Listen to Podcast adc.bmj.com period and ethnicity among others). There is some evidence that pre-testing for sensitisation may offer useful clinical information; therefore, further research should consider them in their outcome measures. For real-life applicability of results, there needs to be an approach in which egg would be prepared to simulate true-to-life circumstances.

Poster presented at BAPIO National Conference, London 2019 Peer reviewed by Subarna Chakravorty PhD & Sunil Daga PhD The new service specification will be used by clinical staff to reflect on practice and outcomes. It enables clinicians to identify standards, rather than accessing them from various sources. It will aid the planning, commissioning, and provision of acute paediatric services and provide a framework against which to audit provision and demonstrate improvement. It would be possible to translate this for use across the UK.

65 had a medical diagnosis and 28 a psychosocial diagnosis . Commonest medical diagnosis was acute infections (18 out of 65) . Commonest psychosocial diagnosis was deliberate self-harm (20 out of 28) . Logistic issues included managing intoxicated patient or offender on the paediatric ward and interdisciplinary communication . HCP felt the biggest challenges were gaps in knowledge around management of substance abuse, intentional overdose and mental health presentations. . They reported interface issues with adult and tertiary services especially when a young person between 14-16 years required Paediatric Intensive Care or specialist advice. . Everyone welcomed training sessions on mental health presentations, substance abuse and suggested topics such as consent and adolescent gynecology . We conducted 17 phone interviews, which involved either a parent, or both a parent and an adolescent. . A prevailing theme was the praise and appreciation they expressed about the services provided on the ward. This included staff expertise and attitude. . The facilities were frequently highlighted as being excellent . Respondents also expressed their preference to stay on a children's ward rather than an adult ward. . Only a few respondents expressed dissatisfaction with their child's stay in the paediatric ward. . Feedback from the training sessions, videos and resource pack has been positive.

developed methaemoglobinaemia as a result. Initial methaemoglobin was 48% which subsequently improved to 3% following 3 doses of methylene blue with good clinical response. Further investigations excluded Systemic lupus erythematosus and Crohn's disease, which have been reported as associated with PD. The infant's recovery was supported with parental nutrition and discharged home with ongoing follow up with Paediatric metabolic specialists.Management of PD is mainly supportive with consideration of use of co-factors that can improve collagen stability, suppression of collagenase and topical application of ointments containing L-proline. Enzyme replacement is also being actively researched.This case illustrates the importance of prompt recognition and treatment of methaemoglobinaemia in infants with unexplained metabolic acidosis. It also highlights awareness of PD, which although, is extremely rare, can be diagnosed through metabolic screening tests and genetic testing, thereby leading to earlier supportive management.