Aims: To gather information on children with minor illness or injury presenting to a paediatric accident and emergency (A&E) department and the decision making process leading to their attendance. Methods: Prospective questionnaire based survey of 465 children selected by systematic sampling from A&E attenders allocated to the lowest triage category. Results: The study population was statistically representative of the total population of A&E attenders. The lower deprivation categories were over represented. Educational attainment, childcare experience, and parental coping skills were important in relation to A&E attendance. More children attended with injury as opposed to illness. There were no significant demographic differences between those children who presented directly to A&E and those who made prior contact with a GP. Just under half the study population had made contact with a general practitioner (GP) before attending A&E. The majority of those children were directly referred to A&E at that point. GPs referred equivalent numbers of children with illness and injury. Conclusions: Parents and GPs view paediatric A&E departments as an appropriate place to seek treatment for children with minor illness or injury.

Aim To document the clinical features and management of infants presenting with fever after their first meningococcal B vaccination and develop guidance for clinicians. Methods A prospective case series over 12 months was conducted in a tertiary paediatric hospital. Infants ≤3 months of age with fever who had received their first set of immunisations within the preceding 72 h were included. Results A total of 92 infants met the inclusion criteria, accounting for 0.78% of the local vaccinated population. The most commonly described associated features were poor feeding, sleepiness and irritability; 66 patients (72%) were admitted to hospital. Median C‐reactive protein (CRP) was 12 mg/L, and median white cell count (WCC) was 16 × 109/L. Fifteen patients (16%) had a lumbar puncture and were commenced on antibiotics. There was one confirmed bacterial infection in an infant who had presented with fever starting 54 h after immunisation. All other microbiology samples were negative. There were no cases of missed serious bacterial infection (SBI) in those patients who were observed or discharged. Conclusions The routine investigation of infants presenting with post‐immunisation fever is not warranted if the infant appears otherwise well on examination. Where other common associated features are present or there is clinical concern, a period of observation is a prudent course of action. Paracetamol should be given peri‐immunisation as per the national guidance. We suggest selective use of investigations, especially inflammatory markers, which are unlikely to discriminate between SBI and post‐immunisation response. We advocate extra caution in infants presenting with fever more than 48 h after immunisation.

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The authors report a case of a 10-year-old boy who presented to the emergency department following an episode of syncope. While on telemetry, the child was found to have runs biventricular tachycardia. Catecholaminergic polymorphic ventricular tachycardia was diagnosed, and the case report discusses this rare but important diagnosis that should be considered in children presenting with syncope.