The study aims to identify ‘missing’ diagnoses amongst paediatric admissions during the UK’s first national lockdown, compared with the previous 5 years. A retrospective observational cohort study of all children (0–15 years) attending for urgent care across Oxfordshire, during the first UK lockdown in 2020, compared to matched dates in 2015–2019, across two paediatric hospitals providing secondary care, including one with tertiary services. Our outcome measures were changes in numbers of patients attending and inpatient diagnoses (using ICD-10 classification) during the first 2020 lockdown, compared with the previous 5 years, were used. We found that total Emergency Department (ED) attendances ( n = 4030) and hospital admissions ( n = 1416) during the first UK lockdown were reduced by 56.8% and 59.4%, respectively, compared to 2015–2019 (5-year means n = 7446.8 and n = 2491.6, respectively). Proportions of patients admitted from ED and length of stay were similar across 2015–2020. ICD-10 diagnoses in lockdown of 2020 ( n = 2843) versus matched 2015–2019 dates ( n = 19,946) demonstrated significantly greater neoplasm diagnoses ( p = 0.0123). Of diagnoses ‘missing’ in lockdown, 80% were categorised as infectious diseases or their sequelae and 20% were non-specific pains/aches/malaise and accidental injury/poisonings. Conclusions : Pandemic public health measures significantly altered paediatric presentations. Oxfordshire hospitals had a 58% reduction in ED attendances/inpatient admissions, with ‘missing’ diagnoses predominantly infection-related illnesses. These are likely driven by a combination of the following: (1) public health infection control measures successfully reducing disease transmission, (2) parents/carers keeping mild/self-limiting disease at home, and (3) pandemic-related healthcare anxieties. Prospective studies are needed to ensure referral pathways identify vulnerable children, those with social concerns, and avoid delayed presentation. What is Known: • Significant reductions of paediatric ED attendances and inpatient admissions are reported globally, throughout national and regional lockdowns for COVID-19. • Previous studies (supplemental table 5 ) examined only ED diagnoses or specific inpatient diagnoses during lockdown periods, demonstrating reductions of infectious diseases, accidents/injuries, and safeguarding referrals. What is New: • Using ICD-10 coding, robustly controlling for five historical years and adopting a hypothesis-independent analysis, demonstrating 80% of ‘missing’ inpatient diagnoses during national COVID-19 lockdown were infectious dise...

Poorly controlled diabetes adversely affects a child's education, with concentration difficulties, alterations in mood, behaviour and fatigue associated with high or low blood glucose levels. Between years 2004-6 we started all toddlers and children on intensive insulin regimens (multiple dose injection or pump) making it imperative that they received support during the school day. This required close monitoring of blood glucose levels and counting carbohydrate intake to adjust rapid-acting insulin dose or pump bolus at every meal. We report our experience of formulating a sustainable structure of support in primary schools based on trained volunteers who partake in the daily ‘Individualised Care Plan (ICP)’.After overcoming multiple barriers, an acceptable system was negotiated with our Primary Care Trust (PCT) and Local Education Authority (LEA). In 2009, the PCT confirmed 3 years funding for a Paediatric Diabetes specialist nurse (PDSN) for schools. In 2010, the first full school year with agreed protocols was in place. By July 2012, our nurses had trained a total of 342 volunteers who provide care for 132 children.The Oxfordshire Schools Intervention Programme ensures that legal obligations are met. A risk assessment allows the LEA to provide indemnity to their school staff to give injections and do blood tests, after training and competency sign-off by a PDSN. Parents, volunteers and PDSN jointly agree a comprehensive ‘ICP’ and utilise a hand-held communication record book. Diabetes control improved (age 4-11 years cohort from 2004 onwards: Mean (SD) HbA1c in 2001-4 = 8.38 (1.09)%; in 2005-8 = 7.74 (0.81)%; in 2009-12 = 7.58 (0.69)%; ANOVA p<0.001). This requires 500-1000 hours of DSN time to train/retrain/problem-solve annually (approximately 5-10days per month). The cost-benefits are discussed.We advocate that our programme supports each child’s ICP, use of intensive insulin regimes in school-day and reassures parents that schools can deliver this safely.

We report an infant case of meningococcal W meningitis presenting within 24 hours of receiving group B meningococcal vaccine (4CMenB), illustrating the dilemma clinicians face in interpreting advice for management of post-immunisation fever and the NICE Fever Guidelines, and highlighting the need for sustained vigilance for bacterial infections in infants with post-4CMenB fever.A 2-month old female infant arrived by ambulance to the local Emergency Department in April 2017 suffering from right-sided focal limb seizures and fever of 39°C, within 24 hours of receiving her 2-month immunisations (including 4CMenB).The seizure terminated with two doses of intravenous lorazepam and suspected sepsis was treated with immediate intravenous antibiotics. Investigations revelealed a normal cranial CT scan; elevated C-reactive protein (263.5 mg/L [0-5]); normal full blood count; normal liver function tests and serum electrolytes.Urine and blood cultures were negative. Cerebrospinal fluid (CSF) obtained 36 hours after antibiotics showed raised white blood cells (1000x10 6 /L), red blood cells (1921x10 6 /L), protein (1750 mg/L [0 -400)], and a low glucose <0.3

Objective: To identify diagnoses which were ‘missing’ amongst paediatric inpatients during the UK’s first national lockdown, compared with the same period over the past five years.Study design: A retrospective observational cohort study of all children (0-15 years) attending for urgent care across Oxfordshire, during the first UK lockdown in 2020, compared to matched dates in 2015-2019. This covers two paediatric hospitals providing secondary care, one with tertiary services. Main outcomes: Changes in numbers of patients attending and inpatient diagnoses (using ICD-10 classification) during the first 2020 lockdown, compared with the previous five years.Results: Total ED attendances (n=4030) and hospital admissions (n=1416) during the first UK lockdown were reduced by 56.8% and 59.4%, respectively, compared to attendances/admissions in 2015-2019 (5-year mean n=7446.8 and n=2491.6, respectively). Proportions of patients admitted from ED and length of stay were similar in lockdown to 2015-2019. Significantly greater numbers of neoplasms were diagnosed during lockdown than the same period in 2015-2019 (p= 0.0123). 80% of diagnoses ‘missing’ during lockdown were categorised as infectious diseases or their sequelae, whilst 20% were non-specific pains/aches/malaise and accidental injury/poisonings. Conclusions: Using standardised ICD-10 codes as a measure of diagnostic activity between years; ‘missing’ diagnoses can be identified. Our findings may suggest parents are supervising infectious illness at home or had anxieties about hospital attendance, with self-limited low-morbidity disease. Prospective studies should establish if parents/carers are adequately supported in caring for their children at home, and that access and referral pathways are appropriate where children have concerning clinical features.