Paediatric Pearls

The March 2011 version is now published.  I have covered the new NICE guideline on food allergy and provided a link to the Allergy Academy which runs some really excellent course on all aspects of allergy in children, including one specifically for ED physicians.   There’s a bit on how to get foreign bodies out of noses and a text box on the paediatric early warning system or PEWS.  I have reminded you all that children under 18 months with a fracture need to be seen by a paediatrician before discharge for a safeguarding assessment.  This guideline comes from a new document put together by the NSPCC and the Welsh Child Protection group.  The pamphlet, downloadable here, describes when to suspect physical abuse in children with fractures and is useful reading for all ED practitioners.  Do leave comments below.

This month’s emergency department version of Paediatric Pearls has information on the NICE guideline on ADHD, normal paediatric observations, the updated resuscitation guidelines and a bit from the literature on children who snore.  Do leave comments and questions.

There is a good reason why “heart rate” can swing the paediatric early warning score (PEWS) from orange to red necessitating a move to resus with the child. Tachycardia in an unwell child is caused by compensated shock until proved otherwise.

Normal heart rate values (from APLS handbook):

<1 yr of age             110-160
 1-2yrs                       100-150
 2-5yrs                         94-140
5-12yrs                        80-120
>12yrs                          60-100

Only when shock has been ruled out should you think about the effect that fever, pain, crying or salbutamol may be having on the child’s heart rate.