Children presenting with convulsions (including status epilepticus) to a paediatric accident and emergency department: an audit of a treatment protocol.

All children who presented in a convulsion, including convulsive status epilepticus, to the accident and emergency department over a 12-month period and who required treatment, were reviewed retrospectively to identify the effectiveness and safety of a specific treatment protocol. This protocol recommends the initial use of one, or if necessary, two doses of rectal or intravenous diazepam (0.4 mg/kg) followed by the simultaneous administration of phenytoin (18 mg/kg) and rectal paraldehyde (0.4 mL/kg), with instructions for maximum doses and timings of administration. Eighty-one evaluable children (52 male) were audited. The mean age of the study population was 4.1 (range 0.1 to 14.9) years. Overall, the presenting convulsion was successfully terminated in 76 children (94%) within the accident and emergency department. In 69 children (85% of the entire study population) this was after a single dose of diazepam (rectal in 41 and intravenous in 28). In only an additional two children did the presenting convulsion stop after a second dose of diazepam. In five of the 10 children (50%) who received paraldehyde and phenytoin as a combination, the convulsion stopped. Nine patients (11%) required admission to the intensive-care unit, five because of persisting convulsive activity, and four because of respiratory depression. The results of this retrospective audit suggest that the current treatment protocol appears to be effective and relatively safe in treating acute convulsions, including convulsive status epilepticus. The audit is to be repeated prospectively to either confirm or refute these findings before recommending any changes to the protocol.

Deaths from injury and poisoning of children in Liverpool: a ten-year survey 1978-1987.

Deaths of children in Liverpool under 16 years of age from injury and poisoning were examined for the period 1978-1987: 174 deaths occurred during the 10-year period. The commonest causes of death were road traffic accidents: 103 cases (60%). Of these 87 were of pedestrians struck by vehicles. Many of these children were very young and were unsupervised, or poorly supervised by other children. Drivers of vehicles were largely responsible for the accidents in 20 cases. The ability of children to cope in various traffic situations is discussed and responsibilities of parents and drivers are considered in relation to matters of accident prevention.

The use of chromic catgut in the primary closure of scalp wounds in children.

A prospective clinical trial examining the benefits of using an absorbable suture for the closure of scalp wounds, is described. One hundred wounds were included, of which 50 were closed with chromic catgut, and 50 were closed with silk. On examination 5 days later, there were no complications in either group. The advantages of using an absorbable suture material in children's scalp wounds are discussed.

Spontaneous passage of a submandibular salivary calculus in a child.

Inflammatory salivary disease in childhood is an infrequent clinical entity. That associated with sialolithiasis is rare. We report a case of a child with spontaneous passage of a submandibular calculus. We believe she represents the youngest patient documented to demonstrate the phenomenon.

Perichondritis.

5 children with abdominal pain of costochondral origin were seen between October, 1987, and February, 1988. 4 were initially misdiagnosed and had unnecessary and costly investigations and inappropriate treatment. An accurate history and a thorough examination are essential to reach the correct diagnosis. A short course of mefenamic acid was effective in all but one child, who responded to a local injection of methylprednisolone.

Acute transient myositis due to Toxocara.

Two children presented with spontaneous, isolated swelling of the lower half of the left leg; this was diagnosed as acute myositis of unknown aetiology. Further investigations showed antibodies to Toxocara. The symptoms resolved within 72 hours and the children were discharged on no treatment.

Baby walkers . . . time to take a stand?

Experience in our hospital and figures from the Home Accident Surveillance System indicate that the number of accidents involving baby walkers is increasing. Safety specifications issued by the British Standards Institution are rarely, if ever, met in full by manufacturers. Home accident prevention measures have been shown to be of limited benefit. We advocate more stringent implementation of safety features in the design of baby walkers.

Drug misuse in adolescence.

Problems of adolescent drug misuse are increasingly common. A retrospective study was undertaken to compare the data from adolescents who attended the accident and emergency department of an urban children's hospital in 1981 and 1985. Epidemiological characteristics of both groups are detailed. The results are discussed and the feasibility of units specialising in the management of adolescents who have misused drugs is considered.

'Hunt the thimble': a study of the radiology of ingested foreign bodies.

The role of radiology in the management of patients with a history of ingested foreign bodies is reviewed in a retrospective study over a 2-year period in a Children's Hospital. If radiography was confined to those children who have a clinical history suggestive of foreign body impaction in the oesophagus, a foreign body aspiration or having swallowed a button battery, the work load and unnecessary radiation arising from this practice could be halved. This study demonstrates another misuse of radiological services.

Air weapon injuries in children: a case for education.

The results of the first 6 months of a 2-year prospective study on the frequency, severity and methods of prevention of air weapon injuries to children are reported. Twenty-eight cases presenting to an urban paediatric accident and emergency department have been analysed. Nineteen of these were males between the ages of 10 and 16 years. At least 18 incidents occurred in public places. The five most serious injuries were of the orbit, face and abdomen. Another nine injuries were near vital structures. Education is needed on the existing guidelines for the safe use of air weapons.

Bereavement counselling after sudden infant death.

Of 14 families who suffered a sudden infant death, eight were followed up intensively over several months and offered individual counselling, parents' group meetings, and interviews with doctors as a way of helping them come to terms with their feelings of loss. Five couples accepted short term support from their health visitor, and one refused help. Many families experienced considerable stress including marital conflict, difficulties with surviving children, and anxiety about future children becoming victims of the sudden infant death syndrome. It was concluded that medical social workers, health visitors, hospital paediatricians, general practitioners, and parent self help groups are in key positions to help. The success of such help is likely to depend on the confidence that each helper has that his or her contribution will be valued by the bereaved family.

Alcohol abuse in adolescence.

Twenty patients between the ages of 11 and 15 years who presented at hospital in 1981 having ingested alcohol were studied. Two were poisoned by another person. The data on the 18 adolescents who poisoned themselves were analysed in detail. Three groups emerged: A--4 patients had drunk alone as an experiment, act of mischief or act of defiance; B--9 patients had been involved in peer group activity; C--5 patients had either made an attempt at suicide or a plea for help. There was a predominance of females. The average age was 13 years 5 months. Most alcohol was obtained from the patients' own homes. The higher-proof beverages caused most problems. Four patients in group C combined alcohol with medicinal drugs and 2 of these had had previous episodes of self-poisoning. No clear evidence of habitual drinking emerged. Only those 8 patients who had emotional or behavioural problems prior to admission were followed up. The importance of the home as a source of alcohol and the pre-existing instability of many of the adolescents indicates that in the management of these young people and in any preventative work the whole family must be involved.

Pelviureteric obstruction in infancy.

Of 33 infants with pelviureteric obstruction, most presented in the first month of life with an abdominal mass and most were males. Half of these patients had bilateral renal pathology. The association between cystic dysplasia in the hydronephrotic kidney and contralateral cystic renal abnormality in patients with unilateral pelviureteric obstruction is noted. There were 34 pyeloureteroplasties performed on 27 patients, mostly with good results, even in patients with bilateral renal pathology.