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Fifteen-minute consultation: Fractures in non-ambulant children with cerebral palsy
Conclusion Low-energy fractures of the lower limb in non-ambulant children with cerebral palsy are relatively common and explained by the presence of reduced bone strength, in the absence of any other unexplained injuries or safeguarding concerns. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - January 20, 2022 Category: Pediatrics Authors: Debelle, G., Morris, H., Shaw, N., Oates, A. Tags: Editor's choice, Best practice and Fifteen Minute Consultations Best practice and Fifteen-minute consultations Source Type: research

Fifteen-minute consultation: how to identify and treat children with acute kidney injury
We present an approach to AKI through case-presentation. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - January 20, 2022 Category: Pediatrics Authors: Scott, M., McCall, G. Tags: Best practice and Fifteen Minute Consultations Best practice and Fifteen-minute consultations Source Type: research

Fifteen-minute consultation: Neonatal hypertension
Neonatal hypertension is a rare but well recognised condition, especially in newborns needing invasive monitoring in the intensive care unit. Recognition of newborns with hypertension remains challenging because of natural variability in blood pressure with postconceptional age and the lack of reference data for different gestational ages. Investigation of neonates with hypertension can be challenging in light of the myriad differing aetiologies. This may be simplified by a systematic approach to investigation. There remains a relative paucity of data to guide the use of pharmacological therapies for hypertension in neonat...
Source: Archives of Disease in Childhood - Education and Practice - January 20, 2022 Category: Pediatrics Authors: Singh, Y., McGeoch, L., Job, S. Tags: Best practice and Fifteen Minute Consultations Best practice and Fifteen-minute consultations Source Type: research

Highlights from this issue
In the years I’ve been in this role I’ve tried to be careful with my conflicts of interest. If anything, the possible conflicts have increased—not because I’ve become more interesting, but because the requirements have become, appropriately, more inclusive. In fact, usually I act in a way which actively biases me against needing to declare the conflict. However, this month I’m going to declare a big conflict of interest while drawing your attention to an excellent paper written by friends and colleagues of mine, Geoff Debelle, Helen Morris, Nick Shaw and Adam Oates. It places a framework aroun...
Source: Archives of Disease in Childhood - Education and Practice - January 20, 2022 Category: Pediatrics Authors: Wacogne, I. D. Tags: Epistle Source Type: research

Point-of-care ultrasound could be an effective alternative to radiology-performed imaging in the diagnosis of intussusception and pneumonia in children
Pneumonia Lung ultrasound was an effective technique in diagnosing childhood pneumonia when conducted by experienced sonographers Reviewing paper: Tsou PY, Chen KP, Wang YH, Fishe J, Gillon J, Lee CC et al. Diagnostic accuracy of lung ultrasound performed by novice vs advanced sonographers for pneumonia in children: A systematic review and meta-analysis. Acad Emerg Med 2019;26:1074–1088. Study question How accurate is ultrasound in the diagnosis of pneumonia? How accurate is the result when comparing sonographers with varying levels of experience? Study design: systematic review and meta-analysis; 25 studies analysed...
Source: Archives of Disease in Childhood - Education and Practice - November 18, 2021 Category: Pediatrics Authors: McIlwham, J. C., Dalrymple, R., Bee, N. Tags: Picket Key publications in paediatrics: Picket Source Type: research

COVID-19 stole my paediatric elective... but I took it back
Most doctors recall their elective with warm nostalgia—a brilliant opportunity, often permitting travel to practise medicine within the context of another culture. While medical curricula vary, this compulsory General Medical Council module is a unifying highlight. During clinical placements, doctors would often ask if I had planned my elective. This popular conversation topic offered a mutually welcomed respite from clinical questioning. Although all the causes of hyponatraemia do not permanently reside on the tip of my tongue, for this question I always knew the answer. I would reply with excitement that I was goin...
Source: Archives of Disease in Childhood - Education and Practice - November 18, 2021 Category: Pediatrics Authors: Lawson, E. Tags: COVID-19 Viewpoint Source Type: research

You are what you read: bias, journal prestige and manipulation
Introduction Researchers aim to publish in the highest-ranking journal possible to enable wider dissemination and for career advancement. Journals are ranked in many ways (table 1), but scientific quality is not important for these rankings. An excellent example is a now retracted paper looking at a possible link between the MMR vaccine and autism. This was published in one of the highest Impact Factor journals in the world, and was subsequently found to be fraudulent. Prior to full retraction, it had gained 3,563 citations, which increased the standing of that journal. We have not cited this paper as we do not wish to inc...
Source: Archives of Disease in Childhood - Education and Practice - November 18, 2021 Category: Pediatrics Authors: Vairavan, M., Prayle, A., Davies, P. Tags: Research in practice Source Type: research

Aligning quality improvement with better child health for the 21st century
Quality improvement (QI) has tremendous potential to tackle the shortcomings of health services. But health professionals have not yet fully embraced QI as part of their day-to-day concerns. Indeed, QI is sometimes experienced as a brake on quality rather than a catalyst for improvement. This can happen, for example, if there is too much emphasis on meeting short-term institutional goals rather than on addressing long-term health needs. This emphasis also risks equating quality with safety and efficiency measures while neglecting patient-centredness and equity. QI does not have to be like this. We suggest that the conscien...
Source: Archives of Disease in Childhood - Education and Practice - November 18, 2021 Category: Pediatrics Authors: Singh, G., Cribb, A. Tags: Open access Quality improvement Source Type: research

Time to think
How many of us have ‘time to think’ in our job plans? Most of us probably do some of our thinking and problem solving outside working hours. I know that Ian (our erudite editor) does much of his deeper thinking while on his bicycle, Anna while running and Fiona while beading. We work in an environment that is dependent on good communication, collaboration and engagement. We need to enable individuals to have time and space to nurture this. We are often too busy rushing around, ticking tasks off lists and working to deadlines. We risk not being able to take stock and review where we are going. A thinking convers...
Source: Archives of Disease in Childhood - Education and Practice - November 18, 2021 Category: Pediatrics Authors: Baverstock, A., Finlay, F. Tags: Wellbeing at work Source Type: research

The development of a family liaison team to improve communication between intensive care unit patients and their families during the COVID-19 pandemic
A family liaison team was developed to improve communication between intensive care unit patients and their families during the COVID-19 pandemic. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - November 18, 2021 Category: Pediatrics Authors: Gabbie, S., Man, K., Morgan, G., Maity, S. Tags: COVID-19 Quality improvement Source Type: research

Guidelines for diagnosing coeliac disease: European Society Paediatric Gastroenterology, Hepatology and Nutrition
Background Coeliac disease (CD) is a lifelong, immune-mediated, systemic disease precipitated by exposure to dietary gluten in genetically predisposed individuals. It affects all age groups with a diverse range of clinical signs and symptoms.1 Over the past five decades, there has been a fourfold increase in the incidence of CD in the UK, which is largely due to increased disease awareness, advances in diagnostic tests and development of screening programmes. However, data from recent population-based studies suggest that at least 1 in 100 people in the UK are affected by CD, meaning approximately 70% (500 000 people) rema...
Source: Archives of Disease in Childhood - Education and Practice - November 18, 2021 Category: Pediatrics Authors: Berry, S., McMahon, N., Henderson, J. Tags: Guideline review Source Type: research

Acute treatment of migraine in children and adolescents: review of the American Academy of Neurology Practice guideline update
Background Migraine is a brain disease that involves episodes of medium to severe headaches along with specific associated symptoms, including nausea, vomiting, photophobia and phonophobia, as defined by criteria developed by the International Headache Society. It is a common and disabling condition in children, estimated to affect ~10% of girls and ~6% of boys1 and it accounts for ~2% of visits to the emergency department in the USA.2 Migraines can disrupt life activities, such as participation in home, school and social functions, and can have a negative effect on quality of life. They can also be challenging to manage. ...
Source: Archives of Disease in Childhood - Education and Practice - November 18, 2021 Category: Pediatrics Authors: Cromb, D., Grigoratos, D. Tags: Guideline review Source Type: research

Guideline review: congenital adrenal hyperplasia clinical practice guideline 2018
Introduction Congenital adrenal hyperplasia (CAH) has an incidence of 1:14 000 to 1:18 000 worldwide. It is caused by autosomal recessive gene mutations, encoding enzymes in the adrenal steroidogenesis pathway. The majority, CYP21A1 mutations, result in 21-hydroxylase deficiency, with: inability to synthesise cortisol and aldosterone; diversion of increased steroid precursors, including 17-hydroxyprogesterone (17-OHP), into androgen production (figure 1). Neonates typically present with virilisation at birth, or in shock, ‘salt-losing crisis’, around days 10–14 of life. Some children present later with si...
Source: Archives of Disease in Childhood - Education and Practice - November 18, 2021 Category: Pediatrics Authors: Prentice, P. Tags: Guideline review Source Type: research

Teenage boy with bullous rash
­ A 14-year-old boy with recent antibiotic treatment for tonsillitis, presented to the emergency department with 1-week history of worsening rash and haemorrhagic bullae involving the bilateral legs, trunk and hands (figures 1 and 2). Laboratory results were significant for proteinuria (2+protein) and haematuria (1+, 5–10 red blood cells/high power field); 24 hours urinary protein and renal function were within normal limits. The patient had an inconclusive skin biopsy. Figure 1Left and right images show palpable purpura with some overlying bullae and vesiculation coalescing into plaques on both lower extremitie...
Source: Archives of Disease in Childhood - Education and Practice - November 18, 2021 Category: Pediatrics Authors: Boyd, M. E., Yusuf, S. Tags: Epilogue Source Type: research

Child with prolonged leg pain and bruising
A 12-year-old boy was admitted to the paediatric ward with a 4-month history of worsening pain and bruising to his legs, which had resulted in a progressive reduction in his mobility. He initially had had difficulty weight bearing, which had then progressed further making him wheelchair bound. On examination, there was extensive bruising (figure 1) to his oedematous legs, worse on his right leg compared with his left. His background of autism and 15q13.3 deletion, along with maternal learning difficulties, made deciphering a clear history difficult. However, there was no account of trauma, and he had been afebrile througho...
Source: Archives of Disease in Childhood - Education and Practice - November 18, 2021 Category: Pediatrics Authors: Bailey, E., Ali, A., Kagalwala, F. Tags: Epilogue Source Type: research