Fever in under 5s: assessment and initial management

New NICE guidance

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This guideline was updated in August 2017. It covers the assessment and early management of fever with no obvious cause in children aged under 5. It aims to improve clinical assessment and help healthcare professionals diagnose serious illness among young children who present with fever in primary and secondary care.

Read full Clinical guideline [CG160] here

The role of trait mindfulness in quality of life and asthma control among adolescents with asthma

The current study focused on the role of trait mindfulness in asthma-related quality of life (QoL) and asthma control in adolescent asthma patients | Journal of Psychosomatic Research

In this cross-sectional study, questionnaire data of 94 adolescents with asthma that were prescribed daily asthma medication were included. Two Structural Equation Models (SEMs), a direct model and an indirect model, were tested.

We found that trait mindfulness was directly related to asthma-related QoL, but not to asthma control. The relationship between trait mindfulness and asthma-related QoL was explained by asthma-specific, but not by general stress. Furthermore, an indirect relation from mindfulness to asthma control via asthma-specific stress was found.

Cross-sectional evidence for a relation between mindfulness and asthma-related QoL is found. These findings may point to the possibility that an intervention aimed at increasing mindfulness could be a promising tool to improve asthma-related QoL in adolescents via a decrease in asthma-specific stress.

Full reference: Cillessen, L. et al. (2017) The role of trait mindfulness in quality of life and asthma control among adolescents with asthma. Journal of Psychosomatic Research. Vol. 99 (August) pp. 143–148.

Child under nutrition project: A report about the current undernourishment of children in England

Patients Association, July 2017

Child NutritionThe Patients Association has issued a report suggesting that under-nutrition among children is not confined to the developing world, but is a problem in Britain today.

The project was undertaken by the Patients Association and funded by a non-restricted education grant from Abbott. A cross-section of health and care staff in four sites – Bradford, Cornwall, Tower Hamlets and Birmingham – were interviewed. Parents were also interviewed in Bradford and Cornwall.

The findings reveal examples of positive efforts in working with children and families across agencies, particularly by public health teams, community and acute health staff; but many are overstretched and unable to meet demand for the types of information and guidance that people need. The report’s recommendations include:

Awareness of under-nutrition should be raised among both professionals and the public
New and existing training and guidance for professionals should include the identification and treatment of under-nutrition
National guidance and a care pathway should be developed specifically for undernutrition.

Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives.

Kendrick D, Ablewhite J, Achana F, Benford P, Clacy R, Coffey F, et al. Keeping Children Safe: a multicentre programme of research to increase the evidence base for preventing unintentional injuries in the home in the under-fives. Programme Grants Appl Res 2017;5(14)

Burns, scalds, falls and poisoning are major causes of death, disability and health service use in the under-fives. We undertook 13 studies to explore factors associated with injuries, what prevents injuries, the cost of the injuries to the NHS and parents, and what parents and children’s centres (which provide families with information, support and co-ordinated services from a range of professionals) were doing to prevent injuries.

We used evidence from these studies to design a resource [an injury prevention briefing (IPB)] for children’s centres to use with parents for preventing house fire injuries. We gave 12 children’s centres the IPB, with training and support to implement it, (IPB+ group) and 12 centres the IPB without training or support (IPB-only group). A further 12 centres were not given the IPB (usual-care group). Children’s centres in both IPB groups used the IPB and increased injury prevention activity, more markedly in the IPB+ centres. The IPB did not increase how many families had a fire escape plan in either IPB group, but did increase some fire escape behaviours in both groups. Providing the IPB without training and support cost less and was slightly more effective than not providing the IPB. Providing the IPB with training and support cost more but was only slightly more effective than not providing the IPB. Children’s centres can increase some fire safety behaviours in families with young children if they are provided with evidence-based resources such as the IPB. A further IPB has been produced for the prevention of fire-related injuries, falls, poisonings and scalds.

Royal College of Paediatrics and Child Health: Position Statement on breastfeeding in the UK

Royal College of Paediatrics and Child Health, August 2017

This reportBaby's Healthcare highlights that the UK has one of the lowest rates of breastfeeding in Europe, and only 34% of babies are receiving some breast milk at 6 months. Recommendations include development of a national strategy to change negative societal attitudes to breastfeeding

Preschool children who are frequent attenders in emergency departments: an observational study of associated demographics and clinical characteristics

Blair M, Poots AJ, Lim V, et al. Preschool children who are frequent attenders in emergency departments: an observational study of associated demographics and clinical characteristics. Archives of Disease in Childhood Published Online First: 02 August 2017. doi: 10.1136/archdischild-2016-311952

Background Unscheduled visits to emergency departments (ED) have increased in the UK in recent years. Children who are repeat attenders are relatively understudied.

Aims To describe the sociodemographic and clinical characteristics of preschoolers who attend ED a large District General Hospital.

Method/study design Observational study analysing routinely collected ED operational data. Children attending four or more visits per year were considered as ‘frequent attenders’. Poisson regression was used with demographic details (age, sex, ethnicity, sociodemographic status) to predict number of attendances seen in the year. We further analysed detailed diagnostic characteristics of a random sample of 10% of attendees.

Main findings 10 169 patients visited in the 12-month period with 16 603 attendances. 655 individuals attended on 3335 occasions. 6.4% of this population accounted for 20.1% of total visits. In the 10% sample, there were 304 attendances, and 69 (23%) had an underlying chronic long-standing illness (CLSI). This group were 2.4 times more likely to be admitted as inpatients compared with those without such conditions, median length of stay of 6.2 hours versus 2.5 hours (p=NS).

Conclusions Frequent ED attenders fall broadly into two distinct clinical groups: those who habitually return with self-limiting conditions and those with or without exacerbation of underlying CLSI. Both groups may be amenable to both additional nursing and other forms of community support to enhance self-care and continuity of care. Further research is required to increase our understanding of specific individual family and health system factors that predict repeat attendance in this age group.

Inpatient provision for children and young people with mental health problems

Education Policy Institute, July 2017

In a new report, the Education Policy Institute (EPI) has examined the state of child and adolescent mental health inpatient services in England. The analysis explores the latest evidence and NHS data on admissions, quality of care, staffing and capacity.


Source: Education Policy Institute





The research highlights 5 challenges to raising standards in young people’s mental health provision:

Workforce shortages
Minimum standards not met 
Provision of beds
Young people in inpatient care
Young people are being left in hospital for longer than necessary due to a lack of community services