The past few decades have seen a huge rise in allergic disease. Recent studies suggest that the prevalence of food allergy in children in the UK is now around 5%.The number of children put on restricted diets by their parents because of presumed allergy is likely to be much higher. A recent population-based study in the Isle of Wight found that 33% of mothers thought their child had had an allergic reaction to food by the age of three. Careful documentation using a targeted and thorough history usually makes it possible to distinguish suspected IgE-mediated allergy from non IgE-mediated. Investigations should be tailored to the suspected mechanism of allergy i.e. allergy tests for suspected IgE-mediated allergy and exclusion/re-introduction diets for non IgE-mediated allergy. Once diagnosed, management requires allergen avoidance guided by a dietician together with education in recognising and treating reactions appropriate to the underlying mechanism. Food allergy is commonly outgrown so regular reassessment is essential both to monitor for tolerance and also to look for development of allergic comorbidities. Accurate diagnosis of food allergy is essential in order to ensure that the correct foods are carefully avoided while safe foods are not excluded unnecessarily.

Nocturnal enuresis is a common condition that can cause much distress to sufferers and their families. It is defined as involuntary wetting while asleep at least twice a week in children over the age of five. Less frequent wetting can be described simply as bedwetting. Primary nocturnal enuresis describes those children who have always been wet. Secondary nocturnal enuresis is defined as a relapse after a child has been completely dry for at least six months. Bedwetting is a very common, and often distressing, condition which can be treated very effectively. Contrary to previous belief, many children do not grow out of it, particularly children with frequent wetting or coexisting bladder dysfunction. Treatment should be instituted in all children over the age of seven years, where desired by the child or parents. Treatment should be considered in children aged five to seven years, especially when wetting is frequent or causing severe family stresses. The NICE quick reference guide for nocturnal enuresis gives more detailed information on treating the condition.

Urinary tract infections (UTIs) are common in children in the community. Epidemiological data from the UK and Sweden suggest that 10% of girls and 3% of boys will have had an infection by 16 years of age. The majority are acute, isolated illnesses that resolve quickly, with no long-term implications for the patient. However, UTIs may be associated with underlying congenital abnormalities, and recurrent infections can lead to renal scarring. Failure to consider the diagnosis, or investigate appropriately following a diagnosis, may therefore result in long-term damage. 

Constipation is the most common childhood gastroenterological  problem, affecting 5-30% of children. Up to a third of these children will develop chronic constipation. The signs and symptoms of constipation in children are seldom clear and there is frequently a delay in seeking help in either a primary or secondary care setting. Patients and their parents often express concern that healthcare professionals do not take the problem seriously and the advice given is sometimes contradictory. Chronic constipation and soiling can have a massive impact on all aspects of a child's life, and that of their family, causing social, educational and psychological problems.

Diarrhoea and vomiting are common symptoms in children. In the majority of cases all that is required is some basic advice on management and appropriate reassurance. However, a few children will be at greater risk of complications or will deteriorate and require hospitalisation. GPs need to be able to differentiate between these groups and recognise the symptoms and signs requiring more active intervention. Guidance from NICE on the diagnosis, assessment and management of diarrhoea and vomiting in children under five provides a synthesis of evidence to aid GPs in the process.It also challenges some of the popular lay and professional myths that have developed around the management of gastroenteritis.

Juvenile idiopathic arthritis (JIA) is one of the most common chronic diseases of childhood. The annual incidence in the UK is 1 in 10,000 children and the prevalence is 1 in 1,000. JIA occurs in all races and geographical areas and is more common in girls.¹ The age of onset peaks between three and six and then again around adolescence. As most children with JIA will first present to primary care, GPs have an important role in diagnosis and management.

What symptoms and signs might indicate child abuse or neglect? What are the referral pathways for child abuse? When should social services be involved?

What are the key features of invasive meningococcal disease? How should suspected cases be managed? Has vaccination been effective?

In the most recent comprehensive survey of the mental health of children in the UK, psychiatric diagnoses were present in 7.7% of boys and 5.1% of girls aged five to ten years. These figures do not include some important disorders (for example of motor function) that overlap and merge with the psychiatric conditions, so they probably underestimate true prevalence.

Symposium: Paediatrics