Garden hazards: trampoline injuries.

Trampolining is more popular than ever, but it can also cause injuries, some of them very serious. Siba Prosad Paul, Torbay Hospital, Torquay, Joanna Barnden, University of Bristol, and Meridith Kane, Yeovil District Hospital, discuss what can be done to prevent them.

At a glance: common (abdominal) surgical conditions in children.

In children, surgical conditions of the abdomen can present with rather non-specific symptoms akin to other common, self-limiting pathologies. These factors can impede diagnosis and the rapid specialist management that is often required. Community practitioners are often the first health professional to see the sick child and advise their caregivers. Therefore it is of upmost importance that they are equipped and confident in their knowledge of the potential surgical conditions that they may encounter in their clinical practice. Suspicion of a serious surgical disorder or a deteriorating child warrants prompt referral to a medical professional. This article aims to provide an overview of the most common abdominal surgical conditions in children and to provide information and suggestions to the community practitioner in order to broadly enhance their outcomes.

Ingestion or aspiration of foreign bodies by children.

Ingestion and aspiration of foreign bodies are common reasons for children presenting to emergency departments. A significant proportion of such events are often unnoticed by the children's parents or carers. Emergency nurses should become suspicious of foreign body ingestion or aspiration if they see symptoms such as stridor, gagging, wheeze and difference in air entry on auscultation ( Hilliard et al 2003 , Paul et al 2010 ). If they suspect airway compromise, or bowel problems such as perforation or obstruction, the children concerned should be dealt with immediately. Definitive management for foreign body removal is generally available at tertiary centres and children should be transferred to specialist services as soon as possible after stabilisation ( McConnell 2013 ). Before discharge, their parents should be educated about possible signs of deterioration and advised about home-safety measures ( Paul and Wilkinson 2012 ).

Varicella and secondary pneumonia in a healthy child: is it time to introduce varicella vaccine in the UK?

A previously healthy 8-month-old boy presented to the emergency department with a 1-week history of chickenpox infection. His routine immunizations were up-to-date. His parents reported a high temperature (up to 39.5°C) in the preceding 48 hours and that he also had a mild cough, episodes of vomiting and loose stools. He had fed poorly in the 24 hours before presentation. Clinical assessment revealed a temperature of 36.7°C, heart rate 130/min, respiratory rate of 34/min and crusted chickenpox lesions. The infant was alert, smiling and playful, and systemic examination was otherwise unremarkable. He was admitted for monitoring of his fluid intake and temperature. As the infant continued to vomit intermittently in the 6 hours post admission, blood investigations were done and intravenous fluids were commenced. Laboratory investigations did not reveal biochemical evidence of dehydration, but they did show raised inflammatory markers: white blood cell count 24.8 × 109/litre, neutrophil count 19.8 × 109/litre and C-reactive protein 227mg/litre. In view of these results and the ongoing high fever, a chest X-ray was performed, revealing right upper lobe consolidation and collapse (Figure 1). Oral amoxicillin and flucloxacillin were started and oral feeding was successfully reestablished over the next 24 hours. He was discharged home after 48 hours, to complete a full 7-day course of oral antibiotics.