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Thriving at work
Many bemoan the loss of The Firm. A historical tribe that worked together and bonded over shared tales, cups of tea, gallows humour and cake on Fridays made by the Consultant’s wife. Changes in hours and shifts have eroded this over the years and we work in teams that may be different each day. So, we need to think about how we create the essential elements of the Firm Culture, within our wider team environments. Psychological safety is at the heart of this. Amy Edmondson1 describes the overlap of high psychological safety and high standards as the ‘learning and high-performance zone’ (see Figure 1). Many...
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

An unusual cause of stridor
A 12-month-old infant was referred with a 6-week history of recurrent admissions with worsening stridor. On each previous admission, the stridor responded well, but transiently, to oral dexamethasone. At this presentation, he required high-dependency unit care with high flow oxygen due to marked increased work of breathing. He was born at term, previously well, and up to date with immunisations. There was no significant family history. There were no smokers and two cats at home. He was afebrile with moderate subcostal recession and tracheal tug. On auscultation, breath sounds were normal with transmitted sounds of inspirat...
Source: Archives of Disease in Childhood - Education and Practice - November 18, 2021 Category: Pediatrics Authors: Garde, A., Hilliard, T. N., Saunders, M., Chopra, M., Langton Hewer, S. C. Tags: Epilogue Source Type: research

An adolescent with recurrent ankle swelling
A 14-year-old girl was admitted to our institute with a history of intermittent bilateral ankle swelling, and moderate but progressively worsening pain which has lasted for 2 years. The patient’s history was unremarkable. She did not take medications and was not involved in any sports activity. She reported no fever, gastrointestinal symptoms, fatigue, weight loss, travels abroad or previous infections. She reported moderate pain at night, associated with a sense of heaviness, tightness and general discomfort, and with no response to ibuprofen. Physical examination was remarkable only for bilateral ankle non-pitting ...
Source: Archives of Disease in Childhood - Education and Practice - November 18, 2021 Category: Pediatrics Authors: Trombetta, A., Genovese, M. R. L., Gortani, G., Barbi, E. Tags: Epilogue Source Type: research

Something hazy drifting in the air...
­ A 7-year-old boy with a background of autism presented to the paediatric emergency department with his left arm ‘feeling strange’ then became difficult to rouse. On examination, he was found to have left arm weakness and a left-sided facial droop without forehead muscle involvement. Three hours later, his symptoms had completely resolved and he was suspected to have had a first seizure. He was admitted for observation and an electroencephalography which showed slower rhythms in the right posterior quadrant, which was reported as within normal appearances for his age. He was discharged home the following d...
Source: Archives of Disease in Childhood - Education and Practice - November 18, 2021 Category: Pediatrics Authors: McCreary, D., McArdle, J., Minks, D., Horridge, K. Tags: Epilogue Source Type: research

Fifteen-minute consultation: Vulval soreness in the prepubertal girl
Case scenario A general practitioner (GP) refers to your general paediatric outpatient clinic a 6-year old girl with an intermittently sore vulva with occasional discharge. Her mother noticed her ‘vagina’/genitalia has been slightly red, and there is intermittent minimal white discharge. Clotrimazole (Canestan), prescribed by her GP, has not made any difference. What are you going to do? In this article, we discuss the aetiology and initial assessment of vulval soreness and related symptoms in the prepubertal girl. The article does not include the differential diagnoses in the peripubertal and postpubertal adol...
Source: Archives of Disease in Childhood - Education and Practice - November 18, 2021 Category: Pediatrics Authors: Chanchlani, N., Hodes, D. Tags: Best practice and Fifteen Minute Consultations Best practice and Fifteen-minute consultations Source Type: research

Public health for paediatricians: Fifteen-minute consultation on addressing child poverty in clinical practice
This article will outline how social determinants impact child health, and provide practical guidance on how to address this problem through a public health lens. The aim is to give frontline practitioners a straightforward, evidence-based framework and practical solutions for tackling child poverty, across three levels: (1) the clinical consultation; (2) the clinical service for the population of children and young people we serve and (3) with a broader policy and social view. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - November 18, 2021 Category: Pediatrics Authors: Singh, G., Zhu, H., Cheung, C. R. Tags: Editor's choice, Best practice and Fifteen Minute Consultations, COVID-19 Best practice and Fifteen-minute consultations Source Type: research

Fifteen-minute consultation: To prescribe or not to prescribe in ADHD, that is the question
Attention-deficit hyperactivity disorder (ADHD) is fraught with controversy. Some clinicians believe it is a biological neurodevelopmental disorder which should be treated with medication. Others are adamant that ADHD is a social construct in which children, who have suffered developmental trauma, are medicalised. Evolutionary science may help us find a solution to this dichotomy by seeing ADHD as an example of an evolutionary mismatch in which children with ADHD are caught in a school environment that does not suit their natures. By considering how to improve the ‘goodness of fit’ between the child and their e...
Source: Archives of Disease in Childhood - Education and Practice - November 18, 2021 Category: Pediatrics Authors: Swanepoel, A. Tags: Best practice and Fifteen Minute Consultations Best practice and Fifteen-minute consultations Source Type: research

Highlights from this issue
I’m writing this, as ever, a couple of months before the print issue is out, with achy legs from joining 11/3 stages of the #RideForTheirLives cycle between London and Glasgow. This ride was intended to draw attention to the fact that environmental damage has a direct impact on children and young people. From this point in October, I don’t know what COP26 holds, but I can tell you that there are a lot of inspirational child health professionals and young people out there, determined to make a difference for children, and recognising that most of our efforts come to naught if there is underlying damage from chil...
Source: Archives of Disease in Childhood - Education and Practice - November 18, 2021 Category: Pediatrics Authors: Wacogne, I. D. Tags: Epistle Source Type: research

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