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Chickenpox is an extremely contagious infectious disease caused by varicella zoster virus (VZV). It is a common childhood illness characterised by an itchy vesicular rash and fever, which usually resolves spontaneously without medical intervention. Serious, and rarely fatal, complications can occur, including pneumonia, central nervous system infection, overwhelming secondary bacterial infections, especially with Group A streptococcus, and necrotising fasciitis. Therefore it is crucial that emergency department (ED) nurses can recognise the signs and symptoms that indicate deterioration. This article reviews best practice management of children with chickenpox, gives up-to-date guidance on the safe use of antipyretics, the avoidance of ibuprofen and discusses immunisation against VZV. It also includes implications for nursing practice and a case study that illustrates some of the challenges that ED nurses may encounter.

Children who present with transient loss of consciousness (T-LOC) are often first seen in emergency departments (EDs). Reflex anoxic seizure (RAS), vasovagal syncope and prolonged respiratory apnoea are benign, syncopal events that can be generally managed by explanation and reassurance. RAS is a short, paroxysmal, self-reverting episode of asystole that is triggered by pain, fear or anxiety and is caused by increased vagal response. It is an important differential diagnosis in pre-school age children who present with T-LOC, but is often underdiagnosed and can sometimes be misdiagnosed as epilepsy. Nurses working in EDs are among the first healthcare professionals to see children in acute settings and should therefore be aware of RAS, the presenting features and management options. This article discusses the epidemiology, pathophysiology and management of RAS, includes an illustrative case study and discusses the role of ED nurses.

Diabetes mellitus is a common condition in children, characterised by chronic hyperglycaemia resulting from an absolute insulin deficiency. It can present in various ways, and hospital admission may result from complications related to previously diagnosed diabetes, or from a new diagnosis. To raise awareness of the condition, Diabetes UK has launched the 4Ts campaign, which highlights the four most common symptoms of diabetes. This article discusses the different clinical presentations, diagnosis and management of children with diabetes, and includes two case studies to illustrate some of the challenges faced by emergency department nurses.

Head injury is the most common cause of injury-related death and permanent disability in children. Minor head trauma is common in childhood and does not require any medical treatment. Although deficits can occur even after mild to moderate head injury, they are markedly greater and become clinically evident following severe head injury. It is important that emergency department clinicians are aware of the signs and symptoms that indicate severe traumatic brain injury and triage for urgent intervention in those children who present with these signs and symptoms. Clinicians also need to know when children can be sent home with reassurance and information, and when they require admission or transfer to a neurosurgical unit. This article examines the literature on head injuries in children, describes assessment, management and treatment, and provides a simple management algorithm.

Children with a petechial rash commonly present to emergency departments. The rash can be associated with serious illnesses, such as invasive meningococcal disease (IMD), but is usually associated with less severe conditions. This article discusses the common and important causes of petechial rash, including IMD, viral illnesses, trauma, Henoch-Schonlein purpura and idiopathic thrombocytopenic purpura. It also analyses the National Institute for Health and Care Excellence (NICE) ( 2014 ) pathway for management of petechial rash in children and examines treatment of the various causes. The article includes two relevant case studies and discusses the role of emergency nurses.

Children with red swollen eyes frequently present to emergency departments. Some patients will have orbital cellulitis, a condition that requires immediate diagnosis and treatment. Orbital cellulitis can be confused with the less severe, but more frequently encountered, periorbital cellulitis, which requires less aggressive management. Delayed recognition of the signs and symptoms of orbital cellulitis can lead to serious complications such as blindness, meningitis and cerebral abscess. This article describes the clinical features, epidemiology and outcomes of the condition, and discusses management and treatment. It also includes a case study.

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.

Although the leading cause of childhood, cancer-related deaths, initial presentations of brain tumours can mimic less serious conditions, which can delay diagnosis. To reduce the time between presentation and diagnosis, the HeadSmart campaign has produced a symptom card to raise suspicion of brain tumours among healthcare professionals in all settings. This article refers to two case studies to describe how emergency department nurses can recognise the signs and symptoms of brain tumours in children. Definitive management is delivered in specialist centres, so safe and prompt transfer is a priority once children are stabilised.

Ingestion and aspiration of foreign bodies are common reasons for children presenting to emergency departments. A significant proportion of such events are often unnoticed by the children's parents or carers. Emergency nurses should become suspicious of foreign body ingestion or aspiration if they see symptoms such as stridor, gagging, wheeze and difference in air entry on auscultation ( Hilliard et al 2003 , Paul et al 2010 ). If they suspect airway compromise, or bowel problems such as perforation or obstruction, the children concerned should be dealt with immediately. Definitive management for foreign body removal is generally available at tertiary centres and children should be transferred to specialist services as soon as possible after stabilisation ( McConnell 2013 ). Before discharge, their parents should be educated about possible signs of deterioration and advised about home-safety measures ( Paul and Wilkinson 2012 ).

In developed countries, invasive meningococcal disease (IMD) is a leading infectious cause of death among children. In the UK, Neisseria meningitidis serogroup B is the most frequently identified cause of IMD. This article describes a clinical audit in which early management of IMD is compared with recommendations in the relevant guidelines. It confirms the importance of early recognition of IMD and the need to review previous, less serious diagnoses in ill children. Emergency department nurses play a vital role in the early recognition and management of IMD. Introduction of a meningococcal B vaccine is likely to benefit children in the UK.

This article describes the management in emergency departments of supraventricular tachycardia (SVT) in children. Of all forms of symptomatic arrhythmia in infants, children and adolescents, SVT is the most common. Its clinical presentation varies with the child's age, and it can be difficult to diagnose in infants and young children. It is important that the nurses in the emergency department consider a diagnosis of SVT in young children with histories of poor feeding, lethargy, irritability, excessive sweating or pallor (Zeigler 1994) and in older children with histories of palpitations, dizziness, chest pain, syncope or shortness of breath (Uzun 2010). If SVT is suspected, a 12-lead electrocardiogram should be recorded. Vagal manoeuvre may be successful but in some cases intravenous adenosine is necessary. Children with Wolff-Parkinson-White syndrome are at risk of sudden cardiac death associated with SVT, and should not be treated with calcium channel blockers or digoxin.

This article is based on two case studies in which children with suspected meningococcal disease were brought to the author's emergency department. It examines the signs and symptoms of the disease, and discusses its management. Emergency practitioners should understand and recognise the signs and symptoms of serious meningococcal disease and refer children to paediatric services immediately.

Head injury is defined as any trauma to the head other than superficial injuries to the face (National Institute for Health and Clinical Excellence 2010) and is the most common type of traumatic injury seen in children (Johnstone et al 1996). A skull fracture, meanwhile, describes a break in the cranial bones and is highly predictive of intracranial injuries (Schutzman and Greenes 2001). Emergency practitioners should understand the signs and symptoms indicative of skull fracture, therefore, and know when to refer children to neurosurgical colleagues. This article examines the literature on skull fractures and the available guidelines on the management of head injuries, and presents a relevant case study.

Physician associates (PAs) were introduced into the NHS to add a new kind of team player to the medical workforce. The role originated in the US where they are known as physician assistants and have been practising since the mid-1960s ( Peate 2016 ).The PA competency and curriculum framework states that a newly qualified PA must be able to perform clinical work 'at the same standard as a newly qualified doctor', and trainees undergo a rigorous two-year postgraduate training ( Peate 2016 ). Before becoming eligible to practise, they must pass a Royal College of Physicians licensing exam and certified PAs are required to retake the examination every six years.

Public Health England (PHE) figures show that there were four times more measles cases in the second quarter of 2016, representing 167 new confirmed infections, than in the same period last year.

Parents of newborns can be reassured if healthcare professionals are aware of benign neonatal sleep myoclonus (BNSM) so it is not mistaken for epilepsy.

In recent years, trampolining has become a common recreational activity for children and young people. Its popularity in the UK has been on the increase since 2005, reflected in the sale of almost 250,000 trampolines in 2014 ( RoSPA 2015 ) and the emergence of indoor trampoline parks and trampolining as a competitive sport ( Council on Sports Medicine and Fitness 2012 ).