BackgroundPaediatricians are commonly asked if they have their own children. Some evidence suggests that paediatricians who have children are perceived by parents to be more credible. Trust and credibility have been identified as important factors in the doctor-patient relationship. There is little research looking into whether paediatricians believe that their own parental status makes a difference to their clinical practice.AimTo establish if paediatricians perceive a difference in practice between those who have and those who do not have children, and identify potential learning needs.MethodWe held four focus groups with paediatricians based in two hospitals. Each group was facilitated by a member of our team and recorded with consent of the participants. Key themes were identified and explored.ResultsWe obtained the views of 29 doctors at every level of paediatric training including consultants; 14 had children.Doctors with children expressed strong opinions that personal experience of parenting was advantageous. They felt they were more empathetic in certain situations, had greater understanding of parental anxiety and spent more time communicating with families. Confidence was increased in assessing development and giving breastfeeding advice. Parental status of the paediatrician was not thought to affect their clinical decision-making process.Doctors without children suggested that experience and training were more important than parental status in the development of their communication skills. They suggested that having young relatives assisted in learning about developmental milestones. Most participants without children did not feel able to give breastfeeding advice.Independent of parental status, participants felt that additional training in communication, development, breast feeding and child behaviour would be beneficial.ConclusionParticipants held similar views to those previously identified in parents that having children may improve understanding of parental anxiety and communication with families. This may increase credibility. All participants could identify areas where additional training could improve practice. Whether having children affects the clinical practice of a paediatrician is an emotive topic and we have illustrated a range of viewpoints on this issue.

Using the RP, 3.8% of all patients would be 'inappropriately' redirected but if decision to re-direct were based only on TN assessment this reduced to 3.6% with a 58% reduction in T4 and 5 patients being seen 'unnecessarily' in the PED. Conclusions Over 30% of T4 and 5 patients presenting to the ED would be appropriate for re-direction to primary care services -12% of all attendances. This would be considerably higher if a more inclusive RP was created to account for trivial and non-urgent presentations to ED. TN assessment safely and accurately identifies patients requiring PED specific care. Aims Clinical assessment in A&E is heavily influenced by physiological parameters. However, paediatric normal ranges have large discontinuities and are based on poor evidence. Evidencebased centile charts (Fleming et al, 2010) demonstrate striking disagreements with widely used ranges. G101(P)TIMEWe studied the change in proportion of children with high triage observations by age, and investigated whether discontinuities at age transitions are associated with discrete changes in management. Methods We obtained details of 14,831 children attending our paediatric A&E in 2013 (excluding psychosocial and trauma) and extracted missing triage observations from scanned records. We determined whether CRP was measured for each patient.Though our department uses PEWS normal ranges (transitions at age 1, 5 and 12) we used the more widespread APLS ranges for classification. High triage observations were determined by APLS, centile charts (90th centile) and derived normal ranges. For APLS, steps in proportions were determined with discontinuous linear regression.Separately, we used spline regression models to test for the presence of steps at age 1, 5 and 12 in length of stay, probability of admission and CRP measurement, with subgroup analysis of children <8y with triage category "fever".For children presenting with wheeze, we compared the proportions receiving burst therapy or intravenous treatment prior to and after the first, fifth and twelfth birthdays. Results The proportion of high triage observations by APLS showed significant steps at age 1, 2, 5 and 12. 16% of APLS classifications mismatched classification by centile chart. With derived age-specific normal ranges, this fell to 2%.We found no evidence of discrete changes in length of stay, probability of admission or measurement of CRP at the age boundaries. Similarly, in the febrile children and wheeze subsets we found no steps. Conclusions The APLS normal ranges create large steps in the proportion of children with high observations at age transitions. However, we found no evidence of effects on management in this large dataset, nor in subgroups where observations contribute strongly to mangement.Nonetheless, given the better performance of newer ranges, we encourage their further trial. Introduction Concerns have been raised about the increasing presentation of children and young people (CYP) to the Emergency Departments (EDs) having taken recreational drugs or alcohol. Ai...

AimsNICE (2016) guidance on the recognition, diagnosis and early management of sepsis aims to expedite interventions in children with ‘high-risk criteria’ for sepsis. Early administration of parenteral broad-spectrum antibiotics is recommended in these children, unless a senior decision-making doctor (ST4+) makes an alternative diagnosis with a separate treatment pathway. We assessed the presenting characteristics and management of children at UCLH NHS Foundation Trust (UCLH) Paediatric Emergency Department (PED) following the introduction of these guidelines. A senior decision-making doctor was available for urgent review of children at all times.MethodsWe audited the notes of all children presenting to UCLH PED from 6th February to 31 st May 2017 (excluding simple trauma or primarily psychosocial presentation). All notes of children with fever or suspicion of infection and one or more high-risk criterion for sepsis were identified on a daily basis, and data entered onto a specific database. High-risk criteria were as defined by NICE, and included: tachypnoea (≥99 th centile), tachycardia (≥99 th centile), additional oxygen requirement, reduced consciousness, reduced urine output and blood lactate ≥2 mmol/L.Results4322 children presented to the PED during the time period. Of these, 216 (5.0%) met one or more high-risk criteria for sepsis. The most common clinical syndrome was viral upper respiratory infection (67 children, 31%). Severe tachycardia was the most prevalent high-risk criterion (159 children, 73%). 25 children (12%) underwent blood testing/IV access, 17 (7.8%) were administered parenteral antibiotics, six (2.8%) were administered intravenous fluid boluses, 16 (7.4%) were admitted to the ward, and one child was transferred to intensive care (in status epilepticus). One child (admitted) had a bacterial pathogen isolated from blood.ConclusionIn this single centre, only 12% of children with one or more high-risk criteria for sepsis underwent blood testing, and 7.8% of children were admitted for parenteral antibiotics. Appropriate de-escalation from the sepsis pathway prevented the admission of an additional two children per day for parenteral antibiotics for presumed sepsis. Given the small proportion of children with high-risk criteria who were deemed to require treatment for sepsis, the availability of appropriately senior decision-making doctors is essential to enable appropriate implementation of these guidelines.