significant changes to society. It has changed the way people behave and how healthcare is provided. In our study, we seek to evaluate the impact of the pandemic on the epidemiology of burns in the paediatric population. Government-implemented lockdown measures and school closures have led to reduced outdoor activities and lifestyle changes. Our regional Paediatric Burns Centre introduced a new standard operating protocol involving a new phone consultation pathway, a secure email platform for effective communication with parents and tertiary referring hospitals. The aim is to reduce physical attendance to hospital where possible, streamline our referral service, avoid unnecessary admissions and empower parents where appropriate. We performed a retrospective comparison over five weeks in which the government imposed lockdown instructions from 23/3/2020 to 30/04/2020 (lockdown period) and compared it to a similar period from a year ago 23/03/2019 to 30/04/2019 (control period). During this period, the total attendance to our Emergency Department (ED) has decreased by 60% in the lockdown period (7127 versus 2936), as expected due to the national advice to avoid unnecessary visits to hospital. The incidence of burn injuries reported was instead greater in proportion-2.8% of all ED attendances, compared to 1.5% in the previous year, despite the overall decrease in total number of burn injuries (n = 83) by 24%. This could be due to a combination of the closure of some local and minor injury facilities, reduced faceto-face consultations with general practitioners and the advice given to the general public that even minor burn injuries still require medical attention for adequate treatment. This instruction is crucial for the well-known potentially lifethreatening complications of burns in children [1]. Concerns were raised by the Royal College of Paediatrics and Child Health that children may be coming to harm from delayed presentation to emergency departments for fears of contracting COVID-19 in hospital. In our cohort of burns patients, only 2 were deemed to have come to harm by delaying presentation. We also noted that the number of referrals to children social care increased from 4% (5/123) in the control period to 12% (12/ 95) in the lockdown period. The reduced opportunity to liaise with allied health professionals and education settings to share information and concerns and to finally agree on a plan for follow up might have been due to a more vigilant approach for the fear of missing child protection concerns. The mean age of patients presenting with burns increased from 2.9 to 4.8 years. School-age children are now spending more time at home due to school closures, and UK statistics have suggested that most burns happen at home [2]. Gender distribution is similar in both periods. The number of inpatients in our centre decreased by 37%. All patients required COVID-19 testing prior to admission to

We suggest that GnRH analogues affect neither the capacity of the endometrium to support invasion nor the invasive potential of the blastocyst in the early stages of implantation.

COVID-19 presented unique challenges in preparing our stand-alone children’s emergency department for the pandemic and has demonstrated well the paediatric adage, ‘children aren’t little adults’.

'It is midnight and you are called to see a thirteen-year-old boy who has been brought to the paediatric emergency department with a 24-hour history of swelling and redness of his left eye. He has had a 'runny nose' for a couple of days. He is systemically well. His upper and lower lids are red and swollen such that his eye is not open fully, though you elicit normal eye movements when you open his eye. Pupils are equal and reactive with no afferent pupillary defect. Visual acuity and colour vision are normal on examination.' In this article, we consider the approach to preseptal and orbital cellulitis in children including the initial assessment and management options.

The limping child is a common presentation to paediatric services. In most instances the cause is benign with few, if any, investigations required. There is, however, always that concern that the limping child may have an underlying limb-threatening or life-threatening disease. This poses a challenge to clinicians, who must find that balance between correctly identifying disease early and avoiding the risks and harms of overinvestigation. In this article we discuss the diagnostic approach to the limping child and present a structure for assessment, investigation and risk management.