Archives of Disease in Childhood - Education and Practice This is an RSS file. You can use it to subscribe to this data in your favourite RSS reader or to display this data on your own website or blog.

Highlights from this issue
You might know that I’m a generalist, and a fairly noisy one at that. When asked what I specialise in, I reply ‘I specialise in not specialising’. Of course, on quite a few levels that’s absolute nonsense. After all, like most people reading this I’ve made a point in specialising in paediatrics and child health. And it is inevitable that I’ve actively forgotten many of the things that I’ve learnt over the years. Is active forgetting an important part of specialisation? I certainly feel the need to jettison some of the less actively useful information in my head to focus on some ite...
Source: Archives of Disease in Childhood - Education and Practice - March 17, 2022 Category: Pediatrics Authors: Wacogne, I. D. Tags: Epistle Source Type: research

Not measuring residual gastric volumes in preterm infants can increase the progression of enteral nutrition with earlier discharge from hospital
Review of: Parker LA, Weaver M, Murgas Torrazza, et al. Effect of gastric residual evaluation on enteral intake in extremely preterm infants a randomised clinical trial. JAMA Pediatrics 2019;173:534–43. Study design Design: Single centre randomised clinical trial. Allocation: Low risk of randomisation bias, used computer generated sequencing. Unclear risk of allocation concealment bias, not clearly described. Blinding: Not blinded. Study question Setting: Level 4 neonatal unit (regional neonatal intensive care unit), USA. Patients: Infants born at ≤32 weeks’ gestation and ≤1250 g due to be fed human milk....
Source: Archives of Disease in Childhood - Education and Practice - January 20, 2022 Category: Pediatrics Authors: Harrison, C. M., Blythe, C. L. Tags: Picket Key publications in paediatrics: Picket Source Type: research

Triage and resuscitation tools for low and middle income countries: how to catch the killer?
Under-5 mortality rates in low and middle-income countries (LMIC) remain high. One major contributing factor is the failure to recognise critically unwell children when they first present to hospital. This leads to delayed or inadequate resuscitation and an increased risk of death. Triage is a key skill in this setting to sort the queue and prioritise patients, even when staff and equipment are scarce. In LMIC, children generally present late in their illness and often have progressed to some degree of multiorgan dysfunction. Following triage, a structured systematic primary survey is critical to ensure the detection of su...
Source: Archives of Disease in Childhood - Education and Practice - January 20, 2022 Category: Pediatrics Authors: Santhanam, I., Moodley, P., Jayaraman, B., Yock-Corrales, A., Cheema, B., Craig, S., Jahn, H. K. Tags: Open access, Problem solving in clinical practice Source Type: research

Paediatric trainees training experiences during the COVID-19 pandemic: a national survey
This study examines trainees’ experiences of paediatric education and training during the COVID-19 pandemic. Paediatric trainees across the UK undertook an online survey. 368 of approximately 4000 trainees responded; quantitative and qualitative data were collected. Although the majority of trainees remained in their specialties, there was significant disruption to training events, teaching and learning opportunities. Despite this, for many, novel opportunities presented themselves that may not have otherwise been accessible. Trainees reported increased virtual learning, reflection, leadership and management opportun...
Source: Archives of Disease in Childhood - Education and Practice - January 20, 2022 Category: Pediatrics Authors: Harmer, M. J., Southgate, G., Raja, M., Alam, S. Tags: Learning and teaching, COVID-19 Source Type: research

Addressing recruitment and retention in paediatrics: a pipeline to a brighter future
Conclusions While some issues share similarities with other specialties in difficulty, much of the context and potential remedies within paediatrics are distinct. A strategic, multi-agency collaborative approach is required urgently to address the significant issues that face both paediatrics and the healthcare system. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - January 20, 2022 Category: Pediatrics Authors: Mallett, P., Thompson, A., Bourke, T. Tags: Learning and teaching, COVID-19 Source Type: research

How and when to use CSF to investigate neonates and children with possible central nervous system infection
A child presented to the emergency department with fever, reduced consciousness, irritability and reduced oral intake. Infective meningitis and encephalitis were within the differential diagnoses. Is a lumbar puncture (LP) indicated and, if so, what is the optimal timing of LP? Will antimicrobial pretreatment affect the cerebrospinal fluid (CSF) results? How can clinicians optimise diagnostic stewardship to benefit individual patients and society at large? Interpretation of rapidly available CSF biochemical tests (protein, glucose and lactate levels) and microscopy can provide a prompt insight into the infective aetiology ...
Source: Archives of Disease in Childhood - Education and Practice - January 20, 2022 Category: Pediatrics Authors: Winzor, G., Atabani, S. F. Tags: Interpretations Source Type: research

How to use a coagulation screen
A coagulation screen is an important screening test when investigating a child who presents with easy bruising or bleeding. Interpretation of a coagulation screen can be challenging for clinicians. Evolution of the haemostasis system during childhood means normal ranges vary with age and needs to be interpreted alongside the clinical information. It is essential to consider preanalytical variables when interpreting a coagulation screen, and the reason for the investigation must always be considered. It is important that the sample is taken under optimal conditions, including sample technique, use of the correct bottle and ...
Source: Archives of Disease in Childhood - Education and Practice - January 20, 2022 Category: Pediatrics Authors: Kapur, S., Gilmore, M., Macartney, C., Thompson, A. Tags: Interpretations Source Type: research

Clinician guide to COVID-19 diagnostics
Introduction The novel SARS-CoV-2 virus responsible for COVID-19 has resulted in a worldwide pandemic. To curtail the ongoing pandemic, emphasis has been placed on enhanced testing. Consequently, there has been an exponential rise in the number of diagnostic platforms that are available. This review gives an overview of the diagnostic methods for COVID-19, highlighting key considerations needed when interpreting the test results. Physiological background The aims of SARS-CoV-2 testing are to (1) diagnose acute infection in symptomatic patients, (2) screen for and diagnose asymptomatic infection and (3) identify past infect...
Source: Archives of Disease in Childhood - Education and Practice - January 20, 2022 Category: Pediatrics Authors: Iro, M. A., Umpleby, H., Pelosi, E. Tags: Interpretations, COVID-19 Source Type: research

Depression in children and young people: identification and management NICE guidelines
The National Institute for Health and Care Excellence (NICE) published guidelines on depression in children and young people in June 2019.1 The guideline covers the identification and management of depression in young people aged 5–18 years. Based on the stepped-care model, it aims to improve recognition and assessment and promote effective treatments for mild and moderate-to-severe depression. This guideline offers updated guidance following and replacing the previous NICE Clinical Guideline 28 published in 2005. What do I need to know? The stepped-care model of depression provides a framework to support identificat...
Source: Archives of Disease in Childhood - Education and Practice - January 20, 2022 Category: Pediatrics Authors: Luxton, R., Kyriakopoulos, M. Tags: Guideline review Source Type: research

Thyroid disorder in children and young people with Down syndrome: DSMIG guideline review
Introduction Thyroid disorders occur more frequently in all age groups of people with Down syndrome (DS) than in the general population. The incidence of hypothyroidism in childhood is 5.5%–10% but higher in the first year of life.1 Hyperthyroidism is also more common, particularly in later childhood. Untreated thyroid disorders can cause significant preventable secondary neurodevelopmental impairment and other health issues. Many of the symptoms associated with hypothyroidism can be present in people with DS normally, such as constipation, dry skin, developmental delay and obesity. This means it is difficult to pick...
Source: Archives of Disease in Childhood - Education and Practice - January 20, 2022 Category: Pediatrics Authors: Dalrymple, R. A. Tags: Guideline review Source Type: research

Painful thoracic swelling in a refugee teenager
Case A 14-year-old refugee, escaping from a Middle East war zone, was admitted with a 3-month history of chest pain and a 2-week history of sternal swelling. The patient had no previous medical history, but reported having been beaten by a policeman at a border at the beginning of his journey. He did not have the following symptoms: cough, wheezing fever, weight loss and sweating. When he was admitted to the hospital, he was afebrile; blood pressure was 120/70 mm Hg, pulse 95 beats per minute and oxygen saturation 97% while breathing ambient air. On physical examination, there was a 10 cm fluctuating swelling in the sterna...
Source: Archives of Disease in Childhood - Education and Practice - January 20, 2022 Category: Pediatrics Authors: Occhipinti, A. A., Di Bella, S., Degrassi, F., Tornese, G., Cova, M. A., Barbi, E. Tags: Epilogue Source Type: research

Malar rash in a young child with neurodevelopmental delay: a quiz
­ A 14-month-old boy born to consanguineous parents presented to our Dermatology Department with a 6-month history of a malar eczematous rash that worsens with sun exposure. He had butterfly-shaped, hyperpigmented exfoliating plaques, preceded by blister formation (figure 1). He was also noticed to have enophthalmos, a pinched nose, microcephaly and a cachectic physique. His height and weight were below the first percentile for his age. In addition, the patient was noticed to have motor and psychosocial delay; he does not respond to simple spoken requests, cannot get into sitting position without help or stand/walk wit...
Source: Archives of Disease in Childhood - Education and Practice - January 20, 2022 Category: Pediatrics Authors: Hamie, L., Nemer, G., Kurban, M. Tags: Epilogue Source Type: research

Making sense of the paediatric ECG: rate and rhythm
A fit, well, asymptomatic 6-year-old girl was referred to clinic for a murmur. Her ECG is shown in figure 1. Using the ECG checklist, which categories highlight possible concerns?Rate, rhythm and PR interval The median heart rate for a 6-year-old girl is 89 bpm (range 68–115 bpm (2nd–98th centile)).1 Here, the ventricular rate is 5–6 large squares (50-60 bpm), signifying bradycardia. The atrial rate is faster (three large squares, 100 bpm). Some P waves are obscured within T waves or QRS complexes. The P waves are not related in the normal way to the QRS complexes. Therefore, the PR interval cannot be cal...
Source: Archives of Disease in Childhood - Education and Practice - January 20, 2022 Category: Pediatrics Authors: Oakley, C., Harris, M., Abumehdi, M. R. Tags: Epilogue Source Type: research

Making sense of the paediatric ECG
In 1901, building on the earlier work of Matteuci and Waller, Einthoven created the first string galvanometer and assigned letters to each specific deflection.1 This was the birth of the ECG as we know it. Since that time, our understanding of the specifics of the ECG waveforms and their connotations for specific diseases has grown exponentially. Even in paediatrics, this non-invasive test can yield a plethora of information and is a key diagnostic tool, but its interpretation can be daunting to the non-expert. We have written a sequence of articles using a stepwise method for interpreting ECGs. We apply this method to som...
Source: Archives of Disease in Childhood - Education and Practice - January 20, 2022 Category: Pediatrics Authors: Harris, M., Oakley, C., Abumehdi, M. R. Tags: Epilogue Source Type: research

Child with acute weakness: dont forget the salts
Case summary A 10-year-old boy presented with severe progressive generalised weakness on a background of 3 days of diarrhoea and vomiting. Vital signs were normal. Peripheral neurological examination revealed grade 1–2 power in all limbs, hypotonia and hyporeflexia. Sensation was fully intact. Cranial nerve examination and speech were normal. The ECG (figure 1) and initial venous blood gas (figure 2) are shown. Figure 1ECG. Figure 2Venous blood gas. Question 1 What abnormalities are present on the ECG? Peaked T waves, prolonged PR segment and loss of P waves? Shortening of the QT interval and Osborn waves (...
Source: Archives of Disease in Childhood - Education and Practice - January 20, 2022 Category: Pediatrics Authors: Boyle, K., McNaughten, B., Thompson, A., Mullen, S. Tags: Epilogue Source Type: research