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  1. Neelam Gupta, Edition editor1,2
  1. 1 Department of Neonatology, Evelina London Children’s Hospital, Guys and St Thomas Hospital NHS Trust, London, UK
  2. 2 Faculty of Life Sciences & Medicine, King's College London, London, UK
  1. Correspondence to Dr Neelam Gupta, Department of Neonatology, Evelina London Children’s Hospital, Guys and St Thomas Hospital NHS Trust, London, UK; Neelam.Gupta{at}

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Spring greetings—we hope this issue has something for all. The theme running through many of the articles is looking beyond immediate fixable problems to explore the unfamiliar, as illustrated by the fantastic guidance on managing gender fluidity and digital harm.

Ludovica Barbi and colleagues provide an insight into how to answer parents’ questions on gender diverse expressions of pre-pubescent children ( see pages 106 ). The authors have included the parent journey in their article, which really highlights how challenging and confusing transition can be for families. Paediatricians need to be able to grasp how to deal with parental questions and provide appropriate support for families in a specialised multidisciplinary setting. The authors have emphasised how childhood gender-diverse behaviour should not be pathologised and how important it is for families to embrace age-appropriate and gender-aware nurturing, without pushing children in any particular direction.

The digital world is evolving fast and now is an inseparable part of childhood personal development. It brings multiple benefits but also exposes children to new health risks, including physical and mental health problems. Safeguarding issues may arise: exploitation, abuse and peer cyberbullying. While paediatricians should advocate for children to have equitable access to digital resources, we also need to be aware of the prospect of digital harm and its potential deleterious health effects. The article by Arthur Joustra and colleagues introduces us to the recognition, prevention and management of digital harm ( see page 120 ). For children and young people, their ‘online life’ can be present as a real-life existence, which is why health professionals urgently need to inculcate exploration of digital life as standard during consultations and be able to provide practical advice to families on digital safety. This article is my editor’s choice, as it is increasingly pertinent to the evolving world our children dwell in.

The guideline review section highlights the British Society of Paediatric Endocrinology and Diabetes (BPSED) guideline on how to manage adrenal insufficiency ( see page 127 ). It addresses various key areas which have not been discussed in preceding NICE guidance, such as a comprehensive definition of what constitutes ‘sick-day situations’, post-vaccination, long distance travel and surgery. Surgical procedures are clearly distinguished into minor and major categories for appropriate management. Martha Mckenna and colleagues provide a concise review of this guideline, which is a helpful must-read for practising paediatricians.

The diagnosis of autoimmune conditions can be challenging, as signs and symptoms may be non-specific. In some cases, autoantibody detection can be used diagnostically and also to inform prognosis. Hayley King and colleagues summarise how this can be helpful in paediatric practice ( see page 137 ). They emphasise that autoantibody detection should only be used in combination with clinical and other laboratory findings and should not be regarded as a blanket test. The article highlights the limitations of this test and cautions against simply extrapolating from adult studies data when managing paediatric autoimmune conditions.

The fifteen minutes consultation article by Rachel Whittaker and colleagues on ‘structured approach to infant with stridor and suspected laryngomalacia’ ( see page 115 ) includes an excellent aetiological summary and provides a detailed approach to the management of laryngomalacia according to clinical severity. The authors have packed in lots of information in a simple, well written article which I highly recommend.

There are so many more highlights than space permits me to mention and I hope you enjoy reading them all. I am thankful to the editorial team behind this excellent issue and of course thank the authors who have filled our pages exceptionally well. We love reading your contributions and hearing your ideas—please keep them coming.

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  • Contributors N/A.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.