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How to perform and interpret a middle cerebral artery transcranial Doppler examination in children at risk of brain injury
Transcranial Doppler (TCD) ultrasound is a non-invasive neuromonitoring technique that falls under the umbrella of point-of-care ultrasound. In this article, we provide a primer to encourage clinicians to perform TCD examinations and to aid them with accurately interpreting the scans. We focus on the middle cerebral artery waveforms and use traumatic brain injury as a model for brain insult. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - March 19, 2024 Category: Pediatrics Authors: Poletto, E., Kanthimathinathan, H. K., Gyorgyi, Z. Tags: Interpretations Source Type: research

Fourteen-year-old girl with complicated hypothyroidism
A 14-year-old girl presented to her general practioner with neck swelling and lethargy. Initial thyroid function showed a free T4 of 6.6 pmol/L (12.6–21.0 pmol/L) and thyroid stimulating hormone 34.9 mIU/L (0.51–4.3 mIU/L). An ultrasound of the thyroid was in keeping with active thyroiditis and anti-TPO antibodies were positive indicating autoimmune hypothyroidism. She had no family history of note. She was started on levothyroxine 75 µg daily with normalisation of her thyroid function within 3 weeks. She was admitted to the emergency department 4 weeks later with progressive fatigue and acute nausea and ...
Source: Archives of Disease in Childhood - Education and Practice - March 19, 2024 Category: Pediatrics Authors: McBay-Doherty, R., Abid, N., Thompson, K., Thompson, A. Tags: Epilogue Source Type: research

Broad complex rhythm in neonates: is it always a cause for concern?
A baby born at 37 weeks’ gestation was noted to have premature beats in utero. He was born in good condition. The premature beats were heard intermittently in the first few hours of life. There was no significant family history. He remained well with normal observations and was discharged home after reassurance was provided. At 9 days of age an irregular pulse was noted again during an assessment for jaundice. On initial assessment, he appeared well. He had an irregular pulse but no other abnormalities in his cardiovascular examination. He required phototherapy for the jaundice. There were no electrolyte abnormalitie...
Source: Archives of Disease in Childhood - Education and Practice - March 19, 2024 Category: Pediatrics Authors: Oswal, A., Bharmappanavara, G., Spentzou, G. Tags: Epilogue Source Type: research

Fifteen-minute consultation on excluding cardiac causes of chest pain
Chest pain can be an extremely worrying symptom for children and parents, but is typically benign and rarely cardiac in origin. It can become problematic for paediatricians in acute care balancing parental expectations and not missing sinister causes. In addition, ordering unnecessary tests can be expensive, can lead to a prolonged hospital stay and unnecessary referrals to clinics. The aim of this review is to give an overview of the common causes of chest pain in children and how to identify cardiac causes using case vignettes. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - March 19, 2024 Category: Pediatrics Authors: Mahmood, U. F., Skinner, G. J. Tags: Editor's choice, Best practice and Fifteen Minute Consultations Source Type: research

Fifteen-minute consultation: When to consider extracorporeal membrane oxygenation
This article provides a concise summary of the technical aspects of ECMO support, indications for referral, complications, outcomes and important considerations for follow-up. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - March 19, 2024 Category: Pediatrics Authors: Fine-Goulden, M. R., Lillie, J. Tags: Best practice and Fifteen Minute Consultations Source Type: research

Fifteen-minute consultation: Investigation and management of hypoglycaemia in the term-born infant
Hypoglycaemia in term infants is very common. Deciding on appropriate investigations and management is often challenging. The aims of this article are to help with understanding when, how and why to investigate symptoms of hypoglycaemia in full-term infants (born ≥37 weeks’ gestational age). (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - March 19, 2024 Category: Pediatrics Authors: Cromb, D., Radomska, M., Thalange, N., Cawley, P. Tags: Best practice and Fifteen Minute Consultations Source Type: research

Fifteen-minute consultation: Approach to the adolescent presenting with hirsutism
Hirsutism, unwanted terminal hair growth in androgen-dependent areas, is a common presentation to general paediatricians, dermatologists and endocrinologists. Polycystic ovarian syndrome is the most common cause but can be challenging to diagnose in young people due to the significant overlap of features with the healthy adolescent population. There are other rare, but important, causes to consider such as non-classic congenital adrenal hyperplasia and androgen-secreting tumours. Hirsutism carries a significant psychological burden for those living with it. This 15 min consultation piece describes the causes of hirsutism, ...
Source: Archives of Disease in Childhood - Education and Practice - March 19, 2024 Category: Pediatrics Authors: Cross, A. S., Moustafa, M., Elder, C. J. Tags: Editor's choice, Best practice and Fifteen Minute Consultations Source Type: research

Fifteen-minute consultation: What paediatricians need to know about vaping
This article highlights essential facts about vaping, signs of addiction and cessation support for CYP as part of health promotion. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - March 19, 2024 Category: Pediatrics Authors: Fenech, A., Baatjes, N., Gunasuntharam, K. Tags: Best practice and Fifteen Minute Consultations Source Type: research

Epistle
The alarming rise in vaping and the use of e-cigarettes by children and young persons (CYP) is a topical issue.1 Although vaping nicotine and its toxic by-products have been established to have many harmful effects, e-cigarette use has been misleadingly advertised as a viable strategy in aiding smoking cessation. There is, however, limited evidence to support this suggestion. This perception that vaping products are safe and harmless compared with combustible tobacco, together with attractive advertising and media influences, have contributed to the growing popularity of e-cigarettes among the young. Over the years, approp...
Source: Archives of Disease in Childhood - Education and Practice - March 19, 2024 Category: Pediatrics Authors: Gupta, N. Tags: Highlights from this issue Source Type: research

Addressing the language barriers to inclusion in paediatric emergency medicine research
Introduction There are many challenges to ensuring good representation within a research study, one such challenge is spoken language.1 In countries where the primary spoken language is English, such as the UK, it has been observed that people who require translation services are frequently excluded from participating in research studies.2–5 The implications of language-based exclusion in research are that essential data could be missed; including how different groups of people present clinically in relation to disease, or differences in responsivity to treatments.6–9 Exclusion based on language ability has the...
Source: Archives of Disease in Childhood - Education and Practice - January 23, 2024 Category: Pediatrics Authors: Walsh, H., Dliso, S., Messahel, S. Tags: Editor's choice Research in practice Source Type: research

A well child with prolonged oral thrush: an unexpected diagnostic journey
Oral thrush is a familiar presentation in both general practice and paediatrics, and is usually responsive to treatment in the community. Here, we present the diagnostic journey of a previously well boy aged 3 years who presented with treatment-resistant thrush and describe how ‘unexpected’ results led to eventual diagnosis and management. This intriguing case was managed jointly by district hospital general paediatric team and tertiary hospital specialist teams. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - January 23, 2024 Category: Pediatrics Authors: Gounari, E., Elfeky, R., Ghataore, L., Muhi-Iddin, N., Buchanan, C. R., Arya, V. B. Tags: Problem solving in clinical practice Source Type: research

Inotrope use in children with septic shock: a guide for general paediatricians
Introduction With a variety of vasoactive agents available with differing modes of action and little in the way of high-quality evidence from the paediatric population, starting and choosing the right inotrope in children with severe sepsis can be a difficult decision. In this paper we discuss basic pharmacology and physiology as well as a reasoned approach on when and how to use inotropes in a general paediatric and emergency department setting until the paediatric critical care retrieval team arrives. Cardiovascular physiological considerations in children with septic shock There are numerous types of shock in paediatric...
Source: Archives of Disease in Childhood - Education and Practice - January 23, 2024 Category: Pediatrics Authors: Kanaris, C., Wahida, R. Tags: Medicines update Source Type: research

Improving induction to support new junior paediatric staff through an electronic induction guide and buddy scheme
The problem Staff changeover is stressful and a source of significant anxiety for rotating clinicians and the wider team; paediatric rotations can be particularly unfamiliar.1–5 Departments take steps to mitigate this and to prepare staff for their role, by providing an induction programme. Induction may include oral presentations, written information, tours and practical sessions to address common areas of confusion and orientate newcomers. However, inductions vary, and their impact may be transient given unfamiliarity and stress hinder learning new information and the volume of information required is likely to be ...
Source: Archives of Disease in Childhood - Education and Practice - January 23, 2024 Category: Pediatrics Authors: Wang, Y. Y., Prendergast, E., Butler, M. Tags: Equipped: quality improvement Source Type: research

Fifteen-minute consultation: Managing post-COVID-19 syndrome (long COVID) in children and young people
Post-COVID-19 syndrome is a new condition that can have a major impact on the physical and mental well-being of children and young people, affecting their ability to access activities including education. Paediatricians and general practitioners need to be able to assess and manage patients with this condition; making the diagnosis, excluding serious pathology, managing comorbidities and accessing appropriate management are crucial. This 15 minute consultation presents an approach to history taking, examination, investigations, management principles and referrals. (Source: Archives of Disease in Childhood - Education and Practice)
Source: Archives of Disease in Childhood - Education and Practice - January 23, 2024 Category: Pediatrics Authors: Wacks, M., Wortley, E., Gregorowski, A., Segal, T. Y., Whittaker, E. Tags: Best practice and Fifteen Minute Consultations, COVID-19 Source Type: research

Safeguarding essentials in modern-day paediatrics: inflicted injuries, body maps and section 47 investigations
The second case in the Safeguarding Essentials in Modern-day Paediatrics series, this article focuses on inflicted injuries, body maps and child protection investigations (CPIs). Using the scenario of a 6-year-old presenting to the emergency department having ‘fallen off a swing’, this article focuses on key considerations for history taking and examination in cases where you suspect injuries may have been inflicted, and how to discuss raising these suspicions with the family, as well as the importance of accurate body map completion. Also covered are CPIs, giving consideration to the legal framework surroundin...
Source: Archives of Disease in Childhood - Education and Practice - January 23, 2024 Category: Pediatrics Authors: Thomas, H., Cromb, D., Alcock, A., Jacob, H. Tags: Best practice and Fifteen Minute Consultations Source Type: research