Overcoming challenges to develop technology for child health

Abstract

Millions of children and young people (CYP) in the UK are affected by chronic or rare health conditions. Rapid advances in science and technology have resulted in CYP with chronic and rare conditions now surviving well into adulthood. New technologies have the potential to improve short- and long-term health outcomes for CYP with health conditions, prevent adult onset disease and complications, and reduce the burden on health services. There is thus a need for targeted investment and appropriate governance in child health technology development to address the specific needs of this population; health technology must be versatile to meet the social, anatomical, cognitive, psychological, and physiological changes inherent to childhood development. Despite the growing demand for health technology for a sizeable global population, industry still wrongly perceives the market size is relatively small, and health technology development is often localised and fragmented with limited scope for spread and adoption. These challenges can be overcome by validating and prioritising unmet needs, involving CYP and their families throughout the innovation pathway, facilitating effective partnerships with key stakeholders, and utilising national and international infrastructure and networks. This paper outlines five innovations supported by NIHR Children and Young People MedTech Co-operative that illustrate how common challenges in child health technology development can be overcome. It is essential that we continue to address such challenges and invest in the health and wellbeing of CYP.

Keywords:

• Children
• health
• innovation
• technology
• young people

1. The need for child health technology

Chronic health conditions affect millions of children and young people (CYP) in the UK and cost the NHS billions of pounds each year. Moreover, many chronic conditions that affect adults have their origins in childhood and adolescence, and account for a significant proportion of the overall NHS budget [1,2]. For instance, asthma affects 1.1 million CYP in the UK and has one of the highest burdens on acute NHS departments, causing over 1000 deaths per year [3]; Epilepsy is the most common significant long-term neurological condition of childhood and affects an estimated 112,000 children and young people in the UK [4].

Poorly controlled health conditions in CYP often result in suboptimal social, psychological, and academic short- and long-term outcomes that extend into adulthood [1]. Childhood and adolescence is a critical time for establishing positive health behaviours and preventing or managing chronic conditions [5]. Thus, early interventions and prevention strategies that aim to reduce the incidence and burden of disease can have significant benefits for CYP, their families, and the NHS [6]. Critically, countries that invest in child health reap economic rewards, with each pound spent on CYP’s health returning over £10 to society over a lifetime [6,7]. The health of CYP is therefore a key factor in determining whether the UK has a healthy and prosperous future [8].

Rapid advances in science and technology over the last few decades have resulted in many more CYP with chronic and rare conditions now surviving well into adulthood [9]. There is increasing evidence that digital platforms provide CYP with support that is not achieved during traditional clinic appointments [10,11], empowering CYP and helping them to feel more independent and confident [12,13]. Furthermore, 89% of adolescents (12–17 years) and 98% of young adults (18–24 years) have access to a smartphone [14], and many CYP are receptive to accessing health information via mobile apps [15,16]. This has facilitated greater access to clinical information and clinical support, which in turn has the potential to increase CYP’s engagement with the management of their health condition.

In addition to digital platforms, many other novel technologies are being utilised to improve the health and wellbeing of CYP with chronic conditions. For instance, 3 D-printing has been applied in specialties such as surgery, dentistry, drug-delivery, orthotics and prosthetics, organs and tissues, and ventilation masks to address the challenge of changing anatomy as children grow and develop [17–20]. Advances in material science are also improving the biocompatibility and safety of paediatric devices such that adverse reactions and toxicity are avoided [21,22].

New devices have been developed that overcome the challenge of drug administration, particularly in younger children, improving adherence, dosing accuracy, and delivery. For example, needle free injection devices such as PharmaJet^® and InsuJet™, have been developed for CYP that are needle phobic [23,24]. It can also be challenging and stressful for CYP to use inhalers and nebulisers for the treatment of acute and chronic respiratory diseases [25,26]. Novel face masks, spacers, and valve holding chambers have been developed to improve compliance and the ability of CYP to use inhalers (particularly those under four years of age) [27–29].

Virtual reality is also being utilised to reduce anxiety in magnetic resonance imaging (MRI) and computed tomography (CT) scans [30], to diminish pain during invasive procedures [31–33], and in the rehabilitation of children with upper limb injuries [34,35]. Furthermore, new techniques have been employed in diagnostic imaging to improve the accuracy of diagnosis in paediatric brain tumours using artificial intelligence [36], as well as to improve the diagnostic accuracy of MRI scans and ultrasound to limit radiation exposure in CYP currently received through diagnostic CT scans [37].

In recent years, the NHS has reinforced its commitment to preventing health conditions in childhood and adolescence, addressing inequalities in health spending between paediatric and adult care, supporting CYP to develop and thrive, building a society that is fully inclusive of people with a disability, and accelerating the adoption of cost-effective health technologies [38–41]. However, the development of child health technology remains considerably behind technology for adult healthcare, and still faces a number of significant challenges.

2. Challenges

In 2020, the number of children aged less than 16 years increased by 8.0% to 12.7 million, accounting for 20% of the population [42]. Despite CYP making up a sizeable proportion of the national and global population, there are numerous technical and developmental challenges when developing technology for CYP. Perhaps most significantly, there is considerable heterogeneity across the paediatric population, with infancy, childhood, and adolescence being periods of rapid anatomical, physiological, psychological, social, and cognitive development [43]. Moreover, there are considerable individual differences in CYP’s development, meaning that two children of the same age may be at distinct developmental stages [44].

This heterogeneity can pose several challenges for research studies seeking to clinically evaluate technology for child health. For example, researchers need to decide whether to stratify research participants by age and/or developmental stage to create more homogenous cohorts. However, such stratification can pose the additional challenge of recruiting large enough populations to statistically power studies.

In addition to considering the development of individual CYP, technology developers also need to consider the child in the context of their family and wider environment (e.g., peers, education). For instance, technologies need to address the transition from dependence on caregivers in childhood to autonomy in late adolescence. This transition, combined with the heterogeneity of CYP, creates the need for innovations and technologies which are versatile and developmentally appropriate.

To date, opportunities for child health technology development have been limited by the perceived market size, with only 0.7% of the digital health global expenditure invested in paediatrics [45]. The perceived lack of market size has in part resulted in industry repurposing technology for CYP that was originally developed for adults, with limited success and occasionally resulting in preventable complications. Examples of this can be found in Case Studies 1, 3 and 4.

Moreover, it is essential that all technologies and innovations aiming to improve the health and wellbeing of CYP are developed and manufactured within robust risk management and governance structures to minimise potential risks. The Medicines and Healthcare products Regulatory Agency (MHRA) is responsible for regulating commercially available medical devices in the UK. Amendments to the Medical Devices Regulations 2002, which govern medical devices regulation in the UK, will come into force in 2023. At this point current CE marking of medical devices in England will be replaced by UKCA [46]. In the US, the Food and Drug Administration (FDA) has released guidance specifically for the development of paediatric medical device assessment [47]. However, no equivalent European guidance exists to manage research of medical devices in children or other vulnerable populations.

A particular area of challenge in paediatrics is rare diseases. While individual rare diseases only affect a small proportion of the population, they are collectively common; there are more than 8000 known rare diseases affecting 1 in 17 people, with 80% of rare diseases affecting children under 5 years; rare diseases have a profound impact on children and their families [48]. However, due to the limited market size and significant heterogeneity in this population of children, there are very few innovations available despite the overwhelming need.

It is important to recognise that all health conditions in CYP have a disproportionately negative effect on quality of life, through impact on education, friendships and peer groups. Studies show that where poor school attendance and poor achievement are present, the risk of ill-health is 4.5 times higher in adulthood [49]. Moreover, preventing ill health and health inequalities in childhood and adolescence also minimises adult health issues and their impact on wider society [1]. Unhealthy lifestyles, which often begin in childhood and adolescence, contribute significantly to health conditions such as stroke, cancer, heart disease, and dementia as well as psychosocial problems [50–53]. For example, in 2015, 63% of adults were overweight or obese, resulting in an estimated £5.1 billion spend on overweight and obesity related health disorders and a further £27 billion cost to the wider society [54].

Finally, technology that has been developed for CYP has often taken place in a relatively emergent manner with little formal coordination, resulting in many failed ventures or with localised adoption without spread. Medical device manufacturers, academics, and clinicians therefore have an unenviable remit to deliver medical technologies for CYP, including producing innovations at scale, ensuring that the innovation is not “out of date” before it gets into the hands of end users, ensuring that it is cost effective, and that it can be adopted within NHS service pathways [55]. Given that chronic diseases are often established in childhood, and account for a large proportion of the annual spend on health care, the need to invest in and develop novel technology is compelling.

3. Defining need to drive technology development

Unmet needs can be defined as issues faced by service users and healthcare service providers, which make day-to-day living difficult or problems in a healthcare setting that limit or impact the delivery of care. Having a comprehensive understanding of unmet needs in child health and paediatrics is not only essential for developing new and effective technologies and innovations, but also ensures that industry aligns existing novel technologies with specific and real needs.

Identifying unmet needs necessitates understanding the experiences of CYP and their parents/carers. The 1989 United Nations Convention on the Rights of the Child [56] states that CYP have the right to express their views freely in all matters that affect them. Thus, CYP and parents/carers should be involved throughout the innovation pathway, from idea inception through to proof of concept, commercialisation, and adoption. Young Persons Advisory Groups (YPAGs) [57], such as Generation R [58], are organised groups of CYP who can advise on all stages of the research and innovation process. As discussed in the paper by Wheeler & Mills et al. in this JMET special issue, there are various approaches which can be used to understand the experiences and needs of CYP and their families, including patient and public involvement and engagement (PPIE), co-design, and experience-based co-design (EBCD), and this approach will vary depending on the project objectives and patient population.

When defining population needs and requirements, it is essential that CYP and families who share their experiences of chronic conditions are representative of the patient population, including those from underserved communities such as those from low-income families or people who speak English as a second language. Digital inclusion agencies, such as Thrive By Design [59], have been established to advise on how to avoid creating a two-tier healthcare system, whereby only people with access, skills, and confidence to use digital technology can access a higher quality of care. Such agencies work with those from underserved communities, and extend their reach to individuals who could be potentially perceived as digitally excluded, with low-digital literacy, or with limited access to technology. However, it is critical that inclusion is integrated into all technologies and innovations, not just digital. Further work and support is therefore needed in this area to ensure that all technologies and innovations for paediatrics and child health are as inclusive as possible.

Unmet needs not only need to be identified, they also need to be validated across multiple contexts and prioritised to effectively allocate resources and ensure maximum impact. The process of prioritising and validating unmet needs requires assessing various factors in tandem, including the impact of addressing the need on CYP’s health and quality of life and NHS services, market competition, the expected adoption of the innovation across the NHS, and the associated economic impacts. Meeting technology push with unmet need is essential. Industry may approach issues in health care from the perspective of the technology available instead of the health care need. By utilising local, national and even international collaborations and networks, unmet needs can be validated and shared to ensure that industry are able to apply the latest technology to these healthcare needs.

The process of identifying and prioritising unmet needs involves working in partnership with CYP and their families, healthcare professionals, industry experts, commissioners, academics, and charities to develop effective innovations that meet the needs of all stakeholders and fit in the wider context of healthcare uptake and delivery. Such collaborations require working across organisational boundaries, disciplines, and professions, and can be very attractive, offering additional finance and resources and enabling a fusion of diverse perspectives and expertise [60–62]. However, collaborations of this type can prove challenging due to differences in processes, communication, motivations, and timescales. To bridge these differences, individuals working across the organisational boundaries and their interpersonal relationships are vital [63]. They act as linchpins between the partnering organisations, forming a critical bond. They can also improve communication and information exchange, help to build trust and commitment, foster joint problem solving, help to resolve conflicts before they escalate and open up additional opportunities for partners [63–66]. Furthermore, although it is important to engage with the wider healthcare workforce in developing paediatric technologies, it is also essential that managed frameworks and structures are utilised to introduce novel technologies into healthcare systems. In addressing appropriate life cycle management elements, risks of the technology to patient safety are significantly minimised.

Consequently, a range of infrastructure in the UK has been established in recent years to facilitate collaborations with key stakeholders to catalyse the development of child health technology, based upon the identification, prioritisation, and validation of unmet needs. In 2014, the first national paediatric health technology network, Technology Innovation Transforming Child Health (TITCH) Network [67] was founded by NIHR Devices for Dignity MedTech Co-operative in partnership with Sheffield Children’s NHS Foundation Trust, and in January 2018, the NIHR funded the first MedTech and In Vitro Diagnostic Co-operative (MIC) dedicated to child health and paediatrics, NIHR Children and Young People MedTech Co-operative [68]. The TITCH Network and NIHR CYP Medtech facilitate collaborations between stakeholders, advise on and support the development and clinical evaluation of technologies, and work with national funding bodies to launch funding calls that are targeted to prioritised, validated unmet needs. Effective and frequent communication with both regulatory and funding bodies is vital to ensure that these parties are aware of current unmet needs that need to be addressed by new funding initiatives.

UK organisations such as the Academic Health Science Networks (AHSNs) [69], the NIHR Clinical Research Network (CRNs) [70], and healthcare innovation hubs (e.g., Medipex Ltd [71]) are also crucial for supporting the development of effective technologies that are more likely to be adopted by NHS service pathways. During 2018-2020 the AHSN networks supported 2540 companies and leveraged over £300 million [70]. The CRN offers support with clinical trials and in 2019/2020 supported more than 6000 studies and recruited over 732,000 participants (adults and paediatrics combined). Although these are largely drug based trials there is an increasing number of supported trials or evaluations of medical technology through the CRN [70]. In addition, building work has commenced to create a new National Centre for Child Health Technology in Sheffield, UK [72]. When launched, it will be the most advanced and largest child health technology centre in the world, bringing together leading global industry partners, small- and medium-sized enterprises (SMEs), academics, clinicians, designers, and engineers directly with CYP and their families, providing rapid knowledge transfer for paediatric health technology development at scale.

Successful medical technology development and adoption also often necessitates partnerships and collaborations with international organisations. For example, NIHR CYP Medtech is actively collaborating with the European Paediatric Translational Research Infrastructure (EPTRI) and has representation on its Board of Directors. EPTRI’s mission is to support basic and translational paediatric healthcare research by facilitating collaborations between industry, healthcare users, and providers [73]. NIHR CYP Medtech is also engaging with the i4Kids Paediatric Innovation Hub in Spain which conducts patient-focused biomedical research to improve wellbeing and quality of life in CYP [74]. An additional international organisation and member of EPTRI is the PedMedDev Hub in Germany which connects people, resources, and infrastructure for improvement of paediatric medical devices [75]. It is vital that these international organisations continue to work together cohesively to accelerate paediatric healthcare technology developments across healthcare systems, with a view to forming a future European Network.

4. Overcoming challenges to develop technology for child health: case studies

NIHR CYP MedTech’s innovation pathway guides collaborations and ensures that novel technologies and innovations have the best possible chance of success. Below are five case studies of projects supported by NIHR CYP MedTech where effective solutions have been found to address validated unmet needs and common challenges in paediatric health technology development.

4.1. Case study 1: 3D printing non-invasive ventilation masks

4.1.1. Challenge

CYP differ greatly from adults, and even within the CYP population there is considerable heterogeneity. Technologies that do not account for these differences, such as scaling down technology designed for adults, often results in inappropriate solutions that can cause short- and long-term adverse outcomes. Importantly, medical devices for CYP also need to comply with the relevant standard regulations if they are being placed on the market.

4.1.2. Unmet need

CYP with acute or chronic respiratory failure require supplemental oxygen, primarily delivered via non-invasive ventilation (NIV) face masks. Masks currently used for CYP are mass-produced, scaled-down versions that have been designed for adults. However, because these masks do not take CYP’s anatomical differences into account, they often have a poor fit, resulting in air leakage and ventilator alarms. To overcome this, masks are tightened by parents/caregivers or healthcare professionals, often leading to facial pressure sores, facial deformity, poor air intake, disturbed sleep, and ultimately poorer health outcomes [76].

4.1.3. Solution and next steps

This project is led by Professor Heather Elphick (Consultant in Paediatric Respiratory and Sleep Medicine, Sheffield Children’s NHS Foundation Trust) supported by NIHR Devices for Dignity (NIHR D4D) and NIHR Children and Young People MedTech (NIHR CypMedTech) cooperatives [68]. The project aims to develop bespoke 3D printed NIV masks for CYP with respiratory failure – ensuring an exact fit for each patient. This project utilises the intricate knowledge of industrial processes, materials expertise, and commercialisation pathways from academia and industry alongside clinical expertise to ensure the masks are fit for purpose and can be produced as part of an NHS service pathway available to all NHS trusts. The importance of service delivery is an often overlooked factor when developing health technology, and therefore the care pathway and service integration are key elements of this project [17]. To date, the project team have developed a mask prototype and demonstrated its effectiveness; 73% of study participants reported that their bespoke mask fitted as well or better than their standard mask. Critically, the bespoke masks resulted in fewer transient drops in O₂ saturations, better CYP and parent/carer sleep, and improvements in all physiological ventilation parameters when compared to standard masks. The team are now seeking funding to further develop the mask and headgear to incorporate CYP and parent/carer feedback and ensure the service pathway can be delivered via a commercialised or NHS adopted clinical pathway [16].

4.2. Case study 2: developing mini-capsules to manage constipation

4.2.1. Challenge

There is a lack of technologies that have been developed to manage conditions which primarily affect CYP. Additionally, developers do not always enable direct input from CYP, meaning that the resulting technology may not meet CYP’s needs and therefore lead to poor adoption.

4.2.2. Unmet need

Approximately 10% of CYP suffer from constipation at some point. Constipation becomes chronic in 30% of CYP, with 27,500 CYP needing hospital treatment each year in England alone. It can be difficult to measure gut transit time with current methods such as X-ray radiopaque markers (ROMs) as there is a risk of radiation to younger patients [77]. Overlapping colon loops can also make it hard to accurately define colon anatomy using two-dimensional films. Thus, a significant number of CYP suffering from constipation are managed using symptoms reported; hence there is an unmet need for an innovative technology to measure gut transit time which would improve and refine the management and treatment of constipation in paediatric patients.

4.2.3. Solution and next steps

This project is led by Professor Luca Marciani (Professor of Gastrointestinal Imaging, University of Nottingham) and supported by NIHR CYP MedTech [68]. It aims to develop mini-capsules that are swallowed by CYP and show up on MRI scans to measure gut transit time [78]. The MAGIC research team collaborated closely with the Nottingham YPAG [58] throughout the duration of the project, from identifying the unmet need and designing the capsules to disseminating the findings and drafting of a future successful grant proposal (MAGIC2 study). The success of this project also demonstrates the importance of involving CYP in research and technology development by enabling CYP to voice their opinions, form a coalition of knowledge, develop key transferable skills, and make a valuable contribution to their community [79].

4.3. Case study 3: a network approach to developing prosthetics

4.3.1. Challenge

Perceived small market size and rapid anatomical development can result in some unmet needs receiving little attention by developers. In some instances an alternative intervention is required to help garner wider support and identify potential solutions.

4.3.2. Unmet need

In addition to the lack of funding to develop prosthetics for CYP with limb loss, rapid developments in CYP’s body size and shape mean that prosthetic limbs (as with other medical technology) quickly become unfit for purpose and redundant. Moreover, CYP often need prosthetics that can accommodate higher wear and damage compared to adults.

Recent work identified 100 previous or current research projects in the field of prosthetics (including implantable and external prosthesis, such as eyes and ears), totalling £44 million of research funding [80]. However, only 10% of this funding was relevant to limb prosthetics and none of the funding was targeted towards the 2,000 CYP with limb loss in the UK who use limb prosthetics [81]. Despite the relatively small number of CYP with an amputation or congenital limb deficiency, many of the current prosthetics have not been developed in collaboration with CYP and do not meet their needs and preferences. Limb loss has a significant impact on CYP’s quality of life [81], and there is therefore a moral and societal need to develop prosthetics that use the latest technology to help CYP with limb loss thrive and lead a better life.

4.3.3. Solution and next steps

The Starworks network is a CYP’s prosthetic research collaboration funded by the Department of Health and Social Care, managed by NIHR D4D and NIHR CypMedTech. The Network was created to bring CYP and their families together with key opinion leaders from the NHS, industry, clinical academia, and leading national research centres with knowledge and expertise in child prosthetics. The network was established in 2016 to increase research to accelerate the translation of new inventions and developments in child prosthetics into everyday use. This initiative is firmly centred on the needs of CYP, their families, and the NHS to ensure there is the ideal balance of “clinical pull” and “technical push” to create an energetic environment in which to innovate and partner with industry. This approach has led to funding for 16 innovative projects, which are helping shape the national agenda on the importance of new innovation in this field by influencing future funding calls. The Starworks network mirrors the learning and approach used by the TITCH Network, and both networks highlight how a coalition of the right stakeholders can lead to positive outcomes for CYP and the NHS.

4.4. Case study 4: augmented reality to improve vision

4.4.1. Challenge

It’s vital that paediatric clinicians, CYP and industry work together when developing novel technologies to ensure CYP-specific needs are understood. However, knowing who to approach and gaining access to these groups and partners can sometimes be challenging

4.4.2. Unmet need

Approximately 24,000 CYP in the UK have a visual impairment (i.e., loss of vision that cannot be corrected with glasses or contact lenses). CYP with low vision can have poorer social, educational, psychological, and physical development as well as poorer quality of life. Many low vision aids used by CYP have been repurposed from technologies developed for adults, with limited success and applicability. Although these low vision aids can improve independent living, access to education/work, and quality of life, they are not suitable for the majority of activities that CYP take part in.

4.4.3. Solution and next steps

NIHR CYP MedTech facilitated a collaboration between the ophthalmology clinical team at Sheffield Children’s NHS Foundation Trust and an SME called GiveVision. Drawing upon the experience of the Ophthalmology team, GiveVision developed an innovative device called “SightPlus,” which is a hands-free, head-mounted, digital low vision aid [82]. This partnership has led to a successful funding application to clinically evaluate the device with CYP, ensuring that the device meets CYP’s needs and preferences. Organisations such as NIHR CYP MedTech are essential for identifying and bringing together key stakeholders to ensure technology developed for CYP is effective and addresses validated unmet needs.

4.5. Case study 5: immersive virtual reality for upper limb injuries

4.5.1. Challenge

Having an incomplete understanding of an unmet need or patient/user requirements can lead to many technologies failing to solve a real problem.

4.5.2. Unmet need

CYP with upper limb injuries often do not complete the extensive rehabilitation exercises they are prescribed. As a result there is a clear need for the development of technologies to encourage these CYP to complete their rehabilitation exercises and reduce the number of hospital appointments. This requires having a clear understanding of the unmet need (i.e., why CYP are not completing their exercises), and ensuring that bespoke technological solutions are developed in a versatile way that meets CYP’s varied anatomical, physiological, and psychological needs. Solutions must also provide an engaging means of delivering treatment and therapy.

4.5.3. Solution and next steps

NIHR CYP MedTech initiated and supported a successful collaboration between immersive virtual reality developers at Sheffield Hallam University, CYP with upper limb injuries, and clinical teams at Sheffield Children’s NHS Foundation Trust. Throughout the project, by working closely with CYP with lived experience, it emerged that anticipated and procedural pain during rehabilitation exercises (the main reason why exercises are often not completed) could be significantly reduced by using immersive virtual reality. As a result, a fully immersive head-mounted display virtual reality device with engaging, developmentally appropriate content for CYP was developed. Healthcare professionals are able to modify the settings on the device to ensure it is tailored to the individual’s rehabilitation needs. A small-scale feasibility study demonstrated that CYP using this device enjoyed and engaged in their rehabilitation exercises to a greater extent with an increased range of movement achieved [34]. This study demonstrates that it is possible to develop versatile technology that leads to better engagement and better medical outcomes for CYP, particularly where there is in-depth understanding of the problem.

5. Conclusion

There are 1.8 billion YP in the world today, with 40% of the global population being under 24 years [83], creating significant future healthcare market opportunities. Ultimately, investment in the health and wellbeing of CYP has the potential to revolutionise future health and healthcare.

However, children are not small adults and they have very different needs and preferences [84]. Rapid anatomical, physiological, cognitive, psychological, and social changes limit the possibilities for repurposing technology designed for adults, and underscore the need to create versatile, bespoke, and developmentally appropriate technology for CYP. A paradigm shift towards the development of technology used to influence health behaviour in childhood and adolescence is needed to impact future health and economic outcomes, such as by reducing the prevalence and burden of major adulthood illnesses such as heart disease, stroke, and cancer.

National networks such as the TITCH Network [67], the NIHR MIC network [85] which includes NIHR CYP MedTech and NIHR D4D, as well as the recently announced National Centre for Child Health Technology [72], have been established to identify and validate unmet needs, support collaborations across private and public sectors, provide a scalable offering of support to industry, secure funding for health technology that directly addresses the unique needs of CYP, and support the evaluation, spread, and adoption of novel technologies. The involvement of CYP in this process is essential to ensure that technology is fit for purpose. Additionally, radical thinking across infrastructure that spans childhood touch points (education, health, wider society) and dedicated recurrent funding to drive collaboration across industry, academics, health and CYP will enhance ‘market pull’ and ‘technology push’ allowing the latest technology advances to be created and developed with minimal barriers for the benefit of CYP.

Acknowledgements

The research reported in this publication was supported by the National Institute for Health Research (NIHR) Children and Young People MedTech Co-operative. The views expressed are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. The authors would like to thank the children, young people, and families who contributed to the case studies outlined.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This paper was funded by the National Institute for Health Research (NIHR) Devices for Dignity MedTech Co-operative (D4D) and NIHR Children and Young People MedTech Co-operative (CYP MedTech). The “3D printing non-invasive ventilation masks” case study was funded by NIHR Invention for Innovation; the “​​Developing mini-capsules to manage constipation” case study was funded by NIHR Invention for Innovation; the “A network approach to developing prosthetics” case study was funded by the Department of Health and Social Care; the “Augmented reality to improve vision” case study was funded by The Children’s Hospital Charity; and the “Immersive virtual reality for upper limb injuries” case study was funded by the Medical Research Council.