Pub Date : 2016-05-18DOI: 10.1136/archdischild-2016-311094
I. Wacogne
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Pub Date : 2016-04-06DOI: 10.1136/archdischild-2016-310517
N. Dipak, R. Nanavati, N. Kabra
A 9-day-old male child born to a 24-year-old mother with three previous healthy children (one boy and two girls) was admitted with gradually increasing swellings over both parietal regions (figure 1), which was noticed on day 3 of life. He was a full-term normal vaginal delivery after an uneventful antenatal period, weighing 2.5 kg. The cutting of the umbilical cord was not associated with excessive bleeding. Vitamin K had been given intramuscularly at birth. A physical examination revealed a haemodynamically stable but pale baby with bilaterally symmetrically soft, fluctuant swellings measuring 3.5–4 cm in diameter over the parietal scalp regions. The rest of the examination was within normal limits. There was no evidence of bleeding from any other site or family history of bleeding tendencies. Figure 1 Bilateral cephalohaematoma. How do you differentiate between the diagnoses below? 1. Caput succedaneum 2. Subgaleal haemorrhage 3. Cephalohaematoma 4. Subgaleal cerebrospinal fluid (CSF) collection C. Cephalohaematoma. Caput succedaneum is a boggy, diffuse subcutaneous scalp swelling that has poorly defined margins and can extend over the suture lines. It is usually associated with moulding of head. A subgaleal bleed is a massive fluctuant swelling, and can extend from the orbital ridges to the nape of the neck. It is …
{"title":"Unexpected bilateral cranial swellings in a neonate","authors":"N. Dipak, R. Nanavati, N. Kabra","doi":"10.1136/archdischild-2016-310517","DOIUrl":"https://doi.org/10.1136/archdischild-2016-310517","url":null,"abstract":"A 9-day-old male child born to a 24-year-old mother with three previous healthy children (one boy and two girls) was admitted with gradually increasing swellings over both parietal regions (figure 1), which was noticed on day 3 of life. He was a full-term normal vaginal delivery after an uneventful antenatal period, weighing 2.5 kg. The cutting of the umbilical cord was not associated with excessive bleeding. Vitamin K had been given intramuscularly at birth. A physical examination revealed a haemodynamically stable but pale baby with bilaterally symmetrically soft, fluctuant swellings measuring 3.5–4 cm in diameter over the parietal scalp regions. The rest of the examination was within normal limits. There was no evidence of bleeding from any other site or family history of bleeding tendencies.\u0000\u0000\u0000\u0000Figure 1 \u0000Bilateral cephalohaematoma.\u0000\u0000\u0000\u0000How do you differentiate between the diagnoses below? \u0000\u00001. Caput succedaneum\u0000\u00002. Subgaleal haemorrhage\u0000\u00003. Cephalohaematoma\u0000\u00004. Subgaleal cerebrospinal fluid (CSF) collection\u0000\u0000C. Cephalohaematoma. Caput succedaneum is a boggy, diffuse subcutaneous scalp swelling that has poorly defined margins and can extend over the suture lines. It is usually associated with moulding of head. A subgaleal bleed is a massive fluctuant swelling, and can extend from the orbital ridges to the nape of the neck. It is …","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":"48 1","pages":"133 - 134"},"PeriodicalIF":0.0,"publicationDate":"2016-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80183809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-03-21DOI: 10.1136/archdischild-2015-309631
H. Jacob, J. Raine
In June 2015, the General Medical Council (GMC) and Nursing and Midwifery Council (NMC) jointly published the guidance Openness and honesty when things go wrong: the professional duty of candour. 1 This guidance was developed in response to the Francis report about the Mid Staffordshire NHS Foundation Trust.2 It elaborates on the joint statement from eight regulators of healthcare professionals in the UK about the professional responsibility of all healthcare professionals to be honest with patients when things go wrong.3 The guidance builds on the principles set out by the GMC in Good Medical Practice and by the NMC in The Code: Professional Standards of Practice and Behaviour for Nurses and Midwives .4 ,5 It is guidance for individuals meaning that even if you are not the person reporting adverse incidents and speaking to patients if things go wrong, you must make sure that someone in the team has taken responsibility for this and support them as needed. This guidance applies to all doctors registered with the GMC across the UK. In addition, there is now a statutory duty of candour, meaning a legal obligation, for NHS organisations within England as well as independent health and social care providers. This follows the Health and Social Care Act, which came into force in November 2014. Different laws apply in other parts of the UK. The Francis report is explicit that any patient harmed by the provision of a healthcare service is informed of the fact and offered an appropriate remedy, regardless of whether a complaint has been made or a question asked about it. The statutory duty of candour applies when a patient has been subjected to moderate harm or worse, as a result of an error. Cases where an error has led to severe harm or …
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Pub Date : 2016-03-17DOI: 10.1136/archdischild-2014-307605a
O. Narayan, S. Ho, W. Lenney, D. Wells, F. Gilchrist
{"title":"Answers to Epilogue questions","authors":"O. Narayan, S. Ho, W. Lenney, D. Wells, F. Gilchrist","doi":"10.1136/archdischild-2014-307605a","DOIUrl":"https://doi.org/10.1136/archdischild-2014-307605a","url":null,"abstract":"","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":"90 1","pages":"112 - 112"},"PeriodicalIF":0.0,"publicationDate":"2016-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72557990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-03-17DOI: 10.1136/archdischild-2015-308998a
{"title":"Answers to Illuminations questions","authors":"","doi":"10.1136/archdischild-2015-308998a","DOIUrl":"https://doi.org/10.1136/archdischild-2015-308998a","url":null,"abstract":"","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":"13 1","pages":"76 - 76"},"PeriodicalIF":0.0,"publicationDate":"2016-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72929633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-03-17DOI: 10.1136/archdischild-2015-309060
F. Ladomenou, B. Gaspar
Children are often referred to immunologists for the evaluation of reduced serum immunoglobulins. Knowledge of the immunoglobulin levels in healthy children of different ages is necessary when estimating immunological deficiency states of various kinds. After the measurement of the serum levels of the three major isotypes, examination of the capacity of the child to form antibodies to several antigens is a reasonable next step in the evaluation. We can rely on vaccine responses to make the distinction between significant primary immunodeficiency diseases and transiently low immunoglobulin levels. On the other hand, normal values of IgM, IgG and IgA are not always enough to exclude a more serious condition. Regardless of immunoglobulin concentrations, if a child's history indicates that further evaluation is warranted, a complete humoral immunity study should be carried out, including IgG subclasses, specific antibody responses and identification of B lymphocyte populations.
{"title":"How to use immunoglobulin levels in investigating immune deficiencies","authors":"F. Ladomenou, B. Gaspar","doi":"10.1136/archdischild-2015-309060","DOIUrl":"https://doi.org/10.1136/archdischild-2015-309060","url":null,"abstract":"Children are often referred to immunologists for the evaluation of reduced serum immunoglobulins. Knowledge of the immunoglobulin levels in healthy children of different ages is necessary when estimating immunological deficiency states of various kinds. After the measurement of the serum levels of the three major isotypes, examination of the capacity of the child to form antibodies to several antigens is a reasonable next step in the evaluation. We can rely on vaccine responses to make the distinction between significant primary immunodeficiency diseases and transiently low immunoglobulin levels. On the other hand, normal values of IgM, IgG and IgA are not always enough to exclude a more serious condition. Regardless of immunoglobulin concentrations, if a child's history indicates that further evaluation is warranted, a complete humoral immunity study should be carried out, including IgG subclasses, specific antibody responses and identification of B lymphocyte populations.","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":"7 1","pages":"129 - 135"},"PeriodicalIF":0.0,"publicationDate":"2016-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80447732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-03-17DOI: 10.1136/archdischild-2016-310754
I. Wacogne
In the UK, paediatricians, in common with other doctors, are required to learn and develop as professionals, or “do CPD”. There are probably as many approaches to this as there are people who maintain professional status. To briefly summarise for those not in the UK, or who are in a training job where things are done a little differently: Our regulatory body, the Royal College of Paediatrics and Child Health, describes the range of things we can legitimately describe as CPD. We—mostly—fill out a diary of our activities, which is scrutinised at our yearly appraisal, the record of which is used by our Responsible Officer to recommend to the General Medical Council that we revalidate—that we maintain our licence to practice. Whether this process is meaningful depends on the person filling out the diary, and to a lesser extent the appraiser. The diary asks us to identify our learning needs, and, I’ll be honest, this is the bit where I fall pretty short. I can spend an hour in a fascinating X-ray meeting, and learn all sorts of amazing things— and even think, and record, that I need to find out a little more about, say, the significance of an incidental finding of an arachnoid cyst on an MRI scan of the brain. But it is very rare that I get the chance to actually answer that question, because there is always something new to look for, think about, find out about. Although I would hope that I’m learning all the time, the completion of the cycle—where I identify my need and address it—is weak for me. At least, it is most of the time. But sometimes I get really lucky. I have the advantage of working with some great folk, and being able to represent a journal, and therefore I can commission an article on precisely that—what do I do about the incidental arachnoid cyst? In this issue my Editor’s Choice is a paper by Chirag Patel and Desi Rodrigues, Fifteen minute consultation: Incidental findings on brain and spine imaging (see page 208). It unpicks one of one of the heartsink features of modern medicine, where you’ve done a test for a perfectly good reason, and have thrown up a seemingly random finding. I often warn families of this very possibility: “The thing is, our tests are sometimes too good, and sometimes turn up with information that we need to share with you, but that actually has nothing to do with why we did the test in the first place.” It’s a compelling reason to minimise testing wherever possible—I’m sure that on many occasions my own well meaning but over-eager investigation has resulted in what will turn out to be a lifetime of higher insurance payments. The complexity of brain imaging—and the complexity of the brain—means that these incidental findings can be perplexing, and set in a chain a series of medical consequences. The “cut out and keep” aspect of the paper is table 1, which at the very least will help you share care with neurosurgeons. Education & Practice is the CPD journal in the Archives of Disease in Childhood stable. I’d like
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Pub Date : 2016-03-16DOI: 10.1136/archdischild-2014-307286
Paul Andrzejowski, W. Carroll
Codeine is a drug that until recently was widely used in children. It was endorsed by the WHO as the second step on the analgesic ladder for cancer pain and has been used routinely for postoperative and breakthrough pain. Recently, its safety and efficacy have been called into question, following deaths after adenotonsillectomy was associated with its use. This has led to regulation by the US Food and Drug Administration, European Medicines Agency and the UK Medicines and Healthcare products Regulatory Agency to place significant restrictions on its use, and some centres have stopped using it altogether. In this article, we discuss the developmental pharmacology underpinning its action, reviewing what is known about the pharmacokinetics, pharmacodynamics and pharmacogenetics in children, how this relates to prescribing, as well as the practical issues and the recent regulatory framework surrounding its use.
可待因是一种直到最近才被广泛用于儿童的药物。它被世界卫生组织认可为癌症疼痛镇痛阶梯的第二步，并已常规用于术后和突破性疼痛。最近，它的安全性和有效性受到质疑，因为它的使用与腺扁桃体切除术后的死亡有关。这导致美国食品和药物管理局(fda)、欧洲药品管理局(European Medicines Agency)和英国药品和保健产品管理局(UK Medicines and Healthcare products Regulatory Agency)对其使用施加了严格限制，一些中心已完全停止使用它。在本文中，我们讨论了其作用的发育药理学基础，回顾了已知的儿童药代动力学，药效学和药物遗传学，这与处方的关系，以及围绕其使用的实际问题和最近的监管框架。
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Pub Date : 2016-03-09DOI: 10.1136/archdischild-2015-309706
D. Marikar
This report by the Royal College of Paediatrics and Child Health (RCPCH) presents evidence-based recommendations for the diagnosis of death by neurological criteria (DNC) in infants aged between 37 weeks corrected gestation and 2 months post term. The preconditions specified in the 2008 Academy of Medical Royal College's (AoMRC's) code of practice1 should be fulfilled:
{"title":"The diagnosis of death by neurological criteria in infants less than 2 months old: RCPCH guideline 2015","authors":"D. Marikar","doi":"10.1136/archdischild-2015-309706","DOIUrl":"https://doi.org/10.1136/archdischild-2015-309706","url":null,"abstract":"This report by the Royal College of Paediatrics and Child Health (RCPCH) presents evidence-based recommendations for the diagnosis of death by neurological criteria (DNC) in infants aged between 37 weeks corrected gestation and 2 months post term.\u0000\u0000The preconditions specified in the 2008 Academy of Medical Royal College's (AoMRC's) code of practice1 should be fulfilled:","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":"78 1","pages":"186 - 186"},"PeriodicalIF":0.0,"publicationDate":"2016-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82581162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-03-01DOI: 10.1136/archdischild-2015-308973
H. Jacob, B. Grodzinski, C. Fertleman
Toilet training is a process that all healthy children go through. It is one of the developmental milestones for which parents most often seek medical help. Despite this, many paediatricians feel unconfident managing children presenting with a toilet training problem. We address some common questions arising when assessing and managing such a child, including identifying rare but important diagnoses not to miss.
{"title":"Fifteen-minute consultation: problems in the healthy child—toilet training","authors":"H. Jacob, B. Grodzinski, C. Fertleman","doi":"10.1136/archdischild-2015-308973","DOIUrl":"https://doi.org/10.1136/archdischild-2015-308973","url":null,"abstract":"Toilet training is a process that all healthy children go through. It is one of the developmental milestones for which parents most often seek medical help. Despite this, many paediatricians feel unconfident managing children presenting with a toilet training problem. We address some common questions arising when assessing and managing such a child, including identifying rare but important diagnoses not to miss.","PeriodicalId":8153,"journal":{"name":"Archives of Disease in Childhood: Education & Practice Edition","volume":"59 1","pages":"119 - 123"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85317090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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