Paediatrics and Child Health (United Kingdom)最新文献

Primary tumours of bone are a diverse group of lesions that range from benign to malignant neoplasms. While primary benign bone tumours are more prevalent than malignancies in children malignant bone tumours are the seventh most common type of malignancies in children, accounting for roughly 3%–5% of cancers between the ages of 0 and 14 years. Whilst certain aspects of benign bone tumours can be challenging to diagnose and differentiate recent research employing advanced molecular and genetic methodologies has expanded our understanding. This in combination with the neoplasm cell architecture establishes the diagnosis. Whilst recent introduction of massively parallel sequencing-based methods has opened new opportunities for diagnosing bone cancers, the diagnosis of bone lesions is reliant on diagnostic imaging and multidisciplinary team (MDT) discussion. While management of benign tumours is dependent on the diagnosis and clinical features in most cases it requires simple curettage and complete excision.

Children frequently present in an acute setting with musculoskeletal complaints. A solitary swollen joint has a broad differential from benign and self-limiting to life or limb threatening. This article aims to describe the more common as well as troubling diagnoses including malignancy, infection and multi-systemic conditions and discusses variation in presentation, examination and investigations between these differentials. It offers a practical approach for health care professionals who encounter a child presenting with a solitary swollen joint without fever.

Oxygen therapy is widely used in the community for patients with chronic hypoxaemia. Although only a small proportion of those are children, more and more paediatric patients are prescribed home oxygen for a variety of indications, most commonly for chronic lung disease related to premature birth. Chronic hypoxaemia in children is diagnosed using pulse oximetry, a method that has limitations, but alternative tests are rarely required. Whilst there are clear advantages in therapy with oxygen outside the hospital setting, clinicians need to be aware of potential impact on family life, housing, school attendance and travel. The process of prescribing is standardised in the UK, and it is crucial for clinicians to understand risks and equipment used to deliver oxygen in the community. Regular follow up is important and input from community-based professionals is hugely beneficial. Some children on long-term oxygen therapy may be able to wean and eventually stop therapy. This process can be supported by a structured protocol. New technologies such as remote monitoring may further improve the care of children with chronic conditions that require long term oxygen therapy.

Acute brain injury is a significant cause of paediatric morbidity and mortality. Management should be tailored towards preventing sustained periods of elevated intracranial pressure (ICP) to limit secondary damage and prevent cerebral herniation. This article aims to promote recognition of children with raised ICP, explore the goals behind available management options and provide clinicians with concise management algorithms in order to promptly reduce ICP and improve patient outcome.

Behçet's disease (BD) is a multi-system inflammatory disease of unknown aetiology characterised by recurrent painful mouth and genital ulcerations. It is a disease of young adults, with a peak age of onset of 25–30 years. Slightly more than one quarter of cases start before the age of 16 years when it is classified as juvenile-onset BD. The eyes are commonly affected and vision may be lost in up to half the patients. Vasculitis may affect vessels of any size but mainly veins, hence the term variable vessel vasculitis. Typical skin lesions include erythema nodosum, pseudofolliculitis or papulopustular lesions and acneiform nodules in post-adolescent patients not on corticosteroids. The bowel, nervous system and joints are also frequently affected. This short review highlights the important clinical features and provides simple advice for diagnosis and principles for management in younger individuals.

Strabismus, also known as a squint, is an ocular misalignment. In the UK the prevalence of strabismus in children is 2.1%. There are multiple causes of strabismus in children; some of which can be sinister and are potentially eye or life threatening. Therefore it is essential that strabismus is identified and managed appropriately and in a timely manner. Amblyopia is frequently associated with strabismus, and can be a cause or a complication of strabismus, it needs to be recognized and treated early to prevent a permanent reduction in visual acuity. This article explains how to correctly assess strabismus in children. A detailed history should be taken, and an ocular examination should be performed using the correct techniques and ocular motility tests. The important red flag features of strabismus in children are also outlined in this article.

Cleft lip and palate (CLP) is the most common craniofacial congenital disorder and one of the most common congenital abnormalities overall. It presents with both gender and ethnic variability as well as syndromic and non-syndromic presentations. The UK model for CLP care is well established, evidence based and showcases an interplay of clinical, audit and research activity on a national scale. This article is a general overview of CLP for the paediatrician within the UK context. It discusses epidemiology, embryology, genetics, classification, UK cleft infrastructure and the schedule of cleft care. It concludes with future insights and further reading recommendations. Throughout, the role of various members of the cleft multidisciplinary team (MDT) are highlighted with especial emphasis on the role of the paediatrician. Upon reading this overview, the reader can expect to understand the multi-faceted elements of CLP care spanning from the antenatal period, throughout childhood and into adulthood.

Preseptal and orbital cellulitis are common paediatric presentations. Despite their incidence, there is no clear evidence-based guidance available to clinicians in the United Kingdom (UK). Orbital cellulitis can cause significant intracranial complications leading to vision loss and even death. An understanding of the clinical presentation, diagnosis, management, and potential complications of paediatric cellulitis is necessary for any health professional involved in the acute care of children. This article aims to develop your knowledge to facilitate your prompt diagnosis of preseptal and orbital cellulitis and to explore management options currently in practice.

Otitis media is a common childhood condition and refers to inflammation of the middle ear. It encompasses a spectrum of diseases including acute otitis media, otitis media with effusion (‘glue ear’) and chronic otitis media which are both common in childhood. This short article offers practical advice about how to evaluate and manage otological presentations. A careful history and examination are essential in children presenting with ear problems. Parents and children should be asked about pain, discharge, hearing loss, delays in speech or learning, reports of tinnitus and balance concerns. Examination includes evaluation of the pinna and mastoid, otoscopy evaluating the ear canal and tympanic membrane alongside nose, throat and neck examination. The management of otitis media differs according to the disease subtype. In acute otitis media, the mainstay of treatment is conservative or medical. Glue ear treatment initially involves active monitoring; surgical intervention or hearing rehabilitation is required in a proportion of cases. In chronic otitis media, non-surgical and surgical options are tailored to the disease under specialist care.

The importance of safeguarding vulnerable children from harm remains a key priority. Organisational changes to the structure of child protection services in England were introduced in 2018, altering the review process for serious safeguarding cases. This article provides an overview of the new multi-agency arrangements and summarizes key learning points from the final analysis of Serious Case Reviews between 2017 and 2019 and the annual review of Local Child Safeguarding Practice Reviews from 2021. Recurring themes highlighted in the reviews include the problem of neglect, contextual safeguarding, and race and racism. We will also consider three aspects of professional practice which influence safeguarding work: the complexities of ‘effective challenge’; interprofessional communication; and managing professional disagreement.