No abstract

The causes of febrile convulsions are usually benign. Such convulsions are common in children and their long-term consequences are rare. However, other causes of seizures, such as intracranial infections, must be excluded before diagnosis, especially in infants and younger children. Diagnosis is based mainly on history taking, and further investigations into the condition are not generally needed in fully immunised children presenting with simple febrile convulsions. Treatment involves symptom control and treating the cause of the fever. Nevertheless, febrile convulsions in children can be distressing for parents, who should be supported and kept informed by experienced emergency department (ED) nurses. This article discusses the aetiology, clinical presentation, diagnosis and management of children with febrile convulsion, and best practice for care in EDs. It also includes a reflective case study to highlight the challenges faced by healthcare professionals who manage children who present with febrile convulsion.

The National Institute for Health and Care Excellence (NICE) ( 2015 ) defines bronchiolitis as a lower respiratory tract infection affecting children under two years, peaking between three and six months. It affects about one in three infants in the first year of life, making it the most common respiratory infection in infants ( NICE 2015 , 2016 ). Of these infants, 2-3% will require admission to hospital ( NICE 2016 ). Respiratory syncytial virus (RSV) is the most common organism detected in the nasopharyngeal aspirate in hospitalised infants, although other viruses such as rhinovirus, parainfluenza virus, influenza virus, adenovirus and human metapneumovirus are increasingly being recognised ( Paul et al 2016 ). As most infants with bronchiolitis are managed at home, the data available from the literature is not reflective of the true incidence and may represent only the 'tip of the iceberg'.

Brain tumours comprise over one quarter of all childhood cancers in the UK and are the most common cause of cancer-related deaths in children. The presentation of brain tumours can vary substantially in children. The presenting symptoms are often similar to less serious conditions, and are often managed as such initially. Therefore, it can be difficult to diagnose brain tumours in children. An early diagnosis is usually associated with more effective treatment and improved health outcomes. The diagnostic interval between first presentation to a health professional and diagnosis for brain tumours in children has been shown to be three times longer in the UK than in other developed countries. As a result, the HeadSmart campaign launched a symptom card in 2011 to increase awareness of brain tumours in children among the general population and healthcare professionals, with the aim of reducing the diagnostic interval to 5 weeks. Nurses have an essential role in early recognition of brain tumours in children, and in providing care and support to the child and their family following a diagnosis.

Bronchiolitis is common in infants. Oxygen therapy, fluids and occasionally respiratory support remain the mainstay of treatment. The NICE guidelines are expected to streamline the management of bronchiolitis and minimize potentially harmful interventions. Further research to find other useful therapies is necessary.