Two Paeds In A Pod

2 Paeds in a PodShow Notes — Episode 83Knife Crime, Febrile Infants, and What's Caught My EyeReleased: May 2026 | Runtime: ~20 minutesIn this episode, Ian covers what's caught his eye in the paediatric literature this fortnight. The main story looks at a landmark national review of child deaths from knife wounds in England — and what it means for those of us working in paediatric emergency and urgent care. He then turns to new data on febrile infants aged 29 to 60 days and the evolving evidence base around risk stratification in that notoriously tricky age group. The episode closes with three quick picks from this fortnight's journal sweep: point-of-care lung ultrasound for pneumonia, reframing conversations about paediatric palliative care, and a flag for the new Surviving Sepsis Campaign paediatric guidelines — which we'll be coming back to in a dedicated episode soon.Main Story 1 — Knife Crime Deaths in Children in England (2019–2024)Knife-related deaths in children and young people represent one of the most pressing — and most inequitable — public health challenges in England today. This month, Roberts and colleagues published a review using the National Child Mortality Database covering every child under 18 who died of a knife wound between April 2019 and March 2024.The headline findings:145 children died over the five-year period — roughly one every two weeksMean age at death was 14.4 years; 90% were maleBlack or Black British children died at a rate more than 13 times higher than white children when corrected for population sizeChildren in the most deprived areas of England had over 7 times the risk of death compared with those in the least deprived areas60% of children died before reaching hospitalOf those who reached hospital, 57% underwent a thoracotomy — reflecting the severity of injuries sustainedInjuries to the chest and neck were responsible for 76% of fatal wounds75% of children had been known to social services prior to their death58% had experienced domestic violence and abuse51% had documented neurodiversity or mental health concernsWhy this matters for paediatric practice: These were not invisible children. The vast majority were known to statutory services. For clinicians working in paediatric emergency and urgent care, this paper is a reminder that every child who comes through our doors carries a history — and that our role extends beyond the presenting complaint. It also raises important questions about pre-hospital intervention, penetrating trauma training in paediatric settings, and the role of the ED as a potential point of early intervention for children at risk.Knife injuries are not confined to major urban centres — the data show deaths distributed across all regions of England.Reference: Roberts T, Odd D, Coveney J, et al. Emergency Medicine Journal. Published April 2026. https://doi.org/10.1136/emermed-2025-215154Main Story 2 — Bacteraemia and Bacterial Meningitis in Low-Risk Febrile Infants Aged 29–60 DaysThe febrile infant aged 29 to 60 days occupies some of the most uncomfortable clinical territory in paediatric emergency medicine. Too old for the automatic full-septic-screen approach applied under 28 days, but too young to rely on clinical examination alone. This paper from Burstein, Xie, and Kuppermann — published in JAMA Pediatrics — examines how the updated PECARN (Pediatric Emergency Care Applied Research Network) febrile infant rule performs in an international sample.What the PECARN rule involves: The rule uses a combination of clinical and laboratory parameters to stratify infants into low, intermediate, and higher risk for invasive bacterial infection (bacteraemia and bacterial meningitis). Key components include temperature, urinalysis findings, absolute neutrophil count, procalcitonin, and — where indicated — CSF analysis.Why this paper matters: The original PECARN derivation and validation studies were predominantly North American. This international validation is an important step in understanding how the rule performs across different healthcare systems, bacterial epidemiology, and rates of prior antibiotic exposure. The full data are behind a paywall, but the publication itself signals continued maturation of the evidence base.For UK practice: NICE guidance for this age group tends towards more liberal investigation. Whether structured risk stratification tools like PECARN could safely reduce lumbar punctures and admissions in a subset of genuinely low-risk infants is an active and important question for UK paediatric emergency practice.Key learning point: Know the PECARN framework. Know its components. And watch this space — this is a field moving quickly.Reference: Burstein B, Xie J, Kuppermann N. JAMA Pediatrics. Published April 2026. https://doi.org/10.1001/jamapediatrics.2026.0971What's Caught My Eye1. Point-of-Care Lung Ultrasound for Paediatric PneumoniaA review in Pediatric Emergency Care summarising the diagnostic performance of bedside lung ultrasound (LUS) for pneumonia in children. Multiple meta-analyses demonstrate sensitivity up to 94% and specificity up to 96% — at least comparable to chest X-ray, often better, and without the radiation burden or logistical delay.The key caveat: distinguishing bacterial consolidation from viral illness or asthma on ultrasound requires training and careful clinical correlation. Overlapping sonographic appearances are common and the technique is operator-dependent.For anyone working in paediatric ED or acute settings who hasn't yet developed confident POCUS skills for respiratory presentations — this is the evidence base saying it's worth the investment.Reference: Marzook N. Pediatric Emergency Care. Vol 42(5):391–399. Published April 2026. https://doi.org/10.1097/PEC.00000000000035332. Shifting the Narrative Around Paediatric Palliative CareStewart and colleagues at Evelina London Children's Hospital, writing in BMJ Paediatrics Open, have produced a thoughtful narrative review examining why paediatric palliative care referral happens late — and what we can do about it.The central argument: the words "palliative care" carry such strong associations with dying that clinicians often delay conversations for fear of undermining hope, and families often hear "giving up" where clinicians intend "additional support." Crucially, directly debunking this myth — saying "palliative care isn't just about end-of-life" — can backfire by activating the very association you're trying to dispel.What works better, the authors argue, is replacing the narrative rather than fighting it. Lead with what palliative care actually looks like — coordinated, holistic, life-enhancing support that runs alongside active treatment from the point of diagnosis. The paper offers a useful metaphor: palliative care is the umbrella, not the rain. You reach for it before the storm, not once you're soaked.A practical, communication-focused paper with something genuinely useful for anyone — trainee or consultant — who has ever felt uncomfortable raising that conversation.Reference: Stewart CE, Vare C, Kerr-Elliott T, et al. BMJ Paediatrics Open. Vol 10(1). Published April 2026. https://doi.org/10.1136/bmjpo-2025-0044133. Surviving Sepsis Campaign Paediatric Guidelines 2026 — FlagThe 2026 update to the Surviving Sepsis Campaign international guidelines for paediatric sepsis and septic shock is out. A panel of 68 international experts produced 61 statements — including 20 new recommendations and 13 updates from the 2020 version. Of note: only three of the 61 recommendations are based on high or moderate quality evidence.We'll be covering this in full in an upcoming episode. For now — get it on your reading list.Reference: Weiss SL, Peters MJ, et al. Pediatric Critical Care Medicine. Vol 27(4):379–434. Published March 2026. https://doi.org/10.1097/PCC.0000000000003927Key TakeawaysThe knife crime mortality data are a call to action for every clinician working with children — clinically, in terms of safeguarding awareness, and as advocates for the children most at riskPECARN febrile infant risk stratification is maturing internationally — if your department doesn't use a structured approach for the 29–60 day febrile infant, now is the time to revisitPoint-of-care lung ultrasound for paediatric pneumonia has strong diagnostic performance — sensitivity and specificity both exceed 90% in meta-analyses, and the skill is worth developingWhen introducing paediatric palliative care, replace the narrative rather than debunking it — lead with what it is, not what it isn'tThe new Surviving Sepsis Campaign guidelines are out — full episode coming soonReferencesAll articles retrieved from PubMed. Based on articles retrieved from PubMed:Roberts T, Odd D, Coveney J, et...

Clinical QuestionIn children presenting with acute severe asthma, does intravenous aminophylline improve meaningful clinical outcomes compared to standard therapy?⸻BackgroundIV aminophylline has historically been used as a second-line infusion in severe paediatric asthma. However, contemporary escalation strategies increasingly prioritise: • Oxygen • High-dose nebulised salbutamol • Systemic corticosteroids • IV magnesium sulphateThis raises the question: does aminophylline still offer incremental benefit?⸻The Evidence ReviewedA systematic review published in Archives of Disease in Childhood analysed: • 9 randomised controlled trials • 466 children • Standard therapy ± IV aminophyllineOutcomes assessed: • Asthma severity scores • Length of stay • Admission rates • PICU admission • Intubation rates • Adverse effects⸻Key FindingsNo significant benefit in: • Speed of clinical improvement • Admission rates • PICU transfer • Intubation rates • Length of hospital staySignificant increase in adverse effects: • Nausea and vomiting (3–5x higher) • Headache • Tremor • Irritability • ArrhythmiasOverall: No improvement in meaningful outcomes, with increased morbidity.⸻Important CaveatA 1998 study (Young & South) suggested possible benefit in the most critically unwell, treatment-refractory children, including: • Reduced duration of intubation • Potential improvement in lung functionThis suggests a potential narrow rescue-therapy window.⸻Implications for Paediatric Emergency Practice (2025)Current best evidence supports: 1. Oxygen 2. Nebulised salbutamol 3. Systemic corticosteroids 4. IV magnesium 5. Structured escalation planningIV aminophylline should be considered: • A rescue therapy of last resort • Not routine second-line treatment⸻Take-Home MessageIV aminophylline has historical presence but limited modern evidence of benefit. For most children with acute severe asthma, it increases adverse effects without improving outcomes.Its role in 2025: rare, selective, and critically contextual.

In this episode we talk to Dr Etimbuk Umana, the lead author of the FIDO study looking at the management of febrile infants in the Emergency Department. FIDO is a PERUKI sponsored study and was recently published in The Lancet: https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(24)00540-6/fulltext

2 Paeds returns with a fresh new look, new in association with team at PERUKI. In our first collaboration we talk to Dr Charlotte Sloane about the current major PERUKI project - establishing the current research priorities for the next 5 years in paediatric emergency medicine. If you want to get involved go to www.peruki.org.uk or email Charlotte at [email protected] You can also watch us on YouTube

We talk to Dr Tom Jackson about his article in Archives of Disease in Childhood looking at the use of Dexmedetomidine as a sedative agent fro children undergoing MRI scans in a district general hospital. Is it better the NICE recommended medications? Article can be found here: https://adc.bmj.com/content/early/2022/03/10/archdischild-2021-322734

There are so many infant milks and formulae available that it can be confusing to healthcare professionals, let alone parents. Where did they come from, what do they contain and what about specialist prescription-only formulae. Host Dr Ashley Reece takes a deep dive into all these issues with our special guest Bahee Van de Bor - dietician and spokesperson of the British Dietetic Association. You can explore more about Bahee's work at www.ukkidsnutrition.com

We are all busy professionals with lots to do in a very limited amount of time, so why should we be concerned about climate change? That's nothing to do with paediatricians surely? Dr Katie Knight explains why its everything to do with paediatricians and the number one public health emergency for our patients not just tomorrow but today.

We are joined by Dr Lucie Etheridge and Julia Avery to discuss their recent article in the October 2021 edition of 'Archives of Disease in Childhood' looking at whether magnesium supplementation is helpful in adolescents with migraine.

We are really proud to introduce another episode from our Advanced Practitioner team, this time from the ANNPs. Rhian Smith, Becky Joyce and Dr Vicky Payne discuss the past, present and future of Advanced Neonatal Nurse Practitioners in the UK.

In this week's pod we chat to Dr Katie McKinnon about the value of limiting screen time in children with concussion. Dr McKinnon is the lead author of an article in this July's edition of ADC that looked at whether the advice we often give about limiting screen time in concussion has any basis in evidence.

In this week's episode we talk to Jessica Talbot and Lucy Brown who are both specialist registrars in paediatric dentistry. What should you do about an avulsed tooth, is tooth decay as big a problem in the UK as we think it is, and how can dentistry help in child protection? I also learn why you should never rinse after brushing...

All paediatricians are lovely cuddly people, right? Well sadly the data suggests rudeness, incivility and unprofessional behaviour remain prevalent in the health workplace. In this episode Dr Ashley Reece, Consultant Paediatrician from West Hertfordshire Hospital, talks to Dr Anna Baverstock, Consultant Paediatrician from Musgrove Park Hospital in Somerset, about when rudeness can occur in our working lives and what can be done to address it.

In the third in our series of ACP podcast specials, Emma Hudson, Chris White and Laura Lee, Advanced Practitioners in Derby, Nottingham and Norfolk and Norwich Children's Emergency Departments discuss their roles and the unique set of skills that ACPs bring to the ED.

Prescribing for children and young people can be one fo the most challenging aspects for healthcare professionals new to paediatrics. In this episode Ashey Reece, Consultant paediatrician at West Hertfordshire Hospitals NHS Trust, and Sumiah Al-Azeib, Lead Pharmacist for Women and Children's services at Medway Hospital Kent, take a deep dive into medicines for children and their top prescribing tips. They also explore the concept of 'druggles'...

Back in January we were delighted to chat with Dr Camilla Kingdon, the RCPCH President Elect to discuss her vision for the future of the College and plans for when she becomes President in May

Safety netting is a crucial component of care within the Emergency Department but often there is very little teaching on how to do it well. In this week's episode Chris White, an Advanced Clinical Practitioner from Nottingham talks to Dr Edward Snelson, a PEM Consultant from Sheffield, about why that might be the case and how we can all improve our safety-netting skills.

We are getting a bit meta this week as we take a look at podcasts themselves. Nice to listen to, but are they of any educational value? Two new voices discuss this as we introduce Dr Adriel Chen - a Foundation Doctor with an interest in Paediatrics, and Dr Ashley Reece - Consultant Paediatrician, medical educator and RCPCH Officer for Assessment.

In the UK, the coronavirus pandemic has shone a light on many aspects of health inequalities. None more so than the issue of food poverty and its effects on child health. In this episode we talk to Dr Ian Sinha, Consultant in Paediatric Respiratory Medicine at Alder Hay Hospital, about what we mean by food poverty and what paediatricians can do about it.

In the second of our special ACP podcasts, Liz Jemmett, a Paediatric ACP from Salford, and guests talk us through the pathway to becoming an Advanced Practitioner. Essential listening for anyone thinking about the role, as well as some top tips for the old hands!

In our first podcast of 2021, Drs Damian Roland and Ally Monroe discuss New Variant COVID-19. What does this mean and what are the implications for paediatrics?

In our final podcast of 2020 we cover a topic much loved by never quite completely understood by many of us, Kawasaki Disease. We talk to Professor Robert Tulloh, Consultant Paediatric Cardiologist from Bristol who brilliantly and simply explains everything you could want to know about this condition and the man after whom it is named.

We are delighted to host this very timely guest podcast as Drs Damian Roland and Ally Monroe discuss the introduction of COVID-19 vaccines.

Kids. They're always finding novel ways of injuring themselves, so what did they get up to during the first UK lockdown? We spoke to paediatric orthopaedic surgeon Mr Pranai Buddhdev about what he and his team found out and subsequently published. Link to study here: https://bit.ly/3qkKK2i

In episode 28 we spoke to Dr Tom Waterfield about the forthcoming Petechiae in Children study - well in this episode we are delighted to welcome Tom back to talk about the results, recently published in The Lancet. Which clinical practice guideline performs the best at detecting a child with meningococcal disease in the febrile child presenting with a non-bleaching rash. Link to the study here: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30474-6/fulltext?rss=yes

Monday marks the start of Advanced Practice Week here in the UK. To celebrate we are delighted to release a first podcast by our new ACP team as Rhian Smith, Katie Barnes and Laura Lee discuss what it means to be an Advanced Practitioner and how the role has evolved.

Originally recorded for Dont Forget The Bubbles, Damian Roland, Ally Munro and Ian Lewins - The Three Muskapeers - have a chat about the current literature around COVID and other current issues in paediatrics.

Accepting the odd sandwich form a drug rep is fine, right? Well maybe not as we talk to Dr Chris van Tulleken (yes he of the brilliant Operation Ouch!) about the influence of the pharmaceutical industry in paediatrics. This podcast was originally recorded and broadcast in September 2019 for Dont Forget the Bubbles

A bit of a different episode this week. Something I have been asked several times is "How did you go about creating and publishing your podcast?" so in this episode I try and explain. What kit you will need, how to go about recording and some top tips to learn from my mistakes.

We all want a positive outcome for any child attending our ED but recognise that doesn't always happen. But how often to adverse events happen, how serious are they and what can we do to prevent them? In this podcast we talk to Dr Amy Plint from the Children's Hospital of Eastern Otario in Canada who has recently published a study looking at exactly these questions in the BMJ Quality and Safety Journal. The article is open access and can be found here: https://qualitysafety.bmj.com/content/qhc/early/2020/04/28/bmjqs-2019-010055.full.pdf This podcast was originally recorded by 2 Paeds for Don't Forget the Bubbles.

Lots of kids have minor head injuries. Lots of kids vomit. Lots of kids vomit after head injury but do they really need a CT brain? Dr Helen Newsome, Clinical Fellow in PEM in Sheffield, wondered the same question and so tried to find the answer. She published her findings in the Archives of Disease in Childhood in December 2019 and we chat to her about this paper. Link to the article here: https://adc.bmj.com/content/104/12/1231

In this very special episode of the podcast, we are delighted to welcome GP, columnist and broadcaster Dr Ellie Cannon on to chat about working as a GP during the COVID-19 pandemic, why she been an advocate for wearing face coverings, and her involvement in ongoing coronavirus vaccine studies.

We talk to Dr Jon Adamson, Consultant in PEM in Birmingham, about his recent paper "The Fifteen Minute Consultation: The Limping Child" published in the June 2020 Edition of ADC Education and Practice. What should we look for in the atraumatic limping child? When should we investigate and what do we really not want to miss?

We return after lockdown as we speak to Dr Simon Clark - the Vice President for Policy at the RCPCH - to discuss the College's response to the question that has arisen during the pandemic; "Where have all the sick kids gone?!?"

In this special podcast edition we talk to Paediatric Infectious Diseases clinical research fellow Dr Alasdair Munro about what we know so far about COVID-19 and children. This talk is based on the blog Alasdair wrote along with Dr Alison Boast for 'Don't Forget The Bubbles' which can be found here: https://bit.ly/2vibXee

In our 50th episode we return to discussing some original research published in the Archives of Disease in Childhood as we speak to lead author Dr Robert Scott-Jupp. Does having resident paediatric consultants reduce the number and 'quality' of acute admissions? And is it financially worth it? The original paper can be found here: https://bit.ly/38YQrdb

In this episode we talk to Dr Rachel Smith, a Paediatric Registrar based in the East Midlands about hypoglycaemia outside of the neonatal period. What is it, why does it matter and how do we investigate it? This episode is aimed at those starting in paediatrics and especially paramedics and pre-hospital crews.

In our first podcast produced in conjunction with the Archives of Disease in Childhood Education and Practice Edition, we talk to Dr Tom Waterfield about his co-authored paper on how to use the clinical signs of meningitis in children. The paper is the Editor's Choice article in the February 2020 edition of ADC Education and Practice and can be found here: https://ep.bmj.com/content/105/1/46

Predicting the future in healthcare is notoriously tricky but something that the RCPCH are attempting to do in their ambitious 'Paediatrics 2040' project. In this podcast we speak to two of the project board members, Dr Hannah Jacob - chair of the RCPCH Trainees committee - and Professor Russell Viner - President of the RCPCH - about what the project involves and how it will impact on RCPCH members.

Never heard of Balint Groups? No, us neither until we saw a Tweet about them from today's guest Dr Nick Schindler who explains what they are (and aren't) and how they can help you, your colleagues and your department to thrive.

In this week's episode we talk to Dr Shilpa Shah and Dr Aimee Henry, both paediatricians based in Northern Ireland, about vaccine hesitancy and a project they have developed called the 'Pro-Vac Movement' to promote positive discussions about childhood immunisations.

Thinking about applying for the RCPCH written exams? You cant afford to miss this week's podcast as we speak to Dr Will Carroll - Assistant Officer for the written exams and co-author of the 'Sunflower' book, and get his top tips for passing first time!

As Winter draws in we have a timely discussion with Dr Ian Wacogne, Consultant Paediatrician from Birmingham and editor of the Education and Practice edition of Archives of Disease in Childhood, about bronchiolitis. In particular we discuss the introduction of a care bundle aimed at ensuring all team members are undertaking, and more importantly NOT undertaking, the same interventions in a condition where often in the management 'less is more'.

We spoke to Dr David Evans the Vice President (Training and Assessment) at the Royal College of Paediatrics and Child Health about how the forthcoming Shape of Training project will be implemented in the UK and how it will affect trainees and trainers. Essential listening fro anyone involved in paediatric training in the UK!

Recorded live at the Human Factors in Paediatrics 2019 Conference in Lancaster - join host Ian Lewins as he talks to a panel of Dr Hilary Jones, Dr Shrouk Messahel, Dr Ian Sinha and Dr Umal Ghori about human factors they see in their daily practice and how we can improve healthcare for children.

We return to clinical topics this week as we discuss with Dr Richard Bowker how to approach the child with atraumatic joint pain presenting to the Emergency Department. What should we look for in the history and examination, what tests should we do and how should we start management of these patients?

In this special podcast episode to mark the end of Baby Loss Awareness week in the UK, we talk to Bereavement Specialist Midwife, Angela Thompson, about her role and why Baby Loss Awareness Week is so important for many parents and families.

We return to the world of neonates this week as we talk to Neonatal Nurse Educators Shaun Edwards and Kellie Fraser on the why, when and how of using Continuous Positive Airways Pressure (CPAP) in neonates.

I've always liked Bob Rogers' description of Facebook as "an educational cul-de-sac." So when horrific descriptions of what happens when you give a child with chickenpox a dose of ibuprofen emerged on the site they surely couldn't be true, could they? Let Dr Alasdair Munro guide you through fact and fiction and hopefully provide a little bit of evidence along the way.

We talk to Jessie McCulloch, Lead Practice Educator at the MeFirst project, about the challenges and the MeFirst approach to communicating with Children and Young People.

We had the pleasure of speaking with Mr Dan Perry, NIHR Clinical Scientist and Children's Orthopaedic Surgeon, about the Forearm Fracture Recovery in Children Evaluation (FORCE) study, and its importance as the first truly online trial.