different aspects of moral distress, and ethical climate, at the end of five randomly selected shifts. Results Response rate: nurses 87(77%)/physicians 30(91%). Moral distress (range 1-16) was low at baseline (M = 2.21; SD = 1.55), but significantly higher for nurses than for physicians (M = 2.40/SD = 1.68 vs M = 1.68/SD = 0.98; p = 0.01). Nurses were less likely to disagree with treatment than physicians (OR = 2.62, p = 0.02). Moral distress at day-level (range1-4) was very low (M = 0.08/SD = 0.21) and significantly depended on being religious (b= 0.16; 95% CI= 0.03 to 0.28) and perceived 'overtreatment' (b = 0.18; 95% CI= 0.07 to 0.30), contrary to 'undertreatment' (b = 0.17; 95% CI -0.63 to 0.29). Highest scores were observed for the following aspects of moral distress: provider (dis)continuity, communication about patient care, and (un)safe levels of staffing. Conclusion In earlier studies, 'expressing concerns' and 'facilitated ethics conversations' proved to diminish moral distress. Possibly in our NICU the existence of structured-multi-disciplinary-medical-ethical-decision-making explains the (very)low levels of moral distress. Aim To develop a Tier 3, family-focused weight management intervention for the early years. Background In the UK roughly 1 in 4 children are overweight or obese by the time they start primary school. According to the literature there are no proven models for working with children under 6 years with extreme obesity. We were required to develop a Tier 3 weight management intervention as part of the Care Pathway for Children's Weight Management in Cornwall. Methodology A review of national guidance and both nationally and locally run programmes for children's weight management was undertaken. The key aspects for successful interventions, appropriate for the early years, were identified. A pilot programme was then developed by our team. Results Successful programmes were already running for children aged 7-13 years The LEAF (Lifestyles, Eating and Activity for Families) clinic was developed for children 6 years and under. It comprises a multi-disciplinary clinic with Community Paediatrician, Specialist Children Dietician and Specialist Activity Advisor, followed by a group intervention in a community setting, before multi-disciplinary follow-up. The intervention covers a broad range of topics that aim to help empower parents to make changes that ultimately improve the body mass index of their children. After...

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Background and AimsWe present a case of a severely autistic 14 year old boy referred to paediatric outpatients with a 1 year history of pica and early morning retching. This was initially considered behavioural in origin. Review of previous Abdominal X-ray (Image 1) revealed a gastric bezoar; at surgery this had resolved but duodenal adhesions were found and divided with recovery of symptoms. Distinguishing which symptoms are behavioural in origin and which are organic can prove a diagnostic conundrum in learning disabled patients. We aim to provide guidance for rational investigation.