At a glance: respiratory tract infections in children.

Respiratory tract infections (RTIs) are one of the most common presentations to child health professionals. It is important that community practitioners are able to distinguish serious RTIs from those which can be managed in the community with advice and reassurance. Common respiratory symptoms include cough, wheeze, fever, tachypnoea and stridor. This paper aims to identify the common presentations of RTIs seen in children. A discussion on asthma with relevance to RTIs is also included. The red flag indicators and children from high risk groups should be identified while assessing a child with suspected RTI and an early referral to a medical professional should be initiated. Community practitioners should be able to reassure parents and educate them on signs of deterioration when the management of a child with RTI is considered appropriate in the community.

Red flag causes of vomiting in infants.

Vomiting is a common presentation in infants and is mostly due to a benign cause. Although vomiting is usually considered to be gastrointestinal in origin, it can be due to dysfunction of other organ systems, some of which may be life threatening. Community practitioners are often the first health professionals to come across these infants. They should assess these infants keeping in mind the 'red flags'. Suspicion of a serious disorder should be followed by prompt referral to a medical professional. This article aims to highlight the commonly encountered causes of vomiting in infants and provides some suggestions to be followed by community practitioners while dealing with an infant presenting with vomiting.

Common surgical problems in children.

This article aims to take the reader through the common presentations and assessment of children presenting with a surgical condition. Although relatively uncommon, most of these conditions need urgent identification and management. After reading this article and completing the questions that follow the reader should be able to: identify the signs and symptoms of a surgical problem; recognise the importance of supporting families with a surgical condition, both pre and post diagnosis; initiate appropriate referral for different surgical conditions.

Antimicrobial policies in the neonatal units of the United Kingdom and Republic of Ireland.

OBJECTIVES: To review antibiotic and antifungal policies in British and Irish neonatal units (NNUs). METHODS: A telephone survey was performed regarding empirical antimicrobial guidelines of NNUs in the UK and Republic of Ireland. RESULTS: The response rate was 91% (202 of 222 NNUs). The guidelines from all responding units covered group B Streptococcus and Escherichia coli, the most common causes of neonatal septicaemia and meningitis. However, 19% did not cover Listeria, the cause of meningitis in 5% to 7% of cases in England and Wales. Second-line recommendations varied greatly between units, with widespread use of broad-spectrum agents. Fungal prophylaxis and treatment guidelines were generally rudimentary. CONCLUSIONS: Empirical antimicrobial recommendations on many NNUs include broad-spectrum antibiotics without ensuring universal coverage of important pathogens. We raise concerns about the selection pressures exerted for resistant pathogens and invasive fungal disease, especially as few units specify fungal prophylaxis or treatment guidance. Development of rational guidelines for the UK and Irish neonatal units might help to optimize treatment while minimizing overuse of broad-spectrum agents.