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Objectives This study was aimed to determine the sample size required to conduct an efficacy randomized controlled trial (RCT) to evaluate superiority of intranasal (IN) lidocaine to placebo as an analgesic option for children presenting to the paediatric emergency department (PED) with migraine or posttraumatic headache with migraine features and to evaluate study protocol feasibility. Study Design This study is a double-blind RCT of children aged 7 to 16 years at a single-centre PED. Thirty-two participants were randomized to receive either IN 2% lidocaine or 0.9% sodium chloride. The primary outcome measure was the proportion of subjects with a Verbal Numeric Rating Scale pain score of <4 at 30 and 60 minutes post-IN therapy. Primary outcome data were analyzed using a test of differences between proportions. Secondary objectives included assessing the feasibility of our study protocol by evaluating recruitment rates, adverse drug events, and PED length of stay (LOS). Results Six of 17 participants in the lidocaine group and 2 of 15 in the placebo group were treated successfully. Using these proportions with 95% confidence intervals and 80% power, the sample size required to find a significant difference between proportions would be 67 participants per arm. Our enrolment rate was 55% and there were no serious adverse drug events. The median PED LOS was similar between groups. Conclusion We determined the sample size required to conduct a definitive RCT to evaluate the superiority of IN lidocaine to placebo and found the study protocol is feasible but identified important considerations in PED migraine trial design. [ABSTRACT FROM AUTHOR]

Question: A 4-year-old child was seen in our clinic with a clinical presentation consistent with community-acquired pneumonia (CAP). He was prescribed oral amoxicillin and a colleague asked about the duration of treatment. What is the current available evidence for treatment duration for uncomplicated CAP in an outpatient setting?, Answer: Previously the recommended duration of antibiotic treatment of uncomplicated CAP was 10 days. Recent evidence from several randomized controlled trials suggests that a 3- to 5-day duration is noninferior to a longer treatment course. In an effort to prescribe the shortest effective duration of antibiotics to minimize the risk of antimicrobial resistance associated with prolonged antibiotic use, family physicians should offer 3 to 5 days of appropriate antibiotics and monitor the recovery of children with CAP., (Copyright © 2023 the College of Family Physicians of Canada.)

Question: A child in my clinic who recently sprained his ankle is experiencing pain and having trouble bearing weight on the affected leg. His mother has been giving him acetaminophen, as she was told never to use nonsteroidal anti-inflammatory drugs (NSAIDs) because of his pharmacologically controlled asthma. Is asthma in children a contraindication to giving NSAIDs? Is NSAID-exacerbated respiratory disease (NERD) a real entity?, Answer: Nonsteroidal anti-inflammatory drugs are effective analgesic and antipyretic medications. While described in adults with some predisposing conditions, NERD has not been clearly described in a large number of children. Nonsteroidal anti-inflammatory drugs can be recommended to children with known wheeze who do not have a history of NERD reaction., (Copyright© the College of Family Physicians of Canada.)

Question: Un enfant qui fréquente ma clinique s'est récemment fait une entorse à la cheville et il éprouve de la douleur et de la difficulté à supporter son poids sur la jambe affectée. Sa mère lui donne de l'acétaminophène parce qu'on lui a dit de ne jamais utiliser d'anti-inflammatoires non stéroïdiens (AINS) en raison de son asthme contrôlé par pharmacologie. L'asthme chez un enfant est-il une contre-indication à l'administration d'AINS? La maladie respiratoire exacerbée par les AINS existe-t-elle comme entité réelle? RÉPONSE: Les AINS sont des médicaments analgésiques et antipyrétiques efficaces. La maladie respiratoire exacerbée par des AINS a été décrite chez des adultes ayant certains facteurs de prédisposition, mais n'a pas été clairement identifiée chez un grand nombre d'enfants. Les AINS peuvent donc être recommandés aux enfants ayant une sibilance connue qui n'ont pas d'antécédents de maladie respiratoire déclenchée par des AINS., (Copyright© the College of Family Physicians of Canada.)