• Paediatrics
• Child Health

The alarming rise in vaping and the use of e-cigarettes by children and young persons (CYP) is a topical issue.1 Although vaping nicotine and its toxic by-products have been established to have many harmful effects, e-cigarette use has been misleadingly advertised as a viable strategy in aiding smoking cessation. There is, however, limited evidence to support this suggestion. This perception that vaping products are safe and harmless compared with combustible tobacco, together with attractive advertising and media influences, have contributed to the growing popularity of e-cigarettes among the young.

Over the years, appropriate smoking legislation has proven to be effective in reducing the use of harmful combustible tobacco products. The landmark announcement by the UK government to introduce bans on disposable e-cigarettes will come in effect later this year or by early 2025. The legislation introduces not only penalties for the sale of these products, but also restrictions on flavours and packaging which entices the CYP. The article by Amanda Fenech and colleagues provides useful information regarding vaping, signs of addiction and a helpful guide for paediatricians on how to practically approach vaping with CYP for health promotion ( see page 60 ).

This edition also has some fantastic articles focused on paediatric endocrinological presentations including hypothyroidism, hirsutism and neonatal hypoglycaemia. Rhiannon McBay-Doherty and colleagues gives us a case of a child with autoimmune hypothyroidism who presented in an emergency department with acute complications, despite normal thyroid function. This Epilogue is an interesting read ( see page 95 ).

The fifteen-minute consultation article by Alexandra Selina Cross and colleagues provides an approach to how to manage an adolescent presenting with hirsutism ( see page 66 ). Hirsutism commonly affects adolescent girls but can be challenging to diagnose in this age group due to the overlap of features with what is normal in the healthy adolescent. The authors introduce a novel assessment tool to help with the assessment of hirsutism in this age group. They suggest a pragmatic approach to investigations and management, including sign-posting to psychological support. The paper provides a simplified approach to this common but challenging presentation. I would highly recommend reading this article.

Dan Cromb and colleagues provide an investigative and management approach to neonatal hypoglycaemi, a common presentation. They highlight the difficulties involved, especially as normative values of blood glucose in the first 48 hours are not universally agreed on. The authors rightly highlight the need to identify at-risk infants early and focus on a preventative approach to avoid the significant morbidities which can occur with severe hypoglycaemia ( see page 73 ).

Rapid advancements in point of care ultrasonography (POCUS) have allowed it to become an integral part of managing paediatric emergencies and providing critical care. POCUS can be beneficial in skilled hands and emerging evidence suggests improved outcomes with its use.2 Elisa Poletto and colleagues discuss a niche use of transcranial doppler (TCD) ultrasound assessment of the middle cerebral artery in traumatic brain injury (TBI). Cerebral blood flow pattern from a TCD may provide useful information on the cerebrovascular status of patients at risk of acquired brain injury. The article provides practical and adaptable details on image acquisition, waveforms and interpretation required for this assessment. The authors acknowledge that while TCD is not accurate enough to replace invasive monitoring or neuroimaging techniques, it may provide complementary information for management ( see page 95 ).

Miriam Fine-Goulden and Jon Lillie discuss the use of extracorporeal membrane oxygenation (ECMO) intervention in paediatric critical car. ECMO support is required for severe but potentially reversible respiratory, cardiac or cardiorespiratory failure. Currently, this intervention can only be provided in limited number of specialised centres, but general paediatricians are invariably involved in the referral of cases and follow-up after recovery, hence it is both relevant to all and very informative. The article provides a concise summary of what ECMO support entails, the threshold for referral, anticipated complications, outcomes and follow-up considerations ( see page 82 ).

The editorial team had great pleasure in bringing together the excellent articles in this issue, and we hope you enjoy it as much as we have. A massive thank you to my fellow editors and to all the authors for their contributions. Please get in touch if you would like to get involved or write for us—we would love to hear from you.