Paediatrics.info

Welcome to the February Epistle, and to an edition of Education and Practice which looks – and perhaps feels – a little different, but which contains most of the sections you are familiar with. Here is a summary of the changes.

First, those of you reading this on paper will have noticed the new cover; this is traditional with a change in Editor in Chief and because we publish on even months you would have also seen the redesign on the blue journal and F&N first.

Next, those of you reading on paper or as downloaded pdfs, we have changed the way the articles are laid out on the page. We think this looks better on the page, and hope that the papers feel a bit better when you read them. Ideally of course, you will not notice anything.

Finally, one of the bugbears of a journal is the...

The paediatrician's role in the developmental assessment of children under the age of 5 is well established, and so he/she might also have a role in the assessment of school-age children, particularly as (i) it is increasingly recognised that subtle presentations of developmental disorders may escape professional notice until school age, (ii) these disorders are interweaving and overlapping, necessitating a truly holistic view and (iii) no another professional group is equipped to deliver a single diagnostic assessment encompassing cognitive, communication, social, emotional and physical domains.

However, assessment in the over-5s requires a different set of skills to the under-5s. The emphasis in this age group shifts from assessing developmental impairment, for example, a specific delay in walking or talking or a low developmental quotient, to assessing factors affecting the child's social or academic function. The paediatrician's task is to apply their knowledge of risks and vulnerabilities, using their experience in general and developmental paediatrics, paediatric neurology and child and adolescent mental health to identify environmental and/or biological factors affecting the child. The diagnostic focus that is a strength of paediatric practice needs to be tempered by a more flexible approach taking account of the child's strengths and difficulties. Finally, the clinician needs to decide if further assessment and investigations are required and make recommendations to help improve the outcome for the child.

In this paper, the author will set out the context for these assessments, and then guide the reader through a clinical approach that the author has found useful.

While reviewing over on BMJ Case Reports, I have come across some very curious paediatric articles and some that are not even catalogued under the paediatric specialty section but related to our practice. They can be found in the archive under the clinical and non-clinical sections. There is an abundance of weird and wonderful information on the website that serves to demonstrate unusual and unique learning points but also in some instances reiterate simpler things that we can sometimes take for granted in our busy working lives.

My area of interest within paediatrics is rheumatology, so to start this series here are a couple of things from adult case reports that I thought I’d share with you here.

Photosensitivity is an important counselling issue in children with systemic lupus erythematosus.1 This was demonstrated by the case of an adult who had unprotected exposure to sunlight, which...

Neonatologists often feel helpless in the management of procedural pain. While we acknowledge that our patients are more frequently and chronically exposed to tissue damaging procedures than any other hospital population, and that they are more vulnerable both in the short and long term, it is not certain that we have any techniques that are proven to be effective. Although we have developed numerous guidelines12 they are not reliably applied in clinical practice.3

It is widely recognised that newborns undergoing intensive care are necessarily subjected to numerous painful procedures.4 Despite the availability of clinical guidelines the majority of painful procedures on neonatal intensive care units (NICUs) are still carried out without any form of analgesia. Even outside the NICU term neonates are subjected to multiple procedures such as blood tests and insertion of nasogastric tubes. Surgical procedures such as circumcision,...

Browsing in Clinical Evidence, I noticed six updated reviews and stumbled upon a couple of head scratchers for me. One of them, literally made my head itch.

Bronchiolitis review. The holy grail has not been found. I thought we had a moderately good treatment in hypertonic saline when I read a systematic review that included four randomised controlled trials (RCT) and showed that 3% saline reduced mean length of stay by a day, and also improved clinical scores, when compared to 0.9% saline. But this review notes two subsequent RCTs that are not very encouraging. The first RCT included 46 children and there was no difference in hospital admission, oxygen saturation or clinical scores between 3% saline plus epinephrine and 0.9% saline plus epinephrine. The second RCT was larger, included 186 children, and also did not show any significant difference when using hypertonic saline. Since I know of...