• paediatrics
• child health

I just stopped myself from typing a really dim start to this Epistle. I found myself about to write ‘We don’t really know what the next few months will bring.’ Of course, this has been far too obvious to be worth stating for quite some time now—and arguably can be extended to any period of a few months in the care or company of children. The world spins, the seasons change, and, ordinarily, in the Northern Hemisphere, the end of summer and the start of autumn starts us thinking about bronchiolitis. This year has been different. First, most of us had no bronchiolitis season last year—although we had plenty of other things to get on with. And second, we’ve been anxiously watching colleagues in the Southern Hemisphere, some of whom have experienced significant out of season epidemics. So, in anticipation of what I’ve decided to call the #TsnotTsunami we bring you an issue, in short, devoid of RSV content.

There’s quite a strong diabetes and glucose flavour to this issue. Philippa Prentice has curated an excellent cluster of articles around the BSPED guidelines for diabetes care. Nicola Heddy reviews the guideline ( see page 220 ), and then Mark Peters gives some helpful thoughts around fluid resuscitation ( see page 223 )—which has become more robust, in contrast with nearly all other fluid guidance being issued. Neil Wright and Rum Thomas give a view on the guideline ( see page 226 ), and then Philippa adds some context (or more accurately some compare and contrast) with the NICE guidance ( see page 229 ). I hope you find them helpful to achieve some clarity in your own care. Then, slipped in at the end of the journal, Kirsty Grey, Rebecca Dalrymple and Andrew Brunton review a paper which suggests that we might be able to lower our threshold at which we describe babies as hypoglycaemic ( see page 255 ). It will be interesting to see if and when this makes it into practice, it would certainly reduce the level of intervention we make.

For my Editor’s choice, however, I’m going to turn to a paper which I hope you will not need to reach for in many children you manage with bronchiolitis—an Interpretation on blood cultures, from Shaun O’Hagan and colleagues ( see page 244 ). It’s got some brilliant ‘back to basics’ points and also brings us up to date with modern practice. I’ll confess that, despite having been taught this a few times, I still have a mental image of microbiologists peering at a broth to determine if it is growing bugs. I will do my best to get rid of this image which, if it were ever true, is now seriously out of date. This article has some excellent clinical scenarios posed which help me embed it into everyday practice.

I have a soft spot for Interpretations papers. I need to share with you that one of the section editors, Sam Behjati, is leaving E&P. I want to thank him for over a decade of hard work with the journal. He describes that he thought we were taking a risk when we appointed him as an SHO to the role, but I don’t think so; it was clear from our first meeting that he had a keen mind, and would not let anything prevent him getting the best possible articles to help you manage children. It’s been a real privilege to benefit from his skills, and I wish him the very best for the future.

And you? I wish you the best for the future, and specifically for the next couple of months. And the couple of months after that, and the couple of months after that too. Enjoy the issue.