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Measuring body composition in children: research and practice
Body composition for paediatricians Measuring body composition provides clinically useful information for many paediatric conditions such as cystic fibrosis, cerebral palsy, eating disorders and inflammatory bowel disease. Body composition measurements provide an insight into disease severity, nutritional status and long-term health risks, enabling paediatricians and allied health professionals to plan and deliver more holistic care. Waist circumference measurements and assessment of fat mass (FM) and percentage fat using dual-energy X-ray absorptiometry (DEXA) are two examples of methods in clinical use. Component models ...
Source: Archives of Disease in Childhood - Education and Practice - July 19, 2023 Category: Pediatrics Authors: Prior, E., Uthaya, S. N., Gale, C. Tags: Research in Practice Source Type: research

Mind the gap: addressing mental health competency on the acute paediatric ward
Problem In acute paediatrics, there is lack of parity between the care of patients with physical and mental health problems, and as paediatricians, we must equip ourselves to redress the balance. This is reflected nationally in National Confidential Enquiry into Patient Outcome and Death and Care Quality Commission data.1 2 We recognise the Royal College of Paediatrics and Child Health’s position statement on the role of the paediatrician in supporting children and young people’s (CYP) mental health3 and the dramatic rise in mental health presentations during the COVID-19 pandemic.4–6 Aims To improve qual...
Source: Archives of Disease in Childhood - Education and Practice - July 19, 2023 Category: Pediatrics Authors: Todd, E., Adamson, R., Leith, E., Davies, A. Tags: Equipment QI Reports Equipped: quality improvement Source Type: research

Catatonic conundrum
This article explores the challenge faced by the team during the assessment and diagnosis of this patient. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - July 19, 2023 Category: Pediatrics Authors: Paterson-Brown, L., Scally, N., Imeson, D., Jones, A., Shivamurthy, V. Tags: Problem solving in clinical practice Source Type: research

Making sense of the paediatric ECG: ST segments
This is a follow on article on different aspects of paediatric ECG interpretation. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - July 19, 2023 Category: Pediatrics Authors: Harris, M., Oakley, C. Tags: Interpretations Source Type: research

Making sense of the paediatric ECG: P waves
Follow-up article on ECG Interpretation series. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - July 19, 2023 Category: Pediatrics Authors: Harris, M., Oakley, C. Tags: Interpretations Source Type: research

How to interpret cardiac biomarkers in children?
This article will focus on the pathophysiology of myocardial injury and heart failure in children and the subsequent cardiac biomarker correlation. It will explain how to interpret the biomarker assay levels obtained for both troponin and NT-proBNP and highlights the importance of a clear clinical question prior to requesting a cardiac biomarker assay level. Clinical cases outline scenarios that may prompt consideration of biomarker analysis in children and aims to equip the reader with an understanding of how to interpret the results. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - July 19, 2023 Category: Pediatrics Authors: McGinn, C., Waterfield, T., McKeeman, G., Morrison, L., Callaghan, S., Watson, C., Casey, F. A. Tags: Interpretations Source Type: research

Epilogue: Anaemia + abdominal mass = is it cancer?
A 2-year-old boy presented with several weeks of pallor, lethargy, intermittent fever and increasing abdominal distension. His temperature was 38°C and blood pressure was 122/62 mm Hg. On examination, there was a left upper quadrant abdominal mass, measuring 10 cm with palpable upper margins. Laboratory investigations are shown in table 1. Previously the boy had Proteus urinary tract infection (UTI) treated with oral antibiotics in the community but no further investigations. He was subsequently treated with intravenous antibiotics with no significant improvement. QuestionsQuestion 1 What is the most appropriate first ...
Source: Archives of Disease in Childhood - Education and Practice - July 19, 2023 Category: Pediatrics Authors: McAlister, P., Irvine, S., Beckett, R., O'Hagan, E., Marshall, D. Tags: Epilogue Source Type: research

Unconventional management approach to a life-threatening neonatal respiratory condition
A steroid-exposed 1100g infant of 27+3 weeks’ gestation was born by emergency caesarean section for maternal COVID-19 pneumonitis. He required ventilation and surfactant administration at birth but continued needing ventilatory support despite a further dose of surfactant and an unsuccessful trial on continuous positive airway pressure (CPAP). It became increasingly difficult to oxygenate and ventilate him adequately, and with progressively worsening chest X-ray changes (figure 1), he warranted transfer to the nearest neonatal intensive care unit (NICU) as per national guidelines.1 2 Questions What are the most strik...
Source: Archives of Disease in Childhood - Education and Practice - July 19, 2023 Category: Pediatrics Authors: Hilton, H., Lok, A., Vasudevan, C., Dale, M. Tags: COVID-19 Epilogue Source Type: research

Secondary survey in paediatric trauma
This article provides a structured approach of the head-to-toe examination required for the secondary survey. We follow the journey of a 9-year-old boy, Peter, who was involved in an accident—electric scooter versus car. After resuscitation and primary survey, you have been asked to carry out the secondary survey. This is a guide of the steps to follow in order to carry out a comprehensive examination to ensure nothing is missed. It highlights the importance of good communication and documentation. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - July 19, 2023 Category: Pediatrics Authors: Mc Auley, C., Mullen, S., Corley, L., McDonald, R., Quinn, N. Tags: Review Source Type: research

Fifteen-minute consultation: A guide to the paediatric primary survey
It’s 21:00 and you receive a stand-by call from the local ambulance service. Peter, a 9-year-old boy, was riding an electric scooter and has collided with a car. He has reduced consciousness, signs of shock and is hypoxic. How will you prepare your team? What are the possible injuries? Who will perform the primary survey? Injury is the leading cause of morbidity and mortality in the paediatric population accounting for approximately half of all attendances to paediatric emergency departments in the UK and Ireland. Major trauma can be distressing for patients, parents and physicians. Managing major trauma is challengi...
Source: Archives of Disease in Childhood - Education and Practice - July 19, 2023 Category: Pediatrics Authors: Kavanagh, K., Mullen, S., Sloane, C., Watson, B., Waterfield, T., Quinn, N. Tags: Best practice and Fifteen Minute Consultations Source Type: research

Fifteen-minute consultation: Management of paediatric minor burns
Burn injuries are a common presentation to the paediatric emergency department (PED) and are painful, distressing and may have long-term sequelae. In adhering to the first aid principles of burns management, we aim to alleviate pain, prevent bacterial contamination and minimise the extent of injury. First aid involves cooling the burn and covering with an appropriate material while simultaneously providing analgesia. Assessing the severity (depth and total body surface area) of the burn are important for prognostication with implications for management. It is imperative to consider non-accidental injury in burns, which be ...
Source: Archives of Disease in Childhood - Education and Practice - July 19, 2023 Category: Pediatrics Authors: McAlister, P., Hagan, G., Lowry, C., Mullen, S. Tags: Best practice and Fifteen Minute Consultations Source Type: research

Fifteen-minute consultation: An overview of major incidents
This article aims to provide a brief understanding of what constitutes as a major incident, how it is declared and the chain of command in communication and action, focusing specifically on the paediatric process. It also aims to highlight important considerations that could potentially be missed (eg, the mental health impact, forensic evidence and so on). (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - July 19, 2023 Category: Pediatrics Authors: Widya, S., Hewitson, R., Patel, T., Roland, D., Dadnam, C. Tags: Editor's choice, Best practice and Fifteen Minute Consultations Source Type: research

Epistle
I am pleased to introduce another invigorating issue which brings a balanced array of articles on clinical conundrums, investigations, skills and practical application of research. This issue is particularly focused on paediatric emergencies, cardiology and mental health. The Fifteen-minute consultation brings a series of best practice papers on paediatric emergencies including management of trauma, major incidents and minor injuries. These articles highlight key guidance with brilliant illustrations and an aide memoire which can be easily adapted into clinical practice. Karl Kavanagh and colleagues describe a structured a...
Source: Archives of Disease in Childhood - Education and Practice - July 19, 2023 Category: Pediatrics Authors: Gupta, N. Tags: Highlights from this issue Source Type: research

Poetry as a tool for reflection
Reflection using poetryImportance of reflective practice in healthcare Reflective practice is that ability to reflect on one’s actions so as to engage in a process of continual learning. Donald Schon.1 The General Medical Council (GMC) guide to Good Medical Practice states that doctors must contribute to and comply with systems to protect patients. One element of this is regular reflection on the standards of practice and the care an individual doctor provides. However, many clinicians find recording their reflections in a meaningful way can be a challenge. Reflection is personal and there is no one way to reflect. T...
Source: Archives of Disease in Childhood - Education and Practice - May 18, 2023 Category: Pediatrics Authors: Osmond, E., Baverstock, A., Holmes, E. Tags: Viewpoint Source Type: research

Implementation of a simulation programme to improve action about racism in paediatric departments
The problem Equality and diversity are strongly embedded within the ethos of the National Health Service (NHS); equality and diversity are a ubiquitous, and important, part of mandatory training. Current training is often asynchronous online learning, which does not allow discussion of nuances or practicalities. Despite this training, many healthcare professionals across all ranks either face racism or witness racism. A British Medical Association (BMA) survey of more than 2000 doctors and medical students found that over 90% of black and Asian respondents, 73% of mixed ethnicity and 64% of white respondents said they beli...
Source: Archives of Disease in Childhood - Education and Practice - May 18, 2023 Category: Pediatrics Authors: Berg, R., Penumala, V. V., Anpananthar, A. Tags: Equipped: quality improvement Source Type: research