• paediatrics
• child health

I am pleased to introduce another invigorating issue which brings a balanced array of articles on clinical conundrums, investigations, skills and practical application of research. This issue is particularly focused on paediatric emergencies, cardiology and mental health.

The Fifteen-minute consultation brings a series of best practice papers on paediatric emergencies including management of trauma, major incidents and minor injuries. These articles highlight key guidance with brilliant illustrations and an aide memoire which can be easily adapted into clinical practice. Karl Kavanagh and colleagues describe a structured approach to paediatric primary survey ( see page 248 ) while the article by Clare McAuley and colleagues demonstrates a secondary survey in paediatric trauma ( see page 253 ). These articles show how vital it is to have a clear and organised approach in emergency medicine, with an emphasis on timely reassessment and communication when managing trauma.

Major incidents are rare but when they occur, children are frequently affected. The immediate need in these situations often exceeds medical capacity and available resources. Stefani Widya and colleagues provide an overview of major incidents in the context of paediatric care. The article covers all aspects of major incident including operational and tactical strategies, triaging tools, training for multiagency response to manage and deliver support during incident and recovery ( see page 236 ). Each hospital is mandated to have mass casualty incident plans and to provide training and learning events for staff. Recent global healthcare events are testament to the importance of having these strategies to enhance the quality of our response and outcomes of patients under these circumstances. For this reason, this is my editor’s choice.

Emily Prior and colleagues provide an overview of techniques to measure body composition and its application in clinical and research arenas. Body composition measurements can provide valuable insights into clinical diagnosis of disease, monitoring of response and prediction of future health risks. However, health professionals should be aware of the challenges and specific assumptions associated with different modelling and the sparsity of reference data, when applying it to clinical or research settings ( see page 285 ).

Our interpretation articles are focused on cardiac investigations, with two follow up articles by Mike Harris and Chris Oakley on ECG interpretations.1 These articles describe how to systematically interpret paediatric ECG, with a specific focus on assessing P waves and ST segments ( see page 271 and 273 ). The key learning points from these articles can be easily referenced and applied to everyday practice. In another article, Claire McGinn and colleagues describes the interpretation and challenges of using cardiac biomarkers in context of myocardial injury and heart failure in paediatrics ( see page 265 ).

One of my favourite sections in the journal is ‘Problem Solving in Clinical Practice’, which presents perplexing cases. Lucy Paterson-Brown and colleagues explore the diagnostic challenges in differentiating between organic and non-organic causes of altered behaviour and mental state, in a case study involving recurrent presentations to the paediatric emergency department. Without revealing more, I will allow you to enjoy exercising your brain on this case conundrum which unravels an interesting diagnosis ( see page 275 ).

In the similar vein, Emily Todd and colleagues allude to the challenges of achieving sustainable change when addressing quality of care and staff confidence in managing mental health issues in an acute paediatric setting. The crucial role of senior leaders to champion care of mental health problems and regular training of staff cannot be underestimated ( see page 282 ).

Hope this Epistle provides a flavour of the exciting contents in this issue. There are many more interesting articles which I have not been able to highlight due to space constraints, but I am sure you will enjoy reading them all.

As always, I feel privileged to be surrounded by talented authors and a fantastic editorial team who make this journal so unique. While we continue to publish amazing articles which are relevant to day-to-day ‘practice and achievements’, capturing readers’ attention for a journal in the current paperless climate is a persisting challenge which we are striving to overcome—on that note, I end by thanking you for your continued support.