An infant simulator programme did not reduce teenage pregnancy
Study design Design: Randomised cluster control trial. Allocation: Schools were randomised 1:1 intervention:control. Randomisation undertaken using random number tables without stratification or blocking. Blinding: Unblinded. Study question Setting: 57 high schools (excluding Catholic schools) in Perth, Western Australia. Participants: 2834 girls aged 13–15 enrolled at an included high school who were nulliparous, 1267 in the intervention schools and 1567 in the control schools. Intervention: Each girl was assigned to care for an infant simulator (Baby Think It Over) doll for 64 hours. The simulator replicates t...
Source: Archives of Disease in Childhood - Education and Practice - May 16, 2017 Category: Pediatrics Authors: Perez-Gaxiola, G. Tags: Journalology, Picket, Pregnancy, Reproductive medicine, Adolescent health, Child health, Competing interests (ethics), Ethics of abortion, Ethics of reproduction Structured abstracts of sentinel articles: picket Source Type: research

Thumb-sucking or nail-biting in childhood led to a reduction in atopic sensitisation but not asthma or hay fever
Study design Design: Prospective longitudinal population-based birth cohort study. Study question Do children who have oral habits (thumb-sucking or nail-biting) have a lower risk of developing atopic sensitisation, asthma and hay fever? Setting: Dunedin, New Zealand, participants born in 1972–1973. Cohorts: A birth cohort of 1037 participants was asked multiple questions at multiple time points. For this study, ‘oral habits’ (frequently sucked their finger/thumb or bit their nails) were assessed at 5, 7, 9 and 11 years. Outcomes: 11 or 12 panel skin prick testing at age 13 and 32 years. Atopic ...
Source: Archives of Disease in Childhood - Education and Practice - May 16, 2017 Category: Pediatrics Authors: Roked, F., North, J. Tags: Journalology, Epidemiologic studies, Picket, Immunology (including allergy), Child health, Asthma, Dermatology, Ear, nose and throat/otolaryngology STRUCTURED ABSTRACTS OF SENTINEL ARTICLES: PICKET Source Type: research

A neonate with abdominal distension and failure to thrive
A full-term male was born after a pregnancy complicated between 22 and 31 weeks of gestation by non-immune hydrops fetalis (NIH). At 48 h of life, the physical examination revealed jaundice, which was treated successfully with conventional phototherapy for 24 h, and mild hepatomegaly, which was not promptly investigated. At 20 days of life, the patient presented with a clinical picture of failure to thrive and significant abdominal distension (figure 1). Liver and spleen were palpable at 7 and 8 cm below the costal margin, respectively. The patient was dystrophic without dysmorphic features or sign...
Source: Archives of Disease in Childhood - Education and Practice - May 16, 2017 Category: Pediatrics Authors: Tadiotto, E., Maines, E., Degani, D., Banzato, C., Balter, R., Gugelmo, G., Dardis, A., Giordano, G., Bordugo, A. Tags: Liver disease, Pancreas and biliary tract, Oncology, Immunology (including allergy), Travel medicine, Tropical medicine (infectious diseases), Echocardiography, Pregnancy, Reproductive medicine, Failure to thrive, Radiology, Physiotherapy, Cystic fibrosis Source Type: research

Developing immunotherapies for childhood cancer
Introduction The development of immune-based treatment (immunotherapy) for childhood cancer is a rapidly advancing field with impressive results already achieved in children with leukaemia.1 2 For cancers resistant to conventional treatments, harnessing the power and specificity of the immune system to fight cancer is one of several current avenues of research. The immune system is essential for controlling cancer progression by continual surveillance and elimination of transformed cells. This protective process is hindered by the ability of cancer cells to develop mechanisms enabling them to ‘hide’ from immune...
Source: Archives of Disease in Childhood - Education and Practice - May 16, 2017 Category: Pediatrics Authors: Capsomidis, A., Anderson, J. Tags: Oncology, Immunology (including allergy), Drugs: infectious diseases, Vaccination / immunisation, Dermatology, Guidelines Research in practice Source Type: research

Newborn pulse oximetry screening in practice
The concept of using pulse oximetry (PO) as a screening test to identify newborn babies with critical congenital heart defects (CCHD) before life-threatening collapse occurs has been debated for some time now. Several recent large studies have consistently shown that PO screening adds value to existing screening techniques with over 90% of CCHDs detected. It can also help identify newborn babies with low oxygen saturations due to infection, respiratory disease and non-critical CCHD. Many countries have now introduced PO screening as routine practice, and as screening gains more widespread acceptance in the UK, we have focu...
Source: Archives of Disease in Childhood - Education and Practice - May 16, 2017 Category: Pediatrics Authors: Ismail, A. Q. T., Cawsey, M., Ewer, A. K. Tags: Problem solving in clinical practice Source Type: research

How to use... urine dipsticks
‘Urine dipstick’, the commonly used point-of-care test, is an extremely sensitive investigation. Results of this test affected by numerous factors, if not meticulously linked with detailed history and examination, can lead a well-meaning clinician down the wrong clinical pathway. The aim of this article is to provide an overview of this every day test, touching on the physiological and technological basis initially, but mainly focusing on common questions like when to request the dipstick test, the correlation of dipstick results with urine specimen collected by different method and complexities of interpretati...
Source: Archives of Disease in Childhood - Education and Practice - May 16, 2017 Category: Pediatrics Authors: Cyriac, J., Holden, K., Tullus, K. Tags: Interpretations Source Type: research

How to use... white blood cell enzyme assays
White blood cell (leucocyte) enzyme assays are an important part of the investigation of potential metabolic disorders, in particular, lysosomal storage disorders. It is imperative that appropriate tests are selected, and that knowledge of the limitations of these assays is applied to avoid erroneous conclusions about confirmation or exclusion of diagnoses. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - May 16, 2017 Category: Pediatrics Authors: Davison, J. Tags: Interpretations, Immunology (including allergy), Metabolic disorders Source Type: research

Tuberculosis (NICE clinical guideline 33)
Introduction The UK has one of the highest rates of tuberculosis (TB) in Western Europe.1 If current trends continue, with over 7500 cases per year,2 England will overtake the whole of the USA in the annual number of TB notifications within the next 2 years.3 TB disease in UK children is relatively rare with
Source: Archives of Disease in Childhood - Education and Practice - May 16, 2017 Category: Pediatrics Authors: Turnbull, L., Bell, C., Child, F. Tags: Guideline review Source Type: research

Unexpected bilateral cranial swellings in a neonate
A 9-day-old male child born to a 24-year-old mother with three previous healthy children (one boy and two girls) was admitted with gradually increasing swellings over both parietal regions (figure 1), which was noticed on day 3 of life. He was a full-term normal vaginal delivery after an uneventful antenatal period, weighing 2.5 kg. The cutting of the umbilical cord was not associated with excessive bleeding. Vitamin K had been given intramuscularly at birth. A physical examination revealed a haemodynamically stable but pale baby with bilaterally symmetrically soft, fluctuant swellings measuring 3.5–4 cm in...
Source: Archives of Disease in Childhood - Education and Practice - May 16, 2017 Category: Pediatrics Authors: Dipak, N. K., Nanavati, R. N., Kabra, N. K. Tags: Immunology (including allergy), Neurological injury, Radiology, Clinical diagnostic tests, Radiology (diagnostics), Trauma, Metabolic disorders, Injury Epilogue Source Type: research

Fifteen-minute consultation: problems in the healthy paediatrician--managing the effects of shift work on your health
"You're not healthy unless your sleep is healthy" Professor William Dement, Stanford University, one of the founders of modern sleep medicine Sleep is fundamental to good health. Healthcare professionals receive little teaching on the importance of sleep, particularly with respect to their own health when working night shifts. Knowledge of basic sleep physiology, together with simple strategies to improve core sleep and the ability to cope with working nights, can result in significant improvements both for healthcare professionals and for the patients they care for. (Source: Archives of Disease in Childhood - ...
Source: Archives of Disease in Childhood - Education and Practice - May 16, 2017 Category: Pediatrics Authors: Farquhar, M. Tags: Best practice Source Type: research

Fifteen-minute consultation: investigation and management of an infant with stridor
We present a structured approach to guide the clinician through initial assessment, examination and management, including referral to ENT surgery. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - May 16, 2017 Category: Pediatrics Authors: Hoskison, E., Grainger, J. Tags: Best practice Source Type: research

Fifteen-minute consultation: the complexities of empirical antibiotic selection for serious bacterial infections--a practical approach
Potentially life-threatening infections require immediate antibiotic therapy. Most early stage antibiotic treatment for these infections is empirical, that is, covering a range of possible target bacteria while awaiting culture results. Empirical antibiotic regimens need to reflect the epidemiology of most likely causative bacteria, type of infection and patient risk factors. Summary data from relevant isolates in similar patients help to identify appropriate empirical regimens. At present, such data are mostly presented as hospital or other aggregate antibiograms, showing antimicrobial susceptibility testing results by ba...
Source: Archives of Disease in Childhood - Education and Practice - May 16, 2017 Category: Pediatrics Authors: Bielicki, J. A., Cromwell, D. A., Sharland, M. Tags: Oncology, Best practice, Drugs: infectious diseases Source Type: research

Fifteen-minute consultation: perinatal palliative care
Perinatal palliative medicine is an emerging subspecialty within paediatric palliative medicine, neonatal medicine, fetal medicine and obstetrics. It comprises patient-focused, non-judgemental shared decision making and aims to provide holistic multidisciplinary support for families. In this paper we define and describe one model for providing perinatal palliative care, drawing on the personal and professional experience of the authors. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - May 16, 2017 Category: Pediatrics Authors: Sidgwick, P., Harrop, E., Kelly, B., Todorovic, A., Wilkinson, D. Tags: Obstetrics and gynaecology, Best practice, Hospice Source Type: research

Highlights from this issue
In 1989 a US military action to capture Panamanian dictator, Manuel Noriega, saw him granted sanctuary in the Apostolic Nunciature in Panama City. For the military to have invaded what was effectively an embassy of the Roman Catholic church would have provoked widespread outrage, and so the besieging forces needed a different strategy to capture their man. What they did would be familiar to anyone who has shared a house with a recently born human, or has worked a nightshift—they deprived him and everyone else inside of sleep. In addition to gunning their engines incessantly, they landed helicopters on a bulldozed pat...
Source: Archives of Disease in Childhood - Education and Practice - May 16, 2017 Category: Pediatrics Authors: Wacogne, I. Tags: Editor's choice Epistle Source Type: research

Thank you to our reviewers 2016
The Editor would like to publicly acknowledge the people listed below who served as reviewers on the journal during 2016. Without their efforts, the quality of the journal could not be sustained. Aarnoudse-Moens, Cornelieke Aarvold, Alexander Abdalla, Safa Abdel-Rahim, Ali Abdel-Rahman, Susan Absoud, Michael Abu-Arafeh, Ishaq Acerini, Carlo Aceti, Arianna Adappa, Roshan Ades, Anne Afzal, Nadeem Agarwal, Shakti Agopian, A.J. agrawal, shakti Ahmed, Mansoor Ainsworth, Sean Akikusa, Jonathan Alansari, Khalid Alexander, Mark Alimovic, Sonja Allegaert, Karel Allegaert, Karel Allen, Stephen Allport, Tom Almossawi, Ofran Alonge, O...
Source: Archives of Disease in Childhood - Education and Practice - May 16, 2017 Category: Pediatrics Tags: Thank you to our reviewers 2016 Source Type: research

The 100 000 Genomes Project: What it means for paediatrics
The 100 000 Genomes Project is a unique, national programme combining research and transformation of clinical care, by undertaking whole genome sequencing (WGS) in patients with rare diseases and cancer. Made possible by technological advances in next-generation sequencing1 and falling costs, this project aims to find the genes which cause a patient's rare disease and identify genetic changes which occur in the tumour of a child or adult with cancer, to understand the mechanism of disease and develop therapies to personalise treatment. Patients are recruited through the National Health Service (NHS) and their medical ...
Source: Archives of Disease in Childhood - Education and Practice - March 19, 2017 Category: Pediatrics Authors: Griffin, B. H., Chitty, L. S., Bitner-Glindzicz, M. Tags: Research in Practice Source Type: research

Diabetes insipidus and the use of desmopressin in hospitalised children
Introduction In February 2016, NHS England released a patient safety alert highlighting the associated mortality and morbidity when desmopressin is omitted in individuals with cranial diabetes insipidus (DI).1 Over a 7-year period, the UK National Reporting and Learning System had identified 76 near misses, 56 dosing errors leading to harm and 4 cases where desmopressin omission has resulted in severe dehydration and death.1 Gleeson et al,2 concerned about the care of adult patients with DI when admitted to hospital, recently reported a retrospective audit in which desmopressin was missed or delayed in 88% of admissions in...
Source: Archives of Disease in Childhood - Education and Practice - March 19, 2017 Category: Pediatrics Authors: Elder, C. J., Dimitri, P. J. Tags: Pharmacy update Medicines update Source Type: research

Integrating teaching into everyday clinical practice
The teaching and training of doctors-in-training in paediatrics has become increasingly challenging in recent times. All too often there is a perception that training must come second to service provision. In this article, the case of a child with community-acquired pneumonia is considered and used to illustrate how a culture of teaching can be embedded in everyday clinical practice. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - March 19, 2017 Category: Pediatrics Authors: King, D., West, N., Elder, C. Tags: Learning and teaching Source Type: research

What do I need to know about aminoglycoside antibiotics?
The aminoglycosides are broad-spectrum, bactericidal antibiotics that are commonly prescribed for children, primarily for infections caused by Gram-negative pathogens. The aminoglycosides include gentamicin, amikacin, tobramycin, neomycin, and streptomycin. Gentamicin is the most commonly used antibiotic in UK neonatal units. Aminoglycosides are polar drugs, with poor gastrointestinal absorption, so intravenous or intramuscular administration is needed. They are excreted renally. Aminoglycosides are concentration-dependent antibiotics, meaning that the ratio of the peak concentration to the minimum inhibitory concentration...
Source: Archives of Disease in Childhood - Education and Practice - March 19, 2017 Category: Pediatrics Authors: Germovsek, E., Barker, C. I., Sharland, M. Tags: Pharmacy update Medicines update Source Type: research

A congenital purplish tumour
An ethnic Bengali baby boy presented at birth with a purplish tender lesion on the medial side of his right knee (figure 1A). In the following weeks, the lesion remained stable in size. An ultrasound scan showed a solid mass, slightly heterogeneous, with a vascular pole but no bone involvement (figure 1B). Question 1 What is your diagnosis?Congenital haemangioma Vascular malformations Infantile myofibroma Malignant tumours Tufted angioma Answer 1 The correct answer is E. Tufted angioma (TA) represents a benign vascular tumour that may be congenital, acquired, sporadic or hereditary.1 It usually occurs during infancy or ear...
Source: Archives of Disease in Childhood - Education and Practice - March 19, 2017 Category: Pediatrics Authors: Matarazzo, L., Delise, A., Zennaro, F., Bussani, R., Demarini, S., Berti, I., Ventura, A. Tags: Oncology, Surgery, Immunology (including allergy), Child health, Pathology, Radiology, Dermatology, Surgical diagnostic tests, Clinical diagnostic tests, Radiology (diagnostics) Epilogue Source Type: research

Handy paediatric dermatology
Dermatological hand signs are common and can be benign (with or without treatment implications), linked to a change in patient's behaviour or herald more severe systemic conditions (dermatomyositis). Despite the peculiarity of underlying diseases, their visual appearances may overlap and sometimes be deceptive. It is therefore important for clinicians to be aware of the possible similarities in such diverse conditions, in order to make a correct diagnosis and target treatment. Which would be the most likely diagnosis for each image based on the cases below: Gottron's papules Psoriasis Cutaneous T-cell lymphoma Chewing pads...
Source: Archives of Disease in Childhood - Education and Practice - March 19, 2017 Category: Pediatrics Authors: Valerio, E., Parata, F., Cutrone, M. Tags: Dermatophile Source Type: research

Fifteen-minute consultation: Approach to the child with an acute confusional state
Acute confusional state (ACS) refers to sudden impairment of cognitive function and represents a major medical emergency. The impairment may be global or confined specifically to a particular faculty of higher mental function, such as memory. This review highlights the importance of relevant medical history and clinical signs and symptoms in reaching the correct diagnosis. In this review, we have presented a diagnostic approach to a child presenting with ACS and described commonly encountered causes, their treatments and outcomes. We have also presented an algorithm for the diagnostic approach to the child with ACS. (Sourc...
Source: Archives of Disease in Childhood - Education and Practice - March 19, 2017 Category: Pediatrics Authors: Prasad, M., Seal, A., Mordekar, S. R. Tags: Best practice Source Type: research

Fifteen-minute consultation: enterovirus meningitis and encephalitis--when can we stop the antibiotics?
Enterovirus (EV) is the most common cause of aseptic meningitis and has a benign course, unlike EV encephalitis, which can result in long-term neurological sequelae. There are no active treatments or prophylactic agents, and management is purely supportive. Obtaining an EV-positive cerebrospinal fluid result usually allows antimicrobial treatment to be stopped. This review will answer some of the common questions surrounding EV meningitis/encephalitis. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - March 19, 2017 Category: Pediatrics Authors: Drysdale, S. B., Kelly, D. F. Tags: Best practice, Drugs: infectious diseases, Meningitis, Infection (neurology) Source Type: research

Management of children and young people with headache
Headache is very common in children and young people. The correct advice and treatment requires consideration of a wide differential diagnosis between primary and secondary headaches, and also of the different types of primary headache. The International Classification of Headache Disorders gives useful descriptions and diagnostic criteria that are especially useful for primary headaches. The National Institute for Health and Care Excellence (NICE) Clinical Guideline 150 provides evidence-based recommendations on treatments for adults and young people from age 12 years. However, the same principles can be applied to y...
Source: Archives of Disease in Childhood - Education and Practice - March 19, 2017 Category: Pediatrics Authors: Whitehouse, W. P., Agrawal, S. Tags: Editor's choice Review Source Type: research

Highlights from this issue
Some of the better advice I had when I first became a consultant was from the colleague who, when the scenario had been carefully described, would say ‘If I were you, I’d fan that with my hat’. Of course, I may be slightly misquoting, but to try to explain the idiom a little, it describes a situation in which the best action is inaction. Inaction is a tremendously underrated skill, because when initially described it sounds like a negative. I don’t get the impression that many families leave a consultation and think to themselves: ‘Well, that’s excellent, we’re going to do nothing ...
Source: Archives of Disease in Childhood - Education and Practice - March 19, 2017 Category: Pediatrics Authors: Wacogne, I. Tags: Epistle Source Type: research

Correction
‘Infants with artificially elevated pulse oximetry levels less likely to be hospitalised during an episode of mild to moderate bronchiolitis’ (Arch Dis Child Ed Pract 2016;101:162–3). The authors omitted the complete reference for the first abstracted article entitled ‘Infants with artificially elevated pulse oximetry levels less likely to be hospitalised during an episode of mild to moderate bronchiolitis’. The authors would like to apologise for the oversight. The full reference for the abstracted paper is as follows: Schuh S, Freedman S, Coates A, et al. Effect of oximetry on hospitalizatio...
Source: Archives of Disease in Childhood - Education and Practice - January 17, 2017 Category: Pediatrics Tags: Correction Source Type: research

Training in research competencies: a strategy for neonatology
The report ‘Turning the tide’ highlighted the need to increase the capacity for clinical research in child health.1 The increase in training posts funded by the National Institute for Health Research (NIHR) will slow the fall in academic consultant positions.2 The rapid growth in clinical trials in neonatology (figure 1), however, means that all neonatal professionals need to have the necessary awareness and skills. Research involvement within a clinical service should be considered a sign of healthcare quality.3 With the separation of academic and clinical specialist training, most trainees have little involve...
Source: Archives of Disease in Childhood - Education and Practice - January 17, 2017 Category: Pediatrics Authors: Menon, G., Turner, M. A., Ogilvy-Stuart, A. L., Greenough, A. Tags: Research in Practice Source Type: research

What do I need to know about penicillin antibiotics?
The penicillins remain the class of antibiotics most commonly prescribed to children worldwide. In an era when the risks posed by antimicrobial resistance are growing, an understanding of antibiotic pharmacology and how to apply these principles in clinical practice is increasingly important. This paper provides an overview of the pharmacology of penicillins, focusing on those aspects of pharmacokinetics, pharmacodynamics and toxicity that are clinically relevant in paediatric prescribing. Penicillin allergy is frequently reported but a detailed history of suspected adverse reactions is essential to identify whether a clin...
Source: Archives of Disease in Childhood - Education and Practice - January 17, 2017 Category: Pediatrics Authors: Barker, C. I., Germovsek, E., Sharland, M. Tags: Pharmacy update, Immunology (including allergy), Drugs: infectious diseases Medicines update Source Type: research

How to use... serum creatinine, cystatin C and GFR
Glomerular filtration rate (GFR) is the best overall measure of kidney function. The GFR is relatively low at birth but increases through infancy and early childhood to reach adult levels of approximately 120 mL/min/1.73 m2 by age 2. While GFR can be measured most accurately by the urinary clearance of an exogenous ideal filtration marker such as inulin, it is more clinically useful to estimate GFR using a single serum measurement of an endogenous biomarker such as creatinine or cystatin C. When in steady state, there is an inverse relationship between creatinine/cystatin C and GFR, allowing GFR to be estimated f...
Source: Archives of Disease in Childhood - Education and Practice - January 17, 2017 Category: Pediatrics Authors: Pasala, S., Carmody, J. B. Tags: Urology, Interpretations, Childhood nutrition, Diet, Childhood nutrition (paediatrics), Renal medicine Source Type: research

How to use a controlled fast to investigate hypoglycaemia
Controlled fasts can play a valuable role in the diagnosis and management of hypoglycaemia in paediatric clinical practice, but are no substitute for the collecting of appropriate critical samples at the time of hypoglycaemia for metabolic and endocrine studies. Fatty acid oxidation defects, hyperinsulinism and adrenal insufficiency should always be excluded prior to organising controlled fasts. Controlled fasts are safe if conducted in an experienced setting with strict protocols in place. Failure to adhere to protocol can defeat the purpose of the study and can potentially be dangerous. Proper planning in conjunction wit...
Source: Archives of Disease in Childhood - Education and Practice - January 17, 2017 Category: Pediatrics Authors: Sreekantam, S., Preece, M. A., Vijay, S., Raiman, J., Santra, S. Tags: Editor's choice, Interpretations, Adrenal disorders, Diabetes, Drugs: endocrine system, Metabolic disorders Source Type: research

Challenging behaviour and learning disabilities: prevention and interventions for children with learning disabilities whose behaviour challenges: NICE guideline 2015
Information about current guideline In May 2015, the National Institute for Health and Care Excellence (NICE) published guidance entitled ‘Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges’.1 The guideline concerns children (aged 12 years or younger) and young adults (13–17 years) covering principles of management. Previously published guidance The British Psychological Society published a report entitled ‘Challenging behaviour: a unified approach’ in 2007.2 This guideline was developed for c...
Source: Archives of Disease in Childhood - Education and Practice - January 17, 2017 Category: Pediatrics Authors: Tanwar, M., Lloyd, B., Julies, P. Tags: Guideline review, Pain (neurology), Child and adolescent psychiatry (paedatrics), Disability, Screening (epidemiology), Screening (public health) Source Type: research

NICE clinical guideline NG39: Major trauma: assessment and initial management
Background Major trauma is the most frequent cause of death in the UK for children aged between 1 and 18 years. It is responsible for 31% of deaths in children aged 1–4 years, increasing to 48% of deaths in young people aged 15–18 years.1 The most common mechanism of injury is high-energy blunt trauma from road traffic collisions. This mechanism is responsible for 41% of injury deaths in children (1–9 years old) and 77% among young people (10–18 years old).2 One of the great advances in outcomes for children has been the development of paediatric major trauma centres (MTCs) withi...
Source: Archives of Disease in Childhood - Education and Practice - January 17, 2017 Category: Pediatrics Authors: Kanani, A. N., Hartshorn, S. Tags: Guideline review, Resuscitation, Trauma, Injury Source Type: research

Congenital abdominal wall defects
Background A 24-year-old Caucasian, nulliparous woman had an abnormal antenatal ultrasound scan at 14 weeks gestation (see figure 1). A repeat scan at 20 weeks confirmed the findings. A fetomaternal medicine consultant counselled parents. At 33+5 weeks gestation, she delivered a 1.9 kg male infant by caesarean section for fetal distress following spontaneous preterm labour. QUESTION 1 What is the anomaly seen? A. Bladder exstrophy B. Abdominal wall defect C. Umbilical hernia You are the paediatric registrar on call and have been called to attend the delivery of the baby. You arrive with the neonatal team. A ...
Source: Archives of Disease in Childhood - Education and Practice - January 17, 2017 Category: Pediatrics Authors: Varghese, A. S., Vause, S., Kamupira, S. R., Emmerson, A. J. B. Tags: Obstetrics and gynaecology, Urology, Drugs: infectious diseases, Pregnancy, Reproductive medicine, Neonatal and paediatric intensive care, Radiology, Renal medicine, Neonatal intensive care, Clinical diagnostic tests, Radiology (diagnostics) Epilogue Source Type: research

Setting up a clinic to assess children and young people for female genital mutilation
It is now mandatory for health, social care professionals and teachers to report to the police all under-18s where female genital mutilation (FGM) has been disclosed by the child or where physical signs of FGM are seen. Such referrals are likely to result in a request for medical examination. New multiagency statutory guidance sets out instructions for physical examination but provides no details how services should be set-up. This review gives practical guidance learnt from the first year of the UK's only dedicated children's FGM service. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - January 17, 2017 Category: Pediatrics Authors: Hodes, D., Creighton, S. M. Tags: Best practice Source Type: research

Fifteen-minute consultation on the healthy child: breast feeding
Despite extensive evidence about the benefits of breast feeding for both infants and mothers, breastfeeding rates in the UK remain low. Most infants presenting with feeding issues are otherwise well but are often over diagnosed with clinical conditions such as maternal milk insufficiency, cow's milk intolerance or reflux. With simple advice and troubleshooting common problems, all child health professionals can support mothers to establish and continue breast feeding exclusively for longer. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - January 17, 2017 Category: Pediatrics Authors: Cleugh, F., Langseth, A. Tags: Best practice, Childhood nutrition, Reproductive medicine, Infant nutrition (including breastfeeding) Source Type: research

Fifteen-minute consultation: the child with systemic arterial hypertension
This article presents a systematic approach to the evaluation of a child with arterial hypertension, highlighting important points on history and examination, out-of-office monitoring and baseline investigations before consideration for more detailed investigations and treatment. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - January 17, 2017 Category: Pediatrics Authors: Singh, C., Jones, H., Copeman, H., Sinha, M. D. Tags: Best practice Source Type: research

Highlights from this issue
I've written before about how working with a bright bunch of editors keeps me very widely informed. A bit like working in any team, by dividing up responsibilities we are able to keep abreast of a good range of what's going on. It's for this reason that I know about the NICE guidance—actually published in 2015—on managing behaviour that challenges in children with learning difficulties (see page 24). Naturally, while I try to read this article from Tanwar, Lloyd and Julies with an eye on how I'm going to advise and support patients, selfishness also always slips in, and I'm squirrelling this one away for use wh...
Source: Archives of Disease in Childhood - Education and Practice - January 17, 2017 Category: Pediatrics Authors: Wacogne, I. Tags: Epistle Source Type: research

Improving motor development in infancy with iron supplementation
Study design Design: Four-group factorial, individually randomised placebo-controlled trial. Allocation: Allocation concealed: randomisation was undertaken by a remote statistician. Pregnant women were assigned to iron and folic acid (active) or folic acid alone. Their newborns were allocated to iron or a placebo control. Blinding: Supplements were delivered in identical dark bottles. Mothers and assessors were blinded. Study question Setting: Hebei, China. A community-based study randomising pregnant woman between June 2009 and December 2011and their babies between December 2009 and June 2011. Patients: 1482 infants of 23...
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2016 Category: Pediatrics Authors: Pedley, M., Brown, N. Tags: Clinical trials (epidemiology), Picket, Drugs: CNS (not psychiatric), Malnutrition, Pregnancy, Reproductive medicine, Developmental paediatrics STRUCTURED ABSTRACTS OF SENTINEL ARTICLES: Picket Source Type: research

Correction
Infants with artificially elevated pulse oximetry levels less likely to be hospitalised during an episode of mild to moderate bronchiolitis (Arch Dis Child Ed Pract 2016;101:162–3). The authors omitted the complete reference for the first abstracted article. The authors would like to apologise for the oversight. The full reference for the abstracted paper is as follows: Schuh S, Freedman S, Coates A, et al. Effect of oximetry on hospitalization in bronchiolitis: a randomized clinical trial. JAMA 2014;312:712–8. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2016 Category: Pediatrics Tags: Correction Source Type: research

Paracetamol: pharmacology, prescribing and controversies
Indications and mechanism of action Paracetamol (internationally known as acetaminophen) is the most common medicine encountered in paediatric practice. It is used widely by parents and health professionals and it has analgesic and antipyretic effects. Its short-term safety and efficacy are well established and it is readily available for purchase over the counter. Its mechanism of action is not fully understood but it is known to inhibit prostaglandin synthesis and is highly selective for cyclooxygenase enzymes in the central nervous system. It also has a weak anti-inflammatory action. An understanding of its pharmacology...
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2016 Category: Pediatrics Authors: Moriarty, C., Carroll, W. Tags: Editor's choice, Immunology (including allergy), Pain (neurology), Child health, Infant health, Neonatal health, Pain (palliative care), Rheumatology, Poisoning, Occupational and environmental medicine Research in practice Source Type: research

Ibuprofen in paediatrics: pharmacology, prescribing and controversies
This article aims to describe the indications and mode of action of the drug, outline its pharmacokinetics and highlight the important key messages regarding its use in clinical practice. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2016 Category: Pediatrics Authors: Moriarty, C., Carroll, W. Tags: Pharmacy update Medicines update Source Type: research

What do I need to know about glycopeptide antibiotics?
This article reviews the pharmacology of the commonly used glycopeptides, vancomycin and teicoplanin, and discusses the practical aspects of their use in the clinical setting. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2016 Category: Pediatrics Authors: Li, S., Starkey, E. S. Tags: Pharmacy update, Drugs: infectious diseases Medicines update Source Type: research

British guideline on the management of asthma: SIGN Clinical Guideline 141, 2014
Clinical bottom line Asthma continues to be one of the most prevalent long-term conditions in childhood and adolescents. Long-term management involves a strong emphasis on supported self-management with the provision of personalised asthma action plans (PAAPs). PAAPs should be reviewed at every clinical encounter alongside review of drug and lifestyle adherence to ensure good asthma control and prevention of asthma attacks. Acute management continues to rest on the prompt delivery of inhaled or nebulised β2 agonists and oral or intravenous corticosteroids with several adjunctive intravenous therapies. Information abou...
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2016 Category: Pediatrics Authors: James, D. R., Lyttle, M. D. Tags: Guideline review, Immunology (including allergy), Adolescent health, Child health, Asthma, Drugs: respiratory system, Guidelines Source Type: research

An unusual cause of back pain
A previously well 10-year-old girl presented with 3 months of L5-S2 back pain. This had started insidiously while in Sudan and woke her nightly. She reported 5 days of constipation and urinary frequency but no neurological symptoms, fevers or weight loss. Her body mass index was normal and she was premenarchal, although had signs of thelarche. Cardiovascular and respiratory examinations were normal. Routine observations were unremarkable. She reported L5-S2 pain upon lumbar extension (not present on palpation). No neurological signs were elicited. Abdominal examination revealed suprapubic fullness, clinically tho...
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2016 Category: Pediatrics Authors: Malley, M., Monaghan, M., Esmail, A., Neophytou, C., Cheng, A. Tags: Oncology, Surgery, Bone and joint infections, Pain (neurology), Reproductive medicine, Child health, Pain (palliative care), Radiology, Rheumatology, Surgical diagnostic tests, Clinical diagnostic tests, Radiology (diagnostics) Epilogue Source Type: research

Quality improvement project to reduce paediatric prescribing errors in a teaching hospital
A quality improvement project to reduce paediatric prescribing errors was carried out in a London teaching hospital between June 2013 and March 2014. It involved paediatric medical and surgical wards and a paediatric intensive care unit. A multi professional team of ‘prescribing champions’ was formed. Baseline audit identified high prescribing error rate. Prescribing standards were taught through workshops and ‘prescribing test’. Feedback of weekly sampling and ‘star chart game’ led to an initial improvement of prescribing errors which was not sustained. Qualitative feedback showed incre...
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2016 Category: Pediatrics Authors: Leach, M. E. H., Pasha, N., McKinnon, K., Etheridge, L. Tags: Medicines regulation E[amp ]P: quality improvement Source Type: research

Public health for paediatricians: population screening
Introduction The concept of population screening—proactive identification of a condition, disease or predisease state in individuals who presume themselves to be healthy but may benefit from early treatment—is a simple one. The translation of this into a screening programme often raises ethical, conceptual and practical challenges. For clinicians used to dealing with patients symptomatically, there are several key differences to understand between treating patients symptomatically compared with the approach to supporting the delivery of a screening programme. There is a range of definitions of screening, which ...
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2016 Category: Pediatrics Authors: Streetly, A., Madden, V. Tags: Drugs: CNS (not psychiatric), Stroke, Hypertension, Pregnancy, Reproductive medicine, Child health, Neonatal health, Screening (epidemiology), Health promotion, Screening (public health) Source Type: research

Febrile neutropenia and refeeding syndrome
This article reviews the current literature and provides useful guidance on these issues. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2016 Category: Pediatrics Authors: Jahn, H. K., Barraclough, S., Currell, S., Tighe, M. P. Tags: Oncology, Epidemiologic studies, Problem solving in clinical practice, Child health Source Type: research

Fifteen-minute consultation: supporting bereaved parents at the time of a child's death
If you are facing a discussion with parents whose child has died, your humanity is as important as your clinical knowledge and skill. Nothing you can say will ever take away the emotional pain they are facing but your involvement on a very human level will make a difference. Listening builds a trusting relationship and is essential if families are to be responded to effectively. The key components needed for good support are honesty, information, choices and time. Parents need to be guided through what will happen next and to know who to turn to when they leave the hospital. They should be offered a follow-up appointment. ...
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2016 Category: Pediatrics Authors: Laurent, S., Samuel, J., Dowling, T. Tags: Best practice, Pain (neurology) Source Type: research

Fifteen-minute consultation: safety assessment prior to discharge of patient admitted for self-harm
Paediatricians often admit young people who have self-harmed, as advised by the National Institute for Health and Care Excellence guidelines. A full psychosocial assessment is essential to understand the underlying needs and risks. In this paper we focus on what the discharging doctor needs to know to arrange for a safe discharge. This involves reviewing the admission notes for red flags. We also give advice on the verbal and non-verbal communication skills needed to contain both the doctor's and the patient's difficult feelings. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2016 Category: Pediatrics Authors: Swanepoel, A. Tags: Best practice Source Type: research

Fifteen-minute consultation: the agar plates your microbiology colleagues want you to be scared about
The WHO has recognised antibiotic resistance as one of the greatest threats to human health. As a microbiologist, antibiotic resistance is a problem that keeps me awake at night and inevitably the impact of antibiotic resistance on paediatricians is a matter of when, and not if. I fear for the future of paediatric services such as neonatology, oncology and elective surgery. A recent US study found that 26.8% of post chemotherapy infections and 38.7–50.9% of post-operative infections were caused by bacteria resistant to standard antibiotic prophylaxis. The authors predicted that this will lead to an additional 6300 in...
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2016 Category: Pediatrics Authors: Winzor, G., Gray, J., Patel, M. Tags: Epidemiologic studies, Best practice, Drugs: infectious diseases Source Type: research