Respiratory tract infections (RTIs) in children are one of the most common reasons for parents consulting health professionals. Most RTIs are self-limiting viral illnesses that will resolve with time and supportive management. However, it is important for the health professional to identify any RTI that may have more serious implications for the child and require medical intervention. Diagnosis can usually be made from the history and presenting symptoms such as cough, wheeze, tachypnea, fever, or stridor. Exclusion of "red flag" symptoms will enable health professionals to appropriately reassure parents and advise symptomatic management with antipyretics and adequate fluid administration. With the expanding role of nurses in ambulatory settings, many children are now being seen by health professionals other than doctors, (eg, advanced nurse practitioners), some of whom are trained in pediatrics while others have limited knowledge of nursing sick children. It is therefore vital that these professionals remain aware of any risk factors and that they can recognize "red flags" in a sick child rapidly and escalate further management appropriately. Some children will require admission to hospital for respiratory support and other therapies, such as intravenous antibiotics and fluids. With advancement of the "non-medical prescriber" within the nursing profession, awareness of when to give or not give antibiotic therapy needs careful consideration, especially in light of the problems that may arise from overuse of antibiotic treatment. Nurses have a vital role, not only in administering medications and supporting other medical interventions, but also in supporting the child and family over the period of illness. The education of the parents and the child, in some instances, about prevention and avoidance to reduce the risks of any further RTIs must be addressed, including immunization and smoking cessation.

The need for adolescents and young adults (AYA) to have suitable age-specific inpatient facilities has been recognised for many years, yet has received relatively little attention. This article reports the successful introduction of an inpatient facility for AYA, aged 17-24 years, on a general paediatric ward in a small district general hospital. From December 2010, a young person's unit (YPU) consisting of an 8-bed area was opened within a 24-bed children's ward. Nursing care was provided by the ward staff, all of whom had been trained in the care of young adults. Policies regarding admission criteria, safeguarding, patient choice, visiting and 'house rules' were drafted, implemented and modified as necessary. Discussions with the adult clinicians (for medical care) and site managers were held to ensure smooth running of the system, and to address any concerns or difficulties. Paediatric patients had priority of admission at times of bed crisis. During 2012, there were a total of 2351 inpatient admissions to the paediatric ward, of whom 379 (16%) were YPU patients aged from 17-24 years. Median length of stay was 2 days for patients aged 17-24 years as compared with 1 day for patients aged less than or equal to 16 years. Patients who chose admission to the paediatric ward tended to be younger, in transition from paediatric to adult services for chronic conditions, or with special needs. Patient surveys showed a high level of satisfaction with the facility. Young adults can be cared for safely and effectively on a paediatric ward with minimal additional costs. The essential ingredients for success include discussion with affected parties to address specific concerns, and the establishment of a clear, simple and unambiguous admission policy.

Ingestion and aspiration of foreign bodies are common reasons for children presenting to emergency departments. A significant proportion of such events are often unnoticed by the children's parents or carers. Emergency nurses should become suspicious of foreign body ingestion or aspiration if they see symptoms such as stridor, gagging, wheeze and difference in air entry on auscultation ( Hilliard et al 2003 , Paul et al 2010 ). If they suspect airway compromise, or bowel problems such as perforation or obstruction, the children concerned should be dealt with immediately. Definitive management for foreign body removal is generally available at tertiary centres and children should be transferred to specialist services as soon as possible after stabilisation ( McConnell 2013 ). Before discharge, their parents should be educated about possible signs of deterioration and advised about home-safety measures ( Paul and Wilkinson 2012 ).

Kawasaki disease (KD) is a systemic vasculitis and it predominantly affects young children. Fever with rash is a common presentation in children and is mostly due to a viral illness needing symptomatic treatment. However, KD should be considered if the child has a high fever lasting for more than 5 days and has got other cardinal features of KD. It is important to get the diagnosis correct as cardiac complications can only be reduced when intravenous immunoglobulin is administered within a critical time frame (maximum 10 days) from the onset of the illness. Nurses play a vital role in managing and supporting children and their families, both in the community and the hospital setting.

Constipation is common in children and can be associated with faecal incontinence. Most often, constipation is idiopathic in nature, and invasive investigations should be reserved for intractable cases and carried out by specialists. Children with constipation can present with a variety of symptoms, including faecal incontinence, rectal bleeding, and abdominal pain. Health visitors play an important role in detecting symptoms early, and the presence of any red flag symptoms should warrant an early referral to specialist services. An essential aim for treatment is to prevent pain associated with defecation, and laxatives are the first line of management for childhood constipation. Chronic constipation can be debilitating and may have long term behavioural and social consequences.