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Guideline review: Child Protection service delivery standards
Background The Children Act, 1989 states that the local authority needs to complete a section 47 investigation when there is any suspicion that a child is suffering or likely to suffer from significant harm.1 In most instances, this includes a child protection medical which forms an important part of the decision-making regarding the best outcome for the child. As with all aspects of healthcare, standardisation is very important. This guideline was published in 2020 in part because of geographical discrepancies in how the process of child protection medical assessments were experienced by both staff and families across the...
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2023 Category: Pediatrics Authors: Norman, C., Jacob, H. Tags: Guideline review Source Type: research

Fifteen-minute consultation: Diagnosing serious pathology in children with headaches presenting to the emergency department
This article will discuss five patient scenarios highlighting red flags and differential diagnoses in children presenting with headache in the emergency department. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2023 Category: Pediatrics Authors: Alhashem, R., Byrne, S., Hall, D. Tags: Best practice and Fifteen Minute Consultations Source Type: research

Acute safeguarding essentials in modern-day paediatrics: neglect, unsupervised minors and modern slavery
As part of a case-series exploring acute safeguarding essentials in modern day paediatrics, this article focusses on themes of neglect, unsupervised minors and modern slavery. Considerations around initial management, relevant legislation and useful resources, and available to all professionals involved in safeguarding children. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2023 Category: Pediatrics Authors: Thomas, H., Cromb, D., Jacob, H. Tags: Best practice and Fifteen Minute Consultations Source Type: research

Acute safeguarding essentials in modern-day paediatrics
This case series addresses the complexities of child safeguarding in modern-day paediatrics, exploring common themes and key pieces of legislation, while emphasising the centrality of the child’s welfare in decision-making at all times. It discusses the evolving nature of child protection, including the importance of a multiagency approach and the rising impact of the internet and social media on child welfare, necessitating awareness of online risks and the development of mitigation strategies. Each article presents a case vignette, prompts for consideration, discussions on specific safeguarding concerns, practical ...
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2023 Category: Pediatrics Authors: Thomas, H., Cromb, D., Jacob, H. Tags: Best practice and Fifteen Minute Consultations Source Type: research

Safeguarding children a priority
When I look through the range of scenarios discussed within this mini-series,1 2 it reminds me of the reason I was drawn into the safeguarding field. These are all difficult areas where highly vulnerable children require our expertise to keep them safe but also areas where the answers are not necessarily that straightforward or intuitive. Equally, they are not scenarios you are likely to come across on a daily basis, so signposting to where the best support is available is critical. ‘Safeguarding is everybody’s responsibility’, a much-quoted statement to which all of us who work within paediatrics would r...
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2023 Category: Pediatrics Authors: Lewis, D. Tags: Editorial Source Type: research

Epistle
This month’s issue has an outstanding selection of articles and I am delighted to announce the introduction of mini-series themes in our best practice section. The first of these is focused on child safeguarding, with David Lewis’ editorial ‘Safeguarding children: a priority’ (see page 392). This is accompanied by Helen Thomas and colleagues, introductory article ‘Acute safeguarding essentials in modern-day paediatrics’ (see page 394) and a follow-on article ‘Neglect, unsupervised minors and modern slavery’ (see page 397). The articles address the complexities and challenges ...
Source: Archives of Disease in Childhood - Education and Practice - November 17, 2023 Category: Pediatrics Authors: Gupta, N. Tags: Highlights from this issue Source Type: research

Diarrhoea, vomiting and reduced wet nappies - a familiar story with unexpected twists
Vomiting and diarrhoea is a common presenting complaint in paediatrics. Most often it is due to a benign and self-limiting infectious illness. Here, we explore the diagnostic journey of a 7-month-old infant with these symptoms presenting in a secondary care hospital and the overnight clinical problem solving involved in tackling the unexpected complexities. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - September 20, 2023 Category: Pediatrics Authors: Jones, E., Song, J., Alam, S. Tags: Problem solving in clinical practice Source Type: research

Tailing growth, neonatal jaundice and anaemia
At medical school, there is a phrase to help us remember that common things are common: ‘If you hear hooves think horses, not zebras’. However, zebras do exist, and from time to time in general paediatric and neonatal practice, we will encounter these rare diagnoses, more of which we can now accurately diagnose through the ever-expanding field of genomics. Our case demonstrates how a rare diagnosis can present with common features of growth restriction, jaundice and anaemia. Paediatricians therefore require a high index of suspicion and increasing knowledge of the logistics of genetic testing. (Source: Archives...
Source: Archives of Disease in Childhood - Education and Practice - September 20, 2023 Category: Pediatrics Authors: Jefferson, L., Ramanan, A. V., Cummins, M., Roderick, M. Tags: Problem solving in clinical practice Source Type: research

NEO-TRAIN pushing the boundaries of quality improvement on the neonatal unit
Key messages WHAT WE ALREADY KNOW ON THIS TOPIC Implementing sustainable change can be challenging. Quality improvement (QI) projects are often small-scale projects over a limited time-period, led by professionals who lack expertise and frequently rotate between hospitals. WHAT THIS STUDY ADDS Interprofessional involvement is key to implementing sustainable change. Using a targeted, evidence-based approach ensures the team is focusing on specific objectives, pooling their time and resources. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY Interprofessional involvement accompanied with training in QI methodology ha...
Source: Archives of Disease in Childhood - Education and Practice - September 20, 2023 Category: Pediatrics Authors: Williamson, S. L., Singh, N. Tags: Quality improvement short report Source Type: research

Four months of tuberculosis (TB) treatment is non-inferior to the current 6-month treatment in drug-susceptible paediatric TB
Study design Design: An open-label, non-inferiority, randomised controlled trial. Allocation: 1:1 allocation, stratified by age, HIV status, treating centre and ethambutol use. Blinding: Single blinding of diagnosis and endpoint tuberculosis (TB) review committees. Study question Setting: Uganda, Zambia, South Africa and India. Patients: 1204 children (aged <16 years) with symptomatic, non-severe, smear-negative TB due to the start of first-line treatment. Intervention: 8 weeks of standard treatment as per local guidelines, followed by isoniazid/rifampicin for 16 weeks in the control arm, and 8 weeks in the intervention...
Source: Archives of Disease in Childhood - Education and Practice - September 20, 2023 Category: Pediatrics Authors: Singhal, G., Friend, A. J. Tags: Picket Key publications in paediatrics: Picket Source Type: research

Developing and assessing health information technologies: opportunities and challenges
Introduction Internationally, billions of dollars have been invested in Health Information Technologies (HITs).1 In the UK, digitally enabled care forms a key pillar of the NHS long term plan, and responses to COVID-19 have been underpinned by data sharing and the use of new technologies. However, HITs represent a wide range of interventions used for storing, analysing or sharing electronic clinical data. They can be highly complex with wide-ranging impacts on health systems (eg, hospital-wide patient records (EPRs) or more focused interventions that are designed to solve specific clinical problems (eg, a dose checking alg...
Source: Archives of Disease in Childhood - Education and Practice - September 20, 2023 Category: Pediatrics Authors: Neame, M. T., Cresswell, K., Sinha, I., Hawcutt, D. B. Tags: Research in Practice Source Type: research

Using coaching skills in paediatric practice: a summary of use and benefits
This paper sets out the use and benefits of adopting a coaching style of conversation within our everyday practice. Here, we present two case examples within a paediatric setting which applies coaching skills to different contexts to help progress meaningful conversations. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - September 20, 2023 Category: Pediatrics Authors: Nahabedian, L., Nahabedian, N. Tags: Learning and teaching Source Type: research

Can we apply more generalism in child health?
Introduction to generalism Generalism has been defined as ‘an approach to the delivery of health care, be it to individuals, families, groups or to communities. Its principles apply wherever and whenever people receive care and advice about their health and well-being. The generalist approach applies equally to individuals and to clinical teams. It is one facet of medical professionalism’.1 Generalism has been advocated by numerous bodies including the Royal College of Physicians,2 the Academy of Medical Royal Colleges3 and Health Education England.4 Generalism is part care provision for children and young peop...
Source: Archives of Disease in Childhood - Education and Practice - September 20, 2023 Category: Pediatrics Authors: Turner, S. W., Shah, R., Dharmarajah, K., Jacob, H. Tags: Learning and teaching Source Type: research

Mysterious chronic skin lesions
A 10-year-old boy presented to our paediatric emergency department with a 10-month history of chronic diffuse cutaneous lesions including a recent lesion on the thumb (figure 1). The child was born in the Comoros, an East African island, and moved to Mayotte, a French East African island, at the age of 6 months with his family. He arrived in France in January 2022, and the lesions were first noted in February by his mother. He had three brothers who were well. His parents were not related, and he had not seen his father in a long time. His vaccinations were up to date. There was no other medical history of note and no simi...
Source: Archives of Disease in Childhood - Education and Practice - September 20, 2023 Category: Pediatrics Authors: Petat, H., Tedbirt, B., Zeggay, A., Michelet, I., Morin, C., Marguet, C. Tags: Epilogue Source Type: research

Two-year-old boy with sparse hair
Our patient was born full term and with no complications from non-consanguineous healthy parents. He was referred to the paediatrics department at 2 years of age for sparse hair. He had a history of recurrent and unexplained fever since he was 3 months old. He was unable to sweat and had dry skin. The maternal uncle of the proband, aged 20 years has the same complaint. On examination, the growth and the mental development were normal. He had skin, hair (figure 1) and teeth (figure 2) abnormalities. His temperature was 38.3°C. The rest of the examination was unremarkable. Screening for sepsis was negative. Test your kno...
Source: Archives of Disease in Childhood - Education and Practice - September 20, 2023 Category: Pediatrics Authors: Barakizou, H. Tags: Epilogue Source Type: research