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AimsAsthma is the commonest chronic condition of childhood with 1 in 11 UK children currently on treatment.1 When properly maintained the asthmatic child can usually lead a normal life, whereas poorly controlled asthma can lead to reduced quality of life, morbidity and mortality, resulting in 25,073 UK paediatric hospital admissions in 2011–12.2 Guidelines facilitating management, aimed at reducing these complications are frequently updated but are not immune to lack of adherence and compliance. In this audit, we focussed on community data which can assist targeting patients at high risk of complications.MethodsWe reviewed all 126 paediatric asthma cases at an urban GP practice. We recorded the percentage of prescribed corticosteroid inhalers collected as a measure of inadherence, number of overdue months of annual review as a measure of noncompliance, and emergency care attendances for asthma as a measure of complication risk, between 01/01/2014–01/01/2015.Abstract G357(P) Figure 1Variation in adherence, compliance and complications with delay in annual reviewAbstract G357(P) Figure 2ResultsThere was no significant difference in adherence for children who attended routine review up to 5 months from due time compared to those attending six to eleven months overdue (74% vs 68%). The latter group was significantly more likely to require emergency care (OD=4, CI=1.29–12.40, p < 0.025) but was also at significantly higher risk to require emergency care than children who attended review over 12 months overdue (OD = 4.33, CI=1.40–13.42, p < 0.025), despite higher rate of inhaler collection (68% vs 50%, OD=4 (CI=1.4–13.4, p < 0.025).ConclusionDespite a high and similar compliance rate, children with low annual review adherence are at significantly higher risk for complications. These results reinforce the usefulness of current guidelines and the importance of annual review for patient education and medication titration. Interestingly the subgroup with the lowest compliance and adherence was not at increased complication risk. This may be due to imprecise diagnosis, milder disease, or overmedication; future investigation of this group can assist in correct resource allocation.Finally our results suggest the importance of targeting those who require treatment (as expressed by inhalers uptake), yet substantially delay the annual review.References accessed 02/15/15 accessed 02/12/15

Aim It has been over a year since the RCPCH circulated interim guidance regarding vitamin D supplements in childhood recommending that breastfed babies from birth and formula fed infants from 6 months should receive vitamin D until 5 years old. Our aim was to assess the percentage of eligible children that take supplements and secondarily vitamin D intake in pregnant and breastfeeding women. Methods We performed a prospective audit in children presenting to the paediatric assessment unit aged from birth up to 5 years from 20/09/14 for 2 months. We recorded: age, ethnic group, gestational age at birth, breastfeeding history, whether patients have taken or taking vitamin D and the indication for that. We also recorded whether the child belonged to a risk group due to prematurity, neurodisability or gastrointestinal problem and whether the child ever presented with seizures due to vitamin D deficiency. Secondary outcomes were percentage of women taking vitamin D supplements during pregnancy and breastfeeding. Results We recruited 158 patients with a mean age of 18 months, 57% were males and 33% were either Afrocarribean or Asian. 15% of the children were at high risk: 13% due to prematurity and 2% due to neurodisability. At the time of the audit only 17% of children were taking vitamin D (image 1) and only 25% had ever taken vitamin D. Of those that were breastfed and less than 6 months 29% were on supplements (image 2); of those older than 6 months only 21% (image 3). Vitamin D was started by parents in 29% and the remaining majority by health professionals. Half of the mothers took vitamin D in pregnancy and only 20% during breastfeeding. Conclusions Despite the circulation of the RCPCH guidelines to paediatricians only a quarter of children under five have ever been on vitamin D. All health care professionals in primary and secondary care should work together towards creating clear and updated policies regarding vitamin D supplements in childhood, pregnancy and lactation, and more work on implementing these policies is needed.

Introduction A two year old girl presented with prolonged bleeding following a fall. A strong family history of haemophilia was ignored during visits to health professionals due to the misconception that female carriers are unaffected! She was extensively investigated and was found to have Factor VIII deficiency which did not respond to Tranexamic acid and Desmopressin. This was discovered three weeks prior to her preoperative assessment for an adenotonsillectomy. Routine pre op checks, which do not always involve clotting and the above misconception, could have affected her severely perioperatively. This case highlights the importance of detailed history taking including family history and remembering that Haemophilia can, and does affect females. Case report AG was born without complication, at term by forceps delivery. Mother had heavy postpartum bleeding. She developed obstructive sleep apnoea, and adeno-tonsillectomy was planned. Three weeks before her pre-operative assessment she fell, tearing her frenulum. Persistent bleeding led to a paediatric assessment. Initial investigation revealed her haemoglobin was 88, APTT 1.5 and APTT ratio 45 and rest normal. Further investigation revealed low Factor VIIIc levels (36), 72% of expected. Other factors were normal. Detailed history taking revealed a family history of Factor VIII deficiency (maternal grandmother: carrier, maternal aunt: affected). AG received Tranexamic Acid and a Desmopressin infusion, followed by a Factor VIII infusion at the Haematology unit due to persistent bleeding. Communications between ENT a haematology is ongoing to carry out a safe surgery. Conclusion This was a near miss event which will require ongoing care from a consultant haematologist. Clinicians need to be aware that Haemophilia can, and does, affect females. 28% of female carriers of Haemophilia A are known to have Factor VIII levels consistent with mild Haemophilia. This case should raise our awareness about thorough history taking, and updating our knowledge about Haemophilia, to avoid future catastrophes. There are also important implications for her mother. We recommend checking Factor VIII activity levels in all haemophilia carriers before haemostatic challenge, such as pregnancy.