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How to interpret spirometry in a child with suspected asthma
This article outlines some of the technical aspects of spirometry together with how the forced expiration manoeuver and bronchodilator responsiveness testing can be performed and interpreted in a child with suspected asthma. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2022 Category: Pediatrics Authors: Brown, A., McNaughten, B., Russell, C., Watters, P., O'Donoghue, D. Tags: Review Source Type: research

Lips do not lie
A 14-year-old boy presented with an 18-month history of lower lip swelling (figures 1 and 2). There was no history of associated trauma or pain. Occasional episodes of runny stools with no presence of mucous or blood were described. There was no other history of swelling or pain. There was no early morning worsening of his lower lip swelling or breathing difficulties. No skin rashes or pruritus was reported. He had suffered from mouth ulcers and perianal abscesses requiring surgical intervention when he was 5 years old. Systemic and perianal examination was normal. Urine dipstick revealed no protein/haematuria. Test your k...
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2022 Category: Pediatrics Authors: Haigh, R., Grahame, L., Vallabhaneni, P. Tags: Epilogue Source Type: research

Large skin lesion at birth
Case presentation A large pigmented lesion was noted across the back on a baby boy at birth. He was born to non-consanguineous parents and by an uncomplicated vaginal delivery at 38+1 weeks. He weighed 2.62 kg. There is no family history of similar skin conditions. On examination, there was a large, asymmetrical, heterogeneously pigmented lesion covering most of his back, extending to the buttocks (figure 1). The margins were irregular and did not contain any hair. It measured 21 cm. There were smaller lesions on his face, scalp and lower limbs (figure 2). No other congenital abnormalities were noted. Postnatal baby check ...
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2022 Category: Pediatrics Authors: Elamin, S., Rafferty, B., Hoey, S. Tags: Epilogue Source Type: research

Infant with a cloudy cornea
A 4-month-old boy presents to the emergency department with a cloudy appearance in his left eye, noted by mum on day of attendance. The patient is systemically well with no temperature, no recent illness or ocular trauma. He is not dysmorphic and was born in the UK at term. There is no family history of hereditary ophthalmological conditions. Examination findings are displayed in figures 1 and 2. You note normal pupillary response to light and full range of eye movements without distress. Red reflexes are present. Questions What signs are present in figures 1 and 2? Leucocoria and buphthalmos Buphthalmos and epiphora Epiph...
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2022 Category: Pediatrics Authors: Doherty, S., Tolson, A., McLoone, E., Mullen, S. Tags: Epilogue Source Type: research

Uncommon urticaria
Introduction A 16-year-old girl was evaluated for an episode, which occurred while swimming in the sea, of widespread urticaria, weakness and pharyngeal constriction, tachycardia, paleness and collapse, which resolved with the administration of an oral antihistamine (epinephrine autoinjector was not available). Over the past year, she had also experienced recurring episodes of itchy wheals on her fingertips and hands after taking food from the refrigerator or washing salad with cold water, and a single episode of diffuse urticaria after another dive into the sea, and she reported an episodic sensation of pharyngeal constri...
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2022 Category: Pediatrics Authors: Migliarino, V., Badina, L., Berti, I., Lega, S., Barbi, E. Tags: Epilogue Source Type: research

Fifteen-minute consultation: The approach to the febrile child
This article highlights the importance of identifying children at particular risk of serious bacterial infection (SBI) using risk factors, red flags and appropriate investigations. Emergency clinicians must be aware of the risk factors for SBI in febrile children, including young age, ill-appearing children and those with complex comorbidities or immunodeficiency. The presence of red flags in febrile children should immediately alert concern and prompt senior clinician review. This article also discusses the appropriate use of investigations and their role in complementing clinical assessment. When discharging children hom...
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2022 Category: Pediatrics Authors: Philbin, D., Hall, D. Tags: Best practice and Fifteen Minute Consultations Best practice and Fifteen-minute consultations Source Type: research

Fifteen-minute consultation: Baby with jaundice in the first 2 weeks of life
There are multiple causes of jaundice in the first 2 weeks of life. The aim of this article is to help explain what these causes are and why they occur. It discusses how to focus on the history, examination and investigations in such cases. Initial management will vary depending on the clinical context; as such, this article also outlines the initial management of the most common scenarios. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2022 Category: Pediatrics Authors: Cromb, D., Chowdhury, N., Teoh, S. Tags: Best practice and Fifteen Minute Consultations Best practice and Fifteen-minute consultations Source Type: research

Fifteen-minute consultation: An approach to the management of PIMS-TS in a district general hospital
The COVID-19 pandemic has caused significant disease across the globe but children seem to be much less affected than adults. Coincidentally with the first wave of the pandemic, a cluster of children with fever, hyperinflammation and shock were identified, and this was first described as paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) by the Royal College of Paediatrics and Child Health. Patients with this novel condition were transferred to tertiary centres for management, increasing the pressure in these hospitals that were already extremely busy. There are multiple challenges...
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2022 Category: Pediatrics Authors: Freitas, J., Sanpera, J., Dessouki, T., Rainsley, V., Nyirenda, M., Canet Tarres, A., Thomas, J. Tags: Best practice and Fifteen Minute Consultations, COVID-19 Best practice and Fifteen-minute consultations Source Type: research

Fifteen-minute consultation: Guide to the young person with menorrhagia and dysmenorrhoea
Adolescents who menstruate commonly present to acute paediatric services. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2022 Category: Pediatrics Authors: Griffiths, A. S., Hall, D. Tags: Best practice and Fifteen Minute Consultations Best practice and Fifteen-minute consultations Source Type: research

Community-engaged medical education: helping to address child health and social inequality
Medical education has a key role in helping to address child health and social inequality. In this paper we describe the rationale for developing a community-engaged approach to education, whereby medical schools partner with local communities. This symbiotic relationship enables medical students to experience authentic learning through working with communities to address local health and social priorities. Case studies of how such approaches have been implemented are described, with key takeaway points for paediatric healthcare professionals wanting to develop community-engaged educational initiatives. (Source: Archives o...
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2022 Category: Pediatrics Authors: Parekh, R., Maini, A., Golding, B., Kumar, S. Tags: Public health Source Type: research

Public health for paediatricians: 15-minute guide to identify and address food insecurity
Food insecurity is a major problem in the UK. It has been both highlighted and exacerbated by the COVID-19 pandemic, and particularly affects children and young people (CYP). The effects of inadequate nutrition manifest themselves in all stages of child development and adversely affect health and educational outcomes. Healthcare professionals working with CYP can address food insecurity at individual, local community, organisational and national levels. The government plays an important role in monitoring and responding to food insecurity, supporting CYP most in need. This paper summarises how food insecurity can be identi...
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2022 Category: Pediatrics Authors: Prendergast, M., Kanella, I., Milton-Jones, H., Moula, Z., Scott, K., Shah, R. Tags: COVID-19 Public health Source Type: research

Epistle
I am writing this Epistle with a sense of exhilaration, having recently hiked in Yosemite Valley. Breaths of clean air, gulped among towering cliffs on pine-clad mountains, invigorated my pledge to fight against climate change and safeguard the health of future generations. It also reminded me that as healthcare professionals (HCPs), we have changed from a primary focus on healthcare to jointly prioritising both healthcare and social inequity. This paradigm shift is evident in the articles of this month’s issue. Medical education plays a key role in helping to address health and social inequalities. To improve the de...
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2022 Category: Pediatrics Authors: Gupta, N. Tags: Highlights from this issue Source Type: research

Antenatal dexamethasone reduces risk of neonatal death among women in low-resource countries without an increase in maternal bacterial infection
Study design: Randomised controlled trial. Allocation: Computer-generated randomisation sequence. Binding: Double-blind, parallel group. Setting: 29 secondary and tertiary level hospitals across Nigeria, Kenya, India, Bangladesh and Pakistan. Patients: Women with a gestational age between 26 weeks and 0 days and 33 weeks and 6 days of gestation with risk of preterm birth within next 48 hours were included. Exclusion criteria were women with severe infection, major congenital malformations and, concurrent or recent use of systemic glucocorticoids. Intervention: In ratio of 1:1, a course of 6 mg intramuscular dexamethasone o...
Source: Archives of Disease in Childhood - Education and Practice - September 19, 2022 Category: Pediatrics Authors: Ahmed, A., Brunton, A. Tags: Key publications in paediatrics: Picket Source Type: research

Respiratory syncytial virus vaccination in pregnancy is not effective enough at reducing infant infections
Review of: Madhi SA, Polack F, Piedra P et al. Respiratory syncytial virus vaccination during pregnancy and effects in infants. N Engl J Med 2020;383:426–39. Design: Randomised placebo controlled trial. Allocation: 1:1 (first global season) and 2:1 ratio (subsequent seasons) vaccine to placebo. Blinding: Observer blind. Setting: Multinational (87 sites in 11 countries). Participants: 4636 healthy pregnant women aged 18–40 years between 28 and 36 weeks gestation. Exclusion criteria were essentially any mother with any underlying health condition or on any medication. Intervention: Women were randomised to receiv...
Source: Archives of Disease in Childhood - Education and Practice - September 19, 2022 Category: Pediatrics Authors: Wesley, C., Winckworth, L. C. Tags: Key publications in paediatrics: Picket Source Type: research

What is machine learning?
The term machine learning (ML) is emerging more often in the medical literature. There are successful clinical applications of ML with the specialties of ophthalmology and radiology leading the way. For example, in ophthalmology the diagnosis of diabetic retinopathy and retinopathy of prematurity,1 and in radiology the diagnosis of stroke or cancers from digital images is promising.2 This success is expected to expand into other medical disciplines including general paediatrics and its subspecialties. Therefore, healthcare practitioners and researchers are most likely to benefit from getting familiar with ML terminology in...
Source: Archives of Disease in Childhood - Education and Practice - September 19, 2022 Category: Pediatrics Authors: Baloglu, O., Latifi, S. Q., Nazha, A. Tags: Research in practice Source Type: research